Papers by Cesare de Gregorio
Journal of Anesthesia, Analgesia and Critical Care, 2021
Severe acute respiratory syndrome coronavirus type 2 has been responsible for an unprecedented pa... more Severe acute respiratory syndrome coronavirus type 2 has been responsible for an unprecedented pandemic, and nowadays, several vaccines proved to be effective and safe, representing the only available strategy to stop the pandemic. While millions of people have safely received vaccine, rare and unusual thrombotic events have been reported and are undergoing investigations to elucidate their nature. Understanding initial trigger, underlying pathophysiology and the reasons for specific site localization of thrombotic events are a matter of debate.We here propose that rare cases of cerebral venous sinus thrombosis, a clinical event that may rapidly evolve to brain death, reported after COVID-19 vaccine, might be consequent to an immune response resulting in inflamed/damaged endothelium, an event similar to that described for cases of cerebral venous sinus thrombosis reported during COVID-19 and not necessarily related to anti-Platelets Factor 4 antibodies, as recently described. Remark...
Journal of Cardiovascular Development and Disease
Background: Left atrial (LA) function is crucial for assessing left ventricular filling in variou... more Background: Left atrial (LA) function is crucial for assessing left ventricular filling in various cardiovascular conditions. Cardiac Amyloidosis (CA) is characterized by atrial myopathy and LA function impairment, with diastolic dysfunction up to restrictive filling pattern, leading to progressive heart failure and arrhythmias. This study evaluates LA function and deformation using speckle tracking echocardiography (STE) in patients with CA compared to a cohort of patients with sarcomeric Hypertrophic Cardiomyopathy (HCM) and a control group. Methods: We conducted a retrospective, observational study (from January 2019 to December 2022) including a total of 100 patients: 33 with ATTR-CA, 34 with HCMs, and 33 controls. Clinical evaluation, electrocardiograms, and transthoracic echocardiography were performed. Echocardiogram images were analyzed in post-processing using EchoPac software for LA strain quantification, including LA-reservoir, LA-conduit, and LA-contraction strain. Resul...
La funzione ventricolare sinistra nel paziente con scompenso cardiaco cronico. Spunti di riflessione sulla tempistica e sulla refertazione minima essenziale nell’ambulatorio di ecocardiografia del territorio
Giornale Italiano Di Cardiologia, May 1, 2011
Journal of Cardiovascular Development and Disease
Background: The detection of subclinical/silent atrial fibrillation (SAF) in the general populati... more Background: The detection of subclinical/silent atrial fibrillation (SAF) in the general population is of the utmost importance, given its potential adverse consequences. Incident AF has been observed in 30% to 70% of patients with implanted devices, but its prevalence may indeed be lower in the general population. The prospective, multicentric, observational Silent Atrial Fibrillation ANCE Research Initiative (SAFARI) study aimed at assessing the SAF prevalence in a real-world outpatient setting by the means of a small, wearable, prolonged ECG Holter monitoring (>5 days) device (CGM HI 3-Lead ECG; CGM TELEMEDICINE, Piacenza, Italy). Methods: Patients ≥ 55 years of age at risk for AF were screened according to the inclusion criteria to undergo prolonged 3-lead ECG Holter monitoring. SAF episodes were classified as follows: Class A, <30 s; Class B, 30 to 299 s; and Class C, ≥300 s. Results: In total, 119 patients were enrolled (64 men; median age 71 (IQR 55–85) years). At a med...
Effects of COVID-19 Infection and Vaccination on the Female Reproductive System: A Narrative Review
Balkan Medical Journal
Kounis syndrome in a patient with multivessel coronary artery disease and DRESS
Clinical Case Reports
European Heart Journal Supplements, Dec 14, 2022
In all cases viral genome (DNA and RNA virus) was absent. A total of 106 heart specimens with a d... more In all cases viral genome (DNA and RNA virus) was absent. A total of 106 heart specimens with a diagnosis of ACM were enrolled, including 73 juvenile SCD (49 M, mean age 26 years) and 33 HTx (18 M, mean age 45 years). Inflammation was reported in 95% of SCD an d 67% of HTx. The inflammatory infiltrate was focal or multifocal in all, except one case of juvenile SCD with diffuse myocarditis in the postero-lateral wall of the left ventricle. In the 24 reviewed cases, the inflammation was focal with a mean inflammatory score of 1.75 ±0.9 in the HTx group and 1.5±0.9 in the SD group (p = NS). By IHC we showed that: a) there is no significant difference in the inflammatory score between SD and HTx; b) the inflammation is mostly near-scarring (13 cases); c) inflammatory cells consist prevalently of cytotoxic T lymphocytes CD3+CD8+ (with CD4 +<CD8+ both in SD and HTx, p < 0.05).
