Papers by Francesco Spera
Journal of Interventional Cardiac Electrophysiology, Sep 30, 2022
Background Spatial differences in conduction velocity (CV) are critical for cardiac arrhythmias i... more Background Spatial differences in conduction velocity (CV) are critical for cardiac arrhythmias induction. We propose a method for an automated CV calculation to identify areas of slower conduction during cardiac arrhythmias and sinus rhythm. Methods Color-coded representations of the isochronal activation map using data coming from the RHYTHMIA™ Mapping System were reproduced by applying a temporal isochronal window at 20 ms. Geodesic distances of the 3D mesh were calculated using an algorithm selecting the minimum distance pathway (MDP). The CV estimation was performed considering points on the boundary of two spatially and temporally adjacent isochrones. For each of the boundary points of a given isochrone, the nearest boundary point of the consecutive isochrone was chosen, the MDP was evaluated, and a map of CV was created. The proposed method has been applied to a population of 29 patients. Results In all cases of perimitral atrial flutter (16 pts out of 29 (55%)), areas with significantly low CV (< 30 cm/s) were found. Half of the cases present regions with low CV located in the anterior wall. No case with low CV at the so-called LA isthmus was observed. Right atrial maps during common atrial flutters showed low CV areas mainly located in the inferior inter-atrial septum. No areas of low CV were observed in subjects without a history of atrial arrhythmia while pts affected by paroxysmal AF showed areas with a limited extension of low CV. Conclusions The proposed software for automated CV estimation allows the identification of low CV areas, potentially helping electrophysiologists to plan the ablation strategy.
Europace
Funding Acknowledgements Type of funding sources: None. Background Catheter ablation (CA) improve... more Funding Acknowledgements Type of funding sources: None. Background Catheter ablation (CA) improves prognosis in patients with electrical storm (ES). However, its effectiveness and timing in patients with ventricular tachycardia and appropriate ICD therapies remain a matter of debate. Purpose Our aim was to investigate whether patients with history of discrete ventricular tachycardia episodes had different clinical features and outcome compared to patients with ES as first arrhythmic occurrence. Methods We enrolled 57 consecutive patients undergoing CA for ES and collected clinical, echocardiographic and electroanatomic mapping data. The primary end point was a composite of death from any cause and recurrences of sustained VT or ventricular fibrillation, appropriate ICD therapy, or ES. Results During a median follow up of 39 months, 28 patients (49%) met the primary end point of arrhythmic recurrence or death from any cause. There were no significant differences between clinical, ele...
European Heart Journal, 2018
Survival analysis with most cases occurring in middle-aged male athletes with a better prognosis ... more Survival analysis with most cases occurring in middle-aged male athletes with a better prognosis than SCA during other activities. P1014 Risk stratification scores for sudden cardiac death in hypertrophic cardiomyopathy: is volume better than diameter?
European Heart Journal Supplements, 2021
Transvenous lead extraction (TLE) has become a pivotal part of a comprehensive lead management st... more Transvenous lead extraction (TLE) has become a pivotal part of a comprehensive lead management strategy, dealing with a continuously increasing demand. Nonetheless, literature about long-term outcomes and the impact of a new device implantation on survival is still lacking. Given these knowledge gaps, the aim of our study was to analyse reimplantation and both early and long-term mortality in patients undergoing TLE, even in a public health perspective, specifically clarifying concerns about reimplantation. This prospective, single-centre, observational, real-world registry consecutively enrolled patients (pts) with cardiac implantable electronic device who underwent TLE at our Hospital, from January 2005 to September 2020. The primary endpoint was to analyse major adverse cardiovascular events (MACEs) in both re-implanted (R Group) and non reimplanted (NR Group); secondary end-point was long-term (after discharge) mortality of the whole cohort, in order to investigate long-term mor...
