Magnoni Dott. Marco
Pubblicazioni su PubMed
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Predictive value of HDL function in patients with coronary artery disease: relationship with coronary plaque characteristics and clinical events.
Ann Med2022 Dec;54(1):1036-1046. doi: 10.1080/07853890.2022.2063374.
Magnoni Marco, Andreini Daniele, Pirillo Angela, Uboldi Patrizia, Latini Roberto, Catapano Alberico L, Maggioni Aldo P, Norata Giuseppe D,
Abstract
BACKGROUND:
HDL is endowed with several metabolic, vascular, and immunoinflammatory protective functions. Among them, a key property is to promote reverse cholesterol transport from cells back to the liver. The aim of this study was to estimate the association of scavenger receptor class B type I (SR-BI)- and ATP binding cassette transporter A1 (ABCA1)-mediated cholesterol efflux (the two major routes for cholesterol efflux to HDL) with the presence, extent, and severity of coronary artery disease (CAD), vascular wall remodelling processes, coronary plaque characteristics, and the incidence of myocardial infarction in the different subgroups of patients from the CAPIRE study.
METHODS:
Patients (?=?525) from the CAPIRE study were divided into two groups: low-risk factors (RF), with 0-1?RF (?=?263), and multiple-RF, with ?2 RFs; within each group, subjects were classified as no-CAD or CAD based on the segment involvement score (SIS) evaluated by coronary computed tomography angiography (SIS = 0 and SIS > 5, respectively). SR-BI- and ABCA1-mediated cholesterol efflux were measured using the plasma of all patients.
RESULTS:
SR-BI-mediated cholesterol efflux was significantly reduced in patients with CAD in both the low-RF and multiple-RF groups, whereas ABCA1-mediated cholesterol efflux was similar among all groups. In CAD patients, multivariable analysis showed that SR-BI-mediated cholesterol efflux
CONCLUSION:
SR-BI-mediated cholesterol efflux capacity is lower in patients with diffuse coronary atherosclerosis. In addition, a lower SR-BI-mediated cholesterol efflux capacity is associated with the worst clinical outcomes in patients with CAD, independently of atherosclerotic plaque features. Key MessagesIncreased cholesterol efflux capacity, an estimate of HDL function, is associated with a reduced CVD risk, regardless of HDL-C levels.HDL-C levels are significantly lower in patients with CAD.Lower SR-BI-mediated cholesterol efflux capacity is observed in patients with diffuse coronary atherosclerosis and is associated with the worst clinical outcomes in patients with CAD, independently of atherosclerotic plaque features.
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Why Do High-Risk Patients Develop or Not Develop Coronary Artery Disease? Metabolic Insights from the CAPIRE Study.
Metabolites2022 Jan;12(2):. doi: 123.
Deidda Martino, Noto Antonio, Cadeddu Dessalvi Christian, Andreini Daniele, Andreotti Felicita, Ferrannini Eleuterio, Latini Roberto, Maggioni Aldo P, Magnoni Marco, Mercuro Giuseppe, On Behalf Of The Capire Investigators
Abstract
Traditional cardiovascular (CV) risk factors (RFs) and coronary artery disease (CAD) do not always show a direct correlation. We investigated the metabolic differences in a cohort of patients with a high CV risk profile who developed, or did not develop, among those enrolled in the Coronary Atherosclerosis in Outlier Subjects: Protective and Novel Individual Risk Factors Evaluation (CAPIRE) study. We studied 112 subjects with a high CV risk profile, subdividing them according to the presence (CAD/High-RFs) or absence of CAD (No-CAD/High-RFs), assessed by computed tomography angiography. The metabolic differences between the two groups were identified by gas chromatography-mass spectrometry. Characteristic patterns and specific metabolites emerged for each of the two phenotypic groups: high concentrations of pyruvic acid, pipecolic acid, p-cresol, 3-aminoisobutyric acid, isoleucine, glyceric acid, lactic acid, sucrose, phosphoric acid, trimethylamine-N-oxide, 3-hydroxy-3-methylglutaric acid, erythritol, 3-hydroxybutyric acid, glucose, leucine, and glutamic acid; and low concentrations of cholesterol, hypoxanthine, glycerol-3-P, and cysteine in the CAD/High-RFs group vs the No-CAD/High-RFs group. Our results show the existence of different metabolic profiles between patients who develop CAD and those who do not, despite comparable high CV risk profiles. A specific cluster of metabolites, rather than a single marker, appears to be able to identify novel predisposing or protective mechanisms towards CAD beyond classic CVRFs.
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Osteopontin as Candidate Biomarker of Coronary Disease despite Low Cardiovascular Risk: Insights from CAPIRE Study.
Cells2022 Feb;11(4):. doi: 669.
Carbone Federico, Meessen Jennifer, Magnoni Marco, Andreini Daniele, Maggioni Aldo Pietro, Latini Roberto, Montecucco Fabrizio
Abstract
Stratification according high cardiovascular (CV) risk categories, still represents a clinical challenge. In this analysis of the CAPIRE study (NCT02157662), we investigate whether inflammation could fit between CV risk factors (RFs) and the presence of coronary artery disease (CAD). In total, 544 patients were included and categorized according with the presence of CAD and CV risk factor burden (low/multiple). The primary endpoint was to verify any independent association of neutrophil-related biomarkers with CAD across CV risk categories. The highest values of osteopontin (OPN) were detected in the low RF group and associated with CAD (23.2 vs. 19.4 ng/mL; = 0.001), although no correlation with plaque extent and/or composition were observed. Conversely, myeloperoxidase (MPO) and resistin did not differ by CAD presence. Again, OPN was identified as independent variable associated with CAD but only in the low RF group (adjOR 8.42 [95% CI 8.42-46.83]; -value = 0.015). As an ancillary finding, a correlation linked OPN with the neutrophil degranulation biomarker MPO ( = 0.085; = 0.048) and resistin ( = 0.177; = 3.4 × 10). In the present study, OPN further strengthens its role as biomarker of CAD, potentially bridging subclinical CV risk with development of atherosclerosis.
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Differential Proteomics of Cardiovascular Risk and Coronary Artery Disease in Humans.
Front Cardiovasc Med2021 ;8():790289. doi: 790289.
Ferrannini Ele, Manca Maria Laura, Ferrannini Giulia, Andreotti Felicita, Andreini Daniele, Latini Roberto, Magnoni Marco, Williams Stephen A, Maseri Attilio, Maggioni Aldo P
Abstract
BACKGROUND:
Proteomics of atypical phenotypes may help unravel cardiovascular disease mechanisms.
AIM:
We aimed to prospectively screen the proteome of four types of individuals: with or without coronary artery disease (CAD), each with or without multiple risk factors. Associations with individual risk factors and circulating biomarkers were also tested to provide a functional context to the protein hits.
MATERIALS AND METHODS:
The CAPIRE study (ClinicalTrials.gov Identifier: NCT02157662) is a cross-sectional study aimed at identifying possible new mechanisms promoting or protecting against atherothrombosis. Quantification (by aptamer technology), ranking (using partial least squares), and correlations (by multivariate regression) of ~5000 plasma proteins were performed in consecutive individuals aged 45-75 years, without previous cardiovascular disease, undergoing computed tomography angiography for suspected CAD, showing either >5/16 atherosclerotic segments (CAD) or completely clean arteries (CAD) and either ? 1 risk factor (RF) or ?3 risk factors (RF) (based on history, blood pressure, glycemia, lipids, and smoking).
RESULTS:
Of 544 individuals, 39% were atypical (93 CAD/RF; 120 CAD/RF) and 61% typical (102 CAD/RF; 229 CAD/RF). In the comparison with CAD/RF adjusted for sex and age, CAD/RF was associated with increased atrial myosin regulatory light chain 2 (MYO) and C-C motif chemokine-22 (C-C-22), and reduced protein shisa-3 homolog (PS-3) and platelet-activating factor acetylhydrolase (PAF-AH). Extending the analysis to the entire cohort, an additional 8 proteins were independently associated with CAD or RF; by logistic regression, the 12-protein panel alone discriminated the four groups with AUC's of 0.72-0.81 (overall = 1.0e). Among them, insulin-like growth factor binding protein-3 is positively associated with RF, lower BMI, and HDL-cholesterol, renin with CAD higher glycated hemoglobin HbA, and smoking.
CONCLUSIONS:
In a CCTA-based cohort, four proteins, involved in opposing vascular processes (healing vs. adverse remodeling), are specifically associated with low CAD burden in high CV-risk individuals (high MYO and C-C-22) and high CAD burden in low-risk subjects (high PS-3 and PAF-AH), in interaction with BMI, smoking, diabetes, HDL-cholesterol, and HbA. These findings could contribute to a deeper understanding of the atherosclerotic process beyond traditional risk profile assessment and potentially constitute new treatment targets.
Copyright © 2022 Ferrannini, Manca, Ferrannini, Andreotti, Andreini, Latini, Magnoni, Williams, Maseri and Maggioni.
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Mannose as a biomarker of coronary artery disease: Angiographic evidence and clinical significance.
Int J Cardiol2022 Jan;346():86-92. doi: 10.1016/j.ijcard.2021.11.038.
Ferrannini Ele, Marx Nikolaus, Andreini Daniele, Campi Beatrice, Saba Alessandro, Gorini Marco, Ferrannini Giulia, Milzi Andrea, Magnoni Marco, Maseri Attilio, Maggioni Aldo P, Burgmaier Mathias,
Abstract
BACKGROUND:
High mannose has previously associated with insulin resistance and cardiovascular disease (CVD). Our objective is to establish whether mannose is associated with anatomical evidence of coronary artery disease (CAD).
