Background Ranolazine is a new antianginal drug that reduces intracellular sodium and calcium accumulation during ischemia, thus potentially limiting myocardial ischemia. It remains unknown, however, ...if the drug can play a role in the pathophysiology of periprocedural myocardial infarction. The aim of this study was to verify in a randomized study if pretreatment with ranolazine before percutaneous coronary intervention (PCI) has any protective effect on periprocedural myocardial damage. Methods Seventy patients with stable angina (age 62 ± 18 years, 42 men) scheduled for elective coronary intervention entered a randomized, double-blind, placebo-controlled pilot trial. For 7 days before the procedure, 35 patients were assigned to receive ranolazine (1,000 mg twice daily) and 35 patients had placebo. Creatine kinase-MB and troponin I levels were measured at baseline and at 8 and 24 hours postprocedure. Results Comparison between the 2 groups did not show any difference in clinical features, extent of coronary artery disease, and technical aspects of PCI. Periprocedural myocardial infarction (ie, postprocedural increase of creatine kinase-MB ≥3 times above the upper limit of normal) was less commonly seen after PCI in the ranolazine than in the placebo group (6% vs 22%, P = .041). Detection of markers of myocardial injury above the upper limit of normal tended to be lower in the ranolazine vs placebo group: 23% vs 40% for creatine kinase-MB ( P = .192) and 31% vs 48% for troponin I ( P = .223). Postprocedural peak markers levels were also significantly lower in the ranolazine vs placebo group (creatine kinase-MB: 3.1 ± 15.0 and 7.7 ± 19.1 ng/mL, P < .05; troponin I: 0.15 ± 0.35 and 0.47 ± 0.49 ng/mL, P < .05). No significant adverse effect was reported by the 2 groups of patients. Conclusions Pretreatment with ranolazine 1,000 mg twice daily for 7 days significantly reduced procedural myocardial injury in elective PCI.
On August 21st, 2017, an earthquake with duration magnitude M
d
= 4.0 and epicentre in Casamicciola Terme hit Ischia island, in the South of Italy. This event caused two fatalities and dozens of ...injured people. Moreover, despite the low magnitude, the earthquake produced significant damages to masonry and reinforced concrete (RC) buildings, with some partial or complete collapse of structures, in a very limited area close to the epicentre, while even at small distance from the most damaged zone the earthquake was just felt by local people and tourists. In the days after the event, discussions concerning the destructive effects of such an earthquake arose in the scientific community—as also reported by local and national media. In this paper, the seismic history of Ischia island is recalled to show and explain the peculiarity of the August 21st earthquake, which is also described in terms of ground motion and response spectra characteristics. The results of the first surveys carried out in Casamicciola Terme are reported, together with appropriate pictures, to introduce and explain the observed damage state of masonry and RC buildings in the epicentral zone. Then, data from the 15th general census of the population and dwellings (ISTAT) is used to define vulnerability classes according to the classification of the European Macrosismic Scale (EMS-98) (Grünthal,
1998
). Seismic damage scenarios are then evaluated combining macro-seismic intensity values obtained using an interpolation method starting from QUEST macro-seismic survey data (Azzaro et al.,
2017
) and fragility curves for A-to-D vulnerability classes and for five damage states, from DS0 (no damage) to DS5 (collapse) trough a Monte Carlo simulation technique. The distributions of Usable, Temporarily or Partially Unusable, and Unusable buildings, which are obtained by using relationships between damage and usability judgments obtained through post-earthquake damage data collected after past seismic events, result in very good accordance with those published in September 1st, 2017 by the Department of Civil Protection, regarding a dataset of about 600 buildings.
