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Claudio Fresco

Publications and source records attributed to Claudio Fresco.

11 recordsLinked to original sources
PubMed2006

Estimation of infarct size by single measurements of creatine kinase levels in patients with a first myocardial infarction.

OBJECTIVE: Enzymatic estimation of infarct size is desirable in the reperfusion era, because a possible discrepancy with the observed asynergic area of the left ventricle may suggest the presence of stunned myocardium. Unfortunately, timely myocardial reperfusion produces a rapid washout of creatine kinase (CK) in blood flow, which overestimates infarct size. In this perspective, we investigated whether the mid-terminal portion of the CK time-activity curve could predict infarct size more reliably. METHODS: Enzymatic infarct size was calculated by peak CK levels, the CK area under the curve and by single CK values, in 103 patients with a first ST-elevation myocardial infarction, and compared to the left ventricular akinetic area. The wall motion asynergy score at follow-up was considered as the actual infarct size. RESULTS: In patients with peak CK within 10 h of symptom onset, CK levels at 30 h showed a high independent correlation (r = 0.83; P < 0.001) with infarct size. In patients with late peak CK (> 10 h), CK levels at 12 h turned out to be the best predictor of infarct size (r = 0.55; P < 0.01). At multivariate regression analysis, peak CK was the best predictor of infarct size in the whole population (r = 0.61; P < 0.001). CONCLUSIONS: In patients with ST-elevation myocardial infarction and early peak CK, infarct size at follow-up could be better estimated with single values of the mid-terminal portion of the CK time-activity curve.

Aged↗
PubMed2006

Lack of improvement of clinical outcomes by a low-cost, hospital-based heart failure management programme.

OBJECTIVE: Heart failure (HF) is a major health problem resulting in a high financial burden for the healthcare system. Many previous HF management programmes reduced adverse clinical outcomes and costs, but they usually involved several professional figures as well as huge investments, requiring resources and budgets not often available in our healthcare system. We evaluated the effects of our HF management programme, which included patient education and regular outpatient contact with the HF team, on re-hospitalisation and death, optimising the few resources already available at our hospital. METHODS: Two hundred consecutive patients admitted to the internal medicine department with a diagnosis of HF were randomised to the intervention group (nurse-led education programme, facilitated telephone communication and follow-up visits with an internist at 15 days, 1 and 6 months) or to the usual care group (follow-up by their primary care physician). The primary endpoints were all-cause readmissions and all-cause deaths during the 6-month post-discharge period. RESULTS: There were 81 all-cause hospital readmissions in the intervention group and 82 in the control group (P = NS). Fourteen patients (14%) in the intervention group and eight patients (8%) in the control group died during the study period (P = NS). Unplanned outpatient visits were less frequent in the intervention group than in the control group (39 [28%] versus 99 [72%], P < 0.001). CONCLUSIONS: The present low-cost HF management programme reduced unplanned outpatient visits but proved ineffective in reducing subsequent readmissions and in improving clinical status. More intense follow-up monitoring and more resources are needed to achieve better results.

Aged↗
PubMed2005

Epidemiology of non-ST elevation acute coronary syndromes in the Italian cardiology network: the BLITZ-2 study.

AIMS: Acute coronary syndromes without ST-segment elevation (NSTEACS) represent an increasingly frequent cause of hospital admission. The BLITZ-2 study was planned to survey the epidemiology and management strategies of NSTEACS in the Italian cardiological network. METHODS AND RESULTS: The study included 1888 patients with NSTEACS in 275 hospitals in 3 weeks. At admission, almost 20% of patients showed clinical signs of heart failure, half showed ST-segment depression, and half showed any positive biochemical myocardial necrosis marker. Patients admitted to hospitals without CathLab (n=973) were older (P=0.0005) and with higher Killip class on admission (P<0.0001) when compared with those admitted to hospitals with CathLab (n=915). During index hospitalization, 76% of the patients initially admitted to hospitals with invasive capability underwent coronary angiography and 39% percutaneous coronary intervention when compared with 39 and 17.2% of those admitted to hospitals without CathLab (P<0.001). Overall, 30-day mortality was 2.4% (2.0% in patients with invasive capability vs. 2.9% in hospitals without CathLab, P=0.2). Cardiac ischaemic events at 30 days (recurrent MI, recurrent angina, and re-hospitalization for ACS) were significantly higher in the group of patients admitted to hospitals without CathLab (OR 1.71, 95% CI 1.24-2.35). However, after multivariable adjustment, only advanced age (OR 1.043, 95% CI 1.021-1.065, P<0.0001) and Killip class >1 (OR 1.633, 95% CI 1.020-2.614, P=0.04) resulted in independent predictors of death, in-hospital MI, and re-admission for ACS, whereas the absence of an on-site CathLab did not predict an adverse outcome (OR 1.104, 95% CI 0.734-1.660). CONCLUSION: According to this, the nationwide registry outcome is only marginally influenced by invasive procedures. Contemporary management of patients with NSTEACS in Italy is primarily driven by resource availability.

