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Article ; Online: Reply.

Cesari, Maurizio

2019 Volume 69, Issue 6, Page(s) 2715–2717

MeSH term(s)	Humans ; Liver Cirrhosis
Language	English
Publishing date	2019-07-17
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	604603-4
ISSN	1527-3350 ; 0270-9139
ISSN (online)	1527-3350
ISSN	0270-9139
DOI	10.1002/hep.30586
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Zs.A 1660: Show issues

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Article: Prevalence and prognostic value of cirrhotic cardiomyopathy as defined according to the proposed new classification.

Cesari, Maurizio / Frigo, Anna Chiara / Piano, Salvatore / Angeli, Paolo

Clinical and experimental hepatology

2021 Volume 7, Issue 3, Page(s) 270–277

Abstract: Aim of the study: Prevalence and prognostic relevance of cirrhotic cardiomyopathy (CCM), as defined according to the new core criteria proposed in 2019, are still unknown. We investigated this relevant issue in a large cohort of cirrhotic patients.: ... ...

Abstract	Aim of the study: Prevalence and prognostic relevance of cirrhotic cardiomyopathy (CCM), as defined according to the new core criteria proposed in 2019, are still unknown. We investigated this relevant issue in a large cohort of cirrhotic patients. Material and methods: We retrospectively interrogated a data set of 162 collected cirrhotic patients followed up for at least 6 years, who underwent standard Doppler echocardiography and were compared with 46 healthy subjects. Left ventricular (LV) geometry, systo-diastolic function, global longitudinal strain and the main hemodynamic parameters were assessed according to current guidelines. Systolic dysfunction was diagnosed if LV ejection fraction (LVEF) ≤ 50% and/or global longitudinal strain (GLS) < 18% or > 22%. Results: Adequate echocardiographic images permitting speckle tracking analysis were available in 83 patients. No patient presented LVEF ≤ 50%, GLS < 18% or > 22% was evident in 25%, advanced diastolic dysfunction was evident in 10%. Overall the prevalence of CCM was 29%. Patients with and without CCM presented similar clinical, biochemical, hemodynamic and echocardiographic features at baseline and similar incidence of death or type 1 hepatorenal syndrome at follow-up. Conclusions: According to the new criteria CCM is detected in 29%, mainly due to altered GLS at rest, but without prognostic relevance and therefore useless for the clinical management of cirrhotic patients. We propose to modify the criteria by removing the LVEF assessment and adding also a stress test assessing the cardiac contractile reserve to distinguish patients with a blunted cardiac response, which could present a worst prognosis.
Language	English
Publishing date	2021-08-23
Publishing country	Poland
Document type	Journal Article
ZDB-ID	2937940-4
ISSN	2449-8238 ; 2392-1099
ISSN (online)	2449-8238
ISSN	2392-1099
DOI	10.5114/ceh.2021.108708
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Article ; Online: Low myocardial mechano-energetic efficiency is an independent predictor of prognosis in advanced chronic liver disease.

Cesari, Maurizio / Frigo, Anna Chiara / Piano, Salvatore / Angeli, Paolo

European journal of gastroenterology & hepatology

2021 Volume 33, Issue 1S Suppl 1, Page(s) e656–e661

Abstract: Objective: We aimed at investigating if a low myocardial mechano-energetic efficiency (MEE) with energy waste could be a feature of cirrhotic cardiomyopathy and predictive of poor prognosis.: Methods: We retrospectively interrogated a large data set ... ...