METHODS:
Plasma mannose concentrations were measured by liquid chromatography/tandem mass spectrometry in a discovery cohort (n = 513) and a validation cohort (n = 221) of carefully phenotyped individuals. In both cohorts CAD was quantitated using state-of-the-art imaging techniques (coronary computed coronary tomography angiography (CCTA), invasive coronary angiography and optical coherence tomography). Information on subsequent CVD events/death was collected. Associations of mannose with angiographic variables and biomarkers were tested using univariate and multivariate regression models. Survival analysis was performed using the Kaplan-Meier estimator.
RESULTS:
Mannose was related to indices of CAD and features of plaque vulnerability. In the discovery cohort, mannose was a marker of quantity and quality of CCTA-proven CAD and subjects with a mannose level in the top quartile had a significantly higher risk of CVD events/death (p = 3.6e-5). In the validation cohort, mannose was significantly associated with fibrous cap thickness
CONCLUSION:
The current data add novel evidence that high mannose is a signature of CAD with a vulnerable plaque phenotype, consistently across measures of severity of vessel involvement and independent of the traditional correlates of CVD, and that it is an independent predictor of incident adverse outcomes.
Copyright © 2021 Elsevier B.V. All rights reserved.
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Metabolomic correlates of coronary atherosclerosis, cardiovascular risk, both or neither. Results of the 2 × 2 phenotypic CAPIRE study.
Int J Cardiol2021 Aug;336():14-21. doi: 10.1016/j.ijcard.2021.05.033.
Deidda Martino, Noto Antonio, Cadeddu Dessalvi Christian, Andreini Daniele, Andreotti Felicita, Ferrannini Eleuterio, Latini Roberto, Maggioni Aldo P, Magnoni Marco, Maseri Attilio, Mercuro Giuseppe,
Abstract
BACKGROUND:
Traditional cardiovascular risk factors (RFs) and coronary artery disease (CAD) do not always run parallel. We investigated functional-metabolic correlations of CAD, RFs, or neither in the CAPIRE (Coronary Atherosclerosis in Outlier Subjects: Protective and Novel Individual Risk Factors Evaluation) 2 × 2 phenotypic observational study.
METHODS:
Two hundred and fortyone subjects were included based on RF burden, presence/absence of CAD (assessed by computed tomography angiography), age and sex. Participants displayed one of four phenotypes: CAD with ?3 RFs, no-CAD with ?3 RFs, CAD with ?1 RF and no-CAD with ?1 RF. Metabolites were identified by gas chromatography-mass spectrometry and pathways by metabolite set enrichment analysis.
RESULTS:
Characteristic patterns and specific pathways emerged for each phenotypic group: amino sugars for CAD/high-RF; urea cycle for no-CAD/high-RF; glutathione for CAD/low-RF; glycine and serine for no-CAD/low-RF. Presence of CAD correlated with ammonia recycling; absence of CAD with the transfer of acetyl groups into mitochondria; high-risk profile with alanine metabolism (all p
CONCLUSIONS:
The present 2 × 2 observational study identified specific metabolic pathways for each of the four phenotypes, providing novel functional insights, particularly on CAD with low RF profiles and on the absence of CAD despite high-risk factor profiles.
Copyright © 2021. Published by Elsevier B.V.
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Erratum. Coronary Artery Disease and Type 2 Diabetes: A Proteomic Study. Diabetes Care 2020;43:843-851.
Diabetes Care2021 Apr;44(4):1071. doi: 10.2337/dc21-er04a.
Ferrannini Giulia, Manca Maria Laura, Magnoni Marco, Andreotti Felicita, Andreini Daniele, Latini Roberto, Maseri Attilio, Maggioni Aldo P, Ostroff Rachel M, Williams Stephen A, Ferrannini Ele
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Extent and characteristics of carotid plaques and brain parenchymal loss in asymptomatic patients with no indication for revascularization.
Int J Cardiol Heart Vasc2020 Oct;30():100619. doi: 100619.
Ammirati Enrico, Moroni Francesco, Magnoni Marco, Rocca Maria A, Messina Roberta, Anzalone Nicoletta, De Filippis Costantino, Scotti Isabella, Besana Francesca, Spagnolo Pietro, Rimoldi Ornella E, Chiesa Roberto, Falini Andrea, Filippi Massimo, Camici Paolo G
Abstract
BACKGROUND AND AIMS:
Extent of subclinical atherosclerosis has been associated with brain parenchymal loss in community-dwelling aged subjects. Identification of patient-related and plaque-related markers could identify subjects at higher risk of brain atrophy, independent of cerebrovascular accidents. Aim of the study was to investigate the relation between extent and characteristics of carotid plaques and brain atrophy in asymptomatic patients with no indication for revascularization.
METHODS AND RESULTS:
Sixty-four patients (aged 69 ± 8 years, 45% females) with carotid stenosis
CONCLUSIONS:
WM and GM have different susceptibility to processes involved in parenchymal loss. Contrary to common belief, our results show that presence of fibrocalcific plaques is associated with brain atrophy.
© 2020 The Authors. Published by Elsevier B.V.
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Association of high-risk coronary atherosclerosis at CCTA with clinical and circulating biomarkers: Insight from CAPIRE study.
J Cardiovasc Comput Tomogr2021 ;15(1):73-80. doi: 10.1016/j.jcct.2020.03.005.
Conte Edoardo, Andreini Daniele, Magnoni Marco, Masson Serge, Mushtaq Saima, Berti Sergio, Canestrari Mauro, Casolo Giancarlo, Gabrielli Domenico, Latini Roberto, Marraccini Paolo, Moccetti Tiziano, Modena Maria Grazia, Pontone Gianluca, Gorini Marco, Maggioni Aldo P, Maseri Attilio, , , , , ,
Abstract
BACKGROUND:
High-risk coronary atherosclerosis features evaluated coronary CT angiography (CCTA) were suggested to have a prognostic role. The present study aimed to evaluate the association of circulating biomarkers with high-risk plaque features assessed by CCTA.
METHODS:
A consecutive cohort of subjects who underwent CCTA because of suspected CAD was screened for inclusion in the CAPIRE study. Based on risk factors (RF) burden patients were defined as having a low clinical risk (0-1 RF with the exclusion of patients with diabetes mellitus as single RF) or an high clinical risk (?3 RFs). In all patients, measurement of inflammatory biomarkers and CCTA analysis focused on high-risk plaque features were performed. Univariate and multivariate logistic regression analysis were used to evaluate the relationship between clinical and biological variables with CCTA advanced plaque features.
RESULTS:
528 patients were enrolled in CAPIRE study. Older age and male sex appeared to be predictors of qualitative high-risk plaque features and associated with the presence of elevated total, non-calcified and low-attenuation plaque volume. Among circulating biomarkers only hs-CRP was found to be associated with qualitative high-risk plaque features (OR 2.02, p?=?0.004 and 2.02, p?=?0.012 for LAP and RI?>?1.1, respectively) with borderline association with LAP-Vol (OR 1.52, p?=?0.076); HbA1c and PTX-3 resulted to be significantly associated with quantitative high-risk plaque features (OR 1.71, p?=?0.003 and 1.04, p?=?0.002 for LAP-Vol, respectively).
CONCLUSIONS:
Our results support the association between inflammatory biomarkers (hs-CRP, PTX- 3), HbA1c and high-risk atherosclerotic features detected by CCTA. Male sex and older age are significant predictors of high-risk atherosclerosis.
Copyright © 2020 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.
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Short-term prognosis of unstable angina in the era of high-sensitivity cardiac troponin: insights for early rule-out strategies.
Coron Artery Dis2020 Dec;31(8):687-693. doi: 10.1097/MCA.0000000000000906.
Gallone Guglielmo, Magnoni Marco, Vergani Vittoria, Ceriotti Ferruccio, Angeloni Giulia, Scarano Paola, Maseri Attilio, Cianflone Domenico
Abstract
BACKGROUND:
It is unclear if strategies to rule-out myocardial infarction (MI) based on a single high-sensitivity troponin T (hsTnT) measurement at the emergency department (ED) presentation may also exclude unstable angina.
METHODS:
We measured hsTnT ex-post on the admission frozen blood sample of 644 subjects with Braunwald IIIB CK-MB-negative unstable angina. This analysis included the 240 patients with hsTnT value ?99th percentile reference limit (UA). We evaluated the clinical outcome of UA patients and the applicability of two rule-out strategies based on the combination of a non-ischemic ECG with (1) a single hsTnT value below the Limit-of-Detection (LoD), (2) a TIMI risk score ?1.
RESULTS:
UA patients with hsTnT ?99th percentile reference limit had a favorable 30-day outcome [0.8% MI, 0% cardiovascular death (CVD)], but the rate of CVD/MI at 180-day was 4.7%. Sensitivities for UA were 94.6% according to the 'TIMI ?1-strategy' and 75.4% according to 'hsTnT-below-LoD-strategy', accounting for 5.4 and 24.6% missed diagnoses, respectively. A prognostic risk stratification to guide appropriate outpatient assessment in potential discharged unrecognized UA patients was developed: a risk score based on the combination of age >60 years and C-reactive protein >4.5 mg/L effectively stratified the 180-day CVD/MI occurrence: 0, 2.5 and 12.7% for score 0, 1 and 2 (log-rank = 0.001, C-statistic = 0.776).
CONCLUSION:
Single measurement hsTnT strategies, successfully tested to rule-out MI, may allow safe ED discharge of patients with a suspected acute coronary syndrome: even if UA may not be excluded, its short-term prognosis is favorable. UA patients with a C-reactive protein >4.5 mg/L and older than 60 years have a substantial medium-term cardiovascular risk and may benefit from a timely outpatient diagnostic assessment.
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Impact of adherence to a Mediterranean Diet pattern on patients with first acute myocardial infarction.
