Papers by Cristina Giglioli
International Journal of Cardiovascular Imaging, Oct 30, 2019
Journal of Interventional Cardiology, Apr 9, 2021
Background. Although the clinical effects of stent malapposition remain controversial, several an... more Background. Although the clinical effects of stent malapposition remain controversial, several analyses of stent registries consistently have found that malapposed struts were frequently identified in patients who experienced stent thrombosis. In this study, which is a subanalysis of the previously published CREBX-OCT study, we compared optical coherence tomography (OCT) analysis at the index percutaneous coronary intervention (PCI) and at six-month follow-up in 37 patients randomly assigned to receive, by a single operator, three different second-generation drug-eluting stents (Cre8, Biomatrix, and Xience) aiming to clarify if the malapposition observed at six-month follow-up was persistent or late-acquired. Moreover, we investigated if there were some differences in the behavior of the three different kinds of stents in relation to the struts malapposition. Material and Methods. We analyzed 614 and 599 cross sections and 5514 and 5377 struts at the index PCI and at six-month follow-up, respectively. e qualitative analysis of the plaque composition among the three groups did not show significant differences. Results. e lumen area did not significantly change from the index procedure to the six-month follow-up in the three groups; on the contrary, the number of malapposed struts increased significantly in the Cre8 and Biomatrix groups but not in the Xience group: 0.58 ± 1.51 and 3.29 ± 5.33 (p < 0.023) in the Cre8 group, 0.55 ± 1.81 and 1.73 ± 2.28 (p < 0.024) in the Biomatrix group, and 0.55 ± 1.5 and 0.25 ± 0.87 (p < 0.166) in the Xience group, respectively. Conclusions. erefore, the malapposition observed at six-month followup in our study population could be mainly considered as acquired and attributable to biomechanical reasons due to the structural differences among the three stents. is trial is registered with Clinical Trials.gov Identifier: NCT02850497.
DOAJ (DOAJ: Directory of Open Access Journals), 2012
Cardiotoxicity is one of the most important adverse event related to anthracycline therapy and ca... more Cardiotoxicity is one of the most important adverse event related to anthracycline therapy and can lead in about 1-5% of cases to the occurrence of heart failure. In a higher percentage of patients treated with these drugs asymptomatic left ventricular dysfunction can occur, so that guidelines recommend a strict clinical and echocardiographic monitoring. However, the occurrence of left ventricular dysfunction can be multifactorial and the search of other concurrent etiologies, including ischemic heart disease, is pivotal in particular in patients at high cardiovascular risk. Here is reported the case of a young man with metabolic syndrome in whom the presence of ischemic heart disease was suspected six years after the diagnosis of cardiomyopathy following treatment with anthracyclines for an Hodgkin's lymphoma; in fact, he was submitted to angiography only when symptoms of angina occurred in addition to left ventricular dysfunction. In this patient coronary angiography showed severe coronary artery disease which was treated with angioplasty and stenting. The present case suggest that also in young patients treated with anthracyclines developing left ventricular dysfunction, ischemic heart disease should be suspected in particular for those at high cardiovascular risk. To exclude this diagnosis a cardiac stress test or coronary angiography/computed tomography should be recommended.
Heart and Vessels
Takotsubo syndrome (TTS) is an acute and usually reversible heart failure syndrome, frequently as... more Takotsubo syndrome (TTS) is an acute and usually reversible heart failure syndrome, frequently associated with emotional or physical stress. Its pathophysiology remains largely unclear, although several mechanisms related to catecholaminergic storm have been proposed. In this study we analyzed during the acute phase of TTS and at follow-up both hemorheological parameters and biomarkers of endothelial damage, whose time course has never been fully explored. In 50 TTS women, we analyzed several hemorheological parameters [whole blood viscosity (WBV) at 0.512 s−1 and at 94.5 s−1, plasma viscosity (PLV), erythrocyte deformability and aggregation index] as well as biomarkers of endothelial dysfunction [von Willebrand Factor (vWF), Plasminogen activator inhibitor-1 and factor VIII levels] during the acute phase and after a median 6 months follow-up. These variables were also assessed in 50 age-matched healthy women. Respect to follow-up, in the acute phase of TTS we observed higher values of white blood cell count, fibrinogen, WBV at low and high shear rates, PLV, erythrocyte aggregation index and lower values of erythrocyte elongation index. Moreover, all biomarkers of endothelial dysfunction resulted significantly higher in the acute phase. During follow-up WBV at 94.5 s−1, erythrocyte elongation index and vWF resulted significantly altered with respect to controls. The results of this study confirm the role of hyperviscosity and endothelial dysfunction in TTS pathophysiology. Moreover, they suggest the persistence of alterations of erythrocyte deformability and endothelial dysfunction even beyond the acute phase that could be the target of therapeutic strategies also during follow-up.
