Publications by authors named "Natale Daniele Brunetti"

Background: It is crucial to distinguish type-1 myocardial infarction (T1MI) from type-2 myocardial infarction (T2MI) at admission and during hospitalization to avoid unnecessary invasive exams and inappropriate admissions to the acute cardiac care unit.

Objectives: The purpose of the study was to define a simple profile derived from commonly used biomarkers to differentiate T1MI from T2MI.

Methods: We prospectively enrolled in an observational study 213 iconsecutive patients with a provisional diagnosis of non-ST-elevation acute myocardial infarction (NSTEMI) admitted to the Cardiology Department.

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Background: Sacubitril/valsartan (S/V) is a cornerstone treatment for heart failure (HF). Beneficial effects on hospitalization rates, mortality, and left ventricular remodeling have been observed in patients with heart failure and reduced ejection fraction (HFrEF). Despite the positive results, the influence of S/V on renal function during long-term follow-up has received little attention.

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Article Synopsis
  • - Telecardiology effectively enables ECG screening for large groups, successfully evaluating non-competitive athletes (NCA) across Italy over a four-year study period.
  • - In a sample of 216,424 NCA, 88 individuals (4.1 per 10,000) were identified with Wolff-Parkinson-White (WPW) syndrome, primarily in the 10-15 year age group, with no significant sex differences noted.
  • - The study revealed that the most common accessory pathways for WPW syndrome were in the right antero-septal, mid-septal, and postero-septal areas, with 9% of those diagnosed exhibiting intermittent pre-excitation.
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Background: Extensive myocardial edema is a key feature of acute takotsubo syndrome (TTS) and it can be quantitatively assessed by T2 mapping cardiac magnetic resonance (CMR) imaging. Clinical correlates of myocardial edema in TTS are not well characterized.

Methods: Sixty patients with acute TTS underwent CMR with T2 mapping within one week of hospitalization.

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Cancer is a remarkable prothrombotic disease, and cancer-associated thrombosis acts as a dreadful omen for poor prognosis. The cornerstone of venous thromboembolism therapy is anticoagulation; however, in patients with venous thromboembolism who are not suitable for anticoagulation (contraindication, failure, or complication), the inferior vena cava filter appears a valuable option in the therapeutic arsenal. The recently heightened trend of steady rise in filter placement mirrors the spread of retrievable devices, together with improvements in physicians' insertion ability, medico-legal issue, and novel and fewer thrombogenic materials.

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Background: Few data are available on long-term drug therapy and its potential prognostic impact after Takotsubo syndrome (TTS). Aim of the study is to evaluate clinical characteristics and long-term outcome of TTS patients on Renin Angiotensin system inhibitors (RASi).

Methods: TTS patients were enrolled in the international multicenter GEIST (GErman Italian Spanish Takotsubo) registry.

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Background: Cardiac remodeling is an adverse phenomenon linked to heart failure (HF) progression. Cardiac remodeling could represent the real therapeutic goal in the treatment of patients with HF and reduced ejection fraction (HFrEF), being potentially reversed through different pharmacotherapies. Currently, there are well-established drugs such as ACEi/ARBs and β-blockers with anti-remodeling effects.

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  • Frailty in older patients (over 75) with non-ST elevation acute myocardial infarction (NSTEMI) is linked to worse clinical outcomes and lower rates of undergoing percutaneous coronary intervention (PCI).
  • The study followed 141 older patients with NSTEMI, finding that those with frailty had significantly higher mortality rates after 30 days and 6 months compared to those without frailty, regardless of whether they received PCI.
  • Despite frailty being associated with a higher risk of death, receiving PCI positively influenced long-term survival rates, suggesting careful patient selection for revascularization could improve outcomes in this population.
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In recent years, the use of cardiac magnetic resonance (CMR) has grown exponentially in clinical practice. The keys for this success are represented by the possibility of tissue characterization, cardiac volumes and myocardial perfusion assessment, biventricular function evaluation, with no use of ionizing radiations and with an extremely interesting profile of reproducibility. The use of late gadolinium enhancement (LGE) nearly compares a non-invasive biopsy for cardiac fibrosis quantification.

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Mitral valve prolapse is a common valve disorder that usually has a benign prognosis unless there is significant regurgitation or LV impairment. However, a subset of patients are at an increased risk of ventricular arrhythmias and sudden cardiac death, which has led to the recognition of "arrhythmic mitral valve prolapse" as a clinical entity. Emerging risk factors include mitral annular disjunction and myocardial fibrosis.

