Di Matteo Dott.ssa Irene
Pubblicazioni su PubMed
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Multidisciplinary Approach in Atrial Fibrillation: As Good as Gold.
J Clin Med2024 Aug;13(16):. doi: 4621.
Lucà Fabiana, Abrignani Maurizio Giuseppe, Oliva Fabrizio, Canale Maria Laura, Parrini Iris, Murrone Adriano, Rao Carmelo Massimiliano, Nesti Martina, Cornara Stefano, Di Matteo Irene, Barisone Michela, Giubilato Simona, Ceravolo Roberto, Pignalberi Carlo, Geraci Giovanna, Riccio Carmine, Gelsomino Sandro, Colivicchi Furio, Grimaldi Massimo, Gulizia Michele Massimo
Abstract
Atrial fibrillation (AF) represents the most common sustained arrhythmia necessitating dual focus: acute complication management and sustained longitudinal oversight to modulate disease progression and ensure comprehensive patient care over time. AF is a multifaceted disorder; due to such a great number of potential exacerbating conditions, a multidisciplinary team (MDT) should manage AF patients by cooperating with a cardiologist. Effective management of AF patients necessitates the implementation of a well-coordinated and tailored care pathway aimed at delivering optimized treatment through collaboration among various healthcare professionals. Management of AF should be carefully evaluated and mutually agreed upon in consultation with healthcare providers. It is crucial to recognize that treatment may evolve due to the emergence of new risk factors, symptoms, disease progression, and advancements in treatment modalities. In the context of multidisciplinary AF teams, a coordinated approach involves assembling a diverse team tailored to meet individual patients' unique needs based on local services' availability.
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Italian Association of Hospital Cardiologists Position Paper 'Gender discrepancy: time to implement gender-based clinical management'.
Eur Heart J Suppl2024 Apr;26(Suppl 2):ii264-ii293. doi: 10.1093/eurheartjsupp/suae034.
Lucà Fabiana, Pavan Daniela, Gulizia Michele Massimo, Manes Maria Teresa, Abrignani Maurizio Giuseppe, Benedetto Francesco Antonio, Bisceglia Irma, Brigido Silvana, Caldarola Pasquale, Calvanese Raimondo, Canale Maria Laura, Caretta Giorgio, Ceravolo Roberto, Chieffo Alaide, Chimenti Cristina, Cornara Stefano, Cutolo Ada, Di Fusco Stefania Angela, Di Matteo Irene, Di Nora Concetta, Fattirolli Francesco, Favilli Silvia, Francese Giuseppina Maura, Gelsomino Sandro, Geraci Giovanna, Giubilato Simona, Ingianni Nadia, Iorio Annamaria, Lanni Francesca, Montalto Andrea, Nardi Federico, Navazio Alessandro, Nesti Martina, Parrini Iris, Pilleri Annarita, Pozzi Andrea, Rao Carmelo Massimiliano, Riccio Carmine, Rossini Roberta, Scicchitano Pietro, Valente Serafina, Zuccalà Giuseppe, Gabrielli Domenico, Grimaldi Massimo, Colivicchi Furio, Oliva Fabrizio
Abstract
It has been well assessed that women have been widely under-represented in cardiovascular clinical trials. Moreover, a significant discrepancy in pharmacological and interventional strategies has been reported. Therefore, poor outcomes and more significant mortality have been shown in many diseases. Pharmacokinetic and pharmacodynamic differences in drug metabolism have also been described so that effectiveness could be different according to sex. However, awareness about the gender gap remains too scarce. Consequently, gender-specific guidelines are lacking, and the need for a sex-specific approach has become more evident in the last few years. This paper aims to evaluate different therapeutic approaches to managing the most common women's diseases.
© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.
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Heart Failure with Preserved Ejection Fraction: How to Deal with This Chameleon.
J Clin Med2024 Feb;13(5):. doi: 1375.