Current Cardiovascular Risk Reports
JACC: Clinical Electrophysiology
The American journal of cardiology, 2017
&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;Early repolarization&amp;amp;amp;amp;amp;am... more &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;Early repolarization&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; (ER) is a frequent finding at standard electrocardiogram (ECG). In this study we assessed whether ER is associated with an increased risk of events, as recently suggested by some studies. We prospectively enrolled 4,176 consecutive subjects without any heart disease who underwent routine ECG recording. ER was diagnosed in case of typical concave ST-segment elevation ≥0.1 mV; a J wave was diagnosed when the QRS showed a notch or a slur in its terminal part. In this study we compared the 6-year outcome of all 687 subjects with ER/J wave and 687 matched subjects without ER/J wave (controls). Both groups included 335 males and 352 females, and age was 48.8 ± 18 years. Overall, 145 deaths occurred (11%), only 11 of which attributed to cardiac causes. No sudden death was reported. Cardiac deaths occurred in 5 (0.8%) and 6 (0.9%) ER/J wave subjects and controls, respectively (odds ratio [OR] 0.85, 95% confidence interval [CI] 0.26 to 2.80, p = 0.79). Both ER (OR 1.68, 95% CI 0.21 to 13.3, p = 0.62) and J wave (OR 0.91, 95% CI 0.28 to 3.00, p = 0.88) showed no association with cardiac death. Total mortality was 11.5% in the ER/J wave group and 10.6% in the control group (OR 1.10, 95% CI 0.78 to 1.56, p = 0.58). Both ER (OR 0.44, 95% CI 0.16 to 1.24, p = 0.12) and J wave (OR 1.20, 95% CI 0.85 to 1.70, p = 0.30) showed also no association with all-cause death. In subjects without any evidence of heart disease, we found no significant association of ER/J wave with the risk of cardiac, as well as all-cause, death at medium-term follow-up.
The American Journal of Cardiology
&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;Early repolarization&amp;amp;amp;amp;amp;am... more &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;Early repolarization&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; (ER) is a frequent finding at standard electrocardiogram (ECG). In this study we assessed whether ER is associated with an increased risk of events, as recently suggested by some studies. We prospectively enrolled 4,176 consecutive subjects without any heart disease who underwent routine ECG recording. ER was diagnosed in case of typical concave ST-segment elevation ≥0.1 mV; a J wave was diagnosed when the QRS showed a notch or a slur in its terminal part. In this study we compared the 6-year outcome of all 687 subjects with ER/J wave and 687 matched subjects without ER/J wave (controls). Both groups included 335 males and 352 females, and age was 48.8 ± 18 years. Overall, 145 deaths occurred (11%), only 11 of which attributed to cardiac causes. No sudden death was reported. Cardiac deaths occurred in 5 (0.8%) and 6 (0.9%) ER/J wave subjects and controls, respectively (odds ratio [OR] 0.85, 95% confidence interval [CI] 0.26 to 2.80, p = 0.79). Both ER (OR 1.68, 95% CI 0.21 to 13.3, p = 0.62) and J wave (OR 0.91, 95% CI 0.28 to 3.00, p = 0.88) showed no association with cardiac death. Total mortality was 11.5% in the ER/J wave group and 10.6% in the control group (OR 1.10, 95% CI 0.78 to 1.56, p = 0.58). Both ER (OR 0.44, 95% CI 0.16 to 1.24, p = 0.12) and J wave (OR 1.20, 95% CI 0.85 to 1.70, p = 0.30) showed also no association with all-cause death. In subjects without any evidence of heart disease, we found no significant association of ER/J wave with the risk of cardiac, as well as all-cause, death at medium-term follow-up.
Circulation, Jan 16, 2017
P revious studies of patients with primary stable microvascular angina showed excellent prognosis... more P revious studies of patients with primary stable microvascular angina showed excellent prognosis despite frequent recurrence of symptoms. 1,2 Recent large studies challenged this view, however, reporting a sizeable rate of major adverse cardiovascular events (MACE) in patients with stable angina and no obstructive coronary artery disease. 3,4 To get further insight into this clinical controversy, we performed longterm follow-up of a rather large population of patients with microvascular angina. We included in this study all patients with primary stable microvascular angina who participated in clinical investigations performed at our institute between 1991 and 2011. All patients had exercise-induced angina, positive exercise stress test, angiographically normal coronary arteries, and no other relevant cardiac or systemic disease. 5 In suspected cases, coronary spasm was excluded by ergonovine test. Patients were carefully characterized for cardiovascular risk factors and symptoms. All patients gave their informed consent to participate in the study, which was approved by our institutional review board. Follow-up was done by clinical visits or structured telephone interview. In the case of death, its cause was established from interview of patient's relatives and, when necessary, clinical records and death certificates. Clinical events included total, cardiovascular, and cardiac death, nonfatal acute myocardial infarction or unstable angina, coronary revascularization, other major cardiovascular events (stroke, transient ischemic attack, pulmonary embolism, etc), emergency room access, hospital admission, and repeat coronary angiography. Finally, patients were asked to report whether their symptoms improved, remained unchanged, or worsened over time. Data were also analyzed to identify predictors of the following clinical end points: (1) total mortality, (2) MACE (cardiovascular death, acute myocardial infarction, coronary revascularization), (3) emergency room access for angina, and (4) lack of symptom improvement. The association of variables with end points was tested by univariable and multivariable Cox regression analysis. Variables showing 2-sided P<0.1 at univariable analysis were included in multivariable models. Data were analyzed with SPSS 21.0 (SPSS Italia). The multivariable association of variables with end points is reported as hazard ratio (HR) with 95% confidence interval (CI). Basal clinical data of patients and follow-up results are summarized in the Table. The population included 250 patients. Vital state was ascertained for 240 patients (96%). At a median follow-up of 16.0 years (interquartile interval, 12-21), total, cardiovascular, and coronary mortality were 10.8%, 3.75%, and 0.83%, respectively (annual rates, 0.68%, 0.23%, and 0.05%, respectively). Among 207 patients with appropriate data, MACE occurred in 17.9% (1.12% per year). Sixty-five of these patients (31.4%) underwent ≥1 new coronary angiograms, and obstructive stenoses were found in 11 patients (5.3%) who underwent coronary revascularization (percutaneous in 9, surgical in 1, both in 1).
