The Experts below are selected from a list of 10482 Experts worldwide ranked by ideXlab platform
Piergiuseppe Agostoni - One of the best experts on this subject based on the ideXlab platform.
-
effects of β2 receptor stimulation by indacaterol in chronic heart failure treated with selective or non selective β blockers a randomized trial
Scientific Reports, 2020Co-Authors: Mauro Contini, Emanuele Spadafora, Simone Barbieri, Paola Gugliandolo, Elisabetta Salvioni, Alessandra Magini, Anna Apostolo, Pietro Palermo, Marina Alimento, Piergiuseppe AgostoniAbstract:Alveolar β2-receptor blockade worsens Lung Diffusion in heart failure (HF). This effect could be mitigated by stimulating alveolar β2-receptors. We investigated the safety and the effects of indacaterol on Lung Diffusion, Lung mechanics, sleep respiratory behavior, cardiac rhythm, welfare, and exercise performance in HF patients treated with a selective (bisoprolol) or a non-selective (carvedilol) β-blocker. Study procedures were performed before and after indacaterol and placebo treatments according to a cross-over, randomized, double-blind protocol in forty-four patients (27 on bisoprolol and 17 on carvedilol). No differences between indacaterol and placebo were observed in the whole population except for a significantly higher VE/VCO2 slope and lower maximal PETCO2 during exercise with indacaterol, entirely due to the difference in the bisoprolol group (VE/VCO2 31.8 ± 5.9 vs. 28.5 ± 5.6, p < 0.0001 and maximal PETCO2 36.7 ± 5.5 vs. 37.7 ± 5.8 mmHg, p < 0.02 with indacaterol and placebo, respectively). In carvedilol, indacaterol was associated with a higher peak heart rate (119 ± 34 vs. 113 ± 30 bpm, with indacaterol and placebo) and a lower prevalence of hypopnea during sleep (3.8 [0.0;6.3] vs. 5.8 [2.9;10.5] events/hour, with indacaterol and placebo). Inhaled indacaterol is well tolerated in HF patients, it does not influence Lung Diffusion, and, in bisoprolol, it increases ventilation response to exercise.
-
the alveolar to arterial oxygen partial pressure difference is associated with pulmonary diffusing capacity in heart failure patients
Respiratory Physiology & Neurobiology, 2016Co-Authors: Marco Morosin, Susanna Sciomer, Elisabetta Salvioni, Marina Alimento, Carlo Vignati, Angela Novi, Fabrizio Veglia, Guido Merli, Gianfranco Sinagra, Piergiuseppe AgostoniAbstract:In chronic heart failure (HF), the alveolar-capillary membrane undergoes a remodeling process that negatively affects gas exchange. In case of alveolar-capillary gas Diffusion impairment, arterial desaturation (SaO2) is rarely observed in HF patients. At play are 3 factors: overall pulmonary diffusing capacity (assessed as Lung Diffusion for CO, DLCO), global O2 consumption (VO2) and alveolar (A) to arterial (a) pO2 gradient (AaDO2). In 100 consecutive stable HF patients, DLCO, resting respiratory gases and arterial blood gases were measured to determine VO2, paO2, pAO2 and AaDO2. DLCO was poorly but significantly related to AaDO2. The correlation improved after correcting AaDO2 for VO2 (p<0.001, r=0.49). Both VO2 and AaDO2 were independently associated with DLCO (p<0.001). Patients with reduced DLCO showed no differences as regards paO2 and pAO2. AaDO2/VO2 showed a higher gradient in patients with lower DLCO. AaDO2 increase and VO2 reduction allow preventing low SaO2 in HF patients with reduced DLCO. Accordingly, we suggest considering AaDO2 and VO2 combined and reporting AaDO2/VO2.
-
alveolar capillary membrane Diffusion measurement by nitric oxide inhalation in heart failure
European Journal of Preventive Cardiology, 2015Co-Authors: Alessandra Magini, Elisabetta Salvioni, Anna Apostolo, Piergiuseppe Agostoni, Fabrizio Veglia, Gianpiero ItalianoAbstract:BackgroundIn heart failure, Lung Diffusion is reduced, it correlates with prognosis and exercise capacity, and it is a therapy target.DesignDiffusion is measured as CO total Diffusion (DLCO), which has two components: membrane Diffusion (Dm) and capillary volume, the latter related to CO and O2 competition for hemoglobin. DLCO needs to be corrected for hemoglobin. Diffusion can also be measured with NO (DLNO), which has a very high affinity for hemoglobin, and thus, the resistance of hemoglobin being trivial, it directly represents Dm. Therefore, Dm is directly calculated from DLNO through a correction factor. DLNO has never been measured in heart failure. The study aims at determining, in heart failure, DLNO, Dm correction factor, and whether DmNO provides Dm estimates comparable to DmCO.MethodsWe measured DLCO, DmCO by multi-maneuver Roughton–Forster method, and DLCO and DLNO by single-breath maneuver in 50 heart failure and 50 healthy subjects.ResultsDLCO was 21.9 ± 4.8 ml/mmHg per min and 16.8 ± 5.1 i...