Lucà Fabiana, Oliva Fabrizio, Abrignani Maurizio Giuseppe, Di Fusco Stefania Angela, Gori Mauro, Giubilato Simona, Ceravolo Roberto, Temporelli Pier Luigi, Cornara Stefano, Rao Carmelo Massimiliano, Caretta Giorgio, Pozzi Andrea, Binaghi Giulio, Maloberti Alessandro, Di Nora Concetta, Di Matteo Irene, Pilleri Anna, Gelsomino Sandro, Riccio Carmine, Grimaldi Massimo, Colivicchi Furio, Gulizia Michele Massimo
Abstract
Heart failure with preserved ejection fraction (HFpEF) is characterized by a notable heterogeneity in both phenotypic and pathophysiological features, with a growing incidence due to the increase in median age and comorbidities such as obesity, arterial hypertension, and cardiometabolic disease. In recent decades, the development of new pharmacological and non-pharmacological options has significantly impacted outcomes, improving clinical status and reducing mortality. Moreover, a more personalized and accurate therapeutic management has been demonstrated to enhance the quality of life, diminish hospitalizations, and improve overall survival. Therefore, assessing the peculiarities of patients with HFpEF is crucial in order to obtain a better understanding of this disorder. Importantly, comorbidities have been shown to influence symptoms and prognosis, and, consequently, they should be carefully addressed. In this sense, it is mandatory to join forces with a multidisciplinary team in order to achieve high-quality care. However, HFpEF remains largely under-recognized and under-treated in clinical practice, and the diagnostic and therapeutic management of these patients remains challenging. The aim of this paper is to articulate a pragmatic approach for patients with HFpEF focusing on the etiology, diagnosis, and treatment of HFpEF.
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[Gender discrepancy: time to implement gender-based clinical management].
G Ital Cardiol (Rome)2024 Feb;25(2):126-139. doi: 10.1714/4187.41763.
Lucà Fabiana, Pavan Daniela, Gulizia Michele Massimo, Manes Maria Teresa, Abrignani Maurizio Giuseppe, Benedetto Francesco Antonio, Bisceglia Irma, Brigido Silvana, Caldarola Pasquale, Calvanese Raimondo, Canale Maria Laura, Caretta Giorgio, Ceravolo Roberto, Chieffo Alaide, Chimenti Cristina, Cornara Stefano, Cutolo Ada, Di Fusco Stefania Angela, Di Matteo Irene, Di Nora Concetta, Fattirolli Francesco, Favilli Silvia, Francese Giuseppina Maura, Gelsomino Sandro, Geraci Giovanna, Giubilato Simona, Ingianni Nadia, Iorio Annamaria, Lanni Francesca, Montalto Andrea, Nardi Federico, Navazio Alessandro, Nesti Martina, Parrini Iris, Pilleri Annarita, Pozzi Andrea, Rao Carmelo Massimiliano, Riccio Carmine, Rossini Roberta, Scicchitano Pietro, Valente Serafina, Zuccalà Giuseppe, Gabrielli Domenico, Grimaldi Massimo, Colivicchi Furio, Oliva Fabrizio
Abstract
It is well established that gender strongly influences cardiovascular risk factors, playing a crucial role in cardiovascular prevention, clinical pathways, diagnostic approach and treatment. Beyond the sex, which is a biological factor, gender entails a socio-cultural condition that impacts access and quality of care due to structural and institutional barriers. However, despite its great importance, this issue has not been adequately covered. Indeed sex and gender differences scarcely impact the clinical approach, creating a lot of disparities in care and outcomes of patients. Therefore, it becomes essential to increase the awareness of the importance of sex and gender influences on cardiovascular diseases. Moreover, new strategies for reducing disparities should be developed. Importantly, these differences should be taken into account in guideline recommendations. In this regard, it is crucial to include a greater number of women in clinical trials, since they are currently underrepresented. Furthermore, more women should be involved as member of international boards in order to develop recommendations and guidelines with more attention to this important topic.The aim of this ANMCO position paper is to shed light on gender differences concerning many cardiovascular drugs in order to encourage a more personalized therapeutic approach.
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[Lipoprotein(a): relationships with atherosclerosis and valvular heart disease, and emerging therapies].
G Ital Cardiol (Rome)2024 Feb;25(2):76-87. doi: 10.1714/4187.41756.
