Papers by Federico Lombardi
American Heart Journal, 2010
Background Atrial fibrillation (AF) is a common arrhythmia that frequently recurs after restorati... more Background Atrial fibrillation (AF) is a common arrhythmia that frequently recurs after restoration of sinus rhythm (SR). Identifying risk factors for recurrence may help define the best strategy for secondary prevention. Methods The GISSI-AF trial enrolled 1,442 patients in SR with at least 2 documented AF episodes in the previous 6 months or after cardioversion in the last 2 weeks. Patients were randomized to valsartan or placebo; all other treatments for AF or underlying heart diseases were allowed. Primary end points were time to first recurrence of AF and proportion of patients with >1 AF episode during 1-year follow-up. We evaluated clinical and electrocardiographic baseline characteristics of all patients to identify independent predictors for AF recurrence using a Cox multivariable model. Results Risk factors for AF recurrence were a history of 2 or more AF episodes in the previous 6 months, independent of the modality of SR restoration, spontaneous (HR 1.42, 95% CI 1.14-1.77, P = .002), or by cardioversion (HR 1.19, 95% CI 1.01-1.40, P = .038), and a lower heart rate during SR (HR 0.99, 95% CI 0.99-1.00, P = .052). The risk factors were the same for >1 AF recurrence. Patients treated with amiodarone had a lower risk for both end points (P b .0001 and P = .017), whereas those on diuretics had a greater risk (P = .009 and P = .003). Conclusions In the GISSI-AF study population, AF history had significant prognostic value independent of the modality of SR restoration. Amiodarone and diuretic treatment affected the rate of AF recurrence.
Physical Review B
We investigate the mechanisms of nuclear decoupling in synthetically tailored graphenoids, where ... more We investigate the mechanisms of nuclear decoupling in synthetically tailored graphenoids, where the electron spin state is introduced by topological manipulation of the lattice. We compare molecular graphenoids containing one and two spin centers, introduced by pentagonal rings in the honeycomb lattice. Exploiting the molecular nature of the systems, we investigate the role of different nuclear species and environments. Variations on the Carr-Purcell-Meiboom-Gill pulse trains are used to prolong the coherence time of the electron spin of the radicaloids, leading to substantial improvements in performance and coherence times up to 300 μs at liquid-nitrogen temperature. The investigation of electron spin coherence as a function of interpulse spacing, with times close to the inverse of the nuclear precession frequency, reveals that a train of pulses in phase with the nuclear precession maximizes the nuclear decoupling. At room temperature the limits imposed by the sample treatment and environment are reached, indicating what amelioration is necessary to further enhance the quantum performance.
International journal of cardiology, May 1, 2018
Images of the Twenty-First Century. Proceedings of the Annual International Engineering in Medicine and Biology Society
ABSTRACT A signal processing technique is proposed for the extraction of short-term variability r... more ABSTRACT A signal processing technique is proposed for the extraction of short-term variability rhythms from the discharge of cardiac sympathetic fibers. In decerebrated and artificially ventilated cats the impulse activity of cardiac preganglionic fibers was recorded in a closed chest preparation together with ECG, arterial pressure, and respiration. The neural signal was fed into an analog spike counter, obtaining a stepwise count signal. Beat-by-beat variability series were extracted; the spike-count signal is sampled once per cardiac cycle convolving with a FIR low-pass filter. The presence of low-frequency and high-frequency rhythms was demonstrated by parametric spectral and cross-spectral analyses
Giornale italiano di cardiologia (2006), 2016
A 56-year-old man presented to the Outpatient Cardiology Unit for dyspnea that had been lasting 6... more A 56-year-old man presented to the Outpatient Cardiology Unit for dyspnea that had been lasting 6 months and an occasional episode of cold perspiration on climbing a flight of stairs. In the suspicion of coronary artery disease, he was prescribed a complete blood panel, an echocardiogram and a treadmill stress test. The echocardiogram, performed as late as 78 days after the first evaluation and only by chance scheduled 2 days before the stress test, enabled a diagnosis of left atrial myxoma for which the patient successfully underwent cardiac surgery. The authors discuss the aspecific and potentially misleading nature of myxoma symptoms and highlight the latency between cardiological evaluation and diagnostic echocardiography.
Hellenic journal of cardiology : HJC = Hellenike kardiologike epitheorese
Clinical autonomic research : official journal of the Clinical Autonomic Research Society, 2017
Journal of atrial fibrillation
Atrial fibrillation (AF) is the most common clinical arrhythmia and represents a major social and... more Atrial fibrillation (AF) is the most common clinical arrhythmia and represents a major social and economic problem. The number of subjects with AF is constantly increasing as a result of aging and improved survival in several cardiac and non-cardiac diseases. Patients with AF are often symptomatic, have a reduced physical capacity and are at high risk for thromboembolic events. Moreover, AF is associated with increased mortality and independent of the management, based either on rhythm or rate control strategy. The safety and efficacy of most anti-arrhythmic drugs are questionable. Increasing attention has therefore been addressed to evaluate the possible therapeutic and/or preventive effects of forms of treatment coming from ancient medical traditions of Far East, like acupuncture and yoga. In traditional Chinese medicine, acupuncture has been found effective in managing patients with paroxysmal supraventricular tachycardia. Recently, also in the Western literature, reports have be...