Acta medica academica, 2020
OBJECTIVE The SYNTAX trial was designed to evaluate whether multivessel disease patients could be... more OBJECTIVE The SYNTAX trial was designed to evaluate whether multivessel disease patients could benefit from percutaneous or surgical revascularization using a paclitaxel eluting stents, but after the introduction of second generation stents, this score needs to be reevaluated. The aim of our study was to analyze the association between SYNTAX score and the prognosis of multivessel patients submitted to percutaneous coronary intervention (PCI) and second generation everolimus eluting stents (EES) implantation. MATERIALS AND METHODS Data on 289 patients with multivessel coronary artery disease submitted to PCI with EES were stored in a dedicated database and retrospectively analyzed. During a mean follow-up period of 14.4±6.4 months, major adverse cardiac and cerebrovascular events (MACCE) including death from any cause, myocardial infarction, target lesion revascularization (TLR) and stroke, were systematically assessed. RESULTS The incidence of MACCE at follow-up was 13.1%; death fr...
International Journal of Cardiology, 2017
BackgroundIn clinical practice there is a gap between guidelines recommendation and antiplatelet ... more BackgroundIn clinical practice there is a gap between guidelines recommendation and antiplatelet strategies used for acute coronary syndrome (ACS). We sought to evaluate appropriateness ofantiplatelet strategies employed in a tertiary center. Methods and results From January to June 2014, 430 ACS were treated with percutaneous coronary intervention by 3 groups of interventional cardiologists. Aspirin and clopidogrel (52%) were the most commonly used antiplatelet therapies, being prasugrel associated with aspirin in 110 (25.5%) and ticagrelor in 97 (22.5%) ACS. Inappropriate use of prasugrel (Tia/Ictus) was found in 2 (1.8%) patients and not recommended use (>75 years, without diabetes or previous myocardial infarction) in 11 (10%). Not recommended use of ticagrelor (plus warfarin) wasfound in 4 (4.4%). Switching from clopidogrel to prasugrel occurred in 29% [28 showing high residual platelet reactivity (HRPR: ADP 10 μmol>70%), and 4 left main stenting], while from clopidogrel to ticagrelor occurred in 13.4% (all showing HRPR, but 1). The most powerful predictor for prescription of 3rd generation P2Y12 inhibitors was the HRPR (OR 5.473, 95%CI 2.41-12.43, P<.0001), whereas the behavior of attending cardiologist (HR 0.674, 95%CI 0.573-0.847, P=.001) and the older age reduced the probability of receiving it (OR0.963, 95%CI 0.943-0.984, P=.001). Conclusions Clopidogrel remained the most common P2Y12 inhibitor employed for ACS. Third generation P2Y12 inhibitor prescription was lower than the one expected by guidelines recommendations, and the switching was largely based on clopidogrel HRPR. These findings suggest the need for a greater effort to improve adherence of cardiology community to current guidelines.
Acta medica academica, 2017
This study aimed to test the association of both the baseline values and post-procedural variatio... more This study aimed to test the association of both the baseline values and post-procedural variations of urinary and serum Neutrophil Gelatinase-Associated Lipocalin (NGAL) and Cystatin C (CysC) with contrast induced nephropathy (CIN) occurrence in patients undergoing percutaneous coronary invasive procedures (PCIP), and compare them to serum creatinine and the estimated glomerular filtration rate (eGFR). In 43 patients admitted to our Cardiac Step-Down Unit and submitted to PCIP, we measured serum creatinine and eGFR as the standard markers for CIN diagnosis, and compared them to both serum and urinary NGAL as well as serum CysC, assessed before and 4 hours after PCIP. Patients who developed CIN (16%) were older, with significantly higher discharge creatinine values, lower eGFR values at creatinine peak, and higher baseline and post-PCIP CysC values. We did not detect any significant association between baseline serum and urinary NGAL values and their 4 hour variations after contrast...