-
the effects of anesthesia muscle paralysis and ventilation on the Lung evaluated by Lung Diffusion for carbon monoxide and pulmonary surfactant protein b
Anesthesia & Analgesia, 2015Co-Authors: Fabiano Di Marco, Cristina Banfi, Anna Apostolo, Piergiuseppe Agostoni, Daniele Bonacina, Emanuele Vassena, Erik Arisi, Stefano Centanni, Roberto FumagalliAbstract:BACKGROUND:An increased alveolar-arterial oxygen tension difference is frequent in anesthetized patients. In this study, we evaluated the effect on the Lung of anesthesia, muscle paralysis, and a brief course of mechanical ventilation.METHODS:Lung Diffusion for carbon monoxide (DLCO), including pulm
-
opposite behavior of plasma levels surfactant protein type b and receptor for advanced glycation end products in pulmonary sarcoidosis
Respiratory Medicine, 2013Co-Authors: Damiano Magri, Cristina Banfi, Salvatore Mariotta, Agnese Ricotta, Alessandro Onofri, Alberto Ricci, Lara Pisani, Filippo Maria Cauti, Stefania Ghilardi, Piergiuseppe AgostoniAbstract:Summary Background No biological marker is currently available for evaluating pulmonary involvement and/or for monitoring the clinical course of sarcoidosis. The present pilot study focused on possible relationships between circulating plasma levels of surfactant protein type B (SP-B) and plasma receptor for advanced glycation end products (RAGE) and Lung function abnormalities in patients with pulmonary sarcoidosis, since both SP-B and RAGE have been previously suggested as Lung injury markers. The plasmatic levels of these two proteins were also investigated with respect to functional capacity, as assessed by a cardiopulmonary exercise test (CPET). Methods Thirty pulmonary sarcoidosis outpatients and fifteen volunteers (Control Group) underwent Lung function tests and CPET. Resting SP-B and RAGE plasma levels were also determined. Patients were then categorized according to the severity of their pulmonary involvement, as assessed in terms of Lung Diffusion for carbon monoxide (DLCO) values. Results Group B showed SP-B levels higher and RAGE levels lower than Group A and Control Group (p Conclusions Circulating plasma levels of SP-B and RAGE showed an opposite behavior in patients with pulmonary sarcoidosis. SP-B values are directly related to alveolar unit damage, supporting a possible role of SP-B as a marker of disease severity in these patients. Differently, RAGE decreases in severe sarcoidosis, suggesting more complex underlying mechanisms.
Anna Apostolo - One of the best experts on this subject based on the ideXlab platform.
-
effects of β2 receptor stimulation by indacaterol in chronic heart failure treated with selective or non selective β blockers a randomized trial
Scientific Reports, 2020Co-Authors: Mauro Contini, Emanuele Spadafora, Simone Barbieri, Paola Gugliandolo, Elisabetta Salvioni, Alessandra Magini, Anna Apostolo, Pietro Palermo, Marina Alimento, Piergiuseppe AgostoniAbstract:Alveolar β2-receptor blockade worsens Lung Diffusion in heart failure (HF). This effect could be mitigated by stimulating alveolar β2-receptors. We investigated the safety and the effects of indacaterol on Lung Diffusion, Lung mechanics, sleep respiratory behavior, cardiac rhythm, welfare, and exercise performance in HF patients treated with a selective (bisoprolol) or a non-selective (carvedilol) β-blocker. Study procedures were performed before and after indacaterol and placebo treatments according to a cross-over, randomized, double-blind protocol in forty-four patients (27 on bisoprolol and 17 on carvedilol). No differences between indacaterol and placebo were observed in the whole population except for a significantly higher VE/VCO2 slope and lower maximal PETCO2 during exercise with indacaterol, entirely due to the difference in the bisoprolol group (VE/VCO2 31.8 ± 5.9 vs. 28.5 ± 5.6, p < 0.0001 and maximal PETCO2 36.7 ± 5.5 vs. 37.7 ± 5.8 mmHg, p < 0.02 with indacaterol and placebo, respectively). In carvedilol, indacaterol was associated with a higher peak heart rate (119 ± 34 vs. 113 ± 30 bpm, with indacaterol and placebo) and a lower prevalence of hypopnea during sleep (3.8 [0.0;6.3] vs. 5.8 [2.9;10.5] events/hour, with indacaterol and placebo). Inhaled indacaterol is well tolerated in HF patients, it does not influence Lung Diffusion, and, in bisoprolol, it increases ventilation response to exercise.