Nutr Metab Cardiovasc Dis2020 Apr;30(4):574-580. doi: 10.1016/j.numecd.2019.11.014.
Magnoni Marco, Scarano Paola, Vergani Vittoria, Berteotti Martina, Gallone Guglielmo, Cristell Nicole, Maseri Attilio, Cianflone Domenico
Abstract
BACKGROUND AND AIMS:
The Mediterranean diet (MD) affects the risk of myocardial infarction and long-term prognosis after a coronary event. Limited data are available regarding the influence of MD on short-term prognosis. We assessed the impact of the MD adherence on in-hospital and short-term outcome in patients with first ST-elevation Myocardial Infarction (STEMI).
METHODS AND RESULTS:
As many as 533 European patients with STEMI and no previous history of coronary artery disease were included in this analysis. Previous dietary habits of each patient were collected with a food frequency questionnaire from which we calculated the FAMI Mediterranean Diet Score (FAMI MD Score), according to the MD adherence. A blood sample was drawn to each patient within 6 h of symptoms onset. Levels of high-sensitivity C-Reactive Protein (hsCRP), Interleukin-6 (IL-6) were measured. Clinical outcome at 180 days and myocardial reperfusion were assessed. Patients with higher FAMI MD Score had lower levels of hsCRP; there were no differences between IL-6 level among FAMI MD Score quintiles. There were no associations between adherence to MD and 180-day adverse events. Lower FAMI MD Score was associated with a higher risk of ineffective myocardial reperfusion after thrombolysis or percutaneous coronary intervention. Similar results were observed for daily consumption of ?4 portions of fruit and vegetable.
CONCLUSIONS:
A positive effect of the Mediterranean diet, and fruit and vegetable intake was observed on hsCRP and the occurrence of effective myocardial reperfusion. These findings confirm the favorable impact of Mediterranean diet adherence not only in primary but also in secondary prevention.
Copyright © 2019 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.
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Coronary Artery Disease and Type 2 Diabetes: A Proteomic Study.
Diabetes Care2020 Apr;43(4):843-851. doi: 10.2337/dc19-1902.
Ferrannini Giulia, Manca Maria Laura, Magnoni Marco, Andreotti Felicita, Andreini Daniele, Latini Roberto, Maseri Attilio, Maggioni Aldo P, Ostroff Rachel M, Williams Stephen A, Ferrannini Ele
Abstract
OBJECTIVE:
Coronary artery disease (CAD) is a major challenge in patients with type 2 diabetes (T2D). Coronary computed tomography angiography (CCTA) provides a detailed anatomic map of the coronary circulation. Proteomics are increasingly used to improve diagnostic and therapeutic algorithms. We hypothesized that the protein panel is differentially associated with T2D and CAD.
RESEARCH DESIGN AND METHODS:
In CAPIRE (Coronary Atherosclerosis in Outlier Subjects: Protective and Novel Individual Risk Factors Evaluation-a cohort of 528 individuals with no previous cardiovascular event undergoing CCTA), participants were grouped into CAD (clean coronaries) and CAD (diffuse lumen narrowing or plaques). Plasma proteins were screened by aptamer analysis. Two-way partial least squares was used to simultaneously rank proteins by diabetes status and CAD.
RESULTS:
Though CAD was more prevalent among participants with T2D (HbA 6.7 ± 1.1%) than those without diabetes (56 vs. 30%,
CONCLUSIONS:
We concluded that ) CAD severity and quality do not differ between participants with T2D and without diabetes; ) renin, GDF15, and adiponectin are shared markers by T2D and CAD; ) several proteins are specifically associated with T2D or CAD; and ) in T2D, lower renin levels may protect against CAD.
© 2020 by the American Diabetes Association.
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Diagnostic performance of aPS/PT antibodies in neuropsychiatric lupus and cardiovascular complications of systemic lupus erythematosus.
Autoimmunity2020 Feb;53(1):21-27. doi: 10.1080/08916934.2019.1696778.
Ramirez Giuseppe A, Canti Valentina, Del Rosso Stefania, Erra Roberta, Moiola Lucia, Magnoni Marco, Bozzolo Enrica P, Manfredi Angelo A, Rovere-Querini Patrizia
Abstract
Systemic lupus erythematosus (SLE) is associated with a constellation of complications affecting multiple organs, including neuropsychiatric manifestations (NPSLE) and ischaemic events, leading to increased long-term morbidity. Antiphospholipid antibodies (aPL) are a major determinant of vascular inflammation and thromboembolic risk. The diagnostic role of anti-phosphatidylserine/prothrombin (aPS/PT) antibodies in this setting is incompletely defined. To verify whether aPS/PT add to diagnostics and disease stratification in patients with SLE with or without other aPL. 131 consecutive patients were studied, including 20 patients with SLE and secondary antiphospholipid syndrome (APS). aPS/PT IgG and IgM were assessed through ELISA and patients were stratified based on the presence of other aPL, on their clinical and laboratory features at time of blood sampling and on their clinical history. Synthetic indices of disease activity, chronic damage and cardiovascular risk were calculated at time of venipuncture. Fifty-one (38.9%) patients with SLE had aPS/PT and 15 (11.5%) patients had aPS/PT as the only aPL (aPS/PT-only). aPS/PT-only patients had a significantly higher prevalence of NPSLE than quadruple aPL-negative patients (?=?.007). Patients with aPS/PT were more likely to have a history of ischaemia, thrombocytopenia and Libman-Sacks' endocarditis. The presence of aPS/PT also associated with previous accrual of at least one damage item (?=?.043), but had limited predictive values for damage progression in the short term. aPS/PT antibodies provide non-redundant information that could contribute to risk assessment and stratification of patients with SLE.
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Coronary Plaque Features on CTA Can Identify Patients at Increased Risk of Cardiovascular Events.
JACC Cardiovasc Imaging2020 Aug;13(8):1704-1717. doi: 10.1016/j.jcmg.2019.06.019.
Andreini Daniele, Magnoni Marco, Conte Edoardo, Masson Serge, Mushtaq Saima, Berti Sergio, Canestrari Mauro, Casolo Giancarlo, Gabrielli Domenico, Latini Roberto, Marraccini Paolo, Moccetti Tiziano, Modena Maria Grazia, Pontone Gianluca, Gorini Marco, Maggioni Aldo P, Maseri Attilio,
Abstract
OBJECTIVES:
This study sought to assess whether coronary atherosclerosis analysis by coronary computed tomography angiography (CTA) may improve prognostic stratification among patients with diffuse coronary artery disease (CAD) BACKGROUND: Coronary CTA has recently emerged as a promising noninvasive tool for advanced analysis of coronary atherosclerosis.
METHODS:
The multicenter CAPIRE (Coronary Atherosclerosis in outlier subjects: Protective and novel Individual Risk factors Evaluation) study is part of the GISSI Outlier Project. A prospective cohort of subjects who underwent coronary CTA for suspected CAD was enrolled. Based on risk factor (RF) burden, patients were defined as having a low clinical risk (0 to 1 RF with the exclusion of patients with diabetes mellitus as single RF) or at high clinical risk (3 or more RFs). Patients with 2 RFs were not enrolled in the study. Coronary CTA advanced plaque assessment was performed. Outcome measures were 3 combined endpoints: acute coronary syndrome (ACS), cardiac death + ACS, and cardiac death + ACS + late revascularization.
RESULTS:
Among the 544 patients enrolled in the CAPIRE study, in 522 patients, a mean follow-up of 37 ± 10 months was obtained (16 patients were excluded due to 1
CONCLUSIONS:
The CAPIRE study confirmed the prognostic value of atherosclerosis assessment by coronary CTA, demonstrating high noncalcified plaque volume as the most ACS-predictive parameter in patients with extensive CAD. (GISSE Outliers CAPIRE [CAPIRE]; NCT02157662).
Copyright © 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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Performance of SLE responder index and lupus low disease activity state in real life: A prospective cohort study.
Int J Rheum Dis2019 Sep;22(9):1752-1761. doi: 10.1111/1756-185X.13663.
Ramirez Giuseppe A, Canti Valentina, Moiola Lucia, Magnoni Marco, Rovere-Querini Patrizia, Coletto Lavinia A, Dagna Lorenzo, Manfredi Angelo A, Bozzolo Enrica P
Abstract
OBJECTIVE:
To prospectively assess the performance of the systemic lupus erythematosus (SLE) responder index (SRI) and the lupus low disease activity state (LLDAS) in a cohort-based, "real-life" clinical setting.
METHODS:
One hundred and thirty-one consecutive patients with SLE were subdivided into two groups based on the need or not to escalate their immune suppressive treatment. Clinimetrics including physician global assessment scale (PGA), SLE Disease Activity Index 2000 (SLEDAI-2K), European Consensus Lupus Activity Measurement index (ECLAM) and British Isles Lupus Assessment Group index (BILAG) 2004 version were measured at baseline and at 6 and 12 months, together with laboratory data and treatment changes. LLDAS and SRI were calculated at each time point.
RESULTS:
Lupus low disease activity state but not SRI-4 correlated with treatment de-escalation. Low disease activity attainment as estimated by LLDAS was more frequent in patients starting with lower SLEDAI-2K, whereas a decrease in SLEDAI score ? 4 points with
CONCLUSION:
Lupus low disease activity state is a valuable tool for assessing response to treatment in the daily rheumatology practice. SRI might be less informative, at least in patients with low basal SLEDAI.
© 2019 Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd.
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Effect of adherence to Mediterranean diet on first ST-elevation myocardial infarction: Insights from multiethnic case-control study.
Nutrition2019 Sep;65():185-190. doi: 10.1016/j.nut.2019.03.014.