Abrignani Maurizio Giuseppe, Maloberti Alessandro, Di Fusco Stefania Angela, Lucà Fabiana, Cesaro Arturo, Acerbo Vincenzo, Fabbri Saverio, Di Matteo Irene, Amico Antonio F, Temporelli Pier Luigi, Riccio Carmine, Colivicchi Furio, Grimaldi Massimo, Gabrielli Domenico, Oliva Fabrizio
Abstract
Lipoprotein(a) [Lp(a)] is a well-established cardiovascular risk factor, whose relationship with atherosclerotic disease has been confirmed by epidemiological, genome-wide association, Mendelian randomization, and meta-analysis studies. This association is determined by its pro-atherogenic, pro-thrombotic and pro-inflammatory properties. Lp(a) is the most common monogenic risk factor for atherosclerosis, with a prevalence of about 1 in 5 people. Recently, its etiopathogenetic relationship with calcific and degenerative valvular heart diseases, particularly with aortic and mitral stenosis, has been suspected. It has not yet been demonstrated whether its reduction translates into a lower risk of cardiovascular events. Up to now, Lp(a) has been considered a non-modifiable risk factor, as current lipid-lowering drugs have limited effects on its levels. New specific lipid-lowering therapies with high efficacy in reducing circulating Lp(a) levels are being investigated in randomized trials; however, the effects of this reduction on cardiovascular outcomes are still being studied.
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Anderson-Fabry Disease: Red Flags for Early Diagnosis of Cardiac Involvement.
Diagnostics (Basel)2024 Jan;14(2):. doi: 208.
Iorio Annamaria, Lucà Fabiana, Pozzi Andrea, Rao Carmelo Massimiliano, Chimenti Cristina, Di Fusco Stefania Angela, Rossini Roberta, Caretta Giorgio, Cornara Stefano, Giubilato Simona, Di Matteo Irene, Di Nora Concetta, Pilleri Anna, Gelsomino Sandro, Ceravolo Roberto, Riccio Carmine, Grimaldi Massimo, Colivicchi Furio, Oliva Fabrizio, Gulizia Michele Massimo, , The Cardiac Rare Diseases Working Group Associazione Nazionale Medici Cardiologi Ospedalieri Anmco
Abstract
Anderson-Fabry disease (AFD) is a lysosome storage disorder resulting from an X-linked inheritance of a mutation in the galactosidase A (GLA) gene encoding for the enzyme alpha-galactosidase A (?-GAL A). This mutation results in a deficiency or absence of ?-GAL A activity, with a progressive intracellular deposition of glycosphingolipids leading to organ dysfunction and failure. Cardiac damage starts early in life, often occurring sub-clinically before overt cardiac symptoms. Left ventricular hypertrophy represents a common cardiac manifestation, albeit conduction system impairment, arrhythmias, and valvular abnormalities may also characterize AFD. Even in consideration of pleiotropic manifestation, diagnosis is often challenging. Thus, knowledge of cardiac and extracardiac diagnostic "red flags" is needed to guide a timely diagnosis. Indeed, considering its systemic involvement, a multidisciplinary approach may be helpful in discerning AFD-related cardiac disease. Beyond clinical pearls, a practical approach to assist clinicians in diagnosing AFD includes optimal management of biochemical tests, genetic tests, and cardiac biopsy. We extensively reviewed the current literature on AFD cardiomyopathy, focusing on cardiac "red flags" that may represent key diagnostic tools to establish a timely diagnosis. Furthermore, clinical findings to identify patients at higher risk of sudden death are also highlighted.
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[ANMCO Position paper: Ionizing radiation exposure and radioprotection in the cath-lab].
G Ital Cardiol (Rome)2023 Nov;24(11):915-932. doi: 10.1714/4129.41234.
Lucà Fabiana, Andreassi Maria Grazia, Gulizia Michele Massimo, Borghini Andrea, Colombo Paola Enrica, Benedetto Francesco Antonio, Bernelli Chiara, Bisceglia Irma, Bisignani Giovanni, Caldarola Pasquale, Canale Maria Laura, Caporale Roberto, Caretta Giorgio, Ceravolo Roberto, Ciconte Vincenzo Antonio, Corda Marco, Cornara Stefano, De Bonis Silvana, De Luca Leonardo, Di Fusco Stefania Angela, Di Matteo Irene, Di Nora Concetta, Favilli Silvia, Gelsomino Sandro, Geraci Giovanna, Giubilato Simona, Matteucci Andrea, Nardi Federico, Navazio Alessandro, Parrini Iris, Pilleri Annarita, Pozzi Andrea, Rao Carmelo Massimiliano, Riccio Carmine, Rossini Roberta, Turazza Fabio Maria, Grimaldi Massimo, Gabrielli Domenico, Picano Eugenio, Colivicchi Furio, Oliva Fabrizio
Abstract
In the last decades, because of the improvements in the percutaneous treatment of coronary heart disease, valvular heart disease, congenital heart defects, and the increasing number of cardiac resynchronization therapy and cardioverter-defibrillator implantations, the interventional cardiologists' radio-exposure has importantly risen, causing concerns for ionizing radiation-associated diseases such as cancer and neurodegenerative disorders. Consequently, the radiation exposure issue importantly affects operators' safety. However, our knowledge of this field is poor and most operators are unaware to be at risk, especially because of the absence of effective preventive measures. The aim of this ANMCO position paper is to improve the awareness of operators and identify new ways of reducing operator ionizing radiation dose and minimizing the risk.