-
Effects of β2-receptor stimulation by indacaterol in chronic heart failure treated with selective or non-selective β-blockers: a randomized trial
'Springer Science and Business Media LLC', 2020Co-Authors: M. Contini, Emanuele Spadafora, Simone Barbieri, Paola Gugliandolo, Elisabetta Salvioni, Alessandra Magini, Anna Apostolo, Marina Alimento, P. Palermo, P. AgostoniAbstract:Alveolar \u3b22-receptor blockade worsens Lung Diffusion in heart failure (HF). This effect could be mitigated by stimulating alveolar \u3b22-receptors. We investigated the safety and the effects of indacaterol on Lung Diffusion, Lung mechanics, sleep respiratory behavior, cardiac rhythm, welfare, and exercise performance in HF patients treated with a selective (bisoprolol) or a non-selective (carvedilol) \u3b2-blocker. Study procedures were performed before and after indacaterol and placebo treatments according to a cross-over, randomized, double-blind protocol in forty-four patients (27 on bisoprolol and 17 on carvedilol). No differences between indacaterol and placebo were observed in the whole population except for a significantly higher VE/VCO2 slope and lower maximal PETCO2 during exercise with indacaterol, entirely due to the difference in the bisoprolol group (VE/VCO2 31.8\u2009\ub1\u20095.9 vs. 28.5\u2009\ub1\u20095.6, p\u2009<\u20090.0001 and maximal PETCO2 36.7\u2009\ub1\u20095.5 vs. 37.7\u2009\ub1\u20095.8\u2009mmHg, p\u2009<\u20090.02 with indacaterol and placebo, respectively). In carvedilol, indacaterol was associated with a higher peak heart rate (119\u2009\ub1\u200934 vs. 113\u2009\ub1\u200930 bpm, with indacaterol and placebo) and a lower prevalence of hypopnea during sleep (3.8 [0.0;6.3] vs. 5.8 [2.9;10.5] events/hour, with indacaterol and placebo). Inhaled indacaterol is well tolerated in HF patients, it does not influence Lung Diffusion, and, in bisoprolol, it increases ventilation response to exercise
-
comprehensive effects of left ventricular assist device speed changes on alveolar gas exchange sleep ventilatory pattern and exercise performance
Journal of Heart and Lung Transplantation, 2018Co-Authors: Anna Apostolo, Mauro Contini, Carlo Vignati, Stefania Paolillo, Vincenzo Tarzia, Jeness Campodonico, Massimo Mapelli, Massimo Massetti, Jonida Bejko, Francesca Maria RighiniAbstract:BACKGROUND Increasing left ventricular assist device (LVAD) pump speed according to the patient's activity is a fascinating hypothesis. This study analyzed the short-term effects of LVAD speed increase on cardiopulmonary exercise test (CPET) performance, muscle oxygenation (near-infrared spectroscopy), Diffusion capacity of the Lung for carbon monoxide (D lco ) and nitric oxide (D lno ), and sleep quality. METHODS We analyzed CPET, D lco and D lno , and sleep in 33 patients supported with the Jarvik 2000 (Jarvik Heart Inc., New York, NY). After a maximal CPET (n = 28), patients underwent 2 maximal CPETs with LVAD speed randomly set at 3 or increased from 3 to 5 during effort (n = 15). Then, at LVAD speed randomly set at 2 or 4, we performed (1) constant workload CPETs assessing O2 kinetics, cardiac output (CO), and muscle oxygenation (n = 15); (2) resting D lco and D lno (n = 18); and (3) nocturnal cardiorespiratory monitoring (n = 29). RESULTS The progressive pump speed increase raised peak volume of oxygen consumption (12.5 ± 2.5 ml/min/kg vs 11.7 ± 2.8 ml/min/kg at speed 3; p = 0.001). During constant workload, from speed 2 to 4, CO increased (at rest: 3.18 ± 0.76 liters/min vs 3.69 ± 0.75 liters/min, p = 0.015; during exercise: 5.91 ± 1.31 liters/min vs 6.69 ± 0.99 liters/min, p = 0.014), and system efficiency (τ = 65.8 ± 15.1 seconds vs 49.9 ± 14.8 seconds, p = 0.002) and muscle oxygenation improved. At speed 4, D lco decreased, and obstructive apneas increased despite a significant apnea/hypopnea index and a reduction of central apneas. CONCLUSIONS Short-term LVAD speed increase improves exercise performance, CO, O2 kinetics, and muscle oxygenation. However, it deteriorates Lung Diffusion and increases obstructive apneas, likely due to an increase of intrathoracic fluids. Self-adjusting LVAD speed is a fascinating but possibly unsafe option, probably requiring a monitoring of intrathoracic fluids.
-
alveolar capillary membrane Diffusion measurement by nitric oxide inhalation in heart failure
European Journal of Preventive Cardiology, 2015Co-Authors: Alessandra Magini, Elisabetta Salvioni, Anna Apostolo, Piergiuseppe Agostoni, Fabrizio Veglia, Gianpiero ItalianoAbstract:BackgroundIn heart failure, Lung Diffusion is reduced, it correlates with prognosis and exercise capacity, and it is a therapy target.DesignDiffusion is measured as CO total Diffusion (DLCO), which has two components: membrane Diffusion (Dm) and capillary volume, the latter related to CO and O2 competition for hemoglobin. DLCO needs to be corrected for hemoglobin. Diffusion can also be measured with NO (DLNO), which has a very high affinity for hemoglobin, and thus, the resistance of hemoglobin being trivial, it directly represents Dm. Therefore, Dm is directly calculated from DLNO through a correction factor. DLNO has never been measured in heart failure. The study aims at determining, in heart failure, DLNO, Dm correction factor, and whether DmNO provides Dm estimates comparable to DmCO.MethodsWe measured DLCO, DmCO by multi-maneuver Roughton–Forster method, and DLCO and DLNO by single-breath maneuver in 50 heart failure and 50 healthy subjects.ResultsDLCO was 21.9 ± 4.8 ml/mmHg per min and 16.8 ± 5.1 i...
-
the effects of anesthesia muscle paralysis and ventilation on the Lung evaluated by Lung Diffusion for carbon monoxide and pulmonary surfactant protein b
Anesthesia & Analgesia, 2015Co-Authors: Fabiano Di Marco, Cristina Banfi, Anna Apostolo, Piergiuseppe Agostoni, Daniele Bonacina, Emanuele Vassena, Erik Arisi, Stefano Centanni, Roberto FumagalliAbstract:BACKGROUND:An increased alveolar-arterial oxygen tension difference is frequent in anesthetized patients. In this study, we evaluated the effect on the Lung of anesthesia, muscle paralysis, and a brief course of mechanical ventilation.METHODS:Lung Diffusion for carbon monoxide (DLCO), including pulm
Mauro Contini - One of the best experts on this subject based on the ideXlab platform.
