Prof.ssa Giannattasio Cristina

Pubblicazioni su PubMed

• Long-term prognostic performance of cardiac magnetic resonance imaging markers versus complicated clinical presentation after an acute myocarditis.
  Int J Cardiol

  2024 Dec;417():132567. doi: 10.1016/j.ijcard.2024.132567.
  
  Ammirati Enrico, Varrenti Marisa, Sormani Paola, Bernasconi Davide, Moro Claudio, Grosu Aurelia, D'Elia Saverio, Raineri Claudia, Quattrocchi Giuseppina, Milazzo Angela, Turco Annalisa, Maestroni Alberto, Valsecchi Maria Grazia, Oliva Fabrizio, Garascia Andrea, Giannattasio Cristina, Camici Paolo G, Pedrotti Patrizia
  
  Abstract
  
  BACKGROUND:
  Identifying markers associated with adverse events after acute myocarditis (AM) is relevant to plan follow-up. We assessed the prognostic performance of previously described cardiac magnetic resonance imaging (CMRI) markers and their combination: septal late gadolinium enhancement (LGE) localization and left ventricular ejection fraction (LVEF) 
  METHODS:
  We retrospectively assessed 248 AM patients (median age of 34 years, 87.1 % male) from 6 hospitals with onset of cardiac symptoms
  RESULTS:
  Thirteen patients (5.2 %) experienced at least one major cardiac event after a median follow-up of 4.7 years with a significant hazard ratio of 35.8 for CCP vs. 9.2 for septal LGE vs. 12.4 for LVEF
  CONCLUSIONS:
  Major cardiac events after an AM are relatively low, and CCP, septal LGE, and LVEF
  Copyright © 2024. Published by Elsevier B.V.
  
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• Secondary prevention and extreme cardiovascular risk evaluation (SEVERE-0): Prevalence of extreme cardiovascular risk in cardiological rehabilitation patients and its impact on functional improvement.
  Nutr Metab Cardiovasc Dis

  2024 Aug;():. doi: S0939-4753(24)00303-X.
  
  Tognola Chiara, Myriam Intravaia Rita Cristina, Senini Eleonora, Pezzoli Stefano, Riccio Alfonso, Gualini Elena, Fabbri Saverio, Bellantonio Valentina, Politi Francesco, Campana Marta, Fucile Ilaria, Mancusi Costantino, Golia Enrica, Cesaro Arturo, De Luca Nicola, Calabrò Paolo, Giannattasio Cristina, Maloberti Alessandro
  
  Abstract
  
  BACKGROUND AND AIMS:
  Patients with recent Acute Coronary Syndrome (ACS) or Chronic Coronary Syndrome (CCS) are all at very high CardioVascular (CV) risk. However, some of them are more likely to experience recurrent cardiovascular events (i.e extreme CV risk). A definition of which patients should be included in this category has been recently proposed by the European Society of Cardiology but data on its prevalence are still lacking, especially in the context of Cardiac Rehabilitation (CR). Furthermore, if this condition had an impact on the CR related functional improvement is not known. Our study has been designed to answer to both these questions.
  
  METHODS AND RESULTS:
  The study included 938 ACS/CCS patients who attended the CR program at the Niguarda Hospital (Milan). Extreme CV patients were defined as the presence of a previous CV events within 2 years or the presence of peripheral arteriopathy or the presence of a multivessel coronary involvement. Functional improvement was evaluated through 6-Minute Walking Test (6-MWT). As many as 26.9% of the patients had an extreme CV risk. They were older (67.8 ± 10.4 vs 64.1 ± 11.1 years; p ? 0.001), had a higher prevalence of CV risk factors and comorbidities and had a lower functional improvement during CR (102.9 ± 68.6 vs 138.1 ± 86.5 m; p ? 0.001). Extreme CV risk present a significant association with the 6-MWT results at multivariate analysis.
  
  CONCLUSION:
  Extreme CV risk is a very frequent condition among patients with ACS/CCS reaching the prevalence of 26.9%. Furthermore, being at extreme CV risk adversely affects the patient's functional improvement obtained during CR.
  
  Copyright © 2024. Published by Elsevier B.V.
  
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• A fearsome evolution of presumed cardiac sarcoidosis: The sarcoid-lymphoma syndrome.
  Int J Cardiol Heart Vasc

  2024 Oct;54():101496. doi: 101496.
  
  Sormani Paola, Ammirati Enrico, Giannattasio Cristina, Garascia Andrea, Pedrotti Patrizia
  
  
  
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• Uric acid and metabolic syndrome: Importance of hyperuricemia cut-off.
  Int J Cardiol

  2024 Dec;417():132527. doi: 10.1016/j.ijcard.2024.132527.
  
  Maloberti Alessandro, Tognola Chiara, Garofani Ilaria, Algeri Michela, Shkodra Atea, Bellantonio Valentina, Le Van Marco, Pedroli Stefano, Campana Marta, Toscani Giorgio, Bombelli Michele, Giannattasio Cristina
  
  Abstract
  
  BACKGROUND:
  The relationship between HyperUricemia (HU) and Metabolic Sindrome (MS) and if Uric Acid (UA) should be inserted into MS definitions is a matter of debate. Aim of our study was to evaluate the correlation between UA and HU with Insulin Resistance (IR) and MS in a population of hypertensive patients. HU was defined with two cut-offs (the classic one of ?6 mg/dL for women and ? 7 for men; the newly proposed URRAH one with ?5.6 mg/dL for both sexes).
  
  METHODS:
  We enrolled 473 Hypertensive patients followed by the Hypertension Unit of San Gerardo Hospital (Monza, Italy). IR was defined through TG/HDL ratio and NCEP-ATP-III criteria were used for MS diagnosis.
  
  RESULTS:
  MS was found in 33.6 % while HU affected 14.8 % of subjects according to the traditional cut-off and 35.9 % with the URRAH cut-off. 9.7 % (traditional cut-off) and 17.3 % (URRAH's threshold) of the subjects had both HU and MS. UA level was significantly higher in MS group (5.7 vs 4.9 mg/dL, p 
  CONCLUSIONS:
  The main finding of our study is that UA and HU significantly relate to IR and MS. The higher the values of UA and the higher the cut-off used, the higher the strength of the relationship.
  
  Copyright © 2024. Published by Elsevier B.V.
  
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• Cardiac amyloidosis red flags: What all the cardiologist have to know.
  Int J Cardiol Cardiovasc Risk Prev

  2024 Jun;21():200271. doi: 200271.
  
  Maloberti Alessandro, Ciampi Claudio, Politi Francesco, Fabbri Saverio, Musca Francesco, Giannattasio Cristina
  
  Abstract
  
  Cardiac amyloidosis is becoming increasingly important among cardiologist and an early diagnosis is very important. Amyloidosis is a systemic disease and many cardiac and extracardiac elements (red flags) should raise the suspicion of the disease. Electrocardiographic and imaging techniques (such as echocardiography, cardiac magnetic resonance and scintigraphy) are useful tools to make a diagnosis together with the presence of orthopedic issues, peripheral neuropathy or plasma cell dyscrasia. Cardiac amyloidosis is also often associated with valvular disorder, heart failure or cardiomyopathy. Red flags are crucial to raise suspicion and reach an early diagnosis, in order to start a targeted treatment strategy that could change the patient's outcome. Indeed, in the last years four new drugs were approved to treat transthyretin amyloidosis.
  
  © 2024 The Author(s).
  
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• Hyperuricemia in Cardiac Rehabilitation Patients: Prevalence and Association with Functional Improvement and Left Ventricular Ejection Fraction.
  High Blood Press Cardiovasc Prev

  2024 Sep;31(5):461-471. doi: 10.1007/s40292-024-00665-x.
  
  Fortuna Matteo, Tognola Chiara, Algeri Michela, Shkodra Atea, Intravaia Rita Cristina Myriam, Pezzoli Stefano, Garofani Ilaria, Morelli Martina, Gualini Elena, Fabbri Saverio, Sciume Luciana, Riccobono Salvatore, Beretta Giovanna, Giannattasio Cristina, Maloberti Alessandro
  
  Abstract
  
  INTRODUCTION:
  The role of uric acid (UA) and Hyper Uricemia (HU) in cardiac rehabilitation (CR) patients have been very little studied.
  
  AIM:
  To evaluate the prevalence of HU and if it is associated to the functional improvement obtained or the left ventricular Ejection Fraction (EF) in CR patients after Acute or Chronic Coronary Syndrome (ACS and CCS respectively).
  
  METHODS:
  We enrol 411 patients (62.4 ± 10.2 years; males 79.8%) enrolled in the CR program at Niguarda Hospital (Milan) from January 2012 to May 2023. HU was defined both as the classic cut-off (> 6 for females, > 7 mg/dL for males) and with the newly identified one by the URRAH study (> 5.1 for females, > 5.6 mg/dL for males). All patients performed a 6MWT and an echocardiography at the beginning and at the end of CR program.
  
  RESULTS:
  Mean UA values were within the normal range (5.6 ± 1.4 mg/dL) with 19.5% (classic cut-off) HU patients with an increase to 47.4% with the newer one. Linear regression analysis showed no role for UA in determining functional improvement, while UA and hyperuricemia (classic cut-off) were associated to admission and discharge EF. The same was not with the URRAH cut-off.
  
  CONCLUSIONS:
  HU is as frequent in CR patients as in those with ACS and CCS. UA didn't correlate with functional recovery while it is associated with admission and discharge EF as also is for HU (classic cut-off). Whit the URRAH cut-off HU prevalence increases significantly, however, it doesn't show any significant association with EF.
  
  © 2024. The Author(s).
  
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• Determinants of invasive left atrial pressure in patients with atrial fibrillation.
  Eur Heart J Cardiovasc Imaging

  2024 Oct;25(11):1590-1598. doi: 10.1093/ehjci/jeae194.
  
  Bonelli Andrea, Degiovanni Anna, Cersosimo Angelica, Spinoni Enrico Guido, Bosco Manuel, Dell'Era Gabriele, Moreo Antonella, De Chiara Benedetta Carla, Gigli Lorenzo, Salghetti Francesca, Arabia Gianmarco, Lombardi Carlo Mario, Brangi Elisa, Giannattasio Cristina, Patti Giuseppe, Curnis Antonio, Metra Marco, Inciardi Riccardo M
  
  Abstract
  
  AIMS:
  Estimation of left ventricular (LV) filling pressures in patients with a history of atrial fibrillation (AF) is challenging due to lack of reliable parameters. This study investigates the association between cardiac structure and function and invasive mean left atrial pressure (LAP).
  
  METHODS AND RESULTS:
  This is a multi-centre prospective study enrolling patients undergoing transcatheter ablation for AF. The invasive measurement of LAP was performed at the time of the procedure while the echocardiography within the previous 24?h. A mean LAP ? 15?mmHg was considered as increased. Overall, 101 patients were included (mean age 65.8 ± 8.5 years, 68% male, mean LV ejection fraction 56.6 ± 8.0%). No significant differences regarding clinical characteristics were detected between the group of patients with normal (n = 47) or increased LAP (n = 54). The latter showed lower values of LV global longitudinal strain, larger left atrial volumes (LAVs) and worse right ventricular (RV) function. After multivariable adjustment, higher E/e' ratio (P = 0.041) and minimal LAV index (LAVI min) (P = 0.031), lower peak atrial longitudinal strain (P = 0.030), and RV free wall longitudinal strain (P = 0.037), but not maximal LAV index (LAVI max) (P = 0.137), were significantly associated with mean LAP. The associations were not modified by cardiac rhythm. Overall, LAVI min showed the best diagnostic accuracy to predict elevated LAP (area under the curve 0.703).
  
  CONCLUSION:
  LA structure and function assessment well correlates with mean LAP in patients with a history of AF. These measures may be used in the assessment of filling pressure in these patients.
  
  © The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site?for further information please contact journals.permissions@oup.com.
  
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• [Contemporary diagnosis and treatment of tricuspid regurgitation: from neglected valve to primetime].
  G Ital Cardiol (Rome)

  2024 Aug;25(8):576-589. doi: 10.1714/4309.42927.
  
  Montalto Claudio, Tognola Chiara, Ghidini Simone, Monticelli Massimiliano, Nava Stefano, Soriano Francesco, Munafò Andrea R, Tavoletta Pasquale, Bruschi Giuseppe, Esposito Giuseppe, Mangieri Antonio, Giannattasio Cristina, De Marco Federico, Oliva Fabrizio, Oreglia Jacopo A
  
  Abstract
  
  Tricuspid insufficiency has long been considered an entity with low prognostic importance and associated with symptoms and signs only secondarily to left heart pathology. Scientific research in recent years has debunked this myth, demonstrating a key role in determining symptoms and signs of right heart failure, even in advanced stages. In parallel, advances in transcatheter technologies have opened up treatment options even for patients with increased surgical risk, who were previously excluded from traditional surgical options, with increasingly convincing results in reducing symptoms and improving the quality of life of our patients. The contemporary challenge is to translate these messages into everyday clinical practice and to encourage the centralization of patients in centers that currently have the expertise for feasibility evaluation and subsequent treatment. In this Review, we will analyze the most recent evidence on the pathophysiology and diagnosis of tricuspid insufficiency, the latest recommendations from European guidelines, and we will try to illustrate the most common technologies for percutaneous treatment and the abundant evidence supporting them.
  
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• Arrhythmic Risk Stratification in Cardiac Amyloidosis: A Review of the Current Literature.
  J Cardiovasc Dev Dis

  2024 Jul;11(7):. doi: 222.
  
  Bonvicini Eleonora, Preda Alberto, Tognola Chiara, Falco Raffaele, Gidiucci Roberto, Leo Giulio, Vargiu Sara, Varrenti Marisa, Gigli Lorenzo, Baroni Matteo, Carbonaro Marco, Colombo Giulia, Maloberti Alessandro, Giannattasio Cristina, Mazzone Patrizio, Guarracini Fabrizio
  
  Abstract
  
  Cardiac amyloidosis is the most frequent infiltrative disease caused by the deposition of misfolded proteins in the cardiac tissue, leading to heart failure, brady- and tachyarrhythmia and death. Conduction disorders, atrial fibrillation (AF) and ventricular arrhythmia (VA) significantly impact patient outcomes and demand recognition. However, several issues remain unresolved regarding early diagnosis and optimal management. Extreme bradycardia is the most common cause of arrhythmic death, while fast and sustained VAs can be found even in the early phases of the disease. Risk stratification and the prevention of sudden cardiac death are therefore to be considered in these patients, although the time for defibrillator implantation is still a subject of debate. Moreover, atrial impairment due to amyloid fibrils is associated with an increased risk of AF resistant to antiarrhythmic therapy, as well as recurrent thromboembolic events despite adequate anticoagulation. In the last few years, the aging of the population and progressive improvements in imaging methods have led to increases in the diagnosis of cardiac amyloidosis. Novel therapies have been developed to improve patients' functional status, quality of life and mortality, without data regarding their effect on arrhythmia prevention. In this review, we consider the latest evidence regarding the arrhythmic risk stratification of cardiac amyloidosis, as well as the available therapeutic strategies.
  
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• HFPEF and HFA-PEFF scores performance and the additional value of cardiac structure and function in patients with atrial fibrillation.
  Int J Cardiol

  2024 Oct;413():132385. doi: 10.1016/j.ijcard.2024.132385.
  
  Bonelli Andrea, Degiovanni Anna, Beretta Daniele, Cersosimo Angelica, Spinoni Enrico G, Bosco Manuel, Dell'Era Gabriele, De Chiara Benedetta C, Gigli Lorenzo, Salghetti Francesca, Lombardi Carlo M, Arabia Gianmarco, Giannattasio Cristina, Patti Giuseppe, Curnis Antonio, Metra Marco, Moreo Antonella, Inciardi Riccardo M
  
  Abstract
  
  BACKGROUND:
  The HFPEF and the HFA-PEFF scores have become useful tools to diagnose heart failure with preserved ejection fraction (HFpEF). Their accuracy in patients with a history of atrial fibrillation (AF) is less known. This study evaluates the association of these scores with invasive left atrial pressure (LAP) and the additional value of cardiac measures.
  
  METHODS:
  This is a multicenter observational prospective study involving patients undergoing ablation of AF. Patients with left ventricular ejection fraction (LVEF) 
  RESULTS:
  A total of 135 patients were enrolled in the study (mean age 65.2 ± 9.1 years, 32% female, mean LVEF 56.9 ± 7.9%). Patients with HFPEF ? 6 or HFA-PEFF ?5 had higher values of NTproBNP and more impaired cardiac function. However, neither HFPEF nor HFA-PEFF score showed a meaningful association with elevated mean LAP (respectively, OR 1.05 [95%CI 0.83-1.34] p = 0.64, and OR 1.09 [95%CI: 0.86-1.39] p = 0.45). The addition of LA indexed minimal volume (LAVi min) improved the ability of the scores (baseline C-statistic 0.51 [95%CI 0.41-0.61] for the HFPEF score and 0.53 [95%CI 0.43-0.64] for the HFA-PEFF score) to diagnose elevated filling pressure (HFPEF + LAVi min: C-statistic 0.70 [95%CI 0.60-0.80], p-value = 0.005; HFA-PEFF + LAVi min: C-statistic 0.70 [95%CI 0.60-0.80], p-value = 0.02).
  
  CONCLUSION:
  In a cohort of patients with a history of AF, the use of the available diagnostic scores did not predict elevated mean LAP. The integration of LAVi min improved the ability to correctly identify elevated filling pressure.
  
  Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.
  
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• Risk of Cardiovascular Events in Metabolically Healthy Overweight or Obese Adults: Role of LDL-Cholesterol in the Stratification of Risk.
  Diagnostics (Basel)

  2024 Jun;14(13):. doi: 1314.
  
  Palatini Paolo, Virdis Agostino, Masi Stefano, Mengozzi Alessandro, Casiglia Edoardo, Tikhonoff Valerie, Cicero Arrigo F G, Ungar Andrea, Parati Gianfranco, Rivasi Giulia, Salvetti Massimo, Barbagallo Carlo Maria, Bombelli Michele, Dell'Oro Raffaella, Bruno Berardino, Lippa Luciano, D'Elia Lanfranco, Masulli Maria, Verdecchia Paolo, Reboldi Gianpaolo, Angeli Fabio, Cianci Rosario, Mallamaci Francesca, Cirillo Massimo, Rattazzi Marcello, Cirillo Pietro, Gesualdo Loreto, Russo Elisa, Mazza Alberto, Giannattasio Cristina, Maloberti Alessandro, Volpe Massimo, Tocci Giuliano, Iaccarino Guido, Nazzaro Pietro, Galletti Ferruccio, Ferri Claudio, Desideri Giovambattista, Viazzi Francesca, Pontremoli Roberto, Muiesan Maria Lorenza, Grassi Guido, Borghi Claudio,
  
  Abstract
  
  The objective of this study was to investigate the longitudinal association of metabolically healthy overweight/obese adults with major adverse cardiovascular events (MACE) and the effect of LDL-cholesterol levels on this association. This study was conducted with 15,904 participants from the URRAH study grouped according to BMI and metabolic status. Healthy metabolic status was identified with and without including LDL-cholesterol. The risk of MACE during 11.8 years of follow-up was evaluated with multivariable Cox regressions. Among the participants aged
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• Serum Uric Acid, Hypertriglyceridemia, and Carotid Plaques: A Sub-Analysis of the URic Acid Right for Heart Health (URRAH) Study.
  Metabolites

  2024 Jun;14(6):. doi: 323.
  
  Agabiti Rosei Claudia, Paini Anna, Buso Giacomo, Maloberti Alessandro, Giannattasio Cristina, Salvetti Massimo, Casiglia Edoardo, Tikhonoff Valerie, Angeli Fabio, Barbagallo Carlo Maria, Bombelli Michele, Cappelli Federica, Cianci Rosario, Ciccarelli Michele, Cicero Arrigo Francesco Giuseppe, Cirillo Massimo, Cirillo Pietro, Dell'Oro Raffaella, D'Elia Lanfranco, Desideri Giovambattista, Ferri Claudio, Galletti Ferruccio, Gesualdo Loreto, Grassi Guido, Iaccarino Guido, Lippa Luciano, Mallamaci Francesca, Masi Stefano, Masulli Maria, Mazza Alberto, Mengozzi Alessandro, Nazzaro Pietro, Palatini Paolo, Parati Gianfranco, Pontremoli Roberto, Quarti-Trevano Fosca, Rattazzi Marcello, Reboldi Gianpaolo, Rivasi Giulia, Russo Elisa, Tocci Giuliano, Ungar Andrea, Verdecchia Paolo, Viazzi Francesca, Volpe Massimo, Virdis Agostino, Muiesan Maria Lorenza, Borghi Claudio,
  
  Abstract
  
  High levels of serum uric acid (SUA) and triglycerides (TG) might promote high-cardiovascular-risk phenotypes, including subclinical atherosclerosis. An interaction between plaques xanthine oxidase (XO) expression, SUA, and HDL-C has been recently postulated. Subjects from the URic acid Right for heArt Health (URRAH) study with carotid ultrasound and without previous cardiovascular diseases (CVD) (n = 6209), followed over 20 years, were included in the analysis. Hypertriglyceridemia (hTG) was defined as TG ? 150 mg/dL. Higher levels of SUA (hSUA) were defined as ?5.6 mg/dL in men and 5.1 mg/dL in women. A carotid plaque was identified in 1742 subjects (28%). SUA and TG predicted carotid plaque (HR 1.09 [1.04-1.27],
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• May Measure Month 2022 in Italy: A Focus on Fixed-dose Combination, Therapeutic Adherence, and Medical Inertia in a Nationwide Survey.
  High Blood Press Cardiovasc Prev

  2024 May;31(3):309-320. doi: 10.1007/s40292-024-00642-4.
  
  Del Pinto Rita, Agabiti Rosei Claudia, Borghi Claudio, Cipollini Franco, Cottone Santina, De Giorgi Giuseppe Antonio, Di Guardo Antonino, Dugnani Maurizio, Fabris Bruno, Giannattasio Cristina, Giacchetti Gilberta, Minuz Pietro, Mulè Giuseppe, Nazzaro Pietro, Parati Gianfranco, Rattazzi Marcello, Saladini Francesca, Salvetti Massimo, Sarzani Riccardo, Savoia Carmine, Tocci Giuliano, Veglio Franco, Volpe Massimo, Vulpis Vito, Baldini Gianluca, Ferri Claudio, Muiesan Maria Lorenza
  
  Abstract
  
  INTRODUCTION:
  Hypertension is the main risk factor for cardiovascular diseases (CVD). Notably, only about half of hypertensive patients manage to achieve the recommended blood pressure (BP) control. Main reasons for the persistence of uncontrolled BP during treatment are lack of compliance on the patients' side, and therapeutic inertia on physicians' side.
  
  METHODS:
  During the global BP screening campaign "May Measure Month" (MMM) (May 1st to July 31st, 2022), a nationwide, cross-sectional, opportunistic study endorsed by the Italian Society of Hypertension was conducted on volunteer adults ? 18 years to raise awareness of the health issues surrounding high BP. A questionnaire on demographic/clinical features and questions on the use of fixed-dose single-pills for the treatment of hypertension was administered. BP was measured with standard procedures.
  
  RESULTS:
  A total of 1612 participants (mean age 60.0±15.41 years; 44.7% women) were enrolled. Their mean BP was 128.5±18.1/77.1±10.4 mmHg. About half of participants were sedentary, or overweight/obese, or hypertensive. 55.5% individuals with complete BP assessment had uncontrolled hypertension. Most were not on a fixed-dose combination of antihypertensive drugs and did not regularly measure BP at home. Self-reported adherence to BP medications was similar between individuals with controlled and uncontrolled BP (95% vs 95.5%).
  
  CONCLUSIONS:
  This survey identified a remarkable degree of therapeutic inertia and poor patients' involvement in the therapeutic process and its monitoring in the examined population, underlining the importance of prevention campaigns to identify areas of unsatisfactory management of hypertension, to increase risk factors' awareness in the population with the final purpose of reducing cardiovascular risk.
  
  © 2024. The Author(s).
  
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• Contemporary Advances in Cardiac Remote Monitoring: A Comprehensive, Updated Mini-Review.
  Medicina (Kaunas)

  2024 May;60(5):. doi: 819.
  
  Preda Alberto, Falco Raffaele, Tognola Chiara, Carbonaro Marco, Vargiu Sara, Gallazzi Michela, Baroni Matteo, Gigli Lorenzo, Varrenti Marisa, Colombo Giulia, Zanotto Gabriele, Giannattasio Cristina, Mazzone Patrizio, Guarracini Fabrizio
  
  Abstract
  
  Over the past decade, remote monitoring (RM) has become an increasingly popular way to improve healthcare and health outcomes. Modern cardiac implantable electronic devices (CIEDs) are capable of recording an increasing amount of data related to CIED function, arrhythmias, physiological status and hemodynamic parameters, providing in-depth and updated information on patient cardiovascular function. The extensive use of RM for patients with CIED allows for early diagnosis and rapid assessment of relevant issues, both clinical and technical, as well as replacing outpatient follow-up improving overall management without compromise safety. This approach is recommended by current guidelines for all eligible patients affected by different chronic cardiac conditions including either brady- and tachy-arrhythmias and heart failure. Beyond to clinical advantages, RM has demonstrated cost-effectiveness and is associated with elevated levels of patient satisfaction. Future perspectives include improving security, interoperability and diagnostic power as well as to engage patients with digital health technology. This review aims to update existing data concerning clinical outcomes in patients managed with RM in the wide spectrum of cardiac arrhythmias and Hear Failure (HF), disclosing also about safety, effectiveness, patient satisfaction and cost-saving.
  
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• Prevalence, Clustering, and Current Management of Cardiovascular Risk Factors Upon First Referral to Hypertension Specialists: the APPROACH Study.
  High Blood Press Cardiovasc Prev

  2024 Jul;31(4):369-379. doi: 10.1007/s40292-024-00650-4.
  
  Del Pinto Rita, Agabiti Rosei Claudia, Di Guardo Antonino, Giannattasio Cristina, Izzo Raffaele, Mazza Alberto, Pucci Giacomo, Sarzani Riccardo, Tocci Giuliano, Veglio Franco, Volpe Massimo, Grassi Guido, Muiesan Maria Lorenza, Ferri Claudio
  
  Abstract
  
  INTRODUCTION:
  Several observational studies have been conducted to assess the prevalence of cardiovascular risk factors in hypertensive patients; however, none has yet investigated prevalence, clustering, and current management of cardiovascular risk factors upon first referral to hypertension specialists, which is the aim of the present study.
  
  METHODS:
  Consecutive adult outpatients with essential/secondary hypertension were included at the time of their first referral to hypertension specialists at 13 Italian centers in the period April 2022-2023 if they had at least one additional major cardiovascular risk factor among LDL-hypercholesterolemia, type 2 diabetes, and cigarette smoking. Prevalence, degree of control, and current management strategies of cardiovascular risk factors were assessed.
  
  RESULTS:
  A total of 255 individuals were included, 40.2% women and 98.4% Caucasian. Mean age was 60.3±13.3 years and mean blood pressure [BP] was 140.3±17.9/84.8±12.3 mmHg). Most participants were smokers (55.3%), had a sedentary lifestyle (75.7%), suffered from overweight/obesity (51%) or high LDL-cholesterol (41.6%), had never adopted strategies to lose weight (55.7%), and were not on a low-salt diet (57.4%). Only a minority of patients reported receiving specialist counseling, and 27.9% had never received recommendations to correct unhealthy lifestyle habits. Nearly 90% of individuals with an estimated high/very high cardiovascular risk profile did not achieve recommended LDL-cholesterol targets.
  
  CONCLUSIONS:
  In patients with hypertension, both pharmacological and lifestyle therapeutic advice are yet to improve before referral to hypertension specialists. This should be considered in the primary care setting in order to optimize cardiovascular risk management strategies.
  
  © 2024. The Author(s).
  
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• Cardiovascular Structural and Functional Parameters in Idiopathic Pulmonary Fibrosis at Disease Diagnosis.
  High Blood Press Cardiovasc Prev

  2024 May;31(3):289-297. doi: 10.1007/s40292-024-00638-0.
  
  Faverio Paola, Maloberti Alessandro, Rebora Paola, Intravaia Rita Cristina Myriam, Tognola Chiara, Toscani Giorgio, Amato Anna, Leoni Valerio, Franco Giovanni, Vitarelli Federica, Spiti Simona, Luppi Fabrizio, Valsecchi Maria Grazia, Pesci Alberto, Giannattasio Cristina
  
  Abstract
  
  INTRODUCTION:
  Prevalence of cardiac and vascular fibrosis in patients with Idiopathic Pulmonary Fibrosis (IPF) has not been extensively evaluated.
  
  AIM:
  In this study, we aimed to evaluate the heart and vessels functional and structural properties in patients with IPF compared to healthy controls. An exploratory analysis regarding disease severity in IPF patients has been done.
  
  METHODS:
  We enrolled 50 patients with IPF (at disease diagnosis before antifibrotic therapy initiation) and 50 controls matched for age and gender. Heart was evaluated through echocardiography and plasmatic NT-pro-brain natriuretic peptide that, together with patients' symptoms, allow to define the presence of Heart Failure (HF) and diastolic dysfunction. Vessels were evaluated through Flow Mediated Dilation (FMD - endothelial function) and Pulse Wave Velocity (PWV-arterial stiffness) RESULTS: Patients with IPF had a prevalence of diastolic disfunction of 83.8%, HF of 37.8% and vascular fibrosis of 76.6%. No statistically significant difference was observed in comparison to the control group who showed prevalence of diastolic disfunction, HF and vascular fibrosis of 67.3%, 24.5% and 84.8%, respectively. Disease severity seems not to affect PWV, FMD, diastolic dysfunction and HF.
  
  CONCLUSIONS:
  Patients with IPF early in the disease course do not present a significant CV fibrotic involvement when compared with age- and sex-matched controls. Bigger and adequately powered studies are needed to confirm our preliminary data and longitudinal studies are required in order to understand the time of appearance and progression rate of heart and vascular involvement in IPF subjects.
  
  © 2024. The Author(s).
  
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• The Therapy and Management of Heart Failure with Preserved Ejection Fraction: New Insights on Treatment.
  Card Fail Rev

  2024 ;10():e05. doi: e05.
  
  Balestrieri Giulio, Limonta Raul, Ponti Enrico, Merlo Anna, Sciatti Edoardo, D'Isa Salvatore, Gori Mauro, Casu Gavino, Giannattasio Cristina, Senni Michele, D'Elia Emilia
  
  Abstract
  
  Heart failure with preserved ejection fraction (HFpEF) is a clinical syndrome characterised by the presence of diastolic dysfunction and elevated left ventricular filling pressure, in the setting of a left ventricular ejection fraction of at least 50%. Despite the epidemiological prevalence of HFpEF, a prompt diagnosis is challenging and many uncertainties exist. HFpEF is characterised by different phenotypes driven by various cardiac and non-cardiac comorbidities. This is probably the reason why several HFpEF clinical trials in the past did not reach strong outcomes to recommend a single therapy for this syndrome; however, this paradigm has recently changed, and the unmet clinical need for HFpEF treatment found a proper response as a result of a new class of drug, the sodium-glucose cotransporter 2 inhibitors, which beneficially act through the whole spectrum of left ventricular ejection fraction. The aim of this review was to focus on the therapeutic target of HFpEF, the role of new drugs and the potential role of new devices to manage the syndrome.
  
  Copyright © The Author(s), 2024. Published by Radcliffe Group Ltd.
  
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• Naphazoline abuse: a rare case of myocardial infarction with nonobstructive coronary arteries.
  J Cardiovasc Med (Hagerstown)

  2024 May;25(5):391-393. doi: 10.2459/JCM.0000000000001604.
  
  Galasso Michele, Cavallotti Cristina, Giannattasio Cristina, Pedrotti Patrizia
  
  
  
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• Serum Uric Acid/Serum Creatinine Ratio and Cardiovascular Mortality in Diabetic Individuals-The Uric Acid Right for Heart Health (URRAH) Project.
  Metabolites

  2024 Mar;14(3):. doi: 164.
  
  D'Elia Lanfranco, Masulli Maria, Cirillo Pietro, Virdis Agostino, Casiglia Edoardo, Tikhonoff Valerie, Angeli Fabio, Barbagallo Carlo Maria, Bombelli Michele, Cappelli Federica, Cianci Rosario, Ciccarelli Michele, Cicero Arrigo F G, Cirillo Massimo, Dell'Oro Raffaella, Desideri Giovambattista, Ferri Claudio, Gesualdo Loreto, Giannattasio Cristina, Grassi Guido, Iaccarino Guido, Lippa Luciano, Mallamaci Francesca, Maloberti Alessandro, Masi Stefano, Mazza Alberto, Mengozzi Alessandro, Muiesan Maria Lorenza, Nazzaro Pietro, Palatini Paolo, Parati Gianfranco, Pontremoli Roberto, Quarti-Trevano Fosca, Rattazzi Marcello, Reboldi Gianpaolo, Rivasi Giulia, Russo Elisa, Salvetti Massimo, Tocci Giuliano, Ungar Andrea, Verdecchia Paolo, Viazzi Francesca, Volpe Massimo, Borghi Claudio, Galletti Ferruccio,
  
  Abstract
  
  Several studies have detected a direct association between serum uric acid (SUA) and cardiovascular (CV) risk. In consideration that SUA largely depends on kidney function, some studies explored the role of the serum creatinine (sCr)-normalized SUA (SUA/sCr) ratio in different settings. Previously, the URRAH (URic acid Right for heArt Health) Study has identified a cut-off value of this index to predict CV mortality at 5.35 Units. Therefore, given that no SUA/sCr ratio threshold for CV risk has been identified for patients with diabetes, we aimed to assess the relationship between this index and CV mortality and to validate this threshold in the URRAH subpopulation with diabetes; the URRAH participants with diabetes were studied ( = 2230). The risk of CV mortality was evaluated by the Kaplan-Meier estimator and Cox multivariate analysis. During a median follow-up of 9.2 years, 380 CV deaths occurred. A non-linear inverse association between baseline SUA/sCr ratio and risk of CV mortality was detected. In the whole sample, SUA/sCr ratio > 5.35 Units was not a significant predictor of CV mortality in diabetic patients. However, after stratification by kidney function, values > 5.35 Units were associated with a significantly higher mortality rate only in normal kidney function, while, in participants with overt kidney dysfunction, values of SUA/sCr ratio > 7.50 Units were associated with higher CV mortality. The SUA/sCr ratio threshold, previously proposed by the URRAH Study Group, is predictive of an increased risk of CV mortality in people with diabetes and preserved kidney function. While, in consideration of the strong association among kidney function, SUA, and CV mortality, a different cut-point was detected for diabetics with impaired kidney function. These data highlight the different predictive roles of SUA (and its interaction with kidney function) in CV risk, pointing out the difference in metabolic- and kidney-dependent SUA levels also in diabetic individuals.
  
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• Triglyceride-glucose Index and Mortality in a Large Regional-based Italian Database (Urrah Project).
  J Clin Endocrinol Metab

  2024 Mar;():. doi: dgae170.
  
  D'Elia Lanfranco, Masulli Maria, Virdis Agostino, Casiglia Edoardo, Tikhonoff Valerie, Angeli Fabio, Barbagallo Carlo Maria, Bombelli Michele, Cappelli Federica, Cianci Rosario, Ciccarelli Michele, Cicero Arrigo F G, Cirillo Massimo, Cirillo Pietro, Dell'Oro Raffaella, Desideri Giovambattista, Ferri Claudio, Gesualdo Loreto, Giannattasio Cristina, Grassi Guido, Iaccarino Guido, Lippa Luciano, Mallamaci Francesca, Maloberti Alessandro, Masi Stefano, Mazza Alberto, Mengozzi Alessandro, Muiesan Maria Lorenza, Nazzaro Pietro, Palatini Paolo, Parati Gianfranco, Pontremoli Roberto, Quarti-Trevano Fosca, Rattazzi Marcello, Reboldi Gianpaolo, Rivasi Giulia, Russo Elisa, Salvetti Massimo, Tocci Giuliano, Ungar Andrea, Verdecchia Paolo, Viazzi Francesca, Volpe Massimo, Borghi Claudio, Galletti Ferruccio
  
  Abstract
  
  PURPOSE:
  Recently, a novel index (triglyceride-glucose index-TyG) was considered a surrogate marker of insulin resistance (IR); in addition, it was estimated to be a better expression of IR than widely used tools. Few and heterogeneous data are available on the relationship between this index and mortality risk in non-Asian populations. Therefore, we estimated the predictive role of baseline TyG on the incidence of all-cause and cardiovascular (CV) mortality in a large sample of the general population. Moreover, in consideration of the well-recognized role of serum uric acid (SUA) on CV risk and the close correlation between SUA and IR, we also evaluated the combined effect of TyG and SUA on mortality risk.
  
  METHODS:
  The analysis included 16,649 participants from the URRAH cohort. The risk of all-cause and CV mortality was evaluated by the Kaplan-Meier estimator and Cox multivariate analysis.
  
  RESULTS:
  During a median follow-up of 144 months, 2569 deaths occurred. We stratified the sample by the optimal cut-off point for all-cause (4.62) and CV mortality (4.53). In the multivariate Cox regression analyses, participants with TyG above cut-off had a significantly higher risk of all-cause and CV mortality, than those with TyG below the cut-off. Moreover, the simultaneous presence of high levels of TyG and SUA was associated with a higher mortality risk than none or only one of the two factors.
  
  CONCLUSIONS:
  The results of this study indicate that these TyG (a low-cost and simple non-invasive marker) thresholds are predictive of an increased risk of mortality in a large and homogeneous general population. In addition, these results show a synergic effect of TyG and SUA on the risk of mortality.
  
  © The Author(s) 2024. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site?for further information please contact journals.permissions@oup.com.
  
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• Neurological hypertensive emergencies: Correlation of blood pressure values with in-hospital outcomes in ischemic stroke.
  Eur J Intern Med

  2024 Jun;124():61-68. doi: 10.1016/j.ejim.2024.01.029.
  
  Giani Valentina, Valobra Tommaso, Capsoni Nicolò, Galasso Michele, De Censi Lorenzo, Ferretti Cecilia, Sultana Andrea, Giacalone Annalisa, Garofani Ilaria, Bombelli Michele, Ceresa Chiara, Gheda Silvia, Agostoni Elio Clemente, Galbiati Filippo, Giannattasio Cristina, Maloberti Alessandro
  
  Abstract
  
  BACKGROUND:
  Few certainties exist regarding optimal management of Blood Pressure (BP) in the very first hours after an ischemic stroke and many questions remain still unanswered. Our work aimed to evaluate the role of BP and its trend as possible determinants of in-hospital mortality (primary outcome), discharge disabilities and hospitalization length (secondary outcomes) in ischemic stroke patients presented with Hypertensive Emergencies (HE).
  
  METHODS:
  We retrospectively evaluated patients presented to Niguarda Hospital, Emergency Department (ED), from 2015 to 2017 with a neurological ischemic HE. BP at ED presentation (T0), its management in ED (T1) and its values at the stroke unit admission (T2) were evaluated.
  
  RESULTS:
  267 patients were included (0.13 % of all ED accesses and 17.9 % of all ischemic strokes). In the whole population, BP values were not associated with in-hospital mortality while T0 and T2 SBP result were associated to discharge disability and hospitalization length. In pre-specified subgroup analysis these associations were confirmed only in untreated subjects (not anti-hypertensive nor thrombolysis). In fact, no significant relationship can be found between BP values and any secondary outcome in thrombolysis and anti-hypertensive treated patients.
  
  CONCLUSIONS:
  BP values and its management can not be related to in-hospital mortality in stroke patients, presented with HE, while they are associated to discharge disability and hospitalization length. In subgroup analysis, results were confirmed only in untreated (not anti-hypertensive therapies nor thrombolytic).
  
  Copyright © 2024 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
  
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• Prognostic Value and Relative Cutoffs of Triglycerides Predicting Cardiovascular Outcome in a Large Regional-Based Italian Database.
  J Am Heart Assoc

  2024 Feb;13(3):e030319. doi: e030319.
  
  Tikhonoff Valérie, Casiglia Edoardo, Virdis Agostino, Grassi Guido, Angeli Fabio, Arca Marcello, Barbagallo Carlo M, Bombelli Michele, Cappelli Federica, Cianci Rosario, Cicero Arrigo F G, Cirillo Massimo, Cirillo Pietro, Dell'oro Raffaella, D'elia Lanfranco, Desideri Giovambattista, Ferri Claudio, Galletti Ferruccio, Gesualdo Loreto, Giannattasio Cristina, Iaccarino Guido, Mallamaci Francesca, Maloberti Alessandro, Masi Stefano, Masulli Maria, Mazza Alberto, Mengozzi Alessandro, Muiesan Maria Lorenza, Nazzaro Pietro, Palatini Paolo, Parati Gianfranco, Pontremoli Roberto, Quarti-Trevano Fosca, Rattazzi Marcello, Reboldi Gianpaolo, Rivasi Giulia, Russo Elisa, Salvetti Massimo, Temporelli Pier Luigi, Tocci Giuliano, Ungar Andrea, Verdecchia Paolo, Viazzi Francesca, Volpe Massimo, Borghi Claudio
  
  Abstract
  
  BACKGROUND:
  Despite longstanding epidemiologic data on the association between increased serum triglycerides and cardiovascular events, the exact level at which risk begins to rise is unclear. The Working Group on Uric Acid and Cardiovascular Risk of the Italian Society of Hypertension has conceived a protocol aimed at searching for the prognostic cutoff value of triglycerides in predicting cardiovascular events in a large regional-based Italian cohort.
  
  METHODS AND RESULTS:
  Among 14?189 subjects aged 18 to 95?years followed-up for 11.2 (5.3-13.2) years, the prognostic cutoff value of triglycerides, able to discriminate combined cardiovascular events, was identified by means of receiver operating characteristic curve. The conventional (150?mg/dL) and the prognostic cutoff values of triglycerides were used as independent predictors in separate multivariable Cox regression models adjusted for age, sex, body mass index, total and high-density lipoprotein cholesterol, serum uric acid, arterial hypertension, diabetes, chronic renal disease, smoking habit, and use of antihypertensive and lipid-lowering drugs. During 139?375 person-years of follow-up, 1601 participants experienced cardiovascular events. Receiver operating characteristic curve showed that 89?mg/dL (95% CI, 75.8-103.3, sensitivity 76.6, specificity 34.1,
  CONCLUSIONS:
  Lower (89?mg/dL) than conventional (150?mg/dL) prognostic cutoff value of triglycerides for cardiovascular events does exist and is associated with increased cardiovascular risk in an Italian cohort.
  
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• Secondary Prevention and Extreme Cardiovascular Risk Evaluation (SEVERE-1), Focus on Prevalence and Associated Risk Factors: The Study Protocol.
  High Blood Press Cardiovasc Prev

  2023 Nov;30(6):573-583. doi: 10.1007/s40292-023-00607-z.
  
  Maloberti Alessandro, Intravaia Rita Cristina Myriam, Mancusi Costantino, Cesaro Arturo, Golia Enrica, Ilaria Fucile, Coletta Silvio, Merlini Piera, De Chiara Benedetta, Bernasconi Davide, Algeri Michela, Ossola Paolo, Ciampi Claudio, Riccio Alfonso, Tognola Chiara, Ardissino Maddalena, Inglese Elvira, Scaglione Francesco, Calabrò Paolo, De Luca Nicola, Giannattasio Cristina
  
  Abstract
  
  INTRODUCTION:
  Despite significant improvement in secondary CardioVascular (CV) preventive strategies, some acute and chronic coronary syndrome (ACS and CCS) patients will suffer recurrent events (also called "extreme CV risk"). Recently new biochemical markers, such as uric acid (UA), lipoprotein A [Lp(a)] and several markers of inflammation, have been described to be associated with CV events recurrence. The SEcondary preVention and Extreme cardiovascular Risk Evaluation (SEVERE-1) study will accurately characterize extreme CV risk patients enrolled in cardiac rehabilitation (CR) programs.
  
  AIM:
   Our aims will be to describe the prevalence of extreme CV risk and its association with newly described biochemical CV risk factors.
  
  AIM:
  Our aims will be to describe the prevalence of extreme CV risk and its association with newly described biochemical CV risk factors.
  
  METHODS:
  We will prospectively enrol 730 ACS/CCS patients at the beginning of a CR program. Extreme CV risk will be retrospectively defined as the presence of a previous (within 2 years) CV events in the patients' clinical history. UA, Lp(a) and inflammatory markers (interleukin-6 and -18, tumor necrosis factor alpha, C-reactive protein, calprotectin and osteoprotegerin) will be assessed in ACS/CCS patients with extreme CV risk and compared with those without extreme CV risk but also with two control groups: 1180 hypertensives and 765 healthy subjects. The association between these biomarkers and extreme CV risk will be assessed with a multivariable model and two scoring systems will be created for an accurate identification of extreme CV risk patients. The first one will use only clinical variables while the second one will introduce the biochemical markers. Finally, by exome sequencing we will both evaluate polygenic risk score ability to predict recurrent events and perform mendellian randomization analysis on CV biomarkers.
  
