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Article ; Online: Characterization of cardiovascular and cerebrovascular controls via spectral causality analysis in patients undergoing surgical aortic valve replacement during a three-month follow-up.

Bari, Vlasta / Gelpi, Francesca / Cairo, Beatrice / Anguissola, Martina / Pugliese, Sara / De Maria, Beatrice / Bertoldo, Enrico Giuseppe / Fiolo, Valentina / Callus, Edward / De Vincentiis, Carlo / Volpe, Marianna / Molfetta, Raffaella / Ranucci, Marco / Porta, Alberto

Physiological measurement

2023 Volume 44, Issue 9

Abstract: Objective. ...

Abstract	Objective.
Language	English
Publishing date	2023-09-29
Publishing country	England
Document type	Journal Article
ZDB-ID	1149545-5
ISSN	1361-6579 ; 0967-3334
ISSN (online)	1361-6579
ISSN	0967-3334
DOI	10.1088/1361-6579/acf992
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Article ; Online: Clinical Course of COVID-19 Infection in Patients Urgently Operated of Cardiac Surgical Procedures.

Garatti, Andrea / Castelvecchio, Serenella / Daprati, Andrea / Molfetta, Raffaella / Volpe, Marianna / De Vincentiis, Carlo / Parolari, Alessandro / Menicanti, Lorenzo

Annals of surgery

2020 Volume 272, Issue 4, Page(s) e275–e279

Abstract: Objective: The aim of this study was to describe the clinical course of a consecutive series of patients operated of urgent cardiac surgery during COVID-19 outbreak.: Background: In Italy, COVID outbreak has mostly occurred in the metropolitan area ... ...

Abstract	Objective: The aim of this study was to describe the clinical course of a consecutive series of patients operated of urgent cardiac surgery during COVID-19 outbreak. Background: In Italy, COVID outbreak has mostly occurred in the metropolitan area of Milan, and in the surrounding region of Lombardy, and previously "conventional" hospitals were converted into COVID spokes to increase ICU beds availability, and to allow only urgent CS procedures. Methods: Among urgent CS patients (left main stenosis with unstable angina, acute endocarditis, valvular regurgitation with impending heart failure), 10 patients (mean age = 57 ± 9 years), despite a negative admission triage, developed COVID-pneumonia postoperatively, at a median of 7 days after CS. Results: Patients showed typical lymphopenia, higher prothrombotic profile, and higher markers of inflammation (ferritin and interleukin-6 values). At the zenith of pulmonary distress, patients presented with severe hypoxia (median PaO2/FIO2 ratio = 116), requiring advanced noninvasive ventilation (Venturi mask and continuous positive airway pressure) in the majority of cases. All patients were treated with hydroxychloroquine, azithromycin, and low-molecular-weight heparin at anticoagulant dose. Overall in-hospital mortality was 10% (1/10), peaking 25% in patients who developed COVID pneumonia immediately after CS. The remaining patients, with late infection, were all discharged home without oxygen support, at a median of 25 days after symptom onset. Conclusions: As postoperative mortality in case of COVID pneumonia is not negligible, meticulous rules (precise triage, safe hospital path, high level of protection for health-care teams, prompt diagnosis of suspicious symptoms) should be strictly followed in patients undergoing CS during COVID pandemic. The role of therapies alternative to CS should be further assessed.
MeSH term(s)	Aged ; COVID-19 ; Cardiac Surgical Procedures/methods ; Cardiac Surgical Procedures/mortality ; Cardiac Surgical Procedures/statistics & numerical data ; Coronavirus Infections/epidemiology ; Coronavirus Infections/prevention & control ; Cross Infection/prevention & control ; Disease Outbreaks/statistics & numerical data ; Emergencies ; Female ; Hospital Mortality/trends ; Hospitalization/statistics & numerical data ; Humans ; Infection Control/methods ; Intensive Care Units/statistics & numerical data ; Italy ; Male ; Middle Aged ; Outcome Assessment, Health Care ; Pandemics/prevention & control ; Pneumonia, Viral/epidemiology ; Pneumonia, Viral/prevention & control ; Postoperative Complications/epidemiology ; Postoperative Complications/physiopathology ; Risk Assessment
Keywords	covid19
Language	English
Publishing date	2020-08-25
Publishing country	United States
Document type	Journal Article
ZDB-ID	340-2
ISSN	1528-1140 ; 0003-4932
ISSN (online)	1528-1140
ISSN	0003-4932
DOI	10.1097/SLA.0000000000004393
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Article ; Online: Monitoring the Evolution of Asynchrony between Mean Arterial Pressure and Mean Cerebral Blood Flow via Cross-Entropy Methods.