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Management of Residual Risk in Chronic Coronary Syndromes. Clinical Pathways for a Quality-Based Secondary Prevention.
J Clin Med2023 Sep;12(18):. doi: 5989.
Giubilato Simona, Lucà Fabiana, Abrignani Maurizio Giuseppe, Gatto Laura, Rao Carmelo Massimiliano, Ingianni Nadia, Amico Francesco, Rossini Roberta, Caretta Giorgio, Cornara Stefano, Di Matteo Irene, Di Nora Concetta, Favilli Silvia, Pilleri Anna, Pozzi Andrea, Temporelli Pier Luigi, Zuin Marco, Amico Antonio Francesco, Riccio Carmine, Grimaldi Massimo, Colivicchi Furio, Oliva Fabrizio, Gulizia Michele Massimo
Abstract
Chronic coronary syndrome (CCS), which encompasses a broad spectrum of clinical presentations of coronary artery disease (CAD), is the leading cause of morbidity and mortality worldwide. Recent guidelines for the management of CCS emphasize the dynamic nature of the CAD process, replacing the term "stable" with "chronic", as this disease is never truly "stable". Despite significant advances in the treatment of CAD, patients with CCS remain at an elevated risk of major cardiovascular events (MACE) due to the so-called residual cardiovascular risk. Several pathogenetic pathways (thrombotic, inflammatory, metabolic, and procedural) may distinctly contribute to the residual risk in individual patients and represent a potential target for newer preventive treatments. Identifying the level and type of residual cardiovascular risk is essential for selecting the most appropriate diagnostic tests and follow-up procedures. In addition, new management strategies and healthcare models could further support available treatments and lead to important prognostic benefits. This review aims to provide an overview of the diagnostic and therapeutic challenges in the management of patients with CCS and to promote more effective multidisciplinary care.
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[ANMCO Position paper: Choosing Wisely - ANMCO proposals for 2023].
G Ital Cardiol (Rome)2023 Sep;24(9):754-765. doi: 10.1714/4084.40686.
Lucà Fabiana, Gulizia Michele Massimo, Abrignani Maurizio Giuseppe, Benedetto Francesco Antonio, Bisceglia Irma, Bisignani Giovanni, Bobbio Marco Carlo, Caldarola Pasquale, Canale Maria Laura, Caretta Giorgio, Ceravolo Roberto, Chimenti Cristina, Ciconte Vincenzo Antonio, Corda Marco, Cornara Stefano, Di Fusco Stefania Angela, Di Matteo Irene, Di Nora Concetta, Favilli Silvia, Francese Giuseppina Maura, Gelsomino Sandro, Gensini Gian Franco, Giubilato Simona, Grimaldi Massimo, Nardi Federico, Navazio Alessandro, Parrini Iris, Pilleri Annarita, Pozzi Andrea, Rao Carmelo Massimiliano, Riccio Carmine, Rossini Roberta, Vernero Sandra, Gabrielli Domenico, Oliva Fabrizio, Colivicchi Furio
Abstract
Nowadays, a progressive and exponential increase in the use of invasive and non-invasive instrumental diagnostics and therapeutic services has been shown. Although unnecessary, instrumental examinations are often largely prescribed, replacing clinical evaluation. Their correct use, on the contrary, would address precise epidemiological and clinical contexts. Therefore identifying whether a test or procedure is appropriate or not plays a crucial role in clinical practice. Several documents from scientific societies and expert groups indicate the most appropriate cardiovascular diagnostic and therapeutic procedures. The international Choosing Wisely campaign invited the main scientific societies to identify five techniques or treatments used in their field that are often unnecessary and may potentially damage patients. The Italian Association of Hospital Cardiologists (ANMCO) joined the project identifying the five cardiological practices in our country at greater risk of inappropriateness in 2014. This list has recently been updated. Moreover, possible solutions to this problem have been proposed.