  CONCLUSIONS:
  Our study proposal was granted by the European Union PNRR M6/C2 call. With this study we will give definitive data on extreme CV risk prevalence rising attention on this condition and leading cardiologist to do a better diagnosis and to carry out a more intensive treatment optimization that will finally leads to a reduction of future ACS recurrence. This will be even more important for cardiologists working in CR that is a very important place for CV risk definition and therapies refinement.
  
  © 2023. The Author(s).
  
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• [Persistent ST-elevation with elevated myocardial necrosis markers: a case of myocardial contusion].
  G Ital Cardiol (Rome)

  2023 Nov;24(11):911-914. doi: 10.1714/4129.41233.
  
  Stucchi Miriam, Galasso Michele, De Censi Lorenzo, Cirò Antonio, Pedrotti Patrizia, Giannattasio Cristina
  
  Abstract
  
  Myocardial contusion is a rare and potentially fatal complication of chest trauma. There is no unique definition for this entity: some authors define myocardial contusion as a mild increase in cardiac biomarkers in the context of chest trauma, while for others the diagnosis requires evidence of pathologic findings at cardiac imaging. Consequently, the real incidence of myocardial contusion remains unknown, varying in reports between 8% and 71%. We describe a case of cardiac contusion secondary to a low-energy blunt chest trauma, manifesting as persistent ST-elevation associated with elevation of myocardial necrosis markers, with consequent myocardial stunning of the right ventricular free wall. As there is no consensus regarding the diagnostic pathway, it is essential to integrate first-level exams (ECG and laboratory findings) with cardiac magnetic resonance imaging, to define the presence of cardiac contusion and its extent, particularly if the echocardiographic data are unconclusive.
  
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• The Results of the URRAH (Uric Acid Right for Heart Health) Project: A Focus on Hyperuricemia in Relation to Cardiovascular and Kidney Disease and its Role in Metabolic Dysregulation.
  High Blood Press Cardiovasc Prev

  2023 Sep;30(5):411-425. doi: 10.1007/s40292-023-00602-4.
  
  Maloberti Alessandro, Mengozzi Alessandro, Russo Elisa, Cicero Arrigo Francesco Giuseppe, Angeli Fabio, Agabiti Rosei Enrico, Barbagallo Carlo Maria, Bernardino Bruno, Bombelli Michele, Cappelli Federica, Casiglia Edoardo, Cianci Rosario, Ciccarelli Michele, Cirillo Massimo, Cirillo Pietro, Desideri Giovambattista, D'Elia Lanfranco, Dell'Oro Raffaella, Facchetti Rita, Ferri Claudio, Galletti Ferruccio, Giannattasio Cristina, Gesualdo Loreto, Iaccarino Guido, Lippa Luciano, Mallamaci Francesca, Masi Stefano, Masulli Maria, Mazza Alberto, Muiesan Maria Lorenza, Nazzaro Pietro, Parati Gianfranco, Palatini Paolo, Pauletto Paolo, Pontremoli Roberto, Pugliese Nicola Riccardo, Quarti-Trevano Fosca, Rattazzi Marcello, Reboldi Gianpaolo, Rivasi Giulia, Salvetti Massimo, Tikhonoff Valerie, Tocci Giuliano, Ungar Andrea, Verdecchia Paolo, Viazzi Francesca, Volpe Massimo, Virdis Agostino, Grassi Guido, Borghi Claudio,
  
  Abstract
  
  The relationship between Serum Uric Acid (UA) and Cardiovascular (CV) diseases has already been extensively evaluated, and it was found to be an independent predictor of all-cause and cardiovascular mortality but also acute coronary syndrome, stroke and heart failure. Similarly, also many papers have been published on the association between UA and kidney function, while less is known on the role of UA in metabolic derangement and, particularly, in metabolic syndrome. Despite the substantial number of publications on the topic, there are still some elements of doubt: (1) the better cut-off to be used to refine CV risk (also called CV cut-off); (2) the needing for a correction of UA values for kidney function; and (3) the better definition of its role in metabolic syndrome: is UA simply a marker, a bystander or a key pathological element of metabolic dysregulation?. The Uric acid Right for heArt Health (URRAH) project was designed by the Working Group on uric acid and CV risk of the Italian Society of Hypertension to answer the first question. After the first papers that individuates specific cut-off for different CV disease, subsequent articles have been published responding to the other relevant questions. This review will summarise most of the results obtained so far from the URRAH research project.
  
  © 2023. The Author(s).
  
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• Effectiveness and Safety of Remdesivir in Treating Hospitalised Patients with COVID-19: A Propensity Score Analysis of Real-Life Data from a Monocentric Observational Study in Times of Health Emergency.
  Clin Drug Investig

  2023 Oct;43(10):763-771. doi: 10.1007/s40261-023-01304-4.
  
  Ughi Nicola, Bernasconi Davide Paolo, Del Gaudio Francesca, Dicuonzo Armanda, Maloberti Alessandro, Giannattasio Cristina, Tarsia Paolo, Travi Giovanna, Scaglione Francesco, Colombo Fabrizio, Bertuzzi Michaela, Adinolfi Antonella, Valsecchi Maria Grazia, Rossetti Claudio, Epis Oscar Massimiliano,
  
  Abstract
  
  BACKGROUND AND OBJECTIVES:
  Remdesivir is an antiviral agent, which was shown to be safe and effective in treating early COVID-19, but its favourable impact in hospitalised patients with non-critical disease is still under investigation. The present study aimed to assess the effectiveness and safety of remdesivir as a treatment for hospitalised patients with COVID-19 by a propensity score analysis of observational data.
  
  METHODS:
  In this monocentric retrospective cohort study, the effectiveness and safety of a 5-day course of remdesivir (200 mg intravenously at Day 1, then 100 mg from Days 2-5) in association with the standard of care were assessed in comparison with the standard of care only. The primary endpoint was the proportion of recovery on Day 14.
  
  RESULTS:
  Of 3662 eligible inpatients who tested positive for the severe acute respiratory syndrome coronavirus 2 genome by nasopharyngeal swab at admission, 861 (24%) non-critical patients were included in a propensity score analysis and 281 (33%) were exposed to remdesivir. In total, 242/281 (86.1%) and 435/580 (75.0%) patients recovered in exposed and non-exposed, respectively, with a relative improvement of 11.1% (95% CI + 5.8 to 16.5%; unadjusted odds ratio: 2.07, 95% CI 1.40-3.05, p = 0.0001; after adjustment by propensity score weighting, odds ratio: 1.92, 95% CI 1.30-2.83, p = 0.001). In treated patients, 1 (0.03%) anaphylactic reaction and 1 (0.03%) acute reaction during drug injection were reported, and 24 (8.5%) patients stopped the treatment due to adverse reactions. No significant differences were found with respect to the secondary efficacy endpoints (in-hospital all-cause death, need for intensive care treatments, clinical improvement score at Day 28) and safety endpoints (any and serious adverse reactions).
  
  CONCLUSION:
  A 5-day course of remdesivir in association with the standard of care effectively promoted recovery from COVID-19 among non-critical in-hospital patients and had an acceptable safety profile.
  
  © 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.
  
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• Natural history and clinical burden of moderate aortic stenosis: a systematic review and explorative meta-analysis.
  J Cardiovasc Med (Hagerstown)

  2023 Sep;24(9):659-665. doi: 10.2459/JCM.0000000000001490.
  
  Morelli Martina, Galasso Michele, Esposito Giuseppe, Soriano Francesco Stefano, Nava Stefano, Da Pozzo Caterina, Bossi Irene, Piccaluga Emanuela, Bruschi Giuseppe, Maloberti Alessandro, Oliva Fabrizio, Oreglia Jacopo Andrea, Giannattasio Cristina, Montalto Claudio
  
  Abstract
  
  AIMS:
  The mortality risk of patients with moderate aortic stenosis is not well known, but recent studies suggested that it might negatively affect prognosis. We aimed to assess the natural history and clinical burden of moderate aortic stenosis and to investigate the interaction of patients' baseline characteristics with prognosis.
  
  METHODS:
  Systematic research was conducted on PubMed. The inclusion criteria were inclusion of patients with moderate aortic stenosis; and report of the survival at 1-year follow-up (minimum). Incidence ratios related to all-cause mortality in patients and controls of each study were estimated and then pooled using a fixed effects model. All patients with mild aortic stenosis or without aortic stenosis were considered controls. Meta-regression analysis was performed to assess the impact of left ventricular ejection fraction and age on the prognosis of patients with moderate aortic stenosis.
  
  RESULTS:
  Fifteen studies and 11?596 patients with moderate aortic stenosis were included. All-cause mortality was significantly higher among patients with moderate aortic stenosis than in controls in all timeframes analysed (all P ?0.0001). Left ventricular ejection fraction and sex did not significantly impact on the prognosis of patients with moderate aortic stenosis ( P ?=?0.4584 and P ?=?0.5792), while increasing age showed a significant interaction with mortality (estimate = 0.0067; 95% confidence interval: 0.0007-0.0127; P ?=?0.0323).
  
  CONCLUSION:
  Moderate aortic stenosis is associated with reduced survival. Further studies are necessary to confirm the prognostic impact of this valvulopathy and the possible benefit of aortic valve replacement.
  
  Copyright © 2023 Italian Federation of Cardiology - I.F.C. All rights reserved.
  
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• Elevated Serum Urea-to-Creatinine Ratio and In-Hospital Death in Patients with Hyponatremia Hospitalized for COVID-19.
  Biomedicines

  2023 May;11(6):. doi: 1555.
  
  Regolisti Giuseppe, Rebora Paola, Occhino Giuseppe, Lieti Giulia, Molon Giulio, Maloberti Alessandro, Algeri Michela, Giannattasio Cristina, Valsecchi Maria Grazia, Genovesi Simonetta
  
  Abstract
  
  Hyponatremia is associated with adverse outcomes in hospitalized patients. An elevated value of the serum urea-to-creatinine ratio (UCR) has been proposed as a proxy of hypovolemia. The aim of this study was to investigate the relationship between the UCR and in-hospital death in patients hospitalized with COVID-19 and hyponatremia. We studied 258 patients admitted for COVID-19 between January 2020 and May 2021 with serum sodium at 40 at baseline, a > 10 mmol/L increase in serum sodium values within the first week of hospitalization was associated with higher odds of in-hospital death (OR = 2.93, 95% CI: 1.03-8.36, = 0.044) compared to patients who experienced a 10 mmol/L increase in serum sodium within the first week of hospital stays may further worsen the in-hospital prognosis.
  
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• Uric acid significantly correlates with the presence of low-voltage areas at the endocardial mapping in patients with non-valvular atrial fibrillation.
  Nutr Metab Cardiovasc Dis

  2023 Jul;33(7):1323-1329. doi: 10.1016/j.numecd.2023.05.002.
  
  Baroni Matteo, Fortuna Matteo, Maloberti Alessandro, Leidi Filippo, Ciampi Claudio Mario, Carbonaro Marco, Testoni Alessio, Vargiu Sara, Varrenti Marisa, Paolucci Marco, Gigli Lorenzo, Giannattasio Cristina, Mazzone Patrizio
  
  Abstract
  
  BACKGROUND AND AIMS:
  Interest in the role of atrial substrate in maintaining Atrial Fibrillation (AF) is growing. Fibrosis is the culprit in the electrical derangement of the myocytes. Many cardiovascular risk factors are known to be linked to atrial scarring; among them Uric Acid (UA) is emerging. The purpose of our study is to find whether UA is associated with Left Atrium (LA) with pathological substrate.
  
  METHODS AND RESULTS:
  81 patients who underwent radiofrequency transcatheter ablation for nonvalvular AF at the cardiological department of the Niguarda Hospital were enrolled in an observational, cross-sectional, single-center study. UA levels were analysed before the procedure. High density electroanatomic mapping of the LA was performed and patients were divided according to the presence or not of areas of pathological substrate (bipolar voltage
  CONCLUSIONS:
  In a population of patients who underwent AF ablation, higher UA levels were significantly associated with pathological LA substrate at electro-anatomical mapping.
  
  Copyright © 2023 The Italian Diabetes Society, 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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• Outcome and Morphofunctional Changes on Cardiac Magnetic Resonance in Patients With Acute Myocarditis Following mRNA COVID-19 Vaccination.
  Circ Heart Fail

  2023 Jun;16(6):e010315. doi: 10.1161/CIRCHEARTFAILURE.122.010315.
  
  Ammirati Enrico, Lupi Laura, Palazzini Matteo, Ciabatti Michele, Rossi Valentina A, Gentile Piero, Uribarri Aitor, Vecchio Chiara R, Nassiacos Daniele, Cereda Alberto, Conca Cristina, Tumminello Gabriele, Piriou Nicolas, Lelarge Coline, Pedrotti Patrizia, Stucchi Miriam, Peretto Giovanni, Galasso Michele, Huang Florent, Ianni Umberto, Procopio Antonio, Saponara Gianluigi, Cimaglia Paolo, Tomasoni Daniela, Moroni Francesco, Turco Annalisa, Sala Simone, Di Tano Giuseppe, Bollano Entela, Moro Claudio, Abbate Antonio, Della Bona Roberta, Porto Italo, Carugo Stefano, Campodonico Jeness, Pontone Gianluca, Grosu Aurelia, Bolognese Leonardo, Salamanca Jorge, Diez-Villanueva Pablo, Ozieranski Krzysztof, Tyminska Agata, Sardo Infirri Loren, Bromage Daniel, Cannatà Antonio, Hong Kimberly N, Adamo Marianna, Quattrocchi Giuseppina, Foà Alberto, Potena Luciano, Garascia Andrea, Giannattasio Cristina, Adler Eric D, Sinagra Gianfranco, Ruschitzka Frank, Camici Paolo G, Metra Marco, Pieroni Maurizio
  
  
  
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• Immune checkpoint inhibitor-associated myocarditis: from pathophysiology to rechallenge of therapy - a narrative review.
  Future Cardiol

  2023 Feb;19(2):91-103. doi: 10.2217/fca-2022-0120.
  
  Tedeschi Andrea, Camilli Massimiliano, Ammirati Enrico, Gentile Piero, Palazzini Matteo, Conti Nicolina, Verde Alessandro, Masciocco Gabriella, Foti Grazia, Giannattasio Cristina, Garascia Andrea
  
  Abstract
  
  Even if immune checkpoint inhibitors have revolutionized the landscape of cancer therapy, their use may be complicated by immune-related adverse events. Among these, myocarditis is the most severe complication. The clinical suspicion often arises after clinical symptoms onset and increase in cardiac biomarkers or electrocardiographic manifestations. Echocardiography and cardiac magnetic resonance imaging are recommended for each patient. However, since they may be misleadingly normal, endomyocardial biopsy remains the gold standard for establishing the diagnosis. Until now, treatment has been based on glucocorticoids even if increasing interest has risen in other immunosuppressive agents. Although myocarditis currently imposes immunotherapy discontinuation, case reports have suggested a safety rechallenge in low-grade myocarditis paving the way for further studies to respond to this unmet clinical need.
  
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• Latent change models of lifestyle in acute coronary syndrome patients: Are lifestyle changes associated with resilience changes?
  Health Psychol Open

  2023 ;10(1):20551029231167836. doi: 20551029231167836.
  
  Greco Andrea, Adorni Roberta, De Matteis Chiara, D'Addario Marco, Fattirolli Francesco, Franzelli Cristina, Giannattasio Cristina, Luyckx Koen, Steca Patrizia
  
  Abstract
  
  This study aimed to examine the role of resilience resources in patients' lifestyle changes after the first Acute Coronary event. 275 Italian patients (84.0% men; mean age = 57.5, SD = 7.9) participated in a longitudinal study. Resilience resources (Self-esteem, Dispositional Optimism, Sense of Coherence - SOC, General and Disease-specific Self-efficacy), and lifestyles (diet, physical activity, and smoking) were assessed twice (at baseline and after 6 months). Path analysis using latent change models was performed to model the combined effect of levels and changes of the resilience resources over lifestyle changes. Patients with strong SOC at baseline were less prone to smoke and more prone to decrease smoking; enhancement in SOC was associated with a smoking decrease. High Disease-specific Self-efficacy at baseline was associated with an improvement in all lifestyles; enhancement in Disease-specific Self-efficacy predicted an increase in physical activity. Findings underline the need to design psychological interventions that promote patients' Disease-specific Self-efficacy and SOC.
  
  © The Author(s) 2023.
  
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• Serum Uric Acid Predicts All-Cause and Cardiovascular Mortality Independently of Hypertriglyceridemia in Cardiometabolic Patients without Established CV Disease: A Sub-Analysis of the URic acid Right for heArt Health (URRAH) Study.
  Metabolites

  2023 Feb;13(2):. doi: 244.
  
  Mengozzi Alessandro, Pugliese Nicola Riccardo, Desideri Giovambattista, Masi Stefano, Angeli Fabio, Barbagallo Carlo Maria, Bombelli Michele, Cappelli Federica, Casiglia Edoardo, Cianci Rosario, Ciccarelli Michele, Cicero Arrigo F G, Cirillo Massimo, Cirillo Pietro, Dell'Oro Raffaella, D'Elia Lanfranco, Ferri Claudio, Galletti Ferruccio, Gesualdo Loreto, Giannattasio Cristina, Grassi Guido, Iaccarino Guido, Lippa Luciano, Mallamaci Francesca, Maloberti Alessandro, Masulli Maria, Mazza Alberto, Muiesan Maria Lorenza, Nazzaro Pietro, Palatini Paolo, Parati Gianfranco, Pontremoli Roberto, Quarti-Trevano Fosca, Rattazzi Marcello, Reboldi Gianpaolo, Rivasi Giulia, Russo Elisa, Salvetti Massimo, Tikhonoff Valerie, Tocci Giuliano, Ungar Andrea, Verdecchia Paolo, Viazzi Francesca, Volpe Massimo, Borghi Claudio, Virdis Agostino,
  
  Abstract
  
  High serum uric acid (SUA) and triglyceride (TG) levels might promote high-cardiovascular risk phenotypes across the cardiometabolic spectrum. However, SUA predictive power in the presence of normal and high TG levels has never been investigated. We included 8124 patients from the URic acid Right for heArt Health (URRAH) study cohort who were followed for over 20 years and had no established cardiovascular disease or uncontrolled metabolic disease. All-cause mortality (ACM) and cardiovascular mortality (CVM) were explored by the Kaplan-Meier estimator and Cox multivariable regression, adopting recently defined SUA cut-offs for ACM (?4.7 mg/dL) and CVM (?5.6 mg/dL). Exploratory analysis across cardiometabolic subgroups and a sensitivity analysis using SUA/serum creatinine were performed as validation. SUA predicted ACM (HR 1.25 [1.12-1.40],
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• Hypertensive emergencies and urgencies: a preliminary report of the ongoing Italian multicentric study ERIDANO.
  Hypertens Res

  2023 Jun;46(6):1570-1581. doi: 10.1038/s41440-023-01232-y.
  
  Vallelonga Fabrizio, Cesareo Marco, Menon Leonardo, Leone Dario, Lupia Enrico, Morello Fulvio, Totaro Silvia, Aggiusti Carlo, Salvetti Massimo, Ioverno Antonella, Maloberti Alessandro, Fucile Ilaria, Cipollini Franco, Nesti Nicola, Mancusi Costantino, Pende Aldo, Giannattasio Cristina, Muiesan Maria Lorenza, Milan Alberto
  
  Abstract
  
  Hypertensive urgencies (HU) and hypertensive emergencies (HE) are challenges for the Emergency Department (ED). A prospective multicentre study is ongoing to characterize patients with acute hypertensive disorders, prevalence of subclinical hypertension-mediated organ damage (HMOD), short- and long-term prognosis; this is a preliminary report. Patients admitted to the ED with symptomatic blood pressure (BP) ?180/110?mmHg were enrolled. They were managed by ED personnel according to their clinical presentations. Subsequently they underwent clinical evaluation and subclinical HMOD assessment at a Hypertension Centre within 72?h from enrolment. 122 patients were included in this report. Mean age was 60.7±13.9 years, 52.5% were females. 18 (14.8%) patients were diagnosed with HE, 108 (88.5%) with HU. There were no differences in gender, BMI, and cardiovascular comorbidities between groups. At ED discharge, 66.7% and 93.6% (p?=?0.003) of HE and HU patients, respectively, had BP?180/110?mmHg. After 72?h, 34.4% of patients resulted normotensive; 35.2%, 22.1%, and 8.2% had hypertension grade 1, 2, and 3, respectively. Patients with uncontrolled BP at office evaluation had higher vascular HMOD (49.1 vs. 25.9%, p?=?0.045). Cardiac (60 vs. 34%, p?=?0.049), renal (27.8 vs. 9.6%, p?=?0.010) and cerebral (100 vs. 21%, p?0.001) HMOD was more frequent in HE compared to HU group. HE showed greater cardiac, renal, and cerebral subclinical HMOD, compared to HU. 72-hours BP control is not associated with different HMOD, except for vascular HMOD; therefore, proper comprehensive examination after discharge from the ED could provide added value in cardiovascular risk stratification of such patients. One third of patients with acute blood pressure rise evaluated to the ED resulted normotensive at office evaluation (
  © 2023. The Author(s), under exclusive licence to The Japanese Society of Hypertension.
  
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• Bi-Caval Valve Implantation to Palliate Symptoms in a Case of Massive Tricuspid Regurgitation.
  Cardiovasc Revasc Med

  2023 Aug;53S():S139-S143. doi: 10.1016/j.carrev.2023.01.014.
  
  Galasso Michele, Cartella Iside, Soriano Francesco, Nava Stefano, Tavoletta Pasquale, De Chiara Benedetta, Oliva Fabrizio, Bruschi Giuseppe, Oreglia Jacopo A, Giannattasio Cristina, Mangieri Antonio, Montalto Claudio
  
  Abstract
  
  Severe tricuspid regurgitation is associated with the occurrence of right failure and increased morbidity and mortality. Transcatheter heterotopic bi-caval valve implantation might offer symptom relief in these patients that are often at prohibitive surgical risk.
  
  Copyright © 2023 Elsevier Inc. All rights reserved.
  
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• Hyperuricemia increases the risk of cardiovascular mortality associated with very high HdL-cholesterol level.
  Nutr Metab Cardiovasc Dis

  2023 Feb;33(2):323-330. doi: 10.1016/j.numecd.2022.11.024.
  
  Palatini Paolo, Virdis Agostino, Masi Stefano, Mengozzi Alessandro, Casiglia Edoardo, Tikhonoff Valerie, Cicero Arrigo F G, Ungar Andrea, Parati Gianfranco, Rivasi Giulia, Salvetti Massimo, Barbagallo Carlo M, Bombelli Michele, Dell'Oro Raffaella, Bruno Berardino, Lippa Luciano, D'Elia Lanfranco, Masulli Maria, Verdecchia Paolo, Reboldi Gianpaolo, Angeli Fabio, Mallamaci Francesca, Cirillo Massimo, Rattazzi Marcello, Cirillo Pietro, Gesualdo Loreto, Mazza Alberto, Giannattasio Cristina, Maloberti Alessandro, Volpe Massimo, Tocci Giuliano, Iaccarino Guido, Nazzaro Pietro, Galletti Ferruccio, Ferri Claudio, Desideri Giovambattista, Viazzi Francesca, Pontremoli Roberto, Muiesan Maria Lorenza, Grassi Guido, Borghi Claudio,
  
  Abstract
  
  BACKGROUND AND AIMS:
  Whether the association between very high HDL-cholesterol levels and cardiovascular mortality (CVM) is modulated by some facilitating factors is unclear. Aim of the study was to investigate whether the risk of CVM associated with very high HDL-cholesterol is increased in subjects with hyperuricemia.
  
  METHODS AND RESULTS:
  Multivariable Cox analyses were made in 18,072 participants from the multicentre URRAH study stratified by sex and HDL-cholesterol category. During a median follow-up of 11.4 years there were 1307 cases of CVM. In multivariable Cox models a J-shaped association was found in the whole population, with the highest risk being present in the high HDL-cholesterol group [>80 mg/dL, adjusted hazard ratio (HR), 1.28; 95%CI, 1.02-1.61; p = 0.031)]. However, a sex-specific analysis revealed that this association was present only in women (HR, 1.34; 95%CI, 1.02-1.77; p = 0.034) but not in men. The risk of CVM related to high HDL-cholesterol was much greater in the women with high uric acid (>0.30 mmol/L, HR 1.61; 95%CI, 1.08-2.39) than in those with low uric acid (HR, 1.17; 95%CI, 0.80-1.72, p for interaction = 0.016). In women older than 70 years with hyperuricemia the risk related to high HDL-cholesterol was 1.83 (95%CI, 1.19-2.80, p 
  CONCLUSION:
  Our data indicate that very high HDL-cholesterol levels in women are associated with CVM in a J-shaped fashion. The risk of CVM is increased by concomitant hyperuricemia suggesting that a proinflammatory/oxidative state can enhance the detrimental cardiovascular effects associated with high HDL-cholesterol.
  
  Copyright © 2022 The Italian Diabetes Society, 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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• Lipoprotein(a): Cardiovascular Disease, Aortic Stenosis and New Therapeutic Option.
  Int J Mol Sci

  2022 Dec;24(1):. doi: 170.
  
  Maloberti Alessandro, Fabbri Saverio, Colombo Valentina, Gualini Elena, Monticelli Massimiliano, Daus Francesca, Busti Andrea, Galasso Michele, De Censi Lorenzo, Algeri Michela, Merlini Piera Angelica, Giannattasio Cristina
  
  Abstract
  
  Atherosclerosis is a chronic and progressive inflammatory process beginning early in life with late clinical manifestation. This slow pathological trend underlines the importance to early identify high-risk patients and to treat intensively risk factors to prevent the onset and/or the progression of atherosclerotic lesions. In addition to the common Cardiovascular (CV) risk factors, new markers able to increase the risk of CV disease have been identified. Among them, high levels of Lipoprotein(a)-Lp(a)-lead to very high risk of future CV diseases; this relationship has been well demonstrated in epidemiological, mendelian randomization and genome-wide association studies as well as in meta-analyses. Recently, new aspects have been identified, such as its association with aortic stenosis. Although till recent years it has been considered an unmodifiable risk factor, specific drugs have been developed with a strong efficacy in reducing the circulating levels of Lp(a) and their capacity to reduce subsequent CV events is under testing in ongoing trials. In this paper we will review all these aspects: from the synthesis, clearance and measurement of Lp(a), through the findings that examine its association with CV diseases and aortic stenosis to the new therapeutic options that will be available in the next years.
  
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• Serum uric acid / serum creatinine ratio as a predictor of cardiovascular events. Detection of prognostic cardiovascular cut-off values.
  J Hypertens

  2023 Jan;41(1):180-186. doi: 10.1097/HJH.0000000000003319.
  
  Casiglia Edoardo, Tikhonoff Valérie, Virdis Agostino, Grassi Guido, Angeli Fabio, Barbagallo Carlo M, Bombelli Michele, Cicero Arrigo F G, Cirillo Massimo, Cirillo Pietro, Dell'Oro Raffaella, D'elia Lanfranco, Desideri Giovambattista, Ferri Claudio, Galletti Ferruccio, Gesualdo Loreto, Giannattasio Cristina, Iaccarino Guido, Lippa Luciano, Mallamaci Francesca, Masi Stefano, Maloberti Alessandro, Masulli Maria, Mazza Alberto, Mengozzi Alessandro, Muiesan Maria Lorenza, Nazzaro Pietro, Palatini Paolo, Parati Gianfranco, Pontremoli Roberto, Quarti-Trevano Fosca, Rattazzi Marcello, Reboldi Gianpaolo, Rivasi Giulia, Salvetti Massimo, Tocci Giuliano, Ungar Andrea, Verdecchia Paolo, Viazzi Francesca, Volpe Massimo, Borghi Claudio,
  
  Abstract
  
  OBJECTIVE:
  In the frame of the Uric Acid Right for Heart Health (URRAH) study, a nationwide multicenter study involving adult participants recruited on a regional community basis from all the territory of Italy under the patronage of the Working Group on Uric Acid and Cardiovascular Risk of the Italian Society of Hypertension, we searched for the cut-off values of the ratio between serum uric acid (SUA) and serum creatinine (sCr) able to predict cardiovascular (CV) events.
  
  METHODS:
  Among 20 724 participants followed-up for 126 ± 64?months, after detecting cut-off by the receiver operating characteristic curves, we calculated by Cox models adjusted for confounders having CV events as dependent variable the hazard ratio (HR) of SUA/sCr > cut-off. We also verified if the role of cut-off varied with increasing SUA/sCr.
  
  RESULTS:
  A plausible prognostic cut-off of SUA/sCr was found and was the same in the whole database, in men and in women (>5.35). The HR of SUA/sCr > cut-off was 1.159 (95% confidence interval [CI] 1.092-1.131, P?0.03) in all, 1.161 (95% CI 1.021-1.335, P?0.02) in men, and 1.444 (95% CI 1.012-1.113, P?0.03) in women. In increasing quintiles of SUA/sCr the cut-offs were >3.08, >4.87, >5.35, >6.22 and >7.58, respectively. The HRs significantly increased from the 3rd to the 5th quintile (1.21, 95% CI 1.032-1.467, P?=?0.018; 1.294, 95% CI 1.101-1.521, P?=?0.002; and 1.642, 95% CI 1.405-1.919, P?0.0001; respectively), that is, over 5.35, whereas the 2nd quintile was not significantly different from the 1st (reference).
  
  CONCLUSION:
  Having SUA/sCr >5.35 is an independent CV risk indicator both in men and women. The cut-off is dynamic and significantly increases with increasing SUA/sCr.
  
  Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.
  
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• Microplastic contamination in commercial salt: An issue for their sampling and quantification.
  Food Chem

  2023 Mar;404(Pt B):134682. doi: 10.1016/j.foodchem.2022.134682.
  
  Di Fiore Cristina, Sammartino Maria Pia, Giannattasio Cristina, Avino Pasquale, Visco Giovanni
  
  Abstract
  
  Sea salt can be considered as a vector of microplastics in the human body. In this work, the sea salts collected from three Italian salterns has been solubilized in MilliQ water and filtered to extract microplastics. The visual quantification of microplastics with a stereomicroscope was carried out on the bases of their size, followed by a classification taking into account their physical characteristics. ATR-FTIR and Raman spectroscopy were used to identify the polymeric type of microplastics. Their significant presence has been revealed: 1653 ± 29 microplastics/kg of sea salt. In total, 80.6 % of microplastics have a fiber shape, 18.9 % a fragmented shape and 2.7 % are sphere. The size of microplastics has been analysed, indicating that the most frequent is between 0 and 500 µm. Polypropylene, polyamide and polyethylene were identified as the most frequent types of polymers. This research could be of global relevance given the significant export of Italian salt to foreign countries.
  
  Copyright © 2022 Elsevier Ltd. All rights reserved.
  
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• CMV seroprevalence and coronary CMV-DNA detection in immunocompetent patients with heart diseases.
  Minerva Med

  2023 Jun;114(3):289-299. doi: 10.23736/S0026-4806.22.07778-3.
  
  Cento Valeria, Colagrossi Luna, Bossi Irene, Armenia Daniele, Nava Alice, Piccinelli Enrico, Maloberti Alessandro, Inglese Elvira, Matarazzo Elisa, DI Ruscio Federica, Paba Pierpaolo, Marcuccilli Fabbio, Perrone Marco, Chiricolo Gaetano, Alteri Claudia, Scaglione Francesco, Vismara Chiara, Campisi Daniela A, Fanti Diana, Romeo Francesco, Andreoni Massimo, Oliva Fabrizio, Ceccherini-Silberstein Francesca, Giannattasio Cristina, Perno Carlo F
  
  Abstract
  
  BACKGROUND:
  Acute coronary syndromes (ACS) are a major cause of morbidity and mortality. As cytomegalovirus (CMV) may contribute to cardio-vascular (CV) manifestations, we sought to provide a proof-of-concept for the involvement of coronary and/or systemic CMV-reactivation as a possible ACS trigger.
  
  METHODS:
  We prospectively enrolled consecutive patients undergoing a coronary angiography for ACS (acute-cases, N.=136), or non-ACS reasons (chronic-cases, N.=57). Matched coronary and peripheral blood-samples were processed for quantification of CMV-DNAemia (RT-PCR), CMV-IgG/IgM, and CMV-IgG avidity (ELISA). Peripheral-blood samples from 17 healthy subjects were included as controls.
  
  RESULTS:
  Out of the 193 cases included, 18.1% were aged ?55 years, 92.5% were Central-European, and 100% immunocompetent. CMV-IgG seroprevalence was 91.7% (95%CI: 87.8-95.6), significantly higher than in healthy-controls (52.9% [95%CI: 29.2-76.5]; P
  CONCLUSIONS:
  CMV-IgG seroprevalence was high in patients with heart diseases. CMV-DNAemia can be found, although uncommonly, in coronary circulation during an ACS, with increased prevalence in older subjects and in absence of CV risk-factors, identifying possible areas for novel interventions.
  
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• Endothelial Dysfunction in Patients with Advanced Heart Failure Treated with Levosimendan Periodic Infusion Compared with Optimal Medical Therapy: A Pilot Study.
  Life (Basel)

  2022 Aug;12(9):. doi: 1322.
  
  Maloberti Alessandro, Sun Jinwei, Zannoni Jessica, Occhi Lucia, Bassi Ilaria, Fabbri Saverio, Colombo Valentina, Gualini Elena, Algeri Michela, Varrenti Marisa, Masciocco Gabriella, Perna Enrico, Oliva Fabrizio, Cipriani Manlio, Frigerio Maria, Giannattasio Cristina
  
  Abstract
  
  Endothelial dysfunction (ED) is frequently found in patients with heart failure (HF). Among several pharmacological agents reported to improve endothelial function, levosimendan seems to be a promising one, even though, to date, only two previously published studies have evaluated its effects on ED in these patients. The aim of our pilot study was to further investigate the role of periodic levosimendan infusion on endothelial function in patients affected by advanced HF. In this cross-sectional study, three different groups were enrolled: 20 patients with advanced HF treated with periodic levosimendan (LEVO), 20 patients with HF on optimal medical therapy (OMT), and 20 healthy subjects (control group). ED was evaluated through flow-mediated dilation (FMD) at the level of the brachial artery. The three groups presented similar ages with significant differences in gender distribution, systolic blood pressure, and chronic kidney disease (eGFR
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• Incident Atrial Fibrillation and In-Hospital Mortality in SARS-CoV-2 Patients.
  Biomedicines

  2022 Aug;10(8):. doi: 1940.
  
  Maloberti Alessandro, Giannattasio Cristina, Rebora Paola, Occhino Giuseppe, Ughi Nicola, Biolcati Marco, Gualini Elena, Rizzi Jacopo Giulio, Algeri Michela, Giani Valentina, Rossetti Claudio, Epis Oscar Massimiliano, Molon Giulio, Beltrame Anna, Bonfanti Paolo, Valsecchi Maria Grazia, Genovesi Simonetta
  
  Abstract
  
  (1) Background: Among the different cardiovascular (CV) manifestations of the coronavirus disease 2019 (COVID-19), arrhythmia and atrial fibrillation (AF) in particular have recently received special attention. The aims of our study were to estimate the incidence of AF in patients hospitalized for COVID-19, and to evaluate its role as a possible predictor of in-hospital all-cause mortality. (2) Methods: We enrolled 3435 people with SARS-CoV2 infection admitted to three hospitals in Northern Italy from February 2020 to May 2021. We collected data on their clinical history, laboratory tests, pharmacological treatment and intensive care unit (ICU) admission. Incident AF and all-cause in-hospital mortality were considered as outcomes. (3) Results: 145 (4.2%) patients developed AF during hospitalization, with a median time since admission of 3 days (I-III quartile: 0, 12). Patients with incident AF were admitted more frequently to the ICU (39.3 vs. 12.4%, p
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• Negative prognostic impact of electrolyte disorders in patients hospitalized for Covid-19 in a large multicenter study.
  J Nephrol

  2023 Apr;36(3):621-626. doi: 10.1007/s40620-022-01429-3.
  
  Genovesi Simonetta, Regolisti Giuseppe, Rebora Paola, Occhino Giuseppe, Belli Michele, Molon Giulio, Citerio Giuseppe, Beltrame Anna, Maloberti Alessandro, Generali Elena, Giannattasio Cristina, Epis Oscar Massimiliano, Rossetti Claudio, Bellelli Giuseppe, De Nalda Ana Lleo, Capua Ilaria, Valsecchi Maria Grazia
  
  Abstract
  
  BACKGROUND:
  The prognostic impact of electrolyte disorders in hospitalized COVID-19 patients is unclear.
  
  METHODS:
  The study included all adult patients hospitalized for COVID-19 in four hospitals in Northern Italy between January 2020 and May 2021 with at least one serum potassium and sodium measurement performed within 3 days since admission. Primary outcome was in-hospital death; secondary outcome was Intensive Care Unit (ICU) admission. A cause-specific Cox proportional-hazards regression model was used for investigating the association between potassium and sodium (as either categorical or continuous variables) and mortality or admission to ICU.
  
  RESULTS:
  Analyses included 3,418 adult hospitalized COVID-19 patients. At multivariable analysis, both hyperkalemia (Hazard Ratio, [HR] 1.833, 95% Confidence Interval [CI] 1.371-2.450) and sK above the median (K 5.1 vs 4.1 mmol/L: HR 1.523, 95% CI 1.295-1.798), and hypernatremia (HR 2.313, 95%CI 1.772-3.018) and sNa above the median (Na 149 vs 139 mmol/L: HR 1.442, 95% CI 1.234-1.686), were associated with in-hospital death, whereas hypokalemia and hyponatremia were not. Hyponatremia was associated with increased hazard of ICU admission (HR 1.884, 95%CI 1.389-2.556).
  
  CONCLUSIONS:
  Electrolyte disorders detected at hospital admission may allow early identification of COVID-19 patients at increased risk of adverse outcomes.
  
  © 2022. The Author(s) under exclusive licence to Italian Society of Nephrology.
  
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• A heart of iron: juvenile haemochromatosis presents with cardiac failure.
  Lancet

  2022 Aug;400(10352):616. doi: 10.1016/S0140-6736(22)01285-5.
  
  Cartella Iside, Tavecchia Giovanni A, Quattrocchi Giuseppina, Giannattasio Cristina, Volpato Elisabetta, Palazzini Matteo, Garascia Andrea, Cipriani Manlio, Frigerio Maria, Ammirati Enrico, Pedrotti Patrizia
  
  
  
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• Associations between Lifestyle Changes and Adherence to COVID-19 Restrictions in Older Adults with Hypertension.
  Int J Environ Res Public Health

  2022 Jun;19(13):. doi: 7853.
  
  D'Addario Marco, Adorni Roberta, Steca Patrizia, Capelli Roberto, Zanatta Francesco, Fattirolli Francesco, Franzelli Cristina, Giannattasio Cristina, Greco Andrea
  
  Abstract
  
  COVID-19 has changed people's routines and imposed new ways of living. This study investigated variations in lifestyles (namely, physical activity, diet, alcohol consumption, and cigarette smoking) between the prepandemic and the pandemic period in a sample of older adults with hypertension. Moreover, it investigated predictors of adherence to government restrictions during the first lockdown period, evidencing the role of relevant sociodemographic indicators and lifestyle changes. A sample of 105 older Italian adults (M_age = 70 years; SD = 5.83) with hypertension was enrolled from a previous longitudinal study and interviewed on the phone between May and August 2020. Updated information about sociodemographic indicators and lifestyle changes was collected. Adherence to restrictions was explored through several questions regarding compliance with home confinement, facemask use, and the observance of social distancing. Results evidenced that only 33% of the respondents abided by all the national restrictions. During the first pandemic peak, considerable changes in lifestyles occurred, particularly regarding physical activity, which diminished in 70% of the sample. Women, unemployed/retired people, and individuals who decreased their amount of physical activity reported higher adherence to rules. Maintaining a healthy lifestyle over time is essential for disease prevention. Therefore, it is essential to continue to inform the population about the importance of a healthy lifestyle, and it is necessary to provide guidelines to maintain and promote it even during housebound periods.
  
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• The role of sense of coherence in reducing anxiety and depressive symptoms among patients at the first acute coronary event: A three-year longitudinal study.
  J Psychosom Res

  2022 Sep;160():110974. doi: 10.1016/j.jpsychores.2022.110974.
  
  Greco Andrea, Brugnera Agostino, Adorni Roberta, Tasca Giorgio A, Compare Angelo, Viganò Anna, Fattirolli Francesco, Giannattasio Cristina, D'Addario Marco, Steca Patrizia
  
  Abstract
  
  OBJECTIVE:
  Although several studies suggest an association between psychological distress and increased morbidity and mortality in various cardiac populations, little is known about positive psychological resources, like Sense of Coherence (SOC), that may reduce distress. This longitudinal observational study aimed to test the hypothesis that a strong SOC predicted a longitudinal decrease in anxiety and depression in a sample of patients after their first acute coronary event.
  
  METHODS:
  A sample of 275 patients completed the Hospital Anxiety Depression Scale (HADS) and the SOC Scale at five time-points (at the baseline and after 6, 12, 24, and 36 months). Longitudinal trajectories of anxiety, depression, and SOC were examined through hierarchical (generalized) linear models, controlling for sociodemographic and clinical indicators.
  
  RESULTS:
  38.6% of patients experienced clinically relevant anxiety symptoms soon after the cardiovascular event, whereas only 20.8% experienced clinically relevant depressive symptoms. Anxiety symptoms decreased over time, plateaued, and then slightly increased, whereas depressive symptoms tended to be stable; these variables were positively associated during all time points. The SOC did not change over time; a strong SOC at baseline predicted decreased anxiety and depression.
  
  CONCLUSION:
  Findings showed a strong relationship between SOC and symptoms of anxiety and depression, and they suggested the importance of a salutogenic approach in clinical practice and the relevance of interventions aimed at increasing resilience resources like the SOC in patients with cardiovascular diseases.
  
  Copyright © 2022 Elsevier Inc. All rights reserved.
  
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• Acupuncture in Arterial Hypertension: Evaluation of its Efficacy with Both Office and Ambulatory Blood Pressure Measurements.
  High Blood Press Cardiovasc Prev

  2022 Sep;29(5):429-434. doi: 10.1007/s40292-022-00530-9.
  
  Migliarese Cristina, Maloberti Alessandro, Gatto Roberto, Algeri Michela, Scarpellini Sara, Giannattasio Cristina
  
  Abstract
  
  INTRODUCTION:
  A possible alternative to pharmacological antihypertensive therapies in grade 1 low risk hypertensive patients or in those experienced drugs adverse effects could be acupuncture.
  
  AIM:
  we focused on its possible effects on BP both as Office BP (OBP) and as Ambulatory BP Monitoring (ABPM) evaluating it before starting a 6 weeks twice weekly (total 12 session) acupuncture cycle and after 2 months from its completion.
  
  METHODS:
  in this prospective study we treated with acupuncture 45 patients: 24 of them presents high-normal BP values and low cardiovascular risk while 21 patients were on anti-hypertensive drug with slightly uncontrolled BP values (from 140 to 145 mmHg for Systolic BP-SBP-and/or from 90 to 95 mmHg for Diastolic BP-DBP).
  
  RESULTS:
  regarding SBP, a significant reduction have been observed for office values (from 134.2?±?15.7 to 125.1?±?12.2, p?=?0.03), and for ABPM 24 h (from 131.1?±?10.7 to 126.0?±?10.1, p?=?0.01) and day-time values (from 134.7?±?10.5 to 127.1?±?18.4, p?=?0.02). For DBP, only ABPM 24 h and day-time values showed significant changes (from 85.3?±?9.1 to 82.1?±?7.5, p?=?0.03; and from 88.5?±?9.3 to 85.7?±?7.8, p?=?0.02). Within session SBP decrease was -?5.8 mmHg (-3.75%) during the first session while it falls to - 2.1 mmHg (- 1.25%) and stands firmly under 2 mmHg for all the next session. At the last session SBP reduction was -?1.9 mmHg (- 1.6%).
  
  CONCLUSIONS:
  we found a significant reduction in office, 24 h and day-time ABPM SBP determined by a 6-weeks twice weekly acupuncture cycle that lasts at least for the first two months after its completion.
  
  © 2022. The Author(s).
  