Scarano Paola, Magnoni Marco, Vergani Vittoria, Berteotti Martina, Cristell Nicole, Maseri Attilio, Cianflone Domenico
Abstract
OBJECTIVE:
This study aimed to assess the protective role of dietary habits and Mediterranean diet adherence in first acute myocardial infarction in patients enrolled in the multicenter and multiethnic FAMI (First Acute Myocardial Infarction) study.
METHODS:
In this study we analyzed a multiethnic case-control population of 1478 individuals (858 from Europe and 620 from China): 739 patients with ST-elevation myocardial infarction (STEMI) without previous history of coronary artery disease who were admitted to the Emergency Department within 6 h of symptoms onset, and 739 age- and sex-matched healthy controls. Dietary habits were collected with a food frequency questionnaire from which we calculated the FAMI Mediterranean Diet Score, according to the adherence to Mediterranean diet.
RESULTS:
European patients with STEMI had significantly lower adherence to Mediterranean diet than controls. Among Chinese populations, there was no association between FAMI Mediterranean Diet Score and STEMI prevalence. The distribution of the main food types suggested that our questionnaire was not an effective tool to study dietary habits in the Chinese population. In the European population, higher adherence to Mediterranean dietary pattern was associated with a protective effect on the risk of STEMI, independently of global cardiovascular risk factor profile. Furthermore, high fruit and vegetable consumption was associated with a significant reduction of STEMI risk.
CONCLUSIONS:
The study found a protective effect of the Mediterranean diet and high fruit and vegetable consumption on the risk of first STEMI, regardless of traditional cardiovascular risk factors in the European population.
Copyright © 2019 Elsevier Inc. All rights reserved.
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Progression of brain white matter hyperintensities in asymptomatic patients with carotid atherosclerotic plaques and no indication for revascularization.
Atherosclerosis2019 Aug;287():171-178. doi: 10.1016/j.atherosclerosis.2019.04.230.
Ammirati Enrico, Moroni Francesco, Magnoni Marco, Rocca Maria A, Anzalone Nicoletta, Cacciaguerra Laura, Di Terlizzi Simona, Villa Chiara, Sizzano Federico, Palini Alessio, Scotti Isabella, Besana Francesca, Spagnolo Pietro, Rimoldi Ornella E, Chiesa Roberto, Falini Andrea, Filippi Massimo, Camici Paolo G
Abstract
BACKGROUND AND AIMS:
Brain white matter hyperintensities (WMHs) have been associated with an increased risk of ischemic stroke and considered as markers of brain ischemia. Progression of WMHs in asymptomatic patients with non-hemodynamically significant carotid plaque could represent a putative marker of plaque vulnerability. We prospectively evaluate progression and determinants of WMHs in this population.
METHODS:
This prospective study included 51 asymptomatic patients with carotid stenosis
RESULTS:
Seventeen subjects (33.3%) had carotid stenoses of 50-70% (Doppler flow velocity) while the rest had stenoses of
CONCLUSIONS:
Half of the patients with carotid plaques of intermediate severity had evidence of WMH progression at follow up. Female gender and systemic factors such as hypercholesterolemia, and lower GFR, but not plaque characteristics or circulating cellular biomarkers, are associated with WMH progression.
Copyright © 2019 Elsevier B.V. All rights reserved.
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The Role of Monocytes and Macrophages in Human Atherosclerosis, Plaque Neoangiogenesis, and Atherothrombosis.
Mediators Inflamm2019 ;2019():7434376. doi: 7434376.
Moroni Francesco, Ammirati Enrico, Norata Giuseppe Danilo, Magnoni Marco, Camici Paolo G
Abstract
Atherosclerosis is one of the leading causes of death and disability worldwide. It is a complex disease characterized by lipid accumulation within the arterial wall, inflammation, local neoangiogenesis, and apoptosis. Innate immune effectors, in particular monocytes and macrophages, play a pivotal role in atherosclerosis initiation and progression. Although most of available evidence on the role of monocytes and macrophages in atherosclerosis is derived from animal studies, a growing body of evidence elucidating the role of these mononuclear cell subtypes in human atherosclerosis is currently accumulating. A novel pathogenic role of monocytes and macrophages in terms of atherosclerosis initiation and progression, in particular concerning the role of these cell subsets in neovascularization, has been discovered. The aim of the present article is to review currently available evidence on the role of monocytes and macrophages in human atherosclerosis and in relation to plaque characteristics, such as plaque neoangiogenesis, and patients' prognosis and their potential role as biomarkers.
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How important is microcirculation in clinical practice?
Eur Heart J Suppl2019 Mar;21(Suppl B):B25-B27. doi: 10.1093/eurheartj/suz015.
Camici Paolo G, Magnoni Marco
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Impact of Cardiovascular Risk Factors and Pharmacologic Treatments on Carotid Intraplaque Neovascularization Detected by Contrast-Enhanced Ultrasound.
J Am Soc Echocardiogr2019 Jan;32(1):113-120.e6. doi: 10.1016/j.echo.2018.09.001.
Magnoni Marco, Ammirati Enrico, Moroni Francesco, Norata Giuseppe D, Camici Paolo G
Abstract
BACKGROUND:
Neovascularization is a marker of plaque vulnerability that can be assessed noninvasively using contrast-enhanced ultrasound (CEUS). The presence and extent of plaque neovascularization and their relation to cardiovascular risk factors and treatments were assessed in asymptomatic patients with carotid stenosis of intermediate severity and no indication for revascularization.
METHODS:
Sixty-six patients aged 69 ± 8 years (59% men) were prospectively enrolled. Plaque neovascularization was assessed using CEUS with sulfur hexafluoride contrast in each of the four carotid segments bilaterally (a total of 528 segments). In each plaque, the presence or absence of contrast enhancement was assessed semiquantitatively as CEUS grade 1 (no signal or signal confined to the adventitia and/or shoulder of the plaque) or CEUS grade 2 (signal within the plaque).
RESULTS:
Plaques were detectable in 289 of 528 carotid segments (54.7%). CEUS grade 2 was present in at least one plaque in 48 of 66 patients (72.7%) and was not influenced by stenosis severity or morphology. The highest CEUS grade 2 prevalence was observed in patients with diabetes and the lowest in those treated with angiotensin-converting enzyme inhibitors and statins, especially when low-density lipoprotein cholesterol was
CONCLUSION:
Intraplaque neovascularization is frequent in asymptomatic patients with intermediate carotid stenosis and is more prevalent in those with diabetes. Low-density lipoprotein cholesterol
Copyright © 2018 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.
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Carotid artery plaque uptake of C-PK11195 inversely correlates with circulating monocytes and classical CD14CD16 monocytes expressing HLA-DR.
Int J Cardiol Heart Vasc2018 Dec;21():32-35. doi: 10.1016/j.ijcha.2018.09.005.
Ammirati Enrico, Moroni Francesco, Magnoni Marco, Busnardo Elena, Di Terlizzi Simona, Villa Chiara, Sizzano Federico, Scotti Isabella, Palini Alessio, Presotto Luca, Bettinardi Valentino, Spagnolo Pietro, Besana Francesca, Gianolli Luigi, Rimoldi Ornella E, Camici Paolo G
Abstract
BACKGROUND:
We explored the relation between blood concentrations of monocyte/lymphocyte subsets and carotid artery plaque macrophage content, measured by positron emission tomography (PET) with C-PK11195.
METHODS AND RESULTS:
In 9 patients with carotid plaques we performed C-PK11195-PET/computed tomography angiography imaging and measurement of absolute concentrations and frequencies of circulating monocytes and T-cell subsets. Plaque standardized uptake value (SUV) for C-PK11195 was negatively correlated with concentrations of total monocytes (r?=?-0.58, p?=?0.05) and CD14CD16HLA-DR classical subset (r?=?-0.82, p?=?0.005). These correlations hold true also in relation to plaque target to background ratio. No correlation was observed between plaque SUV and CD3T lymphocytes, CD4T lymphocytes nor with activated CD3CD4T cells expressing HLA-DR.
CONCLUSIONS:
We first demonstrated a reduction in the absolute concentration of monocytes and particularly in classical monocytes expressing HLA-DR in the presence of an increased uptake of C-PK11195 in carotid plaques. The present work, despite being a pilot study comprising only a small number of subjects provides new insights in the search for specific cellular biomarkers with potential diagnostic and prognostic value in patients with a known carotid plaque.
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Cardiovascular disease and brain health: Focus on white matter hyperintensities.
Int J Cardiol Heart Vasc2018 Jun;19():63-69. doi: 10.1016/j.ijcha.2018.04.006.
Moroni Francesco, Ammirati Enrico, Rocca Maria A, Filippi Massimo, Magnoni Marco, Camici Paolo G
Abstract
Diseases affecting the brain contribute to a substantial proportion of morbidity and mortality in the general population. Conditions such as stroke, dementia and cognitive impairment have a prominent impact on global public health. Despite the heterogeneous clinical manifestations of these conditions and their diverse prognostic implications, current evidence supports a role for cardiovascular disease as a common pathophysiological ground. Brain white matter hyperintensities (WMH) are patchy white matter signal hyperintensity on T2-weighted magnetic resonance imaging sequences commonly found in elderly individuals. WMH appear to have a vascular pathogenesis and have been shown to confer an increased risk of stroke and cognitive decline. Indeed, they were proposed as a marker for central nervous system frailty. Cardiovascular diseases seem to play a key role in the etiology of WMH. Carotid atherosclerosis and atrial fibrillation were shown to be associated with higher WMH burden, while adequate blood pressure control has been reported reducing WMH progression. Aim of the present work is to review the available evidence linking WMH to cardiovascular disease, highlighting the complex interplay between cerebral and cardiovascular health.
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Prognostic implications of high-sensitivity cardiac troponin T assay in a real-world population with non-ST-elevation acute coronary syndrome.