Reviews in Cardiovascular Medicine
TakoTsubo Syndrome (TTS) is a stress-induced cardiac disease characterized by temporary and segme... more TakoTsubo Syndrome (TTS) is a stress-induced cardiac disease characterized by temporary and segmental left ventricle dysfunction, typically involving the apex. Post-menopause women are more frequently affected. ECG and clinical features at presentation may be similar to those observed in acute coronary syndrome (ACS). However underlying pathomechanisms are completely different and, for what concerns TTS, extremely debated and not yet completely understood. Some hypotheses have been proposed during years, mostly regarding catecholamine-induced cardiotoxicity and microvascular dysfunction, usually following a trigger event which may be either "emotional" (primary TTS) or "physical" (secondary TTS). Additional modulators like neuroendocrine disorders (particularly hypothalamic-pituitary-adrenal axis dysfunction and estrogen drop in menopause) may play a crucial role in TTS onset. Despite being originally considered more benign than ACS, several studies have enlightened that TTS and STEMI are burdened by the same inhospital mortality and complications. However, TTS and ACS complications somehow differ for what concerns incidence, the underlying mechanisms, and both long-and short-term outcomes. Full recovery in TTS requires weeks to months and cases of recurrences have been described, but no single clinical feature seems to predict subsequent episodes so far. By now, apart from inhibitors of the Renin-Angiotensin-Aldosterone System (RAASi), no drug has proved to be effective either in the acute or chronic phase in reducing mortality, improving outcome, or preventing recurrences.
Physical Training and Cardiac Rehabilitation in Heart Failure Patients
Advances in Experimental Medicine and Biology, 2018
Regardless of advances in medical and interventional treatment of cardiovascular disease (CVD), a... more Regardless of advances in medical and interventional treatment of cardiovascular disease (CVD), a limited number of patients attend a cardiac rehabilitation (CR) programme on a regular basis. Due to modern therapies more individuals will be surviving an acute cardiovascular event, but the expected burden of chronic heart failure will be increasing worldwide.
Percorso Diagnostico-Terapeutico-Assistenziale nello Scompenso Cardiaco nella Provincia di Messina (2015)
Blunt thoracic trauma and cardiac injury in the athlete: contemporary management
The Journal of Sports Medicine and Physical Fitness, 2018
Commotio cordis and cardiac injuries are rare events usually following a chest blunt traumas duri... more Commotio cordis and cardiac injuries are rare events usually following a chest blunt traumas during sports activities. Various etiologies have been identified to cause electrical (commotio cordis) and/or structural (contusion and further injuries) damage, but high-velocity tools such as baseballs or hockey pucks (also called projectiles) have been chiefly identified. Clinical consequences are challenging, varying from uncomplicated supraventricular arrhythmias to cardiac wall rupture. Ventricular fibrillation is the most remarkable outcome leading to cardiac arrest in some individuals. In this article, up-to-date epidemiological and pathophysiological issues are discussed, along with the most suitable assistance protocols of the injured athlete in the sports arena. Current knowledge about traumatic sports injuries and ensuing cardiovascular sequelae made significant steps forwards than in the past. The majority of athletes (especially the youngest ones) wearing chest protectors are usually preserved from serious outcomes and sudden cardiac death, but further technical effort is encouraged to attain more satisfactory barriers against projectile's impact. Educational campaigns among students, closer team surveillance, implementation of the sports arenas with adequate rescue devices and medical assistance remain mandatory items in contact sports activity.
