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Coronary Artery Disease: HELP
Articles by Paolo Nicola Marino
Based on 37 articles published since 2008
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Between 2008 and 2019, Paolo Marino wrote the following 37 articles about Coronary Artery Disease.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Guideline Italian cardiological guidelines for sports eligibility in athletes with heart disease: part 2. 2013

Biffi, Alessandro / Delise, Pietro / Zeppilli, Paolo / Giada, Franco / Pelliccia, Antonio / Penco, Maria / Casasco, Maurizio / Colonna, Pierluigi / D'Andrea, Antonello / D'Andrea, Luigi / Gazale, Giovanni / Inama, Giuseppe / Spataro, Antonio / Villella, Alessandro / Marino, Paolo / Pirelli, Salvatore / Romano, Vincenzo / Cristiano, Antonio / Bettini, Roberto / Thiene, Gaetano / Furlanello, Francesco / Corrado, Domenico / Anonymous50757. ·National Italian Olympic Committee, Institute of Sports Medicine and Science, Rome, Italy. a.biffi@libero.it ·J Cardiovasc Med (Hagerstown) · Pubmed #23625056.

ABSTRACT: In Italy the existence of a law on health protection of competitive sports since 1982 has favored the creation and the revision of these cardiological guidelines (called COCIS), which have reached their fourth edition (1989-2009). The present article is the second English version, which has summarized the larger version in Italian. The experience of the experts consulted in the course of these past 20 years has facilitated the application and the compatibility of issues related to clinical cardiology to the sports medicine field. Such prolonged experience has allowed the clinical cardiologist to acquire knowledge of the applied physiology of exercise and, on the other hand, has improved the ability of sports physicians in cardiological diagnostics. All this work has produced these guidelines related to the judgment of eligibility for competitive sports in the individual clinical situations and in the different cardiovascular abnormalities and/or heart disease. Numerous arguments are debated, such as interpretation of the athlete's ECG, the utility of a preparticipation screening, arrhythmias, congenital heart disease, cardiomyopathies, arterial hypertension, ischemic heart disease and other particular issues.

2 Review Left atrium function in patients with coronary artery disease. 2014

Facchini, Emanuela / Degiovanni, Anna / Marino, Paolo N. ·Department of Translational Medicine, Clinical Cardiology, Università del Piemonte Orientale, Azienda Ospedaliero Universitaria 'Maggiore della Carità', Novara, Italy. ·Curr Opin Cardiol · Pubmed #24945488.

ABSTRACT: PURPOSE OF REVIEW: The left atrial cavity has recently been identified as a potential biomarker for cardiac and cerebrovascular accidents. This review examines the potential of left atrial size and function in predicting cardiovascular disease in the general population and outcomes in coronary artery disease (CAD) patients. RECENT FINDINGS: The atrium is perfused primarily by branches of the proximal left circumflex coronary artery (LCx), and depression of the cavity mechanical performance has been demonstrated in experimental studies during LCx occlusion. Thus, left atrial volume and function assessment may have prognostic relevance, particularly in CAD patients. Such a line of thinking, however, is challenged by the widespread notion that the contribution by left atrial chamber morphology and functional quantitation to the risk stratification process after a first cardiovascular event is not adequately considered. However, a number of studies have shown that left atrial volume predicts survival and major adverse events after an acute myocardial infarction. Left atrial remodeling also provides an important overall prognostic information and correlates with brain natriuretic peptide after primary percutaneous coronary interventions. SUMMARY: Evaluation of left atrial size and function is currently of great interest and it will be more so in the very near future, given its potential for insights into the pathophysiology of the ischemic heart, which makes it an important clinical risk identifier in CAD patients.

3 Clinical Trial Absolute eosinophils count and the extent of coronary artery disease: a single centre cohort study. 2015

Verdoia, Monica / Schaffer, Alon / Cassetti, Ettore / Di Giovine, Gabriella / Marino, Paolo / Suryapranata, Harry / De Luca, Giuseppe. ·Department of Cardiology, Ospedale "Maggiore della Carità", Eastern Piedmont University, C.so Mazzini, 18, 28100, Novara, Italy. ·J Thromb Thrombolysis · Pubmed #25079972.

ABSTRACT: Leukocytes have been involved in the pathogenesis of atherosclerosis, and recent attention has been raised on eosinophils, that have been claimed for a wide number of cardiovascular pathologies, affecting endocardium, myocardium and vascular walls. However, few data have been reported so far on the relationship between absolute eosinophils count (AEC) and the prevalence and extent of coronary artery disease (CAD), that was the aim of present study. Consecutive patients undergoing non-urgent coronary angiography were included. Haematological parameters were measured at admission. Significant CAD was defined as at least 1 vessel stenosis >50 %, while severe CAD as left main and/or trivessel disease, as evaluated by Quantitative Coronary Angiography. Our population is represented by 3,742 patients, divided according to tertiles values of AEC (≤0.1; 0.1-0.2; >0.2 × 10(3)/µl). Higher eosinophils values were significantly associated to male gender, main established cardiovascular risk factors, previous percutaneous or surgical coronary revascularization, antihypertensive and antiplatelet therapy at admission but inversely with acute presentation. Higher AEC was directly related with platelets count (p < 0.001), haemoglobin levels (p = 0.02), white blood cells count (p = 0.02), higher serum creatinine (p < 0.001), triglycerides (p < 0.001) and glycosylated haemoglobin (p < 0.001), while inversely with HDL cholesterol (p < 0.001). AEC was associated with multivessel disease (p = 0.03), chronic occlusions (p = 0.01), in-stent restenosis (p = 0.002), while inversely with the presence of intracoronary thrombus (p < 0.001). A significant relationship was found between AEC and the prevalence of coronary artery disease (p = 0.049), but not for the extent of more severe LM/trivessel CAD (p = 0.31). At multivariate analysis no independent role of eosinophils was found for CAD (adjusted OR [95 % CI] = 1.02 [0.91-1.15], p = 0.70), or severe CAD (adjusted OR [95 % CI] = 0.99 [0.89-1.1], p = 0.9), even when considering separately acute and elective patients. In conclusion, among patients undergoing coronary angiography, higher eosinophils levels are not independently associated with the prevalence and extent of coronary artery disease, but appear confounded by their link with major cardiovascular risk factors.

4 Clinical Trial High fibrinogen level is an independent predictor of presence and extent of coronary artery disease among Italian population. 2011

De Luca, Giuseppe / Verdoia, Monica / Cassetti, Ettore / Schaffer, Alon / Cavallino, Chiara / Bolzani, Virginia / Marino, Paolo / Anonymous1540679. ·Division of Cardiology, Azienda Ospedaliera-Universitaria "Maggiore Della Carità", Eastern Piedmont University, C.So Mazzini, 18, 28100 Novara, Italy. giuseppe.deluca@maggioreosp.novara.it ·J Thromb Thrombolysis · Pubmed #21080031.

ABSTRACT: Few reports have so far investigated the relationship between fibrinogen levels and the extent of coronary artery disease (CAD) as evaluated by coronary angiography, that is therefore the aim of the current study. We measured fibrinogen in 2,121 consecutive patients undergoing coronary angiography. Patients were divided in 5 groups based on quintiles of fibrinogen levels. Significant CAD was defined as stenosis >50% in at least 1 coronary vessel. We additionally measured carotid intima-media thickness (CIMT) in a subgroup of 359 patients. Patients with elevated fibrinogen were older (P = 0.038), with larger prevalence of diabetes (P = 0.027), female gender (P < 0.0001), hypertension (P < 0.001), chronic renal failure (P < 0.0001), previous CVA (P = 0.036), less often with family history of CAD (P = 0.019) and previous PCI (P < 0.0001), more often presenting with ACS (P < 0.0001), more often on nitrates (P < 0.0001), clopidogrel (P = 0.009) and diuretics (P < 0.0001). Fibrinogen levels were linearly associated with baseline glycaemia (P < 0.017), WBC count (P < 0.0001), creatinine (P < 0.0001), and Platelet count (P < 0.0001) but inversely associated with RBC count (P < 0.0001). Fibrinogen levels were associated with CAD (P = 0.001), especially for extremely high levels (5th percentile, P < 0.0001). At multivariate analysis, after correction for baseline confounding factors, high fibrinogen level (5th percentile) was still associated with the prevalence of CAD (P = 0.034). Furthermore, fibrinogen levels were related with maximal CIMT (r = 0.12; P = 0.01), with larger prevalence of carotid plaques in patients with higher fibrinogen levels (5th quintile) as compared to remaining patients (P = 0.046). This study showed that high fibrinogen level is significantly associated with CAD and carotid atherosclerosis.