Int J Cardiol Heart Vasc2018 Sep;20():14-19. doi: 10.1016/j.ijcha.2018.06.004.
Magnoni Marco, Gallone Guglielmo, Ceriotti Ferruccio, Vergani Vittoria, Giorgio Daniela, Angeloni Giulia, Maseri Attilio, Cianflone Domenico
Abstract
BACKGROUND:
High-sensitivity cardiac troponin T (hsTnT) was recently approved for clinical use by the Food and Drug Administration. The transition from contemporary to hsTnT assays requires a thorough understanding of the clinical differences between these assays.
HYPOTHESIS:
HsTnT may provide a more accurate prognostic stratification than contemporary cardiac troponin I (cTnI) in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS).
METHODS:
HsTnT and cTnI were measured in 644 patients with CK-MB negative NSTE-ACS who were enrolled in the prospective multicenter SPAI (Stratificazione Prognostica dell'Angina Instabile) study. Patients were stratified at the 99th percentile reference limit for each assay. The primary endpoint was cardiovascular death (CVD) or non-fatal myocardial infarction (MI); the secondary endpoint was the occurrence of unstable angina (UA). Follow-up lasted 180?days.
RESULTS:
Patients with hsTnT ?99th percentile were at higher risk of CVD/MI (30-day: 5.9% vs 0.8%, ?=?0.001; 180-day: 11.1% vs 4.7%, ?=?0.004), also after adjusting for TIMI Risk Score. No significant difference in CVD/MI at 180-day was found between hsTnT-positive/cTnI-negative and hsTnT-negative/cTnI-negative patients (adjHR 1.61, 95% CI 0.74-3.49, ?=?0.232). Occurrence of UA was not differently distributed between hsTnT groups dichotomized at the 99th percentile (12.4% vs 12.5% ?=?0.54).
CONCLUSIONS:
Our investigation on a real-world NSTE-ACS population showed good prognostic performance of hsTnT in the risk stratification of the hard endpoint, but did not demonstrate the improved prognostic ability of hsTnT over contemporary cTn. Neither troponin assay predicted the recurrence of UA, suggesting the acute rise of cardiac troponin as a marker of severity, but not the occurrence of future coronary instability.
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Reply to: Is serum uric acid a pretty accurate prognostic predictor of ST elevated acute coronary syndrome? Author: Alexander E. Berezin.
Int J Cardiol2018 Jun;260():22. doi: 10.1016/j.ijcard.2018.01.114.
Magnoni Marco, Cianflone Domenico
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Fractal analysis of plaque border, a novel method for the quantification of atherosclerotic plaque contour irregularity, is associated with pro-atherogenic plasma lipid profile in subjects with non-obstructive carotid stenoses.
PLoS One2018 ;13(2):e0192600. doi: e0192600.
Moroni Francesco, Magnoni Marco, Vergani Vittoria, Ammirati Enrico, Camici Paolo G
Abstract
BACKGROUND AND AIMS:
Plaque border irregularity is a known imaging characteristic of vulnerable plaques, but its evaluation heavily relies on subjective evaluation and operator expertise. Aim of the present work is to propose a novel fractal-analysis based method for the quantification of atherosclerotic plaque border irregularity and assess its relation with cardiovascular risk factors.
METHODS AND RESULTS:
Forty-two asymptomatic subjects with carotid stenosis underwent ultrasound evaluation and assessment of cardiovascular risk factors. Total, low-density lipoprotein (LDL), high-density lipoprotein (HDL) plasma cholesterol and triglycerides concentrations were measured for each subject. Fractal analysis was performed in all the carotid segments affected by atherosclerosis, i.e. 147 segments. The resulting fractal dimension (FD) is a measure of irregularity of plaque profile on long axis view of the plaque. FD in the severest stenosis (main plaque FD,mFD) was 1.136±0.039. Average FD per patient (global FD,gFD) was 1.145±0.039. FD was independent of other plaque characteristics. mFD significantly correlated with plasma HDL (r = -0.367,p = 0.02) and triglycerides-to-HDL ratio (r = 0.480,p = 0.002).
CONCLUSIONS:
Fractal analysis is a novel, readily available, reproducible and inexpensive technique for the quantitative measurement of plaque irregularity. The correlation between low HDL levels and plaque FD suggests a role for HDL in the acquisition of morphologic features of plaque instability. Further studies are needed to validate the prognostic value of fractal analysis in carotid plaques evaluation.
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Relation between characteristics of carotid atherosclerotic plaques and brain white matter hyperintensities in asymptomatic patients.
Sci Rep2017 Sep;7(1):10559. doi: 10559.
Ammirati Enrico, Moroni Francesco, Magnoni Marco, Rocca Maria A, Messina Roberta, Anzalone Nicoletta, De Filippis Costantino, Scotti Isabella, Besana Francesca, Spagnolo Pietro, Rimoldi Ornella E, Chiesa Roberto, Falini Andrea, Filippi Massimo, Camici Paolo G
Abstract
White matter hyperintensities (WMH) can be incidentally found in patients with carotid atherosclerosis on brain magnetic resonance imaging (MRI). We investigated the relationship between WMH and characteristics of carotid plaques in asymptomatic patients without indication for carotid revascularization. We prospectively screened 235 consecutive patients with carotid stenosis
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Serum uric acid on admission predicts in-hospital mortality in patients with acute coronary syndrome.
Int J Cardiol2017 Aug;240():25-29. doi: 10.1016/j.ijcard.2017.04.027.
Magnoni Marco, Berteotti Martina, Ceriotti Ferruccio, Mallia Vincenzo, Vergani Vittoria, Peretto Giovanni, Angeloni Giulia, Cristell Nicole, Maseri Attilio, Cianflone Domenico
Abstract
BACKGROUND:
Despite the association between uric acid and cardiovascular disease has been known for decades, the prognostic value of serum uric acid (UA) in all clinical manifestations of acute coronary syndrome (ACS), namely ST-elevation myocardial infarction (STEMI), NSTEMI and unstable angina, has not been definitively assessed.
METHODS:
This retrospective analysis included patients from previous SPAI and FAMI studies with the aim to investigate the association between serum uric acid and major adverse cardiovascular events at 180days from hospital admission.
RESULTS:
1548 patients were considered and divided in four groups, according UA concentration. Uricemia was significantly associated with gender, BMI, arterial hypertension, HDL-cholesterol, triglycerides, metabolic syndrome and glomerular filtration rate in univariate analysis. Multivariate logistic regression indicated that UA >6.0mg/dL on admission increased the risk of in-hospital mortality in overall population (OR 2.9, 95%CI 1.4-6.1; p=0.0057) and in patients with de novo ACS (OR 3.2, 95%CI 1.5-6.8; p=0.0033). Comparable results were also obtained after adjusting the model for age, gender, body mass index, glomerular filtration rate, metabolic syndrome, acute revascularization and ethnicity. A positive correlation was observed between UA and C reactive protein concentrations in in-hospital deaths only (rho 0.41, p=0.027).
CONCLUSION:
In patients with acute coronary syndrome, uricemia levels above the current international reference limit (6.0mg/dl) were associated with in-hospital mortality, independently from ethnicity and renal function.
Copyright © 2017. Published by Elsevier B.V.
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Circulating CD14+ and CD14CD16- classical monocytes are reduced in patients with signs of plaque neovascularization in the carotid artery.
Atherosclerosis2016 Dec;255():171-178. doi: 10.1016/j.atherosclerosis.2016.10.004.
Ammirati Enrico, Moroni Francesco, Magnoni Marco, Di Terlizzi Simona, Villa Chiara, Sizzano Federico, Palini Alessio, Garlaschelli Katia, Tripiciano Fernanda, Scotti Isabella, Catapano Alberico Luigi, Manfredi Angelo A, Norata Giuseppe Danilo, Camici Paolo G
Abstract
BACKGROUND AND AIMS:
Monocytes are known to play a key role in the initiation and progression of atherosclerosis and contribute to plaque destabilization through the generation of signals that promote inflammation and neoangiogenesis. In humans, studies investigating the features of circulating monocytes in advanced atherosclerotic lesions are lacking.
METHODS:
Patients (mean age 69 years, 56% males) with intermediate asymptomatic carotid stenosis (40-70% in diameter) were evaluated for maximal stenosis in common carotid artery, carotid bulb and internal carotid artery, overall disease burden as estimated with total plaque area (TPA), greyscale and neovascularization in 244 advanced carotid plaques. Absolute counts of circulating CD14+ monocytes, of classical (CD14CD16-), intermediate (CD14CD16+) and non-classical (CD14CD16+) monocytes and HLA-DR+ median fluorescence intensity for each subset were evaluated with flow cytometry.
RESULTS:
No correlation was found between monocytes and overall atherosclerotic burden, nor with high sensitivity C-reactive protein (hsCRP) or interleukin-6 (IL-6). In contrast, plaque signs of neovascularization were associated with significantly lower counts of circulating CD14+ monocytes (297 versus 350 cells/mm, p = 0.039) and of classical monocytes (255 versus 310 cells/mm, p = 0.029).
CONCLUSIONS:
Neovascularized atherosclerotic lesions selectively associate with lower blood levels of CD14+ and CD14CD16- monocytes independently of systemic inflammatory activity, as indicated by normal hsCRP levels. Whether the reduction of circulating CD14+ and CD14CD16- monocytes is due to a potential redistribution of these cell types into active lesions remains to be explored.
Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
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Carotid atherosclerosis, silent ischemic brain damage and brain atrophy: A systematic review and meta-analysis.
Int J Cardiol2016 Nov;223():681-687. doi: 10.1016/j.ijcard.2016.08.234.