Adult↗
PubMed2005

The Left Ventricular Dysfunction Questionnaire: Italian translation and validation.

UNLABELLED: Patients affected by heart failure have a compromised quality of life (QOL) and in the last few years "health related quality of life" has become an important outcome indicator for the evaluation of heart failure treatment. METHODS: Translation into Italian of the Left Ventricular Dysfunction Questionnaire (LVD-36), a new, 36-item, disease-specific health status instrument for patients with congestive heart failure, and its subsequent validation by administration to 50 consecutive patients in our heart failure outpatient clinic. The Italian LVD-36 was compared to the "The Minnesota Living with Heart Failure Questionnaire" (MLHF). RESULTS: The Italian version of the LVD-36 correlates well with MLHF for ejection fraction (EF), NYHA class I and II, etiology and therapy. Since, however, the LVD-36 has only one domain, it may be able to offer more synthetic information than MLHF about patients' status. CONCLUSIONS: The Italian version of the LVD-36 appears to be a reliable instrument for assessing patients' QOL and the degree of limitations imposed on them by the disease. It is short, clear and easy to complete. In patients with heart failure the LVD-36 correlates well with the MLHF and may be considered a new disease-specific instrument to estimate changes in health status, and an useful support in optimizing therapeutic options.

Adrenergic beta-Antagonists↗
PubMed2004

Prognostic significance of the long pentraxin PTX3 in acute myocardial infarction.

BACKGROUND: Inflammation has a pathogenetic role in acute myocardial infarction (MI). Pentraxin-3 (PTX3), a long pentraxin produced in response to inflammatory stimuli and highly expressed in the heart, was shown to peak in plasma approximately 7 hours after MI. The aim of this study was to assess the prognostic value of PTX3 in MI compared with the best-known and clinically relevant biological markers. METHODS AND RESULTS: In 724 patients with MI and ST elevation, PTX3, C-reactive protein (CRP), creatine kinase (CK), troponin T (TnT), and N-terminal pro-brain natriuretic peptide (NT-proBNP) were assayed at entry, a median of 3 hours, and the following morning, a median of 22 hours from symptom onset. With respect to outcome events occurring over 3 months after the index event, median PTX3 values were 7.08 ng/mL in event-free patients, 16.12 ng/mL in patients who died, 9.12 ng/mL in patients with nonfatal heart failure, and 6.88 ng/mL in patients with nonfatal residual ischemia (overall P<0.0001). Multivariate analysis including CRP, CK, TnT, and NT-proBNP showed that only age > or =70 years (OR, 2.11; 95% CI, 1.04 to 4.31), Killip class >1 at entry (OR, 2.20; 95% CI, 1.14 to 4.25), and PTX3 (>10.73 ng/mL) (OR, 3.55; 95% CI, 1.43 to 8.83) independently predicted 3-month mortality. Biomarkers predicting the combined end point of death and heart failure in survivors were the highest tertile of PTX3 and of NT-proBNP and a CK ratio >6. CONCLUSIONS: In a representative contemporary sample of patients with MI with ST elevation, the acute-phase protein PTX3 but not the liver-derived short pentraxin CRP or other cardiac biomarkers (NT-proBNP, TnT, CK) predicted 3-month mortality after adjustment for major risk factors and other acute-phase prognostic markers.

Aged↗
PubMed2004

Aborted myocardial infarction in patients with ST-segment elevation: insights from the Assessment of the Safety and Efficacy of a New Thrombolytic Regimen-3 Trial Electrocardiographic Substudy.