Porta, Alberto / Gelpi, Francesca / Bari, Vlasta / Cairo, Beatrice / De Maria, Beatrice / Panzetti, Cora May / Cornara, Noemi / Bertoldo, Enrico Giuseppe / Fiolo, Valentina / Callus, Edward / De Vincentiis, Carlo / Volpe, Marianna / Molfetta, Raffaella / Pistuddi, Valeria / Ranucci, Marco

Entropy (Basel, Switzerland)

2022 Volume 24, Issue 1

Abstract: Cerebrovascular control is carried out by multiple nonlinear mechanisms imposing a certain degree of coupling between mean arterial pressure (MAP) and mean cerebral blood flow (MCBF). We explored the ability of two nonlinear tools in the information ... ...

Abstract	Cerebrovascular control is carried out by multiple nonlinear mechanisms imposing a certain degree of coupling between mean arterial pressure (MAP) and mean cerebral blood flow (MCBF). We explored the ability of two nonlinear tools in the information domain, namely cross-approximate entropy (CApEn) and cross-sample entropy (CSampEn), to assess the degree of asynchrony between the spontaneous fluctuations of MAP and MCBF. CApEn and CSampEn were computed as a function of the translation time. The analysis was carried out in 23 subjects undergoing recordings at rest in supine position (REST) and during active standing (STAND), before and after surgical aortic valve replacement (SAVR). We found that at REST the degree of asynchrony raised, and the rate of increase in asynchrony with the translation time decreased after SAVR. These results are likely the consequence of the limited variability of MAP observed after surgery at REST, more than the consequence of a modified cerebrovascular control, given that the observed differences disappeared during STAND. CApEn and CSampEn can be utilized fruitfully in the context of the evaluation of cerebrovascular control via the noninvasive acquisition of the spontaneous MAP and MCBF variability.
Language	English
Publishing date	2022-01-02
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2014734-X
ISSN	1099-4300 ; 1099-4300
ISSN (online)	1099-4300
ISSN	1099-4300
DOI	10.3390/e24010080
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Article ; Online: Respiration is a Confounder of the Closed Loop Relationship Between Mean Arterial Pressure and Mean Cerebral Blood Flow.

Porta, Alberto / Gelpi, Francesca / Bari, Vlasta / Cairo, Beatrice / De Maria, Beatrice / May Panzetti, Cora / Cornara, Noemi / Bertoldo, Enrico Giuseppe / Fiolo, Valentina / Callus, Edward / De Vincentiis, Carlo / Volpe, Marianna / Molfetta, Raffaella / Ranucci, Marco

Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual International Conference

2021 Volume 2021, Page(s) 5403–5406

Abstract: This study tested the hypothesis that respiration (RESP) is a confounder or suppressor of the closed loop relationship responsible for the cerebrovascular dynamical interactions as assessed from spontaneous variability of mean arterial pressure (MAP) and ...

Abstract	This study tested the hypothesis that respiration (RESP) is a confounder or suppressor of the closed loop relationship responsible for the cerebrovascular dynamical interactions as assessed from spontaneous variability of mean arterial pressure (MAP) and mean cerebral blood flow (MCBF). The evaluation was carried out in the information domain via transfer entropy (TE) estimated through a linear model-based approach comparing TE markers computed solely over MAP and MCBF series with TE indexes accounting for the eventual action of RESP over MAP and MCBF. We considered 11 patients (age: 76±5 yrs, 7 males) undergoing surgical aortic valve replacement (SAVR) at supine resting (REST) and during active standing (STAND) before and after SAVR surgery. The decrease of the predictive ability of MCBF to MAP when accounting for RESP compared to the one assessed when disregarding RESP suggested that RESP is a confounder of the link from MCBF to MAP along the Cushing reflex instead of being a suppressor. This result was more evident in POST when autonomic control was dramatically depressed and in an unchallenged condition such as REST. RESP did not affect significantly the link from MAP to MCBF along the pressure-to-flow relationship. Clarification of the type of RESP influence on the MAP-MCBF closed loop relationship could favor a deeper characterization of cerebrovascular interactions and the comprehension of cerebral autoregulation mechanisms.Clinical Relevance- This study suggests that respiration is a confounder of the closed loop relationship between MAP and MCBF, especially of the flow-to-pressure causal link. This result might open new possibilities in elucidating the mechanisms of cerebral autoregulation in healthy and pathological populations.
MeSH term(s)	Aged ; Aged, 80 and over ; Aortic Valve ; Arterial Pressure ; Autonomic Nervous System ; Cerebrovascular Circulation ; Humans ; Male ; Respiration
Language	English
Publishing date	2021-12-10
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	2694-0604
ISSN (online)	2694-0604
DOI	10.1109/EMBC46164.2021.9630905
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Article: Clinical Course of COVID-19 Infection in Patients Urgently Operated of Cardiac Surgical Procedures