Moroni Francesco, Ammirati Enrico, Magnoni Marco, D'Ascenzo Fabrizio, Anselmino Matteo, Anzalone Nicoletta, Rocca Maria Assunta, Falini Andrea, Filippi Massimo, Camici Paolo G
Abstract
BACKGROUND:
The widespread use of brain imaging has led to increased recognition of subclinical brain abnormalities, including white matter hyperintensities (WMH) and silent brain infarctions (SBI), which have a vascular origin, and have been associated to a high risk of stroke, disability and dementia. Carotid atherosclerosis (CA) may be causative in the development of WMH, SBI and eventually brain atrophy. Aim of the present systematic review and meta-analysis was to assess the existing evidence linking CA to WMH, SBI and brain atrophy.
METHODS:
The relation between CA and WMH, SBI and brain atrophy was investigated through the systematic search of online databases up to September 2015 and manual searching of references and related citations. Pooled estimates were calculated by random-effects model, using restricted maximum likelihood method with inverse variance weighting method.
RESULTS:
Of the 3536 records identified, fifteen were included in the systematic review and 9 were found to be eligible for the meta-analysis. CA was significantly associated with the presence of WMH (Odds Ratio, OR 1.42, confidence interval, CI 1.22-1.66, p
CONCLUSIONS:
CA was found to be associated to WMH and SBI. While no causative association can be inferred from the available data, the presence of carotid plaque may be considered a significant risk factor for subclinical cerebral damage.
Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
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Applicability of the 2013 ACC/AHA Risk Assessment and Cholesterol Treatment Guidelines in the real world: results from a multiethnic case-control study.
Ann Med2016 ;48(4):282-92. doi: 10.3109/07853890.2016.1168934.
Magnoni Marco, Berteotti Martina, Norata Giuseppe Danilo, Limite Luca Rosario, Peretto Giovanni, Cristell Nicole, Maseri Attilio, Cianflone Domenico
Abstract
BACKGROUND:
The 2013 ACC/AHA cholesterol treatment guidelines have introduced a new cardiovascular risk assessment approach (PCE) and have revisited the threshold for prescribing statins. This study aims to compare the ex ante application of the ACC/AHA and the ATP-III guideline models by using a multiethnic case-control study.
METHODS:
ATP-III-FRS and PCE were assessed in 739 patients with first STEMI and 739 age- and gender-matched controls; the proportion of cases and controls that would have been eligible for statin as primary prevention therapy and the discriminatory ability of both models were evaluated.
RESULTS:
The application of the ACC/AHA compared to the ATP-III model, resulted in an increase in sensitivity [94% (95%CI: 91%-95%) vs. 65% (61%-68%), p
CONCLUSION:
The application of the ACC/AHA model resulted in a significant reduction of first STEMI patients who would have escaped from preventive treatment. Age and ethnicity affected the accuracy of the ACC/AHA model improving the identification of premature STEMI among Europeans only. Key messages According to the ATP-III guideline model, about one-third of patients with STEMI would not be eligible for primary preventive treatment before STEMI. The application of the new ACC/AHA cholesterol treatment guideline model leads to a significant reduction of the percentage of patients with STEMI who would have been considered at lower risk before the STEMI. The global accuracy of the new ACC/AHA model is higher in the Europeans than in the Chinese and, moreover, among the Europeans, the application of the new ACC/AHA guideline model also improved identification of premature STEMI patients.
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Usefulness of High-Sensitivity Cardiac Troponin T for the Identification of Outlier Patients With Diffuse Coronary Atherosclerosis and Low-Risk Factors.
Am J Cardiol2016 May;117(9):1397-404. doi: 10.1016/j.amjcard.2016.02.002.
Magnoni Marco, Masson Serge, Andreini Daniele, Moccetti Tiziano, Modena Maria Grazia, Canestrari Mauro, Berti Sergio, Casolo Giancarlo, Gabrielli Domenico, Marraccini Paolo, Pontone Gianluca, Latini Roberto, Maggioni Aldo Pietro, Maseri Attilio,
Abstract
Novel high-sensitivity assay can detect very low levels of circulating cardiac troponin (hs-cTnT) in apparently healthy subjects. Within normal range, higher levels are associated with coronary artery disease (CAD) and cardiac abnormalities commonly associated to traditional risk factors (RFs) for CAD. Therefore, we investigated the relation between circulating hs-cTnT and CAD in patients with a spectrum of RF burden aiming to assess the added value of hs-cTnT to identify "outlier" patients with CAD despite a low RF burden. Hs-cTnT was measured in 525 stable patients without previous diagnosis of ischemic heart disease with 0 to 1 RF, excluded diabetes, (low-RF group, n = 263) or ?2 RFs (multiple-RF group, n = 262) and without CAD (segment involvement score = 0) or diffuse CAD (segment involvement score >5) at coronary computed tomography angiography. Outlier patients with diffuse CAD despite low-RF burden had similar extent, severity, and plaque composition than patients with multiple RFs. Overall, hs-cTnT was measurable in 81% of patients with median value of 6.0 ng/L. In both groups, hs-cTnT concentration was higher in patients with CAD than in patients with normal coronary arteries (p 6 ng/L) was independently associated with CAD in low-RF group only. Despite very low circulating concentrations, hs-cTnT may identify with a good accuracy the outlier patients with diffuse CAD despite low-RF burden.
Copyright © 2016 Elsevier Inc. All rights reserved.
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Takotsubo cardiomyopathy and neurogenic stunned myocardium: similar albeit different.
Eur Heart J2016 Oct;37(37):2830-2832.
Ancona Francesco, Bertoldi Letizia F, Ruggieri Francesco, Cerri Marco, Magnoni Marco, Beretta Luigi, Cianflone Domenico, Camici Paolo G
Abstract
We demonstrate that in patients with stress cardiomyopathy the type of triggering event is associated with different clinical, instrumental, and laboratory features that characterize the phenotype at presentation.
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.
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Coronary atherosclerosis in outlier subjects at the opposite extremes of traditional risk factors: Rationale and preliminary results of the Coronary Atherosclerosis in outlier subjects: Protective and novel Individual Risk factors Evaluation (CAPIRE) study.
Am Heart J2016 Mar;173():18-26. doi: 10.1016/j.ahj.2015.11.017.
Magnoni Marco, Andreini Daniele, Gorini Marco, Moccetti Tiziano, Modena Maria Grazia, Canestrari Mauro, Berti Sergio, Casolo Giancarlo, Gabrielli Domenico, Marraccini Paolo, Pontone Gianluca, Masson Serge, Latini Roberto, Maggioni Aldo Pietro, Maseri Attilio,
Abstract
Although it is generally accepted that cardiac ischemic events develop when coronary atherosclerosis (coronary artery disease [CAD]) has reached a critical threshold, this is true only to a first approximation. Indeed, there are patients with severe CAD who do not develop ischemic events; conversely, at the other extreme, individuals with minimal CAD may do. Similar exceptions to this paradigm include patients with diffuse CAD with a low risk factor (RF) profile and others with multiple RFs who develop only mild or no CAD. Therefore, the CAPIRE project was designed to investigate whether the specific study of these extreme outlier populations could provide clues for identification of yet unknown risk or protective factors for CAD and ischemic events. In the CAPIRE study, 481 subjects without previous symptoms or history of ischemic heart disease and normal left ventricular systolic function undergoing coronary computed tomography angiography have been selected based on coronary computed tomography angiography findings and cardiovascular RF profile. Therefore, in the whole population, 2 extreme outlier populations have been identified: (1) subjects with no CAD despite multiple RFs, and (2) at the opposite extreme, subjects with diffuse CAD despite a low-risk profile. Each subject has been characterized by clinical, anatomical imaging variables of CAD and baseline circulating biomarkers. Blood samples were collected and stored in a biological bank for further advanced investigations. The project is designed as a prospective, observational, international multicenter study with an initial cross-sectional analysis of clinical, imaging, and biomolecular variables in the selected groups and a longitudinal 5-year follow-up.
Copyright © 2015 Elsevier Inc. All rights reserved.
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Reduction of Circulating HLA-DR T Cell Levels Correlates With Increased Carotid Intraplaque Neovascularization and Atherosclerotic Burden.
JACC Cardiovasc Imaging2016 Oct;9(10):1231-1233. doi: 10.1016/j.jcmg.2015.10.010.
Ammirati Enrico, Magnoni Marco, Moroni Francesco, Di Terlizzi Simona, Scotti Isabella, Villa Chiara, Sizzano Federico, Impellizzeri Matteo, Fanelli Giovanna, Esposito Gloria, Chiesa Roberto, Camici Paolo G
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[The SCOT-HEART study].
G Ital Cardiol (Rome)2015 Nov;16(11):601-7. doi: 10.1714/2066.22424.
Neglia Danilo, Chiappino Dante, Magnoni Marco
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Clinical recommendations on Cardiac-CT in 2015: a position paper of the Working Group on Cardiac-CT and Nuclear Cardiology of the Italian Society of Cardiology.
J Cardiovasc Med (Hagerstown)2016 Feb;17(2):73-84. doi: 10.2459/JCM.0000000000000318.
Andreini Daniele, Martuscelli Eugenio, Guaricci Andrea Igoren, Carrabba Nazario, Magnoni Marco, Tedeschi Carlo, Pelliccia Antonio, Pontone Gianluca,
Abstract
We worked out a position paper on cardiac-computed tomography (CCT) endorsed by the Working Group on CCT and Nuclear Cardiology of the Italian Society of Cardiology. The CCT clinical indications were discussed and formulated according to the following two modalities: a brief paragraph dedicated to each indication, with the description of clinical usefulness of different indications; and each indication was rated by the technical panel for appropriateness, using a score assessing whether the use of CCT for each indication is appropriate, uncertain, or inappropriate. All conventional CCT clinical indications, regarding coronary and noncoronary evaluation, were discussed and rated. Moreover, we wrote specific sections regarding the newest CCT applications, such as stress perfusion computed tomography, noninvasive evaluation of fractional flow reserve, and CCT use in athletes. The present study has the following two main objectives: because the diagnostic performance of coronary computed tomography angiography (CCTA) is strictly dependent on adequate technology and local expertise, we strove to provide clinical recommendations on CCTA that may help Italian physicians involved with this diagnostic tool; and to give an update on new indications of CCTA, such as its use for safely discharging patients with suspected acute coronary syndromes from the emergency department, and latest clinical results that have been made possible by the remarkable technology developments of the scanners.