International Journal of Cardiology, 2016
Clinical Research in Cardiology, 2016
Takotsubo cardiomyopathy (TTC) pathophysiology is still unclear. A transient intracoronary thromb... more Takotsubo cardiomyopathy (TTC) pathophysiology is still unclear. A transient intracoronary thrombosis dissolved at the time of angiography has been hypothesized. We aimed to evaluate the prevalence of thrombophilic disorders in TTC patients. In 75 TTC women, 75 age-and sex-matched acute coronary syndrome (ACS) patients, both enrolled during the acute phase, and in 75 control subjects, we compared the prevalence of congenital and acquired thrombophilic alterations and the values of clotting and endothelial activation biomarkers. Some parameters were reassessed 1 month after the acute phase in TTC patients. No significant difference between the three groups was observed in factor II (G20210A) and V (G1691A) polymorphisms prevalence. Homocysteine levels were significantly higher in ACS patients vs. TTC and control subjects. Lipoprotein(a) values trended to be higher in TTC patients vs. control subjects, though not significantly. Other thrombophilic alterations in TTC patients were similar to that previously reported in healthy women. Von Willebrand factor and plasminogen activator inhibitor-1 were significantly higher in TTC and in ACS patients than controls. Clotting activation biomarkers were not statistically different between TTC patients and controls. During follow-up, in TTC patients, endothelial damage indices significantly decreased while clotting activation biomarkers remained unchanged. In conclusion, our results, showing a rate of thrombophilic alterations in TTC patients similar to control subjects, do not support the transient intracoronary thrombus hypothesis. However, several endothelial damage markers and lipoprotein(a) were higher in TTC patients vs. controls suggesting a role of endothelial dysfunction and of other factors concurring to hyperviscosity, as recently hypothesized.
Clinical cases in mineral and bone metabolism : the official journal of the Italian Society of Osteoporosis, Mineral Metabolism, and Skeletal Diseases
Hypocalcemia is frequent in the setting of endocrine disorders, bone diseases and renal failure. ... more Hypocalcemia is frequent in the setting of endocrine disorders, bone diseases and renal failure. When hypocalcemia is severe it can predispose to life-threatening ventricular arrhythmias; in such cases a rapid admission to hospital and a prompt correction of electrolyte imbalance are needed. We report the case of an old patient suffering from renal failure that was admitted to our cardiac step-down unit because of severe hypocalcemia associated with ventricular arrhythmias. Hypocalcemia was promptly treated and an endocrinologic consult was requested for investigating the causes of this electrolyte imbalance. Our experience suggests the creation of a new synergy between cardiologists and endocrinologists that led us to build a simple and schematic algorithm for the diagnosis and treatment of hypocalcemia.
International Journal of Cardiology, 2015
Archives of Iranian medicine
A 31-year-old athlete was admitted to our hospital for previous inferior myocardial infarction (M... more A 31-year-old athlete was admitted to our hospital for previous inferior myocardial infarction (MI), diagnosed by transthoracic echocardiography, myocardial scintigraphy, and cardiac magnetic resonance, while coronary angiography revealed normal coronary arteries. Laboratory investigations excluded acquired or inherited thrombophilia, immunologic disorders, cardiotropic agents infection, and drug abuse. Antiplatelet therapy was started but, after 15 days, he was rehospitalized with diagnosis of multiple left renal infarctions. A transesophageal echocardiography (TEE) was so performed which excluded a right-to-left shunt, suggestive of patent foramen ovale, or other cardioembolic sources in heart chambers and valve apparatus. Antiplatelet therapy was replaced with oral anticoagulants without any further embolic event at one-year follow-up. This case raises two important questions regarding young patients with cryptogenic MI. First, if TEE should be part of a complete diagnostic pathw...