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• Sense of Coherence Predicts Physical Activity Maintenance and Health-Related Quality of Life: A 3-Year Longitudinal Study on Cardiovascular Patients.
  Int J Environ Res Public Health

  2022 Apr;19(8):. doi: 4700.
  
  Adorni Roberta, Greco Andrea, D'Addario Marco, Zanatta Francesco, Fattirolli Francesco, Franzelli Cristina, Maloberti Alessandro, Giannattasio Cristina, Steca Patrizia
  
  Abstract
  
  Cardiovascular disease (CVD) is the leading cause of morbidity and mortality globally. A physically active lifestyle can improve the health-related quality of life (HRQoL) of people with CVD. Nevertheless, adherence to a physically active lifestyle is poor. This study examined the longitudinal (pre-event, 6-, 12-, 24-, and 36-month follow-ups) physical activity profiles in 275 patients (mean age = 57.1 years; SD = 7.87; 84% men) after the first acute coronary event. Moreover, it investigated the associations among physical activity, sense of coherence (SOC), and HRQoL. Physical activity profiles were identified through latent class growth analysis, and linear regressions were then performed to explore the association between physical activity, SOC, and HRQoL. After the cardiovascular event, 62% of patients reached adequate physical activity levels and maintained them over time (virtuous profile). The remaining 38% could not implement (23%) or maintain (15%) a healthy behavior. A strong SOC at baseline (standardized ? = 0.19, p = 0.002) predicted the probability of belonging to the virtuous profile. Moreover, a strong SOC at baseline (standardized ? = 0.27, p
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• Correction: Gender differences in predictors of intensive care units admission among COVID-19 patients: The results of the SARS-RAS study of the Italian Society of Hypertension.
  PLoS One

  2022 ;17(4):e0267622. doi: e0267622.
  
  Iaccarino Guido, Grassi Guido, Borghi Claudio, Carugo Stefano, Fallo Francesco, Ferri Claudio, Giannattasio Cristina, Grassi Davide, Letizia Claudio, Mancusi Costantino, Minuz Pietro, Perlini Stefano, Pucci Giacomo, Rizzoni Damiano, Salvetti Massimo, Sarzani Riccardo, Sechi Leonardo, Veglio Franco, Volpe Massimo, Muiesan Maria Lorenza,
  
  Abstract
  
  [This corrects the article DOI: 10.1371/journal.pone.0237297.].
  
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• Prevalence, Characteristics, and Outcomes of COVID-19-Associated Acute Myocarditis.
  Circulation

  2022 Apr;145(15):1123-1139. doi: 10.1161/CIRCULATIONAHA.121.056817.
  
  Ammirati Enrico, Lupi Laura, Palazzini Matteo, Hendren Nicholas S, Grodin Justin L, Cannistraci Carlo V, Schmidt Matthieu, Hekimian Guillaume, Peretto Giovanni, Bochaton Thomas, Hayek Ahmad, Piriou Nicolas, Leonardi Sergio, Guida Stefania, Turco Annalisa, Sala Simone, Uribarri Aitor, Van de Heyning Caroline M, Mapelli Massimo, Campodonico Jeness, Pedrotti Patrizia, Barrionuevo Sánchez Maria Isabel, Ariza Sole Albert, Marini Marco, Matassini Maria Vittoria, Vourc'h Mickael, Cannatà Antonio, Bromage Daniel I, Briguglia Daniele, Salamanca Jorge, Diez-Villanueva Pablo, Lehtonen Jukka, Huang Florent, Russel Stéphanie, Soriano Francesco, Turrini Fabrizio, Cipriani Manlio, Bramerio Manuela, Di Pasquale Mattia, Grosu Aurelia, Senni Michele, Farina Davide, Agostoni Piergiuseppe, Rizzo Stefania, De Gaspari Monica, Marzo Francesca, Duran Jason M, Adler Eric D, Giannattasio Cristina, Basso Cristina, McDonagh Theresa, Kerneis Mathieu, Combes Alain, Camici Paolo G, de Lemos James A, Metra Marco
  
  Abstract
  
  BACKGROUND:
  Acute myocarditis (AM) is thought to be a rare cardiovascular complication of COVID-19, although minimal data are available beyond case reports. We aim to report the prevalence, baseline characteristics, in-hospital management, and outcomes for patients with COVID-19-associated AM on the basis of a retrospective cohort from 23 hospitals in the United States and Europe.
  
  METHODS:
  A total of 112 patients with suspected AM from 56?963 hospitalized patients with COVID-19 were evaluated between February 1, 2020, and April 30, 2021. Inclusion criteria were hospitalization for COVID-19 and a diagnosis of AM on the basis of endomyocardial biopsy or increased troponin level plus typical signs of AM on cardiac magnetic resonance imaging. We identified 97 patients with possible AM, and among them, 54 patients with definite/probable AM supported by endomyocardial biopsy in 17 (31.5%) patients or magnetic resonance imaging in 50 (92.6%). We analyzed patient characteristics, treatments, and outcomes among all COVID-19-associated AM.
  
  RESULTS:
  AM prevalence among hospitalized patients with COVID-19 was 2.4 per 1000 hospitalizations considering definite/probable and 4.1 per 1000 considering also possible AM. The median age of definite/probable cases was 38 years, and 38.9% were female. On admission, chest pain and dyspnea were the most frequent symptoms (55.5% and 53.7%, respectively). Thirty-one cases (57.4%) occurred in the absence of COVID-19-associated pneumonia. Twenty-one (38.9%) had a fulminant presentation requiring inotropic support or temporary mechanical circulatory support. The composite of in-hospital mortality or temporary mechanical circulatory support occurred in 20.4%. At 120 days, estimated mortality was 6.6%, 15.1% in patients with associated pneumonia versus 0% in patients without pneumonia (=0.044). During hospitalization, left ventricular ejection fraction, assessed by echocardiography, improved from a median of 40% on admission to 55% at discharge (n=47;
  CONCLUSIONS:
  AM occurrence is estimated between 2.4 and 4.1 out of 1000 patients hospitalized for COVID-19. The majority of AM occurs in the absence of pneumonia and is often complicated by hemodynamic instability. AM is a rare complication in patients hospitalized for COVID-19, with an outcome that differs on the basis of the presence of concomitant pneumonia.
  
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• Biochemical but not imaging parameters are predictive of outcome in septic shock: a pilot study.
  Cardiovasc Ultrasound

  2022 Mar;20(1):6. doi: 6.
  
  Belli Oriana E, Campolo Jonica, Vallerio Paola, Musca Francesco, Moreo Antonella, Maloberti Alessandro, Parolini Marina, Bonacchini Luca, Monti Gianpaola, De Gasperi Andrea, Fumagalli Roberto, Giannattasio Cristina
  
  Abstract
  
  BACKGROUND:
  Septic shock is a severe form of sepsis marked by hypotension with an ominous outcome despite the introduction of modern intensive care. The aim of the present study is to obtain a panel with biomarkers, echocardiographic and vascular parameters to better risk stratify patients and identify those at higher risk of ominous outcome.
  
  METHODS:
  Between May 2013 and April 2016, 35 consecutive patients admitted at the Intensive Care Unit (ICU) of ASST Great Metropolitan Hospital Niguarda with the diagnosis of severe sepsis or septic shock were enrolled. All patients underwent rest echocardiography and several circulating biomarkers of myocardial damage or oxidative stress.
  
  RESULTS:
  The multivariate Cox's proportional hazard model showed that the only independent prognostic predictor for 30-day mortality was the angiopoietin-2, (HR 1.017, 95% CI 1.000-1.034; P?=?0.049). An angiopoietin-2 concentrations ? of 33,418?pg/mL was identified as the optimal threshold for the discrimination between survivors and non survivors at the time of admission in ICU, with a sensitivity of 80% and a specificity of 68%.
  
  CONCLUSIONS:
  Septic shock has a poor in-hospital outcome even when the best of care is implemented. Among the biochemical parameters angiopoietin was able to identify patients at risk of death. The lowest the value at admission, the highest the risk of in-hospital death. No echocardiographic nor vascular parameter was able to predict outcome in this setting.
  
  © 2022. The Author(s).
  
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• Prevalence and Rate of Resolution of Left Atrial Thrombus in Patients with Non-Valvular Atrial Fibrillation: A Two-Center Retrospective Real-World Study.
  J Clin Med

  2022 Mar;11(6):. doi: 1520.
  
  Faggiano Pompilio, Dinatolo Elisabetta, Moreo Antonella, De Chiara Benedetta, Sbolli Marco, Musca Francesco, Curnis Antonio, Belli Oriana, Giannattasio Cristina, Tomasi Cesare, Metra Marco, Santangelo Gloria
  
  Abstract
  
  BACKGROUND AND AIM:
  Thromboembolic events due to left atrial appendage (LAA) thrombosis are the main complication of non-valvular atrial fibrillation (NVAF). Although anticoagulants are effective in patients with NVAF, a minimal residual thromboembolic risk persists. Little is known about the prevalence of LAA thrombus and the rate of resolution after the recommended period of anticoagulation therapy, including vitamin K antagonists (VKA), heparin, and non-vitamin K antagonist oral anticoagulants (NOACs).
  
  METHODS AND RESULTS:
  We aimed to study the prevalence of LAA thrombus in an unselected cohort of patients undergoing transesophageal echocardiogram (TEE), and the determinants of LAA thrombus resolution. We retrospectively analyzed 8888 consecutive TEEs performed over five years in two high-volume centers and included all patients with LAA thrombus. A total of 265 patients (3%) had an LAA thrombus. Among these, 97% presented with AF. Fifty-eight percent of patients were on anticoagulants at least three weeks before the diagnosis. After the LAA thrombus diagnosis, VKAs were prescribed in 52%, heparin in 18.5%, and NOAC in 27% of patients. Among the 183 patients with repeat TEE, performed at (25-75th) 39 days (21-84), 67% showed resolution of the LAA thrombus. Although the rate of thrombus resolution was higher in patients treated with NOACs (NOACs 71%, VKA 66%, Heparin 60%) the difference between anticoagulants was statistically non-significant (VKA, OR 0.9, = 0.83; NOAC, OR 1.23, = 0.42; heparin, OR 0.69, = 0.35). Thus, NOACs were demonstrated to be at least as effective as other anticoagulants in the rate of LAA thrombus resolution. Upon multivariate-adjusted analysis, higher LAA emptying velocities were the only predictor of thrombus resolution. In conclusion, the majority of patients were already on anticoagulants. NOACs could be at least as effective as other anticoagulants, yielding an LAA thrombus resolution in two-thirds of patients. This may have clinical relevance, especially in patients undergoing cardioversion or catheter ablation.
  
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• Serum uric acid levels threshold for mortality in diabetic individuals: The URic acid Right for heArt Health (URRAH) project.
  Nutr Metab Cardiovasc Dis

  2022 May;32(5):1245-1252. doi: 10.1016/j.numecd.2022.01.028.
  
  Masulli Maria, D'Elia Lanfranco, Angeli Fabio, Barbagallo Carlo M, Bilancio Giancarlo, Bombelli Michele, Bruno Berardino, Casiglia Edoardo, Cianci Rosario, Cicero Arrigo F G, Cirillo Massimo, Cirillo Pietro, Dell'Oro Raffaella, Desideri Giovambattista, Ferri Claudio, Gesualdo Loreto, Giannattasio Cristina, Grassi Guido, Iaccarino Guido, Lippa Luciano, Mallamaci Francesca, Maloberti Alessandro, Masi Stefano, Mazza Alberto, Mengozzi Alessandro, Muiesan Maria Lorenza, Nazzaro Pietro, Palatini Paolo, Parati Gianfranco, Pontremoli Roberto, Quarti-Trevano Fosca, Rattazzi Marcello, Reboldi Gianpaolo, Rivasi Giulia, Salvetti Massimo, Tikhonoff Valerie, Tocci Giuliano, Ungar Andrea, Verdecchia Paolo, Viazzi Francesca, Virdis Agostino, Volpe Massimo, Borghi Claudio, Galletti Ferruccio,
  
  Abstract
  
  BACKGROUND AND AIM:
  The URRAH (URic acid Right for heArt Health) Study has identified cut-off values of serum uric acid (SUA) predictive of total mortality at 4.7 mg/dl, and cardiovascular (CV) mortality at 5.6 mg/dl. Our aim was to validate these SUA thresholds in people with diabetes.
  
  METHODS AND RESULTS:
  The URRAH subpopulation of people with diabetes was studied. All-cause and CV deaths were evaluated at the end of follow-up. A total of 2570 diabetic subjects were studied. During a median follow-up of 107 months, 744 deaths occurred. In the multivariate Cox regression analyses adjusted for several confounders, subjects with SUA ?5.6 mg/dl had higher risk of total (HR: 1.23, 95%CI: 1.04-1.47) and CV mortality (HR:1.31, 95%CI:1.03-1.66), than those with SUA
  CONCLUSIONS:
  SUA thresholds previously proposed by the URRAH study group are predictive of total and CV mortality also in people with diabetes. The threshold of 5.6 mg/dl can predict both total and CV mortality, and so is candidate to be a clinical cut-off for the definition of hyperuricemia in patients with diabetes.
  
  Copyright © 2022 The Italian Diabetes Society, 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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• Primary mediastinal large B-cell lymphoma and pregnancy: a challenging clinical scenario.
  Monaldi Arch Chest Dis

  2022 Feb;92(4):. doi: 10.4081/monaldi.2022.2198.
  
  Intravaia Rita, De Chiara Benedetta, Musca Francesco, Casadei Francesca, Santambrogio Gloria, Spanò Francesca, Belli Oriana, Quattrocchi Giuseppina, Giannattasio Cristina, Moreo Antonella
  
  Abstract
  
  A 26-weeks pregnant woman presented with progressively worsening dyspnoea and poor general conditions. Using low-dose radiation multi-imaging techniques and thoracic biopsy a primary mediastinal large B cell was diagnosed. A multidisciplinary approach identified the correct hemodynamic management, the best therapeutic strategy and the timing for delivery.
  
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• Impulsivity assessed ten years earlier and sociodemographic factors predict adherence to COVID-19 related behavioral restrictions in old individuals with hypertension.
  BMC Public Health

  2022 Jan;22(1):185. doi: 185.
  
  Steca Patrizia, Adorni Roberta, Greco Andrea, Zanatta Francesco, Fattirolli Francesco, Franzelli Cristina, Giannattasio Cristina, D'Addario Marco
  
  Abstract
  
  BACKGROUND:
  The COVID-19 pandemic has had clear and dramatic repercussions on health, the economy, and psychosocial well-being. Behavioral measures, such as wearing facemasks and maintaining distance from others, have proven crucial in fighting the contagion's spread. This study aimed to investigate Type A personality traits and sociodemographic predictors of adherence to governmental measures in a sample of frail individuals.
  
  METHODS:
  A sample of 105 Italians over age 60 (Mean age?=?70?years; 60.6% male) affected by hypertension who participated in a previous longitudinal study were assessed through a telephone structured interview. Sociodemographic information and Type A personality traits were retrieved from the original longitudinal study. Adherence behaviors were investigated through several questions regarding the compliance with home confinement, the use of facemasks and the observance of social distancing. Repeated measures Analyses of Variance (RMANOVA), Reliable Change Index, and binomial logistic regression analysis were performed.
  
  RESULTS:
  Only 33.3% of the participants reported adherence to all the governmental COVID-19 measures. Being a woman (OR?=?4.84; 95% CI?=?1.58, 14.90; p?0.01), being retired (OR?=?4.89; 95% CI?=?1.09, 21.86; p?0.05), and suffering from hypertension for a relatively short time (OR?=?4.20; 95% CI?=?1.22, 14.44; p?0.05) positively predicted adherence to the governmental measures. Impulsivity resulted in a stable personality characteristic over the last ten years (p?=?0.30). Having high levels of impulsivity (OR?=?2.28; 95% CI?=?1.13, 4.59; p?0.05) negatively predicted adherence.
  
  CONCLUSIONS:
  Our results demonstrate that impulsivity is a stable personality facet that can have a robust negative impact on adherence behaviors to health claims. Overall, results show the importance to tailor communication strategies that consider the role of sociodemographic indicators and impulsivity to achieve a high level of adherence.
  
  © 2022. The Author(s).
  
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• Uric acid associated with acute heart failure presentation in Acute Coronary Syndrome patients.
  Eur J Intern Med

  2022 May;99():30-37. doi: 10.1016/j.ejim.2022.01.018.
  
  Rebora Paola, Centola Marco, Morici Nuccia, Sacco Alice, Occhino Giuseppe, Viola Giovanna, Oreglia Jacopo, Castini Diego, Persampieri Simone, Sabatelli Ludovico, Ferrante Giulia, Lucreziotti Stefano, Carugo Stefano, Valsecchi Maria Grazia, Oliva Fabrizio, Giannattasio Cristina, Maloberti Alessandro
  
  Abstract
  
  We focused on the role of Uric Acid (UA) as a possible determinant of Heart Failure (HF) related issues in Acute Coronary Syndromes (ACS) patients. Main outcomes were acute HF and cardiogenic shock at admission, secondary outcomes were the use of Non Invasive Ventilation (NIV) and the admission Left Ventricular Ejection Fraction (LVEF). We consecutively enrolled 1269 ACS patients admitted to the cardiological Intensive Care Unit of the Niguarda and San Paolo hospitals (Milan, Italy) from June 2016 to June 2019. Median age was 68 (first-third quartile 59-77) years and males were 970 (76%). All the evaluated outcomes occurred more frequently in the hyperuricemic subjects (UA higher than 6 mg/dL for females and 7 mg/dL for males, n = 292): acute HF 35.8 vs 11.1% (p 
  Copyright © 2022. Published by Elsevier B.V.
  
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• Trends in all-cause mortality of hospitalized patients due to SARS-CoV-2 infection from a monocentric cohort in Milan (Lombardy, Italy).
  Z Gesundh Wiss

  2022 ;30(8):1985-1993. doi: 10.1007/s10389-021-01675-y.
  
  Ughi Nicola, Bernasconi Davide Paolo, Del Gaudio Francesca, Dicuonzo Armanda, Maloberti Alessandro, Giannattasio Cristina, Tarsia Paolo, Puoti Massimo, Scaglione Francesco, Beltrami Laura, Colombo Fabrizio, Bertuzzi Michaela, Bellone Andrea, Adinolfi Antonella, Valsecchi Maria Grazia, Epis Oscar Massimiliano, Rossetti Claudio,
  
  Abstract
  
  BACKGROUND:
  Robust data on case fatality rate (CFR) among inpatients with COVID-19 are still lacking, and the role of patient characteristics in in-hospital deaths remains under-investigated. This study quantified the overall CFR and described its trend in a cohort of hospitalized patients with SARS-CoV-2 in Italy. Admission to ICU, death, or discharge were the secondary outcomes.
  
  METHODS:
  This retrospective study is based on administrative health data and electronic case records of inpatients consecutively admitted to Niguarda Hospital between 21 February and 8 November 2020.
  
  RESULTS:
  An overall CFR of 18% was observed. CFR was significantly reduced during the second wave of contagion (1 June to 30 September, 16%) compared with the first wave (21 February to 31 May, 21%  = 0.015). Such reduction was mainly observed among male inpatients between 40 and 80 years with limited comorbidities. Admission to ICU was associated with a high risk of mortality in both waves. The incidence of severe disease and the need for ICU admission were lower in the second wave.
  
  CONCLUSION:
  CFR in SARS-CoV-2 inpatients was demonstrated to decrease over time. This reduction may partly reflect the changes in hospital strategy and clinical practice. The reasons for this improvement should be further investigated to plan an exit strategy in case of future outbreaks.
  
  KEY MESSAGES:
  Before the advent of anti-COVID-19 vaccines, a multi-wave pattern of contagion was observed, and this trend conditioned the inpatient case fatality rate (CFR), which varied over time accordingly to the waves of contagion.Only preliminary results on the in-hospital mortality trend are available, along with a partial analysis of its determinants. Consequently, robust data on CFR among inpatients with SARS-CoV-2 infection are still lacking, and the role of patient characteristics in in-hospital deaths remains under-investigated. This study shows that the in-hospital mortality in patients with SARS-CoV-2 infection decreases over time.Such reduction was mainly observed among male inpatients between 40 and 80 years with limited comorbidities. Admission to ICU was invariably associated with a high risk of mortality during the whole study period (21 February to 8 November 2020), but the incidence of severe disease and the need for ICU admission were lower in the second wave of contagions (1 October to 8 November 2020). This reduction may partly reflect the impact of changes in hospital strategy and clinical practice. The reasons for this improvement should be further investigated to inform the response to future outbreaks and to plan exit strategy by prioritizing high-risk populations.
  
  SUPPLEMENTARY INFORMATION:
  The online version contains supplementary material available at 10.1007/s10389-021-01675-y.
  
  © The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2021.
  
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• [Giant negative T-waves: a multi-headed monster].
  G Ital Cardiol (Rome)

  2022 Jan;23(1):28. doi: 10.1714/3715.37059.
  
  Di Matteo Irene, Tavecchia Giovanni Amedeo, Giannattasio Cristina
  
  
  
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• The association of uric acid with mortality modifies at old age: data from the uric acid right for heart health (URRAH) study.
  J Hypertens

  2022 Apr;40(4):704-711. doi: 10.1097/HJH.0000000000003068.
  
  Ungar Andrea, Rivasi Giulia, Di Bari Mauro, Virdis Agostino, Casiglia Edoardo, Masi Stefano, Mengozzi Alessandro, Barbagallo Carlo M, Bombelli Michele, Bruno Bernardino, Cicero Arrigo F G, Cirillo Massimo, Cirillo Pietro, Desideri Giovambattista, D'elia Lanfranco, Ferri Claudio, Galletti Ferruccio, Gesualdo Loreto, Giannattasio Cristina, Iaccarino Guido, Ciccarelli Michele, Lippa Luciano, Mallamaci Francesca, Maloberti Alessandro, Mazza Alberto, Muiesan Maria Lorenza, Nazzaro Pietro, Palatini Paolo, Parati Gianfranco, Pontremoli Roberto, Quarti-Trevano Fosca, Rattazzi Marcello, Salvetti Massimo, Tikhonoff Valérie, Tocci Giuliano, Cianci Rosario, Verdecchia Paolo, Viazzi Francesca, Volpe Massimo, Grassi Guido, Borghi Claudio,
  
  Abstract
  
  OBJECTIVES:
  In older individuals, the role of serum uric acid (SUA) as risk factor for mortality is debated. This study investigated the association of SUA with all-cause and cardiovascular (CV) mortality in older adults participating in the large multicentre observational uric acid right for heart health (URRAH) study.
  
  METHODS:
  Eight thousand URRAH participants aged 65+ were included in the analysis. The predictive role of SUA was assessed using Cox regression models stratified according to the cut-off age of 75. SUA was tested as continuous and categorical variable (age-specific quartiles). The prognostic threshold of SUA for mortality was analysed using receiver operating characteristic curves.
  
  RESULTS:
  Among participants aged 65-74, multivariate Cox regression analysis adjusted for CV risk factors and comorbidities identified an independent association of SUA with both all-cause mortality (hazard ratio [HR] 1.169, 95% confidence interval [CI] 1.107-1.235) and CV mortality (HR 1.146, 95% CI 1.064-1.235). The cut-off value of 4.8?mg/dl discriminated mortality status. In participants aged 75+, we observed a J-shaped relationship of SUA with all-cause and CV mortality, with risk increasing at extreme SUA levels.
  
  CONCLUSIONS:
  These results confirmed the predictive role of SUA for all-cause and CV mortality in older adults, while revealing considerable age-related differences. Mortality risk increased at higher SUA levels in participants aged 65-74, with a prognostic threshold of 4.8?mg/dl. The relationship between SUA and mortality was J-shaped in oldest participants. Large interventional studies are needed to clarify the benefits and possible risks of urate-lowering treatments in older adults.
  
  Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
  
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• Heart Rate in Patients with SARS-CoV-2 Infection: Prevalence of High Values at Discharge and Relationship with Disease Severity.
  J Clin Med

  2021 Nov;10(23):. doi: 5590.
  
  Maloberti Alessandro, Ughi Nicola, Bernasconi Davide Paolo, Rebora Paola, Cartella Iside, Grasso Enzo, Lenoci Deborah, Del Gaudio Francesca, Algeri Michela, Scarpellini Sara, Perna Enrico, Verde Alessandro, Santolamazza Caterina, Vicari Francesco, Frigerio Maria, Alberti Antonia, Valsecchi Maria Grazia, Rossetti Claudio, Epis Oscar Massimiliano, Giannattasio Cristina, On The Behalf Of The Niguarda Covid-Working Group
  
  Abstract
  
  The most common arrhythmia associated with COronaVIrus-related Disease (COVID) infection is sinus tachycardia. It is not known if high Heart Rate (HR) in COVID is simply a marker of higher systemic response to sepsis or if its persistence could be related to a long-term autonomic dysfunction. The aim of our work is to assess the prevalence of elevated HR at discharge in patients hospitalized for COVID-19 and to evaluate the variables associated with it. We enrolled 697 cases of SARS-CoV2 infection admitted in our hospital after February 21 and discharged within 23 July 2020. We collected data on clinical history, vital signs, laboratory tests and pharmacological treatment. Severe disease was defined as the need for Intensive Care Unit (ICU) admission and/or mechanical ventilation. Median age was 59 years (first-third quartile 49, 74), and male was the prevalent gender (60.1%). 84.6% of the subjects showed a SARS-CoV-2 related pneumonia, and 13.2% resulted in a severe disease. Mean HR at admission was 90 ± 18 bpm with a mean decrease of 10 bpm to discharge. Only 5.5% of subjects presented HR > 100 bpm at discharge. Significant predictors of discharge HR at multiple linear model were admission HR (mean increase = ? = 0.17 per bpm, 95% CI 0.11; 0.22,
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• The Role of Uric Acid in Acute and Chronic Coronary Syndromes.
  J Clin Med

  2021 Oct;10(20):. doi: 4750.
  
  Maloberti Alessandro, Biolcati Marco, Ruzzenenti Giacomo, Giani Valentina, Leidi Filippo, Monticelli Massimiliano, Algeri Michela, Scarpellini Sara, Nava Stefano, Soriano Francesco, Oreglia Jacopo, Sacco Alice, Morici Nuccia, Oliva Fabrizio, Piani Federica, Borghi Claudio, Giannattasio Cristina
  
  Abstract
  
  Uric acid (UA) is the final product of the catabolism of endogenous and exogenous purine nucleotides. While its association with articular gout and kidney disease has been known for a long time, new data have demonstrated that UA is also related to cardiovascular (CV) diseases. UA has been identified as a significant determinant of many different outcomes, such as all-cause and CV mortality, and also of CV events (mainly Acute Coronary Syndromes (ACS) and even strokes). Furthermore, UA has been related to the development of Heart Failure, and to a higher mortality in decompensated patients, as well as to the onset of atrial fibrillation. After a brief introduction on the general role of UA in CV disorders, this review will be focused on UA's relationship with CV outcomes, as well as on the specific features of patients with ACS and Chronic Coronary Syndrome. Finally, two issues which remain open will be discussed: the first is about the identification of a CV UA cut-off value, while the second concerns the possibility that the pharmacological reduction of UA is able to lower the incidence of CV events.
  
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• Serum Uric Acid and Kidney Disease Measures Independently Predict Cardiovascular and Total Mortality: The Uric Acid Right for Heart Health (URRAH) Project.
  Front Cardiovasc Med

  2021 ;8():713652. doi: 713652.
  
  Russo Elisa, Viazzi Francesca, Pontremoli Roberto, Barbagallo Carlo M, Bombelli Michele, Casiglia Edoardo, Cicero Arrigo F G, Cirillo Massimo, Cirillo Pietro, Desideri Giovambattista, D'Elia Lanfranco, Dell'Oro Raffaella, Ferri Claudio, Galletti Ferruccio, Gesualdo Loreto, Giannattasio Cristina, Iaccarino Guido, Leoncini Giovanna, Mallamaci Francesca, Maloberti Alessandro, Masi Stefano, Mengozzi Alessandro, Mazza Alberto, Muiesan Maria L, Nazzaro Pietro, Palatini Paolo, Parati Gianfranco, Rattazzi Marcello, Rivasi Giulia, Salvetti Massimo, Tikhonoff Valérie, Tocci Giuliano, Quarti Trevano Fosca A L, Ungar Andrea, Verdecchia Paolo, Virdis Agostino, Volpe Massimo, Grassi Guido, Borghi Claudio
  
  Abstract
  
  Serum uric acid predicts the onset and progression of kidney disease, and the occurrence of cardiovascular and all-cause mortality. Nevertheless, it is unclear which is the appropriate definition of hyperuricemia in presence of chronic kidney disease (CKD). Our goal was to study the independent impact of uric acid and CKD on mortality. We retrospectively investigated 21,963 patients from the URRAH study database. Hyperuricemia was defined on the basis of outcome specific cut-offs separately identified by ROC curves according to eGFR strata. The primary endpoints were cardiovascular and all-cause mortality. After a mean follow-up of 9.8 year, there were 1,582 (7.20%) cardiovascular events and 3,130 (14.25%) deaths for all causes. The incidence of cardiovascular and all-cause mortality increased in parallel with reduction of eGFR strata and with progressively higher uric acid quartiles. During 215,618 person-years of follow-up, the incidence rate for cardiovascular mortality, stratified based on eGFR (>90, between 60 and 90 and
  Copyright © 2021 Russo, Viazzi, Pontremoli, Barbagallo, Bombelli, Casiglia, Cicero, Cirillo, Cirillo, Desideri, D'Elia, Dell'Oro, Ferri, Galletti, Gesualdo, Giannattasio, Iaccarino, Leoncini, Mallamaci, Maloberti, Masi, Mengozzi, Mazza, Muiesan, Nazzaro, Palatini, Parati, Rattazzi, Rivasi, Salvetti, Tikhonoff, Tocci, Quarti Trevano, Ungar, Verdecchia, Virdis, Volpe, Grassi and Borghi.
  
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• Identification of a plausible serum uric acid cut-off value as prognostic marker of stroke: the Uric Acid Right for Heart Health (URRAH) study.
  J Hum Hypertens

  2022 Nov;36(11):976-982. doi: 10.1038/s41371-021-00613-5.
  
  Tikhonoff Valérie, Casiglia Edoardo, Spinella Paolo, Barbagallo Carlo M, Bombelli Michele, Cicero Arrigo F G, Cirillo Massimo, Cirillo Pietro, Desideri Giovambattista, D'elia Lanfranco, Ferri Claudio, Galletti Ferruccio, Gesualdo Loreto, Giannattasio Cristina, Iaccarino Guido, Mallamaci Francesca, Maloberti Alessandro, Masi Stefano, Mazza Alberto, Muiesan Maria Lorenza, Nazzaro Pietro, Palatini Paolo, Parati Gianfranco, Pontremoli Roberto, Quarti-Trevano Fosca, Rattazzi Marcello, Rivasi Giulia, Salvetti Massimo, Tocci Giuliano, Ungar Andrea, Verdecchia Paolo, Viazzi Francesca, Virdis Agostino, Volpe Massimo, Grassi Guido, Borghi Claudio,
  
  Abstract
  
  The Working Group on Uric Acid and Cardiovascular Risk of the Italian Society of Hypertension conceived and designed an ad hoc study aimed at searching for prognostic cut-off values of serum uric acid (SUA) in predicting combined (fatal and non-fatal) cerebrovascular (CBV) events in the whole database. The URic acid Right for heArt Health study is a nationwide, multicenter, observational cohort study involving data on subjects aged 18-95 years recruited on a regional community basis from all the territory of Italy under the patronage of the Italian Society of Hypertension with a mean follow-up period of 120.7?±?61.8 months. A total of 14,588 subjects were included in the analysis. A prognostic cut-off value of SUA able to discriminate combined CBV events (>4.79?mg/dL or >284.91?µmol/L) was identified by means of receiver operating characteristic curve in the whole database. Multivariate Cox regression analysis adjusted for confounders (age, sex, arterial hypertension, diabetes, chronic kidney disease, smoking habit, ethanol intake, body mass index, low-density lipoprotein cholesterol, and use of diuretics) identified an independent association between SUA and combined CBV events in the whole database (HR 1.249, 95% confidence interval, 1.041-1.497, p?=?0.016). The results of the present study confirm that SUA is an independent risk marker for CBV events after adjusting for potential confounding variables, including arterial hypertension, and demonstrate that >4.79?mg/dL is a valid prognostic cut-off value.
  
  © 2021. The Author(s), under exclusive licence to Springer Nature Limited.
  
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• Atrial Fibrillation and Clinical Outcomes in a Cohort of Hospitalized Patients with Sars-Cov-2 Infection and Chronic Kidney Disease.
  J Clin Med

  2021 Sep;10(18):. doi: 4108.
  
  Genovesi Simonetta, Rebora Paola, Occhino Giuseppe, Rossi Emanuela, Maloberti Alessandro, Belli Michele, Bonfanti Paolo, Giannattasio Cristina, Rossetti Claudio, Epis Oscar Massimiliano, Ughi Nicola, Valsecchi Maria Grazia
  
  Abstract
  
  The aim of the study was to investigate the role of chronic kidney disease (CKD) on in-hospital mortality and on incident atrial fibrillation (AF) in patients infected with SARS-CoV-2. The incidence of acute kidney injury (AKI) was also investigated. Multivariable regression models were used to assess the association between renal function groups (estimated Glomerular Filtration Rate, eGFR, >60 mL/min, 30-59 mL/min,
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• Determinants of Functional Improvement After Cardiac Rehabilitation in Acute Coronary Syndrome.
  High Blood Press Cardiovasc Prev

  2021 Nov;28(6):579-587. doi: 10.1007/s40292-021-00473-7.
  
  Bianchi Sofia, Maloberti Alessandro, Peretti Alessio, Garatti Laura, Palazzini Matteo, Occhi Lucia, Bassi Ilaria, Sioli Sabrina, Biolcati Marco, Giani Valentina, Monticelli Massimiliano, Leidi Filippo, Ruzzenenti Giacomo, Beretta Giovanna, Giannattasio Cristina, Riccobono Salvatore
  
  Abstract
  
  INTRODUCTION:
  Cardiac rehabilitation (CR) is an effective tool for secondary prevention after acute coronary syndrome (ACS).
  
  AIM:
  Aim of our study was to find the significant determinants of exercise capacity (evaluated with the six-minute walking test-6-MWT) and functional improvement in patients undergoing CR after an ACS.
  
  METHODS:
  The study group included 298 patients (mean age 61.6 ± 10.2 years; males 80.2%) who, after ACS, were enrolled in CR program at Niguarda Hospital in Milan from 2015 to 2018. For all patients, we collected anamnestic, clinical and instrumental cardiological data. All patients performed a 6-MWT at the beginning (6-MWT-1) and at the end (6-MWT-2) of CR program. ? meters were used to represent functional improvement.
  
  RESULTS:
  Multiple linear regression models were carried out for 6-MWT-1, 6-MWT-2, ? meters and % ? meters. Standardized regression coefficients showed that age (? = - 0.237; p
  CONCLUSIONS:
  Our data showed that functional improvement after CR in ACS patients is mainly related to non-cardiological variables. Instead it is related to intrinsic factors, both modifiable (BMI) and non-modifiable (age, sex).
  
  © 2021. The Author(s).
  
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• Prevalence of hypertension mediated organ damage in subjects with high-normal blood pressure without known hypertension as well as cardiovascular and kidney disease.
  J Hum Hypertens

  2022 Jul;36(7):610-616. doi: 10.1038/s41371-021-00604-6.
  
  Maloberti Alessandro, Rebora Paola, Occhino Giuseppe, Alloni Marta, Musca Francesco, Belli Oriana, Spano Francesca, Santambrogio Gloria Maria, Occhi Lucia, De Chiara Benedetta, Casadei Francesca, Moreo Antonella, Valsecchi Maria Grazia, Giannattasio Cristina
  
  Abstract
  
  Purpose of our study was to assess the prevalence of hypertension mediated organ damage (HMOD) in healthy subjects with high-normal Blood Pressure (BP) comparing them with subjects with BP values that are considered normal (
  © 2021. The Author(s), under exclusive licence to Springer Nature Limited.
  
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• Correction: Gender differences in predictors of intensive care units admission among COVID-19 patients: The results of the SARS-RAS study of the Italian Society of Hypertension.
  PLoS One

  2021 ;16(9):e0257181. doi: e0257181.
  
  Iaccarino Guido, Grassi Guido, Borghi Claudio, Carugo Stefano, Fallo Francesco, Ferri Claudio, Giannattasio Cristina, Grassi Davide, Letizia Claudio, Mancusi Costantino, Minuz Pietro, Perlini Stefano, Pucci Giacomo, Rizzoni Damiano, Salvetti Massimo, Sarzani Riccardo, Sechi Leonardo, Veglio Franco, Volpe Massimo, Muiesan Maria Lorenza,
  
  Abstract
  
  [This corrects the article DOI: 10.1371/journal.pone.0237297.].
  
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• Depression symptoms as longitudinal predictors of the psychological impact of COVID-19 pandemic in hypertensive patients.
  Sci Rep

  2021 Aug;11(1):16496. doi: 16496.
  
  D'Addario Marco, Zanatta Francesco, Adorni Roberta, Greco Andrea, Fattirolli Francesco, Franzelli Cristina, Giannattasio Cristina, Steca Patrizia
  
  Abstract
  
  COVID-19 has brought considerable changes and caused critical psychological responses, especially among frail populations. So far, researchers have explored the predictive effect of diverse factors on pandemic-related psychological distress, but none have focused on the impact of prior depression and anxiety symptomatology adopting an extended (10-year) longitudinal design. 105 patients aged over 60, affected by hypertension who participated in a previous longitudinal study were assessed through a follow-up telephone structured interview. The Hospital Anxiety and Depression Scale (HADS) and the Impact of Event Scale-Revised (IES-R) were used for assessing depression and anxiety symptoms and the psychological impact of COVID-19, respectively. Multiple linear regression analyses were conducted. At the assessment, participants did not report clinically relevant depression, anxiety, and psychological pandemic-related distress symptoms. However, significant mean differences between baseline and current follow-up evaluations for both depression and anxiety were found, reflecting a decrease in symptomatology over time (p?.001). Baseline depression symptoms (??=?1.483, p?=?.005) significantly predicted the psychological impact of COVID-19 after 10 years. Conversely, their decrease (??=?-1.640, p?.001) and living with others (??=?-7.274, p?=?.041) significantly contributed to lower psychological distress scores. Our findings provide insight into the predisposing influence of depressive symptoms on pandemic-related psychological distress ten years later. Preventive interventions and strategies considering these factors are needed to better pre-empt the severe mental consequences of the pandemic.
  
  © 2021. The Author(s).
  
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• Troponin elevation in COVID-19 patients: An important stratification biomarker with still some open questions.
  Int J Cardiol

  2021 Oct;341():107-109. doi: 10.1016/j.ijcard.2021.07.049.
  
  Maloberti Alessandro, Biolcati Marco, Giannattasio Cristina
  
  
  
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• Continuous flow left ventricular assist devices do not worsen endothelial function in subjects with chronic heart failure: a pilot study.
  ESC Heart Fail

  2021 Oct;8(5):3587-3593. doi: 10.1002/ehf2.13484.
  
  Cortese Francesca, Ciccone Marco Matteo, Gesualdo Michele, Iacoviello Massimo, Frigerio Maria, Cipriani Manlio, Giannattasio Cristina, Maloberti Alessandro, Giordano Paola
  
  Abstract
  
  AIMS:
  To evaluate endothelial function in subjects with left ventricular assist devices (LVADs), comparing them with subjects with chronic heart failure with reduced ejection fraction on the list for heart transplant (HT) and with HT patients with a normal systolic cardiac function to identify any differences.
  
  METHODS:
  We enrolled 28 subjects with LVAD, 55 subjects with HT, and 42 subjects with heart failure on the transplant list. The subjects underwent a general physical examination, assessment of laboratory blood parameters, and assessment of endothelial function through flow-mediated dilation (FMD) of brachial artery.
  
  RESULTS:
  The three groups were homogeneous as regards age, gender, smoke abuse, C-reactive protein (CRP) and FMD parameters (P = ns). In LVAD group percentage of FMD change showed an inverse correlation with CRP (rho: -0.5, P: 0.003), a well-known marker of inflammation and tissue damage.
  
  CONCLUSIONS:
  Continuous flow related to LVAD seems to not worsen endothelial function. Endothelial function was not affected by cardiovascular risk factors (hypertension, hypercholesterolaemia, diabetes, obesity, and tobacco habit), by the functional status expressed by New York Heart Association class, by the left ventricular systolic function and by the presence or absence of ischaemic heart disease in all the populations analysed. CRP was the only factor able to influence percentage of FMD change in patient with LVAD, reinforcing the hypothesis that inflammation is the main determinant of endothelial function.
  
  © 2021 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
  
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• Home blood pressure monitoring: methodology, clinical relevance and practical application: a 2021 position paper by the Working Group on Blood Pressure Monitoring and Cardiovascular Variability of the European Society of Hypertension.
  J Hypertens

  2021 Sep;39(9):1742-1767. doi: 10.1097/HJH.0000000000002922.
  
  Parati Gianfranco, Stergiou George S, Bilo Grzegorz, Kollias Anastasios, Pengo Martino, Ochoa Juan Eugenio, Agarwal Rajiv, Asayama Kei, Asmar Roland, Burnier Michel, De La Sierra Alejandro, Giannattasio Cristina, Gosse Philippe, Head Geoffrey, Hoshide Satoshi, Imai Yutaka, Kario Kazuomi, Li Yan, Manios Efstathios, Mant Jonathan, McManus Richard J, Mengden Thomas, Mihailidou Anastasia S, Muntner Paul, Myers Martin, Niiranen Teemu, Ntineri Angeliki, O'Brien Eoin, Octavio José Andres, Ohkubo Takayoshi, Omboni Stefano, Padfield Paul, Palatini Paolo, Pellegrini Dario, Postel-Vinay Nicolas, Ramirez Agustin J, Sharman James E, Shennan Andrew, Silva Egle, Topouchian Jirar, Torlasco Camilla, Wang Ji Guang, Weber Michael A, Whelton Paul K, White William B, Mancia Giuseppe,
  
  Abstract
  
  The present paper provides an update of previous recommendations on Home Blood Pressure Monitoring from the European Society of Hypertension (ESH) Working Group on Blood Pressure Monitoring and Cardiovascular Variability sequentially published in years 2000, 2008 and 2010. This update has taken into account new evidence in this field, including a recent statement by the American Heart association, as well as technological developments, which have occurred over the past 20 years. The present document has been developed by the same ESH Working Group with inputs from an international team of experts, and has been endorsed by the ESH.
  
  Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
  
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• Covid and Cardiovascular Diseases: Direct and Indirect Damages and Future Perspective.
  High Blood Press Cardiovasc Prev

  2021 Sep;28(5):439-445. doi: 10.1007/s40292-021-00464-8.
  
  Ruzzenenti Giacomo, Maloberti Alessandro, Giani Valentina, Biolcati Marco, Leidi Filippo, Monticelli Massimiliano, Grasso Enzo, Cartella Iside, Palazzini Matteo, Garatti Laura, Ughi Nicola, Rossetti Claudio, Epis Oscar Massimiliano, Giannattasio Cristina,
  
  Abstract
  
  SARS-CoV-2 infection determines a disease that predominantly affects lungs. However the cytokines storms, determined by the huge immune response to the infection, could affect also other organs and apparatus such as heart and vessels. Beyond the acute inflammation itself also hypercoagulative status has been linked to SARSCoV-2 infection and this surely relates to the increase seen in prevalence of pulmonary embolism and myocardial infarction. A number of cardiac abnormalities and pathologies have been observed, with special attention to cardiac arrhythmias and myocardial involvement. Furthermore, indirect damages determined by the reduction in acute and chronic cardiovascular care, results in a strong mortality and morbidity outcomes in cardiological patients. In this review we will summarise current knowledge on both direct and indirect cardiovascular damages determined by the SARS-CoV-2 pandemia.
  
  © 2021. The Author(s).
  