Abstract	Objective: We aimed at investigating if a low myocardial mechano-energetic efficiency (MEE) with energy waste could be a feature of cirrhotic cardiomyopathy and predictive of poor prognosis. Methods: We retrospectively interrogated a large data set of 115 cirrhotic patients followed up for 6 years and compared with 50 healthy controls. Echocardiographic and haemodynamic parameters were assessed at baseline according with current guidelines. MEE was estimated by echocardiographic stroke volume (z-derived)/(heart rate × 0.6). Results: Cirrhotic patients presented low peripheral vascular resistance, a compensatory hyperdynamic syndrome with increased cardiac work, left atrial and left ventricular (LV) dimension and mass. Systolic parameters and MEE were similar between patients and controls. Patients with cirrhosis and refractory ascites showed significantly lower MEE compared with both patients with treatable ascites and patients without ascites (1.68 ± 0.47 vs. 1.98 ± 0.64 and 1.80 ± 0.37 ml/s; P < 0.05). Increased age and heart rate and reduced body weight, cardiac dimension and work significantly correlated with lower MEE, mostly when compared nonalcoholic with alcoholic cirrhosis (1.65 ± 0.42 vs. 1.95 ± 0.56 ml/s respectively; P = 0.002). Among the cardiovascular parameters left atrium enlargement and reduced MEE were independent predictors of death. Conclusions: In advanced chronic liver disease left ventricular performance is blunted due to an energetically inefficient cardiac mechanical work which correlates with a poor prognosis. Therefore, the simple basal assessment of MEE can identify patients with a worst prognosis which requires a close follow-up.
MeSH term(s)	Ascites ; Cardiomyopathies/diagnostic imaging ; Cardiomyopathies/etiology ; Humans ; Liver Cirrhosis/diagnostic imaging ; Liver Diseases ; Prognosis ; Retrospective Studies ; Stroke Volume
Language	English
Publishing date	2021-08-25
Publishing country	England
Document type	Journal Article
ZDB-ID	1034239-4
ISSN	1473-5687 ; 0954-691X
ISSN (online)	1473-5687
ISSN	0954-691X
DOI	10.1097/MEG.0000000000002198
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Zs.A 2932: Show issues

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Article ; Online: Primary aldosteronism in elderly, old, and very old patients.

Cesari, Maurizio / Seccia, Teresa Maria / Maiolino, Giuseppe / Rossi, Gian Paolo

Journal of human hypertension

2020 Volume 34, Issue 12, Page(s) 807–813

Abstract: Primary aldosteronism (PA) is common, but usually overlooked in the elderly, old, and very old patients in whom the already high absolute risk of cardiovascular events, particularly atrial fibrillation, can be further increased by PA. Although in the ... ...

Abstract	Primary aldosteronism (PA) is common, but usually overlooked in the elderly, old, and very old patients in whom the already high absolute risk of cardiovascular events, particularly atrial fibrillation, can be further increased by PA. Although in the last two decades there has been an explosion of studies devoted to diagnosis, subtyping, and treatment of PA, only relatively scant investigation has addressed these topics in patients older than 65 years of age. This narrative review fills a gap of information on the challenges of diagnosing and managing the PA patients who are 65 years old and older with particular attention to the benefit/risk ratio of pursuing the diagnosis in this cohort, which is markedly expanding owing to ageing of the population worldwide.
MeSH term(s)	Aged ; Atrial Fibrillation ; Humans ; Hyperaldosteronism/diagnosis ; Hyperaldosteronism/epidemiology ; Hyperaldosteronism/therapy ; Hypertension
Language	English
Publishing date	2020-09-14
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	639472-3
ISSN	1476-5527 ; 0950-9240
ISSN (online)	1476-5527
ISSN	0950-9240
DOI	10.1038/s41371-020-00395-2
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Article ; Online: Disease monitoring of Primary Aldosteronism.

Rossi, Gian Paolo / Cesari, Maurizio / Lenzini, Livia / Seccia, Teresa M

Best practice & research. Clinical endocrinology & metabolism

2020 Volume 34, Issue 2, Page(s) 101417

Abstract: Primary aldosteronism (PA) is a highly prevalent cause of arterial hypertension featuring excess cardiovascular events. A timely diagnosis and treatment of PA cures hyperaldosteronism and can provide resolution or improvement of arterial hypertension, ... ...