Internal and Emergency Medicine, 2015
Patients' response to dual antiplatelet therapy (DAPT) is subject to variations and its monitorin... more Patients' response to dual antiplatelet therapy (DAPT) is subject to variations and its monitoring allows to individualize this therapy. In this study, we evaluated if a strategy of tailored DAPT after platelet function testing could reduce high on-treatment platelet reactivity (HPR) and improve outcome of patients treated with stent implantation. In 257 patients undergoing percutaneous angioplasty, platelet function was measured by light transmittance aggregometry (LTA) using 10 lM/L adenosine-diphosphate (ADP) and 1 mM arachidonic acid (AA) as agonists. Patients with HPR by ADP (C70 %) were switched to double-dose clopidogrel, ticlopidine, prasugrel or ticagrelor; in patients with HPR by AA (C20 %) acetylsalicylic acid dose was increased if not contraindicated. Platelet function analysis was repeated 48 hours after therapy variation. At 20-month follow-up major adverse cardiovascular events (MACE) and bleedings were assessed. HPR was detected in 97/257 (37.7 %) patients: 69/257 (26.8 %) had HPR by ADP and 71/257 (27.6 %) had HPR by AA. In patients with HPR by ADP or by AA, tailored DAPT determined a significant reduction in residual platelet reactivity. No significant difference in MACE or bleeding occurrence was documented in HPR patients treated with tailored DAPT vs. those without HPR. HPR patients treated with tailored DAPT had significant lower follow-up MACE and deaths vs. 139 HPR patients not switched, even after propensity score analysis. These results suggest that a DAPT tailored on platelet testing can improve antiplatelet response in HPR patients, possibly reducing their thrombotic events to a level similar to non-HPR patients, without increasing the risk of bleeding.
Internal and emergency medicine, 2013
Acta medica Iranica, 2012
Cardiotoxicity is one of the most important adverse event related to anthracycline therapy and ca... more Cardiotoxicity is one of the most important adverse event related to anthracycline therapy and can lead in about 1-5% of cases to the occurrence of heart failure. In a higher percentage of patients treated with these drugs asymptomatic left ventricular dysfunction can occur, so that guidelines recommend a strict clinical and echocardiographic monitoring. However, the occurrence of left ventricular dysfunction can be multifactorial and the search of other concurrent etiologies, including ischemic heart disease, is pivotal in particular in patients at high cardiovascular risk. Here is reported the case of a young man with metabolic syndrome in whom the presence of ischemic heart disease was suspected six years after the diagnosis of cardiomyopathy following treatment with anthracyclines for an Hodgkin's lymphoma; in fact, he was submitted to angiography only when symptoms of angina occurred in addition to left ventricular dysfunction. In this patient coronary angiography showed se...
Acta medica (Hradec Králové) / Universitas Carolina, Facultas Medica Hradec Králové, 2012
Here we report the case of a 31-year-old man admitted to our hospital with echocardiografic and C... more Here we report the case of a 31-year-old man admitted to our hospital with echocardiografic and Cardiac Magnetic Resonance signs of myocarditis complicated by ventricular tachycardia, initially resolved with direct current shock. After the recurrence of ventricular tachycardia the patient was submitted to electrophysiological study revealing a re-entrant circuit at the level of the medium segment of interventricular septum, successfully treated with transcatheter ablation. This case highlights how the presence of recurrent ventricular arrhythmias at the onset of acute myocarditis, suspected or proven, could be associated with a pre-existing arrhythmogenic substrate, therefore these patients should be submitted to electrophysiological study in order to rule out the presence of arrhythmogenic focuses that can be treated with transcatheter ablation.
Acta medica Iranica, Jan 9, 2013
An 80-year-old diabetic man with severe aortic stenosis was admitted to our hospital for cardioge... more An 80-year-old diabetic man with severe aortic stenosis was admitted to our hospital for cardiogenic shock complicating non-ST-elevation myocardial infarction. Echocardiographic evaluation showed also a severe degree of both left ventricular dysfunction and mitral regurgitation. The patient was initially stabilized with inotropes and mechanical ventilation was necessary because of concurrent pulmonary edema. The day after, he was submitted to coronary angiography showing bivessel coronary disease. Given the high estimated operative risk, the patient was treated with angioplasty and bare metal stent implantation on both right coronary and circumflex artery; contemporarily, balloon aortic valvuloplasty (BAV) was performed with anterograde technique, obtaining a significant increase in planimetric valve area and reduction in transvalvular peak gradient. Few days after the procedure echocardiogram showed an increase in left ventricular ejection fraction, moderate aortic stenosis with mi...