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• Prevalence and outcome of patients with acute myocarditis and positive viral search on nasopharyngeal swab.
  Eur J Heart Fail

  2021 Jul;23(7):1242-1245. doi: 10.1002/ejhf.2247.
  
  Ammirati Enrico, Varrenti Marisa, Veronese Giacomo, Fanti Diana, Nava Alice, Cipriani Manlio, Pedrotti Patrizia, Garascia Andrea, Bottiroli Maurizio, Oliva Fabrizio, Bramerio Manuela, Veronese Silvio, Giannattasio Cristina, Bonoldi Emanuela, Perno Carlo F, Camici Paolo G, Frigerio Maria
  
  
  
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• Acute cardiovascular syndrome in the Italian multiethnic society.
  J Cardiovasc Med (Hagerstown)

  2022 Jan;23(1):e11-e14. doi: 10.2459/JCM.0000000000001207.
  
  Sacco Alice, Palazzini Matteo, Portoghese Alessandro, Ruzzenenti Giacomo, De Ponti Laura, Morici Nuccia, Brunelli Dario, Giannattasio Cristina, Oliva Fabrizio
  
  
  
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• Low Awareness of Cardiovascular Risk Factor Among Patients Admitted in Cardiac Rehabilitation: New Data for Further Implementation of Cardiovascular Rehabilitation Program.
  High Blood Press Cardiovasc Prev

  2021 May;28(3):253-254. doi: 10.1007/s40292-021-00451-z.
  
  Maloberti Alessandro, Monticelli Massimiliano, Bassi Ilaria, Riccobono Salvatore, Giannattasio Cristina
  
  
  
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• Temporal Relation Between Second Dose BNT162b2 mRNA Covid-19 Vaccine and Cardiac involvement in a Patient with Previous SARS-COV-2 Infection.
  Int J Cardiol Heart Vasc

  2021 Apr;():100778. doi: 100778.
  
  Ammirati Enrico, Cavalotti Cristina, Milazzo Angela, Pedrotti Patrizia, Soriano Francesco, Schroeder Jan W, Morici Nuccia, Giannattasio Cristina, Frigerio Maria, Metra Marco, Camici Paolo G, Oliva Fabrizio
  
  Abstract
  
  The Publisher regrets that this article is an accidental duplication of an article that has already been published, https://doi.org/10.1016/j.ijcha.2021.100774. The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at
  
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• Temporal relation between second dose BNT162b2 mRNA Covid-19 vaccine and cardiac involvement in a patient with previous SARS-COV-2 infection.
  Int J Cardiol Heart Vasc

  2021 Jun;34():100774. doi: 100774.
  
  Ammirati Enrico, Cavalotti Cristina, Milazzo Angela, Pedrotti Patrizia, Soriano Francesco, Schroeder Jan W, Morici Nuccia, Giannattasio Cristina, Frigerio Maria, Metra Marco, Camici Paolo G, Oliva Fabrizio
  
  
  
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• Uric acid in chronic coronary syndromes: Relationship with coronary artery disease severity and left ventricular diastolic parameter.
  Nutr Metab Cardiovasc Dis

  2021 May;31(5):1501-1508. doi: 10.1016/j.numecd.2021.01.023.
  
  Maloberti Alessandro, Bossi Irene, Tassistro Elena, Rebora Paola, Racioppi Angelo, Nava Stefano, Soriano Francesco, Piccaluga Emanuela, Piccalò Giacomo, Oreglia Jacopo, Vallerio Paola, Pirola Roberto, De Chiara Benedetta, Oliva Fabrizio, Moreo Antonella, Valsecchi Maria Grazia, Giannattasio Cristina
  
  Abstract
  
  BACKGROUND AND AIMS:
  Uric Acid (UA) has been related to the development of Cardio-Vascular (CV) events in patients affected by Chronic Coronary Syndromes (CCS). Among various hypothesis, two arise: UA may negatively act on coronary artery determining a higher degree of atherosclerotic disease, and/or on heart determining a higher prevalence of diastolic dysfunction. Both the above hypothesized effects are object of our investigation.
  
  METHODS AND RESULTS:
  231 patients who were admitted to the cardiological department of the Niguarda Hospital (Milan, Italy) for CCS from January 2017 to June 2018 were enrolled. Coronary atherosclerotic burden was evaluated from coronary angiography as the number and type of involved vessels, as well as with both Gensini and Syntax scores. All subjects underwent a complete echocardiogram. At unadjusted and adjusted/multivariable analysis, UA levels were not significantly associated with variables analysed from the coronary angiography (number and type of vessels involved, neither the Gensini and Syntax scores) as well as with echocardiographic parameters regarding systolic and diastolic function.
  
  CONCLUSIONS:
  In conclusion, the main finding of our work is the absence of a role for UA in determining coronary arteries disease as well as LV diastolic dysfunction in CCS subjects. Taking together the results of previous studies with ours, we hypothesize that UA could act on heart (both on coronary arteries and on LV function) in an early phase of the disease, whereas while in the advanced stages other factors (previous myocardial infarction, previous myocardial revascularization and so on) may overshadow its effects.
  
  Copyright © 2021 The Italian Diabetes Society, 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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• Ankle-Brachial Index Is a Predictor of In-Hospital Functional Status but Not of Complications in Hospitalized Elderly Patients.
  Gerontology

  2021 ;67(6):674-680. doi: 10.1159/000514450.
  
  Maloberti Alessandro, Fribbi Francesco, Motto Elena, Vallerio Paola, Occhi Lucia, Palazzini Matteo, Peretti Alessio, Ferraro Giovanni, Agrati Antonio, Colombo Fabrizio, Giannattasio Cristina
  
  Abstract
  
  INTRODUCTION:
  Atherosclerosis causes a chronic reduction of vascularization with consequent impairment of the performance of organs, like the brain or muscles, which determines the functional and cognitive decline of the elderly and their ability to respond to acute stressful condition. Therefore, our aim was to evaluate if ankle brachial index (ABI) could effectively be a determinant of in-hospital functional status and complications in elderly hospitalized patients.
  
  METHODS:
  This is a monocentric cross-sectional study of 189 patients aged 65 years or older. The study was undertaken at the Internal Medicine ward of Niguarda Hospital in Milan. ABI (BOSO ABY-System 100) and in-hospital status (activities of daily living, ADL and instrumental activities of daily living, IADL) were collected on the second day of hospitalization. Complications (falls and delirium episodes) were also recorded during the whole hospitalization period.
  
  RESULTS:
  The average age of patients was 79.3 ± 6.9 years. Among outcomes, only ADL (r = 0.192, p = 0.007) and IADL score (r = 0.200, p = 0.005) showed significant correlation with ABI. Moreover, during the subsequent logistic regression, ABI remained among the statistically significant determinants of both scores (? = 0.231, p = 0.013 and ? = 0.314, p = 0.001, respectively).
  
  CONCLUSIONS:
  The main result of our study is the finding of ABI as a significant determinant of acute in-hospital functional impairment (evaluated as ADL and IADL scores). The continuous exposure of the brain and muscles to the reduced perfusions induced by vascular atherosclerosis, probably determined the reduced ability to respond to stressful conditions.
  
  © 2021 S. Karger AG, Basel.
  
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• Association of uric acid with kidney function and albuminuria: the Uric Acid Right for heArt Health (URRAH) Project.
  J Nephrol

  2022 Jan;35(1):211-221. doi: 10.1007/s40620-021-00985-4.
  
  Russo Elisa, Viazzi Francesca, Pontremoli Roberto, Barbagallo Carlo Maria, Bombelli Michele, Casiglia Edoardo, Cicero Arrigo Francesco Giuseppe, Cirillo Massimo, Cirillo Pietro, Desideri Giovambattista, D'Elia Lanfranco, Ferri Claudio, Galletti Ferruccio, Gesualdo Loreto, Giannattasio Cristina, Iaccarino Guido, Leoncini Giovanna, Mallamaci Francesca, Maloberti Alessandro, Masi Stefano, Mengozzi Alessandro, Mazza Alberto, Muiesan Maria Lorenza, Nazzaro Pietro, Palatini Paolo, Parati Gianfranco, Rattazzi Marcello, Rivasi Giulia, Salvetti Massimo, Tikhonoff Valérie, Tocci Giuliano, Ungar Andrea, Verdecchia Paolo, Virdis Agostino, Volpe Massimo, Grassi Guido, Borghi Claudio,
  
  Abstract
  
  BACKGROUND:
  Hyperuricemia is commonly observed in patients with chronic kidney disease (CKD). However, a better understanding of the relationship among uric acid (UA) values, glomerular filtration rate (GFR) and albuminuria may shed light on the mechanisms underlying the excess of cardiovascular mortality associated with both chronic kidney disease and hyperuricemia and lead to better risk stratification. Our main goal was to study the relationships between serum uric acid and kidney disease measures (namely estimated GFR [eGFR] and albuminuria) in a large cohort of individuals at cardiovascular risk from the URic acid Right for heArt Health (URRAH) Project database.
  
  METHODS:
  Clinical data of 26,971 individuals were analyzed. Factors associated with the presence of hyperuricemia defined on the basis of previously determined URRAH cutoffs for cardiovascular and all-cause mortality were evaluated through multivariate analysis. Chronic kidney disease was defined as eGFR?60 ml/min per 1.73 m and/or abnormal urinary albumin excretion diagnosed as: (i) microalbuminuria if urinary albumin concentration was?>?30 and???300 mg/L, or if urinary albumin-to-creatinine ratio (ACR) was?>?3.4 mg/mmol and???34 mg/mmol; (ii) macroalbuminuria if urinary albumin concentration was?>?300 mg/L, or if ACR was?>?34 mg/mmol.
  
  RESULTS:
  Mean age was 58?±?15 years (51% males, 62% with hypertension and 12% with diabetes), mean eGFR was 81 ml/min per 1.73m2with a prevalence of eGFR?60 and micro- or macroalbuminuria of 16, 15 and 4%, respectively. Serum uric acid showed a trend towards higher values along with decreasing renal function. Both the prevalence of gout and the frequency of allopurinol use increased significantly with the reduction of eGFR and the increase in albuminuria. Hyperuricemia was independently related to male gender, eGFR strata, and signs of insulin resistance such as body mass index (BMI) and triglycerides.
  
  CONCLUSIONS:
  The lower the eGFR the higher the prevalence of hyperuricemia and gout. In subjects with eGFR?60 ml/min the occurrence of hyperuricemia is about 10 times higher than in those with eGFR?>?90 ml/min. The percentage of individuals treated with allopurinol was below 2% when GFR was above 60 ml/min, it increased to 20% in the presence of CKD 3b and rose further to 35% in individuals with macroalbuminuria.
  
  © 2021. The Author(s).
  
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• Protein Intake and Physical Activity in Newly Diagnosed Patients with Acute Coronary Syndrome: A 5-Year Longitudinal Study.
  Nutrients

  2021 Feb;13(2):. doi: 634.
  
  Greco Andrea, Brugnera Agostino, Adorni Roberta, D'Addario Marco, Fattirolli Francesco, Franzelli Cristina, Giannattasio Cristina, Maloberti Alessandro, Zanatta Francesco, Steca Patrizia
  
  Abstract
  
  Cardiovascular disease is one of the most common causes of hospitalization and is associated with high morbidity and mortality rates. Among the most important modifiable and well-known risk factors are an unhealthy diet and sedentary lifestyle. Nevertheless, adherence to healthy lifestyle regimes is poor. The present study examined longitudinal trajectories (pre-event, 6-, 12-, 24-, 36-, and 60-month follow-ups) of protein intake (fish, legumes, red/processed meat) and physical activity in 275 newly-diagnosed patients with acute coronary syndrome. Hierarchical Generalized Linear Models were performed, controlling for demographic and clinical variables, the season in which each assessment was made, and the presence of anxiety and depressive symptoms. Significant changes in protein intake and physical activity were found from pre-event to the six-month follow-up, suggesting the adoption of healthier behaviors. However, soon after the six-month follow-up, patients experienced significant declines in their healthy behaviors. Both physical activity and red/processed meat intake were modulated by the season in which the assessments took place and by anxiety symptoms over time. The negative long-term trajectory of healthy behaviors suggests that tailored interventions are needed that sustain patients' capabilities to self-regulate their behaviors over time and consider patient preference in function of season.
  
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• The importance of including uric acid in the definition of metabolic syndrome when assessing the mortality risk.
  Clin Res Cardiol

  2021 Jul;110(7):1073-1082. doi: 10.1007/s00392-021-01815-0.
  
  Pugliese Nicola Riccardo, Mengozzi Alessandro, Virdis Agostino, Casiglia Edoardo, Tikhonoff Valerie, Cicero Arrigo F G, Ungar Andrea, Rivasi Giulia, Salvetti Massimo, Barbagallo Carlo M, Bombelli Michele, Dell'Oro Raffaella, Bruno Berardino, Lippa Luciano, D'Elia Lanfranco, Verdecchia Paolo, Mallamaci Francesca, Cirillo Massimo, Rattazzi Marcello, Cirillo Pietro, Gesualdo Loreto, Mazza Alberto, Giannattasio Cristina, Maloberti Alessandro, Volpe Massimo, Tocci Giuliano, Georgiopoulos Georgios, Iaccarino Guido, Nazzaro Pietro, Parati Gianfranco, Palatini Paolo, Galletti Ferruccio, Ferri Claudio, Desideri Giovambattista, Viazzi Francesca, Pontremoli Roberto, Muiesan Maria Lorenza, Grassi Guido, Masi Stefano, Borghi Claudio,
  
  Abstract
  
  INTRODUCTION:
  Serum uric acid (SUA) has been depicted as a contributory causal factor in metabolic syndrome (MS), which in turn, portends unfavourable prognosis.
  
  AIM:
  We assessed the prognostic role of SUA in patients with and without MS.
  
  METHODS:
  We used data from the multicentre Uric Acid Right for Heart Health study and considered cardiovascular mortality (CVM) as death due to fatal myocardial infarction, stroke, sudden cardiac death, or heart failure.
  
  RESULTS:
  A total of 9589 subjects (median age 58.5 years, 45% males) were included in the analysis, and 5100 (53%) patients had a final diagnosis of MS. After a median follow-up of 142 months, we observed 558 events. Using a previously validated cardiovascular SUA cut-off to predict CVM (>?5.1 mg/dL in women and 5.6 mg/dL in men), elevated SUA levels were significantly associated to a worse outcome in patients with and without MS (all p?0.0001) and provided a significant net reclassification improvement of 7.1% over the diagnosis of MS for CVM (p?=?0.004). Cox regression analyses identified an independent association between SUA and CVM (Hazard Ratio: 1.79 [95% CI, 1.15-2.79]; p?0.0001) after the adjustment for MS, its single components and renal function. Three specific combinations of the MS components were associated with higher CVM when increasing SUA levels were reported, and systemic hypertension was the only individual component ever-present (all p?0.0001).
  
  CONCLUSION:
  Increasing SUA levels are associated with a higher CVM risk irrespective of the presence of MS: a cardiovascular SUA threshold may improve risk stratification.
  
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• High heart rate amplifies the risk of cardiovascular mortality associated with elevated uric acid.
  Eur J Prev Cardiol

  2021 Feb;():. doi: zwab023.
  
  Palatini Paolo, Parati Gianfranco, Virdis Agostino, Reboldi Gianpaolo, Masi Stefano, Mengozzi Alessandro, Casiglia Edoardo, Tikhonoff Valerie, Cicero Arrigo F G, Ungar Andrea, Rivasi Giulia, Salvetti Massimo, Barbagallo Carlo M, Bombelli Michele, Dell'Oro Raffaella, Bruno Berardino, Lippa Luciano, D'Elia Lanfranco, Verdecchia Paolo, Angeli Fabio, Mallamaci Francesca, Cirillo Massimo, Rattazzi Marcello, Cirillo Pietro, Gesualdo Loreto, Mazza Alberto, Giannattasio Cristina, Maloberti Alessandro, Volpe Massimo, Tocci Giuliano, Georgiopoulos Georgios, Iaccarino Guido, Nazzaro Pietro, Galletti Ferruccio, Ferri Claudio, Desideri Giovambattista, Viazzi Francesca, Pontremoli Roberto, Muiesan Maria Lorenza, Grassi Guido, Borghi Claudio,
  
  Abstract
  
  AIMS:
  Whether the association between uric acid (UA) and cardiovascular disease is influenced by some facilitating factors is unclear. The aim of this study was to investigate whether the risk of cardiovascular mortality (CVM) associated with elevated UA was modulated by the level of resting heart rate (HR).
  
  METHODS AND RESULTS:
  Multivariable Cox analyses were made in 19 128 participants from the multicentre Uric acid Right for heArt Health study. During a median follow-up of 11.2?years, there were 1381 cases of CVM. In multivariable Cox models both UA and HR, either considered as continuous or categorical variables were independent predictors of CVM both improving risk discrimination (P???0.003) and reclassification (P?0.0001) over a multivariable model. However, the risk of CVM related to high UA (?5.5?mg/dL, top tertile) was much lower in the subjects with HR
  CONCLUSION:
  This data suggest that the contribution of UA to determining CVM is modulated by the level of HR supporting the hypothesis that activation of the sympathetic nervous system facilitates the action of UA as a cardiovascular risk factor.
  
  Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: journals.permissions@oup.com.
  
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• Emergent Biosensing Technologies Based on Fluorescence Spectroscopy and Surface Plasmon Resonance.
  Sensors (Basel)

  2021 Jan;21(3):. doi: 906.
  
  Camarca Alessandra, Varriale Antonio, Capo Alessandro, Pennacchio Angela, Calabrese Alessia, Giannattasio Cristina, Murillo Almuzara Carlos, D'Auria Sabato, Staiano Maria
  
  Abstract
  
  The purpose of this work is to provide an exhaustive overview of the emerging biosensor technologies for the detection of analytes of interest for food, environment, security, and health. Over the years, biosensors have acquired increasing importance in a wide range of applications due to synergistic studies of various scientific disciplines, determining their great commercial potential and revealing how nanotechnology and biotechnology can be strictly connected. In the present scenario, biosensors have increased their detection limit and sensitivity unthinkable until a few years ago. The most widely used biosensors are optical-based devices such as surface plasmon resonance (SPR)-based biosensors and fluorescence-based biosensors. Here, we will review them by highlighting how the progress in their design and development could impact our daily life.
  
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• Effects of Environmental Factors on Severity and Mortality of COVID-19.
  Front Med (Lausanne)

  2020 ;7():607786. doi: 607786.
  
  Kifer Domagoj, Bugada Dario, Villar-Garcia Judit, Gudelj Ivan, Menni Cristina, Sudre Carole, Vu?kovi? Frano, Ugrina Ivo, Lorini Luca F, Posso Margarita, Bettinelli Silvia, Ughi Nicola, Maloberti Alessandro, Epis Oscar, Giannattasio Cristina, Rossetti Claudio, Kalogjera Livije, Per?ec Jasminka, Ollivere Luke, Ollivere Benjamin J, Yan Huadong, Cai Ting, Aithal Guruprasad P, Steves Claire J, Kantele Anu, Kajova Mikael, Vapalahti Olli, Sajantila Antti, Wojtowicz Rafal, Wierzba Waldemar, Krol Zbigniew, Zaczynski Artur, Zycinska Katarina, Postula Marek, Luk?i? Ivica, ?ivljak Rok, Markoti? Alemka, Brachmann Johannes, Markl Andreas, Mahnkopf Christian, Murray Benjamin, Ourselin Sebastien, Valdes Ana M, Horcajada Juan P, Castells Xavier, Pascual Julio, Allegri Massimo, Primorac Dragan, Spector Tim D, Barrios Clara, Lauc Gordan
  
  Abstract
  
  Most respiratory viruses show pronounced seasonality, but for SARS-CoV-2, this still needs to be documented. We examined the disease progression of COVID-19 in 6,914 patients admitted to hospitals in Europe and China. In addition, we evaluated progress of disease symptoms in 37,187 individuals reporting symptoms into the COVID Symptom Study application. Meta-analysis of the mortality risk in seven European hospitals estimated odds ratios per 1-day increase in the admission date to be 0.981 (0.973-0.988,
  Copyright © 2021 Kifer, Bugada, Villar-Garcia, Gudelj, Menni, Sudre, Vu?kovi?, Ugrina, Lorini, Posso, Bettinelli, Ughi, Maloberti, Epis, Giannattasio, Rossetti, Kalogjera, Per?ec, Ollivere, Ollivere, Yan, Cai, Aithal, Steves, Kantele, Kajova, Vapalahti, Sajantila, Wojtowicz, Wierzba, Krol, Zaczynski, Zycinska, Postula, Luk?i?, ?ivljak, Markoti?, Brachmann, Markl, Mahnkopf, Murray, Ourselin, Valdes, Horcajada, Castells, Pascual, Allegri, Primorac, Spector, Barrios and Lauc.
  
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• Metabolic syndrome is related to vascular structural alterations but not to functional ones both in hypertensives and healthy subjects.
  Nutr Metab Cardiovasc Dis

  2021 Apr;31(4):1044-1052. doi: 10.1016/j.numecd.2020.11.011.
  
  Maloberti Alessandro, Bombelli Michele, Vallerio Paola, Milani Martina, Cartella Iside, Tavecchia Giovanni, Tognola Chiara, Grasso Enzo, Sun Jinwei, De Chiara Benedetta, Riccobono Salvatore, Grassi Guido, Giannattasio Cristina
  
  Abstract
  
  BACKGROUND AND AIMS:
  Metabolic Syndrome (MS) has been related to an impairment in arterial structural and functional properties with heterogeneous results. In this paper we focused on the effects of MS on arterial carotid-femoral PWV and common carotid IMT in two different populations, one of hypertensive patients and one of healthy controls.
  
  METHODS AND RESULTS:
  We enrolled 816 consecutive HT and 536 healthy controls. Vascular structural (IMT) and functional (PWV) properties were evaluated. NCEP-ATP-III criteria were used for diagnosis of MS. MS was diagnosed in 26.9% and 6.9% in hypertensive and control subjects, respectively. PWV was similar in controls with and without MS (7.7 ± 1.9 vs 7.6 ± 1.1 m/s, p = 0.69), while IMT was higher in controls with than those without MS (0.64 ± 0.18 vs 0.57 ± 0.13 mm, p = 0.02). Hypertensives with MS were older (57.9 ± 12.2 vs 52.7 ± 14.1 years, p 
  CONCLUSIONS:
  the main finding of our work is that MS is a significant determinant of IMT while this is not the case for PWV. This result have been confirmed both in hypertensive subjects and in healthy controls.
  
  Copyright © 2020 The Italian Diabetes Society, 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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• Left atrial volume indexed for height is a new sensitive marker for subclinical cardiac organ damage in female hypertensive patients.
  Hypertens Res

  2021 Jun;44(6):692-699. doi: 10.1038/s41440-021-00614-4.
  
  Airale Lorenzo, Paini Anna, Ianniello Eugenia, Mancusi Costantino, Moreo Antonella, Vaudo Gaetano, Avenatti Eleonora, Salvetti Massimo, Bacchelli Stefano, Izzo Raffaele, Sormani Paola, Arrivi Alessio, Muiesan Maria Lorenza, Esposti Daniela Degli, Giannattasio Cristina, Pucci Giacomo, De Luca Nicola, Milan Alberto,
  
  Abstract
  
  Left atrial enlargement (LAe) is a subclinical marker of hypertensive-mediated organ damage, which is important to identify in cardiovascular risk stratification. Recently, LA indexing for height was suggested as a more accurate marker of defining LAe. Our aim was to test the difference in LAe prevalence using body surface area (BSA) and height definitions in an essential hypertensive population. A total of 441 essential hypertensive patients underwent complete clinical and echocardiographic evaluation. Left atrial volume (LAV), left ventricular morphology, and systolic-diastolic function were evaluated. LAe was twice as prevalent when defined using height (LAe) indexation rather than BSA (LAe) (51% vs. 23%, p?0.001). LAe, but not LAe, was more prevalent in females (p?0.001). Males and females also differed in left ventricular hypertrophy (p?=?0.046) and left ventricular diastolic dysfunction (LVDD) indexes (septal Em/Etdi: p?=?0.009; lateral Em/Etdi: p?=?0.003; mean Em/Etdi: p?0.002). All patients presenting LAe also met the criteria for LAe. According to the presence/absence of LAe, we created three groups (Norm?=?BSA-/h-; DilH?=?BSA-/h+; DilHB = BSA+/h+). The female sex prevalence in the DilH group was higher than that in the other two groups (Norm: p?0.001; DilHB: p?=?0.036). LVH and mean and septal Em/Etdi increased from the Norm to the DilH group and from the DilH to the DilHB group (p?0.05 for all comparisons). These results show that LAe identified twice as many patients as comparing LAe to LAe, but that both LAe and LAe definitions were associated with LVH and LVDD. In female patients, the LAe definition and its sex-specific threshold seem to be more sensitive than LAe in identifying chamber enlargement.
  
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• Effects of intensive urate lowering therapy with febuxostat in comparison with allopurinol on pulse wave velocity in patients with gout and increased cardiovascular risk: the FORWARD study.
  Eur Heart J Cardiovasc Pharmacother

  2022 May;8(3):236-242. doi: 10.1093/ehjcvp/pvaa144.
  
  Desideri Giovambattista, Rajzer Marek, Gerritsen Martijn, Nurmohamed Michael T, Giannattasio Cristina, Tausche Anne-Kathrin, Borghi Claudio
  
  Abstract
  
  AIMS:
  Hyperuricaemia and gout are strongly related with traditional cardiovascular risk factors and vascular damage. This study aimed to assess whether febuxostat and allopurinol could differently influence carotid-femoral pulse wave velocity (cfPWV) in patients with gout and elevated serum uric acid (SUA) levels.
  
  METHODS AND RESULTS:
  A multi-centre, multinational, phase IV, randomized, parallel-group, active-controlled, open-label trial with blind endpoints evaluation. One hundred and ninety-seven adults with gout and SUA levels ?8?mg/dL were randomized to febuxostat or allopurinol in a 1:1 ratio for 36?weeks. The primary outcome was the comparison of the effects of febuxostat and allopurinol on changes in cfPWV. The mean cfPWV values at randomization and Week 36 were 8.69 and 9.00?m/s, respectively for subjects randomized to febuxostat and 9.02 and 9.05?m/s for subjects randomized to allopurinol. No statistically significant changes in cfPWV by treatment assignment were observed at any time point for any of the assessed parameters. More subjects who received febuxostat had serum urate concentrations ?6?mg/dL following treatment (78.3% vs. 61.1% at Week 36, P?=?0.0137). Treatment-emergent adverse events were reported by 51 (52.0%) patients randomized to febuxostat and 63 (62.5%) patients randomized to allopurinol. The majority of events were mild in both treatment groups and included gout flares and arthralgia.
  
  CONCLUSION:
  In patients with gout and elevated SUA levels the arterial stiffness remained stable both with febuxostat and allopurinol. Febuxostat was more effective and faster than allopurinol in achieving the SUA target. Both treatments were safe and well tolerated.
  
  Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021.
  
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• Relationships between diuretic-related hyperuricemia and cardiovascular events: data from the URic acid Right for heArt Health study.
  J Hypertens

  2021 Feb;39(2):333-340. doi: 10.1097/HJH.0000000000002600.
  
  Maloberti Alessandro, Bombelli Michele, Facchetti Rita, Barbagallo Carlo Maria, Bernardino Bruno, Rosei Enrico Agabiti, Casiglia Edoardo, Cicero Arrigo Francesco Giuseppe, Cirillo Massimo, Cirillo Pietro, Desideri Giovambattista, D'elia Lanfranco, Dell'Oro Raffaella, Ferri Claudio, Galletti Ferruccio, Giannattasio Cristina, Loreto Gesualdo, Iaccarino Guido, Lippa Luciano, Mallamaci Francesca, Masi Stefano, Mazza Alberto, Muiesan Maria Lorenza, Nazzaro Pietro, Parati Gianfranco, Palatini Paolo, Pauletto Paolo, Pontremoli Roberto, Quarti-Trevano Fosca, Rattazzi Marcello, Rivasi Giulia, Salvetti Massimo, Tikhonoff Valerie, Tocci Giuliano, Ungar Andrea, Verdecchia Paolo, Viazzi Francesca, Volpe Massimo, Virdis Agostino, Grassi Guido, Borghi Claudio,
  
  Abstract
  
  OBJECTIVE:
  Although the relationship between hyperuricemia and cardiovascular events has been extensively examined, data on the role of diuretic-related hyperuricemia are still scanty. The present study was designed to collect information on the relationship between diuretic-related hyperuricemia and cardiovascular events.
  
  METHODS:
  The URic acid Right for heArt Health (URRAH) study is a nationwide, multicentre, observational cohort study involving data on individuals recruited from all the Italy territory under the patronage of the Italian Society of Hypertension with an average follow-up period of 122.3?±?66.9 months. Patients were classified into four groups according to the diuretic use (yes vs. no) and serum uric acid (SUA) levels (higher vs. lower than the median value of 4.8?mg/dl). All-cause death, cardiovascular deaths and first cardiovascular event were considered as outcomes.
  
  RESULTS:
  Seventeen thousand, seven hundred and forty-seven individuals were included in the analysis. Mean age was 57.1?±?15.2 years, men were 45.3% and SBP and DBP amounted to 144.1?±?24.6 and 85.2?±?13.2?mmHg. 17.2% of individuals take diuretics of whom 58% had SUA higher than median value. Patients with hyperuricemia without diuretic use served as reference group. In multivariate adjusted analysis (sex, age, SBP, BMI, glucose, total cholesterol, and glomerular filtration rate) individuals with hyperuricemia and diuretic use exhibit a similar risk for the three outcomes as compared with the reference group.
  
  CONCLUSION:
  Our study showed that diuretic-related hyperuricemia carry a similar risk of cardiovascular events and all-cause mortality when compared with individuals that present hyperuricemia in absence of diuretic therapy.
  
  Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
  
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• Costs and effects of cardiovascular risk reclassification using the ankle-brachial index (ABI) in addition to the Framingham risk scoring in women.
  Atherosclerosis

  2021 Jan;317():59-66. doi: 10.1016/j.atherosclerosis.2020.11.004.
  
  Cortesi Paolo Angelo, Maloberti Alessandro, Micale Mariangela, Pagliarin Federica, Antonazzo Ippazio Cosimo, Mazzaglia Giampiero, Giannattasio Cristina, Mantovani Lorenzo Giovanni
  
  Abstract
  
  BACKGROUND AND AIMS:
  Ankle brachial index (ABI) is a simple and cheap parameter to assess the presence of atherosclerosis. It could also help correctly reclassify the cardiovascular risk when added to the Framingham risk score (FRS). Recent evidence has demonstrated improvement in prediction performance of ABI when added to FRS, particularly in women. However, no studies have been published yet evaluating the cost-effectiveness of this approach. This study attempts to fill in this gap by assessing the cost-effectiveness of ABI measurements in primary prevention in women.
  
  METHODS:
  We developed a Markov model to compare two different strategies for assessing the cardiovascular risk (low, intermediate and high) among women in the general population: 1) FRS strategy, and 2) FRS + ABI strategy; and the relative impact associated with interventions for preventing CV events in intermediate and high-risk categories.
  
  RESULTS:
  In the base-case analysis, FRS + ABI reported an additional cost of ? 110 and a gain of 0.0039 QALYs per patient, resulting in an ICER of ? 27.986/QALY, when compared to FRS alone. The ICER improved to ?1.641/QALY when using a lifetime horizon. The effectiveness of preventive CV disease interventions reported also a significant impact. A 32% reduction of CV events was the minimum value estimated to maintain FRS + ABI as a cost-effective strategy.
  
  CONCLUSIONS:
  The addition of ABI to FRS is a cost-effective approach in women classified at low and intermediate risk with FRS only. This new approach gives the possibility to reclassify and allocate them into the appropriate risk group and treatment.
  
  Copyright © 2020 Elsevier B.V. All rights reserved.
  
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• Determinants of healing among patients with coronavirus disease 2019: the results of the SARS-RAS study of the Italian Society of Hypertension.
  J Hypertens

  2021 Feb;39(2):376-380. doi: 10.1097/HJH.0000000000002666.
  
  Mancusi Costantino, Grassi Guido, Borghi Claudio, Carugo Stefano, Fallo Francesco, Ferri Claudio, Giannattasio Cristina, Grassi Davide, Letizia Claudio, Minuz Pietro, Muiesan Maria Lorenza, Perlini Stefano, Pucci Giacomo, Rizzoni Damiano, Salvetti Massimo, Sarzani Riccardo, Sechi Leonardo, Veglio Franco, Volpe Massimo, Iaccarino Guido,
  
  Abstract
  
  OBJECTIVE:
  The burst of COVID-19 epidemics in Italy prompted the Italian Society of Hypertension to start an observational study to explore the characteristics of the hospitalized victims of the disease. The current analysis aimed to investigate the predictors of healing among Italian COVID-19 patients. We also assessed the effect of angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers on the outcome.
  
  METHODS:
  We designed a cross-sectional, observational, multicenter, nationwide survey in Italy to explore the demographic and clinical characteristics of patients with confirmed COVID-19 infection. We analyzed information from 2446 charts of Italian patients admitted for certified COVID-19 in 27 hospitals. Healing from COVID-19 infection, defined as two consecutive negative swabs, was reported in 544 patients (22.2%), 95% of them were hospitalized.
  
  RESULTS:
  Age and Charlson Comorbidity Index were significantly lower in healing compared with nonhealing patients (63?±?15 vs. 69?±?15 and 2?±?2 vs. 3?±?2, both P?0.05). In multivariable regression model, predictors of healing were younger age (OR: 0.99; 95% CI 0.98-0.99, P?=?0.0001), absence of chronic kidney disease (OR: 0.35; 95% CI 0.17-0.70, P?=?0.003) or heart failure (OR: 0.44; 95% CI, 0.28-0.70, P?=?0.001). In the subgroup of patients suffering from hypertension and/or heart failure (n?=?1498), no differences were observed in the use of ACE inhibitors and angiotensin receptor blockers.
  
  CONCLUSION:
  Our study demonstrated that younger age and absence of comorbidities play a major role in determining healing in patients with COVID-19. No effects of ACE inhibitors and angiotensin receptor blockers on the outcome was reported.
  
  Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
  
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• Nutraceuticals in Chronic Coronary Syndromes: Preclinical Data and Translational Experiences.
  High Blood Press Cardiovasc Prev

  2021 Jan;28(1):13-25. doi: 10.1007/s40292-020-00416-8.
  
  Tognola Chiara, Alessandro Maloberti, Milani Martina, Cartella Iside, Tavecchia Giovanni, Grasso Enzo, Sun Jinwey, Giannattasio Cristina
  
  Abstract
  
  Non-pharmacological treatments have always been considered important in the management of Chronic Coronary Syndromes. Nutraceuticals ("Nutrition" + "Pharmaceutical") could fall both under the definition of non-pharmacological treatment and pharmacological one or, probably more correctly, in the middle of these two kinds of therapies. However, the word "nutraceuticals" never appears in the latest guidelines on this issue. This is probably determined by the fact that evidences on this topic are scarce and most of the published articles are based on preclinical data while translational experiences are available only for some molecules. In this review we will focus on nutraceutical strategies that act on the ischemic myocardium itself and not only on the cardiovascular risk factors. As demonstrated by the important number of papers published in recent years, this is an evolving topic and evaluated substances principally act on two mechanisms (cardiac energetics and ischemia-reperfusion damage) that will be also reviewed.
  
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• Gender differences in predictors of intensive care units admission among COVID-19 patients: The results of the SARS-RAS study of the Italian Society of Hypertension.
  PLoS One

  2020 ;15(10):e0237297. doi: e0237297.
  
  Iaccarino Guido, Grassi Guido, Borghi Claudio, Carugo Stefano, Fallo Francesco, Ferri Claudio, Giannattasio Cristina, Grassi Davide, Letizia Claudio, Mancusi Costantino, Minuz Pietro, Perlini Stefano, Pucci Giacomo, Rizzoni Damiano, Salvetti Massimo, Sarzani Riccardo, Sechi Leonardo, Veglio Franco, Volpe Massimo, Muiesan Maria Lorenza,
  
  Abstract
  
  BACKGROUND:
  The global rate of intensive care unit (ICU) admission during the COVID-19 pandemic varies within countries and is among the main challenges for health care systems worldwide. Conflicting results have been reported about the response to coronavirus infection and COVID-19 outcomes in men and women. Understanding predictors of intensive care unit admission might be of help for future planning and management of the disease.
  
  METHODS AND FINDINGS:
  We designed a cross-sectional observational multicenter nationwide survey in Italy to understand gender-related clinical predictors of ICU admission in patients with COVID-19. We analyzed information from 2378 charts of Italian patients certified for COVID-19 admitted in 26 hospitals. Three hundred ninety-five patients (16.6%) required ICU admission due to COVID19 infection, more frequently men (74%), with a higher prevalence of comorbidities (1,78±0,06 vs 1,54±0,03 p
  CONCLUSIONS:
  Our study demonstrates that gender is the primary determinant of the disease's severity among COVID-19. Obesity is the condition more often observed among those admitted to ICU within both genders.
  
  TRIAL REGISTRATION:
  Clinicaltrials.gov: NCT04331574.
  
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• Hyperuricemia prevalence in healthy subjects and its relationship with cardiovascular target organ damage.
  Nutr Metab Cardiovasc Dis

  2021 Jan;31(1):178-185. doi: 10.1016/j.numecd.2020.08.015.
  
  Maloberti Alessandro, Qualliu Esmerilda, Occhi Lucia, Sun Jinwei, Grasso Enzo, Tognola Chiara, Tavecchia Giovanni, Cartella Iside, Milani Martina, Vallerio Paola, Signorini Stefano, Brambilla Paolo, Casati Marco, Bombelli Michele, Grassi Guido, Giannattasio Cristina
  
  Abstract
  
  BACKGROUND AND AIM:
  Heterogeneous results have been obtained in the relationship between Uric Acid (UA) and Target Organ Damage (TOD). In the present study we sought to assess the prevalence of hyperuricemia in healthy subjects as well as the role of UA in determining TOD. We evaluated vascular, cardiac and renal TODs in the whole population as well as sub-grouped by gender.
  
  METHODS AND RESULTS:
  As many as 379 blood donors participated at the present analysis. TOD was evaluated as Pulse Wave Velocity (PWV), Left Ventricular Mass Index (LVMI) and carotid Intima-Media Thickness (IMT). Hyperuricemia was defined with the classic cut-off (>7.0 in men and >6.0 mg/dL in women) but also with a most recently defined one (5.6 mg/dL for both sex). Hyperuricemia was present in 6.3% of the whole population (7.3% males, 2.8% females) considering the classic cut-off, while, with the recently identified one, it was present in 28.2% of the whole population (37.3% males, 4.7% females). Despite all the evaluated TODs significantly correlated with UA, linear multivariate regression analysis showed that none of them, except for GFR, displayed UA as a significant covariate. Similar figures were found also when both correlation and linear regression analyses were repeated in the two genders separately.
  
  CONCLUSIONS:
  Hyperuricemia is an important problem also in healthy subjects and its prevalence could further increase if lower cut-off will be used. In this specific population UA is significantly associated with renal impairment while this was not the case for cardiac and vascular damage.
  
  Copyright © 2020 The Italian Diabetes Society, 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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• Predictors of medium- and long-term mortality in elderly patients with acute pulmonary embolism.
  Heliyon

  2020 Sep;6(9):e04857. doi: e04857.
  
  Polo Friz Hernan, Orenti Annalisa, Gelfi Elia, Motto Elena, Primitz Laura, Cavalieri d'Oro Luca, Giannattasio Cristina, Vighi Giuseppe, Cimminiello Claudio, Boracchi Patrizia
  
  Abstract
  
  INTRODUCTION:
  Data on medium- and long-term prognostic factors for death in elderly patients with acute Pulmonary Embolism (APE) are lacking. The present study aimed to assess sPESI score and the Charlson Comorbidity Index (CCI) as medium- and long-term predictors of mortality in elderly patients with haemodinamically stable APE.
  
  METHODS:
  All consecutive patients aged?65 years old, evaluated at the emergency department (ED) of our hospital from 2010 through 2014, with a final diagnosis of APE, were included in this retrospective cohort study.
  
  RESULTS:
  Study population:162 patients, female:36.5%, median age:79 years old, 74% presented a sPESI score>0, and 61% a CCI? 1. All causes mortality: 19.8%, 23.5%, 26.5%, 32.1% and 48.2% at 3, 6 months, 1, 2 and 5 years after APE. Univariate regression analysis: CCI?1 was associated with a higher mortality at 3, 6 months, 1, 2 and 5 years. Multivariate Cox analysis: CCI?1 associated with increased mortality at 3 months (HR:4.29; IC95%:1.46-12.59), 6 months (HR:5.33; IC95%:1.84-15.44), 1 year (HR:4.87; IC95%:1.87-12.70), 2 years (HR:3.78; IC95%:1.74-8.25), and 5 years (HR:2.30; IC95%:1.33-3.99). sPESI score?1 was not found to be related to an increased medium-or long-term mortality. Negative predictive values (IC95%) of CCI?1 were 93.65% (87.61-99.69), 93.65% (87.61-99.69), 92.06% (85.37-98.76), 87.3% (79.05-95.55) and 71.61% (60.13-83.1) for mortality at 3, 6 months, 1, 2 and 5 years.
  
  CONCLUSION:
  In elderly patients with a confirmed normotensive APE, unlike sPESI score, CCI showed to be an independent prognostic factor for medium- and long-term mortality. In these patients, after the acute phase following a PE event, the assessment of the comorbidities burden represents the most appropriate approach for predicting medium- and long-term mortality.
  
  © 2020 The Author(s).
  
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• Impact of admission serum acid uric levels on in-hospital outcomes in patients with acute coronary syndrome.
  Eur J Intern Med

  2020 Dec;82():62-67. doi: 10.1016/j.ejim.2020.07.013.
  
  Centola Marco, Maloberti Alessandro, Castini Diego, Persampieri Simone, Sabatelli Ludovico, Ferrante Giulia, Lucreziotti Stefano, Morici Nuccia, Sacco Alice, Oliva Fabrizio, Rebora Paola, Giannattasio Cristina, Mafrici Antonio, Carugo Stefano
  
  Abstract
  
  BACKGROUND:
  To assess the association between admission serum uric acid (SUA) levels and in-hospital outcomes in a real-world patients population with acute coronary syndrome (ACS) and to investigate the potential incremental prognostic value of SUA added to GRACE score (GRACE-SUA score).
  
  METHODS:
  The data of consecutive ACS patients admitted to Coronary Care Unit of San Paolo and Niguarda hospitals in Milan (Italy) were retrospectively analyzed.
  
  RESULTS:
  1088 patients (24% female) were enrolled. Mean age was 68 years (IQR 60-78). STEMI and NSTE-ACS patients were 504 (46%) and 584 (54%) respectively. SUA (OR 1.72 95%CI 1.33-2.22, p 
  CONCLUSIONS:
  High admission levels of SUA are independently associated with in-hospital adverse outcomes and mortality in a contemporary population of ACS patients. The inclusion of SUA to GRACE risk score seems to lead to a more accurate prediction of in-hospital mortality in this study population.
  
  Copyright © 2020 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
  
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• Serum uric acid, predicts heart failure in a large Italian cohort: search for a cut-off value the URic acid Right for heArt Health study.
  J Hypertens

  2021 Jan;39(1):62-69. doi: 10.1097/HJH.0000000000002589.
  
  Muiesan Maria L, Salvetti Massimo, Virdis Agostino, Masi Stefano, Casiglia Edoardo, Tikhonoff Valérie, Barbagallo Carlo M, Bombelli Michele, Cicero Arrigo F G, Cirillo Massimo, Cirillo Pietro, Desideri Giovambattista, D'Eliak Lanfranco, Ferri Claudio, Galletti Ferruccio, Gesualdo Loreto, Giannattasio Cristina, Iaccarino Guido, Mallamaci Francesca, Maloberti Alessandro, Mazza Alberto, Nazzaro Pietro, Palatini Paolo, Parati Gianfranco, Pontremoli Roberto, Rattazzi Marcello, Rivasi Giulia, Tocci Giuliano, Ungar Andrea, Verdecchia Paolo, Viazzi Francesca, Volpe Massimo, Grassi Guido, Borghi Claudio,
  
  Abstract
  
  OBJECTIVE:
  To assess the prognostic cut-off values of serum uric acid (SUA) in predicting fatal and morbid heart failure in a large Italian cohort in the frame of the Working Group on Uric Acid and Cardiovascular Risk of the Italian Society of Hypertension.
  
  METHODS:
  The URic acid Right for heArt Health (URRAH) study is a nationwide, multicentre, cohort study involving data on individuals aged 18-95 years, recruited on a community basis from all regions of Italy under the patronage of the Italian Society of Hypertension with a mean follow-up period of 128?±?65 months. Incident heart failure was defined on the basis of International Classification of Diseases Tenth Revision codes and double-checked with general practitioners and hospital files. Multivariate Cox regression models having fatal and morbid heart failure as dependent variables, adjusted for sex, age, SBP, diabetes, estimated glomerular filtration rate, smoking habit, ethanol intake, BMI, haematocrit, LDL cholesterol, previous diagnosis of heart failure and use of diuretics as possible confounders, were used to search for an association between SUA as a continuous variable and heart failure. By means of receiver operating characteristic curves, two prognostic cut-off values (one for all heart failure and one for fatal heart failure) were identified as able to discriminate between individuals doomed to develop the event. These cut-off values were used as independent predictors to divide individuals according to prognostic cut-off values in a multivariate Cox models, adjusted for confounders.
  
