Abstract Background The role of eplerenone in arterial hypertension has been investigated only in small studies. To systematically assess the efficacy and tolerability of eplerenone in patients with ...mild to moderate arterial hypertension, we did a meta-analysis of controlled randomized trials. Methods We performed an electronic literature search of Medline, Pubmed, Scopus and Cochrane databases for studies published up to March 31, 2014. Randomized studies comparing eplerenone with placebo or other antihypertensive drugs for net reduction of systolic and diastolic blood pressures (SBP; DBP) from baseline and for incidence of adverse events were considered. Weighted mean differences (WMD) and odds ratios with 95% confidence interval were calculated for continuous and dichotomous data, respectively. Results A total of 11 trials and 3566 patients were overall included. Compared to placebo, eplerenone significantly reduced either SBP WMD − 8.07, 95% CI − 8.17 to − 7.96 mm Hg, p < 0.00001 and DBP WMD − 4.08, − 4.15 to − 4.01 mm Hg, p < 0.00001. In the overall comparison, reduction of both SBP and DBP with eplerenone was greater than other antihypertensive agents (WMD for SBP − 1.50 mm Hg, p < 0.0001; WMD for DBP − 0.54 mm Hg, p < 0.00001); this was essentially driven by a greater anti-hypertensive action vs enalapril and losartan for SBP and vs losartan for DBP. Rates of any adverse event were significantly higher with eplerenone than placebo (odds ratio 1.37, 95% CI 1.1 to 1.71; p = 0.005), whereas the occurrence of serious adverse events and hyperkalemia was similar. There was no difference between eplerenone and other antihypertensives in the frequency of any or serious adverse events, whereas hyperkalemia was more common with eplerenone (odds ratio 2.36, 95% CI 1.00 to 5.57; p = 0.05). Conclusion This study-level meta-analysis provides a robust evidence that eplerenone has a reassuring safety profile and is effective in lowering blood pressure in patients with mild-to-moderate hypertension; this effect is at least comparable to that of other anti-hypertensive agents (PROSPERO Registration No. CRD42014010071).
Our aim was to compare three-dimensional (3D) and 2D and 3D speckle-tracking (2D-STE, 3D-STE) echocardiographic parameters with conventional right ventricular (RV) indexes in patients with chronic ...pulmonary hypertension (PH), and investigate whether these techniques could result in better correlation with hemodynamic variables indicative of heart failure.
Seventy-three adult patients (mean age, 53±13 years; 44% male) with chronic PH of different etiologies were studied by echocardiography and cardiac catheterization (25 precapillary PH from pulmonary arterial hypertension, 23 obstructive pulmonary heart disease, and 23 postcapillary PH from mitral regurgitation). Thirty healthy subjects (mean age, 54±15 years; 43% male) served as controls. Standard 2D measurements (RV-fractional area change-tricuspid annular plane systolic excursion) and mitral and tricuspid tissue Doppler annular velocities were obtained. RV 3D volumes and global and regional ejection fraction (3D-RVEF) were determined. RV strains were calculated by 2D-STE and 3D-STE. RV 3D global-free-wall longitudinal strain (3DGFW-RVLS), 2D global-free-wall longitudinal strain (GFW-RVLS), apical-free-wall longitudinal strain, basal-free-wall longitudinal strain, and 3D-RVEF were lower in patients with precapillary PH (P<0.0001) and postcapillary PH (P<0.01) compared to controls. 3DGFW-RVLS (hazard ratio 4.6, 95% CI 2.79 to 8.38, P=0.004) and 3D-RVEF (hazard ratio 5.3, 95% CI 2.85 to 9.89, P=0.002) were independent predictors of mortality. Receiver operating characteristic curves showed that the thresholds offering an adequate compromise between sensitivity and specificity for detecting hemodynamic signs of RV failure were 39% for 3D-RVEF (AUC 0.89), -17% for 3DGFW-RVLS (AUC 0.88), -18% for GFW-RVLS (AUC 0.88), -16% for apical-free-wall longitudinal strain (AUC 0.85), 16 mm for tricuspid annular plane systolic excursion (AUC 0.67), and 38% for RV-FAC (AUC 0.62).
In chronic PH, 3D, 2D-STE and 3D-STE parameters indicate global and regional RV dysfunction that is associated with RV failure hemodynamics better than conventional echo indices.