Abstract	Primary aldosteronism (PA) is a highly prevalent cause of arterial hypertension featuring excess cardiovascular events. A timely diagnosis and treatment of PA cures hyperaldosteronism and can provide resolution or improvement of arterial hypertension, even when the latter is resistant to drug treatment. Accordingly, strategies to screen early and widely the hypertensive patients for PA by means of simplified diagnostic algorithms are justified. Such strategies are particularly beneficial in subgroups of hypertensive patients, who are at the highest cardiovascular risk. Broadening of screening strategies means facing with an increased number of patients where monitoring the disease becomes necessary. Hence, after identification of the surgically and non surgically curable cases of PA and implementation of targeted treatment physicians are faced with the challenges of follow-up, which are scantly discussed in the literature. Hence, the purpose of this paper is to provide some recommendations on how to optimize the monitoring of patients in whom the PA subtype has been diagnosed and treatment, either with unilateral laparoscopic adrenalectomy or medically, has been instituted.
MeSH term(s)	Adrenalectomy/adverse effects ; Diagnostic Techniques, Endocrine/trends ; Humans ; Hyperaldosteronism/complications ; Hyperaldosteronism/diagnosis ; Hyperaldosteronism/epidemiology ; Hyperaldosteronism/therapy ; Hypertension/diagnosis ; Hypertension/epidemiology ; Hypertension/etiology ; Mass Screening/methods ; Mass Screening/trends ; Monitoring, Physiologic/methods ; Monitoring, Physiologic/trends ; Prevalence
Language	English
Publishing date	2020-03-10
Publishing country	Netherlands
Document type	Journal Article ; Review
ZDB-ID	2052339-7
ISSN	1878-1594 ; 1532-1908 ; 1521-690X
ISSN (online)	1878-1594 ; 1532-1908
ISSN	1521-690X
DOI	10.1016/j.beem.2020.101417
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Article ; Online: The cardiovascular consequences of hyperaldosteronism.

Rossi, Gian Paolo / Seccia, Teresa Maria / Maiolino, Giuseppe / Cesari, Maurizio

Annales d'endocrinologie

2020 Volume 82, Issue 3-4, Page(s) 174–178

Abstract: Primary aldosteronism (PA), the most common form of secondary hypertension, has been considered for decades as a "benign" form of hypertension, but evidences progressively built up to show that patients with PA had an excess rate of cardiovascular damage ...

Abstract	Primary aldosteronism (PA), the most common form of secondary hypertension, has been considered for decades as a "benign" form of hypertension, but evidences progressively built up to show that patients with PA had an excess rate of cardiovascular damage as compared to blood pressure-matched essential hypertensive patients. This review provides an updated view of structural and electrical cardiac remodeling and of vascular changes in hyperaldosteronism, and how they can favor development of cardiovascular events. The link between hyperaldosteronism and resistant hypertension is also examined, and the impact of targeted treatment of hyperaldosteronism on cardiovascular changes is finally discussed.
MeSH term(s)	Aldosterone/blood ; Blood Pressure/physiology ; Cardiovascular Diseases/etiology ; Cardiovascular Diseases/metabolism ; Humans ; Hyperaldosteronism/complications ; Hyperaldosteronism/metabolism ; Hyperaldosteronism/physiopathology ; Hypertension/blood ; Hypertension/etiology ; Hypertension/physiopathology
Chemical Substances	Aldosterone (4964P6T9RB)
Language	English
Publishing date	2020-02-28
Publishing country	France
Document type	Journal Article ; Review
ZDB-ID	299-9
ISSN	2213-3941 ; 0003-4266
ISSN (online)	2213-3941
ISSN	0003-4266
DOI	10.1016/j.ando.2020.02.006
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Uh III Zs.132: Show issues

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Article ; Online: Aldosterone and right ventricular dysfunction: more data to be collected with prospective cohort studies.

Rossi, Gian P / Cesari, Maurizio

Journal of cardiovascular medicine (Hagerstown, Md.)

2016 Volume 17, Issue 1, Page(s) 1–3

MeSH term(s)	Aldosterone ; Cohort Studies ; Heart Failure ; Humans ; Prospective Studies ; Ventricular Dysfunction, Left ; Ventricular Dysfunction, Right
Chemical Substances	Aldosterone (4964P6T9RB)
Language	English
Publishing date	2016-01
Publishing country	United States
Document type	Comment ; Editorial ; Research Support, Non-U.S. Gov't
ZDB-ID	2223461-5
ISSN	1558-2035 ; 1558-2027
ISSN (online)	1558-2035
ISSN	1558-2027
DOI	10.2459/JCM.0000000000000214
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Zs.A 5210: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 559: Show issues

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Article ; Online: Effects of Mineralocorticoid and AT1 Receptor Antagonism on The Aldosterone-Renin Ratio In Primary Aldosteronism-the EMIRA Study.