5 Article Impact of Long-Term Dual Antiplatelet Therapy on Immature Platelet Count and Platelet Reactivity. 2018

Verdoia, Monica / Pergolini, Patrizia / Rolla, Roberta / Barbieri, Lucia / Schaffer, Alon / Marino, Paolo / Bellomo, Giorgio / Suryapranata, Harry / De Luca, Giuseppe / Anonymous631000. ·1 Division of Cardiology, Azienda Ospedaliera-Universitaria "Maggiore della Carità", Eastern Piedmont University, Novara, Italy. · 2 Clinical Chemistry, Azienda Ospedaliera-Universitaria "Maggiore della Carità", Eastern Piedmont University, Novara, Italy. · 3 Department of Cardiology, Ospedale S. Andrea, Vercelli, Italy. · 4 Department of Cardiology, Ospedale S. Biagio, Domodossola, Italy. · 5 Department of Cardiology, UMC St Radboud, Nijmegen, The Netherlands. ·Angiology · Pubmed #29082748.

ABSTRACT: The immature platelet count (IPC) is a potential marker of platelet reactivity. We assessed the relationship between IPC during chronic dual antiplatelet therapy (DAPT) and the response to antiplatelet drugs (acetylsalycilic acid + clopidogrel/ticagrelor). We included 286 patients: 167 (58.4%) patients received ticagrelor and 119 (41.6%) received clopidogrel. At a median follow-up of 46.5 days, the variation in IPC displayed an absolute median (interquartile range [IQR]) of -11.9 × 10

6 Article Vitamin D Binding Protein rs7041 polymorphism and high-residual platelet reactivity in patients receiving dual antiplatelet therapy with clopidogrel or ticagrelor. 2017

Verdoia, Monica / Daffara, Veronica / Pergolini, Patrizia / Rolla, Roberta / Marino, Paolo / Bellomo, Giorgio / Carriero, Alessandro / De Luca, Giuseppe / Anonymous1810904. ·Department of Cardiology, "Maggiore della Carità" Hospital, Eastern Piedmont University, Novara, Italy. · Clinical Chemistry, "Maggiore della Carità" Hospital, Eastern Piedmont University, Novara, Italy. · Department of Radiology, "Maggiore della Carità" Hospital, Eastern Piedmont University, Novara, Italy. · Department of Cardiology, "Maggiore della Carità" Hospital, Eastern Piedmont University, Novara, Italy. Electronic address: giuseppe.deluca@maggioreosp.novara.it. ·Vascul Pharmacol · Pubmed #28433569.

ABSTRACT: BACKGROUND: Vitamin D deficiency represents a major health problem in general population, especially for its association with cardiovascular disorders and thrombotic risk, even in patients on dual antiplatelet therapy (DAPT). Vitamin D Binding Protein (VDBP) is the main transporter of vitamin D in the bloodstream and genetic polymorphisms of this protein have been shown to account for a significant variability of vitamin D levels and its systemic effects. Contrasting data have linked the rs7041 T→G substitution with cardiovascular disease. However, no study has so far addressed the role of rs7041 polymorphism on platelet reactivity in patients on DAPT, that was the aim of the present study. METHODS: Patients treated with DAPT (ASA and clopidogrel or ticagrelor) for an ACS or elective PCI were scheduled for platelet function assessment at 30-90days post-discharge. Platelet function was assessed by Multiplate® (Roche Diagnostics AG), and VDBP genetic status by polymerase chain reaction and restriction fragment length polymorphism technique. Fasting samples were obtained for main chemistry parameters and vitamin D levels assessment. RESULTS: We included 400 patients, 187 (46.8%) receiving clopidogrel and 213 (53.2%) ticagrelor. The genetic polymorphism rs7041 (T→G) was observed in 318 patients, (79.5%), in 38.7% of them in homozygosis. Main clinical and chemistry features did not significantly differ according to genetic status, but for a higher rate of ACE-inhibitors and beta-blockers use among the carriers of the G allele (p=0.04 and p=0.01, respectively). VDBP genetic status did not affect the rate of HRPR with ADP-antagonists (25.6% vs 24.6% vs 28.5%, p=0.59; adjusted OR[95%CI]=0.94[0.52-1.7], p=0.83 for T/G patients; adjusted OR[95%CI]=1.14[0.6-2.2], p=0.67 for G homozygotes). However, the rate of HRPR with ADP-antagonists was influenced by severe hypovitaminosis D (< 10ng/ml) only in patients carrying the G allele, especially in homozygosis (T/T: 25.9% vs 26.1%, p=0.99; G carriers: 22.1% vs 35.3%, p=0.02, p CONCLUSION: The present study shows that rs7041 polymorphism of Vitamin D Binding Protein does not affect platelet reactivity or the rate of HRPR among patients receiving DAPT. However the carriage of the G allele could condition the impact of hypovitaminosis D on the response to antiplatelet agents, increasing the occurrence of HRPR especially in homozygotes, thus suggesting a more significant role of vitamin D deficiency among these patients.

7 Article Immature platelet fraction and the extent of coronary artery disease: A single centre study. 2017

Verdoia, Monica / Nardin, Matteo / Rolla, Roberta / Marino, Paolo / Bellomo, Giorgio / Suryapranata, Harry / De Luca, Giuseppe / Anonymous6330902. ·Department of Cardiology, Ospedale "Maggiore della Carità", Università del Piemonte Orientale, Novara, Italy. · Department of Cardiology, Ospedale "Maggiore della Carità", Università del Piemonte Orientale, Novara, Italy; Department of Medicine, ASST "Spedali Civili", University of Brescia, Italy. · Department of Clinical Chemistry, Ospedale "Maggiore della Carità", Università del Piemonte Orientale, Novara, Italy. · Department of Cardiology, UMC St Radboud, Nijmegen, The Netherlands. · Department of Cardiology, Ospedale "Maggiore della Carità", Università del Piemonte Orientale, Novara, Italy. Electronic address: giuseppe.deluca@med.uniupo.it. ·Atherosclerosis · Pubmed #28388444.

ABSTRACT: BACKGROUND AND AIMS: Immature platelet fraction (IPF) represents the quote of younger and larger sized circulating platelets, a potential marker of platelet reactivity and major cardiovascular events. We aimed to assess the relationship between IPF levels and the prevalence and extent of coronary artery disease (CAD) in patients undergoing coronary angiography. METHODS: A cohort of consecutive patients undergoing coronary angiography in a single centre were included. Significant CAD was defined as at least 1 vessel stenosis >50%, while severe CAD was defined as left main and/or three-vessel disease. IPF levels were measured at admission by routine blood cells count (A Sysmex XE-2100). RESULTS: We included 1789 patients, divided according to quartiles values of IPF. IPF levels were directly related to active smoke (p = 0.02), and non-acute coronary syndrome as indication to angiography (p < 0.001), higher levels of haemoglobin and uric acid (p < 0.001, respectively) and lower platelet count (p = 0.003). Angiographic features did not significantly differ according to quartiles values of IPF, but for a lower degree of TIMI flow in patients with a higher percentage of reticulated platelets (p = 0.01) and a higher rate of lesions involving bifurcations (p = 0.05). IPF levels did not affect the prevalence of CAD (77% vs. 82.2% vs. 79.1% vs. 75.6%, p = 0.34, adjusted OR [95% CI] = 0.93 [0.82-1.05], p = 0.22), nor of severe left main/three-vessel CAD (28.5% vs. 34.4% vs. 32.2% vs. 33.1%, p = 0.27; adjusted OR [95% CI] = 0.99 [0.90-1.1], p = 0.88). CONCLUSIONS: The present study shows that among patients undergoing coronary angiography, the immature platelet fraction (IPF) is not associated with the prevalence and extent of coronary artery disease, and, therefore, should not be overlooked as a marker of coronary atherosclerosis.

8 Article Impact of high-dose statins on vitamin D levels and platelet function in patients with coronary artery disease. 2017

Verdoia, Monica / Pergolini, Patrizia / Rolla, Roberta / Nardin, Matteo / Schaffer, Alon / Barbieri, Lucia / Daffara, Veronica / Marino, Paolo / Bellomo, Giorgio / Suryapranata, Harry / De Luca, Giuseppe / Anonymous8450892. ·Department of Cardiology, Ospedale "Maggiore della Carità", Eastern Piedmont University, Novara, Italy. Electronic address: ve.monica@libero.it. · Clinical Chemistry, Ospedale "Maggiore della Carità", Eastern Piedmont University, Novara, Italy. · Department of Cardiology, Ospedale "Maggiore della Carità", Eastern Piedmont University, Novara, Italy; Department of Internal Medicine, Spedali Civili Hospital, Brescia, Italy. · Department of Cardiology, Ospedale "Maggiore della Carità", Eastern Piedmont University, Novara, Italy. · Department of Cardiology, Ospedale "Maggiore della Carità", Eastern Piedmont University, Novara, Italy; Cardiologia, Ospedale S. Andrea, Vercelli, Italy. · Department of Cardiology, UMC St Radboud, Nijmegen, The Netherlands. · Department of Cardiology, Ospedale "Maggiore della Carità", Eastern Piedmont University, Novara, Italy. Electronic address: giuseppe.deluca@maggioreosp.novara.it. ·Thromb Res · Pubmed #28068529.