OBJECTIVES: The investigators undertook a systematic, comprehensive analysis of the therapeutic response and clinical outcomes of reperfusion therapy for acute ST-segment elevation myocardial infarction (STEMI) in 5,470 patients from the Assessment of the Safety and Efficacy of a New Thrombolytic Regimen (ASSENT)-3 trial. BACKGROUND: Prompt effective reperfusion therapy for acute STEMI may attenuate major myocardial necrosis. METHODS: We prospectively collected sequential electrocardiographs and clinical data. Aborted myocardial infarction (MI) was defined as maximal creatine kinase < or =2x upper limit of normal coupled with typical evolutionary electrocardiographic changes. RESULTS: Of the patients, 727 (13.3%) had an aborted MI, with the highest frequency (25%) occurring in patients treated <1 h after symptom onset. As compared with MI patients, patients with aborted MI more often had complete ST-segment resolution at 60 min (56.3% vs. 30.2%, p < 0.001) and 180 min (61.5% vs. 53%, p < 0.001); they also had smaller infarct sizes based on QRS score at discharge (2.37 vs. 4.62, p <0.001). Mortality in aborted MI patients compared with those who had true MI was 3.9% versus 4.6% at 30-day and 7.0% versus 7.4% at 1-year. The baseline-adjusted mortality was significantly lower in patients with aborted MI (odds ratio [OR] 0.76, 95% confidence interval [CI] 0.63 to 0.92, p = 0.005 for 30-day and OR 0.70, 95% CI 0.50 to 0.98, p = 0.035 for one year). A very low-risk subset was identified with > or =70% ST-segment resolution at 60 min whose 30-day and 1-year mortality was 1.0% and 2.7%, respectively, compared with 5.9% and 9.3% in aborted MI patients with <70% ST-segment resolution at 60 min (all p < or = 0.002). CONCLUSIONS: Prompt fibrinolytic treatment improved the likelihood of aborted MI. The subgroup with complete 60-min ST-segment resolution had the best clinical outcomes.

Aged↗
PubMed2004

Prevalence, clinical characteristics, quality of life, and prognosis of patients with congestive heart failure and isolated left ventricular diastolic dysfunction.

Prevalence of isolated left ventricular (LV) diastolic dysfunction has been reported to be as high as one-third of all heart failure (HF) cases, with an increasing prevalence in the elderly population. However, there is a paucity of prospective data about the prevalence and prognosis of isolated LV diastolic dysfunction in an unselected population of patients hospitalized with HF. Therefore, we prospectively evaluated 179 consecutive patients discharged from our hospital with HF to assess the prevalence of systolic versus diastolic LV dysfunction among patients hospitalized with HF and to compare their demographics, clinical features, self-perceived quality of life (QOL), and 6-month readmission rate and mortality. Among them, 133 (59% men, median age 74 years) showed in sinus rhythm and had no significant primary valvular disease. LV diastolic dysfunction was diagnosed on the basis of the European Study Group on Diastolic HF echocardiographic criteria. QOL was assessed at hospital discharge and 6-month follow-up visit using the Minnesota Living with HF questionnaire. Survival of patients with HF was compared with that of age- and sex-matched general population. In all, 29 patients (22%) had isolated LV diastolic dysfunction and 102 (78%) had prevalent LV systolic dysfunction (ie, LV ejection fraction </= 45%). There was no difference in age, sex, or New York Heart Association functional class between patients with LV diastolic or systolic dysfunction. QOL scores were similar between the 2 patient groups with HF both at discharge (39.4 and 34) and at 6-month visit (10.4 and 10.4). Both 6-month readmission rate (48% and 48%) and median inhospital length-of-stay during readmissions (10 days and 10 days) were similar between the 2 patient groups with HF. Finally, 6-month survival, adjusted for age and sex, was similar between patients with LV diastolic or systolic dysfunction (hazard ratio 0.68; 95% confidence interval 0.20-2.35). Using standardized echocardiographic criteria, isolated LV diastolic dysfunction among unselected patients hospitalized with HF was less than previously reported. Patients with HF and isolated diastolic dysfunction showed similar clinical symptoms, self-perceived QOL, readmission rate, and 6-month mortality to patients with prevalent LV systolic dysfunction.

Adrenergic beta-Antagonists↗
PubMed2003

[Early prehospital thrombolysis in acute myocardial infarct: a moral obligation?].