Thrombus aspiration during percutaneous coronary intervention can result in improved rates of normal epicardial flow and myocardial perfusion, but several unmet needs remain. The purpose of the ...Delivery of thrombolytIcs before thrombectomy in patientS with ST-segment elevatiOn myocardiaL infarction Undergoing primary percuTaneous coronary interventION (DISSOLUTION) trial was to evaluate the hypothesis that local delivery of thrombolytics can enhance the efficacy of thrombus aspiration in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. A total of 102 patients with ST-segment elevation myocardial infarction and angiographic evidence of massive thrombosis in the culprit artery were randomly assigned to receive a local, intrathrombus bolus of 200,000 U of urokinase (n = 51) or saline solution (n = 51) by way of an infusion microcatheter, followed by manual aspiration thrombectomy. The end points included the final Thrombolysis In Myocardial Infarction flow grade and frame count, myocardial blush grade, 60-minute ST-segment resolution >70%, and major adverse cardiac and cerebrovascular events, defined as the death, reinfarction, stroke, or clinically driven target vessel revascularization at 6 months. The use of intrathrombus urokinase was associated with a significantly higher incidence of Thrombolysis In Myocardial Infarction flow grade 3 (90% vs 66%, p = 0.008) and lower postpercutaneous coronary intervention Thrombolysis In Myocardial Infarction frame count (19 ± 15 vs 25 ± 17, p = 0.033). The postprocedural myocardial perfusion was significantly increased with the use of urokinase (myocardial blush grade 2 or 3, 68% vs 45%, p = 0.028), with more patients showing ST-segment resolution >70% (82% vs 55%, p = 0.006). At 6 months of follow-up, the patients treated with intrathrombus urokinase showed a better major adverse cardiac event-free survival (6% vs 21%; log-rank p = 0.044). In conclusion, local, intrathrombus delivery of thrombolytics before manual thrombectomy improved the postprocedural coronary flow and myocardial perfusion and the 6-month clinical outcomes.
In the present paper, we analyse ground tilt and seismicity at Campi Flegrei caldera and Ischia Island, two volcanic areas located in the south of Italy. These areas have been well studied for many ...years from a petrological, volcanological and geophysical view point. Moreover, due to the high seismic and volcanic risk for the populations living there, they are continuously monitored by networks of geophysical and geochemical sensors. We summarize the most important results that we obtained so far, concerning the observations of relationships between seismic activity and ground tilt anomalies, focusing on the time interval 2015–2018. First, we present a detailed description of the tiltmeter and seismic networks in both the investigated areas, as well as their development and improvement over time that has enabled high quality data collection. From the joint analysis of the seismic and borehole tiltmeter signals, we often notice concurrence between tilt pattern variations and the occurrence of seismicity. Moreover, the major tilt anomalies appear to be linked with the rate and energy of volcano-tectonic earthquakes, as well as with exogenous phenomena like solid Earth tides and hydrological cycles. The analysis that we present has potential applicability to other volcanic systems. Our findings show how the joint use tilt and seismic data can contribute to better understanding of the dynamics of volcanoes.
Abstract
This work provides the mean ground deformation rates and ground displacement time series of the Campi Flegrei caldera (Italy) retrieved by satellite remote sensing data analysis from 1992 to ...2021. Synthetic Aperture Radar (SAR) images acquired by ERS 1–2 (1992–2002), Envisat (2003–2011) and Cosmo-SkyMed (2011–2021) are processed by multi-temporal SAR Interferometry (InSAR) approach using the same technique, parameters and reference system, to obtain for the first time a homogeneous and time-continuous dataset. The validation of the InSAR products is carried out by comparison with the measurements provided by precise levelling lines and cGNSS stations. The produced outcomes offer an overview on the temporal behaviour of ground deformation at Campi Flegrei along an unprecedented time window of about 30 years and can be exploited by the scientific community for supporting and improving the knowledge of the dynamics of the caldera.
Chest pain is frequently reported in Fabry disease (FD). However, its mechanism and clinical relevance are unclear.
Basal troponin I level, exercise stress test, single-photon emission computed ...tomography imaging with (99m)Tc sestamibi, coronary angiography with thrombolysis in myocardial infarction (TIMI) frame count and left ventricular angiography and endomyocardial biopsy were obtained in 13 patients with FD with angina. Ratio of external to lumen diameter of intramural arteries (E/L ratio), myocyte diameter, and extent of fibrosis were morphometrically evaluated by using tissue sections. Controls for coronary angiography and histology were 25 patients with FD without angina and 20 mitral stenosis patients with normal left ventricular function. Troponin I level was elevated in 6 of the 13 patients. Exercise stress test showed evidence of myocardial ischemia, and single-photon emission computed tomography was positive for stress-induced perfusion defects in all patients with FD with angina. Epicardial coronaries were structurally normal but showed slow flow in all and were associated with aneurisms of posterior left ventricular wall in 3 cases. Histology showed remarkable lumen narrowing of most intramural arteries (mean E/L ratio=3.5+/-1.2; P<0.001 versus both control groups), because of hypertrophy and proliferation of smooth muscle and endothelial cells, both engulfed by glycosphingolipids. Replacement fibrosis exceeded that of both controls (P<0.001). Small vessel disease correlated with coronary slow flow and extent of fibrosis, but did not with patients' age, sex, and degree of left ventricular hypertrophy.
patients with FD with angina have perfusion defects, slow coronary flow, and luminal narrowing of intramural arteries. Small vessel disease may contribute to symptomatic limitation and progressive myocardial dysfunction.
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