European Journal of Clinical Pharmacology, 2021
Purpose Only a few studies are available on dose-related effects of sacubitril/valsartan (angiote... more Purpose Only a few studies are available on dose-related effects of sacubitril/valsartan (angiotensin receptor neprilysin inhibition (ARNI)) in real-life patients with heart failure and reduced ejection fraction (HFrEF). We sought to investigate clinical and functional effects in real-life HFrEF patients receiving ARNI at a different cumulative dose. Methods This was an observational study in consecutive outpatients admitted for HFrEF from October 2017 to June 2019. The PARADIGM criteria were needed for enrolment. ARNI was uptitrated according to blood pressure, drug tolerability, renal function and kaliemia. At least 10-month follow-up was required in each patient. Clinical assessment, Kansas City Cardiomyopathy Questionnaire (KCCQ) score, 6-min walk test and strain echocardiography were performed in each patient on a regular basis during the observational period. At the end of the study, patients were divided into two groups based on the median yearly dose of the ARNI medication. Results A total of 90 patients, 64 ± 11 years, 82% males, were enrolled. The cutoff dose was established in 75 mg BID, and the study population was divided into group A (≤ 75 mg), 52 patients (58%), and group B (> 75 mg), 38 patients (42%). The follow-up duration was 12 months (range 11-13). NYHA class, KCCQ score and 6MWT performance ameliorated in both groups, with a quicker time to benefit in group B. The proportion of patients walking > 350 m increased from 21 to 58% in group A (p < 0.001), and from 29 to 82% in group B (p < 0.001). A positive effect was also disclosed in the left ventricular remodelling, strain deformation and diastolic function. Conclusion One-year ARNI treatment was effective in our real-life HFrEF patient population, leading to clinical and functional improvement in both study groups, slightly greater and with a shorter time to benefit in group B.
European Journal of Preventive Cardiology, 2020
Journal of Cardiovascular Medicine, 2020
Nutrients, 2017
Genistein, a soy-derived isoflavone, may improve cardiovascular risk profile in postmenopausal wo... more Genistein, a soy-derived isoflavone, may improve cardiovascular risk profile in postmenopausal women with metabolic syndrome (MetS), but few literature data on its cardiac effects in humans are available. The aim of this sub-study of a randomized double-blind case-control study was to analyze the effect on cardiac function of one-year genistein dietary supplementation in 22 post-menopausal patients with MetS. Participants received 54 mg/day of genistein (n = 11) or placebo (n = 11) in combination with a Mediterranean-style diet and regular exercise. Left ventricular (LV) systolic function was assessed as the primary endpoint, according to conventional and strain-echocardiography measurements. Also, left atrial (LA) morphofunctional indices were investigated at baseline and at the final visit. Results were expressed as median with interquartile range (IQ). A significant improvement of LV ejection fraction (20.3 (IQ 12.5) vs. −1.67 (IQ 24.8); p = 0.040)), and LA area fractional change (11.1 (IQ 22.6) vs. 2.8 (9.5); p = 0.034)) were observed in genistein patients compared to the controls, following 12 months of treatment. In addition, body surface area indexed LA systolic volume and peak LA longitudinal strain significantly changed from basal to the end of the study in genistein-treated patients. One-year supplementation with 54 mg/day of pure genistein improved both LV ejection fraction and LA remodeling and function in postmenopausal women with MetS.
Journal of Clinical & Experimental Cardiology, 2016
Modern ultrasound technology allows investigating both atrial and ventricular morphofunctional ab... more Modern ultrasound technology allows investigating both atrial and ventricular morphofunctional abnormalities. This article deals with the rising evidence for strain echocardiography to be a promising tool for preclinical assessment of left atrial chamber impairment and disease staging in several clinical settings.