-
effects of β2 receptor stimulation by indacaterol in chronic heart failure treated with selective or non selective β blockers a randomized trial
Scientific Reports, 2020Co-Authors: Mauro Contini, Emanuele Spadafora, Simone Barbieri, Paola Gugliandolo, Elisabetta Salvioni, Alessandra Magini, Anna Apostolo, Pietro Palermo, Marina Alimento, Piergiuseppe AgostoniAbstract:Alveolar β2-receptor blockade worsens Lung Diffusion in heart failure (HF). This effect could be mitigated by stimulating alveolar β2-receptors. We investigated the safety and the effects of indacaterol on Lung Diffusion, Lung mechanics, sleep respiratory behavior, cardiac rhythm, welfare, and exercise performance in HF patients treated with a selective (bisoprolol) or a non-selective (carvedilol) β-blocker. Study procedures were performed before and after indacaterol and placebo treatments according to a cross-over, randomized, double-blind protocol in forty-four patients (27 on bisoprolol and 17 on carvedilol). No differences between indacaterol and placebo were observed in the whole population except for a significantly higher VE/VCO2 slope and lower maximal PETCO2 during exercise with indacaterol, entirely due to the difference in the bisoprolol group (VE/VCO2 31.8 ± 5.9 vs. 28.5 ± 5.6, p < 0.0001 and maximal PETCO2 36.7 ± 5.5 vs. 37.7 ± 5.8 mmHg, p < 0.02 with indacaterol and placebo, respectively). In carvedilol, indacaterol was associated with a higher peak heart rate (119 ± 34 vs. 113 ± 30 bpm, with indacaterol and placebo) and a lower prevalence of hypopnea during sleep (3.8 [0.0;6.3] vs. 5.8 [2.9;10.5] events/hour, with indacaterol and placebo). Inhaled indacaterol is well tolerated in HF patients, it does not influence Lung Diffusion, and, in bisoprolol, it increases ventilation response to exercise.
-
comprehensive effects of left ventricular assist device speed changes on alveolar gas exchange sleep ventilatory pattern and exercise performance
Journal of Heart and Lung Transplantation, 2018Co-Authors: Anna Apostolo, Mauro Contini, Carlo Vignati, Stefania Paolillo, Vincenzo Tarzia, Jeness Campodonico, Massimo Mapelli, Massimo Massetti, Jonida Bejko, Francesca Maria RighiniAbstract:BACKGROUND Increasing left ventricular assist device (LVAD) pump speed according to the patient's activity is a fascinating hypothesis. This study analyzed the short-term effects of LVAD speed increase on cardiopulmonary exercise test (CPET) performance, muscle oxygenation (near-infrared spectroscopy), Diffusion capacity of the Lung for carbon monoxide (D lco ) and nitric oxide (D lno ), and sleep quality. METHODS We analyzed CPET, D lco and D lno , and sleep in 33 patients supported with the Jarvik 2000 (Jarvik Heart Inc., New York, NY). After a maximal CPET (n = 28), patients underwent 2 maximal CPETs with LVAD speed randomly set at 3 or increased from 3 to 5 during effort (n = 15). Then, at LVAD speed randomly set at 2 or 4, we performed (1) constant workload CPETs assessing O2 kinetics, cardiac output (CO), and muscle oxygenation (n = 15); (2) resting D lco and D lno (n = 18); and (3) nocturnal cardiorespiratory monitoring (n = 29). RESULTS The progressive pump speed increase raised peak volume of oxygen consumption (12.5 ± 2.5 ml/min/kg vs 11.7 ± 2.8 ml/min/kg at speed 3; p = 0.001). During constant workload, from speed 2 to 4, CO increased (at rest: 3.18 ± 0.76 liters/min vs 3.69 ± 0.75 liters/min, p = 0.015; during exercise: 5.91 ± 1.31 liters/min vs 6.69 ± 0.99 liters/min, p = 0.014), and system efficiency (τ = 65.8 ± 15.1 seconds vs 49.9 ± 14.8 seconds, p = 0.002) and muscle oxygenation improved. At speed 4, D lco decreased, and obstructive apneas increased despite a significant apnea/hypopnea index and a reduction of central apneas. CONCLUSIONS Short-term LVAD speed increase improves exercise performance, CO, O2 kinetics, and muscle oxygenation. However, it deteriorates Lung Diffusion and increases obstructive apneas, likely due to an increase of intrathoracic fluids. Self-adjusting LVAD speed is a fascinating but possibly unsafe option, probably requiring a monitoring of intrathoracic fluids.
-
circulating plasma surfactant protein type b as biological marker of alveolar capillary barrier damage in chronic heart failure
Circulation-heart Failure, 2009Co-Authors: Damiano Magri, Maurizio Bussotti, Maura Brioschi, Jeanpaul Schmid, Elena Tremoli, Cristina Banfi, Mauro Contini, Anna Apostolo, Pietro Palermo, Susanna SciomerAbstract:Background— Surfactant protein type B (SPB) is needed for alveolar gas exchange. SPB is increased in the plasma of patients with heart failure (HF), with a concentration that is higher when HF severity is highest. The aim of this study was to evaluate the relationship between plasma SPB and both alveolar-capillary Diffusion at rest and ventilation versus carbon dioxide production during exercise. Methods and Results— Eighty patients with chronic HF and 20 healthy controls were evaluated consecutively, but the required quality for procedures was only reached by 71 patients with HF and 19 healthy controls. Each subject underwent pulmonary function measurements, including Lung Diffusion for carbon monoxide and membrane Diffusion capacity, and maximal cardiopulmonary exercise test. Plasma SPB was measured by immunoblotting. In patients with HF, SPB values were higher (4.5 [11.1] versus 1.6 [2.9], P=0.0006, median and 25th to 75th interquartile), whereas Lung Diffusion for carbon monoxide (19.7�4.5 versus 24.6...