This study focuses on the seismic vulnerability of masonry buildings damaged by the 2009 L’Aquila earthquake. A geo-referenced database of 32,520 masonry residential buildings was compiled in the ...aftermath of the earthquake under the coordination of the Italian Department of Civil Protection through the AeDES survey form. The availability of this enormous amount of data provides an exceptional opportunity to examine in depth damage data and their correlation with the main parameters available from the post-earthquake survey. The original database was grouped into 20 building classes, defined as a function of vertical and horizontal structural types. Damage levels defined according to the European Macroseismic Scale classification are used to derive damage probability matrices and relevant vulnerability curves for these classes. The influences of connection systems, the quality/regularity of the masonry wall layout and the horizontal structural type on the building response are analysed in detail. A vulnerability classification, also supported by the use of statistical post hoc tests, is used to detect a reduced number of independent classes. The parameters of the non-crossing fragility curves are determined via the maximum likelihood estimation method by adopting a lognormal cumulative function to determine the exceedance probabilities of the considered damage levels. The impact of “mixed” classes, characterized by multiple vertical and/or horizontal structural types, on the derivation of the fragility curves is also investigated. Finally, the adaptation of the general version of the fragility curves to large-scale applications based on poor (census) data is also demonstrated, leading to curves that are easily usable in regional/national seismic loss assessments.
Background
Most antiarrhythmic interventional therapies for atrial fibrillation (AF) have been provided with special focus on the treatment of left‐sided valvular disease and enlarged left atrium but ...few studies have assessed AF associated with congenital heart disease and dilated right atrium.
Hypothesis
We hypothesized that right atrial (RA) function assessed by two‐dimensional (2DSTE) and three‐dimensional (3DSTE) speckle‐tracking echocardiography in patients with atrial septal defect (ASD) before and after percutaneous trancatheter closure could predict paroxysmal atrial fibrillation (PAF) development.
Methods
Seventy‐three patients with hemodynamically significant secundum ASD were prospectively studied and followed up for 6 months after occluder insertion and compared with a normal age‐matched group (n = 73). A subgroup of 17 patients who developed PAF after device implantation was also studied. RA peak global longitudinal strain (PS) was determined using 2DSTE. Standard deviations (SDs) of times to peak strain (TPS) were calculated as indices of dyssynchrony. RA volumes, emptying fraction (EF), and expansion index (EI) were determined using 3DSTE.
Results
RA‐PS, EF, and EI (pre‐closure values) were reduced in patients with atrial devices compared with controls, and further reductions were observed in patients with PAF. Pre‐closure 3D‐RA‐EI (P = 0.009) and RA‐TPS (P = 0.023) were independent predictors of PAF by multivariate analysis after adjustment for age and left atrial dysfunction. The areas under the ROC‐curve (AUC) for 3D‐RA‐EI, RA‐PS, RA‐TPS (pre‐closure values) showed high discriminative values(from 0.76 to 0.85) in predicting PAF. By combining 3D‐RA‐EI and RA‐TPS, the AUC increased to 0.90.
Conclusions
Two‐dimensional and three‐dimensional speckle tracking echocardiography was clinically helpful in ASD patients in revealing right atrial dilatation and dysfunction pre‐existent to device closure and associated with PAF development. RA parameters had a higher association with PAF compared to both the size of the implanted device and left atrial indices.
Existing RC buildings are often vulnerable to seismic loading, thus requiring retrofitting strategies to mitigate such vulnerability. This is certainly true for existing RC buildings realized in ...Italy before ‘70s and often designed to sustain gravity loads only. Such (low-standard) RC buildings typically present failure typologies very different from newly designed buildings, often exhibiting shear failures in beams/columns and beam-column joints. Retrofitting strategies should be chosen carefully looking at safety at collapse, but also at seismic capacity at less severe performance levels, considering non-structural components as well, which can significantly affect expected annual losses.
In this work, the as-built assessment and the retrofit design and assessment of Italian pre-70 RC case-study buildings – designed for gravity loads only – is presented. These buildings have been located in several sites in Italy, characterized by different seismic hazard, and they have been assessed, as commonly performed in design practice, in a code-based approach according to Italian seismic prescriptions, post-processing the occurrence of shear failures. For each building/site, the safety index has been evaluated at two different limit states. Their retrofit has been designed aiming at the resolution of the detected shear failures. Resulting seismic performance are compared to seismic demand in all the considered sites to quantify the effectiveness of the adopted retrofitting strategy depending on the seismic hazard throughout all the Italian country. Lastly, a preliminary estimation of cost of intervention is also presented.