  RESULTS:
  A total of 21?386 individuals were included in the analysis. In Cox analyses, SUA as a continuous variable was a significant predictor of all [hazard ratio 1.29 (1.23-1.359), P?0.0001] and fatal [hazard ratio 1.268 (1.121-1.35), P?0.0001] incident heart failure. Cut-off values of SUA able to discriminate all and fatal heart failure status were identified by mean of receiver operating characteristic curves in the whole database: SUA more than 5.34?mg/dl (confidence interval 4.37-5.6, sensitivity 52.32, specificity 63.96, P?0.0001) was the univariate prognostic cut-off value for all heart failure, whereas SUA more than 4.89?mg/dl (confidence interval 4.78-5.78, sensitivity 68.29, specificity 49.11, P?0.0001) for fatal heart failure. The cut-off for all heart failure and the cut-off value for fatal heart failure were accepted as independent predictors in the Cox analysis models, the hazard ratios being 1.645 (1.284-2.109, P?0.0001) for all heart failure and 1.645 (1.284-2.109, P?0.0001) for fatal heart failure, respectively.
  
  CONCLUSION:
  The results of the current study confirm that SUA is an independent risk factor for all heart failure and fatal heart failure, after adjusting for potential confounding variables and demonstrate that a prognostic cut-off value can be identified for all heart failure (>5.34?mg/dl) and for fatal heart failure (>4.89?mg/dl).
  
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• Thoracic radiotherapy as a risk factor for heart ischemia in subjects treated with chest irradiation and chemotherapy and without classic cardiovascular RISK factors.
  Radiother Oncol

  2020 Nov;152():146-150. doi: 10.1016/j.radonc.2020.07.004.
  
  Vallerio Paola, Maloberti Alessandro, Palazzini Matteo, Occhi Lucia, Peretti Alessio, Nava Stefano, Soriano Francesco, Musca Francesco, De Chiara Benedetta, Belli Oriana, Moreo Antonella, Bisceglia Irma, Lestuzzi Chiara, Giannattasio Cristina
  
  Abstract
  
  BACKGROUND AND PURPOSE:
  Radiation Induced Heart Disease (RIHD) represents a late effect of chest irradiation, contributing in increasing mortality rate in oncological patients by affecting pericardium, myocardium, valvs and coronaries. Currently, regarding the risk of Coronary Artery Disease (CAD), a cardiological screening involving exercise stress electrocardiography after 5-10 years from radiotherapy is advised. We sought to determine the rate of ischemia at exercise stress electrocardiography in a population of patients without cardiovascular risk factors who sustained radiotherapy, using a cohort of patients presenting with at least one cardiovascular risk factor as control group.
  
  DESIGN AND METHODS:
  A population of 115 patients who sustained chest irradiation (and associated chemotherapy), presenting without classic cardiovascular risk factors or typical symptoms suggesting CAD, was evaluated with exercise stress electrocardiography. 135 patients with at least one risk factor for cardiovascular disease candidate to stress testing for primary prevention or for atypical symptoms served as control group.
  
  RESULTS:
  The cohort of irradiated patients without classical cardiovascular risk factors is younger (48.7 ± 10.1 vs 60.5 ± 10.8 years, p 
  CONCLUSIONS:
  Chest irradiation represents a strong cardiovascular risk factor. In fact, prevalence of positive ECG-stress test is not different (nor higher and nor lower) in irradiated subjects without cardiovascular risk and not irradiated patients with classic cardiovascular risk.
  
  Copyright © 2020 Elsevier B.V. All rights reserved.
  
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• Long-Term Risk of Major Adverse Cardiovascular Events in Patients With Acute Coronary Syndrome: Prognostic Role of Complete Blood Cell Count.
  Angiology

  2020 Oct;71(9):831-839. doi: 10.1177/0003319720938619.
  
  Morici Nuccia, Molinari Valentina, Cantoni Silvia, Rubboli Andrea, Antolini Laura, Sacco Alice, Cattaneo Marco, Alicandro Gianfranco, Oreglia Jacopo A, Oliva Fabrizio, Giannattasio Cristina, Brunelli Dario, La Vecchia Carlo, Valgimigli Marco, Savonitto Stefano
  
  Abstract
  
  Individual parameters of complete blood count (CBC) have been associated with worse outcome in patients with acute coronary syndrome (ACS). However, the prognostic role of CBC taken as a whole has never been evaluated for long-term incidence of major adverse cardiovascular events (MACEs). Patients were grouped according to their hematopoietic cells' inflammatory response at different time points during hospital stay. Patients with admission white blood cell count >10 × 10/L, discharge hemoglobin 250 × 10/L were defined as "high-risk CBC." Among 1076 patients with ACS discharged alive, 129 (12%) had a "high-risk CBC" and 947 (88%) had a "low-risk CBC." Patients with "high-risk CBC" were older and had more comorbidities. Over a median follow-up of 665 days, they experienced a higher incidence of MACE compared to "low-risk CBC" patients (18.6% vs 8.1%). After adjustment for age, age-adjusted Charlson comorbidity index, female sex, cardiac arrest, suboptimal discharge therapy, coronary artery bypass, and ejection fraction, a high-risk CBC was significantly associated with increased MACE occurrence (adjusted hazard ratio 1.80; 95% CI: 1.09-3.00). The CBC was a prognostic marker in patients with ACS, and its evaluation at admission and discharge could better classify patient's risk and improve therapeutic management.
  
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• What hypertensive patients want to know [and from whom] about their disease: a two-year longitudinal study.
  BMC Public Health

  2020 Mar;20(1):308. doi: 308.
  
  Cappelletti Erika R, Greco Andrea, Maloberti Alessandro, Giannattasio Cristina, Steca Patrizia, D'Addario Marco
  
  Abstract
  
  BACKGROUND:
  This study explored both the evolution of the information needs and the perceived relevance of different health information sources in patients with essential hypertension. It also investigated the relationships between information needs and the perceived relevance of information sources with socio-demographic and clinical variables.
  
  METHODS:
  Two hundred and two patients with essential arterial hypertension were enrolled in the study and evaluated at baseline and during three follow-ups at 6, 12 and 24?months after baseline. Patients had a mean age of 54.3?years [range 21-78; SD?=?10.4], and 43% were women. Repeated measures ANOVA, Bonferroni post hoc tests, and Cochran's Q Test were performed to test differences in variables of interest over time.
  
  RESULTS:
  It was observed a significant reduction in all the domains of information needs related to disease management except for pharmacological treatment and risks and complications. At baseline, patients reported receiving health information primarily from specialists, general practitioners, relatives, and television, but the use of these sources decreased over time, even if the decrease was significant only for relatives. Multiple patterns of relationships were found between information needs and the perceived relevance of sources of information and socio-demographics and clinical variables, both at baseline and over time.
  
  CONCLUSIONS:
  The findings showed a general decrease in both the desire for information and the perceived relevance of different information sources. Hypertensive patients appeared to show little interest in health communication topics as their disease progressed. Understanding patients' information needs and the perceived relevance of different information sources is the first step in implementing tailored communication strategies that can promote patients' self-management skills and optimal clinical outcomes.
  
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• Association between uric acid and pulse wave velocity in hypertensive patients and in the general population: a systematic review and meta-analysis.
  Blood Press

  2020 Aug;29(4):220-231. doi: 10.1080/08037051.2020.1735929.
  
  Rebora Paola, Andreano Anita, Triglione Nicola, Piccinelli Enrico, Palazzini Matteo, Occhi Lucia, Grassi Guido, Valsecchi Maria Grazia, Giannattasio Cristina, Maloberti Alessandro
  
  Abstract
  
  The association between serum uric acid (SUA) and pulse wave velocity (PWV), has been extensively evaluated but with some discrepancies in results. A further limitation refers to the fact that only few data were analyzed taking into account the possible effects of gender. The purpose of this study was to estimate the association between SUA and arterial stiffness in general population and hypertensive patients, as a whole population and as divided by gender, by pooling results from existing studies. Carotid-femoral and brachial-ankle PWV (cf- and ba-PWV) have been analyzed separately and subgroup analyses by gender are reported. Among 692 potentially relevant works, 24 articles were analyzed. Seven studies referred to cf-PWV in the general population with an overall positive association at adjusted analysis for both males and females (beta regression coefficient (ß): 0.07; 95%CI: 0.03; 0.11 and ß: 0.06; 95%CI: 0.03; 0.09, respectively). Twelve studies referred to ba-PWV in the general population with the finding of a positive association at adjusted analysis for females (ß: 0.04; 95% confidence interval (CI): 0.01;0.07), but not for males (ß: 0.13; 95%CI: -0.09; 0.34). In hypertensive patients only four studies evaluated cf-PWV and one ba-PWV with only one study (with cf-PWV) finding positive association. The association between SUA and cf-PWV resulted significant in general population in both males and females while it was only significant for female regarding ba-PWV. Furthermore, the few available studies found no significant relationship between SUA and both cf- and ba-PWV in hypertensive subjects.
  
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• Identification of the Uric Acid Thresholds Predicting an Increased Total and Cardiovascular Mortality Over 20 Years.
  Hypertension

  2020 Feb;75(2):302-308. doi: 10.1161/HYPERTENSIONAHA.119.13643.
  
  Virdis Agostino, Masi Stefano, Casiglia Edoardo, Tikhonoff Valerie, Cicero Arrigo F G, Ungar Andrea, Rivasi Giulia, Salvetti Massimo, Barbagallo Carlo M, Bombelli Michele, Dell'Oro Raffaella, Bruno Berardino, Lippa Luciano, D'Elia Lanfranco, Verdecchia Paolo, Mallamaci Francesca, Cirillo Massimo, Rattazzi Marcello, Cirillo Pietro, Gesualdo Loreto, Mazza Alberto, Giannattasio Cristina, Maloberti Alessandro, Volpe Massimo, Tocci Giuliano, Georgiopoulos Georgios, Iaccarino Guido, Nazzaro Pietro, Parati Gianfranco, Palatini Paolo, Galletti Ferruccio, Ferri Claudio, Desideri Giovambattista, Viazzi Francesca, Pontremoli Roberto, Muiesan Maria Lorenza, Grassi Guido, Borghi Claudio,
  
  Abstract
  
  Serum uric acid (SUA) levels discriminating across the different strata of cardiovascular risk is still unknown. By utilizing a large population-based database, we assessed the threshold of SUA that increases the risk of total mortality and cardiovascular mortality (CVM). The URRAH study (Uric Acid Right for Heart Health) is a multicentre retrospective, observational study, which collected data from several large population-based longitudinal studies in Italy and subjects recruited in the hypertension clinics of the Italian Society of Hypertension. Total mortality was defined as mortality for any cause, CVM as death due to fatal myocardial infarction, stroke, sudden cardiac death, or heart failure. A total of 22 714 subjects were included in the analysis. Multivariate Cox regression analyses identified an independent association between SUA and total mortality (hazard ratio, 1.53 [95% CI, 1.21-1.93]) or CVM (hazard ratio, 2.08 [95% CI, 1.146-2.97];
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• Usefulness of Cardiac Magnetic Resonance for Recurrent Pericarditis.
  Am J Cardiol

  2020 Jan;125(1):146-151. doi: 10.1016/j.amjcard.2019.09.026.
  
  Imazio Massimo, Pivetta Emanuele, Palacio Restrepo Sara, Sormani Paola, Pedrotti Patrizia, Quarta Giovanni, Brucato Antonio, Bubbico Elisa, Dal Corso Maria, Milazzo Angela, Quattrocchi Giuseppina, Andriani Monica, Lobetti Bodoni Luisa, Davini Ottavio, Sironi Sandro, Giannattasio Cristina, Giustetto Carla, Bogaert Jan, Adler Yehuda, Bucciarelli Ducci Chiara, De Ferrari Gaetano Maria
  
  Abstract
  
  Cardiac magnetic resonance (CMR) offers the capability to objectively detect pericarditis by identifying pericardial thickening, edema/inflammation by Short-TI Inversion Recovery-T2 weighted (STIR-T2w) imaging, edema/inflammation or fibrosis by late gadolinium enhancement (LGE), and presence of pericardial effusion. This is especially helpful for the diagnosis of recurrent pericarditis. Aim of the present paper is to assess the diagnostic accuracy of CMR findings as well as their potential prognostic value for the diagnosis of recurrent pericarditis. Multicenter cohort study of consecutive patients with recurrent pericarditis evaluated by CMR. We included 128 consecutive cases (60 males, 47%; mean age 48 ± 14 years). CMR was performed at a mean time of 12 days (95% confidence interval 15 to 21) after the clinical diagnosis. We evaluated the diagnostic accuracy and areas under the receiver operating characteristic (ROC) curve for CMR diagnostic criteria and complications (additional recurrences, cardiac tamponade, and constrictive pericarditis). Areas under the ROC curve were respectively 64% for pericardial thickening, 84% for pericardial edema, 82% for pericardial LGE, and 71% for pericardial effusion. After a mean follow-up of 34 months, recurrences occurred in 52% of patients, tamponade in 6%, and constrictive pericarditis in 11%. Using a multivariable Cox model, elevation of CRP and presence of CMR pericardial thickening were predictors of adverse events, whereas the presence of CMR LGE was associated with a lower risk. The prognostic model for adverse events using gender, age, CRP level, and all CMR variables showed a C-index of 0.84. In conclusion, CMR findings show high diagnostic accuracy and may help identifying patients at higher risk of complications.
  
  Copyright © 2019 Elsevier Inc. All rights reserved.
  
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• Short and long-term mortality in elderly patients with suspected not confirmed pulmonary embolism.
  Eur J Intern Med

  2020 Mar;73():36-42. doi: 10.1016/j.ejim.2019.10.024.
  
  Polo Friz Hernan, Orenti Annalisa, Brambilla Mattia, Caleffi Alessandro, Pezzetti Valentina, Cavalieri d'Oro Luca, Giannattasio Cristina, Vighi Giuseppe, Cimminiello Claudio, Boracchi Patrizia
  
  Abstract
  
  INTRODUCTION:
  Most patients evaluated for suspected pulmonary embolism(PE) conclude the Emergency Department(ED) work-up with a diagnosis of PE not confirmed(PE excluded;PE-E). We aimed to investigate the clinical features, short and long-term mortality, and prognostic factors for death in elderly with PE-E, and to compare these figures with those of patients with PE confirmed(PE-C).
  
  METHODS:
  Consecutive patients ?65 years old evaluated in the ED for clinically suspected hemodynamically stable acute PE were included in this retrospective cohort study.
  
  RESULTS:
  Study population: 657 patients with suspected PE, PE-C:162(24.65%). When compared with PE-C, patients with PE-E presented a higher prevalence of chronic cardiopulmonary disease (17.37% vs 8.02%, p?=?0.003), a lower prevalence of pulse rate >110 (13.13% vs 25.93%; p0 was associated with higher short and long-term mortality (30-day:HR:5.31,p?=?0.029; 5 year:HR:2.18, p 0) only with higher long-term mortality (30-day: HR:1.60, p?=?0.342; 5 year: HR:1.41, p?=?0.038).
  
  CONCLUSION:
  In real world haemodinamically stable elderly patients evaluated in the ED for suspected PE, short and long-term mortality was markedly high regardless whether PE was confirmed or excluded. At the time to set management and follow up strategies, elderly patients with PE excluded should not be considered a low-risk population.
  
  Copyright © 2019 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
  
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• Serum uric acid and fatal myocardial infarction: detection of prognostic cut-off values: The URRAH (Uric Acid Right for Heart Health) study.
  J Hypertens

  2020 Mar;38(3):412-419. doi: 10.1097/HJH.0000000000002287.
  
  Casiglia Edoardo, Tikhonoff Valérie, Virdis Agostino, Masi Stefano, Barbagallo Carlo M, Bombelli Michele, Bruno Bernardino, Cicero Arrigo F G, Cirillo Massimo, Cirillo Pietro, Desideri Giovambattista, D'Elia Lanfranco, Ferri Claudio, Galletti Ferruccio, Gesualdo Loreto, Giannattasio Cristina, Iaccarino Guido, Lippa Luciano, Mallamaci Francesca, Maloberti Alessandro, Mazza Alberto, Muiesan Maria Lorenza, Nazzaro Pietro, Palatini Paolo, Parati Gianfranco, Pontremoli Roberto, Quarti-Trevano Fosca, Rattazzi Marcello, Rivasi Giulia, Salvetti Massimo, Tocci Giuliano, Ungar Andrea, Verdecchia Paolo, Viazzi Francesca, Volpe Massimo, Grassi Guido, Borghi Claudio,
  
  Abstract
  
  OBJECTIVE:
  The Working Group on Uric Acid and Cardiovascular Risk of the Italian Society of Hypertension conceived and designed an ad-hoc study aimed at searching for prognostic cut-off values of serum uric acid (SUA) in predicting fatal myocardial infaction (MI) in women and men.
  
  METHODS:
  The URic acid Right for heArt Health study is a nationwide, multicentre, observational cohort study involving data on individuals aged 18-95 years recruited on a regional community basis from all the territory of Italy under the patronage of the Italian Society of Hypertension with a mean follow-up period of 122.3?±?66.9 months.
  
  RESULTS:
  A total of 23?467 individuals were included in the analysis. Cut-off values of SUA able to discriminate MI status were identified by mean of receiver operating characteristic curves in the whole database (>5.70?mg/dl), in women (>5.26?mg/dl) and in men (>5.49?mg/dl). Multivariate Cox regression analyses adjusted for confounders (age, arterial hypertension, diabetes, chronic kidney disease, smoking habit, ethanol intake, BMI, haematocrit, LDL cholesterol and use of diuretics) identified an independent association between SUA and fatal MI in the whole database (hazard ratio 1.381, 95% confidence intervals, 1.096-1.758, P?=?0.006) and in women (hazard ratio 1.514, confidence intervals 1.105-2.075, P?0.01), but not in men.
  
  CONCLUSION:
  The results of the current study confirm that SUA is an independent risk factor for fatal MI after adjusting for potential confounding variables, and demonstrate that a prognostic cut-off value associated to fatal MI can be identified at least in women.
  
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• Getting to the heart of the matter in a multisystem disorder: Erdheim-Chester disease.
  Lancet

  2019 Aug;394(10198):e19. doi: 10.1016/S0140-6736(19)31787-8.
  
  Buono Andrea, Bassi Ilaria, Santolamazza Caterina, Moreo Antonella, Pedrotti Patrizia, Sacco Alice, Morici Nuccia, Giannattasio Cristina, Oliva Fabrizio, Ammirati Enrico
  
  
  
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• Cardiovascular Remodeling after Endovascular Treatment for Thoracic Aortic Injury.
  Ann Vasc Surg

  2019 Nov;61():134-141. doi: 10.1016/j.avsg.2019.04.015.
  
  Vallerio Paola, Maloberti Alessandro, D'Alessio Ilenia, Lista Alfredo, Varrenti Marisa, Castelnuovo Samuela, Marone Matteo, Piccinelli Enrico, Grassi Guido, Palmieri Bruno, Giannattasio Cristina
  
  Abstract
  
  BACKGROUND:
  Thoracic endovascular aortic repair (TEVAR) currently represents the gold standard of treatment for thoracic aortic injury (TAI). Nevertheless, there is an ongoing debate surrounding its safety and subsequent cardiovascular effects. Our aim is to assess heart and vascular structure and function remodeling after TEVAR in TAI young patients.
  
  METHODS:
  We evaluated 20 patients (18 men, age 41 ± 14 years, 11 treated with Gore CTAG, 9 with Medtronic Valiant) with office and 24-hr blood pressure (BP) with specific vascular stiffness analysis (Mobil-O-Graph), aortic diameters (computed tomography scan) and left ventricular mass index (LVMI echocardiogram). Evaluation was done after a median time of 5.0 ± 3.5 years from the trauma.
  
  RESULTS:
  After TAI 12 patients (55%) developed hypertension. When patients were divided according to treating time, those treated for more than 3 years show higher LVMI, PWV, and ascending aorta dilatation.
  
  CONCLUSIONS:
  Our study shows that TEVAR for TAI is associated with heart and vascular remodeling. The presence of TEVAR modifies aortic functional properties and could induce an increase in BP that can promote aortic and cardiac damage, even in young patients.
  
  Copyright © 2019 Elsevier Inc. All rights reserved.
  
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• Could two-dimensional radial strain be considered as a novel tool to identify pre-clinical hypertrophic cardiomyopathy mutation carriers?
  Int J Cardiovasc Imaging

  2019 Dec;35(12):2167-2175. doi: 10.1007/s10554-019-01668-9.
  
  Santambrogio Gloria Maria, Maloberti Alessandro, Vallerio Paola, Peritore Angelica, Spanò Francesca, Occhi Lucia, Musca Francesco, Belli Oriana, De Chiara Benedetta, Casadei Francesca, Facchetti Rita, Turazza Fabio, Manfredini Emanuela, Giannattasio Cristina, Moreo Antonella
  
  Abstract
  
  Treatment of overt form of hypertrophic cardiomyopathy (HCM) is often unsuccessful. Efforts are focused on a possible early identification in order to prevent or delaying the development of hypertrophy. Our aim was to find an echocardiographic marker able to distinguish mutation carriers without left ventricular hypertrophy (LVH) from healthy subjects. We evaluated 28 patients, members of eight families. Three types of mutation were recognized: MYBPC3 (five families), MYH7 (two families) and TNNT2 (one family). According to genetic (G) and phenotypic (Ph) features, patients were divided in three groups: Group A (10 patients), mutation carriers with LVH (G+/Ph+); Group B (9 patients), mutation carriers without LVH (G+/Ph-); Group C (9 patients), healthy subjects (G-/Ph-). Echocardiography examination was performed acquiring standard 2D, DTI and 2D-strain imaging. Global longitudinal strain (GLS) and global radial strain (GRS) at basal and mid-level were measured. GRS was significantly different between group B and C at basal level (32.18%?±?9.6 vs. 44.59%?±?12.67 respectively; p-value?0.0001). In basal posterior and basal inferior segments this difference was particularly evident. ROC curves showed for both the involved segments good AUCs (0.931 and 0.861 for basal posterior and inferior GRS respectively) with the best predictive cut-off for basal posterior GRS at 43.65%, while it was 38.4% for basal inferior GRS. Conversely, GLS values were similar in the three group. 2D longitudinal strain is a valid technique to study HCM. Radial strain and particularly basal posterior and inferior segmental reduction could be able to identify mutation carriers in a pre-clinical phase of disease.
  
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• Pulse wave velocity progression over a medium-term follow-up in hypertensives: Focus on uric acid.
  J Clin Hypertens (Greenwich)

  2019 Jul;21(7):975-983. doi: 10.1111/jch.13603.
  
  Maloberti Alessandro, Rebora Paola, Andreano Anita, Vallerio Paola, De Chiara Benedetta, Signorini Stefano, Casati Marco, Besana Silvia, Bombelli Michele, Grassi Guido, Valsecchi Maria Grazia, Giannattasio Cristina
  
  Abstract
  
  The role of uric acid (UA) on the arterial stiffness progression has been evaluated only in three studies. Our aim was to evaluate its role as a possible determinant of the pulse wave velocity (PWV) progression over a 3.7 ± 0.5 years follow-up period in hypertensive patients. Specific sex analysis was done due to the well-known sex interaction with UA levels. We enrolled 422 consecutive hypertensive outpatients. At baseline anamnestic, blood pressure (BP) and laboratory data as well as PWV were assessed. PWV was performed again at follow-up examination. Hyperuricemia was defined as a UA > 6 mg/dL for women and > 7 mg/dL for men. Baseline age was 53.2 ± 13 years, 58% were males, systolic and diastolic BP (SBP/DBP) 141.7 ± 17.7/86.8 ± 10.8 mm Hg, UA 5.2 ± 1.4 mg/dL, and PWV 8.5 ± 1.9 m/s. At follow-up, despite better BP values (-8.5 ± 24.6 for SBP and -7.5 ± 15.4 for DBP), PWV increases to 9.1 ± 2.3 m/s (P 
  ©2019 Wiley Periodicals, Inc.
  
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• Vascular Aging and Disease of the Large Vessels: Role of Inflammation.
  High Blood Press Cardiovasc Prev

  2019 Jun;26(3):175-182. doi: 10.1007/s40292-019-00318-4.
  
  Maloberti Alessandro, Vallerio Paola, Triglione Nicola, Occhi Lucia, Panzeri Francesco, Bassi Ilaria, Pansera Francesco, Piccinelli Enrico, Peretti Alessio, Garatti Laura, Palazzini Matteo, Sun Jinwei, Grasso Enzo, Giannattasio Cristina
  
  Abstract
  
  Structural and functional arterial properties commonly impair with aging process. These effects on vasculature could act at many levels from microcirculation to large vessels. Above normal aging process classic cardio-vascular risk factors (hypertension, diabetes mellitus, dyslipidemia, etc.) accelerate the physiological process leading to premature structural and functional alterations that has also been termed early vascular aging. Target organ damage evaluation could be clinically important since these alterations precede by many years' cardiovascular events and so their assessment can predict the onset of more serious and costly events giving the opportunity to prevent CV events by earlier therapeutic intervention. This review will focus on large artery functional properties and particularly on the role of inflammation on the aortic stiffening process.
  
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• Unusual presence of 'ghosts' following lead extraction for recurrent reactive pericarditis: a case report.
  Eur Heart J Case Rep

  2018 Dec;2(4):yty127. doi: yty127.
  
  Bentivegna Riccardo, Cattafi Giuseppe, Giannattasio Cristina, Moreo Antonella
  
  Abstract
  
  BACKGROUND:
  The presence of a persistent fibrous sheath in right-sided heart chambers after transvenous lead extraction has already been described in some studies as echocardiographic tubular mobile masses called 'ghosts'. Their presence has been associated with cardiac device-related infective endocarditis or local device infection, but to the best of our knowledge, this is the first case where 'ghosts' have been reported among non-infected patients.
  
  CASE SUMMARY:
  We present a case of a 73-year-old woman hospitalized due to worsening dyspnoea and a significant pericardial effusion, relapsed after pericardiocentesis with removal of about 1500?mL of non-haemorrhagic fluid. The patient's history revealed a previous dual-chamber pacemaker implantation due to symptomatic sick sinus syndrome. Transoesophageal echocardiography (TOE), essential to exclude endocarditis vegetations suggested an etiopathogenesis of mechanical irritation caused by the distal end of the passive fixation atrial lead on the right atrial appendage wall. Considering the echocardiographic report and the condition of reactive pericarditis with the early relapse of the significant pericardial effusion after pericardiocentesis, we opted for a lead removal procedure to eliminate the stimulus causing the irritation, with transoesophageal echocardiographic monitoring, thus the early detection of a 'ghost' was possible.
  
  DISCUSSION:
  This is the first clinical case describing the presence of fibrin 'ghosts' sometime after the implantation of a pacemaker, highlighting a non-exclusively infectious genesis, and emphasizing the importance of TOE for the early detection of this post-extraction complication and its monitoring.
  
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• Kounis Syndrome: Report of Two Cases with Peculiar Presentation and Diagnostic Issues.
  High Blood Press Cardiovasc Prev

  2019 Apr;26(2):145-149. doi: 10.1007/s40292-019-00312-w.
  
  Maloberti Alessandro, Pansera Francesco, Sala Oscar, Fusco Rossana, Pierri Alessandra, Bossi Irene, Giannattasio Cristina
  
  
  
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• Relationship between vascular damage and left ventricular concentric geometry in patients undergoing coronary angiography: a multicenter prospective study.
  J Hypertens

  2019 Jun;37(6):1183-1190. doi: 10.1097/HJH.0000000000002052.
  
  Salvetti Massimo, Paini Anna, Facchetti Rita, Moreo Antonella, Carerj Scipione, Maloberti Alessandro, Gaibazzi Nicola, Faggiano Pompilio, Mureddu Gianfranco, Rigo Fausto, Giannattasio Cristina, Muiesan Maria Lorenza,
  
  Abstract
  
  BACKGROUND:
  Vascular structural (intima-media thickness) and functional (carotid pulse wave velocity, cPWV) alterations are related to different patterns of left ventricular (LV) geometry in general population samples and in hypertensive patients. The relationship between vascular damage, evaluated by both echotracking ultrasound and coronary angiography, and LV geometry has not been prospectively analyzed.
  
  METHODS:
  In eight Italian centers, 399 consecutive patients, without history of prior coronary artery disease and with clinical indication to coronary angiography, prospectively underwent cardiac standard ultrasound examination for the evaluation of LV mass, indexed by height to 2.7 power (LVMi?g/m) and relative wall thickness (RWT), the measurement of Doppler flow in the left anterior descending artery (LAD) and the echocardiographic calcium score (eCS). In all patients measurement of common carotid intima-media thickness (cIMT) and cPWV by carotid ultrasound, with the realtime echotracking system was performed. The noninvasive evaluations were performed blindly to clinical information, before coronary angiography.
  
  RESULTS:
  cIMT and cPWV were higher in patients with concentric LV hypertrophy (LVH) (LVMi???49?g/m in men and ?47?g/m in women and RWT???0.42) as compared with those with normal LVMi and geometry (N: LVMi?49?g/m in men and 50%) was greater in patients with concentric LVH and concentric remodeling, as compared with N. Patients with both concentric LVH and concentric remodeling showed higher values of cIMT and cPWV and distal LAD velocity and a greater prevalence of coronary stenosis (>50%) than patients with RWT less than 0.42.
  
  CONCLUSION:
  Our results further reinforced the observation that in patients undergoing elective coronary angiography, concentric geometry is associated with structural and functional carotid alterations, with higher distal LAD flow velocity and eCS. In this large group of patients, concentric geometry is associated with a greater prevalence of coronary stenosis, as assessed by coronary angiography. These results might contribute to explain the greater cardiovascular risk associated with concentric remodeling and LVH.
  
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• A longitudinal inquiry into directionality of effects between coping and information needs in hypertensive patients.
  Psychol Res Behav Manag

  2018 ;11():567-580. doi: 10.2147/PRBM.S168912.
  
  Greco Andrea, Cappelletti Erika Rosa, Luyckx Koen, D'Addario Marco, Giannattasio Cristina, Steca Patrizia
  
  Abstract
  
  PURPOSE:
  It is well recognized that effective health communication is associated with better adherence to medical prescriptions, behavioral changes, and enhanced perception of control over the disease. However, there is limited knowledge about the variables on which to tailor health messages. This study examined whether coping strategies were related to information needs over time in a sample of patients with hypertension.
  
  PATIENTS AND METHODS:
  A three-wave longitudinal design was used to examine the potential reciprocal relationships among variables. The sample included 271 patients (43.5% women) affected by essential arterial hypertension with a mean age of 54.66 years (SD =10.74 years; range 30-78 years). Data on patients' demographic characteristics, coping strategies, and information needs were collected three times over 12 months. To test the directionality of the relationships linking coping to information needs, cross-lagged path analyses were applied in a structural equation modeling approach.
  
  RESULTS:
  Active coping was related to a greater need for information regarding behavioral habits; avoidance coping was negatively associated with the need for information regarding daily life activities, while passive coping showed a positive relationship with this need. Moreover, results sustained the hypothesis that the relationship between coping and information needs was bi-directional. In fact, greater need for information about the disease and its pharmacological treatment was related to greater adoption of active coping strategies. The need for information about risk and complications was associated with the coping strategy related to alcohol use.
  
  CONCLUSION:
  These results provide important suggestions for implementing more effective intervention programs aimed at fostering patients' self-care abilities. As it was possible to modify coping strategies, health care providers may consider measuring patients' strategies before the medical examination so they have time to refine the information they give to patients.
  
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• Mycotic coronary aneurysms.
  J Cardiovasc Med (Hagerstown)

  2019 Jan;20(1):10-15. doi: 10.2459/JCM.0000000000000734.
  
  Buono Andrea, Maloberti Alessandro, Bossi Irene M, Piccaluga Emanuela, Piccalò Giacomo, Oreglia Jacopo A, Moreo Antonella, Russo Claudio F, Oliva Fabrizio, Giannattasio Cristina
  
  Abstract
  
  : Mycotic coronary aneurysm is a rare infective disease of arterial vessel walls. Their development could be linked to the presence of an infective endocarditis or could represent a primary infection at the site of an implanted intracoronary stent. Bacterial agents, particularly Staphylococcus aureus, are the most common etiological agents. Due to an aspecific clinical presentation and examination, diagnosis could be challenging. Multiple imaging techniques (both invasive and noninvasive) are often required to reach the final diagnosis. Prognosis is characterized by high morbidity and mortality rates and, in fact, a tempestive treatment is required, although, to date, scanty data concerning the optimal treatment choice are present in literature.
  
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• Clustering of Lifestyle Risk Factors in Acute Coronary Syndrome: Prevalence and Change after the First Event.
  Appl Psychol Health Well Being

  2018 Nov;10(3):434-456. doi: 10.1111/aphw.12141.
  
  Monzani Dario, D'Addario Marco, Fattirolli Francesco, Giannattasio Cristina, Greco Andrea, Quarenghi Francesco, Steca Patrizia
  
  Abstract
  
  BACKGROUND:
  Healthy lifestyles are modifiable risk factors for acute coronary syndrome (ACS) onset and recurrence. While unhealthy lifestyles tend to cluster together within the general healthy population, little is known about the prevalence and clustering of these behaviours in people with ACS before and after the first acute event. The aim of this study was to identify lifestyle profiles of patients with ACS and to explore their change after their first coronary event.
  
  METHODS:
  Three hundred and fifty-six patients completed self-report measures of healthy habits at the beginning of cardiac rehabilitation and 6 months later. By adopting a person-oriented approach, we analysed lifestyle clustering and its change over time. Differences in depression, anxiety, and negative illness perception among lifestyle profiles were assessed.
  
  RESULTS:
  We identified seven profiles, ranging from more maladaptive to healthier clusters. Findings showed a strong interrelation among unhealthy habits in patients. We highlighted a moderate individual and group stability of cluster membership over time. Moreover, unhealthier lifestyle profiles were associated with higher levels of depression, anxiety, and negative illness perception.
  
  CONCLUSION:
  These results may have implications for the development and implementation of multimodal interventions addressing wider-ranging improvement in lifestyles by targeting multiple unhealthy behaviours in patients with ACS.
  
  © 2018 The International Association of Applied Psychology.
  
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• Comorbidity burden conditions the prognostic performance of D-dimer in elderly patients with acute pulmonary embolism.
  Am J Emerg Med

  2019 May;37(5):799-804. doi: 10.1016/j.ajem.2018.07.034.
  
  Polo Friz Hernan, Pezzetti Valentina, Orenti Annalisa, Caleffi Alessandro, Corno Valeria, Crivellari Chiara, Petri Francesco, Polo Friz Melisa, Punzi Veronica, Teruzzi Daniela, d'Oro Luca Cavalieri, Giannattasio Cristina, Vighi Giuseppe, Cimminiello Claudio, Boracchi Patrizia
  
  Abstract
  
  INTRODUCTION:
  The prognostic accuracy of D-dimer for risk assessment in acute Pulmonary Embolism (APE) patients may be hampered by comorbidities. We investigated the impact of comorbidity burden (CB) by using the Charlson Comorbidity Index (CCI), on the prognostic ability of D-dimer to predict 30 and 90-day mortality in hemodynamically stable elderly patients with APE.
  
  METHODS:
  All patients aged >65?years with normotensive APE, consecutively evaluated in the Emergency Department since 2010 through 2014 were included in this retrospective cohort study. Area under the curve (AUC) and ½ Net Reclassification Improvement (NRI) were calculated.
  
  RESULTS:
  Study population: 162 patients, median age: 79.2?years. The optimal cut-off value of CCI score for predicting mortality was ?1 (Low CB) and >1 (High CB), AUC?=?0.786. Higher levels of D-dimer were associated with an increased risk death at 30 (HR?=?1.039, 95%CI:1.000-1.080, p?=?0.049) and 90?days (HR?=?1.039, 95%CI:1.009-1.070, p?=?0.012). When added to simplified Pulmonary Embolism Severity Index (sPESI) score, D-dimer increased significantly the AUC for predicting 30-day mortality in Low CB (AUC?=?0.778, 95%CI:0.620-0.937, ½NRI?=?0.535, p?=?0.015), but not in High CB patients (AUC?=?0.634, 95%CI:0.460-0.807, ½ NRI?=?0.248, p?=?0.294). Similarly, for 90-day mortality D-dimer increased significantly the AUC in Low CB (AUC?=?0.786, 95%CI:0.643-0.929, ½NRI?=?0.424, p-value?=?0.025), but not in High CB patients (AUC?=?0.659, 95%CI:0.541-0.778, ½NRI?=?0.354, p-value?=?0.165).
  
  CONCLUSION:
  In elderly patients with normotensive APE, comorbidities condition the prognostic performance of D-dimer, which was found to be a better predictor of death in subjects with low CB. These results support multimarker strategies for risk assessment in this population.
  
  Copyright © 2018 Elsevier Inc. All rights reserved.
  
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• Impact of serial echocardiography in the management of primary cardiac lymphoma.
  J Saudi Heart Assoc

  2018 Apr;30(2):160-163. doi: 10.1016/j.jsha.2017.08.001.
  
  Cereda Alberto Francesco, Moreo Antonella Maurizia, Sormani Paola, De Chiara Benedetta, Casadei Francesca, Zancanella Michelle, Rusconi Chiara, Cairoli Roberto, Giannattasio Cristina
  
  
  
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• Evaluation of adhesion molecules and immune parameters in HIV-infected patients treated with an atazanavir/ritonavir- compared with a lopinavir/ritonavir-based regimen.
  J Antimicrob Chemother

  2018 Aug;73(8):2162-2170. doi: 10.1093/jac/dky178.
  
  Squillace Nicola, Trabattoni Daria, Muscatello Antonio, Sabbatini Francesca, Maloberti Alessandro, Giannattasio Cristina, Masetti Michela, Fenizia Claudio, Soria Alessandro, Clerici Mario, Gori Andrea, Bandera Alessandra
  
  Abstract
  
  OBJECTIVES:
  To evaluate changes in pro-atherosclerotic biomarkers and endothelial function in patients initiating two different PI-based regimens as part of ART.
  
  DESIGN:
  Prospective randomized 24?week study. Treatment-naive HIV-infected patients with CD4+ T cell count >250?cells/mm3 started PI-based regimens including atazanavir/ritonavir (Group A) or lopinavir/ritonavir (Group B) and were followed up in an observational follow-up study until week 96.
  
  METHODS:
  The expression of immune activation and adhesion molecules on CD4+ and CD8+ cells and plasma cytokine levels were assessed at weeks 0, 4, 12, 24, 48, 72 and 96. Flow-mediated dilation (FMD), pulse-wave velocity (PWV) and intima-media thickness (IMT) were measured at weeks 0 and 24. Median changes within (signed rank test) and between (Wilcoxon test) arms were calculated.
  
  RESULTS:
  Twenty-seven patients were enrolled, of whom 15 were treated with atazanavir/ritonavir and 12 with lopinavir/ritonavir. After 96?weeks of ART, CD25+/CD8+ T cells and plasma concentration of MCP-1/CCL-2 rose whereas CD44+/CD8+ T cells decreased significantly in both groups. Differences between treatments were noted for HLA-DRII+/CD8+, CD44+/CD4+ and CD11a+/CD4+, with significant increases in Group B versus Group A. No differences between groups regarding IMT, PWV and FMD were found at baseline and week 24.
  
  CONCLUSIONS:
  ART initiation with PI-based regimens led to a decrease in pro-atherosclerotic biomarkers at week 24, which then rebounded at week 96. Lopinavir/ritonavir treatment resulted in an unfavourable modulation of such markers compared with atazanavir/ritonavir treatment.
  
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• Not every fulminant lymphocytic myocarditis fully recovers.
  J Cardiovasc Med (Hagerstown)

  2018 Aug;19(8):453-454. doi: 10.2459/JCM.0000000000000664.
  
  Veronese Giacomo, Cipriani Manlio, Petrella Duccio, Pedrotti Patrizia, Giannattasio Cristina, Garascia Andrea, Oliva Fabrizio, Klingel Karin, Frigerio Maria, Ammirati Enrico
  
  
  
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• In Memoriam: Alberto Zanchetti (Parma July 27, 1926 - Milan March 24, 2018).
  J Clin Hypertens (Greenwich)

  2018 May;20(5):826-828. doi: 10.1111/jch.13315.
  
  Mancia Giuseppe, Magrini Fabio, Morganti Alberto, Stella Andrea, Schwartz Peter J, Cuspidi Cesare, Giannattasio Cristina, Grassi Guido, Parati Gianfranco, , Weber Michael A, Lackland Daniel
  
  
  
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• Therapeutic Approach to Hypertension Urgencies and Emergencies in the Emergency Room.
  High Blood Press Cardiovasc Prev

  2018 Jun;25(2):177-189. doi: 10.1007/s40292-018-0261-4.
  
  Maloberti Alessandro, Cassano Giulio, Capsoni Nicolò, Gheda Silvia, Magni Gloria, Azin Giulia Maria, Zacchino Massimo, Rossi Adriano, Campanella Carlo, Beretta Andrea Luigi Roberto, Bellone Andrea, Giannattasio Cristina
  
  Abstract
  
  Hypertensive urgencies-emergencies are important and common events. They are defined as a severe elevation in BP, higher than 180/120 mmHg, associated or not with the evidence of new or worsening organ damage for emergencies and urgencies respectively. Anamnestic information, physical examination and instrumental evaluation determine the following management that could need oral (for urgencies) or intravenous (for emergencies) anti-hypertensives drugs. The choice of the specific drugs depend on the underlying causes of the crisis, patient's demographics, cardiovascular risk and comorbidities. For emergencies a maximum BP reduction of 20-25% within the first hour and then to 160/110-100 over next 2-6 h, is considered appropriate with a further gradual decrease over the next 24-48 h to reach normal BP levels. In the case of hypertensive urgencies, a gradual lowering of BP over 24-48 h with an oral medication is the best approach and an aggressive BP lowering should be avoided. Subsequent management with particular attention on chronic BP values control is important as the right treatment of the acute phase.
  
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• Clinical Presentation and Outcome in a Contemporary Cohort of Patients With Acute Myocarditis: Multicenter Lombardy Registry.
  Circulation

  2018 Sep;138(11):1088-1099. doi: 10.1161/CIRCULATIONAHA.118.035319.
  
  Ammirati Enrico, Cipriani Manlio, Moro Claudio, Raineri Claudia, Pini Daniela, Sormani Paola, Mantovani Riccardo, Varrenti Marisa, Pedrotti Patrizia, Conca Cristina, Mafrici Antonio, Grosu Aurelia, Briguglia Daniele, Guglielmetto Silvia, Perego Giovanni B, Colombo Stefania, Caico Salvatore I, Giannattasio Cristina, Maestroni Alberto, Carubelli Valentina, Metra Marco, Lombardi Carlo, Campodonico Jeness, Agostoni Piergiuseppe, Peretto Giovanni, Scelsi Laura, Turco Annalisa, Di Tano Giuseppe, Campana Carlo, Belloni Armando, Morandi Fabrizio, Mortara Andrea, Cirò Antonio, Senni Michele, Gavazzi Antonello, Frigerio Maria, Oliva Fabrizio, Camici Paolo G,
  
  Abstract
  
  BACKGROUND:
  There is controversy about the outcome of patients with acute myocarditis (AM), and data are lacking on how patients admitted with suspected AM are managed. We report characteristics, in-hospital management, and long-term outcome of patients with AM based on a retrospective multicenter registry from 19 Italian hospitals.
  
  METHODS:
  A total of 684 patients with suspected AM and recent onset of symptoms (70 years of age and those >50 years of age without coronary angiography were excluded. The final study population comprised 443 patients (median age, 34 years; 19.4% female) with AM diagnosed by either endomyocardial biopsy or increased troponin plus edema and late gadolinium enhancement at cardiac magnetic resonance.
  
  RESULTS:
  At presentation, 118 patients (26.6%) had left ventricular ejection fraction
  CONCLUSIONS:
  In this contemporary study, overall serious adverse events after AM were lower than previously reported. However, patients with left ventricular ejection fraction
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• In healthy normotensive subjects age and blood pressure better predict subclinical vascular and cardiac organ damage than atherosclerosis biomarkers.
  Blood Press

  2018 Oct;27(5):262-270. doi: 10.1080/08037051.2018.1461010.
  
  Maloberti Alessandro, Farina Francesca, Carbonaro Marco, Piccinelli Enrico, Bassi Ilaria, Pansera Francesco, Grassi Guido, Mancia Giuseppe, Palestini Paola, Giannattasio Cristina
  
  Abstract
  
  PURPOSE:
  Only few studies evaluated biomarkers useful for defining the cardiovascular risk of a subject in a pre-clinical condition (i.e. healthy subjects). In this context we sought to determine the relationships of Plasminogen activator inhibitor type 1 (PAI-1), P-Selectin, Tissue Inhibitors Metalloproteinases type 1 (TIMP-1) and Cystatin-C with subclinical Target Organ Damage (TOD) in normotensive and normoglycemic subjects without known cardiovascular and kidney diseases.
  
  MATERIALS AND METHODS:
  480 blood donors participated at the present analysis. TOD was evaluated as Pulse Wave Velocity (PWV), Left Ventricular Hypertrophy (LVH) and Intima Media Thickness (IMT) and carotid plaque presence) grouped together under carotid TOD.
  