ABSTRACT: BACKGROUND: Statins represent a pivotal treatment in coronary artery disease, offering a reduction in cardiovascular risk even beyond their lipid-lowering action. However, the mechanism of these "pleiotropic" benefits of statins is poorly understood. Vitamin D has been suggested as a potential mediator of the anti-inflammatory, anti-thrombotic and vascular protecting effects of statins. Aim of present study was to assess the impact of a high-intensity statin therapy on vitamin D levels and platelet function in patients with coronary artery disease. METHODS: Patients discharged on dual antiplatelet therapy and high-intensity statins after an ACS or elective PCI were scheduled for main chemistry and vitamin D levels assessment at 30-90days post-discharge. Vitamin D (25-OHD) dosing was performed by chemiluminescence method through the LIAISON® Vitamin D assay (Diasorin Inc). Platelet function was assessed by Multiplate® (multiple platelet function analyser; Roche Diagnostics AG). RESULTS: Among 246 patients included, 142 were discharged on a new statin therapy or with an increase in previous dose (Inc-S), while 104 were already receiving a high-dose statin at admission, that remained unchanged (Eq-S). Median follow-up was 75.5days. Patients in the Inc-S group were younger (p=0.01), smokers (p<0.001), with a less frequent history of hypercholesterolemia (p=0.05), diabetes (p=0.03), hypertension (p=0.02), or previous cardiovascular events (p<0.001). They were more often admitted for an acute coronary syndrome (p<0.001) and used less anti-hypertensive drugs or nitrates. Higher total circulating calcium was observed in the Inc-S group (p=0.004), while baseline vitamin D levels were similar in the 2 groups (p=0.30). A significant reduction in the circulating low-density lipoprotein (LDL) cholesterol was observed in the Inc-S group. Vitamin D levels increased in the Inc-S patients but not in the Eq-S group (delta-25OHD: 23.2±20.5% vs 3.1±4.7%, p=0.003), with a linear relationship between the magnitude of vitamin D elevation and the reduction of LDL cholesterol (r=-0.17, p=0.01). Platelet reactivity was significantly lower in the Inc-S patients, when evaluating aggregation with different platelet activating stimuli (arachidonic acid, p=0.02, collagen, p=0.004, thrombin-activating peptide, p=0.07, ADP, p=0.002). CONCLUSIONS: In patients with coronary artery disease, the addition of a high-intensity statin treatment, besides the lipid-lowering effects, is associated to a significant increase in vitamin D levels and lower platelet reactivity, potentially providing explanation of the "pleiotropic" benefits of statins therapy in cardiovascular disease.

9 Article Vitamin D levels and high-residual platelet reactivity in patients receiving dual antiplatelet therapy with clopidogrel or ticagrelor. 2016

Verdoia, Monica / Pergolini, Patrizia / Rolla, Roberta / Sartori, Chiara / Nardin, Matteo / Schaffer, Alon / Barbieri, Lucia / Daffara, Veronica / Marino, Paolo / Bellomo, Giorgio / Suryapranata, Harry / De Luca, Giuseppe / Anonymous191089. ·a Department of Cardiology , Ospedale "Maggiore della Carità",Eastern Piedmont University , Novara , Italy. · b Clinical Chemistry , Ospedale "Maggiore della Carità", Eastern Piedmont University , Novara , Italy. · c Department of Cardiology , UMC St Radboud , Njimegen , The Netherlands. ·Platelets · Pubmed #27540959.

ABSTRACT: BACKGROUND: Suboptimal platelet inhibition still represents an important challenge, especially for patients undergoing percutaneous coronary interventions (PCIs). However, very few are known so far on the predictors of high-residual platelet reactivity (HRPR) despite antiplatelet strategies. Increasing attention has been paid in the last years to the role of vitamin D in atherothrombosis. Therefore, the aim of our study was to evaluate the impact of vitamin D levels on platelet function in patients treated with dual antiplatelet therapy (DAPT). Patients treated with DAPT (ASA and clopidogrel or ticagrelor) after a recent acute coronary syndrome (ACS) or elective PCI were scheduled for platelet function assessment at 30-90 days post-discharge. Platelet function was assessed by whole blood impedance aggregometry (Multiplate®-Roche Diagnostics AG), HRPR was considered for ASPI test values > 862 AU*min (for ASA) and adenosine diphosphate (ADP) test values ≥417 AU*min (for ADP-antagonists). Fasting samples were obtained for main chemistry parameters and vitamin D level assessment. Our population is represented by 503 patients, who were divided according to vitamin D quartiles (≤9.1; 9.2-14.4; 14.5-21.7; >21.7 ng/ml). Lower vitamin D levels related with age (p = 0.04), diabetic status (p = 0.05), and previous coronary surgery (p = 0.007), therapy with beta-blockers and statins (p = 0.01 and p = 0.02). Vitamin D inversely related to the levels of total cholesterol (p = 0.01), triglycerides (p < 0.001), hemoglobin (p = 0.05), and HbA1c (p < 0.001). Significantly higher platelet reactivity was observed after platelet stimulation with ADP (p = 0.01), but not with other platelet activators. The prevalence of HRPR for ASA was low (1.2%) and not conditioned by Vitamin D levels (adjusted OR[95%CI] = 1.56[0.71-3.5], p = 0.27). HRPR with ADP-antagonists was observed in 26% of patients, and the rate increased with lower vitamin D quartiles (37.3% vs 22.2% vs 24.4% vs 20.2%, p = 0.005, adjusted OR[95%CI] = 1.23[1.02-1.49], p = 0.04). An absolute increase in HRPR with lower vitamin D levels was similarly observed among patients receiving ticagrelor (adjusted OR[95% CI] = 1.40[0.95-2.06], p = 0.08), and those on clopidogrel (adjusted OR[95%CI] = 1.31[0.99-1.75], p = 0.06). Thus, lower vitamin D levels are associated with higher platelet reactivity and impaired effectiveness of ADP-antagonists, while not influencing the effectiveness of ASA. Future studies will tell whether vitamin D supplementation can reduce platelet reactivity, overcoming the phenomenon of resistance to antiplatelet agents.

10 Article Vitamin D status, diabetes mellitus and coronary artery disease in patients undergoing coronary angiography. 2016

Nardin, Matteo / Verdoia, Monica / Schaffer, Alon / Barbieri, Lucia / Marino, Paolo / De Luca, Giuseppe / Anonymous6230868. ·Department of Cardiology, Ospedale "Maggiore della Carità", Eastern Piedmont University, Novara, Italy. · Department of Cardiology, Ospedale "Maggiore della Carità", Eastern Piedmont University, Novara, Italy. Electronic address: giuseppe.deluca@maggioreosp.novara.it. ·Atherosclerosis · Pubmed #27205868.

ABSTRACT: BACKGROUND AND AIMS: Growing attention has been addressed to the cardiovascular effects of vitamin D, in order to prevent the vascular wall degeneration and the progression of atherosclerosis. Diabetes mellitus is an established risk factor for coronary artery disease, where the enhanced pro-inflammatory and pro-thrombotic status could render even more important the athero-protective effects of vitamin D. Therefore, we aimed to evaluate the impact of diabetes on vitamin D levels and its relationship with the extent of CAD. METHODS: Consecutive patients undergoing non urgent coronary angiography were included. Admission samples were collected for vitamin D levels assessment. Significant coronary artery disease was defined as at least 1 vessel stenosis >50%, severe coronary artery disease as left main and/or trivessel disease, as evaluated by quantitative coronary angiography. RESULTS: Patients included were 1859, among them 641 were diabetics (34.5%). Diabetic patients displayed older age, higher rate of renal failure, previous cardiovascular events, hypercholesterolemia, hypertension, glycaemia, HbA1c, creatinine, uric acid (p < 0.001, respectively). Lower levels of haemoglobin, total cholesterol, high and low density lipoprotein cholesterol (p < 0.001) were found in diabetics. Diabetic patients displayed significantly lower levels of vitamin D (p = 0.003), however diabetes did not emerge as an independent predictor of hypovitaminosis-D (adjusted OR [95% CI] = 0.95[0.72, 1.26], p = 0.72). In diabetics, lower vitamin D levels were associated to female gender (p = 0.003), glucose control and lower haemoglobin levels (p < 0.001). Lower levels of vitamin D were related with the prevalence (adjusted OR [95% CI] = 1.54[1.12-2.12], p = 0.008) and severity (adjusted OR [95% CI] = 1.28[1.014-1.621], p = 0.038) of coronary artery disease. CONCLUSIONS: The present study shows that diabetes mellitus is not an independent predictor of hypovitaminosis-D. However, diabetic patients showed lower vitamin D levels that were independently associated with an increased prevalence and severity of coronary artery disease.

