Publications by authors named "Marchionni N"
Background: Atrial fibrillation (AF) is the most common arrhythmia diagnosed at an older age. AF is associated with frailty, a condition possibly justifying the higher rate of complications and mortality in aged individuals. This study was aimed at describing the characteristics correlated to frailty in older AF subjects.
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- Septic embolization, a common complication of infective endocarditis (IE), can lead to serious issues like acute coronary syndrome, although it's rare and affects 22-50% of patients.
- This study analyzed 649 patients with left-sided IE from 2013 to 2023, focusing on coronary embolism (CE) through various diagnostic methods, with a median follow-up duration of 4.7 years.
- Results showed CE occurred in only 1.2% of patients, primarily treated surgically, and those with CE were more likely to have cerebral embolisms, highlighting the need for early detection and better management strategies in IE cases.
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- Recent heart failure (HF) guidelines emphasize early initiation and rapid adjustment of medical therapies for patients with reduced ejection fraction to lower the chances of rehospitalization and death.
- * For elderly patients, this intensive approach may not be practical due to frailty, multiple health issues, and risks of negative side effects, along with a lack of effective monitoring during treatment adjustments.
- * In patients with preserved ejection fraction, sodium-glucose cotransporter 2 inhibitors have shown benefits for reducing hospitalizations and cardiovascular deaths, but their effectiveness in certain heart conditions remains untested due to the absence of relevant clinical trials.
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- The study focuses on the impact of surgical aortic valve replacement (SAVR) on global longitudinal strain (GLS) in patients with severe aortic stenosis (AS) and preserved left ventricular ejection fraction (LVEF).
- It involved 108 patients who underwent echocardiography before surgery, a week after, and at twelve months post-surgery, with findings showing an initial decrease in GLS that later improved significantly, particularly in patients with mild diastolic dysfunction.
- The results indicate that while SAVR initially reduces GLS regardless of diastolic dysfunction severity, it ultimately leads to recovery of GLS over time, especially in those with grade I dysfunction.
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- Transthyretin cardiac amyloidosis (ATTR-CA) primarily impacts older adults with various chronic health issues, leading to significant physical and emotional difficulties.
- New drugs show promise in early treatment stages, prompting a need for thorough assessments of patients' functional abilities and quality of life.
- Incorporating comprehensive geriatric assessment tools into standard care can help identify early signs of frailty and improve management strategies for older ATTR-CA patients.
Gender difference in long-term effect of cardiac rehabilitation; data from CRAGE-extra study.
Int J Cardiol Cardiovasc Risk Prev
June 2024
Introduction: The positive effect of cardiac rehabilitation (CR) is demonstrated in younger and older patients. However, it is quite debated whether the beneficial effect is similarly maintained in both genders during follow-up.
Aim: to determine if the improvement obtained after CR remained significant at 1-year follow-up in older population, testing the influence of gender on this outcome.
Aortic stenosis (AS) represents a notable paradigm for cardiovascular (CV) and geriatric disorders owing to comorbidity. Transcatheter aortic valve replacement (TAVR) was initially considered a therapeutic strategy in elderly individuals deemed unsuitable for or at high risk of surgical valve replacement. The progressive improvement in TAVR technology has led to the need to refine older patients' stratification, progressively incorporating the concept of frailty and other geriatric vulnerabilities.
View Article and Find Full Text PDFObjective: To analyze the use of the Pressure Recording Analytical Method (PRAM), an hemodynamic monitoring system, in evaluating intraoperative and postoperative hemodynamic instability in patients undergoing endovascular repair for abdominal aortic aneurysm, and to evaluate if the decision to refer patients to a ordinary ward or to a Cardiac Step-Down Unit (CSDU) after the intervention on the basis of intraoperative hemodynamic monitoring could be more cost-effective.
Materials And Methods: After preoperative clinical evaluation, 44 patients were divided in this non-randomised study into two groups according to their postoperative destination: Group 1-ward (N=22) and Group 2-CSDU (N=22). All patients underwent monitoring with PRAM during the intervention and in the 24 postoperative hours, measuring several indices of myocardial contractility and other hemodynamic variables.
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- Intracoronary in-stent restenosis (ISR) often happens 3 to 6 months after stent placement; while drug-eluting stents have reduced ISR, cases still occur.
- An 81-year-old woman with a history of multiple heart procedures experienced reiterant ISR, leading researchers to focus on intra-stent factors after excluding others.
- A diagnosis of potential coronary vasculitis was proposed, possibly triggered by the stent, and the patient's ISR did not recur after starting steroid treatment, highlighting the importance of considering biological causes for effective management.
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- Diabetes Mellitus (DM) patients have a higher risk of severe outcomes from COVID-19, and the role of metformin in reducing mortality has been debated in various studies.
- A retrospective study analyzed COVID-19 positive patients with DM in two Italian hospitals, focusing on the effect of metformin on in-hospital mortality while accounting for other risk factors using the COVID-19 Mortality Risk Score (MRS).
- Results indicated that while initial findings suggested a reduction in mortality associated with metformin, this significance disappeared after adjusting for confounding factors, highlighting the importance of using validated risk assessment tools in future research.