-
alveolar membrane conductance decreases as bnp increases during exercise in heart failure rationale for bnp in the evaluation of dyspnea
Journal of Cardiac Failure, 2009Co-Authors: Gaia Cattadori, Damiano Magri, Susanna Sciomer, Mauro Contini, Anna Apostolo, Karlman Wasserman, Chiara Meloni, Saima Mustaq, Daniele Andreini, Fabrizio VegliaAbstract:Abstract Background In left ventricular failure (LVF) patients, brain natriuretic peptide (BNP), Lung Diffusion for carbon monoxide (DLCO), and alveolar-membrane conductance (DM) correlate with LVF severity and prognosis. The reduction of DLCO and DM during exercise reflects pulmonary edema formation. Methods and Results To evaluate, in LVF patients, the correlation between BNP and Lung Diffusion parameters at rest and during exercise, we studied 17 severe LVF patients, 13 moderate, and 10 normals measuring BNP and Lung Diffusion parameters before, at the end, and 1 hour after a 10-minute high-intensity constant-workload exercise. At rest, a significant correlation exists between BNP and Lung Diffusion parameters. Resting BNP, DLCO, and DM correlate with peak oxygen consumption ( P P P P Conclusions In severe LVF, BNP changes during exercise correlate with simultaneous reductions in DM, suggesting that BNP increase and pulmonary edema formation could be related.
-
Lung function with carvedilol and bisoprolol in chronic heart failure is β selectivity relevant
European Journal of Heart Failure, 2007Co-Authors: Maurizio Bussotti, Susanna Sciomer, Mauro Contini, Anna Apostolo, Pietro Palermo, Piergiuseppe Agostoni, Gaia Cattadori, Cesare FiorentiniAbstract:BACKGROUND Carvedilol is a beta-blocker with similar affinity for beta1- and beta2 receptors, while bisoprolol has higher beta1 affinity. The respiratory system is characterized by beta2-receptor prevalence. Airway beta receptors regulate bronchial tone and alveolar beta receptors regulate alveolar fluid re-absorption which influences gas Diffusion. AIMS To compare the effects of carvedilol and bisoprolol on Lung function in patients with chronic heart failure (CHF). METHODS AND RESULTS We performed a double-blind, cross-over study in 53 CHF patients. After 2 months of full dose treatment with either carvedilol or bisoprolol, we assessed Lung function by salbutamol challenge, carbon monoxide Lung Diffusion (DLCO), including membrane conductance (DM), and gas exchange during exercise. FEV1 and FVC were similar; after salbutamol FEV1 was higher with bisoprolol (p<0.04). DLco was 82+/-21% of predicted with carvedilol and 90+/-20% with bisoprolol (p<0.01) due to DM changes. Peak VO2 was 17.8+/-4.5 mL/min/kg on bisoprolol and 17.0+/-4.6 on carvedilol, (p<0.05) with no differences in bronchial tone (same expiratory time) throughout exercise. Differences were greater in the 22 subjects with DLCO<80%. CONCLUSION Carvedilol and bisoprolol have different effects on DLCO and response to salbutamol. DLCO differences, being DM related, are due to changes in active membrane transport which is under alveolar beta2-receptor control. Peak VO2 was slightly higher with bisoprolol particularly in CHF patients with reduced DLCO.
Pietro Palermo - One of the best experts on this subject based on the ideXlab platform.
-
effects of β2 receptor stimulation by indacaterol in chronic heart failure treated with selective or non selective β blockers a randomized trial
Scientific Reports, 2020Co-Authors: Mauro Contini, Emanuele Spadafora, Simone Barbieri, Paola Gugliandolo, Elisabetta Salvioni, Alessandra Magini, Anna Apostolo, Pietro Palermo, Marina Alimento, Piergiuseppe AgostoniAbstract:Alveolar β2-receptor blockade worsens Lung Diffusion in heart failure (HF). This effect could be mitigated by stimulating alveolar β2-receptors. We investigated the safety and the effects of indacaterol on Lung Diffusion, Lung mechanics, sleep respiratory behavior, cardiac rhythm, welfare, and exercise performance in HF patients treated with a selective (bisoprolol) or a non-selective (carvedilol) β-blocker. Study procedures were performed before and after indacaterol and placebo treatments according to a cross-over, randomized, double-blind protocol in forty-four patients (27 on bisoprolol and 17 on carvedilol). No differences between indacaterol and placebo were observed in the whole population except for a significantly higher VE/VCO2 slope and lower maximal PETCO2 during exercise with indacaterol, entirely due to the difference in the bisoprolol group (VE/VCO2 31.8 ± 5.9 vs. 28.5 ± 5.6, p < 0.0001 and maximal PETCO2 36.7 ± 5.5 vs. 37.7 ± 5.8 mmHg, p < 0.02 with indacaterol and placebo, respectively). In carvedilol, indacaterol was associated with a higher peak heart rate (119 ± 34 vs. 113 ± 30 bpm, with indacaterol and placebo) and a lower prevalence of hypopnea during sleep (3.8 [0.0;6.3] vs. 5.8 [2.9;10.5] events/hour, with indacaterol and placebo). Inhaled indacaterol is well tolerated in HF patients, it does not influence Lung Diffusion, and, in bisoprolol, it increases ventilation response to exercise.