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Appropriateness of Dyslipidemia Management Strategies in Post-Acute Coronary Syndrome: A 2023 Update.
Metabolites2023 Aug;13(8):. doi: 916.
Lucà Fabiana, Oliva Fabrizio, Rao Carmelo Massimiliano, Abrignani Maurizio Giuseppe, Amico Antonio Francesco, Di Fusco Stefania Angela, Caretta Giorgio, Di Matteo Irene, Di Nora Concetta, Pilleri Anna, Ceravolo Roberto, Rossini Roberta, Riccio Carmine, Grimaldi Massimo, Colivicchi Furio, Gulizia Michele Massimo,
Abstract
It has been consistently demonstrated that circulating lipids and particularly low-density lipoprotein cholesterol (LDL-C) play a significant role in the development of coronary artery disease (CAD). Several trials have been focused on the reduction of LDL-C values in order to interfere with atherothrombotic progression. Importantly, for patients who experience acute coronary syndrome (ACS), there is a 20% likelihood of cardiovascular (CV) event recurrence within the two years following the index event. Moreover, the mortality within five years remains considerable, ranging between 19 and 22%. According to the latest guidelines, one of the main goals to achieve in ACS is an early improvement of the lipid profile. The evidence-based lipid pharmacological strategy after ACS has recently been enhanced. Although novel lipid-lowering drugs have different targets, the result is always the overexpression of LDL receptors (LDL-R), increased uptake of LDL-C, and lower LDL-C plasmatic levels. Statins, ezetimibe, and PCSK9 inhibitors have been shown to be safe and effective in the post-ACS setting, providing a consistent decrease in ischemic event recurrence. However, these drugs remain largely underprescribed, and the consistent discrepancy between real-world data and guideline recommendations in terms of achieved LDL-C levels represents a leading issue in secondary prevention. Although the cost-effectiveness of these new therapeutic advancements has been clearly demonstrated, many concerns about the cost of some newer agents continue to limit their use, affecting the outcome of patients who experienced ACS. In spite of the fact that according to the current recommendations, a stepwise lipid-lowering approach should be adopted, several more recent data suggest a "strike early and strike strong" strategy, based on the immediate use of statins and, eventually, a dual lipid-lowering therapy, reducing as much as possible the changes in lipid-lowering drugs after ACS. This review aims to discuss the possible lipid-lowering strategies in post-ACS and to identify those patients who might benefit most from more powerful treatments and up-to-date management.
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Management of oral anticoagulant therapy after intracranial hemorrhage in patients with atrial fibrillation.
Front Cardiovasc Med2023 ;10():1061618. doi: 1061618.
Lucà Fabiana, Colivicchi Furio, Oliva Fabrizio, Abrignani Maurizio, Caretta Giorgio, Di Fusco Stefania Angela, Giubilato Simona, Cornara Stefano, Di Nora Concetta, Pozzi Andrea, Di Matteo Irene, Pilleri Anna, Rao Carmelo Massimiliano, Parlavecchio Antonio, Ceravolo Roberto, Benedetto Francesco Antonio, Rossini Roberta, Calvanese Raimondo, Gelsomino Sandro, Riccio Carmine, Gulizia Michele Massimo
Abstract
Intracranial hemorrhage (ICH) is considered a potentially severe complication of oral anticoagulants (OACs) and antiplatelet therapy (APT). Patients with atrial fibrillation (AF) who survived ICH present both an increased ischemic and bleeding risk. Due to its lethality, initiating or reinitiating OACs in ICH survivors with AF is challenging. Since ICH recurrence may be life-threatening, patients who experience an ICH are often not treated with OACs, and thus remain at a higher risk of thromboembolic events. It is worthy of mention that subjects with a recent ICH and AF have been scarcely enrolled in randomized controlled trials (RCTs) on ischemic stroke risk management in AF. Nevertheless, in observational studies, stroke incidence and mortality of patients with AF who survived ICH had been shown to be significantly reduced among those treated with OACs. However, the risk of hemorrhagic events, including recurrent ICH, was not necessarily increased, especially in patients with post-traumatic ICH. The optimal timing of anticoagulation initiation or restarting after an ICH in AF patients is also largely debated. Finally, the left atrial appendage occlusion option should be evaluated in AF patients with a very high risk of recurrent ICH. Overall, an interdisciplinary unit consisting of cardiologists, neurologists, neuroradiologists, neurosurgeons, patients, and their families should be involved in management decisions. According to available evidence, this review outlines the most appropriate anticoagulation strategies after an ICH that should be adopted to treat this neglected subset of patients.
