Occhi Dott.ssa Lucia
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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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Intermediate-high-risk pulmonary embolism treated with local ultrasound-facilitated thrombolysis: a single-center experience.
J Cardiovasc Med (Hagerstown)2022 May;23(5):347-349. doi: 10.2459/JCM.0000000000001295.
Sacco Alice, Serafini Lisa, Occhi Lucia, Morici Nuccia, Rampoldi Antonio
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Determinants of Functional Improvement After Cardiac Rehabilitation in Acute Coronary Syndrome.
High Blood Press Cardiovasc Prev2021 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 Hypertens2022 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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Ankle-Brachial Index Is a Predictor of In-Hospital Functional Status but Not of Complications in Hospitalized Elderly Patients.
Gerontology2021 ;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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Hyperuricemia prevalence in healthy subjects and its relationship with cardiovascular target organ damage.
Nutr Metab Cardiovasc Dis2021 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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Thoracic radiotherapy as a risk factor for heart ischemia in subjects treated with chest irradiation and chemotherapy and without classic cardiovascular RISK factors.
Radiother Oncol2020 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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[Clinical and diagnostic key points of left ventricular hypertrophy in adults: insights from the ANMCO Lombardy experience].
G Ital Cardiol (Rome)2020 Jun;21(6):447-456. doi: 10.1714/3359.33329.
Iacovoni Attilio, De Chiara Benedetta, Sormani Paola, Campana Marco, Agostini Francesco, Faggiano Pompilio, Occhi Lucia, Dadone Viola, Raineri Claudia, Moreo Antonella, Di Tano Giuseppe,
Abstract
Left ventricular hypertrophy is a common complication of different diseases. Among these, cardiac involvement of amyloidosis or Anderson-Fabry disease are often unrecognized. Early diagnosis is therefore crucial because new therapies can impact the progression of these diseases. Different specific signs unmasked by clinical, laboratory, and non-invasive diagnostic tests such as echocardiography or cardiac magnetic resonance could guide clinicians towards an appropriate diagnosis. The aim of this review is to underline the major diagnostic clues of different forms of left ventricular hypertrophy in adult patients, guiding clinicians towards a more appropriate diagnosis.
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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 Press2020 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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Assessment of right ventricular function in advanced heart failure with nonischemic dilated cardiomyopathy: insights of right ventricular elastance.
J Cardiovasc Med (Hagerstown)2020 Feb;21(2):134-143. doi: 10.2459/JCM.0000000000000921.
Bianco Francesco, Bucciarelli Valentina, Ammirati Enrico, Occhi Lucia, Musca Francesco, Tonti Giovanni, Frigerio Maria, Gallina Sabina
Abstract
BACKGROUND:
The right ventriculoarterial coupling (R-V/A), a measure of right ventricular systolic dysfunction (RVSD) adaptation/maladaptation to chronic overload, and consequent pulmonary hypertension, has been little investigated in nonischemic dilated cardiomyopathy (NIDCM). We examined the correlates of R-V/A and traditional echocardiographic indices of RVSD, over the spectrum of pulmonary hypertension and tertiles of mean pulmonary artery pressures (PAPm).
METHODS:
In 2016-2017, we studied 81 consecutive patients for heart transplant/advanced heart failure. Inclusion criteria were NIDCM, reduced ejection fraction (?40%) and sinus rhythm. R-V/A was computed as the RV/pulmonary elastances ratio (R-Elv/P-Ea), derived from a combined right heart catheterization/transthoracic- echocardiographic assessment [right heart catheterization/transthoracic-echocardiographic (RHC/TTE)].
RESULTS:
A total of 68 patients (mean age 64?±?7 years, 82% men) were eligible. After adjustments, R-Elv and P-Ea were higher in isolated postcapillary-pulmonary hypertension (Ipc-PH) than combined-pulmonary hypertension (Cpc-PH) (P?=?0.004 and P?=?0.002, respectively), whereas R-V/A progressively decreased over Ipc-PH and Cpc-PH (P?=?0.006). According to PAPm increment, P-Ea congruently increased (P-Trend?=?0.028), R-Elv progressively decreased (P-Trend
CONCLUSION:
Among NIDCM HF patients, in a small cohort study, RHC/TTE-derived R-V/A assessment demonstrated good correlations with pulmonary hypertension types and RV functional status. These data suggest that R-V/A encloses comprehensive information of the whole cardiopulmonary efficiency, better clarifying the amount of RVSD, with good reliability.
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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 Imaging2019 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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Vascular Aging and Disease of the Large Vessels: Role of Inflammation.
High Blood Press Cardiovasc Prev2019 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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A New Life: Motherhood After Heart Transplantation. A Single-center Experience and Review of Literature.
Transplantation2018 Sep;102(9):1538-1544. doi: 10.1097/TP.0000000000002281.
Macera Francesca, Occhi Lucia, Masciocco Gabriella, Varrenti Marisa, Frigerio Maria
Abstract
BACKGROUND:
Pregnancy after heart transplantation (HTx) may expose the recipient to hemodynamic and immunologic risks and the newborn to toxic effects of immunosuppressive therapy. Adequate preconception counseling is crucial to identify optimal timing and to modify immunosuppressive therapy to minimize risks for both the mother and the fetus.
METHODS:
We describe our experience with 12 pregnancies occurred in 11 women who had undergone HTx at our center.
RESULTS:
Pregnancies ran without severe complications or rejections, and none of the babies have shown major defects at birth. However, as reported in the literature, weight at birth rated in lower range in most of the newborns, probably due to in utero cyclosporine exposure. Up to now, none of the babies showed clinical signs of heart disease, although more than half of the mothers had an inherited or familial cardiomyopathy.
CONCLUSIONS:
Despite potential mother and fetal complications, successful pregnancy and delivery are possible after HTx, provided that optimum timing, close monitoring, and therapy adjustments are guaranteed. Becoming a mother appears to be an important achievement for young women after HTx, even when there is a risk to transmit an inheritable heart disease.
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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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