-
circulating plasma surfactant protein type b as biological marker of alveolar capillary barrier damage in chronic heart failure
Circulation-heart Failure, 2009Co-Authors: Damiano Magri, Maurizio Bussotti, Maura Brioschi, Jeanpaul Schmid, Elena Tremoli, Cristina Banfi, Mauro Contini, Anna Apostolo, Pietro Palermo, Susanna SciomerAbstract:Background— Surfactant protein type B (SPB) is needed for alveolar gas exchange. SPB is increased in the plasma of patients with heart failure (HF), with a concentration that is higher when HF severity is highest. The aim of this study was to evaluate the relationship between plasma SPB and both alveolar-capillary Diffusion at rest and ventilation versus carbon dioxide production during exercise. Methods and Results— Eighty patients with chronic HF and 20 healthy controls were evaluated consecutively, but the required quality for procedures was only reached by 71 patients with HF and 19 healthy controls. Each subject underwent pulmonary function measurements, including Lung Diffusion for carbon monoxide and membrane Diffusion capacity, and maximal cardiopulmonary exercise test. Plasma SPB was measured by immunoblotting. In patients with HF, SPB values were higher (4.5 [11.1] versus 1.6 [2.9], P=0.0006, median and 25th to 75th interquartile), whereas Lung Diffusion for carbon monoxide (19.7�4.5 versus 24.6...
-
Lung function with carvedilol and bisoprolol in chronic heart failure is β selectivity relevant
European Journal of Heart Failure, 2007Co-Authors: Maurizio Bussotti, Susanna Sciomer, Mauro Contini, Anna Apostolo, Pietro Palermo, Piergiuseppe Agostoni, Gaia Cattadori, Cesare FiorentiniAbstract:BACKGROUND Carvedilol is a beta-blocker with similar affinity for beta1- and beta2 receptors, while bisoprolol has higher beta1 affinity. The respiratory system is characterized by beta2-receptor prevalence. Airway beta receptors regulate bronchial tone and alveolar beta receptors regulate alveolar fluid re-absorption which influences gas Diffusion. AIMS To compare the effects of carvedilol and bisoprolol on Lung function in patients with chronic heart failure (CHF). METHODS AND RESULTS We performed a double-blind, cross-over study in 53 CHF patients. After 2 months of full dose treatment with either carvedilol or bisoprolol, we assessed Lung function by salbutamol challenge, carbon monoxide Lung Diffusion (DLCO), including membrane conductance (DM), and gas exchange during exercise. FEV1 and FVC were similar; after salbutamol FEV1 was higher with bisoprolol (p<0.04). DLco was 82+/-21% of predicted with carvedilol and 90+/-20% with bisoprolol (p<0.01) due to DM changes. Peak VO2 was 17.8+/-4.5 mL/min/kg on bisoprolol and 17.0+/-4.6 on carvedilol, (p<0.05) with no differences in bronchial tone (same expiratory time) throughout exercise. Differences were greater in the 22 subjects with DLCO<80%. CONCLUSION Carvedilol and bisoprolol have different effects on DLCO and response to salbutamol. DLCO differences, being DM related, are due to changes in active membrane transport which is under alveolar beta2-receptor control. Peak VO2 was slightly higher with bisoprolol particularly in CHF patients with reduced DLCO.
-
spironolactone improves Lung Diffusion in chronic heart failure
European Heart Journal, 2005Co-Authors: Piergiuseppe Agostoni, Maurizio Bussotti, Mauro Contini, Alessandra Magini, Anna Apostolo, Gaia Cattadori, Daniele Andreini, Pietro PalermoAbstract:Aims To evaluate whether anti-aldosteronic treatment influences Lung Diffusion (DLCO) in chronic heart failure (HF) patients. Spironolactone improves clinical conditions and prognosis in chronic HF and reduces connective tissue matrix turnover; DLCO abnormalities in chronic HF are related to increase in fibrosis and connective tissue derangement. Methods and results Thirty stable chronic HF patients, with reduced DLCO (<80% of predicted), were randomly assigned to active treatment (25 mg spironolactone daily) or placebo in addition to conventional anti-failure treatment. They were evaluated by quality of life questionnaire, laboratory investigations, cardiopulmonary exercise test, and pulmonary function test, which included DLCO and membrane diffusing capacity (DM). The evaluation was done before treatment and 6 months after. Quality of life score and standard pulmonary function tests were not significantly affected by spironolactone, while active treatment increased DLCO due to an increase of DM (DLCO: 18.3±3.9 vs. 19.9±5.5 mL/min/mmHg; DM: 28.1±7.7 vs. 33.3±8.6 mL/min/mmHg) and peak oxygen consumption (peak VO2 16.8±1.9 vs.18.6±2.2 mL/min/kg). Increments of DLCO and peak VO2 were linearly related ( R =0.849, P <0.001). Conclusion These data show a positive effect of spironolactone on gas Diffusion and exercise capacity suggesting a novel mechanism by which anti-aldosteronic drugs improve HF clinical condition and prognosis.