© 2023 Lucà, Colivicchi, Oliva, Abrignani, Caretta, Di Fusco, Giubilato, Cornara, Di Nora, Pozzi, Di Matteo, Pilleri, Rao, Parlavecchio, Ceravolo, Benedetto, Rossini, Calvanese, Gelsomino, Riccio and Gulizia.
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A Tailored Antithrombotic Approach for Patients with Atrial Fibrillation Presenting with Acute Coronary Syndrome and/or Undergoing PCI: A Case Series.
J Clin Med2022 Jul;11(14):. doi: 4089.
Giubilato Simona, Lucà Fabiana, Pozzi Andrea, Caretta Giorgio, Cornara Stefano, Pilleri Anna, Di Nora Concetta, Amico Francesco, Di Matteo Irene, Favilli Silvia, Rossini Roberta, Riccio Carmine, Colivicchi Furio, Gulizia Michele Massimo,
Abstract
The combination of oral anticoagulants (OAC) and dual antiplatelet therapy (DAPT) is the mainstay for the treatment of patients with atrial fibrillation (AF) presenting with acute coronary syndrome (ACS) and/or undergoing PCI. However, this treatment leads to a significant increase in risk of bleeding. In most cases, according to the most recent guidelines, triple antithrombotic therapy (TAT) consisting of OAC and DAPT, typically aspirin and clopidogrel, should be limited to one week after ACS and/or PCI (default strategy). On the other hand, in patients with a high ischemic risk (i.e., stent thrombosis) and without increased risk of bleeding, TAT should be continued for up to one month. Direct oral anticoagulants (DOAC) in triple or dual antithrombotic therapy (OAC and P2Y12 inhibitor) should be favored over vitamin K antagonists (VKA) because of their favorable risk/benefit profile. The choice of the duration of TAT (one week or one month) depends on a case-by-case evaluation of a whole series of hemorrhagic or ischemic risk factors for each patient. Likewise, the specific DOAC treatment should be selected according to the clinical characteristics of each patient. We propose a series of paradigmatic clinical cases to illustrate the decision-making work-up in clinical practice.
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osteomyelitis in a Poodle dog: case report and literature review.
J Vet Diagn Invest2022 Jul;34(4):703-708. doi: 10.1177/10406387221100996.
Rampacci Elisa, Sforna Monica, Dentini Alfredo, Di Matteo Irene, Lidano Plinio, Capucci Cristiana, Passamonti Fabrizio
Abstract
Paenibacilli are gram-variable, endospore-forming bacteria that occupy various ecologic niches. These microorganisms have been known to infect humans occasionally at various anatomic sites. However, in humans, as well as in other vertebrate animals, the relationship between disease and isolation of spp. remains poorly understood. We report here a case of infection in an adult Poodle dog. The animal had nodules in the lungs and multifocal osteolytic expansile bone lesions. From bone, was recovered by culture and identified by MALDI-TOF mass spectroscopy and 16S rDNA sequencing; pyogranulomatous inflammation was observed in lung and bone specimens. The microorganism was resistant to clindamycin and imipenem. Four-month treatment with amoxicillin-clavulanate resulted in clinical resolution of disease in this dog. Nevertheless, therapy for more prolonged periods should be considered because recurrent infections can occur as a result of the transition of spores to vegetative cells. Disease caused by a species has not been reported previously in dogs, to our knowledge.
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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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Negative concordant T waves during paced ventricular rhythm: An honest enemy is better than a false friend.
J Electrocardiol2017 ;50(4):507-509. doi: 10.1016/j.jelectrocard.2017.03.006.
di Matteo Irene, Crea Pasquale
Abstract
The ECG diagnosis of myocardial infarction and ischemia in pacemaker patients is often challenging. The three criteria, proposed by Sgarbossa et al. in 1996, useful to suspect myocardial ischaemia in patient with left bundle branch block were demonstrated to be valid also in pacemaker patients. In the last years, concordant negative T waves in patients with ventricular paced rhythm were linked to various expressions of acute myocardial injury. If available, comparison with previous ECG is crucial. Partial persistence of cardiac memory during fusion beats created an anomalous concordance between negative T waves and QRS axis and could induce erroneous suspicions. AV delay modification could help to unmask this situation.