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For a long time, the study of heart failure focused on single heart chamber disease. There is, instead, growing attention on the interplay between the atria and the ventricles during the cardiac cycle and on the consequences of an altered chamber coupling on global heart performance and heart failure. This review aimed to explore the principles of atrioventricular (AV) function and coupling of the left heart and the consequences that their disruption could have in several diseases.

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Background: Brugada syndrome (BrS) is an inherited primary channelopathy syndrome associated with the risk of ventricular fibrillation (VF) and sudden cardiac death in a structurally normal heart.

Aim Of The Study: The aim of this study was to clinically and genetically evaluate a large family with severe autosomal dominant Brugada syndrome.

Methods: Clinical and genetic studies were performed.

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In recent decades, there has been considerable effort in investigating the clinical utility of renal Doppler measurements in both cardiovascular and renal disorders. In particular, a measure of renal arterial resistance, the renal resistive index (RRI), has been demonstrated to predict chronic kidney disease progression and acute kidney injury in different clinical settings. Furthermore, it is linked to a poorer prognosis in individuals suffering from chronic heart failure.

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Impaired pulmonary circulation hemodynamics are characteristic of pulmonary hypertension (PH). We therefore sought to evaluate possible correlations between endothelial function noninvasively assessed by brachial artery flow-mediated dilation (FMD) and hemodynamic parameters at right-sided cardiac catheterization in patients with clinically suspected PH. Consecutive outpatients with suspected PH were enrolled in the study.

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Article Synopsis
  • Oral anticoagulant therapy for atrial fibrillation includes traditional vitamin K antagonists like warfarin and newer direct-acting oral anticoagulants (DOACs) such as dabigatran and rivaroxaban, with DOACs being preferred due to lower bleeding risks.
  • Anticoagulant switching from warfarin to DOACs is a common practice, but understanding the implications of this switch, especially for patients with both atrial fibrillation and heart failure, remains crucial.
  • A machine learning analysis was conducted to examine the effects of switching from warfarin to DOACs in heart failure patients with atrial fibrillation, highlighting the positive impacts of DOACs beyond just preventing blood clots
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Background: Systemic Sclerosis (SSc), an intricate autoimmune disease causing tissue fibrosis, introduces cardiovascular complexities, notably pulmonary hypertension (PH), affecting both survival and quality of life. This study centers on evaluating echocardiographic parameters and endothelial function using flow-mediated dilatation (FMD) in SSc patients, aiming to differentiate those with and without pulmonary arterial hypertension (PAH). The emphasis lies in early detection, given the heightened vulnerability of the right ventricle (RV) in the presence of PH.

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Left ventricular noncompaction (LVNC) is commonly described as a congenital cardiomyopathy characterized by prominent myocardial trabeculae and deep intertrabecular recesses extending in the left ventricular chamber. Clinical presentation can differ considerably from asymptomatic individuals to those presenting with heart failure and other serious complications. Diagnosis is usually made by two-dimensional transthoracic echocardiography or cardiac magnetic resonance.

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  • This study examines the impact of starting PCSK9 inhibitors (PCSK9i) at the time of hospitalization for acute coronary syndrome (ACS) on lipid levels and cardiovascular (CV) events in a real-world setting.
  • It analyzed data from 771 ACS patients, revealing that a significant 68.3% achieved the target LDL-C of < 55 mg/dL within a median of 37 days after hospitalization.
  • Results showed that lower LDL-C levels were associated with reduced risks of major cardiovascular events, suggesting that early and aggressive lipid management with PCSK9i is both safe and beneficial for ACS patients.
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Background: Recently, abnormal thyroid function was shown to be common in patients with Takotsubo syndrome (TTS), being classified into "endocrine-type" and "stress-type" responses. The aim of this study was to investigate the association between thyroid homeostasis and TTS in a larger international registry.

Methods: In total 288 patients with TTS were enrolled through the GEIST multicentre registry from Germany, Italy and Spain.

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  • Mutations in the dystrophin gene are linked to skeletal muscle diseases, including Duchenne and Becker Muscular Dystrophy and X-linked dilated cardiomyopathy (DCM).
  • A 37-year-old woman diagnosed with DCM had a specific mutation (p.Asp3368Gly) identified through whole exome sequencing, which was found to have a potentially harmful impact on the protein's function.
  • Genetic testing revealed the mutation occurred de novo, with her 8-year-old son also carrying the same variant, enabling early diagnosis of a related skeletal muscle condition despite him showing no significant symptoms.
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