11 Article Parathyroid Hormone Levels and High-Residual Platelet Reactivity in Patients Receiving Dual Antiplatelet Therapy With Acetylsalicylic Acid and Clopidogrel or Ticagrelor. 2016

Verdoia, Monica / Pergolini, Patrizia / Rolla, Roberta / Nardin, Matteo / Barbieri, Lucia / Schaffer, Alon / Bellomo, Giorgio / Marino, Paolo / Suryapranata, Harry / De Luca, Giuseppe / Anonymous1680865. ·Department of Cardiology, Ospedale "Maggiore della Carità", Eastern Piedmont University, Novara, Italy. · Clinical Chemistry, Ospedale "Maggiore della Carità", Eastern Piedmont University, Novara, Italy. · Department of Cardiology, UMC St Radboud, Nijmegen, the Netherlands. ·Cardiovasc Ther · Pubmed #27086085.

ABSTRACT: BACKGROUND: High-residual-on-treatment platelet reactivity still represents a challenging issue, potentially vanishing the benefits of dual antiplatelet treatment in patients with coronary artery disease. However, very few is known on the determinants of suboptimal response to antiplatelet agents. Recent interests have emerged on the potential prothrombotic effect of parathyroid hormone (PTH). Therefore, the aim of the present study was to assess the impact of parathyroid hormone (PTH) on platelet reactivity in patients receiving DAPT after an acute coronary syndrome or PCI. METHODS: Patients treated with DAPT (ASA and clopidogrel or ticagrelor) were scheduled for platelet function assessment at 30- to 90-days postdischarge. By whole blood impedance aggregometry, HRPR was considered for ASPI test >862 AU*min (for ASA) and ADP test values ≥417 AU*min (for ADP antagonists). RESULTS: We included 362 patients on DAPT, 125 (34.5%) receiving clopidogrel, and 237 (65.5%) on ticagrelor. Patients were divided according to PTH quartiles values (<45.8; 45.8-60.3; 60.4-88; ≥88.1 pg/mL). Higher PTH was associated with older age (P = 0.001); renal failure (P < 0.001), higher HDL cholesterol (P = 0.006) and creatinine (P < 0.001) and lower 25-OH cholecalciferol (P < 0.001). Suboptimal response to ASA was infrequent (2.8%), and not influenced by the levels of PTH (P = 0.57). ADP-mediated platelet aggregation was significantly increased in patients with higher PTH (P = 0.03), with an absolute increase in the prevalence of HRPR to ADP antagonists for higher PTH (24.7% vs. 40%, P = 0.007 for 4th vs. 1-3rd quartiles, adjusted OR[95%CI] = 2.04[1.14-3.64], P = 0.02). By the use of the ROC curve, we identified PTH levels above 96.7 pg/mL as the best predictor of HRPR with ADP antagonists (adjusted OR[95%CI] = 2.52[1.31-4.87], P = 0.006). Higher rate of HRPR was confirmed for PTH >96.7 pg/mL among the subgroup of patients on clopidogrel (51.5 vs. 85.7%, P = 0.001; adjusted OR[95%CI] = 12.5[2.6-60.9], P = 0.002), but not among ticagrelor-treated patients (11.3 vs. 16.7%, P = 0.31; adjusted OR[95%CI] = 1.55[0.56-4.6], P = 0.42). CONCLUSION: In patients receiving dual antiplatelet therapy for coronary artery disease, higher PTH levels are associated with an increased ADP-mediated platelet reactivity and suboptimal response to clopidogrel, especially for values above 96.7 pg/mL, while not influencing the effectiveness of ASA and ticagrelor.

12 Article Impact of renal function on mean platelet volume and its relationship with coronary artery disease: A single-centre cohort study. 2016

Verdoia, Monica / Barbieri, Lucia / Schaffer, Alon / Bellomo, Giorgio / Marino, Paolo / De Luca, Giuseppe / Anonymous13270863. ·Division of Cardiology, AOU Maggiore della Carità, Eastern Piedmont University, Novara. Italy. · Clinical Chemistry, AOU Maggiore della Carità, Eastern Piedmont University, Novara. Italy; Departement of Translational Medicine, Eastern Piedmont University, Novara, Italy. · Division of Cardiology, AOU Maggiore della Carità, Eastern Piedmont University, Novara. Italy; Departement of Translational Medicine, Eastern Piedmont University, Novara, Italy. · Division of Cardiology, AOU Maggiore della Carità, Eastern Piedmont University, Novara. Italy; Departement of Translational Medicine, Eastern Piedmont University, Novara, Italy; Centro di Biotecnologie per la Ricerca Medica Applicata (BRMA), Eastern Piedmont University, Novara, Italy. Electronic address: giuseppe.deluca@med.unipmn.it. ·Thromb Res · Pubmed #27039166.

ABSTRACT: BACKGROUND: Mean platelet volume (MPV) has been proposed as a marker of platelet reactivity and cardiovascular disease. Chronic kidney disease (CKD) significantly favors the occurrence of cardiovascular events, by increasing the circulating levels of a wide spectrum of pro-oxidant and pro-thrombotic mediators. However, opposite alterations of platelet function, both enhanced aggregability and increased bleeding diathesis have been reported in these patients, with contrasting results on the effects of renal function on MPV and coronary artery disease, that were assessed in present study. METHODS: In patients undergoing coronary angiography, MPV and renal function (serum creatinine and estimated Glomerular Filtration Rate, eGFR, by MDRD formula) were assessed at admission. Coronary artery disease (CAD) was defined as a stenosis >50% in at least 1 coronary vessel, while severe CAD as left main or trivessel disease. RESULTS: Among 3712 patients, 1044 (28.1%) had chronic kidney disease. CKD was related with age, female gender, diabetes and glycemic control, history of myocardial infarction, cerebrovascular accidents, coronary artery bypass grafting and left ventricular dysfunction or arrhythmias as indication to angiography, therapy with angiotensin-receptor blockers, nitrates, diuretics and calcium-antagonists, but lower rate of smoking, lower fibrinogen levels, haemoglobin, total and HDL cholesterol (p<0.001, respectively). CKD patients displayed increased severity and complexity of CAD (p<0.001) and significantly larger platelet volume (p<0.001), with CKD resulting as independent predictor of MPV above the median (≥10.85fl; Adjusted OR[95%CI]=1.56[1.23,1.99], p=0.002). Moreover, in the 1044 patients with renal failure, higher platelet volume (above the median value; ≥10.85fl) was associated with age (p=0.05), haemoglobin levels and platelet count (p<0.001), but not to a higher prevalence or extent of coronary artery disease (CAD: adjusted OR[95%CI]=0.80[0.58-1.09], p=0.16; severe CAD, adjusted OR[95%CI]=1.07[0.81-1.41], p=0.65). CONCLUSIONS: Higher values of MPV are observed among patients with chronic kidney disease, inversely relating to eGFR. However, larger platelet size does not contribute to explain the increased severity of coronary artery disease observed among these patients.

13 Article Indications and immediate and long-term results of a novel pericardium covered stent graft: Consecutive 5 year single center experience. 2016

Secco, Gioel Gabrio / Serdoz, Roberta / Kilic, Ismail Dogu / Caiazzo, Gianluca / Mattesini, Alessio / Parisi, Rosario / De Luca, Giuseppe / Pistis, Gianfranco / Marino, Paolo Nicola / Di Mario, Carlo. ·NIHR Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom. · Interventional Cardiology, "Antonio E Biagio E Cesare Arrigo" Hospital, Alessandria, Italy. · Department of Cardiology, Pamukkale University, Denizli, Turkey. · Department of Cardiology, University of Eastern Piedmont, Novara, Italy. ·Catheter Cardiovasc Interv · Pubmed #26541909.