International Journal of Cardiology, 2016
Comment on: “One-year GH replacement therapy reduces early cardiac target organ damage (TOD) in adult GHD patients” by Boschetti et al
Endocrine, 2016
Dear Editor, We read with great interest the recent article by Boschetti et al. entitled “One-yea... more Dear Editor, We read with great interest the recent article by Boschetti et al. entitled “One-year GH replacement therapy reduces early cardiac target organ damage (TOD) in adult GHD patients” published in Endocrine [1]. This study hypothesized that coronary microcirculation (coronary blood flow reserve, CFR) and left ventricular (LV) diastolic dysfunction (mitral E/A ratio), early markers of cardiovascular (CV) disease, could be improved by early start of GH replacement therapy (GHRT). The authors demonstrated this assumption in 14 adult-onset GHD patients with no previous cardiac disease or CV risk factors over a period of 12 months. GHRT significantly improved both these markers, as well as decreasing resting blood pressure and LDLcholesterol levels, mildly higher at baseline in patients than in controls. There are no data from randomized controlled trials in adult GHD patients regarding benefits of GH replacement on CV morbidity and mortality. Over the last few years, clinical studies showed positive effects of prolonged (extended) GHRT on the CV risk profile in the majority of GHD patients, but some aspects still need to be elucidated. We recently demonstrated that conventional risk factors play a similar prognostic role as in the general population, and they must be fully considered while managing GHD patients. Hypertension and age, and to a lesser extent also LDL-cholesterol, were major determinants of composite CV events (chiefly nonfatal) in 53 non-diabetic adult GHD patients followed up to 12 years [2]. Based on our studies, simplistic models aimed at establishing the CV risk in this clinical setting usually lead to equivocal conclusions, especially in predicting a true CV mortality rate. This is likely due to the unpredictable combination of several cofactors, among which LV hypertrophy, which has been substantiated in our series [2, 3], although not considered by Boschetti et al. in their study. In this regard, LV diastolic dysfunction may also depend on LV geometric remodeling and it should not be identified by the mitral E/A ratio alone, which has unfortunately been demonstrated as a misleading marker. On the contrary, we appreciated the study protocol through which the authors evaluated CFR in their 14 patients, demonstrating a blunted pattern in approximately 28 % of them, with significant improvement after GHRT. However, CFR depends on either microcirculatory impairment and/or epicardial coronary artery stenosis. These two conditions are pathophysiologically different, being the first one caused by a lacking capillary recruitment, as in patients with diabetes, hypertension, obesity or low IGF-1, and the second by a capillary derecruitment, aimed at maintaining normal capillary pressure. Therefore, impaired CFR in GHD patients may be determined by two different (at times combined) microcirculatory disorders, requiring specific treatment. Since the authors found a blunted pattern in one third of cases, which is the same occurrence of hypertension in the general population, it would be interesting to know whether office resting blood pressure or 24-h monitoring were higher in such patients or not, in * Lorenzo Curtò curto.loren@libero.it
È cambiato qualcosa nelle abitudini dei genitori fumatori in ambito domestico negli ultimi 15 anni? Indagine epidemiologica tra gli alunni della città di Agrigento
Giornale Italiano Di Cardiologia, Dec 1, 2012
4Azienda Sanitaria Provinciale di Agrigento 5 Divisione di Cardiologia-UTIC e Riabilitazione Card... more 4Azienda Sanitaria Provinciale di Agrigento 5 Divisione di Cardiologia-UTIC e Riabilitazione Cardiovascolare, A.O. Buccheri La Ferla Fatebenefratelli, Palermo Background. Exposure of children to passive tobacco smoking in the household setting has been demonstrated to cause respiratory diseases. Early atherosclerosis has also been demonstrated in young people previously exposed to passive tobacco smoking. Functional damage can initiate at the fetal age due to maternal smoking, with a tendency towards over-time progress. To date only scant data are available about indoor parental smoking attitudes and their changes after campaigns against smoke and risk factors in exposed youths. Questionnaires are useful tools in order to search for information on cigarette smoking and parental household lifestyle. In this study, we asked pupils of primary schools for providing information on their relatives’ every 5 years throughout the period 1994-2009. Methods. A multiple-choice answer questionnaire about sharing household parental smoking was administered to all primary school children (mean age 10.5 ± 0.5 years) of the city of Agrigento (Sicily, Italy). Results. A total of 2221 questionnaires were collected from 637 children in 1994, 687 in 1999, 516 in 2004, and 381 in 2009. Important findings show a significant reduction in both smoking parents and exposure to passive tobacco smoking (from 64% in 1994 to 45% in 2009, p<0.00001). In 2009, 22% of mothers and 39% of fathers resulted to be smokers in the household setting yet. Conclusions. In agreement with the 2011 Italian DOXA survey on the general population, the present study demonstrates a negative trend in the prevalence of household smoker parents (predominantly mothers) and exposure of children to passive tobacco smoking. These results likely reflect such a greater awareness about smoke-related risks in children, and the effectiveness of medical campaigns against cardiovascular risk factors
RECENTI APPLICAZIONI DELLE NUOVE METODICHE ULTRA-SONICHE ALLO STUDIO DELLA CARDIOPATIA IPERTENSIVA (parte 1)
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Papers by Cesare de Gregorio