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Markers of inflammation associated with plaque progression and instability in patients with carotid atherosclerosis.
Mediators Inflamm2015 ;2015():718329. doi: 718329.
Ammirati Enrico, Moroni Francesco, Norata Giuseppe Danilo, Magnoni Marco, Camici Paolo G
Abstract
Atherosclerosis is the focal expression of a systemic disease affecting medium- and large-sized arteries, in which traditional cardiovascular risk factor and immune factors play a key role. It is well accepted that circulating biomarkers, including C-reactive protein and interleukin-6, reliably predict major cardiovascular events, including myocardial infarction or death. However, the relevance of biomarkers of systemic inflammation to atherosclerosis progression in the carotid artery is less established. The large majority of clinical studies focused on the association between biomarkers and subclinical atherosclerosis, that is, carotid intima-media thickening (cIMT), which represents an earlier stage of the disease. The aim of this work is to review inflammatory biomarkers that were associated with a higher atherosclerotic burden, a faster disease progression, and features of plaque instability, such as inflammation or neovascularization, in patients with carotid atherosclerotic plaque, which represents an advanced stage of disease compared with cIMT. The association of biomarkers with the occurrence of cerebrovascular events, secondary to carotid plaque rupture, will also be presented. Currently, the degree of carotid artery stenosis is used to predict the risk of future cerebrovascular events in patients affected by carotid atherosclerosis. However, this strategy appears suboptimal. The identification of suitable biomarkers could provide a useful adjunctive criterion to ensure better risk stratification and optimize management.
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Non-invasive molecular imaging of vulnerable atherosclerotic plaques.
J Cardiol2015 Apr;65(4):261-9. doi: 10.1016/j.jjcc.2015.01.004.
Magnoni Marco, Ammirati Enrico, Camici Paolo G
Abstract
The growing discoveries coming from clinical and basic research during the past decades have revolutionized our knowledge regarding pathophysiologic mechanisms underlying the atherosclerotic process and its thrombotic complications. The traditional view focusing on the severity of stenosis of atherosclerotic plaque has given way to the evidence that the clinical complications of atherosclerotic vascular disease, particularly the propensity to develop thrombotic complications, are determined mainly by the biological composition of the plaque. This paradigm shift has reinforced the need to move from the sole anatomical assessment toward combined anatomic and functional imaging modalities enabling the molecular and cellular characterization of the disease on top of its structural properties. Together, the progress to identify molecular targets related to plaque vulnerability and the improvement of imaging techniques for the detection of such molecular targets have allowed us to obtain new important pathophysiological information. This might allow better patient stratification for the identification of subjects at high risk to develop premature atherosclerosis who might need an aggressive therapeutic approach. Nuclear techniques, magnetic resonance imaging, computed tomography angiography, and contrast-enhanced ultrasound represent the currently available non-invasive imaging modalities for molecular imaging which can provide different and complementary insights into the biological features of the atherosclerotic process. This clinical review will discuss the evidence and potential translational applications of the individual imaging techniques particularly concerning their ability to detect the main atherosclerotic features related to plaque vulnerability, such as plaque inflammation and intertwined neovascularization.
Copyright © 2015. Published by Elsevier Ltd.
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The predictive role of renal function and systemic inflammation on the onset of de novo atrial fibrillation after cardiac surgery.
Eur J Prev Cardiol2016 Jan;23(2):206-13. doi: 10.1177/2047487314564896.
Limite Luca R, Magnoni Marco, Berteotti Martina, Peretto Giovanni, Durante Alessandro, Cristell Nicole, Laricchia Alessandra, Camici Paolo G, Alfieri Ottavio, Cianflone Domenico
Abstract
BACKGROUND:
The association between postoperative atrial fibrillation (POAF) and renal function was previously grounded in patients undergoing coronary artery bypass grafting through unknown mechanisms. We aim to investigate the association between renal function and POAF in a cohort composed mostly of patients undergoing valve surgery and to explore the role of inflammation as a pathogenic mechanism linking renal dysfunction and arrhythmogenesis.
METHODS:
Altogether 444 patients who underwent cardiac surgery without previous history of atrial fibrillation were analysed. Serum creatinine and high sensitivity C-reactive protein (hs-CRP) concentrations were obtained at baseline and on the 3rd, 8th and 15th postoperative day; estimated glomerular filtration rate (eGFR) was calculated by the Modified Diet Renal Disease (MDRD) formula. Patients were divided into three groups on the basis of baseline eGFR.
RESULTS:
Overall, 173 (39%) patients developed POAF, 29.5% in the group with normal eGFR (?90?ml/min/1.73?m(2)), 43.3% among patients with eGFR 60-90?ml/min/1.73?m(2) and 55.6% in the group with eGFR ?60?ml/min/1.73?m(2). Patients developing POAF had lower eGFR on all the samples. At baseline preoperatively hs-CRP levels did not differ in the two groups.On multivariate analysis, age and eGFR were identified as independent predictors of POAF. The risk of POAF progressively increased from mild impairment (odds ratio (OR) 1.59, 95% confidence interval (CI) 1.01-2.50) to severe reduction of renal function (OR 2.35, 95% CI 1.25-4.48).
CONCLUSIONS:
Age and eGFR were identified as the strongest predictors of POAF in a population largely composed of valve surgery patients. Renal function, even from early stage, is independently associated with the increasing risk of developing POAF.
© The European Society of Cardiology 2014.
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Non-invasive imaging of vascular inflammation.
Front Immunol2014 ;5():399. doi: 399.
Ammirati Enrico, Moroni Francesco, Pedrotti Patrizia, Scotti Isabella, Magnoni Marco, Bozzolo Enrica P, Rimoldi Ornella E, Camici Paolo G
Abstract
In large-vessel vasculitides, inflammatory infiltrates may cause thickening of the involved arterial vessel wall leading to progressive stenosis and occlusion. Dilatation, aneurysm formation, and thrombosis may also ensue. Activated macrophages and T lymphocytes are fundamental elements in vascular inflammation. The amount and density of the inflammatory infiltrate is directly linked to local disease activity. Additionally, patients with autoimmune disorders have an increased cardiovascular (CV) risk compared with age-matched healthy individuals as a consequence of accelerated atherosclerosis. Molecular imaging techniques targeting activated macrophages, neovascularization, or increased cellular metabolic activity can represent effective means of non-invasive detection of vascular inflammation. In the present review, novel non-invasive imaging tools that have been successfully tested in humans will be presented. These include contrast-enhanced ultrasonography, which allows detection of neovessels within the wall of inflamed arteries; contrast-enhanced CV magnetic resonance that can detect increased thickness of the arterial wall, usually associated with edema, or mural enhancement using T2 and post-contrast T1-weighted sequences, respectively; and positron emission tomography associated with radio-tracers such as [(18)F]-fluorodeoxyglucose and the new [(11)C]-PK11195 in combination with computed tomography angiography to detect activated macrophages within the vessel wall. Imaging techniques are useful in the diagnostic work-up of large- and medium-vessel vasculitides, to monitor disease activity and the response to treatments. Finally, molecular imaging targets can provide new clues about the pathogenesis and evolution of immune-mediated disorders involving arterial vessels.
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Need for new non-invasive imaging strategies to identify high-risk asymptomatic patients with carotid stenosis.
Int J Cardiol2013 Oct;168(4):4342-3. doi: 10.1016/j.ijcard.2013.05.079.
Ammirati Enrico, Magnoni Marco, Camici Paolo G
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Molecular study of human herpesvirus 6 and 8 involvement in coronary atherosclerosis and coronary instability.
J Med Virol2012 Dec;84(12):1961-6. doi: 10.1002/jmv.23355.
Magnoni Marco, Malnati Mauro, Cristell Nicole, Coli Stefano, Russo Domenico, Ruotolo Giacomo, Cianflone Domenico, Alfieri Ottavio, Lusso Paolo, Maseri Attilio
Abstract
Several lines of evidence suggest the involvement of infectious agents in the pathogenesis of atherosclerosis. Furthermore, a correlation between infection-driven inflammatory burden and acute manifestation of coronary artery disease has been hypothesized. The aim of this work was to assess whether human herpesvirus (HHV)-6 and HHV-8, two DNA viruses with a distinct tropism for endothelium and lymphocytes, may be associated with coronary instability. An age- and gender-matched cross-sectional study was undertaken in 70 patients with testing of plasma HHV-6 and HHV-8 DNA load in different cardiovascular clinical settings: 29 patients with acute myocardial infarction, 21 patients with stable coronary artery disease, and 20 patients without coronary and carotid artery atherosclerosis subjected to cardiac valve replacement. In all patients, HHV-6 and HHV-8 plasma DNA was tested by using highly sensitive, calibrated quantitative real-time PCR assays which employ a synthetic DNA calibrator to adjust for DNA extraction and amplification efficiency. HHV-8 viremia was undetectable in all three groups. HHV-6 viremia was detected in a substantial fraction of the samples examined (18.6%) without significant differences among the three groups (ST segment elevation myocardial infarction: 17.2%; stable coronary artery disease: 14.3%; patients without coronary and carotid artery atherosclerosis: 25%). Furthermore, no significant differences in plasma HHV-6 load were observed amongst the three groups of patients. These findings indicate that coronary instability is not associated specifically with active HHV-6 or HHV-8 infection. However, an unusually high rate of active HHV-6 infection was documented among patients without atherosclerosis admitted to hospital with cardiac disease.