-
does Lung Diffusion impairment affect exercise capacity in patients with heart failure
Heart, 2002Co-Authors: Piergiuseppe Agostoni, Maurizio Bussotti, Pietro Palermo, Marco GuazziAbstract:Objective: To determine whether there is a relation between impairment of Lung Diffusion and reduced exercise capacity in chronic heart failure. Design: 40 patients with heart failure in stable clinical condition and 40 controls participated in the study. All subjects underwent standard pulmonary function tests plus measurements of resting Lung Diffusion (carbon monoxide transfer, Tlco), pulmonary capillary volume (Vc), and membrane resistance (Dm), and maximal cardiopulmonary exercise testing. In 20 patients and controls, the following investigations were also done: (1) resting and constant work rate Tlco; (2) maximal cardiopulmonary exercise testing with inspiratory O 2 fractions of 0.21 and 0.16; and (3) rest and peak exercise blood gases. The other subjects underwent Tlco, Dm, and Vc measurements during constant work rate exercise. Results: In normoxia, exercise induced reductions of haemoglobin O 2 saturation never occurred. With hypoxia, peak exercise uptake (peak Vo 2 ) decreased from (mean (SD)) 1285 (395) to 1081 (396) ml/min (p 2 in heart failure (normoxia 2 correlated with O 2 arterial content at rest and during peak exercise in both normoxia and hypoxia. Tlco, Vc, and Dm increased during exercise. The increase in Tlco was greater in patients who had a smaller reduction of exercise capacity with hypoxia. Alveolar–arterial O 2 gradient at peak correlated with exercise capacity in heart failure during normoxia and, to a greater extent, during hypoxia. Conclusions: Lung Diffusion impairment is related to exercise capacity in heart failure.
Alessandro Brunelli - One of the best experts on this subject based on the ideXlab platform.
-
development of a patient centered aggregate score to predict survival after Lung resection for non small cell Lung cancer
The Journal of Thoracic and Cardiovascular Surgery, 2013Co-Authors: Alessandro Brunelli, Francesco Xiume, Majed Refai, Michele Salati, Rossana Berardi, Paola Mazzanti, Cecilia PompiliAbstract:Objective The objective of this analysis was to develop a survival aggregate score (SAS), including objective and subjective patient-based parameters, and assess its prognostic role after major anatomic resection for non–small cell Lung cancer. Methods A total of 245 patients underwent major Lung resections for non–small cell Lung cancer with preoperative evaluation of quality of life (Short-Form 36v2 survey) and complete follow-up. The Cox multivariable regression and bootstrap analyses were used to identify prognostic factors of overall servival, which were weighted to construct the scoring system and summed to generate the SAS. Results Cox regression analysis showed that the factors negatively associated with overall survival and used to construct the score were 36-item short-form health survey physical component summary score less than 50 (hazard ratio [HR], 1.7; P = .008), aged older than 70 years (HR, 1.9; P = .002), and carbon monoxide Lung Diffusion capacity less than 70% (HR, 1.7; P = .01). Patients were grouped into 4 risk classes according to their SAS. The 5-year overall survival was 78% in class SAS0, 59% in class SAS1, 42% in class SAS2, and 14% in class SAS3 (log-rank test, P P = .01), pT2 (log-rank test, P = .02), or pT3-4 (log-rank test, P = .001), and in those with stages pN0 (log-rank test, P = .0005) or pN1-2 (log-rank test, P = .02). The 5-year cancer-specific survival was 83% in class SAS0, 71% in class SAS1, 63% in class SAS2, and 17% in class SAS3 (log-rank test, P Conclusions This system may be used to refine stratification of prognosis for clinical and research purposes.
-
ers ests clinical guidelines on fitness for radical therapy in Lung cancer patients surgery and chemo radiotherapy
European Respiratory Journal, 2009Co-Authors: Alessandro Brunelli, Gaetano Rocco, Anne Charloux, C T Bolliger, Jeanpaul Sculier, Gonzalo Varela, Marc Licker, Mark K Ferguson, Corinne Faivrefinn, R M HuberAbstract:A collaboration of multidisciplinary experts on the functional evaluation of Lung cancer patients has been facilitated by the European Respiratory Society (ERS) and the European Society of Thoracic Surgery (ESTS), in order to draw up recommendations and provide clinicians with clear, up-to-date guidelines on fitness for surgery and chemo-radiotherapy. The subject was divided into different topics, which were then assigned to at least two experts. The authors searched the literature according to their own strategies, with no central literature review being performed. The draft reports written by the experts on each topic were reviewed, discussed and voted on by the entire expert panel. The evidence supporting each recommendation was summarised, and graded as described by the Scottish Intercollegiate Guidelines Network Grading Review Group. Clinical practice guidelines were generated and finalized in a functional algorithm for risk stratification of the Lung resection candidates, emphasising cardiological evaluation, forced expiratory volume in 1 s, systematic carbon monoxide Lung Diffusion capacity and exercise testing. Contrary to Lung resection, for which the scientific evidences are more robust, we were unable to recommend any specific test, cut-off value, or algorithm before chemo-radiotherapy due to the lack of data. We recommend that Lung cancer patients should be managed in specialised settings by multidisciplinary teams.
