Publications by authors named "Rigatelli G"
Although anticoagulation remains the cornerstone treatment for patients with acute pulmonary embolism (PE), catheter-directed therapy (CDT) has generated great interest as an adjunctive option for those presenting with hemodynamic decompensation or high risk for deterioration and in whom systemic thrombolysis has failed or is contraindicated. However, randomized controlled data supporting the efficacy and safety of CDT in addition to antithrombotic therapy in patients with high-risk and intermediate- to high-risk PE compared with anticoagulation and systemic thrombolysis alone are lacking. This paucity of high-quality data hampers guideline recommendations regarding the optimal therapeutic approach in such patients with PE.
View Article and Find Full Text PDFCarina: A major determinant in the pathophysiology and treatment of coronary bifurcation lesions.
Catheter Cardiovasc Interv
December 2024
Article Synopsis
- Research over the past ten years has improved our understanding of coronary bifurcations, which are junctions in blood vessels that can be critical in heart conditions.
- The carina, or the central part of these bifurcations, influences important blood flow patterns and shear stress, which can affect the development of atherosclerosis.
- This review aims to summarize the current knowledge about the role of the carina in coronary bifurcations to help interventional cardiologists develop better treatment approaches.
Article Synopsis
- * The study included 226 patients with a mean age of 70.9 years, finding that DOAC treatment correlated with significantly lower all-cause and cardiovascular mortality compared to VKA treatment over a median follow-up of about 55 months.
- * VKA therapy was identified as an independent predictor of cardiovascular death, highlighting the advantages of using DOACs in patients with AF and coronary bifurcation lesions.
Although the entire vascular bed is constantly exposed to the same risk factors, atherosclerosis manifests a distinct intra-individual pattern in localization and progression within the arterial vascular bed. Despite shared risk factors, the development of atherosclerotic plaques is influenced by physical principles, anatomic variations, metabolic functions, and genetic pathways. Biomechanical factors, particularly wall shear stress (WSS), play a crucial role in atherosclerosis and both low and high WSS are associated with plaque progression and heightened vulnerability.
View Article and Find Full Text PDFArticle Synopsis
- The study of coronary artery disease (CAD) focuses on understanding how plaque forms and develops, which is critical for improving treatment methods.
- Current coronary angiography (CAG) has limitations as it can only provide static images of arterial blockages without revealing the underlying mechanisms or predicting disease progression.
- A modified CAG technique analyzes blood flow patterns using fluid mechanics principles, helping to identify various flow types and their relationship with arterial lesions, paving the way for better treatment options for CAD.
Article Synopsis
- This study investigates the impact of patent foramen ovale (PFO) on mortality and clinical deterioration risk in patients with intermediate-high-risk pulmonary embolism (PE), using data from the Italian Pulmonary Embolism Registry (IPER).
- Out of 450 PE patients analyzed, 15.1% were found to have PFO, which was linked to significantly higher death rates (29.4% vs. 3.1%) and clinical deterioration within 48 hours (38.2% vs. 3.6%).
- The presence of PFO was identified as a strong predictor for both 30-day mortality and increased risk of deterioration, with statistics showing a hazard ratio of
Backgrounds: Effectiveness of patent foramen ovale (PFO) closure on relief of migraine, is still unclear. We sought to analyse the long-term (>10 years) effects of interatrial septal shunt repair on disabling migraine performing a retrospective non-randomised study.
Methods: Clinical records of patients with disabling, medication-refractory migraine and PFO or significant ASD referred to our centre for closure from 2006 to 2018, were analysed.
Article Synopsis
- Side branch predilatation (SBPD) during coronary bifurcation interventions is discouraged by current guidelines, yet there is limited data on its long-term clinical outcomes.
- This study examined the long-term mortality outcomes for patients undergoing SBPD versus those who did not, using a large patient registry and careful statistical matching.
- Results showed that patients who underwent SBPD had higher all-cause and cardiovascular mortality rates compared to those who did not, indicating that while SBPD might improve angiographic results, it does not lead to better overall survival.
Article Synopsis
- - This study analyzed trends in venous thromboembolism (VTE) mortality across the 27 EU Member States from 2012 to 2020, focusing on differences based on sex and age.
- - A total of 96,037 deaths were identified, revealing a consistent decline in the age-adjusted mortality rate from 2.86 to 2.53 per 100,000 individuals during the study period, with no significant differences found between males and females.
- - While the overall mortality is decreasing, higher rates were noted in eastern European countries like Bulgaria and Lithuania, compared to lower rates in Mediterranean nations such as Italy and Spain, indicating ongoing disparities in VTE mortality across Europe.
Aims: Data regarding hypertrophic cardiomyopathy (HCM)-related mortality in United States young adults, defined as those aged between 25 and 44 years, are lacking. We sought to assess the trends in HCM-related mortality among US young adults between 1999 and 2019 and determine differences by sex, race, ethnicity, urbanization and census region.
Methods: Mortality data were retrieved by the Centers for Disease Control and Prevention (CDC) Wide-Ranging Online Data for Epidemiologic Research (WONDER) dataset from January 1999 to December 2019.
The ratio of tricuspid annular plane systolic excursion (TAPSE) to echocardiographically measured systolic pulmonary artery pressure (PASP) has been proposed as a surrogate of RV-arterial coupling. In this analysis, we assess the prognostic role of TAPSE/PASP for early clinical deterioration and short-term mortality in an often clinically challenging population of intermediate-high-risk patients with pulmonary embolism (PE). A post hoc analysis of intermediate-high-risk patients with PE enrolled in the Italian Pulmonary Embolism Registry (ClinicalTrials.
View Article and Find Full Text PDFThe prognostic value of exercise stress test after complex left main (LM) coronary artery bifurcation (LM) stenting has been poorly investigated. To partially fill this gap in knowledge, we retrospectively analyzed the procedural and medical data of consecutive patients referred to our center for complex LM bifurcation disease between January 2008 and May 2018 who were treated using either single- or dual-stenting techniques. The prognostic impact of an exercise stress test, performed 6 months after the coronary intervention, was evaluated in 502 patients (316 males, mean age 70.
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- - The study analyzed sudden cardiac deaths (SCDs) in individuals under 39 in Italy from 2013 to 2019 using WHO mortality data and ICD-10 codes.
- - Out of 314 total deaths due to SCD during this period, 70% were males, with age-adjusted mortality rates showing a slight increase that was not statistically significant.
- - The joinpoint regression analysis indicated a plateau in age-standardized SCD-related mortality rates across both genders, highlighting that SCD continues to be a public health concern in Italy.
Atrial septal defects (ASD) and Patent foramen ovale (PFO) represent the most common congenital heart diseases (CHD) adulthood. These two clinical entities, having different embryological origin, as well as clinical manifestations, clinical course and treatment must be carefully distinguished. Right heart failure and pulmonary hypertension are considered the major determinants of morbidity and mortality in ASD.
View Article and Find Full Text PDFResidence time in complex left main bifurcation disease after stenting.
Cardiovasc Revasc Med
April 2024
Article Synopsis
- The study examines the mean resident time (RT) after left main (LM) bifurcation stenting using patient-specific computational fluid dynamics (CFD) in 27 patients, highlighting the techniques used: provisional cross-over stenting, DK crush, and Nano-inverted T (NIT).
- Results show that the NIT technique yielded the lowest mean RT (0.33 seconds), while provisional stenting had the highest, revealing a significant difference in wall shear stress (WSS) across the techniques.
- The findings suggest that double-stenting approaches, particularly the NIT technique, result in better hemodynamic outcomes compared to provisional stenting in patients with complex LM bifurcation disease.