Garatti, Andrea / Castelvecchio, Serenella / Daprati, Andrea / Molfetta, Raffaella / Volpe, Marianna / De Vincentiis, Carlo / Parolari, Alessandro / Menicanti, Lorenzo

Ann Surg

Abstract: OBJECTIVE: The aim of this study was to describe the clinical course of a consecutive series of patients operated of urgent cardiac surgery during COVID-19 outbreak. BACKGROUND: In Italy, COVID outbreak has mostly occurred in the metropolitan area of ... ...

Abstract	OBJECTIVE: The aim of this study was to describe the clinical course of a consecutive series of patients operated of urgent cardiac surgery during COVID-19 outbreak. BACKGROUND: In Italy, COVID outbreak has mostly occurred in the metropolitan area of Milan, and in the surrounding region of Lombardy, and previously "conventional" hospitals were converted into COVID spokes to increase ICU beds availability, and to allow only urgent CS procedures. METHODS: Among urgent CS patients (left main stenosis with unstable angina, acute endocarditis, valvular regurgitation with impending heart failure), 10 patients (mean age = 57 ± 9 years), despite a negative admission triage, developed COVID-pneumonia postoperatively, at a median of 7 days after CS. RESULTS: Patients showed typical lymphopenia, higher prothrombotic profile, and higher markers of inflammation (ferritin and interleukin-6 values). At the zenith of pulmonary distress, patients presented with severe hypoxia (median PaO2/FIO2 ratio = 116), requiring advanced noninvasive ventilation (Venturi mask and continuous positive airway pressure) in the majority of cases. All patients were treated with hydroxychloroquine, azithromycin, and low-molecular-weight heparin at anticoagulant dose. Overall in-hospital mortality was 10% (1/10), peaking 25% in patients who developed COVID pneumonia immediately after CS. The remaining patients, with late infection, were all discharged home without oxygen support, at a median of 25 days after symptom onset. CONCLUSIONS: As postoperative mortality in case of COVID pneumonia is not negligible, meticulous rules (precise triage, safe hospital path, high level of protection for health-care teams, prompt diagnosis of suspicious symptoms) should be strictly followed in patients undergoing CS during COVID pandemic. The role of therapies alternative to CS should be further assessed.
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #767004
Database	COVID19

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Article ; Online: Clinical Course of COVID-19 Infection in Patients Urgently Operated of Cardiac Surgical Procedures

Garatti, Andrea / Castelvecchio, Serenella / Daprati, Andrea / Molfetta, Raffaella / Volpe, Marianna / De Vincentiis, Carlo / Parolari, Alessandro / Menicanti, Lorenzo

Annals of Surgery

2020 Volume 272, Issue 4, Page(s) e275–e279

Keywords	Surgery ; covid19
Language	English
Publisher	Ovid Technologies (Wolters Kluwer Health)
Publishing country	us
Document type	Article ; Online
ZDB-ID	340-2
ISSN	1528-1140 ; 0003-4932
ISSN (online)	1528-1140
ISSN	0003-4932
DOI	10.1097/sla.0000000000004393
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Evaluation of the impact of surgical aortic valve replacement on short-term cardiovascular and cerebrovascular controls through spontaneous variability analysis.