  RESULTS:
  3.1% of the subjects showed a PWV higher than 10?m/sec with those subjects exerting significantly lower values of P-Selectine (0.068?±?0.015 vs 0.08?±?0.036?mg/L, p?=?.014). 8.8% of the subjects showed carotid TOD that was associated with higher Cystatin-C values (0.67?±?0.17 vs 0.63?±?0.14?mg/L, p?=?.045). Finally 23.8% of the subjects showed LVH with no significant differences regarding biomarkers. Despite some significant correlations between biomarkers and TOD, at the multivariate analysis none came out to be as significant predictor of the assessed TOD.
  
  CONCLUSIONS:
  in normotensive and normoglycemic healthy subjects, the evaluated biomarkers of atherosclerotic process didn't show any significant association with cardiac, carotid and vascular TOD while age and BP are its principal predictors.
  
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• Isolated systolic hypertension in the young: a position paper endorsed by the European Society of Hypertension.
  J Hypertens

  2018 Jun;36(6):1222-1236. doi: 10.1097/HJH.0000000000001726.
  
  Palatini Paolo, Rosei Enrico Agabiti, Avolio Alberto, Bilo Gregorz, Casiglia Edoardo, Ghiadoni Lorenzo, Giannattasio Cristina, Grassi Guido, Jelakovich Bojan, Julius Stevo, Mancia Giuseppe, McEniery Carmel M, O'Rourke Michael F, Parati Gianfranco, Pauletto Paolo, Pucci Giacomo, Saladini Francesca, Strazzullo Pasquale, Tsioufis Konstantinos, Wilkinson Ian B, Zanchetti Alberto
  
  Abstract
  
  : Whether isolated systolic hypertension in the young (ISHY) implies a worse outcome and needs antihypertensive treatment is still a matter for dispute. ISHY is thought to have different mechanisms than systolic hypertension in the elderly. However, findings from previous studies have provided inconsistent results. From the analysis of the literature, two main lines of research and conceptualization have emerged. Simultaneous assessment of peripheral and central blood pressure led to the identification of a condition called pseudo or spurious hypertension, which was considered an innocent condition. However, an increase in pulse wave velocity has been found by some authors in about 20% of the individuals with ISHY. In addition, obesity and metabolic disturbances have often been documented to be associated with ISHY both in children and young adults. The first aspect to consider whenever evaluating a person with ISHY is the possible presence of white-coat hypertension, which has been frequently found in this condition. In addition, assessment of central blood pressure is useful for identifying ISHY patients whose central blood pressure is normal. ISHY is infrequently mentioned in the guidelines on diagnosis and treatment of hypertension. According to the 2013 European Guidelines on the management of hypertension, people with ISHY should be followed carefully, modifying risk factors by lifestyle changes and avoiding antihypertensive drugs. Only future clinical trials will elucidate if a benefit can be achieved with pharmacological treatment in some subgroups of ISHY patients with associated risk factors and/or high central blood pressure.
  
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• High sodium intake and arterial stiffness.
  J Hypertens

  2018 Apr;36(4):754-758. doi: 10.1097/HJH.0000000000001658.
  
  Salvi Paolo, Giannattasio Cristina, Parati Gianfranco
  
  
  
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• Role of T1 mapping as a complementary tool to T2* for non-invasive cardiac iron overload assessment.
  PLoS One

  2018 ;13(2):e0192890. doi: e0192890.
  
  Torlasco Camilla, Cassinerio Elena, Roghi Alberto, Faini Andrea, Capecchi Marco, Abdel-Gadir Amna, Giannattasio Cristina, Parati Gianfranco, Moon James C, Cappellini Maria D, Pedrotti Patrizia
  
  Abstract
  
  BACKGROUND:
  Iron overload-related heart failure is the principal cause of death in transfusion dependent patients, including those with Thalassemia Major. Linking cardiac siderosis measured by T2* to therapy improves outcomes. T1 mapping can also measure iron; preliminary data suggests it may have higher sensitivity for iron, particularly for early overload (the conventional cut-point for no iron by T2* is 20ms, but this is believed insensitive). We compared T1 mapping to T2* in cardiac iron overload.
  
  METHODS:
  In a prospectively large single centre study of 138 Thalassemia Major patients and 32 healthy controls, we compared T1 mapping to dark blood and bright blood T2* acquired at 1.5T. Linear regression analysis was used to assess the association of T2* and T1. A "moving window" approach was taken to understand the strength of the association at different levels of iron overload.
  
  RESULTS:
  The relationship between T2* (here dark blood) and T1 is described by a log-log linear regression, which can be split in three different slopes: 1) T2* low, 30ms, weak relationship. All subjects with T2*20ms, 38% had low T1 with most of the subjects in the T2* range 20-30ms having a low T1.
  
  CONCLUSIONS:
  In established cardiac iron overload, T1 and T2* are concordant. However, in the 20-30ms T2* range, T1 mapping appears to detect iron. These data support previous suggestions that T1 detects missed iron in 1 out of 3 subjects with normal T2*, and that T1 mapping is complementary to T2*. The clinical significance of a low T1 with normal T2* should be further investigated.
  
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• Cardiac Biomarkers Release in Preadolescent Athletes After an High Intensity Exercise.
  High Blood Press Cardiovasc Prev

  2018 Mar;25(1):89-96. doi: 10.1007/s40292-017-0243-y.
  
  Peretti A, Mauri L, Masarin A, Annoni G, Corato A, Maloberti A, Giannattasio Cristina, Vignati G
  
  Abstract
  
  INTRODUCTION:
  An elevation of cardiac troponins has been described in healthy athletes after endurance exercises. The clinical significance of this increase is unclear and the lack of awareness of this phenomenon may lead to inappropriate management of these subjects.
  
  AIM:
  We sought to determine wether an intensive cycling training could determine a biomarkers elevation.
  
  METHODS:
  We evaluated serum high sensitivity cardiac troponin T, NH(2)-terminal pro-brain natriuretic peptide, CK-MB and CK in 21 healthy male preadolescent athletes (age 9.2 ± 1.7 years) after an intensive cycling training prolonged until muscular exhaustion (mean duration 16'41?). During exercise heart rhythm and rate were monitored with Holter.
  
  RESULTS:
  62% of the group had an elevation of cardiac biomarkers: specifically, 6 children had an increase in troponin levels; 3 of them had an elevation of pro-brain natriuretic peptides as well. Pro-brain natriuretic peptides resulted increased in 9 subjects. There was no relation between troponin elevation and heart rate, age or exercise duration; subjects with increased pro-brain natriuretic peptides had mean and maximal heart rates lower than children with normal natriuretic peptides levels. Other sports were performed in 50% of subjects with normal troponins and only in 17% of those with increased values.
  
  CONCLUSIONS:
  A short, high-intensity exercise caused an elevation of cardiac biomarkers in 62% of our subjects. The grade of training may influence the release of troponin and this increase is probably related to a temporary discrepancy between O2 delivery and consumption. Increases in natriuretic peptides levels are possibly expression of different adaptations to exercise.
  
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• Sex-related relationships between uric acid and target organ damage in hypertension.
  J Clin Hypertens (Greenwich)

  2018 Jan;20(1):193-200. doi: 10.1111/jch.13136.
  
  Maloberti Alessandro, Maggioni Simone, Occhi Lucia, Triglione Nicola, Panzeri Francesco, Nava Stefano, Signorini Stefano, Falbo Rosanna, Casati Marco, Grassi Guido, Giannattasio Cristina
  
  Abstract
  
  Heterogeneous results have been obtained in the relationship between serum uric acid (SUA) and target organ damage (TOD) in patients with hypertension. Clinic blood pressure, SUA, and cardiac, arterial (carotid and aortic), and renal TOD were assessed in 762 consecutive patients with hypertension. Hyperuricemia was defined as an SUA >7.0 in men and >6.0 mg/dL in women. Men with hyperuricemia compared with those with normal SUA showed lower estimated glomerular filtration rates and E/A ratios and a higher prevalence of carotid plaques. Women with hyperuricemia showed lower estimated glomerular filtration rates and E/A ratios and a higher intima-media thickness. Except for pulse wave velocity, all TODs significantly correlated with SUA. However, at multivariate analysis, only estimated glomerular filtration rate was significantly determined by SUA. Our data provide evidence on the role of SUA in the development of TOD only in the case of renal alteration. It is likely that SUA may indirectly act on the other TODs through the increase in blood pressure and the decrease in glomerular filtration rate.
  
  ©2017 Wiley Periodicals, Inc.
  
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• Relationship Between 24-Hour Ambulatory Central Systolic Blood Pressure and Left Ventricular Mass: A Prospective Multicenter Study.
  Hypertension

  2017 Dec;70(6):1157-1164. doi: 10.1161/HYPERTENSIONAHA.117.09917.
  
  Weber Thomas, Wassertheurer Siegfried, Schmidt-Trucksäss Arno, Rodilla Enrique, Ablasser Cornelia, Jankowski Piotr, Lorenza Muiesan Maria, Giannattasio Cristina, Mang Claudia, Wilkinson Ian, Kellermair Jörg, Hametner Bernhard, Pascual Jose Maria, Zweiker Robert, Czarnecka Danuta, Paini Anna, Salvetti Massimo, Maloberti Alessandro, McEniery Carmel
  
  Abstract
  
  UNLABELLED:
  We investigated the relationship between left ventricular mass and brachial office as well as brachial and central ambulatory systolic blood pressure in 7 European centers. Central systolic pressure was measured with a validated oscillometric device, using a transfer function, and mean/diastolic pressure calibration. M-mode images were obtained by echocardiography, and left ventricular mass was determined by one single reader blinded to blood pressure. We studied 289 participants (137 women) free from antihypertensive drugs (mean age: 50.8 years). Mean office blood pressure was 145/88 mm?Hg and mean brachial and central ambulatory systolic pressures were 127 and 128 mm?Hg, respectively. Mean left ventricular mass was 93.3 kg/m, and 25.6% had left ventricular hypertrophy. The correlation coefficient between left ventricular mass and brachial office, brachial ambulatory, and central ambulatory systolic pressure was 0.29, 0.41, and 0.47, respectively (=0.003 for comparison between brachial office and central ambulatory systolic pressure and 0.32 for comparison between brachial and central ambulatory systolic pressure). The results were consistent for men and women, and young and old participants. The areas under the curve for prediction of left ventricular hypertrophy were 0.618, 0.635, and 0.666 for brachial office, brachial, and central ambulatory systolic pressure, respectively (=0.03 for comparison between brachial and central ambulatory systolic pressure). In younger participants, central ambulatory systolic pressure was superior to both other measurements. Central ambulatory systolic pressure, measured with an oscillometric cuff, shows a strong trend toward a closer association with left ventricular mass and hypertrophy than brachial office/ambulatory systolic pressure.
  
  CLINICAL TRIAL REGISTRATION:
  URL: https://www.clinicaltrials.gov. Unique identifier: NCT01278732.
  
  © 2017 American Heart Association, Inc.
  
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• Determinants of carotid-femoral pulse wave velocity progression in hypertensive patients over a 3.7 years follow-up.
  Blood Press

  2018 Feb;27(1):32-40. doi: 10.1080/08037051.2017.1378069.
  
  Meani Paolo, Maloberti Alessandro, Sormani Paola, Colombo Giulia, Giupponi Luca, Stucchi Miriam, Varrenti Marisa, Vallerio Paola, Facchetti Rita, Grassi Guido, Mancia Giuseppe, Giannattasio Cristina
  
  Abstract
  
  OBJECTIVE:
  The role of risk factors on the progression of arterial stiffness has not yet been extensively evaluated. The aim of the current longitudinal study was to evaluate the determinants of the PWV progression over a 4 years follow-up period in hypertensive subjects.
  
  MATERIALS AND METHODS:
  We enrolled 333 consecutive hypertensive outpatients 18-80 aged, followed by the Hypertension Unit of St. Gerardo Hospital (Monza, Italy). At baseline anamnestic, clinical, BP, laboratory data and cfPWV were assessed. We performed a PWV follow-up examination with a median time amounting to 3.75?±?0.53 years.
  
  RESULTS:
  At baseline the mean age was 54.5?±?12.6 years, SBP and DBP were 141.3?±?18.6 and 86.4?±?10.4?mmHg and PWV was 8.56?±?1.92 m/s. Despite an improvement in BP control (from 37 to 60%), at follow-up the population showed a PWV increase (?PWV 0.87?±?3.05 m/s). PWV and ?PWV gradually increased in age decades. In patients with uncontrolled BP values at follow-up ?PWV showed a greater increase as compared to patients with controlled BP (1.46?±?3.67 vs 0.62?±?2.61 m/s, p?.05). The independent predictors of ?PWV were age, baseline PWV, baseline SBP/MBP and ?SBP/MBP.
  
  CONCLUSIONS:
  the accelerated arterial aging in treated hypertensive subjects is in large measure explained by age and BP values. PWV changes over time would probably give important information that need further future research studies.
  
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• Comorbidity assessment as predictor of short and long-term mortality in elderly patients with hemodynamically stable acute pulmonary embolism.
  J Thromb Thrombolysis

  2017 Oct;44(3):316-323. doi: 10.1007/s11239-017-1540-y.
  
  Polo Friz Hernan, Corno Valeria, Orenti Annalisa, Buzzini Chiara, Crivellari Chiara, Petri Francesco, Polo Friz Melisa, Punzi Veronica, Teruzzi Daniela, Cavalieri d'Oro Luca, Giannattasio Cristina, Vighi Giuseppe, Cimminiello Claudio, Boracchi Patrizia
  
  Abstract
  
  Elderly patients presenting with acute pulmonary embolism (PE) frequently have significant underlying comorbidities which may condition the prognosis. The current study aimed to determine the ability of Charlson comorbidity index (CCI) score to predict short and long-term mortality in elderly patients with hemodynamically stable acute PE. All hemodynamically stable patients aged >65 years with acute PE, evaluated in the Emergency Department since 2010 through 2014, were included in this retrospective cohort study. CCI, simplified pulmonary embolism severity index (sPESI) scores and vital status were recorded. Were included 162 patients with confirmed PE, out of 657 suspected cases (24.7%). Median age: 79.2 years, 74.1% presented an sPESI?>?1 and 61.1% a CCI?>?1. The overall 30, 90-day and 2-year mortality was 11.7% (95%CI 6.6-16.6), 19.8% (95%CI 13.4-25.7) and 31.8% (95%CI 24.1-38.8). For 30-day mortality sPESI showed an AUC 0.642 (95%CI 0.511-0.772) and adding CCI as covariate did not increase its prognostic performance. For 90-day mortality, in an adjusted model including sPESI and CCI, CCI showed a HR 1.282 (95%CI 1.151-1.429, p-value?0.001), and sPESI a HR?=?NS(p-value?=?0.267). For 2-year mortality, in an adjusted model including sPESI and CCI, CCI showed a HR 1.295 (95%CI 1.180-1.421, p-value?0.001) and sPESI a HR?=?NS(p-value?=?0.353). In elderly patients with hemodynamically stable PE, the CCI score was found to be an independent predictor of mortality. CCI shows a significantly better ability to predict 90-day and 2-year mortality than sPESI. The assessment of comorbidity burden by using the CCI score may be proposed as an useful tool to predict mortality in these patients.
  
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• Medium-term effect of sublingual l-glutathione supplementation on flow-mediated dilation in subjects with cardiovascular risk factors.
  Nutrition

  2017 Jun;38():41-47. doi: 10.1016/j.nut.2016.12.018.
  
  Campolo Jonica, Bernardi Stefano, Cozzi Lorena, Rocchiccioli Silvia, Dellanoce Cinzia, Cecchettini Antonella, Tonini Annamaria, Parolini Marina, De Chiara Benedetta, Micheloni Gianpaolo, Pelosi Gualtiero, Passino Claudio, Giannattasio Cristina, Parodi Oberdan
  
  Abstract
  
  OBJECTIVE:
  Supplementation of glutathione (GSH) may be a positive strategy to improve the endogenous antioxidant defense required to counteract many acute and chronic diseases. However, the efficacy of GSH treatment seems to be closely related to type of administration, degree of absorption, and increase of its concentrations. The aim of this study was to test a new sublingual formulation of L-GSH, which enters directly the systemic circulation, to assess its efficacy on circulating biochemical markers of hepatic metabolism, lipid profile, and oxidative stress and on peripheral vascular function compared with placebo in patients with cardiovascular risk factors (CVRF).
  
  METHODS:
  We enrolled 16 healthy men with CVRF in a double-blinded, randomized placebo-controlled crossover study. At each visit, blood samples were collected for biochemistry analyses and peripheral endothelial function (reactive hyperemia index [RHI]) and stiffness were measured by Endo-PAT2000.
  
  RESULTS:
  In the overall population, a decrease in total and low-density lipoprotein cholesterol was highlighted after L-GSH supplementation compared with placebo (P = 0.023 and P = 0.04, respectively). On the contrary, no difference was observed in RHI and oxidative stress markers between L-GSH and placebo in the study population. However, seven participants with baseline abnormal RHI (?1.67) compared with those with normal RHI showed a significant reduction of arterial stiffness after L-GSH administration, (P = 0.007 and P = 0.037, respectively).
  
  CONCLUSIONS:
  Supplementation of L-GSH compared with placebo influences the lipid profile of patients with CVRF. Sublingual L-GSH may represent a valid prevention of vascular damage in patients with CVRF and endothelial dysfunction.
  
  Copyright © 2017 Elsevier Inc. All rights reserved.
  
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• Late Echocardiographic Study of Aortic Valve and Aortic Root after Surgery for Type A Acute Aortic Dissection.
  J Cardiovasc Echogr

  2016 ;26(3):78-82. doi: 10.4103/2211-4122.187948.
  
  Molteni Martina, De Chiara Benedetta, Casadei Francesca, Botta Luca, Merlanti Bruno, Russo Claudio Francesco, Giannattasio Cristina, Moreo Antonella
  
  Abstract
  
  OBJECTIVE:
  In case of concomitant aortic regurgitation (AR) valve, sparing operation is considered the first choice in selected patients. The aim of this retrospective clinical and echocardiographic study was to evaluate the long-term survival results of conservative approach and the determinants of recurrent AR.
  
  METHODS:
  From 2000 to 2011, fifty patients (median: 63 years and interquartile range: 53-72) underwent an aortic valve-sparing procedure for acute aortic dissection, and discharged alive. The long-term clinical and echocardiographic outcome was analyzed.
  
  RESULTS:
  Late all-causes mortality was 18% (nine patients) at a median follow-up of 55.8 months. Ten patients (20%) underwent re-operations, five of them for aortic valve/root recurrent disease; freedom from proximal re-operation was 90%. Two-third of the patients had a preoperative AR grade
  CONCLUSIONS:
  Preoperative AR and late aortic root diameter were not the predictors of late AR. Late AR is higher in patients who underwent aortic commissures and cusps resuspension compared to the only replacement of the ascending aorta.
  
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• Mitral periprosthetic leakage: contemporary results of surgical correction at a single centre.
  Interact Cardiovasc Thorac Surg

  2017 Aug;25(2):185-190. doi: 10.1093/icvts/ivx101.
  
  Botta Luca, De Chiara Benedetta, Quattrocchi Salvina, Casadei Francesca, Borgia Francesco, Giannattasio Cristina, Moreo Antonella, Russo Claudio Francesco
  
  Abstract
  
  OBJECTIVES:
  Mitral periprosthetic leakage (PPL) is a serious complication following valve replacement. Conflicting outcomes of surgical treatment have been reported in the presence of multiple previous cardiac operations and associated co-pathological conditions.
  
  METHODS:
  Sixty-five symptomatic patients (37 women, mean age 64.8 years) underwent conventional operations at our hospital from 2006 to 2015. Mitral PPL was the leading surgical indication, although associated procedures were included. Previous transcatheter procedures and leaks involving multiple prostheses were excluded. The median number of past mitral operations was 2 (range 1-5). PPL recurrence was observed in 29% of cases. A previous operation on the aortic or tricuspid valve was performed in 31 patients.
  
  RESULTS:
  Mitral PPL involved one-, two- or three-quarters of the mitral perimeter in 46, 43 and 11% of cases. Prosthetic refixation or replacement was performed in 24 and 41 patients, respectively. Annular reconstruction was necessary in 17% of prosthetic replacements. Associated procedures were performed in 19 patients. The operation was executed through a right minithoracotomy (unclamped aorta) in 20% of patients. In-hospital deaths occurred in 3.1%. After a median follow-up of 60 months, freedom from all-cause mortality was 96.8, 91.5 and 88.8% at 1, 3 and 5 years. Lateral leaks [P?=?0.03; hazard ratio (HR)?=?4.57, 95% confidence interval (CI): 1.13-18.3] and PPL relapse (P?=?0.03; HR?=?4.33, 95% CI: 1.12-16.7) were independently associated with death. At follow-up, 4 patients had a?>2+ recurrent leak and 2 were reoperated.
  
  CONCLUSIONS:
  A customized conventional mitral reoperation still represents a satisfactory and effective treatment option for PPL and should be considered even in patients with very complex issues.
  
  © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
  
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• [Catecholamine-induced myocarditis in pheochromocytoma].
  G Ital Cardiol (Rome)

  2017 Feb;18(2):164-168. doi: 10.1714/2663.27302.
  
  Muratori Davide, Pedrotti Patrizia, Baroni Matteo, Belloni Armando, Quattrocchi Giuseppina, Milazzo Angela, Giannattasio Cristina, Roghi Alberto
  
  Abstract
  
  Pheochromocytoma is a rare tumor, usually benign, potentially lethal in case of crisis with acute release of catecholamines. The heart is a target and the clinical presentation can mimic various cardiac conditions, thus rendering diagnosis elusive. Cardiac magnetic resonance is a valuable non-invasive diagnostic tool for the evaluation of cardiomyopathies; it allows the identification of catecholamine-induced myocarditis pattern and, in some cases, it can detect the primary tumor. The definitive treatment of pheochromocytoma is surgical, while the acute crisis may require mechanical support to circulation. We here report a case of pheochromocytoma in a 25-year-old man complicated by catecholamine-induced myocarditis and heart failure.
  
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• Arterial Stiffness in Aortic Stenosis: Relationship with Severity and Echocardiographic Procedures Response.
  High Blood Press Cardiovasc Prev

  2017 Mar;24(1):19-27. doi: 10.1007/s40292-016-0176-x.
  
  Bruschi Giuseppe, Maloberti Alessandro, Sormani Paola, Colombo Giulia, Nava Stefano, Vallerio Paola, Casadei Francesca, Bruno Jolie, Moreo Antonella, Merlanti Bruno, Russo Claudio, Oliva Fabrizio, Klugmann Silvio, Giannattasio Cristina
  
  Abstract
  
  INTRODUCTION:
  Aortic stenosis (AS) is more than only a degenerative disease, it could be also an atherosclerotic-like process involving the valve instead of the vessels. Little is known about the relation of arterial stiffness and AS.
  
  AIM:
  We sought to determine wether pulse wave velocity (PWV), is related to AS severity and to the procedures response, both as surgical aortic-valve-replacement (AVR) and trascatheter-aortic-valve-implantation (TAVI).
  
  METHODS:
  30 patients with severe AS were treated (15 AVR, 15 TAVI). Before the procedures (t0) and after 1 week (t1) echocardiography and PWV were evaluated.
  
  RESULTS:
  On the whole population, subjects with higher PWV showed higher transvalvular pressure gradient at baseline (mean: 56.5 ± 15.1 vs 45.4 ± 9.5; peak: 93.3 ± 26.4 vs 73.3 ± 14.9, p = 0.02) and, a significantly greater response to the procedures (mean: -42.9 ± 17.2 vs -27.9 ± 10.1, peak: -68.7 ± 29.2 vs -42.8 ± 16.4, p = 0.02). When the two different procedures groups were separated, data were confirmed only in the TAVI subgroup.
  
  CONCLUSIONS:
  In patients undergoing procedures for AS, PWV is correlated with transvalvular gradient and, in TAVI subjects, is able to predict the echocardiographic response. Baseline evaluation of PWV in patients candidates to TAVI can help the selection of subjects, even if larger and longer studies are needed before definitive conclusion can be drawn.
  
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• Quantitative changes in late gadolinium enhancement at cardiac magnetic resonance in the early phase of acute myocarditis.
  Int J Cardiol

  2017 Mar;231():216-221. doi: 10.1016/j.ijcard.2016.11.282.
  
  Ammirati Enrico, Moroni Francesco, Sormani Paola, Peritore Angelica, Milazzo Angela, Quattrocchi Giuseppina, Cipriani Manlio, Oliva Fabrizio, Giannattasio Cristina, Frigerio Maria, Roghi Alberto, Camici Paolo G, Pedrotti Patrizia
  
  Abstract
  
  BACKGROUND:
  The presence of late gadolinium enhancement (LGE) at cardiac magnetic resonance (CMR) has diagnostic and prognostic value in patients with acute myocarditis (AM). Aim of our study was to quantify the changes in LGE extension (LGE%) early after AM and evaluate its relations with biventricular function and morphology.
  
  METHODS:
  We investigated 76 consecutive patients with AM (acute onset of chest pain/heart failure/ventricular arrhythmias not explained by other causes, and raised troponin) that met CMR criteria based on myocardial oedema at T2-weighted images and LGE on post-contrast images at median time of 6days from onset of symptoms. We quantified LGE% at baseline and after 148days in 49 patients.
  
  RESULTS:
  Median left ventricular (LV)-ejection fraction (EF) was 64% (interquartile range [Q1-Q3]: 56-67%), and LGE% 9.4% (Q1-Q3: 7.5-13.2%). LGE% was correlated with LV end-systolic volume index (LV-ESVi; r=+0.34; p=0.003). LGE% was inversely correlated with LV-EF (r=-0.31; p=0.009) and time to CMR scan (r=-0.25; p=0.028). In the 49 patients with a second CMR scan, despite no significant variations in LV-EF, a significant decrease of LGE% was observed (p
  CONCLUSIONS:
  In the acute phase of AM the LGE extension is a dynamic process that reflects impairment of LV function and is time dependent. LGE% appears one of the CMR parameters with the largest relative variations in the first months after AM.
  
  Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
  
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• Annexin A5 in treated hypertensive patients and its association with target organ damage.
  J Hypertens

  2017 Jan;35(1):154-161.
  
  Maloberti Alessandro, Meani Paolo, Vallerio Paola, Varrenti Marisa, Casadei Francesca, Musca Francesco, Facchetti Rita, Di Blasio Anna M, Ravassa Susanna, Mancia Giuseppe, Giannattasio Cristina
  
  Abstract
  
  OBJECTIVE:
  Annexin A5 (AnxA5) has been previously linked to the presence of carotid and cardiac target organ damage (TOD) in the context of heart failure and rheumatologic patients. However, information is scant in the context of hypertension. Aim of our study was to evaluate AnxA5 in treated hypertension patients compared with normotensive controls and to determine whether it is associated with vascular and heart TOD evaluated as arterial stiffness, carotid plaque and left ventricular hypertrophy.
  
  METHODS:
  We enrolled 123 consecutive treated hypertension and 124 normotensive controls. TOD was evaluated as pulse wave velocity (PWV, complior), left ventricular hypertrophy (echocardiography) and intima-media thickness and carotid plaque presence (ecographic methods). AnxA5 levels was dosed and compared in patients with and without hypertension and with and without TOD.
  
  RESULTS:
  With similar age hypertension patients showed higher SBP, DBP and AnxA5 levels (13.9?±?11.1 vs 10.1?±?8.4?ng/ml, P?0.001) compared with controls. Regarding TOD hypertension showed higher PWV (8.5?±?1.8 vs 7.6?±?1.5?m/s, P?0.001) and LVMI (121.7?±?29.3 vs 113.5?±?21.1?g/m, P?0.05), whereas carotid intima-media thickness was superimposable. AnxA5 correlates with PWV (r?=?0.13, P?0.05) and DBP (r?=?0.15, P?0.01), whereas it has never been found as a significant independent predictor of TOD in linear regression analysis.
  
  CONCLUSION:
  Our data have shown that AnxA5 levels are increased in treated hypertension patients. In this condition, it is probably released in the plasma as a defensive mechanism through its anti-inflammatory and anticoagulants effects. We found a significant association with arterial stiffness, but AnxA5 was not found to be a significant predictor of TOD.
  
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• Evolut R Implantation to Treat Severe Pure Aortic Regurgitation in a Patient With Mitral Bioprosthesis.
  Ann Thorac Surg

  2016 Dec;102(6):e521-e524. doi: 10.1016/j.athoracsur.2016.05.054.
  
  Bruschi Giuseppe, Colombo Paola, Nava Stefano, Musca Francesco, Merlanti Bruno, Belli Oriana, Soriano Francesco, Botta Luca, De Caria Danile, Giannattasio Cristina, Russo Claudio F
  
  Abstract
  
  Transcatheter aortic valves have been designed to treat high-risk surgical candidates affected by severe aortic stenosis, but little is known about the use of transcatheter valves in patients with severe pure aortic regurgitation. We describe the implantation of Medtronic CoreValve Evolut R (Medtronic, Minneapolis, MN) to treat an 82-year-old patient affected by severe pure aortic regurgitation who underwent prior mitral valve replacement with a biological valve protruding into the left ventricular outflow tract.
  
  Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
  
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• Mast cells and acute coronary syndromes: relationship between serum tryptase, clinical outcome and severity of coronary artery disease.
  Open Heart

  2016 ;3(2):e000472. doi: e000472.
  
  Morici Nuccia, Farioli Laura, Losappio Laura Michelina, Colombo Giulia, Nichelatti Michele, Preziosi Donatella, Micarelli Gianluigi, Oliva Fabrizio, Giannattasio Cristina, Klugmann Silvio, Pastorello Elide Anna
  
  Abstract
  
  OBJECTIVE:
  To assess the relationship between serum tryptase and the occurrence of major cardiovascular and cerebrovascular events (MACCE) at 2-year follow-up in patients admitted with acute coronary syndrome (ACS). To compare serum tryptase to other validated prognostic markers (maximum high-sensitivity troponin (hs-Tn), C reactive protein (CRP) levels at admission, Synergy between percutaneous coronary intervention with Taxus and Cardiac Surgery (SYNTAX) score).
  
  METHODS:
  We measured serum tryptase at admission in 140 consecutive patients with ACS and in 50 healthy controls. The patients' follow-up was maintained for 2?years after discharge. The predictive accuracy of serum tryptase for 2-year MACCE was assessed and compared with hs-Tn, CRP and SYNTAX score.
  
  RESULTS:
  Serum tryptase levels at admission were significantly higher in patients with ACS compared with the control group (p=0.0351). 2 years after discharge, 28/140 patients (20%) experienced MACCE. Serum tryptase levels, maximum hs-Tn measurements and SYNTAX score were higher in patients who experienced MACCE compared with those without (p
  CONCLUSIONS:
  In patients with ACS, serum tryptase measured during index admission is significantly correlated to the development of MACCE up to 2?years, demonstrating a possible long-term prognostic role of this biomarker.
  
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• Comprehensive evaluation of cardiac involvement in eosinophilic granulomatosis with polyangiitis (EGPA) with cardiac magnetic resonance.
  Eur J Intern Med

  2017 Apr;39():51-56. doi: 10.1016/j.ejim.2016.09.014.
  
  Cereda Alberto Francesco, Pedrotti Patrizia, De Capitani Lucio, Giannattasio Cristina, Roghi Alberto
  
  Abstract
  
  BACKGROUND:
  Eosinophilic granulomatosis with polyangiitis (EGPA) is a systemic necrotizing vasculitis characterized by hypereosinophilia. EGPA typically develops in three clinical phases, beginning with asthma, followed by tissue eosinophilia and finally systemic vasculitis. Cardiac involvement is the most important predictor of mortality; it occurs in approximately 15-60% of EGPA patients, a significant proportion of whom are asymptomatic and have normal electrocardiogram (ECG) and echocardiogram. Early detection and management of cardiac disease could positevely affect prognosis. Cardiovascular magnetic resonance (CMR) has emerged as the gold standard cardiac imaging technique in the evaluation of cardiomyopathies, due to its ability to reliably assess anatomy, function, and tissue characterization.
  
  AIM:
  Purpose of this study was to assess the role of CMR in detecting cardiac disease in patients with EGPA in clinical remission.
  
  METHODS:
  A dedicated CMR protocol including functional analysis, and pre and post-contrast tissue characterization was performed in 11 patients with EGPA and the results were compared with 11 healthy subjects.
  
  RESULTS:
  EGPA patients had lower left ventricular ejection fraction compared to controls (56±19 vs 68.7±5.2, p value 0.02). Late gadolinium enhancement (LGE), representing replacement fibrosis, was positive in 9/11 (82%) patients, mainly with a non-ischemic pattern. In 3/11 (27%) patients a left ventricular thrombus was detected; in 3/11 (27%) patients myocardial edema was detected. CMR parameters of interstitial fibrosis were significantly more elevated in EGPA patients compared to controls.
  
  CONCLUSIONS:
  Patients with EGPA in clinical remission showed a high cardiovascular burden as demonstrated by lower EF, signs of active inflammation, presence of interstitial and replacement fibrosis and intraventricular thrombosis. Further studies on wider populations are warranted to better understand how these findings could impact on prognosis and eventually guide therapy.
  
  Copyright © 2016 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
  
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• Prognostic impact of late gadolinium enhancement in the risk stratification of heart transplant patients.
  Eur Heart J Cardiovasc Imaging

  2017 Feb;18(2):130-137. doi: 10.1093/ehjci/jew186.
  
  Pedrotti Patrizia, Vittori Claudia, Facchetti Rita, Pedretti Stefano, Dellegrottaglie Santo, Milazzo Angela, Frigerio Maria, Cipriani Manlio, Giannattasio Cristina, Roghi Alberto, Rimoldi Ornella
  
  Abstract
  
  AIMS:
  The aim of the present study was to assess the association of the presence and amount of late gadolinium enhancement (LGE) at cardiac magnetic resonance (CMR) with cardiovascular adverse events in patients with orthotopic heart transplantation (HTx).
  
  METHODS AND RESULTS:
  We enrolled 48 patients (mean age, 54.7 ± 14.6 years; 37 men) at various stages after HTx. All patients underwent standard CMR at 1.5 T, to characterize both cardiac anatomy and LGE. Late gadolinium enhancement was detected in 26 patients (54%). All-cause and cardiovascular mortalities, and a composite of major adverse cardiovascular events (MACE) recurrence were evaluated during the follow-up period for a median of 5.16 years. Ten patients (21%) died and 26 (54%) were readmitted because of MACE. Multivariate Cox analysis identified as independent predictors of MACE a diagnosis of cardiac allograft vasculopathy (CAV) (HR 3.63; 1.5-8.7 95% CI; P = 0.0039), left ventricular end systolic volume index (HR 1.04; 95% CI 1.01-1.079; P = 0.008), LGE mass (HR 1.04; 1.01-1.06 95% CI; P = 0.0007), LGE % of left ventricular mass (HR 1.083; 1.03-1.13 95% CI; P = 0.0002). Independent predictors of all-cause death were CAV (HR 6.33; 95% CI 1.33-30.03; P = 0.0201), LGE mass (HR 1.04; 1.01-1.07 95% CI; P = 0.005), LGE % of left ventricular mass (HR 1.075; 1.02-1.13 95% CI; P = 0.007). Patients with CAV had a risk of MACE by 5 years of 67% (95% CI 0.309-0.851%); the addition of 7.9 LGE % to the risk model increased the predicted risk to 88% (95% CI 0.572-0.967%).
  
  CONCLUSIONS:
  The current study demonstrated that the presence of CAV and the total amount of LGE have a significant independent association with MACE and mortality in HTx patients.
  
  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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• A Type A and Type D Combined Personality Typology in Essential Hypertension and Acute Coronary Syndrome Patients: Associations with Demographic, Psychological, Clinical, and Lifestyle Indicators.
  PLoS One

  2016 ;11(9):e0161840. doi: e0161840.
  
  Steca Patrizia, D'Addario Marco, Magrin Maria Elena, Miglioretti Massimo, Monzani Dario, Pancani Luca, Sarini Marcello, Scrignaro Marta, Vecchio Luca, Fattirolli Francesco, Giannattasio Cristina, Cesana Francesca, Riccobono Salvatore Pio, Greco Andrea
  
  Abstract
  
  Many studies have focused on Type A and Type D personality types in the context of cardiovascular diseases (CVDs), but nothing is known about how these personality types combine to create new profiles. The present study aimed to develop a typology of Type A and Type D personality in two groups of patients affected by and at risk for coronary disease. The study involved 711 patients: 51.6% with acute coronary syndrome, 48.4% with essential hypertension (mean age = 56.4 years; SD = 9.7 years; 70.7% men). Cluster analysis was applied. External variables, such as socio-demographic, psychological, lifestyle, and clinical parameters, were assessed. Six groups, each with its own unique combined personality profile scores, were identified: Type D, Type A-Negatively Affected, Not Type A-Negatively Affected, Socially Inhibited-Positively Affected, Not Socially Inhibited, and Not Type A-Not Type D. The Type A-Negatively Affected cluster and, to a lesser extent, the Type D cluster, displayed the worst profile: namely higher total cardiovascular risk index, physical inactivity, higher anxiety and depression, and lower self-esteem, optimism, and health status. Identifying combined personality profiles is important in clinical research and practice in cardiovascular diseases. Practical implications are discussed.
  
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• Total pericardial agenesis mimicking arrhythmogenic right ventricular dysplasia.
  J Cardiovasc Med (Hagerstown)

  2016 Dec;17 Suppl 2():e216-e217. doi: 10.2459/JCM.0000000000000425.
  
  Pedrotti Patrizia, Peritore Angelica, Cereda Alberto, Giannattasio Cristina, Imazio Massimo
  
  Abstract
  
  : We report the incidental finding of pericardial agenesis in a patient with electrocardiographic and echocardiographic abnormalities mimicking arrhythmogenic right ventricular dysplasia. The anatomic findings were clearly depicted by cardiac magnetic resonance. The patient was asymptomatic and the clinical relevance of this finding would be raised in case a possible differential diagnosis of right heart overload should be necessary. Diagnosis may be easily suspected from the ECG and echocardiography; MRI will provide definite diagnosis.
  
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• Long-Term Effects of Radiotherapy on Arterial Stiffness in Breast Cancer Women.
  Am J Cardiol

  2016 Sep;118(5):771-6. doi: 10.1016/j.amjcard.2016.06.001.
  
  Vallerio Paola, Sarno Laura, Stucchi Miriam, Musca Francesco, Casadei Francesca, Maloberti Alessandro, Lestuzzi Chiara, Mancia Giuseppe, Moreo Antonella, Palazzi Mauro, Giannattasio Cristina
  
  Abstract
  
  Radiotherapy for breast cancer may expose heart and vessels to late radiation-induced complications. Although recent technical progress in radiation therapy (RT) has been associated with drastic reduction in cardiovascular (CV) mortality, the prolonged life expectancy of patients with cancer requires CV evaluation for many years. The aim of our study was to evaluate local changes in vascular and cardiac function because of previous breast RT. We enrolled 43 patients treated with RT 15 years ago for breast cancer. CV risk factors and atherosclerotic carotid damage were investigated in all women. We divided patients into 2 groups: R (n = 25) treated to right breast and L (n = 18) to left breast. All subjects were submitted to standard echocardiography and functional arteries evaluation by carotid-radial pulse-wave velocity (crPWV; Complior) and AIx (Sphygmocor; Atcor Medical). Global mean age was 69.5 ± 8 years old. CV risk factors were equally allocated in 2 groups. No patients had history of cardiac or artery disease. R had a significantly increased crPWV (9.9 ± 1.4 vs 8.9 ± 1.1, p = 0.001) on right arm compared with left arm, and in L group, crPWV was similarly higher on the left arm than on right arm (9.6 ± 1.5 vs 8.9 ± 1.4, p = 0.011). AIx was significantly increased in the ipsilateral arm only in L (32.1 ± 7.6 vs 28.3 ± 6.8, p = 0.05). Central blood pressure estimation was not different in the right and left arms. No correlations were found with hormone therapy or chemotherapy. Our data show a local arterial stiffening because of radiation that can be involved in increased CV risk in breast cancer-treated patients.
  
  Copyright © 2016 Elsevier Inc. All rights reserved.
  
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• Infective endocarditis of an aortic intimal flap due to Streptococcus agalactiae in a patient with Sjögren's syndrome: an unusual clinical case report.
  Echocardiography

  2016 Sep;33(9):1434-5. doi: 10.1111/echo.13274.
  
  De Chiara Benedetta, Peritore Angelica, Sara Roberto, Giannattasio Cristina, Moreo Antonella
  
  
  
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• Partial Anomalous Pulmonary Venous Return as Rare Cause of Right Ventricular Dilation: A Retrospective Analysis.
  Congenit Heart Dis

  2016 Jul;11(4):365-8. doi: 10.1111/chd.12382.
  
  Sormani Paola, Roghi Alberto, Cereda Alberto, Peritore Angelica, Milazzo Angela, Quattrocchi Giuseppina, Giannattasio Cristina, Pedrotti Patrizia
  
  Abstract
  
  INTRODUCTION:
  Partial anomalous pulmonary venous return (PAPVR) is an uncommon cause of right ventricular dilation. It may be difficult to identify and often remains undiagnosed.
  
  METHODS:
  We reviewed the database of the Cardiac Magnetic Resonance (CMR) Laboratory of Niguarda Hospital, in order to identify the cases of PAPVR between 2008 and 2014.
  
  RESULTS:
  On a total number of 7832 CMR scans, we identified 24 patients with PAPVR (14 male, age 41?±?18 y) corresponding to 0.31% of the total population. Only 30% of patients had been referred for known or suspected PAPVR, 33% of patients had been referred for suspected right ventricular arrhythmogenic dysplasia and 37% had been referred for other cardiac disease. PAPVR involved mainly the right pulmonary veins (18 patients, 75%) and in 62% of our cases was associated with an atrial septal defect. Eight patients underwent corrective surgery in our institution, which confirmed and successfully repaired the anomalies.
  
  CONCLUSIONS:
  PAPVR is a rare congenital cardiac pathology which should be suspected in case of unexplained right chambers enlargement. CMR imaging allows an accurate anatomic and functional definition of this pathology and associated abnormalities. Early correction has an excellent prognosis and prevents long term complications like pulmonary hypertension, right ventricular failure and atrial fibrillation.
  
  © 2016 Wiley Periodicals, Inc.
  
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• Giant apparently not dissecting aneurysm and severe aortic valve insufficiency in an elite athlete.
  Eur Heart J

  2016 Aug;37(32):2527. doi: 10.1093/eurheartj/ehv683.
  
  Cereda Alberto, Sormani Paola, Russo Claudio F, Moreo Antonella, Giannattasio Cristina
  
  
  
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• Asymptomatic aortic mural thrombus in a minimally atherosclerotic vessel.
  Interact Cardiovasc Thorac Surg

  2016 Mar;22(3):371-3. doi: 10.1093/icvts/ivv349.
  
  Maloberti Alessandro, Oliva Fabrizio, De Chiara Benedetta, Giannattasio Cristina
  
  Abstract
  
  Aortic mural thrombi in a normal (non-aneurysmal or minimally atherosclerotic) vessel are an uncommon condition. They are usually located in the descending aorta and, less frequently, in the aortic arch or in the abdominal aorta. The typical clinical presentation is the appearance of symptoms/signs of peripheral arterial embolization, such as lower limb or visceral ischaemia, but these can also be accidentally found in asymptomatic patients. We report the case of a 40-year old man with untreated hypertension and dyslipidaemia admitted to hospital for atypical chest pain associated with an elevation in high-sensitivity troponin T with normal creatine kinase isoenzime MB creatine kinase isoenzyme. Elektrocardiogram (EKG) and transthoracic echocardiography were non-diagnostic; in order to exclude an aortic dissection, a gated chest computed tomography was performed and showed an aortic thrombus on a minimally atherosclerotic wall. Then, a transoesophageal echocardiography confirmed an aortic floating thrombus (7 × 4 mm). Cardiac surgeons advised against surgery and therapy with antiplatelet, low molecular weight heparin, ?-blocker, antihypertensive and lipid-lowering drugs was initiated. A complete resolution of the thrombus was observed at the 12-day tomographic control.
  
  © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
  
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• Erratum to: Effects of Renal Sympathetic Denervation on Arterial Stiffness and Blood Pressure Control in Resistant Hypertensive Patients: A Single Centre Prospective Study.
  High Blood Press Cardiovasc Prev

  2015 Dec;22(4):451. doi: 10.1007/s40292-015-0124-1.
  
  Baroni Matteo, Nava Stefano, Giupponi Luca, Meani Paolo, Panzeri Francesco, Varrenti Marisa, Maloberti Alessandro, Soriano Francesco, Agrati Antonio Maria, Ferraro Giovanni, Colombo Fabrizio, Rampoldi Antonio, Mancia Giuseppe, Colombo Paola, Klugmann Silvio, Giannattasio Cristina
  
  
  
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• Acute coronary syndrome: a rare case of multiple endocrine neoplasia syndromes with pheochromocytoma and medullary thyroid carcinoma.
  Cancer Biol Med

  2015 Sep;12(3):255-8. doi: 10.7497/j.issn.2095-3941.2015.0016.
  
  Maloberti Alessadro, Meani Paolo, Pirola Roberto, Varrenti Marisa, Boniardi Marco, De Biase Anna Maria, Vallerio Paola, Bonacina Edgardo, Mancia Giuseppe, Loli Paola, Giannattasio Cristina
  
  Abstract
  
  Pheochromocytoma is a tumor arising from neuroectodermal chromaffin tissues in the adrenal gland or extra-adrenal paraganglia (paragangliomas). The prevalence of the tumor is 0.1%-0.6% in the hypertensive population, of which 10%-20% are malignant. Pheochromocytoma produces, stores, and secretes catecholamines, as well as leads to hypertensive crisis, arrhythmia, angina, and acute myocardial infarction without coronary artery diseases. We report a case of acute coronary syndrome (ACS) with a final diagnosis of multiple endocrine neoplasia with pheochromocytoma and medullary thyroid carcinoma (MTC).
  
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• Effects of Renal Sympathetic Denervation on Arterial Stiffness and Blood Pressure Control in Resistant Hypertensive Patients: A Single Centre Prospective Study.
  High Blood Press Cardiovasc Prev

  2015 Dec;22(4):411-6. doi: 10.1007/s40292-015-0121-4.
  
  Baroni Matteo, Nava Stefano, Giupponi Luca, Meani Paolo, Panzeri Francesco, Varrenti Marisa, Maloberti Alessandro, Soriano Francesco, Agrati Antonio Maria, Ferraro Giovanni, Colombo Fabrizio, Rampoldi Antonio, Mancia Giuseppe, Colombo Paola, Klugmann Silvio, Giannattasio Cristina
  
  Abstract
  
  Renal denervation (RD) is an intriguing treatment strategy for resistant hypertension. However, limited data are available about its long time efficacy as well as its effects on intermediate phenotypes like arterial stiffness and carotid IMT. 12 patients (9 males, mean 69 years) with resistant hypertension underwent bilateral RDN (Medtronic System) since April 2012 in Niguarda Ca' Granda Hospital (Milan). Patients were studied before intervention, and at 1, 3, 6 and 12 months after RD. Carotid intima media thickness (Esaote Mylab) and carotid-femoral pulse wave velocity (Complior, Alam medical) were assessed at each step. Compared to baseline, patients showed a marked reduction of office systolic blood pressure at each follow-up step (p
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• [Syncope: an untreated symptom with a lifesaving intervention].
  G Ital Cardiol (Rome)

  2015 Sep;16(9):517-8. doi: 10.1714/1988.21532.
  
  Giupponi Luca, De Chiara Benedetta, Spanò Francesca, Giannattasio Cristina, Taglieri Corrado, Moreo Antonella
  
  Abstract
  
  We report the case of a 61-year-old woman referred to our center for cardiac evaluation after a syncope, with echocardiographic findings of a papillary fibroelastoma on the edge of the non-coronary aortic cusp. The three-dimensional transesophageal approach provided a unique understanding of the size and shape of the mass and it favorably directed the surgeon towards treatment with conservative surgery.
  
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• Differential incremental value of ultrasound carotid intima-media thickness, carotid plaque, and cardiac calcium to predict angiographic coronary artery disease across Framingham risk score strata in the APRES multicentre study.
  Eur Heart J Cardiovasc Imaging

  2016 Sep;17(9):991-1000. doi: 10.1093/ehjci/jev222.
  
  Gaibazzi Nicola, Rigo Fausto, Facchetti Rita, Carerj Scipione, Giannattasio Cristina, Moreo Antonella, Mureddu Gian Francesco, Salvetti Massimo, Grolla Elisabetta, Faden Giacomo, Cesana Francesca, Faggiano Pompilio
  
  Abstract
  
  AIMS:
  According to recent data, more accurate selection of patients undergoing coronary angiography for suspected coronary artery disease (CAD) is needed. From the Active PREvention Study multicentre prospective study, we further analyse whether carotid intima-media thickness (cIMT), carotid plaques (cPL), and echocardiographic cardiac calcium score (eCS) have incremental discriminatory and reclassification predictive value for CAD over clinical risk score in subjects undergoing coronary angiography, specifically depending on their low, intermediate, or high class of clinical risk.
  
  METHODS AND RESULTS:
  In eight centres, 445 subjects without history of prior CAD but with chest pain of recent onset and/or a positive/inconclusive stress test for ischaemia prospectively underwent clinically indicated elective coronary angiography after cardiac and carotid ultrasound assessments with measurements of cIMT, cPL, and eCS. The study population was divided into subjects at low (10%), intermediate (10-20%), and high (>20%) Framingham risk score (FRS). Ultrasound parameters were tested for their incremental value to predict CAD over FRS, in each pre-test risk category. No significant difference could be appreciated between the discrimination value of FRS and Diagnostic Imaging for Coronary Artery Disease score for the presence of CAD. eCS or cPL demonstrated significant incremental prediction over FRS, consistently in the three FRS categories (P
  CONCLUSIONS:
  Ultrasound eCS and cPL assessments were significant predictors of angiographic CAD in patients without prior CAD but with signs or symptoms suspect for CAD, independently and incrementally to FRS, across all pre-test risk probability strata, although in high-risk subjects, only eCS maintained an incremental value. The use of cIMT was not significantly incrementally useful in any FRS risk category.
  
  Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.
  
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• Iron Stores, Hepcidin, and Aortic Stiffness in Individuals with Hypertension.
  PLoS One

  2015 ;10(8):e0134635. doi: e0134635.
  
  Valenti Luca, Maloberti Alessandro, Signorini Stefano, Milano Marta, Cesana Francesca, Cappellini Fabrizio, Dongiovanni Paola, Porzio Marianna, Soriano Francesco, Brambilla Maura, Cesana Giancarlo, Brambilla Paolo, Giannattasio Cristina, Fargion Silvia
  
  Abstract
  
  BACKGROUND & AIMS:
  Iron accumulation within the arterial wall has been hypothesized to promote atherosclerosis progression. Aim of this study was to evaluate whether the hormone hepcidin and iron stores are associated with arterial stiffness in subjects with essential hypertension.
  
  METHODS:
  Circulating hepcidin, ferritin, and mutations in the hemochromatosis gene were compared between subjects included in the first vs. third tertile (n=284 each) of carotid-femoral pulse wave velocity (PWV) in an unselected cohort of patients with arterial hypertension.
  
  RESULTS:
  At univariate logistic regression analysis, high PWV was associated with higher ferritin levels (p=0.010), but lower hepcidin (p=0.045), and hepcidin ferritin/ratio (p
  CONCLUSIONS:
  In conclusion, hyperferritinemia is associated with high aortic stiffness and cardiac diastolic dysfunction, while low circulating hepcidin with high aortic stiffness.
  
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• [The conundrum of therapeutic management in acute myocardial infarction complicated by endoventricular thrombosis: moving between different risks].
  G Ital Cardiol (Rome)

  2015 ;16(7-8):437-41. doi: 10.1714/1954.21248.
  
  Varrenti Marisa, Morici Nuccia, De Chiara Benedetta, Oreglia Jacopo Andrea, Pedrotti Patrizia, Giannattasio Cristina, Klugmann Silvio, Roghi Alberto
  
  Abstract
  
  Coronary artery disease is a rare entity in young patients and accurate assessment of its prevalence is difficult. Although coronary artery disease is frequently a silent process, it may also acutely present with myocardial infarction (MI). One of the most feared complications of MI is left ventricular thrombus formation. Transthoracic echocardiography is recommended for all patients with MI, and cardiac magnetic resonance should be considered because of its higher sensitivity if thrombus cannot clearly be demonstrated. The optimal treatment is based on anticoagulant therapy that should be started early and maintained for 3-4 months after the index event. We report the case of a 35-year-old male patient with anterior MI, complicated by left ventricular thrombus formation, extensive edema, microvascular obstruction and hemorrhagic core of the apical septum on cardiac magnetic resonance assessment.
  
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• Changes in Dietary Behavior among Coronary and Hypertensive Patients: A Longitudinal Investigation Using the Health Action Process Approach.
  Appl Psychol Health Well Being

  2015 Nov;7(3):316-39. doi: 10.1111/aphw.12050.
  
  Steca Patrizia, Pancani Luca, Greco Andrea, D'Addario Marco, Magrin Maria Elena, Miglioretti Massimo, Sarini Marcello, Scrignaro Marta, Vecchio Luca, Cesana Francesca, Giannattasio Cristina, Fattirolli Francesco, Zanettini Renzo
  
  Abstract
  
  BACKGROUND:
  Cardiovascular diseases (CVDs) are a major cause of worldwide morbidity and mortality. Nutrition plays an important role in the primary, secondary, and tertiary prevention of CVDs. The present longitudinal study used the Health Action Process Approach (HAPA) to investigate changes in dietary behavior in coronary patients (CPs) affected by acute coronary syndrome and hypertensive patients (HPs) affected by essential arterial hypertension.
  
  METHODS:
  CPs (N = 250) and HPs (N = 246) completed a questionnaire during three measurement points (baseline, 6-month follow-up, and 12-month follow-up). Statistical analyses included a repeated measures ANOVA and a multi-sample structural equation model.
  
  RESULTS:
  HPs showed no changes in dietary behavior, whereas CPs improved their nutrition at 6 months and then maintained the healthier diet. The multi-sample analysis indicated equivalence of the HAPA model for both patient populations.
  
  CONCLUSIONS:
  These findings provide further evidence for the generalisability of the HAPA model, shedding light on dietary behavior among CVD patients and particularly on hypertensive patients which has received little attention. Moreover, the equivalence of the model suggests that the process of change is almost identical for individuals who are at high risk for a coronary event (i.e. HPs) and individuals who have already had the event (i.e. CPs).
  
  © 2015 The International Association of Applied Psychology.
  
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• The impact of age and risk factors on carotid and carotid-femoral pulse wave velocity.
  J Hypertens

  2015 Jul;33(7):1446-51. doi: 10.1097/HJH.0000000000000582.
  
  Kozakova Michaela, Morizzo Carmela, Guarino Daniela, Federico Giovanni, Miccoli Mario, Giannattasio Cristina, Palombo Carlo
  
  Abstract
  
  OBJECTIVE:
  Segmental carotid-femoral pulse-wave velocity (PWV) is a gold standard method for arterial stiffness assessment; recently, a local carotid PWV measurement by ultrasound has been developed. The present study compared the impact of age and established risk factors on carotid and carotid-femoral PWV.
  
  METHODS:
  Three hundred and seven volunteers (167 men; age from 15 to 78 years) free of cardiovascular disease, diabetes, antihypertensive and lipid-lowering treatment underwent sequential measurement of carotid and carotid-femoral PWV.
  
  RESULTS:
  In the entire study population, both carotid and carotid-femoral PWV were independently associated mainly with age and blood pressure. In individuals more than 50 years old (N?=?132, 80 men), carotid-femoral PWV, but not carotid PWV, was also associated with high-density lipoprotein (HDL)-cholesterol and fasting glucose. The annual increase in carotid and carotid-femoral PWV was similar (0.087?±?0.004 and 0.090?±?0.005? m/s, respectively; P?=?0.69). Carotid PWV increased with age more rapidly in women than in men (0.099?±?0.005 vs. 0.076?±?0.005? m/s per year, P?0.005), whereas carotid-femoral PWV showed a steeper increase in individuals more than 50 years old than individuals aged 50 years or less (0.150?±?0.019 vs. 0.088?±?0.007? m/s per year, P?=?0.001).
  
  CONCLUSION:
  In apparently healthy population, both carotid and carotid-femoral PWV were influenced above all by age and blood pressure. Other established cardiovascular risk factors had a limited impact only on carotid-femoral PWV of older individuals. The age-related increase in carotid and carotid-femoral PWV seemed to follow different patterns; increase in carotid PWV showed age-sex interaction, being steeper in women, whereas increase in carotid-femoral PWV was more prominent in older individuals.
  
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• Effects of Cancer Therapy Targeting Vascular Endothelial Growth Factor Receptor on Central Blood Pressure and Cardiovascular System.
  Am J Hypertens

  2016 Feb;29(2):158-62. doi: 10.1093/ajh/hpv077.
  
  Moreo Antonella, Vallerio Paola, Ricotta Riccardo, Stucchi Miriam, Pozzi Mattia, Musca Francesco, Meani Paolo, Maloberti Alessandro, Facchetti Rita, Di Bella Sara, Giganti Maria Olga, Sartore-Bianchi Andrea, Siena Salvatore, Mancia Giuseppe, Giannattasio Cristina
  
  Abstract
  
  BACKGROUND:
  In the last 2 decades, new drugs that oppose the effects of vascular endothelial growth factor receptor (VEGFR), and thus angiogenesis, have considerably improved treatment of solid tumors. These anti-VEGFR drugs, however, are burdened by several side effects, particularly relevant on heart and vessels. The aim of this study was to analyze the changes in cardiovascular structure and function associated with use of anti-VEGFR drugs.
  
  METHODS:
  Twenty-nine patients (27 affected by renal and 2 by thyroid cancer), received treatment with anti-VEGFR drugs. Brachial blood pressure (BP), central BP, carotid-femoral pulse wave velocity (cfPWV), augmentation index (Aix), and several echocardiographic markers of systolic and diastolic left ventricular functions including global longitudinal strain were measured before starting treatment (T0), after 2 (T1), and 6 weeks (T2) of treatment.
  
  RESULTS:
  Anti-VEGFR treatment was accompanied by a significant increase of both peripheral (systolic BP +13±15.5mm Hg, diastolic BP +7.1±9.3mm Hg, P
  CONCLUSIONS:
  All the changes regarding BP and cfPWV appear early after treatment initiation and seem to be reversible if treatment is stopped, instead diastolic and systolic left ventricular function are persistently altered by anti-VEGFR drugs.
  
  © American Journal of Hypertension, Ltd 2015. All rights reserved. For Permissions, please email: journals.permissions@oup.com.
  
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• Structural and Functional Abnormalities of Carotid Artery and Their Relation with EVA Phenomenon.
  High Blood Press Cardiovasc Prev

  2015 Dec;22(4):373-9. doi: 10.1007/s40292-015-0100-9.
  
  Maloberti Alessandro, Meani Paolo, Varrenti Marisa, Giupponi Luca, Stucchi Miriam, Vallerio Paola, Giannattasio Cristina
  
  Abstract
  
  Early vascular aging is a process characterized by a reduction in arterial elastin with an increase in collagen that has been related to cardiovascular risk factor and can determine an increased arterial stiffness and central blood pressure. It can be measured by several non invasive methods and in different arterial segment. The present paper will focus on functional (local stiffness parameter) and structural (intima media thickness) carotid arteries alterations typically evaluated by ultrasound methods. Methodological, research and clinical issue has been reviewed.
  
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• Paroxysmal supraventricular tachycardia as first manifestation of right atrial hemangioma during endovascular treatment of intracranial arteriovenous fistulas.
  Oncotarget

  2015 Jun;6(16):14060-4.
  
  Spanò Francesca, Cereda Alberto, Moreo Antonella, Bonacina Edgardo, Peritore Angelica, Roghi Alberto, Giannattasio Cristina, Pedrotti Patrizia
  
  Abstract
  
  We report the description of a cardiac mass occupying almost the entire right atrium in a young man who developed paroxysmal supraventricular tachycardia during endovascular treatment of intracranial arteriovenous fistulas. The mass was detected at echocardiographic examination, its tissue characteristics were defined with cardiac magnetic resonance and it was successfully surgically removed. The histopathological findings were consistent with a mixed type cavernous-capillary hemangioma of the heart. The intriguing co-existence of cardiac hemangioma and cerebral arteriovenous fistulas, to the best of our knowledge, has not been previously reported in English Literature.
  
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• Increased nocturnal heart rate and wave reflection are early markers of cardiovascular disease in Williams-Beuren syndrome children.
  J Hypertens

  2015 Apr;33(4):804-9; discussion 809. doi: 10.1097/HJH.0000000000000454.
  
  Maloberti Alessandro, Cesana Francesca, Hametner Bernhard, Dozio Dario, Villa Paolo, Hulpke-Wette Martin, Schwarz Achim, Selicorni Angelo, Wassertheurer Siegfried, Mancia Giuseppe, Giannattasio Cristina
  
  Abstract
  
  OBJECTIVE:
  Williams-Beuren syndrome (WBS) is a genetic disorder that involves elastin gene causing cardiovascular abnormalities and increased risk. However, data on arterial function in these patients are only few and conflicting. Aim of this study was to evaluate dynamic behaviour of central and peripheral blood pressure (BP) and arterial stiffness parameters early in the course of WBS.
  
  METHODS:
  We enrolled 19 WBS paediatric patients (age 13?±?4 years) and 23 age, height and BP-matched controls (10?±?4 years). We evaluated 24-h ambulatory BP values via an ambulatory blood pressure monitoring (ABPM) system (Mobil-O-Graph) also capable to calculate 24-h central BP and 24-h arterial stiffness parameters. Carotid-femoral PWV (cf-PWV) was assessed in all WBS individuals (Complior).
  
  RESULTS:
  BP values were similar in WBS and control, during the daytime and the night-time. The same behaviour applies to 24-h central BP. However, during the night, WBS showed heart rate values (HR; 78?±?10 vs. 71?±?9?bpm; P?0.03), augmentation index (Aix; 24.6?±?13.5% vs. 16.5?±?8.9%; P?=?0.03) and reflection magnitude (68 5.8 vs. 63.5 8.1; P?=?0.02) higher than controls. The HR, Aix and reflection magnitude reduction in the day-night shift was lower in WBS than in controls. Cf-PWV in WBS children did not differ when compared with their normalized expected value.
  
  CONCLUSION:
  In WBS children, the higher night-time HR, Aix and reflection magnitude and their impaired physiological reduction in the day-night shift suggests an abnormal sympathetic cardiovascular control, an augmented wave reflection and an increase in small arteries resistance. These alterations possibly due to a sympathetic overactivity can be regarded as earlier hallmarks of cardiovascular dysfunction in these patients.
  
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• [A matter of perspective: multimodality imaging of a giant cardiac mass].
  G Ital Cardiol (Rome)

  2015 Mar;16(3):186-7. doi: 10.1714/1820.19830.
  
  Baroni Matteo, Nava Stefano, Vignati Gabriele, Marianeschi Stefano Maria, Giannattasio Cristina, Pedrotti Patrizia
  
  Abstract
  
  A newborn was suspected of having situs inversus with levocardia based on chest X-ray. Echocardiography ruled out this hypothesis but revealed a giant cardiac mass that was confirmed by magnetic resonance imaging. Coronary angiography showed that the right coronary artery ran on the surface of the mass, and only partial debulking surgery was performed to relieve right heart compression. Histological examination classified the mass as cardiac fibroma. Complex diagnostic work-up allowed correct anatomic definition of the mass as well as its relationship with adjacent structures, and helped guide surgical planning.
  
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• Cardiac metastatic melanoma: Imaging diagnostic clues.
  J Cardiol Cases

  2015 Aug;12(2):33-36. doi: 10.1016/j.jccase.2015.03.001.
  
  Pedrotti Patrizia, Musca Francesco, Torre Massimo, Pirola Roberto, De Biase Anna Maria, Fieschi Stefano, Quattrocchi Giuseppina, Roghi Alberto, Giannattasio Cristina
  
  Abstract
  
  A 47-year-old male was admitted to hospital for severe pericardial effusion; he had undergone surgical removal of cutaneous melanoma 10 years before. Echocardiography-guided pericardiocentesis revealed the presence of intramyocardial masses, which were better defined and characterized, together with pericardial involvement, by cardiac magnetic resonance. Pericardial fluid drained was negative for malignant cells, so video-assisted thoracoscopy was performed and pathologic tissue was biopsied, leading to the diagnosis of metastatic melanoma. Multidisciplinary approach and multimodality imaging played a key role in allowing the diagnostic workup in this complex case. .
  
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• Brachial and central blood pressure in HIV-infected subjects.
  Hypertens Res

  2015 Jun;38(6):405-12. doi: 10.1038/hr.2015.25.
  
  Maloberti Alessandro, Dozio Dario, Betelli Mauro, Bandera Alessandra, Squillace Nicola, Gori Andrea, Castoldi Giovanna, Stella Andrea, Mancia Giuseppe, Giannattasio Cristina
  
  Abstract
  
  HIV infected subjects present an unfavorable cardiovascular (CV) risk profile that is determined by the infection itself, highly active anti-retroviral therapy (HAART) and other factors, such as chronic kidney disease (CKD). Information is scant and contradictory on whether these factors are associated with arterial stiffness and blood pressure (BP) alteration. Our study aimed to evaluate those parameters in HIV-positive subjects both with and without HAART and with and without CKD, which was defined as the presence of microalbuminuria with a normal glomerular filtration rate. We enrolled 94 HIV-infected subjects without known CV risk factors and compared them with 37 control subjects. We recorded brachial and central BP (pulse wave analysis) and pulse wave velocity ( SphygmoCor). HIV-positive subjects of similar ages and with similar BP values showed central pulse pressure values that were significantly greater than those of controls; this was also the case for the Aix value. Central systolic and pulse pressure values and Aix were significantly greater in HIV-positive subjects with HAART and CKD than in the other HIV-positive subgroups and control subjects. PWV was also superimposable between groups when the data were analyzed relative to the presence of HAART and CKD. Our study shows that the unfavorable CV risk profile associated with HIV infection includes an increase in both central BP and Aix. The central BP increase seems to be favored by renal damage, which apparently has a role in the early stages of the disease.
  
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• Multiparametric carotid and cardiac ultrasound compared with clinical risk scores for the prediction of angiographic coronary artery disease: a multicenter prospective study.
  J Hypertens

  2015 Jun;33(6):1291-300. doi: 10.1097/HJH.0000000000000543.
  
  Moreo Antonella, Gaibazzi Nicola, Faggiano Pompilio, Mohammed Moemen, Carerj Scipione, Mureddu Gianfrancesco, Pigazzani Filippo, Muiesan Lorenza, Salvetti Massimo, Cesana Francesca, Faden Giacomo, Facchetti Rita, Giannattasio Cristina, Rigo Fausto
  
  Abstract
  
  OBJECTIVE:
  Cardiovascular risk prediction is deemed fundamental and the assessment of organ damage is emerging as a potentially 'downstream' picture of individual risk. Our aim was to assess the feasibility and value of prediction of coronaropathy [coronary artery disease (CAD)] of integrated cardiovascular ultrasound examination.
  
  METHODS:
  This multicenter study involved eight cardiology centers that enrolled 457 consecutive patients. Blood pressures, carotid intima-media thickness (cIMT), carotid pulse wave velocity (cPWV), semiquantitative score of cardiac calcifications, global myocardial longitudinal strain (GLS), and rest Doppler flow velocity on the left anterior descending (LAD) coronary artery were measured. After coronary angiography, patients were divided in CAD, n?=?273, at least one coronary stenosis higher than 50%, and no CAD, n?=?184.
  
  RESULTS:
  CAD were older (65.9?±?10.7 versus 63.1?±?11.2 years, mean?±?standard deviation, P?=?0.01), and had higher blood pressure (137.0?±?18.8/77.5?±?11.1 versus 130.2?±?17.4/75.1?±?9.7?mmHg, P?0.02), cIMT (791.4?±?165.5 versus 712.0?±?141.5 mcm, P?0.0001), cPWV (median: 9 versus 8.1 m/s, P?0.01), score of calcium (median, 2 versus 1, P?0.0001), LAD velocity (median, 38 versus 36, P?0.07), and lower GLS (-17.6?±?4.3 versus -19.3?±?5.1, P?0.05) than no CAD. Score of calcium was feasible in the totality of patients, cIMT in 97%, cPWV in 86%, GLS in 88%, and LAD in 84%. A combination of at least three variables was measurable in 80% of the patients. All ultrasound parameters significantly predicted CAD. However, in a stepwise logistic regression, the only combined predictors of obstructive CAD were score of calcium, cIMT, and LAD velocity.
  
  CONCLUSION:
  In Echo-Lab, Rome, Italy, the integrated cardiovascular ultrasound study is feasible in a high percentage of patients. The combination of three parameters, that is, score of calcium, cIMT, and LAD velocity, has incremental predictive value for obstructive CAD.
  
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• Right anterior mini-thoracotomy direct aortic self-expanding trans-catheter aortic valve implantation: A single center experience.
  Int J Cardiol

  2015 Feb;181():437-42. doi: 10.1016/j.ijcard.2014.11.108.
  
  Bruschi Giuseppe, De Marco Federico, Botta Luca, Barosi Alberto, Colombo Paola, Mauri Silvia, Cannata Aldo, Morici Nuccia, Colombo Tiziano, Fratto Pasquale, Nonini Sandra, Soriano Francesco, Mondino Michele, Giannattasio Cristina, Klugmann Silvio
  
  Abstract
  
  OBJECTIVE:
  Transcatheter aortic valve implantation (TAVI) has been designed to treat elderly patients with severe aortic stenosis at high risk for surgery. These patients are also often affected by severe iliac-femoral arteriopathy, rendering the trans-femoral approach unusable. We report our experience with the direct-aortic approach to treat these patients.
  
  METHODS:
  From May 2008 to November 2013 two hundred and thirty-two patients (131 female, 56%) with severe symptomatic aortic stenosis and no reasonable surgical option due to excessive risk were evaluated for TAVI at our department. Of these patients, 202 were deemed eligible for TAVI. Of this group, 50 underwent CoreValve implantation by the direct aortic approach through a right anterior mini-thoracotmy (28 female, 56%), mean age 81.2±6.9. A combined team of cardiologists, cardiac surgeons with expertise in hybrid procedures, and anesthetists performed all the procedures.
  
  RESULTS:
  Twenty-eight (56%) patients were female and 11 (22%) were redo at TAVI. We used a 23-mm CoreValve Evolute in 3 patients (6%), and the most used valve size was the 29mm in 46% of patients. Mean hemodynamic trans-aortic gradient was less than 5mmHg. The paravalvular regurgitation was ? grade 1 in 46 patients as assessed by peri-procedural transesophageal echocardiography (TEE). Seven patients (7/43, 16%) required a permanent pacemaker implantation; 30-day mortality was 6% (3 patients). Seven patients (14.8%) died during follow-up. Actuarial survival at 2years is 84.7±5.3%.
  
  CONCLUSIONS:
  Transcatheter aortic valve implantation with the direct aortic approach is safe and feasible, offering a new attractive option to treat selected high-risk patients with severe aortic stenosis and peripheral vasculopathy, including those requiring a re-do procedure.
  
  Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
  
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• Ultrasound carotid intima-media thickness, carotid plaque and cardiac calcium incrementally add to the Framingham Risk Score for the prediction of angiographic coronary artery disease: a multicenter prospective study.
  Int J Cardiol

  2014 Dec;177(2):708-10. doi: 10.1016/j.ijcard.2014.09.195.
  
  Gaibazzi Nicola, Rigo Fausto, Facchetti Rita, Carerj Scipione, Giannattasio Cristina, Moreo Antonella, Mureddu Gianfrancesco, Paini Anna, Grolla Elisabetta, Faden Giacomo, Cesana Francesca, Faggiano Pompilio
  
  
  
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• Diagnostic and therapeutic problems of isolated systolic hypertension.
  J Hypertens

  2015 Jan;33(1):33-43. doi: 10.1097/HJH.0000000000000424.
  
  Mancia Giuseppe, Giannattasio Cristina
  
  Abstract
  
  Prevalence of isolated systolic hypertension increases with age, due to progressive elevation of SBP, and is a major risk factor for cardiovascular morbidity and mortality. Extensive research has shown that lowering SBP improves cardiovascular outcomes in patients with isolated systolic hypertension, yet SBP control rates remain largely inadequate regardless of antihypertensive treatment. Arterial stiffness is a major determinant of elevated SBP resulting from structural changes in the vascular system, mediated by neurohormonal alterations that occur with vascular ageing. Clinical data have demonstrated an independent association between arterial stiffness and cardiovascular outcomes. Therefore, arterial stiffness has the potential to be an important therapeutic target in the management of isolated systolic hypertension. Current antihypertensive treatments have limited effects on arterial stiffness, so the development of new treatments addressing neurohormonal alterations central to vascular ageing is important. Such therapies may represent effective strategies in the future management of SBP.
  
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• Renal artery stenosis as the cause of resistant arterial hypertension: an unusual technique for revascularization.
  J Clin Hypertens (Greenwich)

  2014 Jul;16(7):536-7. doi: 10.1111/jch.12331.
  
  De Biase Anna, Varrenti Marisa, Meani Paolo, Cesana Francesca, Pirola Roberto, Giupponi Luca, Alloni Marta, Vallerio Paola, Moreo Antonella, Rampoldi Antonio, Giannattasio Cristina
  
  
  
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• Delayed, severe thrombocytemia after abciximab infusion for primary angioplasty in acute coronary syndromes: Moving between systemic bleeding and stent thrombosis.
  Platelets

  2015 ;26(5):498-500. doi: 10.3109/09537104.2014.898181.
  
  Giupponi Luca, Cantoni Silvia, Morici Nuccia, Sacco Alice, Giannattasio Cristina, Klugmann Silvio, Savonitto Stefano
  
  
  
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• Cardiac magnetic resonance imaging of left ventricular apical hypoplasia in two complex congenital clinical syndromes.
  Circ J

  2014 ;78(6):1507-9.
  
  Baroni Matteo, Pedrotti Patrizia, Nava Stefano, Giannattasio Cristina, Roghi Alberto
  
  
  
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• Similarities and differences between renal sympathetic denervation and carotid baroreceptor stimulation.
  Curr Vasc Pharmacol

  2014 Jan;12(1):63-8.
  
  Grassi Guido, Seravalle Gino, Brambilla Gianmaria, Cesana Francesca, Giannattasio Cristina, Mancia Giuseppe
  
  Abstract
  
  The two novel approaches recently introduced for the treatment of resistant hypertension, i.e. carotid baroreceptor stimulation and renal denervation, share a number of similarities but are also characterized by important differences. The similarities include the evidence that both interventions have as common pathophysiological background the state of sympathetic overdrive characterizing essential hypertension. In addition both procedures 1) are invasive, 2) exert in the short-term period clearcut blood pressure lowering effects and 3) still face a number of open questions, particularly related to the long-term blood pressure lowering effects, impact on end-organ damage and on cardiovascular events. The differences include the fact that two procedures act on distinct targets that trigger sympathetic activation and consequently blood pressure increase. In addition, only in the case of carotid baroreceptor stimulation the blood pressure effects can be easily assessed immediately following the implantation. Finally, the economic costs, metabolic effects and impact on vagal modulation of heart rate are different between the two interventions. This paper will provide a comparison of the background, effects and outcome of renal denervation and carotid baroreceptor stimulation, stressing whenever possible the clinical implications of the main features of the two interventions.
  
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• Impact of blood glucose variability on carotid artery intima media thickness and distensibility in type 1 diabetes mellitus.
  Blood Press

  2013 Dec;22(6):355-61. doi: 10.3109/08037051.2013.791413.
  
  Cesana Francesca, Giannattasio Cristina, Nava Stefano, Soriano Francesco, Brambilla Gianmaria, Baroni Matteo, Meani Paolo, Varrenti Marisa, Paleari Felice, Gamba Pierluigi, Facchetti Rita, Alloni Marta, Grassi Guido, Mancia Giuseppe
  
  Abstract
  
  AIMS:
  Diabetes mellitus is characterized by structural and functional alterations of the large- and medium-size arteries. Whether blood glucose variability, i.e. the glycemic oscillations occurring during the 24-h period, represents a risk factor for vascular alterations additional to and independent on HbA1c in type 1 diabetes mellitus is still undefined. The present study was carried out with the aim at investigating the impact of different measures of blood glucose variability on arterial structure and function. We studied 17 non-complicated type 1 diabetic patients (11 males, six females) with an age of 40.8 ± 7.6 years (mean ± SD). In each patient, 24-h glucose profile was obtained by continuous glucose monitoring system and glucose variability was expressed as mean ± SD of 24-h blood glucose levels, mean amplitude of glycemic excursions and postprandial hyperglycemic spikes. Arterial structure and function was measured as carotid IMT and stiffness.
  
  MAJOR FINDINGS:
  The different approaches to assessing blood glucose variability well correlated between and with HbA1c. Carotid IMT and stiffness showed significant correlations with age, blood pressure, heart rate and daily insulin intake but a non- significant correlation with blood glucose variability.
  
  PRINCIPAL CONCLUSION:
  Thus, in type 1 diabetes mellitus, measures of glycemic variability are useful in predicting both actual and long-lasting glycemic control. In absence of diabetes-related complications and of any intima-media thickness alterations, the major predictors of arterial distensibility are represented by traditional risk factors beside glycemic 24-h control.
  
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• Does the 9p region affect arterial stiffness? Results from a cohort of hypertensive individuals.
  Blood Press

  2013 Oct;22(5):302-6. doi: 10.3109/08037051.2013.765627.
  
  Cesana Francesca, Nava Stefano, Menni Cristina, Boffi Lucia, Varrenti Marisa, Meani Paolo, Maloberti Alessandro, Grassi Guido, Giannattasio Cristina, Mancia Giuseppe
  
  Abstract
  
  OBJECTIVE:
  Evidence exists that arterial stiffness, i.e. an independent predictor of cardiovascular and all-causes mortality, has a genetic component. The 9p21 region is associated with a greater susceptibility to coronary disease. Whether this can be ascribed to the fact that genes located on chromosome 9p may also regulate arterial stiffness is largely unknown, however. We evaluate the influence of single nucleotide polymorphisms (SNPs) from 9p on carotid-femoral pulse wave velocity (C-F PWV), measured via the Complior method, in a cohort of 821 hypertensive subjects.
  
  DESIGN:
  The selected tagSNPs were screened with a custom-designed 384-plex VeraCode GoldenGate Genotyping assay on Illumina BeadXpress Reader platform. Association analysis was done using PLINK considering C-F PWV as a quantitative trait (linear regression assuming an additive model) adjusting for sex, age, systolic blood pressure and body mass index (BMI). We used false discovery rate (FDR) to account for multiple testing.
  
  RESULTS:
  Although none of the 384 SNPs was significant after adjusting for multiple testing, probably due to the small sample size of the study population, a trend of association with C-F PWV was observed for rs300622 and rs2381640.
  
  CONCLUSIONS:
  These data suggest that SNPs located on chromosome 9p may affect arterial stiffness. Further studies are needed to confirm our finding on a larger sample and define the physiopathological link of the present results.
  
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• Variant on chromosome 9p is associated with left ventricular mass: results from two cohorts of essential hypertensive individuals.
  J Hypertens

  2012 Nov;30(11):2144-50. doi: 10.1097/HJH.0b013e3283581f7e.
  
  Menni Cristina, Boffi Lucia, Cesana Francesca, Viviani Anselmi Chiara, Nava Stefano, Bertola Francesca, Blasio Anna M Di, Roncarati Roberta, Trimarco Valentina, Marino Marina, Trimarco Bruno, Grassi Guido, Giannattasio Cristina, Mancia Giuseppe
  
  Abstract
  
  OBJECTIVES:
  It is well known that among hypertensive patients, an increased left ventricular mass (LVM) is a powerful predictor of cardiovascular morbidity and mortality. However, the mechanisms underlying LVM in hypertension are not completely understood, as the absolute value of blood pressure and other risk factors associated do not predict alone a definite LVM progression. Recently, the 9p21 chromosomal region has been consistently associated with coronary heart disease.
  
  METHODS AND RESULTS:
  We examined the association of 384 single nucleotide polymorphisms (SNPs) in the short arm of chromosome 9 with LVM in 821 hypertensive individuals from northern Italy. We identified a SNP (rs894379) in the intronic region of the centlein, centrosomal protein (CNTLN) gene on chromosome 9p22, whose minor allele G is associated with an increased LVM. We performed a follow-up validation analysis for the top SNP in 1038 hypertensive individuals from southern Italy. We then combined the results and found a nominal association for rs894379 (? ?= ?2.46, P ?=? 0.0026).
  
  CONCLUSION:
  We describe a new variant associated with echocardiography LVM. This result, though it needs to be further investigated, may improve our understanding of the genetic determination of this prognostically relevant trait.
  
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• Blood pressure control in Italian essential hypertensives treated by general practitioners.
  Am J Hypertens

  2012 Nov;25(11):1182-7. doi: 10.1038/ajh.2012.108.
  
  Giannattasio Cristina, Cairo Matteo, Cesana Francesca, Alloni Marta, Sormani Paola, Colombo Giulia, Grassi Guido, Mancia Giuseppe
  
  Abstract
  
  BACKGROUND:
  Adequate control of blood pressure (BP) is limited worldwide. This has serious consequences for public health because in hypertensive patients, uncontrolled BP is associated with a higher incidence of cardiovascular events, particularly stroke. The aim of this study was to investigate BP control in a cohort of treated patients with diagnosed hypertension, who were under general practitioner care in Italy.
  
  METHODS:
  Data were collected by 2,643 physicians on 8,572 individual Italian patients. Office BP was measured 5 min after seating each patient and then 3-5 min later. For each patient, data such as medical history of patients, physical examination data, antihypertensive drug usage, and self-BP measurement frequency were obtained.
  
  RESULTS:
  Male prevalence was 48.4%, and mean age was 64.3 ± 10.5 years. Based on the second measurement, BP control (
  CONCLUSIONS:
  In treated Italian hypertensives effective BP control remains uncommon largely due to the failure to appropriately reduce the systolic BP. The stricter values recommended by the ESH/ESC guidelines for diabetic patients are achieved only by a small fraction of hypertensive diabetic population.
  
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• Radiofrequency-based carotid wall tracking: a comparison between two different systems.
  J Hypertens

  2012 Aug;30(8):1614-9. doi: 10.1097/HJH.0b013e328354dd44.
  
  Palombo Carlo, Kozakova Michaela, Guraschi Nicola, Bini Giacomo, Cesana Francesca, Castoldi Giovanna, Stella Andrea, Morizzo Carmela, Giannattasio Cristina
  
  Abstract
  
  OBJECTIVES:
  A direct measurement of carotid stiffness implies an accurate assessment of changes in carotid diameter and pressure during cardiac cycle. Radiofrequency-based wall-tracking systems (WTS) are capable to track arterial wall movement with adequate spatial and temporal resolution, and to provide carotid pressure estimate from calibrated distension waveforms. The aim of the present study was to compare the values of carotid distension and beta-stiffness index acquired in the same population by two commercially available WTS, in order to determine whether their measures can be pooled in clinical studies. In addition, a local carotid pulse pressure (PP) obtained from calibrated distension waveforms was compared with that obtained from pressure waveforms.
  
  METHODS:
  In 105 patients, right common carotid artery (CCA) systo-diastolic excursions were assessed during the same session and by the same operator both by WTS implemented in Esaote system (QAS, MyLab) and in Aloka system (E-track; Alpha 10). In 78 patients, carotid PP was also estimated by applanation tonometry.
  
  RESULTS:
  Despite comparable blood pressure and heart rate values during the two acquisitions, CCA distension was significantly lower (363 ± 162 vs. 458 ± 176 ?m, P
  CONCLUSIONS:
  The values of carotid distension and stiffness obtained by two different WTS are not interchangeable and cannot be merged into a common database. Calibrated distension curves may provide an acceptable estimate of local carotid pressure.
  
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• Tissue Doppler, triplane echocardiography, and speckle tracking echocardiography: different ways of measuring longitudinal myocardial velocity and deformation parameters. A comparative clinical study.
  Echocardiography

  2012 Apr;29(4):428-37. doi: 10.1111/j.1540-8175.2011.01618.x.
  
  Fontana Antonella, Zambon Antonella, Cesana Francesca, Giannattasio Cristina, Trocino Giuseppe
  
  Abstract
  
  AIMS:
  The aim of our study was to compare global and segmental longitudinal myocardial velocity and deformation obtained from three different echocardiographic techniques of postprocessing analysis (two-dimensional tissue Doppler imaging (2D TDI), triplane tissue Doppler imaging (3D TDI), and speckle tracking echocardiography (STE)), in a group of consecutive subjects referred to echocardiography with different clinical indications, and to assess their reproducibility.
  
  METHODS AND RESULTS:
  Standard echocardiograms with high frame rate gray-scale images and color coded TDI apical views, and a single beat TDI triplane apical section of the left ventricle were acquired at two different times. Longitudinal velocity and deformation parameters were obtained in postprocessing in 103 subjects from TDI and STE derived curves, and absolute values were compared to test the variability of the three techniques. All the measures were repeated twice, for a test-retest study. The times to peak velocity and deformation were similar by TDI and STE; other parameters showed significant difference (P 0.9) was acceptable, meaning that measures obtained at two different times did not differ significantly in between.
  
  CONCLUSION:
  TDI and speckle tracking are both feasible and reproducible. Myocardial velocity and deformation parameters obtained with them are significantly different. STE is the most reproducible technique, whereas TDI based measurements are lower reproducible. STE can easily be used during clinical follow up for its feasibility and high reproducibility.
  
  © 2012, Wiley Periodicals, Inc.
  
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• Early alterations in left ventricular diastolic function in normotensive diabetic patients.
  Blood Press

  2012 Apr;21(2):110-5. doi: 10.3109/08037051.2012.625670.
  
  Capra Anna, Galderisi Maurizio, Giannattasio Cristina, Innelli Pasquale, Facchetti Rita, Cesana Francesca, Alloni Marta, Carugo Stefano, Grassi Guido, de Divitiis Oreste, Mancia Giuseppe
  
  Abstract
  
  In diabetes mellitus, structural and functional alterations of the heart can be already present at the time of first diagnosis. However, how early these alterations may occur has never been fully clarified. The present study aimed at investigating cardiac functional abnormalities in uncomplicated hypertensive or normotensive patients with a recent diagnosis of diabetes mellitus. We studied 40 diabetics (24 normotensives and 16 hypertensives) by means of routine echocardiography plus pulse tissue Doppler analysis. Data were compared with those obtained in healthy age- and sex-matched controls. Left ventricular remodelling was more evident in hypertensive diabetics than in normotensive diabetics vs controls. Diastolic function was altered in diabetic patients only when detected by pulse tissue Doppler analysis and not by conventional transmitral Doppler evaluation. Normotensive patients with type 2 diabetes with little or no evidence at standard echocardiography of alterations in cardiac structure and function, already displayed an alteration in diastolic function when the evaluation was based on the tissue Doppler approach. Patients with type 2 diabetes combined to hypertension showed more evident functional cardiac alterations at echocardiography. These findings support the conclusion that cardiac abnormalities are very early phenomena in type 2 diabetes.
  
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• Comparison of echotracking and magnetic resonance assessment of abdominal aorta distensibility and relationships with pulse wave velocity.
  Ultrasound Med Biol

  2011 Dec;37(12):1970-6. doi: 10.1016/j.ultrasmedbio.2011.09.009.
  
  Giannattasio Cristina, Cesana Francesca, Maestroni Silvia, Salvioni Alessandra, Maloberti Alessandro, Nava Stefano, Cairo Matteo, Madotto Fabiana, Zerboni Filippo, Sironi Sandro, Grassi Guido, Mancia Giuseppe
  
  Abstract
  
  Arterial distensibility can be measured either by echotracking or by nuclear magnetic resonance (MRI). Little information, however, is available on the comparison between the two methods and on the relationships between the results obtained with the two approaches and the arterial stiffness gold standard measurement, i.e., pulse wave velocity (PWV). In 28 normotensive subjects (age 33.0 ± 10.4 years, mean ± SD) we measured aortic diameter 1 cm above iliac bifurcation, aortic pulse pressure by tonometry and calculated arterial distensibility via the Reneman formulae for both methods. Aortic diameter and aortic distensibility were not superimposable and higher values were systematically detected with the MRI approach than with the ultrasound one. However, PWV showed a significant correlation with aortic distensibility values obtained by both methods (r = 0.50 and r = 0.49, p 
  Copyright © 2011. Published by Elsevier Inc.
  