Giornale italiano di cardiologia (2006), 2017
The introduction of non-vitamin K antagonist oral anticoagulants (NOACs) into clinical practice h... more The introduction of non-vitamin K antagonist oral anticoagulants (NOACs) into clinical practice has revolutionized the prevention and the therapeutic approaches to thromboembolic events in patients with nonvalvular atrial fibrillation and represents with no doubts one of the most remarkable advances in the history of cardiovascular medicine over the last years. NOACs beyond a comparable efficacy with vitamin K antagonists allow to overcome the limitations of this last category of drugs owing to their less drug to drug interactions and a predictable anticoagulant effect that allows a fixed dose administration without the need for continuous monitoring. However, the penetration of NOACs into the Italian market is still lower than predicted with respect to their use in other European countries.The aim of this review is to critically analyze the reasons behind this attitude through the adoption of the nominal group technique, a methodology that permits to reach an official consensus.
Heart rhythm, Feb 1, 2017
Medical Hypotheses, 2016
The exact mechanisms of sudden unexpected death in epilepsy remain elusive, despite there is cons... more The exact mechanisms of sudden unexpected death in epilepsy remain elusive, despite there is consensus that SUDEP is associated with severe derangements in the autonomic control to vital functions as breathing and heart rate regulation. Heart rate variability (HRV) has been advocated as biomarker of autonomic control to the heart. Cardiac dysautonomia has been found in diseases where other branches of the autonomous nervous system are damaged, as Parkinson disease and multiple system atrophy. In this perspective, an impaired HRV not only is a risk factor for sudden cardiac death mediated by arrhythmias, but also a potential biomarker for monitoring a progressive decline of the autonomous nervous system. This slope may lead to an acute imbalance of the regulatory pathways of vital functions after seizure and then to SUDEP.
Journal of the American College of Cardiology, 2016
Cardiac magnetic resonance (CMR) is useful for the diagnosis of left ventricular noncompaction (L... more Cardiac magnetic resonance (CMR) is useful for the diagnosis of left ventricular noncompaction (LVNC). However, there are limited data regarding its prognostic value. The goal of this study was to evaluate the prognostic relevance of CMR findings in patients with LVNC. A total of 113 patients with an echocardiographic diagnosis of LVNC underwent CMR at 5 referral centers. CMR diagnostic criterion of LVNC (noncompacted/compacted ratio >2.3 in end-diastole) was confirmed in all patients. We performed left ventricular (LV) and right ventricular quantitative analysis and late gadolinium enhancement (LGE) assessments and analyzed the following LVNC diagnostic criteria: left ventricular noncompacted myocardial mass (LV-ncMM) >20% and >25%, total LV-ncMM index >15 g/m(2), noncompacted/compacted ratio ≥3:1 ≥1 of segments 1 to 3 and 7 to 16 or ≥2:1 in at least 1 of segments 4 to 6 of the American Heart Association model. Outcome was a composite of thromboembolic events, heart failure hospitalizations, ventricular arrhythmias, and cardiac death. At a mean follow-up of 48 ± 24 months, cardiac events (CEs) occurred in 36 patients (16 heart failure hospitalizations, 10 ventricular arrhythmias, 5 cardiac deaths, and 5 thromboembolic events). LV dilation, impaired LV ejection fraction, and LV-ncMM >20% was significantly more frequent in patients with CEs. LV fibrosis was detected by using LGE in 11 cases. CMR predictors of CEs were LV dilation and LGE. LGE was associated with improved prediction of CEs, compared with clinical data and CMR functional parameters in all 3 models. No CEs occurred in patients without dilated cardiomyopathy and/or LGE. In patients with LVNC evaluated by using CMR, the degree of LV trabeculation seems to have no prognostic impact over and above LV dilation, LV systolic dysfunction, and presence of LGE.
Circulation: Cardiovascular Imaging, 2016
Background— The aim of this study was to determine the prognostic benefit of cardiac magnetic res... more Background— The aim of this study was to determine the prognostic benefit of cardiac magnetic resonance (CMR) over transthoracic echocardiography (TTE) in ischemic cardiomyopathy and nonischemic dilated cardiomyopathy patients evaluated for primary prevention implantable cardioverter–defibrillator therapy. Methods and Results— We enrolled 409 consecutive ischemic and dilated cardiomyopathy patients (mean age: 64±12 years; 331 men). All patients underwent TTE and CMR, and left ventricle end-diastolic volume, left ventricle end-systolic volume, and left ventricle ejection fraction (LVEF) were evaluated. In addition, late gadolinium enhancement was also assessed. All patients were followed up for major adverse cardiac events (MACE) defined as a composite end point of long runs of nonsustained ventricular tachycardia, sustained ventricular tachycardia, aborted sudden cardiac death, or sudden cardiac death. The median follow-up was 545 days. CMR showed higher left ventricle end-diastolic...