Porta, Alberto / Fantinato, Angela / Bari, Vlasta / Gelpi, Francesca / Cairo, Beatrice / De Maria, Beatrice / Bertoldo, Enrico Giuseppe / Fiolo, Valentina / Callus, Edward / De Vincentiis, Carlo / Volpe, Marianna / Molfetta, Raffaella / Ranucci, Marco

PloS one

2020 Volume 15, Issue 12, Page(s) e0243869

Abstract: We assessed the effect of surgical aortic valve replacement (SAVR) on cardiovascular and cerebrovascular controls via spontaneous variability analyses of heart period, approximated as the temporal distance between two consecutive R-wave peaks on the ... ...

Abstract	We assessed the effect of surgical aortic valve replacement (SAVR) on cardiovascular and cerebrovascular controls via spontaneous variability analyses of heart period, approximated as the temporal distance between two consecutive R-wave peaks on the electrocardiogram (RR), systolic, diastolic and mean arterial pressure (SAP, DAP and MAP) and mean cerebral blood flow (MCBF). Powers in specific frequency bands, complexity, presence of nonlinear dynamics and markers of cardiac baroreflex and cerebral autoregulation were calculated. Variability series were acquired before (PRE) and after (POST) SAVR in 11 patients (age: 76±5 yrs, 7 males) at supine resting and during active standing. Parametric spectral analysis was performed based on the autoregressive model. Complexity was assessed via a local nonlinear prediction approach exploiting the k-nearest-neighbor strategy. The presence of nonlinear dynamics was checked by comparing the complexity marker computed over the original series with the distribution of the same index assessed over a set of surrogates preserving distribution and power spectral density of the original series. Cardiac baroreflex and cerebral autoregulation were estimated by assessing the transfer function from SAP to RR and from MAP to MCBF and squared coherence function via the bivariate autoregressive approach. We found that: i) orthostatic challenge had no effect on cardiovascular and cerebrovascular control markers in PRE; ii) RR variance was significantly reduced in POST; iii) complexity of SAP, DAP and MAP variabilities increased in POST with a greater likelihood of observing nonlinear dynamics over SAP compared to PRE at supine resting; iv) the amplitude of MCBF variations and MCBF complexity in POST remained similar to PRE; v) cardiac baroreflex sensitivity decreased in POST, while cerebrovascular autoregulation was preserved. SAVR induces important changes of cardiac and vascular autonomic controls and baroreflex regulation in patients exhibiting poor reactivity of cardiovascular regulatory mechanisms, while cerebrovascular autoregulation seems to be less affected.
MeSH term(s)	Aged ; Arterial Pressure ; Cerebrovascular Circulation ; Coronary Circulation ; Diastole ; Electrocardiography ; Female ; Humans ; Male ; Nonlinear Dynamics ; Systole ; Time Factors ; Transcatheter Aortic Valve Replacement
Language	English
Publishing date	2020-12-10
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	1932-6203
ISSN (online)	1932-6203
DOI	10.1371/journal.pone.0243869
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Article ; Online: Complexity and Nonlinearities of Short-Term Cardiovascular and Cerebrovascular Controls after Surgical Aortic Valve Replacement.

Porta, Alberto / Fantinato, Angela / Bari, Vlasta / Cairo, Beatrice / De Maria, Beatrice / Bertoldo, Enrico Giuseppe / Fiolo, Valentina / Callus, Edward / De Vincentiis, Carlo / Volpe, Marianna / Molfetta, Raffaella / Ranucci, Marco

Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual International Conference

2020 Volume 2020, Page(s) 2569–2572

Abstract: We assessed the effect of surgical aortic valve replacement (SAVR) on cardiovascular and cerebrovascular controls with particular attention to their complexity and presence of nonlinear behaviors via the analysis of spontaneous variability of heart ... ...