ABSTRACT: BACKGROUND: The use of covered stent grafts during percutaneous coronary intervention (PCI) is a life saving solution to seal acute iatrogenic vessel rupture. However, the presence of an impenetrable mechanical barrier is also appealing during treatment of friable coronary plaques but the synthetic PTFE-membrane that might trigger excessive neointimal proliferation has limited its elective-use. Pericardium tissue may offer an appealing "natural" alternative. Aim of our study is to report the consecutive 5-year single center experience with the use of pericardium-covered stents (PCS) (ITGI-Medical, Israel) in a variety of emergency and elective applications. METHODS: Nineteen consecutive patients undergoing implantation of PCS at the Royal Brompton in the last 5-years. Reasons for PCS implantation included treatment of degenerated vein grafts, large coronary aneurysms, and acute iatrogenic vessel rupture. RESULTS: Angiographic success, defined as the ability of the device to be deployed in the indexed lesion with no contrast extravasation with residual angiographic stenosis <30% and a final thrombolysis in myocardial infarction (TIMI)-3 flow was achieved in all cases. Procedural success, defined as the achievement of angiographic success without any major adverse cardiovascular event (MACE) was achieved in 94.7% of patients. In-stent restenosis (ISR) was observed in 26.3% and all patients underwent successful target vessel revascularization with DES (mean time to restenosis 9.0 ± 4.0 months). At a mean follow-up of 32.5 ± 23.3 months no acute or late stent thrombosis was observed. CONCLUSION: PCSs were effective in the treatment of friable embolization-prone coronary plaques, sealing of acute iatrogenic vessel rupture and exclusion of large aneurysms with no thrombosis but high target lesion revascularization.

14 Article Neutrophil to Lymphocyte Ratio and the Extent of Coronary Artery Disease: Results From a Large Cohort Study. 2016

Verdoia, Monica / Barbieri, Lucia / Di Giovine, Gabriella / Marino, Paolo / Suryapranata, Harry / De Luca, Giuseppe / Anonymous1580825. ·Department of Cardiology, Ospedale "Maggiore della Carità", Eastern Piedmont University, Novara, Italy. · Department of Cardiology, UMC St Radboud, Nijmegen, the Netherlands. ·Angiology · Pubmed #25818102.

ABSTRACT: The neutrophil to lymphocyte ratio (NLR), an inflammatory biomarker, may be of predictive and prognostic value for cardiovascular (CV) events. We evaluated the relationship of NLR with the prevalence and extent of coronary artery disease (CAD) in consecutive patients undergoing elective or urgent coronary angiography. Our population (n = 3738 patients) was divided into NLR quartiles. Higher NLR was associated with aging and established CV risk factors, previous percutaneous coronary revascularization, acute presentation, and more complex pharmacological therapy. The NLR was related to platelet count, white blood cell count, creatinine, glycemia, uric acid, and C-reactive protein (all P = .001) levels but inversely related to hemoglobin (P < .001), total cholesterol (P = .005), and triglycerides (P < .001) levels. The NLR was associated with multivessel disease (P < .001), anterior descending, right coronary arteries (P < .001) or circumflex branch lesions (P = .01), percentage of stenosis (P < .001), coronary calcification (P < .001), and intracoronary thrombus (P < .001) but inversely with in-stent restenosis (P < .001) and thrombolysis in myocardial infarction flow (P = .04). The NLR was directly related to the prevalence of CAD (P = .001) and severe CAD (P < .001). In patients undergoing coronary angiography, the NLR is independently associated with the prevalence and severity of CAD.

15 Article Platelet Larger Cell Ratio and High-on Treatment Platelet Reactivity During Dual Antiplatelet Therapy. 2015

Verdoia, Monica / Pergolini, Patrizia / Rolla, Roberta / Nardin, Matteo / Barbieri, Lucia / Schaffer, Alon / Bellomo, Giorgio / Marino, Paolo / Suryapranata, Harry / De Luca, Giuseppe / Anonymous4340844. ·Department of Cardiology, Ospedale "Maggiore della Carità", Eastern Piedmont University, C.so Mazzini, 18, 28100, Novara, Italy. · Clinical Chemistry, Ospedale "Maggiore della Carità", Eastern Piedmont University, Novara, Italy. · Cardiology, UMC St Radboud, Nijmegen, The Netherlands. · Department of Cardiology, Ospedale "Maggiore della Carità", Eastern Piedmont University, C.so Mazzini, 18, 28100, Novara, Italy. giuseppe.deluca@maggioreosp.novara.it. ·Cardiovasc Drugs Ther · Pubmed #26428927.

ABSTRACT: BACKGROUND: Low response to antiplatelet agents has been associated to an increased risk of thrombotic complications and recurrent ischemic events. Platelet size has been proposed as a potential marker of platelet reactivity. Therefore, the aim of the present study was to evaluate the impact of platelet Larger Cell Ratio (p-LCR) on platelet aggregation and the prevalence of residual high-on treatment platelet reactivity (HRPR) in patients receiving dual antiplatelet therapy (DAPT) after a recent acute coronary syndrome or coronary revascularization. METHODS: Patients treated with DAPT (ASA and clopidogrel or ticagrelor) were scheduled for platelet function assessment at 30-90 days post-discharge. HRPR was considered for ASPI test >862 AU*min (for ASA) or ADP test values ≥417 AU*min (for ADP-antagonists) using impedance aggregometry. RESULTS: Our population consisted of 530 patients receiving DAPT, who were divided in tertiles according to values of p-LCR (< 27.6; 27.6-34.7; ≥34.7 l). p-LCR was related with use of beta-blockers (p = 0.02) and statins (p = 0.002), and inversely with acute presentation (p = 0.05). Higher platelet count (p < 0.001) and haemoglobin levels (p = 0.001) were observed in higher p-LCR tertiles. The prevalence of HRPR for ASA was low and not significantly different across tertiles of p-LCR (1.1 vs 1.1 vs 1.7%, p = 0.66; adjusted OR[95%CI] = 1.68[0.66-4.29], p = 0.27). Moreover, p-LCR did not influence the occurrence of HRPR for ADP-antagonists (24.4% vs 20.9% vs 25.6 %%, p = 0.80, adjusted OR[95%CI] = 0.88[0.67-1.17], p = 0.38) and similar results were obtained when considering separately patients receiving clopidogrel (adjusted OR[95%CI] = 1.21[0.86-1.69], p = 0.29) or ticagrelor (adjusted OR[95%CI] = 1.17[0.69-2], p = 0.56). CONCLUSION: In patients receiving DAPT for coronary artery disease, p-LCR does not impact platelet reactivity. Larger platelets did not influence the prevalence of high-on treatment platelet reactivity with the antiplatelet agents ASA, clopidogrel or ticagrelor.

16 Article Impact of diabetes on fibrinogen levels and its relationship with platelet reactivity and coronary artery disease: A single-centre study. 2015

Di Giovine, Gabriella / Verdoia, Monica / Barbieri, Lucia / Schaffer, Alon / Aimaretti, Gianluca / Bellomo, Giorgio / Marino, Paolo / Suryapranata, Harry / Sinigaglia, Fabiola / De Luca, Giuseppe / Anonymous130836. ·Department of Cardiology, Eastern Piedmont University, Novara, Italy. · Department of Translational Medicine, Eastern Piedmont University, Novara, Italy. · Department of Cardiology, Eastern Piedmont University, Novara, Italy; Department of Translational Medicine, Eastern Piedmont University, Novara, Italy. · Department of Cardiology, UMC St Radboud, Nijmegen, The Netherlands. · Department of Cardiology, Eastern Piedmont University, Novara, Italy; Department of Translational Medicine, Eastern Piedmont University, Novara, Italy. Electronic address: giuseppe.deluca@maggioreosp.novara.it. ·Diabetes Res Clin Pract · Pubmed #26163440.