Copyright © 2012 Wiley Periodicals, Inc.
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Coexistence of multiple and widespread cardiovascular complications in a patient with Marfan syndrome.
J Clin Ultrasound2013 ;41(3):195-8. doi: 10.1002/jcu.21912.
Magnoni Marco, Figini Filippo, Piraino Daniela, Cianflone Domenico
Abstract
Inherited connective tissue diseases such as Marfan syndrome are frequently associated with cardiovascular manifestations. Aortic involvement with dilation and dissection is the most common finding and the major cause of death in Marfan syndrome patients. We report the echocardiographic study of a 53-year-old male patient with uncommon coexistence of cardiovascular abnormalities typical of connective tissue disease at first clinical presentation in acute clinical setting: dissection of the descending aorta associated with severe mitral regurgitation due to leaflet flail and massive aortic insufficiency due to ascending aortic enlargement, leading to left ventricular dilation and dysfunction.
Copyright © 2012 Wiley Periodicals, Inc.
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Left main pentaforcation: an uncommon coronary variant detected by multidetector computed tomography.
J Cardiovasc Med (Hagerstown)2012 Oct;13(10):665-6. doi: 10.2459/JCM.0b013e32834dc61f.
Magnoni Marco, Ottonelli Cesare, Andreini Daniele
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An inverted location of the bicuspid valve disease: a variant of a variant.
Circulation2011 Nov;124(20):e513-5. doi: 10.1161/CIRCULATIONAHA.111.055285.
Magnoni Marco, Turri Carlo, Roghi Alberto, Merlanti Bruno, Maseri Attilio
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Assessment of Takayasu arteritis activity by carotid contrast-enhanced ultrasound.
Circ Cardiovasc Imaging2011 Mar;4(2):e1-2. doi: 10.1161/CIRCIMAGING.110.960906.
Magnoni Marco, Dagna Lorenzo, Coli Stefano, Cianflone Domenico, Sabbadini Maria Grazia, Maseri Attilio
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[The innovative clinical research promoted by the Italian Association of Hospital Cardiologists].
G Ital Cardiol (Rome) -
IMAGE CARDIO MED: Two different mechanisms of myocardial ischemia involving 2 separate myocardial segments in a patient with normal coronary angiography.
Circulation2010 Jan;121(1):e1-3. doi: 10.1161/CIRCULATIONAHA.109.878314.
Magnoni Marco, Esposito Antonio, Coli Stefano, Scuteri Lea, De Cobelli Francesco, Cianflone Domenico, Del Maschio Alessandro, Maseri Attilio
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A surprise behind the dark.
Eur J Echocardiogr2009 Oct;10(7):887-8. doi: 10.1093/ejechocard/jep089.
Magnoni Marco, Coli Stefano, Cianflone Domenico
Abstract
Standard ultrasound has a poor accuracy in the detection of carotid plaque surface irregularities and ulcers, which are features of vulnerable lesions. Sonographic contrast agents can improve vessel wall lumen definition, thus potentially overcoming this limitation. Recent studies also suggest that contrast ultrasound can be used to study intraplaque neovascularizaion, a potential marker of high-risk lesions. This case represents a striking example of the added value of contrast ultrasound to improve diagnostic accuracy of vascular studies, particularly in the detection of plaque surface irregularities and plaque neovascularization.
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Contrast-enhanced ultrasound imaging of periadventitial vasa vasorum in human carotid arteries.
Eur J Echocardiogr2009 Mar;10(2):260-4. doi: 10.1093/ejechocard/jen221.
Magnoni Marco, Coli Stefano, Marrocco-Trischitta Massimiliano M, Melisurgo Giulio, De Dominicis Davide, Cianflone Domenico, Chiesa Roberto, Feinstein Steve B, Maseri Attilio
Abstract
AIMS:
Arterial vasa vasorum (VV) are known to be involved in the atherosclerotic process. The aim of the present study was to explore whether ultrasound imaging with contrast agent is able to visualize adventitial VV in human carotid atherosclerosis.
METHODS AND RESULTS:
We studied with standard ultrasound 25 patients with carotid stenosis >50% (ATS group) and 15 patients without carotid artery plaques and an intima-media thickness (IMT)
CONCLUSION:
Periadventitial contrast signal was detected in all patients and BFI thickness was higher in patient with carotid atherosclerosis and correlated with IMT.
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Contrast-enhanced ultrasound imaging of intraplaque neovascularization in carotid arteries: correlation with histology and plaque echogenicity.
J Am Coll Cardiol2008 Jul;52(3):223-30. doi: 10.1016/j.jacc.2008.02.082.
Coli Stefano, Magnoni Marco, Sangiorgi Giuseppe, Marrocco-Trischitta Massimiliano M, Melisurgo Giulio, Mauriello Alessandro, Spagnoli Luigi, Chiesa Roberto, Cianflone Domenico, Maseri Attilio
Abstract
OBJECTIVES:
This study was designed to evaluate contrast-enhanced ultrasound imaging of carotid atherosclerosis as a clinical tool to study intraplaque neovascularization.
BACKGROUND:
Plaque neovascularization is associated with plaque vulnerability and symptomatic disease; therefore, imaging of neovascularization in carotid atherosclerosis may represent a useful tool for clinical risk stratification and monitoring the efficacy of antiatherosclerotic therapies.
METHODS:
Thirty-two patients with 52 carotid plaques were studied by standard and contrast-enhanced ultrasound imaging. In 17 of these patients who underwent endarterectomy, the surgical specimen was available for histological determination of microvessel density by CD31/CD34 double staining. Plaque echogenicity and degree of stenosis at standard ultrasound imaging were evaluated for each lesion. Contrast-agent enhancement within the plaque was categorized as absent/peripheral (grade 1) and extensive/internal (grade 2).
RESULTS:
In the surgical subgroup, plaques with higher contrast-agent enhancement showed a greater neovascularization at histology (grade 2 vs. grade 1 contrast-agent enhancement: median vasa vasorum density: 3.24/mm(2) vs. 1.82/mm(2), respectively, p = 0.005). In the whole series of 52 lesions, echolucent plaques showed a higher degree of contrast-agent enhancement (p
CONCLUSIONS:
Carotid plaque contrast-agent enhancement with sonographic agents correlates with histological density of neovessels and is associated with plaque echolucency, a well-accepted marker of high risk lesions, but it is unrelated to the degree of stenosis. Contrast-enhanced carotid ultrasound imaging may provide valuable information for plaque risk stratification and for assessing the response to antiatherosclerotic therapies, beyond that provided by standard ultrasound imaging.
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Reduction of mitral valve regurgitation caused by acute papillary muscle ischemia.
Nat Clin Pract Cardiovasc Med2007 Jan;4(1):51-4.
Magnoni Marco, Coli Stefano, La Canna Giovanni, Meloni Carlo, Cianflone Domenico, Maseri Attilio
Abstract
BACKGROUND:
A 67-year-old man was admitted to a coronary care unit for non-ST-segment elevation myocardial infarction with complicating acute heart failure. Severe mitral regurgitation was detected by echocardiography at presentation. Repeat echocardiography carried out during another ischemic episode revealed a marked reduction in the patient's mitral regurgitation that was related to decreased apical traction of the valve leaflets.
INVESTIGATIONS:
Physical examination, electrocardiography, laboratory tests, coronary angiography, chest radiography, echocardiography.
DIAGNOSIS:
Mitral regurgitation associated with acute coronary syndrome.
MANAGEMENT:
Early revascularization by percutaneous coronary intervention, supported by pharmacological therapy to decrease left ventricular filling pressure.
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Myocardial infarction complicating the initial phase of an ovarian stimulation protocol.
Int J Cardiol2007 Jan;115(1):e56-7.
Coli Stefano, Magnoni Marco, Melisurgo Giulio, Persico Paola, Doldi Nicola, De Cobelli Francesco, Del Maschio Alessandro, Cianflone Domenico, Maseri Attilio
Abstract
Two previous reports have reported myocardial infarction during ovarian hyperstimulation syndrome, a complication of controlled ovarian stimulation characterized by ascites, pleural effusion, hemoconcentration and an increased thromboembolic risk, but no association with the initial phase (before treatment with human chorionic gonadotropin) of a normal ovarian stimulation protocol for infertility has ever been described. We report the first case, to our knowledge, of acute myocardial infarction occurring during the initial phase of an otherwise uncomplicated ovarian stimulation protocol. A young woman with infertility associated to polycystic ovary syndrome was treated with leuprolide acetate and recombinant follicle stimulating hormone to induce ovarian stimulation for in vitro fertilization and embryo transfer. After 12 days the patient presented a non-ST elevation myocardial infarction, which was treated with aspirin, clopidogrel, enoxaparin, intravenous nitrates and beta blockers. Cardiac catheterization showed angiographically normal coronary arteries. Echocardiography showed a circumscribed akinesis of the inferior apical segment of the left ventricle and right ventricular apex, which was confirmed by cardiac magnetic resonance. A screening for thrombophilic diathesis was negative. The patient was discharged and remained asymptomatic at 1 and 3 months follow up. Further ovarian stimulations were excluded and a trial of oocyte retrieval on spontaneous cycle was planned. Myocardial infarction can complicate ovarian stimulation protocols for infertility even in their early phase without any sign of ovarian hyperstimulation syndrome.
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Images in cardiovascular medicine. Not so mural thrombus.
Circulation2006 Jan;113(3):e38.
Coli Stefano, Magnoni Marco, Meloni Carlo, Cianflone Domenico, Maseri Attilio
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