-
the european thoracic database project composite performance score to measure quality of care after major Lung resection
European Journal of Cardio-Thoracic Surgery, 2009Co-Authors: Alessandro Brunelli, Gaetano Rocco, Richard G Berrisford, Gonzalo VarelaAbstract:BACKGROUND: Performance measurement is an essential element of quality improvement initiatives. The objective of this study was to develop a composite performance score (CPS) incorporating processes and outcomes measures available in the European Society of Thoracic Surgeons (ESTS) Database and apply it to stratify performance of participating units. METHODS: A total of 1656 major Lung resections for malignant primary neoplastic disease were collected in the ESTS database from 2001 through 2003 and were analyzed. For the purpose of this study only data collected from units contributing more than 50 consecutive cases were included. Three quality domains were selected: preoperative care, operative care, and postoperative outcome. According to best available evidence the following measures were selected for each domain: preoperative care (% of predicted postoperative carbon monoxide Lung Diffusion capacity (ppoDLCO) measurement in patients with predicted postoperative forced expiratory volume in one second (ppoFEV1) <40%), operative care (% of systematic lymph node dissection), and outcomes (risk-adjusted cardiopulmonary morbidity and mortality rates). Morbidity and mortality risk models were developed by hierarchical logistic regression and validated by bootstrap analyses. Individual processes and outcomes scores were rescaled according to their standard deviations and summed to generate the CPS, which was used to rate units. RESULTS: CPS ranged from -4.4 to 3.7. Individual scores were poorly correlated with each other. Two units were negative outliers and two positive outliers (outside 95% confidence limits). Compared to the rating obtained by using the risk-adjusted mortality rates, all units changed their positions when ranked by CPS. CONCLUSIONS: The composite performance score methodology may support future peer-based organizational quality benchmarking initiatives and may be used for regulatory and credentialing purposes.
-
original research resectional Lung surgeryevaluation of expiratory volume Diffusion capacity and exercise tolerance following major Lung resection a prospective follow up analysis
Chest, 2007Co-Authors: Alessandro Brunelli, Francesco Xiume, Majed Refai, Michele Salati, Rita Marasco, Valeria Sciarra, Armando SabbatiniAbstract:Background:Lung resections determine a variable functional reduction depending on the extent of the resection and the time elapsed from the operation. The objectives of this study were to prospectively investigate the postoperative changes in FEV1, carbon monoxide Lung Diffusion capacity (Dlco), and exercise tolerance after major Lung resection at repeated evaluation times. Methods:FEV1, Dlco, and peak oxygen consumption (Vo2peak) calculated using the stair climbing test were measured in 200 patients preoperatively, at discharge, and 1 month and 3 months after lobectomy or pneumonectomy. Preoperative and repeated postoperative measures were compared, and a time-series, cross-sectional regression analysis was performed to identify factors associated with postoperative Vo2peak. Results:One month after lobectomy, FEV1, Dlco, and Vo2peak values were 79.5%, 81.5%, and 96% of preoperative values and recovered up to 84%, 88.5%, and 97% after 3 months, respectively. One month after pneumonectomy, FEV1percentage of predicted, Dlcopercentage of predicted, and Vo2peak values were 65%, 75%, and 87% of preoperative values, and were 66%, 80%, and 89% after 3 months, respectively. Three months after lobectomy, 27% of patients with COPD had improved FEV1, 34% had improved Dlco, and 43% had improved Vo2peak compared to preoperative values. The time-series, cross-sectional regression analysis showed that postoperative Vo2peak values were directly associated with preoperative values of Vo2peak, and postoperative values of FEV1and Dlco, and were inversely associated with age and body mass index. Conclusions:Our findings may be used during preoperative counseling and for deciding eligibility for operation along with other more traditional measures of outcome.
-
evaluation of expiratory volume Diffusion capacity and exercise tolerance following major Lung resection a prospective follow up analysis
Chest, 2007Co-Authors: Alessandro Brunelli, Francesco Xiume, Majed Refai, Michele Salati, Rita Marasco, Valeria Sciarra, Armando SabbatiniAbstract:Abstract Background: Lung resections determine a variable functional reduction depending on the extent of the resection and the time elapsed from the operation. The objectives of this study were to prospectively investigate the postoperative changes in FEV 1 , carbon monoxide Lung Diffusion capacity (Dlco), and exercise tolerance after major Lung resection at repeated evaluation times. Methods: FEV 1 , Dlco, and peak oxygen consumption (Vo 2 peak) calculated using the stair climbing test were measured in 200 patients preoperatively, at discharge, and 1 month and 3 months after lobectomy or pneumonectomy. Preoperative and repeated postoperative measures were compared, and a time-series, cross-sectional regression analysis was performed to identify factors associated with postoperative Vo 2 peak. Results: One month after lobectomy, FEV 1 , Dlco, and Vo 2 peak values were 79.5%, 81.5%, and 96% of preoperative values and recovered up to 84%, 88.5%, and 97% after 3 months, respectively. One month after pneumonectomy, FEV 1 percentage of predicted, Dlcopercentage of predicted, and Vo 2 peak values were 65%, 75%, and 87% of preoperative values, and were 66%, 80%, and 89% after 3 months, respectively. Three months after lobectomy, 27% of patients with COPD had improved FEV 1 , 34% had improved Dlco, and 43% had improved Vo 2 peak compared to preoperative values. The time-series, cross-sectional regression analysis showed that postoperative Vo 2 peak values were directly associated with preoperative values of Vo 2 peak, and postoperative values of FEV 1 and Dlco, and were inversely associated with age and body mass index. Conclusions: Our findings may be used during preoperative counseling and for deciding eligibility for operation along with other more traditional measures of outcome.