ABSTRACT: BACKGROUND: Previous reports have suggested an association between elevated fibrinogen and CAD. Few studies have so far investigated the impact of diabetes on fibrinogen levels and its association with coronary artery disease (CAD) and platelet reactivity in diabetic patients that are therefore the aims of the current study. METHODS: We measured fibrinogen in 3280 consecutive patients undergoing coronary angiography. Samples were collected at admission for fibrinogen levels assessment. Coronary disease was defined for at least 1 vessel stenosis >50% as evaluated by QCA. RESULTS: Diabetes was observed in 1201 out of 3280 patients. Diabetic patients were older with more hypercholesterolemia, hypertension, higher BMI, more renal failure, previous MI or coronary revascularization (p<0.001, respectively) and smoking (p=0.001). Diabetic patients were more often on ACE-inhibitors, ARBs, b-blockers, calcium-antagonists, diuretics, statins (p<0.001, respectively), and ASA (p=0.004). Diabetic patients displayed higher glycaemia and HbA1c (p<0.001), higher creatinine and triglycerides (p<0.001) but lower total and HDL cholesterol (p<0.001) and haemoglobin (p<0.001). Diabetic patients had higher fibrinogen levels (p=0.003), however neither diabetes nor glucose homeostasis parameters resulted as independent predictors of hyperfibrinogenemia. Furthermore, among diabetic patients, higher fibrinogen levels did not affect platelet reactivity and were not associated with the prevalence of CAD (adjusted OR[95%CI]=0.99 [0.82-1.19], p=0.9). Similar results were found for severe CAD (adjusted OR[95%CI]=0.94 [0.82-1.08], p=0.40). CONCLUSIONS: Our study showed that diabetes and glycaemic control are not independent predictors of hyperfibrinogenemia. Among diabetic patients, elevated fibrinogen is not associated with platelet reactivity and the prevalence and extent of CAD.

17 Article Mean platelet volume and high-residual platelet reactivity in patients receiving dual antiplatelet therapy with clopidogrel or ticagrelor. 2015

Verdoia, Monica / Pergolini, Patrizia / Rolla, Roberta / Nardin, Matteo / Barbieri, Lucia / Schaffer, Alon / Bellomo, Giorgio / Marino, Paolo / Suryapranata, Harry / De Luca, Giuseppe. ·Eastern Piedmont University, Ospedale 'Maggiore della Carità', Department of Cardiology , C.so Mazzini, 18 28100 Novara , Italy +39 0321 3733141 ; +39 0321 3733407 ; giuseppe.deluca@maggioreosp.novara.it. ·Expert Opin Pharmacother · Pubmed #26067422.

ABSTRACT: OBJECTIVE: High on-treatment platelet reactivity (HRPR) is associated with a two- to ninefold increased risk of recurrent ischemic events among patients receiving dual antiplatelet therapy (DAPT) for coronary artery disease. However, its determinants are still poorly understood. The aim of the present study was to assess the impact of mean platelet volume (MPV) on platelet reactivity in patients receiving DAPT after an acute coronary syndrome or PCI. METHODS: Patients treated with DAPT (acetylsalicylic acid [ASA] and clopidogrel or ticagrelor) were scheduled for platelet function assessment at 30 - 90 days post-discharge. By whole blood impedance aggregometry, HRPR was considered for ASPI test > 862 aggregation units (AU)*min (for ASA) and ADP test values ≥ 417 AU*min (for ADP-antagonists). RESULTS: Our population is represented by a total of 487 patients on DAPT, divided according to MPV tertiles (< 10.4 fl; 10.4 - 11.29 fl; ≥ 11.3 fl). Larger-sized platelets were associated with use of statins (p < 0.001) and beta-blockers (p = 0.03), higher hemoglobin levels (p = 0.002) and lower platelets count (p < 0.001). Higher platelet reactivity was observed at ASPI test in patients with higher MPV (r = 0.12, p = 0.008), but not for ADP-mediated aggregation (r = -0.007, p = 0.88). However, a low prevalence of HRPR was observed with ASA, with no impact of MPV tertiles (1.2 vs 1.1 vs 1.6%, p = 0.70, adjusted OR [95% CI] = 1.05 [0.51 - 1.77], p = 0.87). MPV did not influence the prevalence of HRPR for ADP-antagonists (25.9 vs 1 vs 26.5%, p = 0.89; adjusted OR [95% CI] = 1.1 [0.84 - 1.45], p = 0.50) with similar results among the 259 patients receiving clopidogrel (adjusted OR [95% CI] = 1.15 [0.82 - 1.62], p = 0.43) and the 228 patients on ticagrelor (adjusted OR [95% CI] = 1.46 [0.84 - 2.55], p = 0.18). CONCLUSION: In patients receiving DAPT, MPV does not affect the response to major antiplatelet therapies. In fact, MPV elevation does not influence the risk of HRPR with clopidogrel, ticagrelor or ASA.

18 Article Impact of sex on uric acid levels and its relationship with the extent of coronary artery disease: A single-centre study. 2015

Barbieri, Lucia / Verdoia, Monica / Schaffer, Alon / Marino, Paolo / Suryapranata, Harry / De Luca, Giuseppe / Anonymous1630825. ·Division of Cardiology, Eastern Piedmont University, Novara, Italy. · Department of Cardiology, UMC St Radboud, Nijmegen, HS, The Netherlands. · Division of Cardiology, Eastern Piedmont University, Novara, Italy. Electronic address: giuseppe.deluca@med.unipmn.it. ·Atherosclerosis · Pubmed #25818387.

ABSTRACT: BACKGROUND: Serum uric acid (SUA) elevation has been largely addressed in the past as a possible risk factor for cardiovascular disease. However, uric acid has not clearly emerged as independent risk factor for coronary artery disease. Several studies in literature have assessed sex-related differences in the association between elevated SUA levels and cardiovascular events with conflicting results. Therefore, aim of the current study was to evaluate the relationship between uric acid levels and the extent of coronary artery disease in male and female patients undergoing coronary angiography. METHODS: Our population is represented by 3520 consecutive patients undergoing coronary angiography from March 2007 to October 2012. Patients were divided according to Tertiles of SUA (Males, Group 1, ≤5.5 mg/dL-0.33 mmol/mol, n = 762, Group 2, 5.5-6.8 mg/dL-0.33-0.40 mmol/mol, n = 829 and Group 3 ≥6.8 mg/dL-0.40 mmol/mol, n = 851), (Females, Group 1, ≤4.8 mg/dL-0.28 mmol/mol, n = 349, Group 2, 4.8-6.3 mg/dL-0.28-0.37 mmol/mol, n = 359 and Group 3 ≥ 6.3 mg/dL-0.37 mmol/mol, n = 370). Fasting samples were collected for uric acid levels assessment. Coronary disease was defined for at least 1 vessel stenosis >50% as evaluated by QCA. Severe coronary disease was defined as three-vessel disease and/or left main disease. RESULTS: Among 3520 patients, we identified 2442 men (69.4%) and 1078 women (30.6%). Males had higher levels of uric acid than women (6.33 ± 1.7 vs 5.8 ± 1.9 - p < 0.001). The association between elevated uric acid (≥7 mg/dl or 0.42 mmol/l) and male gender was confirmed after correction for baseline confounding factors (Adjusted OR = 1.28 [1.01-1.62], p = 0.004). Males displayed a significantly higher prevalence and extent of CAD (p < 0.001) and more complex coronary lesions (p < 0.001). However, no significant relationship was observed between uric acid and CAD (Adjusted OR [95%CI] = 0.90 [0.76-1.06], p = 0.22) or severe CAD (Adjusted OR [95%CI] = 0.89 [0.79-1.01], p = 0.08). Among females, higher SUA levels were significantly associated with higher prevalence of severe CAD (p < 0.001) (Adjusted OR [95% CI] = 1.29 [1.03-1.62], p = 0.03). CONCLUSION: Our study showed that uric acid levels are significantly higher in men. However, high uric acid levels are associated with severe CAD only in women. Future large studies are certainly needed to confirm our findings and to evaluate the effects of SUA lowering therapies on cardiovascular prevention and outcome, especially in women.

19 Article Glycosylated hemoglobin and the risk of periprocedural myocardial infarction in non-diabetic patients. 2015

Verdoia, Monica / Schaffer, Alon / Barbieri, Lucia / Di Giovine, Gabriella / Marino, Paolo / Suryapranata, Harry / De Luca, Giuseppe / Anonymous4270822. ·Division of Cardiology, Azienda Ospedaliera-Universitaria "Maggiore della Carità", Eastern Piedmont University, Novara, Italy. · Department of Cardiology, UMC St Radboud, Nijmegen, The Netherlands. · Division of Cardiology, Azienda Ospedaliera-Universitaria "Maggiore della Carità", Eastern Piedmont University, Novara, Italy. Electronic address: giuseppe.deluca@maggioreosp.novara.it. ·J Diabetes Complications · Pubmed #25736187.