Circulation: Cardiovascular Imaging, 2016
Background— Computed tomography coronary angiography (cTCA) and stress cardiac magnetic resonance... more Background— Computed tomography coronary angiography (cTCA) and stress cardiac magnetic resonance (stress-CMR) are suitable tools for diagnosing obstructive coronary artery disease in symptomatic patients with previous history of revascularization. However, performance appraisal of noninvasive tests must take in account the consequent diagnostic testing, invasive procedures, clinical outcomes, radiation exposure, and cumulative costs rather than their diagnostic accuracy only. We aimed to compare an anatomic (cTCA) versus a functional (stress-CMR) strategy in symptomatic patients with previous myocardial revascularization procedures. Methods and Results— Six hundred patients with chest pain and previous revascularization included in a prospective observational registry and evaluated by clinically indicated cTCA (n=300, mean age 68.2±9.7 years, male 255) or stress-CMR (n=300, mean age 67.6±9.7 years, male 263) were enrolled and followed-up in terms of subsequent noninvasive tests, in...
Arrhythmia & Electrophysiology Review, 2016
Holter monitors are tools of proven efficacy in diagnosing and monitoring cardiac arrhythmias. De... more Holter monitors are tools of proven efficacy in diagnosing and monitoring cardiac arrhythmias. Despite the fact their use is widely prescribed by general practitioners, little is known about their evolving role in the management of patients with cryptogenic stroke, paroxysmal atrial fibrillation, unexplained recurrent syncope and risk stratification in implantable cardioverter defibrillator or pacemaker candidates. New Holter monitoring technologies and loop recorders allow prolonged monitoring of heart rhythm for periods from a few days to several months, making it possible to detect infrequent arrhythmias in patients of all ages. This review discusses the advances in this area of arrhythmology and how Holter monitors have improved the clinical management of patients with suspected cardiac rhythm diseases.
Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, Aug 1, 2016
We surely agree with Wessel et al. that heart period fluctuations are linked to many physiologica... more We surely agree with Wessel et al. that heart period fluctuations are linked to many physiological oscillations. As already explained in the 1996 heart rate variability (HRV) standards,1 these oscillations include those of respiration,2 blood pressure,3 etc. The shifts in the respiration-related HRV components into the nominal low-frequency band are also known4 as is the fact that the low-frequency HRV modulations cannot be taken as a single reliable expression of sympathetic activity.1 It is difficult to consider respiration as an overwhelming determinant of short-term HRV. Adding additional provocations to constant controlled breathing still leads …
Rev Soc Bras Med Trop, 2005
Computing in Cardiology 2013, Sep 1, 2013
ABSTRACT Aim of this study was to assess changes of blood pressure (BP) variability spectrum in r... more ABSTRACT Aim of this study was to assess changes of blood pressure (BP) variability spectrum in response to a sympathetic stimulation during a tilt-up stress test. Thirty patients (21 males, 69 ±10 years) with AF were included in the study. Surface ECG and non-invasive beat-to-beat BP were recorded for 10 minutes at rest and during tilt (in 19 patients). The systolic and diastolic BP series were resampled at 1Hz using cubic spline interpolation and spectral analysis was performed using autoregressive (AR) models. The total power was decomposed into M contributions, one for each pole. The poles whose frequency was in the Low Frequency (LF, 0.03–0.15 Hz) or High Frequency (HF, 0.15–0.4 Hz) were selected. LF component power increased during tilt in both systolic and diastolic BP (rest vs. tilt: systolic BP: 6.5 ± 5.3 vs. 13.0 ± 13.4 p
International journal of cardiology, 2016
Critical limb ischemia (CLI) is a major health problem with no adequate treatment. Since CLI is c... more Critical limb ischemia (CLI) is a major health problem with no adequate treatment. Since CLI is characterized by insufficient tissue vascularization, efforts have focused on the discovery of novel angiogenic factors. Cyclophilin A (CyPA) is an immunophilin that has been shown to promote angiogenesis in vitro and to enhance bone marrow (BM) cell mobilization in vivo. However, its potential as an angiogenic factor in CLI is still unknown. Thus, this study aimed to evaluate whether CyPA might induce neo-angiogenesis in ischemic tissues. Wild-type C57Bl/6j mice underwent acute hind-limb ischemia (HLI) and received a single intramuscular administration of recombinant CyPA or saline. Limb perfusion, capillary density and arteriole number in adductor muscles were significantly increased after CyPA treatment. Interestingly, BM-derived CD117(+) cell recruitment was significantly higher in ischemic adductor tissue of mice treated with CyPA versus saline. Therefore, the effect of CyPA on isola...
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Papers by Federico Lombardi