Abstract	We assessed the effect of surgical aortic valve replacement (SAVR) on cardiovascular and cerebrovascular controls with particular attention to their complexity and presence of nonlinear behaviors via the analysis of spontaneous variability of heart period (HP), systolic and diastolic arterial pressure (SAP and DAP) and mean cerebral blood flow (MCBF). Variability series were acquired before (PRE) and after (POST) SAVR in 12 patients (age: 76±4.7 yrs, 7 males) at rest in supine position and during active standing. Complexity was assessed via a local nonlinear prediction approach exploiting the k-nearest neighbor strategy. The presence of nonlinear dynamics was checked by comparing the complexity marker computed over the original series with the distribution of values assessed over 100 surrogates preserving distribution and power spectral density of the original series but with random phases. We found that: i) HP variance was significantly reduced in POST; ii) the complexity of SAP and DAP variabilities increased in POST with a greater likelihood of observing nonlinear dynamics over SAP compared to PRE at supine rest; iii) the amplitude of MCBF fluctuations and its complexity in POST remained similar to PRE. SAVR induces important changes of the cardiac and vascular autonomic controls, while cerebrovascular regulation seems to be less affected.
MeSH term(s)	Aged ; Aged, 80 and over ; Aortic Valve/surgery ; Autonomic Nervous System ; Blood Pressure ; Cardiovascular System ; Heart Rate ; Humans ; Male
Language	English
Publishing date	2020-10-05
Publishing country	United States
Document type	Journal Article
ISSN	2694-0604
ISSN (online)	2694-0604
DOI	10.1109/EMBC44109.2020.9175321
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Article: Anaemia as an inflammation-mediated condition during chronic heart failure. Possible role of fibrinogen.

Morelli, Sergio / Di Girolamo, Fabiana / Angelino, Alessandra / Fravolini, Francesca / Mancusi, Carmine / Diurni, Veronica / Molfetta, Raffaella / Acconcia, Cristina / Balsano, Francesco

Acta cardiologica

2008 Volume 63, Issue 5, Page(s) 565–570

Abstract: Background: In patients with chronic heart failure (CHF) anaemia is a common finding and may worsen clinical conditions. Moreover, CHF itself could be involved in the pathogenesis of anaemia. Early studies suggested a pathogenic role of inflammation ... ...

Abstract	Background: In patients with chronic heart failure (CHF) anaemia is a common finding and may worsen clinical conditions. Moreover, CHF itself could be involved in the pathogenesis of anaemia. Early studies suggested a pathogenic role of inflammation mediators. Objectives: The objectives of the study were to assess the relationship between CHF and haemoglobin (Hgb) plasma levels, and to investigate a possible link between fibrinogen plasma levels and anaemia. Methods: This retrospective study included consecutively hospitalized patients with CHF and left ventricular ejection fraction (LVEF) < 50%. Patients without signs or symptoms of CHF and with LVEF > or = 50% were selected as controls. Patients with secondary anaemia were excluded. Results: 257 patients (72% men) with CHF and 224 controls (65% men) were studied.The average +/- SD of Hgb in CHF patients was 12.38 +/- 1.98 g/dl vs. 13.43 +/- 1.64 g/dl in controls (P < 0.0001). A total of 69 patients (26.7%) had both CHF and anaemia. Plasma fibrinogen concentration was higher in the patients compared with the control subjects (364.83 +/- 123.76 mg/dl vs. 343.44 +/- 135.43 mg/dl; respectively; P = 0.013). Patients with anaemia showed a significantly higher plasma fibrinogen concentration compared to those without anaemia (400.57 +/- 132.36 mg/dl vs. 351.72 +/- 118.13 mg/dl; P = 0.0059). Stepwise logistic regression analysis showed that female gender, creatinine plasma levels, and fibrinogen plasma levels were independently associated with anaemia. No significant relationship between fibrinogen and creatinine plasma concentration was found. Conclusion: Anaemia is common in CHF patients and it is associated with heart failure severity.The increase of fibrinogen plasma levels in CHF patients seems to confirm that chronic inflammation is involved in the pathogenesis of anaemia.
MeSH term(s)	Aged ; Anemia/epidemiology ; Anemia/etiology ; Anemia/physiopathology ; Case-Control Studies ; Chronic Disease ; Female ; Fibrinogen/metabolism ; Heart Failure/complications ; Heart Failure/drug therapy ; Heart Failure/physiopathology ; Humans ; Inflammation/complications ; Inflammation/physiopathology ; Italy/epidemiology ; Logistic Models ; Male ; Retrospective Studies ; Risk Factors ; Stroke Volume ; Ventricular Function, Left
Chemical Substances	Fibrinogen (9001-32-5)
Language	English
Publishing date	2008-10
Publishing country	England
Document type	Journal Article
ZDB-ID	390197-x
ISSN	0001-5385
ISSN	0001-5385
DOI	10.2143/AC.63.5.2033222
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