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- - The study explores the relationship between frailty and health status in older patients with transthyretin cardiac amyloidosis (ATTR-CA), utilizing the Kansas City Cardiomyopathy Questionnaire (KCCQ) for health assessment.
- - Out of 168 patients screened, 138 were enrolled, revealing that 14.5% were frail and the median health status score was 66.
- - Results indicated that factors like age and frailty level significantly impacted health status, suggesting future research could further clarify how frailty affects quality of life and prognosis in these patients.
Background: Anisakis infects humans by consuming contaminated undercooked or raw fish, leading to gastric anisakiasis, gastro-allergic anisakiasis, or asymptomatic contamination. Although larvae usually die when penetrating the gastric tissue, cases of intra- and extra-abdominal spread were described. We report the first probable case of pericardial anisakiasis.
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- A study was conducted using a large administrative database from Italy to assess the effects of oral anticoagulant treatment on patients with non-valvular atrial fibrillation, revealing only 61.1% of patients received appropriate anticoagulants while a significant number were under-treated.
- When analyzing outcomes over approximately 2.9 years, vitamin-K antagonists (VKAs) showed slightly better results in preventing ischemic strokes compared to direct oral anticoagulants (DOACs), although this difference varied based on specific patient treatments.
- The research emphasized that despite better clinical outcomes with DOACs, a large percentage of patients remain inadequately treated, highlighting the necessity for educational initiatives to ensure proper anticoagulant use.
Background: Infective endocarditis (IE) is a severe disease associated with high morbidity and mortality. Little is known about the best management of elderly patients with IE. In these patients, surgery may be challenging.
View Article and Find Full Text PDFBackground: Atrial fibrillation (AF) is associated with chronic inflammation, a hallmark of ageing process. The aim of this study was to determine interleukin-6 (IL-6)-associated variables, also exploring acylcarnitines, expression of mitochondrial abnormalities.
Methods: We evaluated 22 controls and 50 patients with persistent AF.
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- Older patients often have renal impairment, which can affect outcomes post-cardiac surgery, but its importance isn't fully considered in current surgical risk assessments.
- This study looked at how different formulas for estimating kidney function (eGFR) can predict worsening renal function (WRF) in patients aged 75 and older undergoing elective cardiac surgery.
- Findings showed that a combination of previous health issues, physical performance, and eGFR effectively predict WRF, suggesting that enhancing risk scores with these factors could improve outcomes for older surgical patients.*
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- The study investigates the effectiveness of surgical intervention for patients with left-sided infective endocarditis (IE) who have intermediate-length vegetations (10-15 mm), where current guidelines do not specify surgical necessity.
- Researchers analyzed data from 638 patients over a decade, comparing outcomes between those treated with surgery and those treated medically, particularly focusing on survival rates.
- Results showed that patients with uncomplicated IE who underwent surgery had significantly better 5-year survival rates compared to those who were treated medically, indicating that surgical treatment may be beneficial even without specific guideline indications.
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- * Results indicated that 10% of patients were frail and nearly half (46%) exhibited depressive symptoms, both of which were linked to poorer perceptions of social support and increased conflict with caregivers.
- * The findings suggest that tertiary care clinics should enhance support for patient-caregiver relationships to ultimately improve the patients' quality of life.
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- The aging population is increasingly living with chronic diseases, leading to higher rates of frailty, which is linked to more health complications and greater healthcare resource use.
- Frailty poses significant challenges in medical care, necessitating early detection and treatment to avoid further functional decline and increased mortality.
- The EHRA consensus document addresses the specific needs of elderly and frail patients regarding cardiac arrhythmias, providing insights on assessment and management while highlighting gaps in research and knowledge in this area.
Introduction: Patients with hypertrophic cardiomyopathy (HCM) are at increased risk of stroke, but the incidence and factors associated with cardioembolic events in HCM patients without atrial fibrillation (AF) remain unresolved. We determined the incidence of stroke in patients in sinus rhythm (SR) monitored with a cardiac implantable electronic device (CIED).
Methods: All consecutive patients diagnosed with HCM and referred to CIED implantation with >16 years at diagnosis and ≥ 1 year follow-up post CIED implantation were retrospectively reviewed.
Cardiac rehabilitation (CR) improves clinical and functional recovery in older patients after acute cardiac syndromes, whose outcome is influenced by cardiac disease severity, but also by comorbidity and frailty. The aim of the study was to analyze the predictors of physical frailty improvement during the CR program. Data were collected in all patients aged > 75 years consecutively admitted from 1 January to December 2017 to our CR, consisting of 5-day-per-week of 30-min session of biking or calisthenics on alternate days for 4 weeks.
View Article and Find Full Text PDFHigh platelet reactivity (HPR) on clopidogrel is an established thrombotic risk factor after percutaneous coronary intervention (PCI). The introduction of more potent antiplatelet drugs has partially surpassed this issue. However, in the setting of concomitant atrial fibrillation (AF) and PCI clopidogrel is still the most adopted P2Y inhibitor.
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