Copyright © 2017 Elsevier Inc. All rights reserved.
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Coronary sinus activation patterns in patients with and without left bundle branch block undergoing electroanatomic mapping system-guided cardiac resynchronization therapy device implantation.
Heart Rhythm2017 Feb;14(2):225-233. doi: 10.1016/j.hrthm.2016.10.025.
Del Greco Maurizio, Zorzi Alessandro, Di Matteo Irene, Cima Anna, Maines Massimiliano, Angheben Carlo, Catanzariti Domenico
Abstract
BACKGROUND:
Implantation of the left ventricular (LV) lead in segments with delayed electrical activation may improve response to cardiac resynchronization therapy (CRT).
OBJECTIVE:
The purpose of this study was to evaluate the amount and regional distribution of LV electrical delay (LVED) in patients with or without left bundle branch block (LBBB).
METHODS:
We enrolled 60 patients who underwent electroanatomic mapping system-guided CRT device implantation. Activation mapping of the coronary sinus (CS) branches was performed using an insulated guidewire. LVED was defined as the interval between the beginning of the QRS complex on the surface electrocardiogram (ECG) and the local electrogram and expressed in milliseconds or as percentage of the total QRS duration (LVED%).
RESULTS:
Forty-three patients showed a LBBB and 17 a non-LBBB electrocardiographic pattern. A total of 148 CS branches (mean 2.5 per patient; range 2-4 per patient) were mapped. Patients with LBBB showed higher maximum LVED (135 ms [108-150 ms] vs 100 ms [103-110 ms]; P 50% of the total QRS duration, >75% of the total QRS duration, and >85 ms was significantly higher in patients with LBBB than in patients without LBBB.
CONCLUSION:
Patients without LBBB showed lower LVED and more heterogeneous electrical activation of the CS than did patients with LBBB. This finding may contribute to a lower rate of response to CRT of patients without LBBB and suggests the use of activation mapping to guide LV lead placement.
Copyright © 2016 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.
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Three-Dimensional Electroanatomic Mapping System-Enhanced Cardiac Resynchronization Therapy Device Implantation: Results From a Multicenter Registry.
J Cardiovasc Electrophysiol2017 Jan;28(1):85-93. doi: 10.1111/jce.13120.
Del Greco Maurizio, Maines Massimiliano, Marini Massimiliano, Colella Andrea, Zecchin Massimo, Vitali-Serdoz Laura, Blandino Alessandro, Barbonaglia Lorella, Allocca Giuseppe, Mureddu Roberto, Marenna Biondino, Rossi Paolo, Vaccari Diego, Chianca Roberto, Indiani Stefano, DI Matteo Irene, Angheben Carlo, Zorzi Alessandro
Abstract
INTRODUCTION:
Cardiac resynchronization therapy (CRT) device implantation guided by an electroanatomic mapping system (EAMS) is an emerging technique that may reduce fluoroscopy and angiography use and provide information on coronary sinus (CS) electrical activation. We evaluated the outcome of the EAMS-guided CRT implantation technique in a multicenter registry.
METHODS:
During the period 2011-2014 we enrolled 125 patients (80% males, age 74 [71-77] years) who underwent CRT implantation by using the EnSite system to create geometric models of the patient's cardiac chambers, build activation mapping of the CS, and guide leads positioning. Two hundred and fifty patients undergoing traditional CRT implantation served as controls. Success and complication rates, fluoroscopy and total procedure times in the overall study population and according to center experience were collected. Centers that performed ?10 were defined as highly experienced.
RESULTS:
Left ventricular lead implantation was successful in 122 (98%) cases and 242 (97%) controls (P = 0.76). Median fluoroscopy time was 4.1 (0.3-10.4) minutes in cases versus 16 (11-26) minutes in controls (P
CONCLUSIONS:
EAMS-guided CRT implantation proved safe and effective in both high- and low-experienced centers and allowed to reduce fluoroscopy use by ?75% and angiography rate by ?70%.
© 2016 Wiley Periodicals, Inc.
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