ABSTRACT: BACKGROUND: Alterations of glucose homeostasis have been reported to occur even in non-diabetic patients, thus increasing the risk of cardiovascular events and worsening the outcome after an acute myocardial infarction (AMI). Still debated is the role of impaired glucose control in patients undergoing percutaneous coronary intervention (PCI), as hyperglycemia, represents an important pro-thrombotic stimulus, increasing platelet reactivity and potentially procedural complications. Therefore, the aim of our study was to assess the association between glycosylated hemoglobin and periprocedural myocardial infarction (PMI) in non-diabetic patients undergoing PCI. METHODS: We included patients without history of diabetes undergoing elective PCI. PMI was defined as creatine kinase-MB increase by 3 times the upper limit normal or by 50% of an elevated baseline value, whereas periprocedural myonecrosis as Troponin I increase by 3× ULN or 50% of baseline. RESULTS: Our population is represented by 1199 patients, who were divided according to tertile values of glycosylated hemoglobin (HbA1c). Higher HbA1c was associated with ageing (p<0.001), hypertension (p=0.005), previous myocardial infarction (p=0.009), PCI (p<0.001) or CABG (p=0.001), treatment with diuretics (p<0.001), higher levels of glycemia (p<0.001) and white blood cells (p=0.02), multivessel coronary artery disease (p=0.03), higher rate of instent restenosis (p=0.02). HbA1c did not impact on periprocedural myocardial infarction (p=0.85; adjusted OR [95% CI]=0.91 [0.74-1.12], p=0.38) or myonecrosis (p=0.69; adjusted OR [95% CI]=0.95 [0.80-1.13], p=0.56). Similar results were obtained fasting glycemia for PMI (p=0.82, adjusted OR [95% CI]=0.90 [0.71-1.14], p=0.37) and myonecrosis (p=0.21, adjusted OR [95% CI]=1.02 [0.84-1.24], p=0.84) and confirmed in high-risk subsets of patients. CONCLUSIONS: In non-diabetic patients undergoing elective PCI, neither glycosylated hemoglobin levels nor fasting glycemia are associated with the risk of periprocedural myocardial infarction and necrosis.

20 Article Homocysteine Levels Influence Platelet Reactivity in Coronary Artery Disease Patients Treated With Acetylsalicylic Acid. 2015

Verdoia, Monica / Schaffer, Alon / Pergolini, Patrizia / Rolla, Roberta / Barbieri, Lucia / Bellomo, Giorgio / Sinigaglia, Fabiola / Marino, Paolo / Suryapranata, Harry / De Luca, Giuseppe / Anonymous7670821. ·*Department of Cardiology, Azienda Ospedaliera-Universitaria Maggiore della Carità, Eastern Piedmont University, Novara, Italy; †Department of Clinical Chemistry, Azienda Ospedaliera-Universitaria Maggiore della Carità, Eastern Piedmont University, Novara, Italy; ‡Department of Translational Medicine, Centro di Biotecnologie per la Ricerca Medica Applicata (BRMA), Eastern Piedmont University, Novara, Italy; and §Department of Cardiology, UMC St Radboud, Nijmegen, the Netherlands. ·J Cardiovasc Pharmacol · Pubmed #25714593.

ABSTRACT: BACKGROUND: Suboptimal platelet inhibition with antiplatelet treatments is associated with a severe prognosis in patients with coronary artery disease (CAD), and the identification of its determinants is still challenging. Homocysteine elevation has emerged as a prothrombotic factor, influencing coagulative status and endothelial function and potentially modulating platelet aggregation. We therefore aimed to evaluate the effects of homocysteine (Hcy) levels on platelet reactivity in patients receiving acetylsalicylic acid (ASA) with or without ADP antagonists. METHODS: Patients undergoing coronary angiography and receiving ASA (100-160 mg daily) for >7 days, with or without ADP antagonists, were included. Aggregation tests were performed by multiple electrode aggregometry. Suboptimal platelet inhibition was defined as on-treatment aggregation above the lower limit of normality. RESULTS: Our population is represented by 508 ASA-treated patients, 406 (80.1%) of whom on dual antiplatelet therapy (ASA and ADP antagonists). Hcy levels above the median (15.1 nmol/mL) were associated with male gender (P = 0.04), hypertension (P = 0.004), hypercholesterolemia (P = 0.03), aging, renal failure (P < 0.001, respectively), previous coronary bypass grafting (P = 0.04), therapy with calcium antagonists (P = 0.04) and diuretics (P = 0.001), and multivessel CAD (P = 0.03). Higher Hcy is directly related with serum creatinine and uric acid (P < 0.001). Suboptimal platelet inhibition was found in 16 patients (3.2%) for ASA and for ADP antagonists in 80 patients (19.7%). Hcy levels significantly affected suboptimal response to ASA, but not to ADP-mediated aggregation. In fact, a linear relationship was found between homocysteine and platelet reactivity after stimulation with arachidonic acid (r = 0.14, P = 0.004) and collagen (r = 0.12, P = 0.02), but not with ADP (r = 0.02, P = 0.77). Moreover, after correction for baseline differences, Hcy above the median was confirmed as an independent predictor of impaired ASA response [adjusted odds ratio (95% confidence interval) = 3.7 (1.08-12.4), P = 0.04]. CONCLUSIONS: Among patients with CAD, elevated homocysteine is an independent predictor of suboptimal response to ASA, but not to ADP antagonists.

21 Article Impact of red blood cells count on the relationship between high density lipoproteins and the prevalence and extent of coronary artery disease: a single centre study [corrected]. 2015

Schaffer, Alon / Verdoia, Monica / Cassetti, Ettore / Barbieri, Lucia / Perrone-Filardi, Pasquale / Marino, Paolo / De Luca, Giuseppe. ·Division of Cardiology, Azienda Ospedaliera-Universitaria "Maggiore della Carità", Eastern Piedmont University, C.so Mazzini, 18, 28100, Novara, Italy. ·J Thromb Thrombolysis · Pubmed #25680891.

ABSTRACT: We have hypothesized that high red blood cells (RBC) count can potentially play an atheroprotective role in patients with coronary atherosclerosis. We, therefore, have investigated the relationship between high density lipoproteins cholesterol (HDL-C) and RBC levels in patients undergoing coronary angiography. Coronary artery disease (CAD) is a major cause of mortality. Impaired lipid profile represents a major risk factor for atherosclerosis. High density lipoprotein (HDL) is a key factor in atherosclerosis disease development. RBC can mimic HDL's reverse cholesterol transportation with a potential atheroprotective role. Coronary angiography has been evaluated in 3,534 patients. Fasting samples were collected for haematology and lipids levels assessment. Coronary disease was defined for at least 1 vessel stenosis >50 %. Patients were divided according to HDL-C and RBC tertiles. Lower HDL-C was significantly associated to the prevalence of CAD (84.8 vs 78.5 vs 67.3 %, p ≤ 0.001; adjusted OR [95 % CI] = 1.55 [1.3-1.8], p < 0.001) and severe CAD (30 % vs 30 % vs 24.4 %, p = 0.002; adjusted OR [95 % CI] = 1.08 [1.01-1.16], p = 0.02), this relationship was maintained even dividing our population according to RBC tertiles (p < 0.001).In conclusion, HDL-C levels are directly related to RBC count and inversely to the prevalence and extent of coronary disease. Higher RBC levels can reduce the risk of CAD in patients with lower HDL-C levels, suggesting an important atheroprotective role.

22 Article Impact of age on mean platelet volume and its relationship with coronary artery disease: a single-centre cohort study. 2015

Verdoia, Monica / Schaffer, Alon / Barbieri, Lucia / Bellomo, Giorgio / Marino, Paolo / Sinigaglia, Fabiola / Suryapranata, Harry / De Luca, Giuseppe / Anonymous780817. ·Division of Cardiology, AOU Maggiore della Carità, Eastern Piedmont University, Novara, Italy. · Clinical Chemistry, AOU Maggiore della Carità, Eastern Piedmont University, Novara, Italy; Departement of Translational Medicine, Eastern Piedmont University, Novara, Italy. · Division of Cardiology, AOU Maggiore della Carità, Eastern Piedmont University, Novara, Italy; Departement of Translational Medicine, Eastern Piedmont University, Novara, Italy. · Departement of Translational Medicine, Eastern Piedmont University, Novara, Italy; Centro di Biotecnologie per la Ricerca Medica Applicata (BRMA), Eastern Piedmont University, Novara, Italy. · Department of Cardiology, UMC St Radboud, Nijmegen, The Netherlands. · Division of Cardiology, AOU Maggiore della Carità, Eastern Piedmont University, Novara, Italy; Departement of Translational Medicine, Eastern Piedmont University, Novara, Italy; Centro di Biotecnologie per la Ricerca Medica Applicata (BRMA), Eastern Piedmont University, Novara, Italy. Electronic address: giuseppe.deluca@med.unipmn.it. ·Exp Gerontol · Pubmed #25562813.