Rossi, Gian Paolo / Ceolotto, Giulio / Rossitto, Giacomo / Maiolino, Giuseppe / Cesari, Maurizio / Seccia, Teresa Maria

The Journal of clinical endocrinology and metabolism

2020 Volume 105, Issue 6

Abstract: Context: While current guidelines recommend the withdrawal of mineralocorticoid receptor antagonist (MRA) and renin-angiotensin system blockers for the screening and detection of primary aldosteronism (PA), this can worsen hypokalemia and control of ... ...

Abstract	Context: While current guidelines recommend the withdrawal of mineralocorticoid receptor antagonist (MRA) and renin-angiotensin system blockers for the screening and detection of primary aldosteronism (PA), this can worsen hypokalemia and control of high blood pressure (BP) values. Objective: To investigate whether aldosterone/renin ratio (ARR) values were affected by the MRA canrenone and/or by canrenone plus olmesartan treatment in patients with PA. Design: Within-patient study. Setting: The European Society of Hypertension center of excellence at the University of Padua. Patients: Consecutive patients with an unambiguous diagnosis of PA subtyped by adrenal vein sampling. Interventions: Patients were treated for 1 month with canrenone (50-100 mg orally), and for an additional month with canrenone plus olmesartan (10-20 mg orally). Canrenone and olmesartan were up-titrated over the first 2 weeks until BP values and hypokalemia were controlled. Patients with unilateral PA were adrenalectomized; those with bilateral PA were treated medically. Main outcome measures: BP, plasma levels of sodium and potassium, renin and aldosterone. Results: Canrenone neither lowered plasma aldosterone nor increased renin; thus, the high ARR and true positive rate remained unaffected. Addition of the angiotensin type 1 receptor blocker raised renin and slightly lowered aldosterone, which reduced the ARR and increased the false negative rate. Conclusions: At doses that effectively controlled serum potassium and BP values, canrenone did not preclude an accurate diagnosis in patients with PA. Addition of the angiotensin type 1 receptor blocker olmesartan slightly raised the false negative rate. Hence, MRA did not seem to endanger the accuracy of the diagnosis of PA.
MeSH term(s)	Aldosterone/blood ; Angiotensin II Type 1 Receptor Blockers/therapeutic use ; Canrenone/therapeutic use ; Drug Therapy, Combination ; Female ; Follow-Up Studies ; Humans ; Hyperaldosteronism/blood ; Hyperaldosteronism/drug therapy ; Hyperaldosteronism/pathology ; Imidazoles/therapeutic use ; Male ; Middle Aged ; Mineralocorticoid Receptor Antagonists/therapeutic use ; Prognosis ; Prospective Studies ; Receptor, Angiotensin, Type 1/chemistry ; Renin/blood ; Renin-Angiotensin System/drug effects ; Tetrazoles/therapeutic use
Chemical Substances	Angiotensin II Type 1 Receptor Blockers ; Imidazoles ; Mineralocorticoid Receptor Antagonists ; Receptor, Angiotensin, Type 1 ; Tetrazoles ; Aldosterone (4964P6T9RB) ; Canrenone (78O20X9J0U) ; olmesartan (8W1IQP3U10) ; Renin (EC 3.4.23.15)
Language	English
Publishing date	2020-02-10
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	3029-6
ISSN	1945-7197 ; 0021-972X
ISSN (online)	1945-7197
ISSN	0021-972X
DOI	10.1210/clinem/dgaa080
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Article ; Online: Laparoscopic mechanical latero-lateral esophagojejunostomy after total gastrectomy for cancer in the elderly: technical notes and results.