In this study, seismic vulnerability of Italian masonry buildings is analyzed taking advantage of the post-earthquake damage data recently released by the Italian Department of Civil Protection ...through the online platform Da.D.O. (Dolce et al. 2019).
The main purpose of the study is to describe the damage attitude of several building's typologies, univocally defined by means of structural and geometrical features. To this aim, a time-consuming data processing has been performed to obtain a more effective taxonomy, based on masonry quality layout, type of horizontal structure, presence/absence of retrofit interventions, construction age and number of storeys.
Moreover, to avoid bias in vulnerability analysis, the most reliable datasets has been detected through a comprehensive data analysis, also integrating the original database with census data. Then, damage analysis has been done, converting the damage observed on vertical structures in 5+1 damage levels of the whole building according to the European Macroseismic Scale classification. ShakeMaps in terms of peak parameters released by National Institute of Geophysics and Volcanology are also considered to characterize ground motion shaking at each building's location. Lastly, a lognormal statistical model has been used to derive vulnerability curves for considered typologies, fully investigating the influence of each building's feature on damage attitude.
This work aims estimating seismic losses in residential-reinforced concrete buildings, highlighting the influence of infills and services. First, the mechanical-based "POST"-method is used to perform ...simplified (nonlinear static) structural analyses, in the "shear-type" building hypothesis. Then, drift-based fragility curves and repair cost analysis, specific for infills and services, are used to obtain expected damage and losses. Lastly, the whole proposed loss assessment methodology is applied to a wide building stock struck by L'Aquila (Italy) 2009-earthquake and damaged to infills. The numerical-versus-observed comparison of damage scenario and seismic losses allows a promising validation of the procedure.
We investigated the Campi Flegrei caldera using a quantitative approach to retrieve the spatial and temporal variations of the stress field. For this aim we applied a joint inversion of geodetic and ...seismological data to a dataset of 1,100 optical levelling measurements and 222 focal mechanisms, recorded during the bradyseismic crisis of 1982–1984. The inversion of the geodetic dataset alone, shows that the observed ground deformation is compatible with a source consisting of a planar crack, located at the centre of the caldera at a depth of about 2.56 km and a size of about 4 × 4 km. Inversion of focal mechanisms using both analytical and graphical approaches, has shown that the key features of the stress field in the area are: a nearly subvertical
σ
1
and a sub-horizontal, roughly NNE-SSW trending
σ
3
. Unfortunately, the modelling of the stress fields based only upon the retrieved ground deformation source is not able to fully account for the stress pattern delineated by focal mechanism inversion. The introduction of an additional regional background field has been necessary. This field has been determined by minimizing the difference between observed slip vectors for each focal mechanism and the theoretical maximum shear stress deriving from both the volcanic (time-varying) and the regional (constant) field. The latter is responsible for a weak NNE-SSW extension, which is consistent with the field determined for the nearby Mt. Vesuvius volcano. The proposed approach accurately models observations and provides interesting hints to better understand the dynamics of the volcanic unrest and seismogenic processes at Campi Flegrei caldera. This procedure could be applied to other volcanoes experiencing active ground deformation and seismicity.
Calderas are collapse structures related to the emptying of magmatic reservoirs, often associated with large eruptions from long-lived magmatic systems. Understanding how magma is transferred from a ...magma reservoir to the surface before eruptions is a major challenge. Here we exploit the historical, archaeological and geological record of Campi Flegrei caldera to estimate the surface deformation preceding the Monte Nuovo eruption and investigate the shallow magma transfer. Our data suggest a progressive magma accumulation from ~1251 to 1536 in a 4.6 ± 0.9 km deep source below the caldera centre, and its transfer, between 1536 and 1538, to a 3.8 ± 0.6 km deep magmatic source ~4 km NW of the caldera centre, below Monte Nuovo; this peripheral source fed the eruption through a shallower source, 0.4 ± 0.3 km deep. This is the first reconstruction of pre-eruptive magma transfer at Campi Flegrei and corroborates the existence of a stationary oblate source, below the caldera centre, that has been feeding lateral eruptions for the last ~5 ka. Our results suggest: 1) repeated emplacement of magma through intrusions below the caldera centre; 2) occasional lateral transfer of magma feeding non-central eruptions within the caldera. Comparison with historical unrest at calderas worldwide suggests that this behavior is common.
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