The Journal of invasive cardiology, 2013
Percutaneous coronary intervention (PCI) requires the use of iodinated contrast medium and conseq... more Percutaneous coronary intervention (PCI) requires the use of iodinated contrast medium and consequently poses the risk of contrast-induced nephropathy (CIN), which can negatively impact on outcome. Patients with chronic kidney disease (CKD) are at particularly high risk of CIN. In this study, we investigated the role of continuous renal replacement therapy (CRRT) performed before and after versus only after PCI in patients with CKD. We studied 46 consecutive patients with CKD (mean creatinine >2 mg/dL) submitted to PCI: 21 (mean creatinine 2.7 ± 1.6 mg/dL) treated with CRRT only after PCI (CRRTpost) and 25 (mean creatinine 3.0 ± 1.3 mg/dL) with CRRT before and after PCI (CRRTpre-post). CRRT was performed with hemofiltration (creatinine <3 mg/dL) or hemodiafiltration (creatinine >3 mg/dL), initiated 6-8 hours before PCI and re-started immediately post PCI for 18-24 hours. Creatinine showed a greater reduction in CRRTpre-post (2.4 ± 1.0 vs. 3.0 ± 1.3 mg/dL; P=.002) with respe...
Acta cardiologica, 2013
The rehospitalization rate for decompensated heart failure (HF) is high and can be ascribed also ... more The rehospitalization rate for decompensated heart failure (HF) is high and can be ascribed also to a suboptimal decongestion before discharge. Congestion can be treated with diuretics or continuous renal replacement therapy (CRRT). Aim of this study was to evaluate if diuretics and CRRT, used in agreement to international guidelines, may have a dissimilar decongestion ability in patients with decompensated HF with different baseline characteristics. In 88 patients with HF (NYHA class Ill-IV) we evaluated the effect of CRRT (n = 46) and intravenous diuretics (n = 42) on clinical and instrumental signs of congestion. A clinical score was obtained as the sum of signs and symptoms of HF to estimate the severity of each patient's clinical condition.The choice of diuretics or CRRT was guided by renal impairment or diuretics' resistance. A significant reduction in clinical HF score was observed in the CRRT group at discharge vs admission (1.3 +/- 1.9 vs 5.7 +/- 2.3, P < 0.001) ...
High Blood Pressure & Cardiovascular Prevention, 2013
Previous studies analyzing the impact of hypertension (HTN) on myocardial infarction (MI) outcome... more Previous studies analyzing the impact of hypertension (HTN) on myocardial infarction (MI) outcome reached conflicting results and scarce data are available in patients treated with percutaneous coronary intervention (PCI). In this study the prognostic impact of HTN history in ST-elevation MI (STEMI) and Non-STEMI (NSTEMI) patients treated with PCI was analyzed. We compared characteristics of 1,031 STEMI and 437 NSTEMI patients, in relation to the presence of HTN. Median follow-up duration was 40.2 months. HTN was significantly higher in NSTEMI vs. STEMI patients (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). NSTEMI patients were older, with higher values of left ventricular ejection fraction (LVEF) and more frequently with previous myocardial revascularization than STEMI patients either among hypertensives and non-hypertensives. At univariate analysis HTN resulted associated with long-term mortality in STEMI but not in NSTEMI patients. At multivariate analysis HTN was not associated with either in-hospital and long-term mortality in both NSTEMI and STEMI group. In conclusion, in the PCI era HTN does not influence MI patients prognosis; other factors, such as age, admission LVEF, coronary disease extension, previous MI and creatinine levels are independently associated with MI patients outcome even though this should not discourage from a strict control of HTN after the acute event.
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Papers by Cristina Giglioli