Acute myocardial infarction accounts for a large proportion of deaths from cardiovascular diseases. Occlusive thrombosis superimposed on a ruptured atheroma in an epicardial coronary artery is firmly established as the immediate cause of an acute myocardial infarction. Clinical research has focused on reducing the time to treatment, because necrosis of viable myocardial tissue mainly happens during the 30 to 90 min after coronary artery occlusion. Consequently, if the coronary artery can be reperfused during this period, extensive myocardial necrosis can be prevented and left ventricular function can be preserved. Indeed the mortality reduction by thrombolytic treatment compared with control is considerably higher in patients treated within 2 hours of symptom onset. Thrombolytic treatment during the first hour resulted in a 50% mortality reduction, which indicates 50 to 60 lives saved per 1000 patients treated. Early patency has crucial prognostic significance because the meta-analysis of all randomized trials of prehospital versus in-hospital thrombolysis shows that reducing treatment delay by 1 hour saves approximately 20 lives per 1000 patients treated. One way to reduce the delay is to bring the treatment to the patient in the prehospital setting. The safety and feasibility of prehospital thrombolysis strongly depend on the possibility of a rapid and correct diagnosis in the prehospital setting. To diagnose a myocardial infarction a standard 12-lead electrocardiogram is recorded and interpreted either on site by the emergency physician or, after telephone transmission, by a cardiologist on duty at the receiving coronary care unit. This approach has been proved to be safe. The most suitable prehospital thrombolytics are the third-generation agents given as a bolus, which have been tested in large hospital randomized control trials such as GUSTO-V and ASSENT III (reteplase and tenecteplase respectively), and the prehospital trial ASSENT III PLUS (tenecteplase). Hopefully future management of acute myocardial infarction with ST-segment elevation will include prehospital thrombolysis as a complementary part of any reperfusion strategy.

Coronary Artery Disease↗
PubMed2003

The Kansas City Cardiomyopathy Questionnaire: Italian translation and validation.

BACKGROUND: Several studies have demonstrated that patients affected by heart failure have a compromised quality of life and, in the last few years, "health-related quality of life" has become an important outcome indicator for the evaluation of heart failure treatment and a basis for the improvement of its strategies. METHODS: The translation into Italian of the Kansas City Cardiomyopathy Questionnaire (KCCQ), a new, 23 item, disease-specific health status instrument for patients with congestive heart failure, and its subsequent validation by asking 50 consecutive patients in our heart failure outpatient clinic to answer it. The KCCQ was compared to the "Minnesota Living with Heart Failure Questionnaire" (MLHF). RESULTS: The Italian version of the KCCQ correlates well with the MLHF for all domains with the exclusion of symptom stability score and MLHF emotional domain. However, the KCCQ, due to its multiple domains, provided more detailed information about the patients' status, and identified the more compromised ones. CONCLUSIONS: The KCCQ appears to be a valid and reliable instrument for the assessment of a patient's quality of life and the degree of limitations imposed upon him/her by the disease. When compared to the MLHF, the KCCQ, however, is somewhat more sensitive in identifying more compromised patients. This capacity could be advantageously used for the identification of clinical changes in future trials and lead to a better planning of new therapeutic interventions.

Adrenergic beta-Antagonists↗
PubMed2002

Variations in lipoprotein levels after myocardial infarction and unstable angina: the LATIN trial.

BACKGROUND: The aim of this study was to prospectively evaluate the magnitude of the variations in lipid levels in a large population of patients admitted for acute myocardial infarction (MI) and unstable angina (UA). Clinical data and blood samples were prospectively collected from consecutive patients with MI and UA. METHODS: The study population consisted of patients with symptoms lasting < or = 12 hours (for MI) or with the last episode of rest pain within 12 hours and associated with ECG changes (for UA). The exclusion criteria were recent hospitalization for any reason or current treatment with lipid-lowering drugs. Blood samples were obtained at admission, the following morning, at discharge and after 3 months. Samples were centrifuged immediately and 4 aliquots of serum were stored at -20 degrees C. The measurements were performed centrally. RESULTS: We enrolled 1864 patients (1275 with MI and 589 with UA). Serum levels of total and LDL-cholesterol decreased significantly after admission, both in MI and UA patients. After 3 months, serum levels of total cholesterol returned to baseline, while those of LDL-cholesterol were still significantly lower. Between admission and the following morning, total and LDL-cholesterol decreased significantly by 7 and 10% respectively for MI and by 5 and 6% for UA. Lipid measurements not performed at admission accounted for a significant decrease in the number of patients identifiable as hyperlipidemic and suitable for lipid-lowering treatment (18% of MI patients and 11% of UA patients). CONCLUSIONS: Serum cholesterol concentrations drop significantly during hospitalization for an acute coronary syndrome after a few hours from admission to the coronary care unit. Lipid profile assessment should be scheduled at admission in order to correctly identify hyperlipidemic patients.

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