ABSTRACT: METHODS: Our population is represented by a cohort of 3750 patients undergoing coronary angiography. Elderly were defined according to age ≥ 75 years. MPV was measured at admission. Significant coronary artery disease was defined as a stenosis >50% in at least 1 coronary vessel, while severe CAD was defined as left main and/or three-vessel disease. RESULTS: A total of 1170 out of 3750 (31.2%) patients were ≥ 75 years old. Advanced age was associated with female gender (p<0.001), hypertension (p<0.001), renal failure (p<0.001), previous myocardial infarction (p=0.03) coronary artery bypass grafting (p<0.001) indication to angiography (p<0.001), therapy with angiotension-receptor blockers, (p=0.003), nitrates, diuretics and calcium-antagonists (p<0.001), serum creatinine (p<0.001), fibrinogen (p<0.001) and C reactive protein (p=0.02), but inversely to percutaneous coronary interventions (p=0.02), dyslipidemia, family history of CAD and smoking (p<0.001, respectively), use of statins (p=0.02) and beta blockers (p=0.003), haemoglobin, total cholesterol and triglycerides (p<0.001, respectively), white blood cells (p=0.009) and platelet count (p=0.006). Elderly patients displayed a significantly larger platelet volume (p<0.001), with a direct linear relationship between age and the MPV (r=0.08, p<0.001), with age being confirmed as an independent predictor of larger MPV (≥10.85fl) at multivariate analysis (adjusted OR [95% CI]=1.18 [1.01-1.40], p=0.04). Among the elderly, MPV value above the median (≥10.85fl) was not associated with a higher prevalence of coronary artery disease (77.3 vs. 79.4%, p=0.39, adjusted OR [95% CI]=0.94 [0.66-1.33], p=0.71), or higher prevalence of severe CAD (35.2 vs. 32.4%, p=0.28, adjusted OR [95% CI]=1.34 [0.99-1.82], p=0.06). CONCLUSION: Advanced age was directly associated with larger mean platelet volume that, however, did not contribute to explain the higher prevalence and extent of coronary artery disease observed in elderly patients.

23 Article Elevated homocysteine and the risk of contrast-induced nephropathy: a cohort study. 2015

Barbieri, Lucia / Verdoia, Monica / Schaffer, Alon / Niccoli, Giampaolo / Perrone-Filardi, Pasquale / Bellomo, Giorgio / Marino, Paolo / Suryapranata, Harry / Luca, Giuseppe De. ·Division of Cardiology, Azienda Ospedaliera-Universitaria "Maggiore della Carità," Eastern Piedmont University, Novara, Italy. · Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy. · Department of Medicine, Cardiovascular and Immunological Sciences, University of Naples Federico II, Naples, Italy. · Clinical Chemistry, Azienda Ospedaliera-Universitaria "Maggiore della Carità," Eastern Piedmont University, Novara, Italy. · Department of Cardiology, UMC St Radboud, Nijmegen, the Netherlands. · Division of Cardiology, Azienda Ospedaliera-Universitaria "Maggiore della Carità," Eastern Piedmont University, Novara, Italy giuseppe.deluca@maggioreosp.novara.it. ·Angiology · Pubmed #24830422.

ABSTRACT: Contrast-induced nephropathy (CIN) is a common complication in patients with impaired kidney function undergoing coronary angiography/angioplasty. We evaluated whether elevated homocysteine (known to be associated with free radical generation and oxidative stress) increases the risk of CIN. Patients (n = 876) with creatinine clearance <60 mL/min undergoing coronary angiography or percutaneous coronary intervention (PCI) were divided into tertiles of homocysteine levels. Contrast-induced nephropathy was defined as ≥0.5 mg/dL or ≥25% creatinine increase 24 to 48 hours post-PCI. A significant relationship was observed between homocysteine levels and the risk of CIN (P = .033), confirmed after correction for baseline confounding factors, adjusted odds ratio, OR (95% confidence interval, [CI]) = 1.68 (1.09-2.59), P = .019. This association was also significant applying the new definition of contrast-induced acute kidney injury (11.9% in group 1, 10.4% in group 2, and 22.8% in group 3; P < .001), adjusted OR (95% CI) = 1.96 (1.3-2.95), P = .001. Future studies are needed to confirm our findings and to define the role of homocysteine in CIN.

24 Article Relationship between glycoprotein IIIa platelet receptor gene polymorphism and coronary artery disease. 2015

Verdoia, Monica / Cassetti, Ettore / Schaffer, Alon / Barbieri, Lucia / Giovine, Gabriella Di / Nardin, Matteo / Marino, Paolo / Sinigaglia, Fabiola / Luca, Giuseppe De / Anonymous4980786. ·Division of Cardiology, Azienda Ospedaliera-Universitaria "Maggiore della Carità", Eastern Piedmont University, Novara, Italy. · Department of Translational Medicine and Centro di Biotecnologie per la Ricerca Medica Applicata (BRMA), Eastern Piedmont University, Novara, Italy. ·Angiology · Pubmed #24586027.

ABSTRACT: Glycoprotein IIb/IIIa (GP IIb/IIIa) is a key receptor for platelet aggregation and adhesion. We investigated whether a single-nucleotide polymorphism of GP IIIa subunit (Leu33Pro-PlA(1)/PlA(2) allele) is associated with the extent of coronary artery disease (CAD) in a consecutive cohort of 1518 patients undergoing coronary angiography. Significant CAD was defined as at least a stenosis >50% and severe CAD as left main disease and/or trivessel disease. Additionally, carotid intima-media thickness (cIMT) was evaluated in 339 patients. The PlA(2) allele was observed in 458 (30.2%) patients and associated with hypercholesterolemia (P = .03). No difference was observed in the prevalence of CAD (72.6% vs 70.1%, P = .29; adjusted odds ratio, OR [95% confidence interval, CI] = 0.85 [0.67-1.08], P = .19) and severe CAD (27.5% vs 26.5%, adjusted OR [95% CI] = 0.93 [0.72-1.19], P = .55). Furthermore, Leu33Pro polymorphism did not affect cIMT and the prevalence of carotid plaques. Therefore, this polymorphism cannot be regarded as a risk factor for coronary or carotid atherosclerosis.

25 Article Pre-diabetes and the risk of contrast induced nephropathy in patients undergoing coronary angiography or percutaneous intervention. 2014

Barbieri, Lucia / Verdoia, Monica / Schaffer, Alon / Cassetti, Ettore / Di Giovine, Gabriella / Marino, Paolo / Suryapranata, Harry / De Luca, Giuseppe. ·Division of Cardiology, Azienda Ospedaliera-Universitaria "Maggiore della Carità", Eastern Piedmont University, Novara, Italy. · Department of Cardiology, UMC St Radboud, Nijmegen, The Netherlands. · Division of Cardiology, Azienda Ospedaliera-Universitaria "Maggiore della Carità", Eastern Piedmont University, Novara, Italy. Electronic address: p.de_luca@libero.it. ·Diabetes Res Clin Pract · Pubmed #25458324.

ABSTRACT: BACKGROUND: Contrast induced nephropathy (CIN) is a complication of coronary angiography/percutaneous intervention (PCI). It is known that diabetes is an independent risk factor for CIN, but we have no data regarding the association between CIN and glycemic levels in patients without diabetes. Aim of our study was to evaluate whether high level of glycated-haemoglobin in patients without diabetes is associated with an increased risk of CIN. METHODS: A total of 1324 patients without diabetes, undergoing elective/urgent coronary angiography/angioplasty were divided according to quartiles of baseline glycated-haemoglobin. CIN was defined as an absolute ≥ 0.5mg/dL or a relative ≥ 25% increase in creatinine level at 24-48 h after the procedure. RESULTS: Patients with elevated glycated-haemoglobin were older, with hypertension, metabolic syndromes, previous history of AMI, PCI and CABG. They had higher gycaemia, fasting-glycaemia and triglycerides but lower HDL-cholesterol. Patients with higher glycated-haemoglobin were more often on therapy with statins, diuretics and calcium-antagonist at admission, had higher basal, 24 and 48 h creatinine, lower creatinine clearance and lower ejection fraction. They had the highest incidence of PCI and contrast volume-eGFR rate. CIN occurred in 10.6% of patients with a linear association with glycated-haemoglobin (p=0.001). No relationship was found between glycaemia/fasting glycaemia at admission and CIN. The multivariate analysis confirmed the association between elevated glycated haemoglobin (above the median value 5.7%) and the risk of CIN after adjustment for baseline confounding factors (Adjusted OR [95% CI]=1.69 [1.14-2.51], p=0.009). In fact, the results were consistent in major high-risk subgroups. CONCLUSION: This is the first study showing that among patients without diabetes undergoing coronary angiography/PCI elevated glycated-haemoglobin but not glucose levels is independently associated with the risk of CIN.

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