Atherosclerosis, Apr 1, 2015
Background: Smoking induces an impairment of endothelium-dependent vasodilatation. In this study ... more Background: Smoking induces an impairment of endothelium-dependent vasodilatation. In this study we assessed whether smoking also causes an impairment of endothelium-independent vasodilatation. Methods: We studied 2 groups of young healthy subjects: 1) 12 medical students (24.5 ± 0.9 years; 6 male) without cardiovascular risk factors (CVRFs), except smoking (≥10 cigarettes/day); 2) 12 matched controls (24.5 ± 1.1 years; 6 male) without any CVRF. Nitrate-mediated dilatation (NMD) of the brachial artery was assessed in response to the random administration of 4 different doses (10, 20, 30 and 40 μg) of sublingual nitroglycerin (NTG). Flow-mediated dilatation (FMD) was also assessed. Results: The increasing doses of NTG determined a progressive increase of NMD in both groups, but the dose-response curve was significantly lower in smokers compared to controls (p < 0.001). FMD was also lower in smokers, compared to controls (6.12 + 0.6 vs. 8.06 + 0.9%, p < 0.001). Conclusions: Our data show that smoking induces an early impairment of endothelium-independent arterial dilatation.
Atherosclerosis, 2015
Smoking induces an impairment of endothelium-dependent vasodilatation. In this study we assessed ... more Smoking induces an impairment of endothelium-dependent vasodilatation. In this study we assessed whether smoking also causes an impairment of endothelium-independent vasodilatation. We studied 2 groups of young healthy subjects: 1) 12 medical students (24.5 ± 0.9 years; 6 male) without cardiovascular risk factors (CVRFs), except smoking (≥10 cigarettes/day); 2) 12 matched controls (24.5 ± 1.1 years; 6 male) without any CVRF. Nitrate-mediated dilatation (NMD) of the brachial artery was assessed in response to the random administration of 4 different doses (10, 20, 30 and 40 μg) of sublingual nitroglycerin (NTG). Flow-mediated dilatation (FMD) was also assessed. The increasing doses of NTG determined a progressive increase of NMD in both groups, but the dose-response curve was significantly lower in smokers compared to controls (p < 0.001). FMD was also lower in smokers, compared to controls (6.12 + 0.6 vs. 8.06 + 0.9%, p < 0.001). Our data show that smoking induces an early imp...
Circulation, Nov 25, 2014
Quaderni D Italianistica, Oct 1, 1994
Piccola biblioteca 283 L'integrazione si manifesterà, 'divinamente,' alla fine del poema, anzi in... more Piccola biblioteca 283 L'integrazione si manifesterà, 'divinamente,' alla fine del poema, anzi in quel dopo poema che è il canto XX" (40).
Atherosclerosis, 2015
Smoking induces an impairment of endothelium-dependent vasodilatation. In this study we assessed ... more Smoking induces an impairment of endothelium-dependent vasodilatation. In this study we assessed whether smoking also causes an impairment of endothelium-independent vasodilatation. We studied 2 groups of young healthy subjects: 1) 12 medical students (24.5 ± 0.9 years; 6 male) without cardiovascular risk factors (CVRFs), except smoking (≥10 cigarettes/day); 2) 12 matched controls (24.5 ± 1.1 years; 6 male) without any CVRF. Nitrate-mediated dilatation (NMD) of the brachial artery was assessed in response to the random administration of 4 different doses (10, 20, 30 and 40 μg) of sublingual nitroglycerin (NTG). Flow-mediated dilatation (FMD) was also assessed. The increasing doses of NTG determined a progressive increase of NMD in both groups, but the dose-response curve was significantly lower in smokers compared to controls (p < 0.001). FMD was also lower in smokers, compared to controls (6.12 + 0.6 vs. 8.06 + 0.9%, p < 0.001). Our data show that smoking induces an early imp...
Circulation, Nov 25, 2014
Uploads
Papers by Francesco Spera