Evoli, Luca P / Amato, Lavinia / Renzi, Claudio / Valeri, Manuel / Capone, Orazio / Giuliani, Nadia / Cesari, Maurizio / Contine, Alessandro

Minerva surgery

2021 Volume 77, Issue 1, Page(s) 35–40

Abstract: Background: The realization of an esophagojejunostomy is a critical step in total gastrectomy. Several techniques based on a Roux-En-Y restoration of gastrointestinal continuity were described with similar results. We report our laparoscopic experience ... ...

Abstract	Background: The realization of an esophagojejunostomy is a critical step in total gastrectomy. Several techniques based on a Roux-En-Y restoration of gastrointestinal continuity were described with similar results. We report our laparoscopic experience in intracorporeal esophagojejunostomy. Methods: Adults who underwent laparoscopic total gastrectomy for cancer with latero-lateral (functional termino-terminal) Roux en Y intracorporeal esophagojejunostomy with linear stapler from January 2014 to December 2018 were included. Demographics, intra- and postoperative outcomes including 30-day readmissions and mortality were considered. Results: Thirty-two patients were included. Nodal dissection D1 was 16. Median operative time was 280'. Median blood loss was 200 mL. Fluid oral intake is usually resumed on the second postoperative day and soft solid diet is started on the third postoperative day. Three patients had minimal anastomotic leakage and they underwent nonoperative management. Median postoperative stay was 8.5 days. Conclusions: This technique may improve the ergonomics of esophagojejunostomy creation. The procedure is suitable for experienced laparoscopic surgeons.
MeSH term(s)	Adult ; Aged ; Anastomosis, Roux-en-Y/methods ; Anastomosis, Surgical ; Gastrectomy/methods ; Humans ; Laparoscopy/methods ; Stomach Neoplasms/surgery
Language	English
Publishing date	2021-06-23
Publishing country	Italy
Document type	Journal Article
ZDB-ID	3067899-7
ISSN	2724-5438
ISSN (online)	2724-5438
DOI	10.23736/S2724-5691.21.08798-0
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Article ; Online: Arterial Hypertension, Aldosterone, and Atrial Fibrillation.

Seccia, Teresa M / Caroccia, Brasilina / Maiolino, Giuseppe / Cesari, Maurizio / Rossi, Gian Paolo

Current hypertension reports

2019 Volume 21, Issue 12, Page(s) 94

Abstract: Purpose: Atrial fibrillation is the most common sustained arrhythmia, with a prevalence of 1-2% in the general population and over 15% in people older than 80 years. Due to aging of the population it imposes an increasing burden on the healthcare system ...

Abstract	Purpose: Atrial fibrillation is the most common sustained arrhythmia, with a prevalence of 1-2% in the general population and over 15% in people older than 80 years. Due to aging of the population it imposes an increasing burden on the healthcare system because of the need for life-long pharmacological treatment and the associated increased risk of heart failure and hospitalization. Hence, identification of the factors that predispose to atrial fibrillation it is of utmost relevance. Recent findings: Several conditions exist that are characterized by inappropriately high levels of aldosterone, mostly primary aldosteronism and the severe or drug-resistant forms of arterial hypertension. In these forms, aldosterone can cause prominent target organ damage, mostly in the heart, vasculature, and kidney. This review examines the experimental data and clinical evidences that support a link between hyperaldosteronism and atrial fibrillation, and how this knowledge should lead to a change in our management of the hypertensive patients presenting with atrial fibrillation.
MeSH term(s)	Aldosterone/adverse effects ; Aldosterone/blood ; Aldosterone/physiology ; Atrial Fibrillation/blood ; Atrial Fibrillation/etiology ; Atrial Fibrillation/physiopathology ; Heart Failure/blood ; Heart Failure/etiology ; Heart Failure/physiopathology ; Humans ; Hyperaldosteronism/blood ; Hyperaldosteronism/complications ; Hyperaldosteronism/physiopathology ; Hypertension/blood ; Hypertension/etiology ; Hypertension/physiopathology ; Randomized Controlled Trials as Topic
Chemical Substances	Aldosterone (4964P6T9RB)
Language	English
Publishing date	2019-11-18
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	2057367-4
ISSN	1534-3111 ; 1522-6417
ISSN (online)	1534-3111
ISSN	1522-6417
DOI	10.1007/s11906-019-1001-4
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