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• Impact of body mass index and waist circumference on the long-term risk of diabetes mellitus, hypertension, and cardiac organ damage.
  Hypertension

  2011 Dec;58(6):1029-35. doi: 10.1161/HYPERTENSIONAHA.111.175125.
  
  Bombelli Michele, Facchetti Rita, Sega Roberto, Carugo Stefano, Fodri Danilo, Brambilla Gianmaria, Giannattasio Cristina, Grassi Guido, Mancia Giuseppe
  
  Abstract
  
  Obesity is associated with a higher risk of developing diabetes mellitus (DM), hypertension (HT), and left ventricular hypertrophy (LVH). The present study assessed in the general population the impact of body weight and visceral obesity on the development of alterations in glucose metabolism and cardiac structure, as well as of elevation in blood pressure. In 1412 subjects randomly selected and representative of the general population of Monza, we assessed twice (in 1990/1991 and 2000/2001) body mass index (BMI); waist circumference; office, home, and 24-hour ambulatory (24-hour) blood pressure, fasting glycemia, and left ventricular mass (echocardiography). New-onset high-risk conditions were DM; impaired fasting glucose; office, home, and 24-hour HT; and LVH. The incidence of new-onset DM; impaired fasting glucose; office, home, and 24-hour HT; and LVH increased progressively from the quintile with the lowest to the quintile with the highest BMI values. Adjusting for confounders, the risk of developing new-onset DM; impaired fasting glucose; office, home, and 24-hour HT; and LVH increased significantly for an increase of 1 kg/m(2) of BMI and 1 cm of waist circumference (respectively, 8.4% [P
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• Prevalence of 'borderline' values of cardiovascular risk factors in the clinical practice of general medicine in Italy: results of the BORDERLINE study.
  High Blood Press Cardiovasc Prev

  2011 Jun;18(2):43-51. doi: 10.2165/11593420-000000000-00000.
  
  Tocci Giuliano, Ferrucci Andrea, Passerini Jasmine, Averna Maurizio, Bellotti Paolo, Bruno Graziella, Cosentino Francesco, Crepaldi Gaetano, Giannattasio Cristina, Modena Maria Grazia, Nati Giulio, Tiengo Antonio, Trimarco Bruno, Vanuzzo Diego, Volpe Massimo
  
  Abstract
  
  INTRODUCTION:
  The prevalence of patients with 'borderline' levels of cardiovascular risk factors has been rarely investigated, being often reported in studies evaluating abnormal values of these parameters. The BORDERLINE study represents a pilot experience to primarily identify the prevalence of 'high-normal' conditions, such as pre-hypertension, lipid and glucose levels in the upper range of normality in the setting of general practice in Italy.
  
  AIM:
  The aim of this study was to evaluate the prevalence of patients with 'borderline' values of cardiovascular risk factors in Italy.
  
  METHODS:
  Involved physicians were asked to evaluate the first 20 outpatients, consecutively seen in June 2009. Data were collected in a study-designed case-report form, in which physicians identified thresholds rather than reported absolute values of several clinical parameters. High-normal values were defined as follows: blood pressure (BP) 130-140/85-90?mmHg; total cholesterol 180-200?mg/dL; low-density lipoprotein cholesterol (LDL-C) 130-150?mg/dL; high-density lipoprotein cholesterol (HDL-C) 30-40?mg/dL in males and 40-50?mg/dL in females; triglycerides 130-150?mg/dL and fasting glucose 100-110?mg/dL.
  
  RESULTS:
  Fifty-three Italian physicians provided valuable clinical data on 826 individual outpatients, among which 692 (83.7%, 377 women, mean age 60.9?±?13.2 years, body mass index 26.6?±?5.0?kg/m2) were included in the present analysis. Prevalence of borderline values of systolic BP and total cholesterol levels were at least comparable with those in the normal limits of the corresponding parameters, whereas prevalence of borderline diastolic BP, LDL-C, HDL-C, triglycerides and fasting glucose levels was significantly lower than that of normal values, but higher than that of abnormal values of the corresponding parameters.
  
  CONCLUSIONS:
  Using this sample of healthy subjects in the setting of general practice in Italy, our results demonstrated a relatively high prevalence of borderline values of cardiovascular risk factors, which was at least comparable with that of normal, but significantly higher than that of abnormal thresholds. These preliminary findings may prompt more extensive investigations in the area of 'borderline' cardiovascular risk. This information may, in fact, potentially enable the design of more effective prevention strategies in the future to limit the burden of cardiovascular disease in the general population in Italy. Received for publication 4 March 2011; accepted for publication 20 April 2011.
  
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• Persistence of arterial functional abnormalities after successful coronary revascularization.
  J Hypertens

  2011 Jul;29(7):1374-9. doi: 10.1097/HJH.0b013e328347a0e3.
  
  Giannattasio Cristina, Capra Anna C M, Calchera Ivan, Colombo Virgilio, Cesana Francesca, Nava Stefano, Maloberti Alessandro, Alloni Marta, Facchetti Rita, Trocino Giuseppe, Grassi Guido, Paolini Giovanni, Mancia Giuseppe
  
  Abstract
  
  BACKGROUND:
  In patients with myocardial ischemia and coronary atherosclerosis, arterial stiffness and endothelial function are impaired. Whether these alterations can be favorably affected by successful coronary revascularization is debated.
  
  METHODS:
  We studied 39 hospitalized patients 59.3 ± 3.2 years old (mean ± SEM). In 21 patients with angiographic evidence of significant coronary artery stenosis, revascularization procedures were performed (stenting n = 11 and bypass surgery n = 10). The remaining patients had no significant stenosis and thus served as controls. Prerevascularization measurements included carotido-femoral pulse wave velocity (PWV), radial artery flow-mediated vasodilatation and a complete echocardiographic examination. The same measurements were performed 6 months later. Pharmacological treatment consisted of different cardiovascular drugs and remained substantially unchanged over the 6-month follow-up period.
  
  RESULTS:
  With the exception of an increased left ventricular mass index (LVMI; 130 ± 5.3 versus 105.8 ± 7.2 g/m(2), P
  CONCLUSION:
  Cardiac revascularization has no effect on arterial function, assessed either as arterial stiffness or as flow-mediated vasodilatation. On the contrary, the improvement in coronary blood flow triggers local cardiac changes, namely, a reduction in LVMI and an improvement in diastolic function.
  
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• Association between ADRA1A gene and the metabolic syndrome: candidate genes and functional counterpart in the PAMELA population.
  J Hypertens

  2011 Jun;29(6):1121-7. doi: 10.1097/HJH.0b013e328346d72c.
  
  Grassi Guido, Padmanabhan Sandosh, Menni Cristina, Seravalle Gino, Lee Wai K, Bombelli Michele, Brambilla Gianmaria, Quarti-Trevano Fosca, Giannattasio Cristina, Cesana Giancarlo, Dominiczak Anna, Mancia Giuseppe
  
  Abstract
  
  OBJECTIVES:
  There is currently uncertainty about whether metabolic syndrome has a common underlying process. We performed a gene-centric association study of metabolic syndrome in 98 major cardiometabolic genes in the large, well phenotyped Pressioni Arteriose Monitorate e Loro Associazioni (PAMELA) study. We followed this with functional studies to elucidate a possible mechanism for the top association signal.
  
  METHODS:
  From the PAMELA cohort, we sampled 1407 individuals with information on the metabolic syndrome (ATPIII criteria). We analyzed 1324 tagging single-nucleotide polymorphisms (SNPs) in 98 candidate genes selected, based on known pathways involved in sympathetic nervous system, oxidative stress, renin-angiotensin system and sodium balance.
  
  RESULTS:
  The SNP rs17055869 near the alpha-1A-adrenoreceptor gene (ADRA1A) showed the strongest association with metabolic syndrome (odds ratio 1.7, CI 1.3-2.2; P = 0.00007, P = 0.000098 after permutation). In order to determine a functional basis for this association, we examined in a subgroup of metabolic syndrome patients whether the allelic distribution of the above-mentioned gene is different according to the different degree of the metabolic syndrome-related sympathetic activation, directly assessed by the gold standard method to assess neuroadrenergic drive, that is microneurographic recording of efferent postganglionic muscle sympathetic nerve traffic. All metabolic syndrome patients with a lesser degree of sympathetic activation were homozygous for the major allele (C), whereas those with a very pronounced sympathetic overdrive had an over-representation of the minor T allele (P
  CONCLUSION:
  Thus, the rs17055869 SNP near the 3' end of ADRA1A is significantly associated with metabolic syndrome and it may be involved in determining a greater level of sympathetic activation in metabolic syndrome patients.
  
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• Endothelium in polycythemia secondary to obstructive lung disease.
  J Appl Physiol (1985)

  2011 May;110(5):1158-9. doi: 10.1152/japplphysiol.00202.2011.
  
  Mancia Giuseppe, Giannattasio Cristina
  
  
  
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• Ultrasonographic backscatter of the carotid artery wall in patients with HIV infection: a pilot study.
  Blood Press

  2010 Dec;19(6):344-50. doi: 10.3109/08037051.2010.506997.
  
  Giannattasio Cristina, Failla Monica, Squillace Nicola, Dolara Alberto, Cesana Francesca, Sabbatini Francesca, Bandera Alessandra, Facchetti Rita, Dozio Dario, Gori Andrea, Mancia Giuseppe
  
  Abstract
  
  AIMS:
  The aim of our study was to measure carotid intima-media thickness (cIMT) and risk factors associated with its development and progression, and to evaluate arterial wall characteristics through integrated backscatter analysis (IBS) in HIV patients.
  
  METHODS:
  Perspective cohort study enrolling 44 HIV patients treated with antiretroviral drugs who underwent standard B Mode cIMT measurement and tissue characterization of carotid wall by means of dedicated software by acoustic densitometry, at time 0 and 2 years later.
  
  MAJOR FINDINGS:
  Cross-sectional evaluation performed at baseline found that cIMT value correlated significantly with age (r = 0.42, p = 0.005) and systolic blood pressure (r = 0.31, p = 0.04). No correlation was found between cIMT and CD4, HIV-RNA, triglycerides or total cholesterol. There was no difference between the group with versus the group with no protease inhibitors treatment. cIMT progression during 2 years of observation was statistically significant (median, interquartile range [IQR]: 0.005, 0-0.031). No correlation was found between IBS and duration of disease and kind of therapy, whereas a significant association was found between cIMT and IBS (r = 0.33, p = 0.03). No noticeable changes of IBS were observed during 2 years observation.
  
  CONCLUSIONS:
  Classic risk factors greatly affect cIMT than time of HIV infection, duration of antiretroviral therapy exposure and use of protease inhibitors. IBS is a promising technique for the evaluation of arterial wall composition in HIV patients.
  
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• Low anthracyclines doses-induced cardiotoxicity in acute lymphoblastic leukemia long-term female survivors.
  Pediatr Blood Cancer

  2010 Dec;55(7):1343-7. doi: 10.1002/pbc.22637.
  
  Amigoni Maria, Giannattasio Cristina, Fraschini Donatella, Galbiati Marianna, Capra Anna Clara Maria, Madotto Fabiana, Cesana Francesca, Jankovic Momcilo, Masera Giuseppe, Mancia Giuseppe
  
  Abstract
  
  BACKGROUND:
  High dosage anthracyclines in pediatric patients with acute lymphoblastic leukemia (ALL) is associated with cardiotoxicity. However, data on the cardiac effects of lower cumulative doses of these drugs are not conclusive. The aim of this study was to assess the cardiac effects of low cumulative anthracycline doses in long-term survivors of ALL.
  
  PROCEDURE:
  Echocardiograms were performed on 62 long-term ALL survivors, without any overt or sub-clinical signs or symptoms of heart failure. The interval after stopping therapy was 12.6 ± 4.3 years; the mean cumulative dose of anthracyclines was 228.2 ± 42.3 mg/m(2) . Left ventricular (LV) structure and function were studied by echocolor-Doppler. An age, gender and body surface area (BSA) matched group of healthy subjects was used as controls. Cardiac data were analyzed before and after BSA normalization.
  
  RESULTS:
  Long term survivors of ALL, showed a lower LV mass index, interventricular septal and posterior wall thickness, which were independently related to gender and to age at which the ALL diagnosis was made. Data analyzed according to gender showed that abnormalities were confined to the female group. No alterations were observed in the ALL male group versus the corresponding control group. No relationship was observed between the echocardiografic abnormalities and the duration of follow-up or the anthracycline mean dose employed.
  
  CONCLUSIONS:
  In the absence of any signs or symptoms of heart failure, female ALL survivors treated with low cumulative anthracycline doses, showed a reduced LV mass and wall thickness. This suggests that in female ALL survivors an echocardyographic follow-up should be recommended.
  
  Copyright © 2010 Wiley-Liss, Inc.
  
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• Energy-based hemostatic devices in laparoscopic adrenalectomy.
  Langenbecks Arch Surg

  2010 Feb;395(2):111-4. doi: 10.1007/s00423-009-0563-z.
  
  Sartori Paola Vincenza, Romano Fabrizio, Uggeri Fabio, Colombo Giovanni, Caprotti Roberto, Giannattasio Cristina, Scotti Mauro Alessandro, Delitala Alberto, Prada Massimo, Uggeri Franco
  
  Abstract
  
  PURPOSE:
  In literature, few papers compare different hemostatic devices in laparoscopic adrenalectomy. This sequential cohort study analyzes the outcomes of laparoscopic adrenalectomy performed by different hemostatic instruments, to evaluate if any of them has any advantage over the other and as secondary endpoints, the impact of body mass index (BMI) and tumor size on the indication, and the outcome of laparoscopic adrenalectomy.
  
  METHODS:
  Forty-six patients, aged 54.6 +/- 46 years, underwent laparoscopic adrenalectomy over 5 years. Mean BMI was 27 +/- 4.8 kg/m(2). Twenty-four patients had a left tumor, and 22 had a right one. Patients were divided into two groups according to the hemostatic device: Ultracision was used in 26 patients, and Ligasure was used in 20. Groups were well matched for histology, tumor size and site, BMI, gender, and age.
  
  RESULTS:
  Mean operating time was 126.5 +/- 52 min, blood losses were 101 +/- 169 mm, conversion rate was 6.5%, morbidity was 26%, and hospitalization was 5.3 +/- 2.5 days. Groups did not differ for surgical time, blood losses, complications, and conversion rate; BMI and length of surgery were not related. Tumor side and size did not affect surgical time, regardless of the hemostatic tool. Patients submitted to left adrenalectomy bled more (p = 0.007) and had more complications (p = 0.016) than those undergone operation on the right side.
  
  CONCLUSIONS:
  Obesity (BMI > 30) and large masses do not contraindicate laparoscopic adrenalectomy. Left adrenalectomies bleed more and have a higher morbidity. Hemostatic device choice is up to surgeon's preference.
  
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• Left ventricular hypertrophy increases cardiovascular risk independently of in-office and out-of-office blood pressure values.
  J Hypertens

  2009 Dec;27(12):2458-64. doi: 10.1097/HJH.0b013e328330b845.
  
  Bombelli Michele, Facchetti Rita, Carugo Stefano, Madotto Fabiana, Arenare Francesca, Quarti-Trevano Fosca, Capra Anna, Giannattasio Cristina, Dell'Oro Raffaella, Grassi Guido, Sega Roberto, Mancia Giuseppe
  
  Abstract
  
  OBJECTIVES:
  Previous studies have shown that left ventricular hypertrophy (LVH) represents a cardiovascular risk factor independently of clinic blood pressure (BP). The present study was aimed at determining the impact of LVH on the incidence of cardiovascular morbid and fatal events taking into account not only classical risk factors but also home and ambulatory BP values, which have been shown to have an important independent prognostic impact.
  
  METHODS:
  In 1716 patients belonging to the 'Pressioni Arteriose Monitorate E Loro Associazioni' population of Monza, we quantified left ventricular mass index and identified LVH by standard cutoff values. We also measured clinic, home and 24-h ambulatory BPs together with serum glucose and lipids.
  
  RESULTS:
  During a follow-up of 148 months, the rate of fatal and nonfatal (hospitalizations) cardiovascular events as well as of all-cause death was markedly greater (four-fold to five-fold) in patients as compared with those without LVH. In LVH individuals, the increased risk remained significant even when data were adjusted for a large number of other confounding factors including home BP, 24-h mean BP and ambulatory BP. Results were similar when left ventricular mass was indexed by height and body surface area. A 10% increase in left ventricular mass index was associated with a significant increase in cardiovascular risk or all-cause deaths. In multivariate analysis, left ventricular mass index was always an independent predictor of cardiovascular events and death for any cause.
  
  CONCLUSION:
  Our data provide evidence that LVH is an important risk factor even when the contribution of different BPs to risk is fully taken into account.
  
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• Simultaneous measurement of beat-to-beat carotid diameter and pressure changes to assess arterial mechanical properties.
  Hypertension

  2008 Nov;52(5):896-902. doi: 10.1161/HYPERTENSIONAHA.108.116509.
  
  Giannattasio Cristina, Salvi Paolo, Valbusa Filippo, Kearney-Schwartz Anna, Capra Anna, Amigoni Maria, Failla Monica, Boffi Lucia, Madotto Fabiana, Benetos Athanasios, Mancia Giuseppe
  
  Abstract
  
  Use of local arterial distensibility measurements by change in carotid artery diameter divided by pulse pressure has limitations because blood pressure is often taken in a vessel distant or at a time different from where and when change in diameter is taken. In 92 subjects (23 to 91 years of age), carotid artery diameter was continuously measured ecographically, whereas blood pressure was continuously measured simultaneously tonometrically on the contralateral artery, the 2 signals being synchronized via 2 EKGs. Within each cardiac cycle, there was a linear relationship between the changes in vessel diameter and the changes in blood pressure during either the protomesosystole or the diastole after the dicrotic notch. The diastolic slope was displaced upward and steeper than the systolic slope, the pressure-diameter loop showing a hysteresis. Both slopes showed a high reproducibility when data were averaged over a several-second period. There were small differences between consecutive cardiac cycles, suggesting that modulation of arterial mechanical response to continuous changes in intravascular pressure may undergo physiological variations. In the 92 subjects, systolic and diastolic slopes correlated significantly with distensibility values obtained by Reneman formula and exhibited a close inverse relationship with each subject's age and systolic blood pressure, thereby showing the ability to reflect age- and pressure-dependent large artery stiffening. This method may allow precise assessment of man's arterial mechanical properties within each cardiac cycle. This highly dynamic assessment may help to collect information on properties of normal and altered large elastic arteries and the mechanisms involved in disease.
  
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• Long-term risk of diabetes, hypertension and left ventricular hypertrophy associated with the metabolic syndrome in a general population.
  J Hypertens

  2008 Aug;26(8):1602-11. doi: 10.1097/HJH.0b013e328302f10d.
  
  Mancia Giuseppe, Bombelli Michele, Facchetti Rita, Madotto Fabiana, Corrao Giovanni, Trevano Fosca Quarti, Giannattasio Cristina, Grassi Guido, Sega Roberto
  
  Abstract
  
  OBJECTIVES:
  Metabolic syndrome is accompanied by an increased risk of developing diabetes mellitus. Limited or no evidence exists on whether and to what extent metabolic syndrome increases the risk of developing office hypertension, daily-life hypertension and left ventricular hypertrophy.
  
  METHODS:
  In 1412 individuals representative of the population of Monza, plasma glucose, office, home and ambulatory blood pressure, and echocardiographic left ventricular mass index were measured between 1990 and 1992 and 10 years later. New onset diabetes mellitus, new onset office, home and ambulatory hypertension as well as new onset left ventricular hypertrophy were assessed in individuals with and without metabolic syndrome (Adult Treatment Panel criteria) at the first examination.
  
  RESULTS:
  New onset diabetes mellitus, hypertension and left ventricular hypertrophy were all much more frequent in individuals with metabolic syndrome than in those without. In patients with metabolic syndrome, the adjusted risk of new onset diabetes mellitus was five to six times greater (P
  CONCLUSION:
  In the general population, metabolic syndrome is associated with a marked increase in the risk not only of new onset diabetes mellitus but also of new onset office and daily-life hypertension, and left ventricular hypertrophy. This may account for the increased rate of cardiovascular morbidity and mortality exhibited with this condition in long-term studies.
  
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• Increased arterial stiffness in normoglycemic normotensive offspring of type 2 diabetic parents.
  Hypertension

  2008 Feb;51(2):182-7. doi: 10.1161/HYPERTENSIONAHA.107.097535.
  
  Giannattasio Cristina, Failla Monica, Capra Anna, Scanziani Elisabetta, Amigoni Maria, Boffi Lucia, Whistock Christine, Gamba Pierluigi, Paleari Felice, Mancia Giuseppe
  
  Abstract
  
  Diabetes is associated with a reduction of arterial distensibility. Limited information exists regarding whether or how early this appears in the course of the disease. We studied 54 normoglycemic, normotensive, healthy offspring of 2 parents with type 2 diabetes mellitus and 55 age- and sex-matched healthy control subjects. Carotid diastolic diameter and systodiastolic change were measured by echo tracking (Wall Track System) and wall thickness by echocolor Doppler (Sonos 5500, Philips). Pulse pressure was measured by a semiautomatic device positioned on the brachial artery and arterial distensibility calculated by Reneman formula. Blood pressure, blood glucose, glycohemoglobin, and insulin sensitivity (homeostasis model assessment index) were normal or only slightly elevated and by and large similar in the 2 groups. Compared with control subjects, offspring of diabetic parents showed similar carotid diameters at diastole and a reduced increase in carotid diameter at systole (-16%), a reduced carotid artery distensibility (-30%), and an increased pulse pressure (+21.8%), all differences being statistically significant (Por=25 kg/m(2)). Carotid artery wall thickness was not different between the 2 groups. Thus, subjects with predisposition to diabetes show carotid artery stiffening even in the absence of blood pressure alterations, as well as substantial alterations of glucose metabolism, body mass index, and changes in carotid wall thickness. This suggests that, in diabetes, alterations in arterial mechanical properties represent an early phenomenon, which may occur in the absence of metabolic and blood pressure alterations.
  
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• HIV and metabolic syndrome: a comparison with the general population.
  J Acquir Immune Defic Syndr

  2007 Aug;45(4):426-31.
  
  Bonfanti Paolo, Giannattasio Cristina, Ricci Elena, Facchetti Rita, Rosella Elena, Franzetti Marzia, Cordier Laura, Pusterla Luigi, Bombelli Michele, Sega Roberto, Quirino Tiziana, Mancia Giuseppe
  
  Abstract
  
  OBJECTIVE:
  To compare the prevalence of metabolic syndrome (MS) in HIV-positive patients with that from a sample of a general Italian population.
  
  DESIGN:
  Cross-sectional study.
  
  METHODS:
  A total of 1263 HIV-infected patients 18 years of age or older were recruited in 18 centers for infectious diseases in northern and central Italy. Controls were 2051 subjects aged 25 to 74 years representative of the residents of Monza, a town in Milan province, who were enrolled in the Pressioni Arteriose Monitorate E Loro Associazioni study.
  
  RESULTS:
  The prevalence of MS in the HIV group was 20.8%, whereas in the control group, it was only 15.8%, with the difference being statistically significant. The age- and gender-adjusted risk of having MS in HIV-infected patients was twice as great as that in controls. Compared with controls, HIV-infected patients had a greater prevalence of the impaired fasting glucose, increased plasma triglycerides, and reduced high-density lipoprotein cholesterol components. MS prevalence was similar in treated and never-treated HIV-infected patients, and so were the various MS components.
  
  CONCLUSIONS:
  The risk of MS is greater in HIV-infected patients compared with the general population because of a greater prevalence of lipid and glucose abnormalities. The prevalence of MS and its components is similar in treated and untreated HIV-positive patients.
  
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• Effects of prostaglandin E1alpha cyclodextrin [corrected] treatment on endothelial dysfunction in patients with systemic sclerosis.
  J Hypertens

  2007 Apr;25(4):793-7.
  
  Giannattasio Cristina, Pozzi MariaRosa, Gardinali Marco, Montemerlo Elisabetta, Citterio Francesca, Maestroni Silvia, Fantini Elena, Failla Monica, Robuschi Maria, Bianco Salvatore, Mancia Giuseppe
  
  Abstract
  
  OBJECTIVE:
  Systemic sclerosis (SSc) is characterized by an altered nitric oxide (NO): endothelin I ratio and by endothelial dysfunction.
  
  AIMS:
  To verify the effects of prostaglandin E1 (PGE1) alpha-cyclodestrin treatment on endothelial function, quantified as flow-mediated dilation (FMD) of the radial artery.
  
  METHODS:
  In 16 women with SSc (age 57 +/- 2.7 years, means +/- SE) in whom a diagnosis of SSc had been made several years earlier (7.1 +/- 1.2 years), FMD was evaluated by an echotracking technique on the radial artery, using trinitroglycerin vasodilation as a non-endothelial measure of the vessel's ability to increase its diameter maximally. FMD was evaluated after 4 months washout period and after 4 months cyclic infusion of PGE1 alpha-cyclodestrin. Expired NO was measured at the same time.
  
  RESULTS:
  PGE1 alpha-cyclodestrin cyclic infusions did not modify systolic and diastolic blood pressure, heart rate or trinitroglycerin radial artery vasodilation. On the other hand, it induced a marked and significant increase in FMD of the radial artery, which was also accompanied by an increase in blood flow and expired NO.
  
  CONCLUSIONS:
  Endothelial dysfunction and reduced FMD associated with SSc are improved by cyclic treatment with PGE1 alpha-cyclodestrin. This effect occurs together with a concomitant increase in expired NO, suggesting its direct positive influence on endothelial function. It may also partly explain the clinical beneficial effect of the drug in SSc.
  
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• Relationship between arterial distensibility and coronary atherosclerosis in angina patients.
  J Hypertens

  2007 Mar;25(3):593-8.
  
  Giannattasio Cristina, Capra Anna, Facchetti Rita, Viscardi Luigina, Bianchi Francesca, Failla Monica, Colombo Virgilio, Grieco Antonio, Mancia Giuseppe
  
  Abstract
  
  OBJECTIVE:
  Arterial stiffening is associated with an increased risk of cardiovascular disease. However, limited evidence exists on whether it also relates to subclinical atherosclerosis, thereby providing a non-invasive marker of the overall cardiovascular status. The aim of the present study was to provide information on arterial stiffening in angina patients in whom angiographic evaluation allowed quantification of coronary atherosclerosis.
  
  METHODS:
  We studied 101 patients with angina from a large number admitted to our hospital for coronary angiography. In each patient, radial (RA), subdiaphragmatic aorta (AO) and carotid (CA) distensibility (Dist) were measured by an ultrasonic device, following ultrasonic exclusion of atherosclerotic lesions at these specific sites. Patients were classified into three groups according to the angiographic findings: (i) no significant coronary lesions (lumen obstruction 50%).
  
  RESULTS:
  Age, male prevalence, previous cardiovascular disease and interventions were progressively greater or more common from group A to C, whereas several other risk factors (plasma glucose, serum cholesterol, smoking, history of hypertension, etc.) did not differ between the three groups or between the group with single vessel (B) versus the group with multivessel disease (C). CA and AO Dist decreased progressively from group A to C with a significant relationship in the group as a whole between distensibility values and the number of diseased vessels. The progressive decrease in AO Dist from group A to C remained significant after adjustment for variables that showed between-group differences (such as gender, age and systolic blood pressure) and the ROC curve showed it to be a more sensitive and specific marker of coronary atherosclerosis than CA Dist. RA Dist was similar in the three groups and showed no relationship with the number of diseased vessels in the group as a whole.
  
  CONCLUSION:
  In patients with angina, AO and CA Dist are related to the severity of coronary atherosclerosis, with the relationship being better for alterations in aortic than in carotid mechanical properties. Large elastic artery (and in particular aortic) stiffening can thus be considered as a marker of the severity of coronary atherosclerosis, providing non-invasive obtainable information on the need to proceed with further clinical examinations.
  
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• Metabolic syndrome in the Pressioni Arteriose Monitorate E Loro Associazioni (PAMELA) study: daily life blood pressure, cardiac damage, and prognosis.
  Hypertension

  2007 Jan;49(1):40-7.
  
  Mancia Giuseppe, Bombelli Michele, Corrao Giovanni, Facchetti Rita, Madotto Fabiana, Giannattasio Cristina, Trevano Fosca Quarti, Grassi Guido, Zanchetti Alberto, Sega Roberto
  
  Abstract
  
  The prevalence of the metabolic syndrome (National Cholesterol Education Program Adult Treatment Panel III criteria) and its relationships with daily life blood pressures, cardiac damage, and prognosis were determined in 2013 subjects from a Northern Italian population aged 25 to 74 years. Home blood pressure, 24-hour blood pressure, and left ventricular mass index (echocardiography) were also measured. Cardiovascular and noncardiovascular deaths were registered over 148 months. Metabolic syndrome was found in 16.2% of the sample, an office blood pressure elevation being the most frequent (95.4%) and the blood glucose abnormality the least frequent (31.5%) component. There was in metabolic syndrome a frequent elevation in home and/or 24-hour average blood pressure, as well as a greater left ventricular mass index and prevalence of left ventricular hypertrophy, which was manifest even when data were adjusted for between-group differences, including blood pressure. The adjusted risk of cardiovascular and all-cause mortality was greater in metabolic syndrome subjects (+71.0% and +37.0%; P
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• Aortic stiffness as a predictor of coronary atherosclerosis.
  J Hypertens

  2006 Dec;24(12):2347-8.
  
  Giannattasio Cristina
  
  
  
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• Expert consensus document on arterial stiffness: methodological issues and clinical applications.
  Eur Heart J

  2006 Nov;27(21):2588-605.
  
  Laurent Stephane, Cockcroft John, Van Bortel Luc, Boutouyrie Pierre, Giannattasio Cristina, Hayoz Daniel, Pannier Bruno, Vlachopoulos Charalambos, Wilkinson Ian, Struijker-Boudier Harry,
  
  Abstract
  
  In recent years, great emphasis has been placed on the role of arterial stiffness in the development of cardiovascular diseases. Indeed, the assessment of arterial stiffness is increasingly used in the clinical assessment of patients. Although several papers have previously addressed the methodological issues concerning the various indices of arterial stiffness currently available, and their clinical applications, clinicians and researchers still report difficulties in selecting the most appropriate methodology for their specific use. This paper summarizes the proceedings of several meetings of the European Network for Non-invasive Investigation of Large Arteries and is aimed at providing an updated and practical overview of the most relevant methodological aspects and clinical applications in this area.
  
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• Obesity and vascular stiffness: when body fat has an adverse impact on arterial dynamics.
  J Hypertens

  2005 Oct;23(10):1789-91.
  
  Grassi Guido, Giannattasio Cristina
  
  
  
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• Relationship of office, home, and ambulatory blood pressure to blood glucose and lipid variables in the PAMELA population.
  Hypertension

  2005 Jun;45(6):1072-7.
  
  Mancia Giuseppe, Facchetti Rita, Bombelli Michele, Polo Friz Hernan, Grassi Guido, Giannattasio Cristina, Sega Roberto
  
  Abstract
  
  Alterations in blood glucose and cholesterol are more frequently detectable in hypertensive than in normotensive conditions. However, no information exists as to whether this phenomenon involves only office or also home and 24-hour ambulatory blood pressure (ie, when values are representative of daily life). In 2045 subjects enrolled in the Pressioni Arteriose Monitorate E Loro Associazioni (PAMELA) study, we measured home, 24-hour, and office blood pressure. Measurements also included fasting blood glucose and serum total and HDL cholesterol values. Prevalence of diabetes (> or =126 mg/dL or use of antidiabetic drugs), impaired fasting blood glucose (> or =110 to or =240 mg/dL or 200 mg/dL) increased progressively from "optimal" to "normal," "high-normal," and "elevated" office systolic or diastolic blood pressure. Fasting blood glucose and total serum cholesterol also increased progressively from the first to the fourth group, with HDL cholesterol values showing a concomitant progressive decrease. This was also the case for quartiles of office, home, and 24-hour blood pressure. In the whole population, there was a positive correlation between serum cholesterol or blood glucose and all blood pressure values (P always
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• Different relation between 24-h blood pressure and distensibility at different peripheral arteries. Data from the European Lacidipine Study on Atherosclerosis (ELSA).
  J Hypertens

  2005 Mar;23(3):557-62.
  
  Giannattasio Cristina, Failla Monica, Hennig Michael, Hollweck Regina, Laurent Stephan, Mallion Jean Michel, Reid John, Safar Michel, Bond Gene, Zanchetti Alberto, Mancia Giuseppe
  
  Abstract
  
  INTRODUCTION:
  The European Lacidipine Study on Atherosclerosis (ELSA) has been planned to investigate the effect of reduction in office and ambulatory blood pressure by lacidipine versus atenolol on carotid artery wall thickness in mild to moderate essential hypertensive patients with no metabolic abnormalities. One prespecified sub-study of ELSA focused on measurements of arterial distensibility in the carotid as well as in the radial artery to determine the relationship of functional arterial properties with office versus ambulatory blood pressure (BP) values as well as the correspondence between functional and structural arterial alterations.
  
  METHODS:
  The sub-study was conducted on 124 patients recruited in four centres (Monza-Milan, Paris, Grenoble and Glasgow). BP was measured both by a mercury sphygmomanometer and by 24-h ambulatory monitoring. Common carotid artery wall thickness was measured by certified sonographers as described in the main study. Common carotid and radial artery distensibility were obtained by echotracking techniques, which allowed to relate changes in arterial diameter with systo-diastolic BP changes.
  
  RESULTS:
  Carotid artery wall distensibility showed (1) a negative correlation with office and more so 24-h average systolic BP (r = -0.45 and -0.58, P
  CONCLUSION:
  These data suggest that stiffening of large elastic artery is reflected more by ambulatory than office BP elevations, systolic BP being much more important than diastolic. Alterations of large elastic arteries function is related to structural wall changes. Functional and structural properties of middle-size muscle arteries are independent of BP.
  
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• Arterial stiffening influence of sympathetic nerve activity: evidence from hand transplantation in humans.
  Hypertension

  2005 Apr;45(4):608-11.
  
  Giannattasio Cristina, Failla Monica, Lucchina Stefano, Zazzeron Chiara, Scotti Valentina, Capra Anna, Viscardi Luigina, Bianchi Francesca, Vitale Giovanni, Lanzetta Marco, Mancia Giuseppe
  
  Abstract
  
  Studies in animals and humans suggest that sympathetic activity exerts a stiffening influence on large and middle-sized artery walls. We sought to obtain further evidence on this issue by measuring radial artery distensibility in an allotransplanted and thus denervated hand using the contralateral artery as control. In 2 men, blood pressure was measured by a semiautomatic device (Dinamap). Diastolic diameter, systo-diastolic diameter excursion (ultrasound Wall Track system), and distensibility (Reneman formula) of both radial arteries were measured at a level corresponding to 4 cm below the suture of the transplanted hand 40 days after surgery and every 4 weeks for the next 6 months. After surgery, systo-diastolic diameter excursion and distensibility were much greater in the transplanted radial artery than in the contralateral vessel, reaching values similar to the contralateral ones after 4 months, when signs of reinnervation of the transplanted hands had appeared. Radial deinnervation was accompanied by an increased arterial distensibility, which provides further evidence of the sympathetic stiffening effect on arterial wall in humans.
  
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• Endothelial function and dysfunction. Part I: Methodological issues for assessment in the different vascular beds: a statement by the Working Group on Endothelin and Endothelial Factors of the European Society of Hypertension.
  J Hypertens

  2005 Jan;23(1):7-17.
  
  Deanfield John, Donald Ann, Ferri Claudio, Giannattasio Cristina, Halcox Julian, Halligan Sean, Lerman Amir, Mancia Giuseppe, Oliver James J, Pessina Achille C, Rizzoni Damiano, Rossi Gian Paolo, Salvetti Antonio, Schiffrin Ernesto L, Taddei Stefano, Webb David J,
  
  Abstract
  
  An enormous number of studies in the last two decades have been devoted to investigating the role of the endothelium in cardiovascular diseases. Nonetheless, the optimal methodology for investigating the multifaceted aspects of endothelial dysfunction is still under debate. Biochemical markers, molecular genetic tests and invasive and non-invasive tools with and without pharmacological and physiological stimuli have been introduced. Furthermore newer pharmacological tools have been proposed. However, the application of these methodologies should fulfil a number of requirements in order to provide conclusive answers in this area of research. Thus, the most relevant methodological issues in the research on endothelial function and dysfunction are summarized in this paper.
  
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• Arterial stiffness.
  Curr Hypertens Rep

  2004 Oct;6(5):331-2.
  
  Giannattasio Cristina
  
  
  
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• Cardiovascular risk profile and blood pressure control in Italian hypertensive patients under specialist care.
  J Hypertens

  2004 Jan;22(1):51-7.
  
  Mancia Giuseppe, Volpe Roberto, Boros Stefano, Ilardi Maura, Giannattasio Cristina
  
  Abstract
  
  BACKGROUND:
  Information on the association between high hypertension and metabolic risk factors in Italy is limited. Furthermore, data on the rate of blood pressure control in the Italian hypertensive population are restricted to some Italian regions only, and refer usually to surveys performed, in most instances, several years ago.
  
  METHODS:
  In the present study, a total of 4059 essential hypertensive patients were examined consecutively from March to June 2000 by 450 cardiovascular specialists (cardiologists, internists and diabetologists) operating throughout the Italian territory. Analysable data were obtained in 3812 patients.
  
  RESULTS:
  Blood pressure control by treatment (
  CONCLUSIONS:
  Thus, in Italy, hypertension continues to be a poorly controlled condition. Despite being a Mediterranean country, the occurrence of hypertension is commonly associated with metabolic risk factors and often with a high or very high cardiovascular risk profile. This is not properly identified by specialist physicians.
  
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• Nonpharmacologic treatment of hypertension by respiratory exercise in the home setting.
  Am J Hypertens

  2004 Apr;17(4):370-4.
  
  Meles Ester, Giannattasio Cristina, Failla Monica, Gentile Gaetano, Capra Anna, Mancia Giuseppe
  
  Abstract
  
  BACKGROUND:
  Device-guided breathing exercises at home have a potential to become a nonpharmacologic treatment of high blood pressure (BP). The aim of this study was to evaluate the impact of device-guided breathing exercises on both office and home BP.
  
  METHODS:
  A total of 79 mild hypertensive individuals, either medicated or unmedicated, with BP > 140/90 mm Hg were enrolled. After a 2-week run-in phase, in both the control and treatment groups daily home blood pressure was monitored for 8 weeks. The treatment group also engaged in 15-min daily sessions with device-guided breathing exercises.
  
  RESULTS:
  A total of 47 treatment patients and 26 control subjects completed the study. In the control group both office and home BP showed small nonsignificant reductions. Device-guided breathing exercises reduced mean office BP (systolic/diastolic) by 5.5/3.6 mm Hg (P
  CONCLUSION:
  Our data show that device-guided breathing exercises have an antihypertensive effect that can be seen in conditions closer to daily life than the setting of the physician's office.
  
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• Effects of heart rate changes on arterial distensibility in humans.
  Hypertension

  2003 Sep;42(3):253-6.
  
  Giannattasio Cristina, Vincenti Antonio, Failla Monica, Capra Anna, Cirò Antonio, De Ceglia Sergio, Gentile Gaetano, Brambilla Roberta, Mancia Giuseppe
  
  Abstract
  
  In rats, an increase in heart rate by pacing is accompanied by progressive large-artery stiffening. Whether this is also the case in humans is unknown. We enrolled 20 patients who were chronically implanted with a pacemaker because of atrioventricular block or sick sinus syndrome. Arterial distensibility was measured by an echo-tracking device. In 10 patients, the evaluation was performed on the radial artery by using continuous finger blood pressure measurements, whereas in the remaining 10 patients, the common carotid artery was studied with a semiautomatic measure of brachial artery blood pressure. Diastolic diameter, systodiastolic diameter change, and distensibility were obtained at baseline (heart rate 63+/-2 beats/min) and after atrial and ventricular sequential pacing at a heart rate of 90 and 110 beats/min. At baseline, the diameter was 7.8+/-0.3 mm in the carotid artery and 2.4+/-0.1 mm in the radial artery; the respective systodiastolic diameter change values were 375.4+/-31.0 and 55.9+/-9.0 (microm) and the distensibility values were 1.4+/-0.1 and 0.7+/-0.1 (1/mm Hg 10-3). Blood pressure and diameter were not significantly modified by increasing heart rate, which markedly modified systodiastolic diameter change and distensibility. In the radial artery, distensibility was reduced by 47% (P
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• [Study of arterial distensibility in man. Modulating mechanisms, pathological conditions and effects of treatment].
  Ital Heart J Suppl

  2003 Jun;4(6):467-76.
  
  Giannattasio Cristina, Failla Monica, Corsi Davide, Capra Anna, Meles Ester, Gentile Gaetano, Fantini Elena, Boffi Lucia, Maestroni Silvia, Scotti Valentina, Mancia Giuseppe
  
  Abstract
  
  The reduction of large arterial distensibility has several adverse consequences for the cardiovascular system. This paper reviews the evidence we have obtained by measuring distensibility through quantification of changes in arterial diameter vs blood pressure changes at large elastic and middle size muscle artery sites. Evidence shows that arterial distensibility is reduced in conditions such as hypercholesterolemia, hypertension, diabetes, and congestive heart failure. In some conditions (e.g. hypertension) the alterations are not uniformly distributed in the arteries of different structure and size whereas in others (e.g. diabetes and heart failure) they are widespread. In diabetes evidence is available that distensibility changes occur early in the course of the disease. Evidence is also available that in all above conditions treatment can improve arterial distensibility thereby reversing the initial abnormality. This is due to a variable combination of structural and functional factors. However, technical ability to determine their precise role in distensibility changes in humans is limited.
  
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• How to assess central arterial blood pressure?
  J Hypertens

  2003 Mar;21(3):495-6.
  
  Giannattasio Cristina
  
  
  
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• Arterial distensibility in humans. Modulating mechanisms, alterations in diseases and effects of treatment.
  J Hypertens

  2002 Oct;20(10):1889-99.
  
  Giannattasio Cristina, Mancia Giuseppe
  
  Abstract
  
  Reduction of large artery distensibility has several adverse consequences for the cardiovascular system. This paper reviews the evidence obtained by measuring distensibility through quantification of changes in arterial diameter versus blood pressure changes at large elastic and middle size muscle artery sites. Evidence is available that arterial distensibility is reduced in conditions as varied as hypercholesterolemia, hypertension, diabetes and congestive heart failure. In some conditions (e.g. hypertension) the alterations are not uniformly distributed in arteries of different structure and size whereas in others (e.g. diabetes and heart failure) they are widespread. In diabetes evidence is available that distensibility changes occur early in the course of the disease. Evidence is also available that in all above conditions treatment can improve arterial distensibility thereby reversing the initial abnormality. This appears to be due to a variable combination of structural and functional factors. Technical ability to determine their precise role in distensibility changes in humans is limited, however.
  
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• Effects of hematocrit changes on flow-mediated and metabolic vasodilation in humans.
  Hypertension

  2002 Jul;40(1):74-7.
  
  Giannattasio Cristina, Piperno Alberto, Failla Monica, Vergani Anna, Mancia Giuseppe
  
  Abstract
  
  Endothelial function is noninvasively assessed by measuring nitric oxide-dependent increase in radial artery diameter accompanying the elevation in shear stress induced by increasing blood flow through a short-lasting ischemia of the hand. However, shear stress also depends on blood viscosity, whose changes might thus affect nitric oxide increase in a manner that is not properly reflected by blood flow changes. In 12 subjects with hemochromatosis, we measured ultrasonographically radial artery diameter and blood flow responses to a 4-minute ischemia of the hand. This was done also after removing 500 mL of blood (and concomitantly infusing 500 mL of saline), which significantly (P
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• Radial, carotid and aortic distensibility in congestive heart failure: effects of high-dose angiotensin-converting enzyme inhibitor or low-dose association with angiotensin type 1 receptor blockade.
  J Am Coll Cardiol

  2002 Apr;39(8):1275-82.
  
  Giannattasio Cristina, Achilli Felice, Failla Monica, Capra Anna, Vincenzi Antonella, Valagussa Franco, Mancia Giuseppe
  
  Abstract
  
  UNLABELLED:
  objectives; The aim of this study was to determine whether in patients with congestive heart failure (CHF) a distensibility (Dist) reduction: 1) similarly occurs in different arteries; 2) is related to CHF severity; and 3) is reversible with treatment. background: Several studies suggest that CHF is accompanied by a reduced arterial Dist.
  
  METHODS:
  We measured diameter in radial artery, carotid artery (CA) and abdominal aorta (AO) by echotracking. Distensibility was obtained by relating it to blood pressure. Data were collected in 30 patients with CHF (New York Heart Association functional class I to III) under standard treatment with diuretic, digitalis and angiotensin-converting enzyme (ACE) inhibitor in whom CHF severity was assessed by maximum oxygen consumption (VO(2)max) percentage and in 30 age- and gender-matched controls. Patients with CHF were then randomized to maintain standard treatment (n = 10), double the ACE inhibitor dose (n = 10) or add an angiotensin II antagonist (n = 10) and restudied after two months.
  
  RESULTS:
  Distensibility was markedly reduced in the CHF group in all three vessels (p
  CONCLUSIONS:
  Congestive heart failure is characterized by a reduction of Dist of large-elastic and middle-sized muscular arteries. The reduction of large-elastic artery Dist is related to the CHF severity. These alterations can be reversed by drugs, effectively interfering with the renin-angiotensin system either at the ACE or at the angiotensin receptor level.
  
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