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Featured researches published by G. Riccardi.


American Heart Journal | 2000

β-Blockade therapy in chronic heart failure: Diastolic function and mitral regurgitation improvement by carvedilol

Soccorso Capomolla; Oreste Febo; Marco Gnemmi; G. Riccardi; Cristina Opasich; Angelo Caporotondi; Andrea Mortara; GianDomenico Pinna; Franco Cobelli

BACKGROUND: In patients with chronic heart failure, the use of carvedilol therapy induces clinical and hemodynamic improvement. However, although the benefits of this beta-blocker have been established in patients with chronic heart failure, the mechanisms underlying them and the changes in left ventricular systolic function, diastolic function, and mitral regurgitation during long-term therapy remain unclear. OBJECTIVE: To identify the clinical and functional effects of carvedilol, focusing on diastolic function and mitral regurgitation variations. METHODS: Forty-five consecutive patients with chronic heart failure (ejection fraction 24% +/- 7%), 17 with dilated ischemic and 28 with nonischemic cardiomyopathy, were treated with carvedilol (mean dose 44 +/- 30 mg) and matched for clinical (New York Heart Association functional class and heart failure duration) and hemodynamic (cardiac index and pulmonary wedge pressure) characteristics to a control group. Clinical and echocardiographic variables were measured in the 2 groups at baseline and after 6 months and the results compared. RESULTS: After 6 months of treatment with carvedilol, left ventricular ejection fraction had increased from 24% +/- 7% to 29% +/- 9% (P <.0001); this change was caused by a reduction in end-systolic volume index (106 +/- 41 vs 93 +/- 37 mL/m(2); P <. 0001). Deceleration time of early diastolic filling increased (134 +/- 74 vs 196 +/- 63 ms; P <.0001). Seventeen of the 27 patients with demonstrated improvement of left ventricular diastolic filling moved from having a restrictive filling pattern to having a normal or pseudonormal left ventricular filling pattern. In the control group, no significant changes in deceleration time of early diastolic filling were found (139 +/- 74 vs 132 +/- 45 ms; P = not significant). The effective regurgitant orifice area decreased significantly in the carvedilol group but not in the control group. These changes were associated with a significant reduction of the mitral regurgitant stroke volume in the carvedilol group (50 +/- 25 vs 16 +/- 13 mL; P <.0001) but not in the control group (57 +/- 29 vs 47 +/- 24 mL; P = not significant). These changes of mitral regurgitation were closely associated with significant improvement of forward aortic stroke volume (r = -.57, P <.0001). These findings were not observed in patients in the control group. CONCLUSIONS: The results of this study show that long-term carvedilol therapy in patients with chronic heart failure was able to prevent or partially reverse progressive left ventricular dilatation. The effects on left ventricular remodeling were associated with a concomitant recovery of diastolic reserve and a decrease of mitral regurgitation, which have been demonstrated to be powerful prognostic predictors in such patients. Overall these findings provide important insights into the pathophysiologic mechanisms by which carvedilol improves the clinical course of patients with chronic heart failure.


American Heart Journal | 1997

Dobutamine and nitroprusside infusion in patients with severe congestive heart failure: Hemodynamic improvement by discordant effects on mitral regurgitation, left atrial function, and ventricular function

Soccorso Capomolla; Massimo Pozzoli; Cristina Opasich; Oreste Febo; G. Riccardi; Fabrizio Salvucci; Roberto Maestri; Massimo Sisti; Franco Cobelli; Luigi Tavazzi

OBJECTIVES In patients with severe heart failure additional therapeutic support with intravenous inotropic or vasodilator drugs is frequently used in the attempt to obtain hemodynamic control. The nature and extent to which diastolic filling, atrial function, and mitral regurgitation are modified by these drugs have not been fully explored. The aim of this study was to compare the acute adaptations of the left ventricular performance, left atrial function, and mitral regurgitation that accompanied hemodynamic improvement during intravenous dobutamine and nitroprusside infusions in patients with severe chronic heart failure. METHODS Forty consecutive patients with severe heart failure were evaluated by simultaneous echo-Doppler and hemodynamic investigations at baseline and during nitroprusside and dobutamine administration. Mitral flow velocity variables, left atrial and ventricular volumes, left atrial reservoir, conduit and pump volumes, and mitral regurgitation jet area were compared by analysis of variance for repeated measurements. RESULTS Nitroprusside increased cardiac output (2.1 +/- .5 vs 2.6 +/- .5 L/min/m2, p < 0.004), reduced left ventricular filling pressure (25 +/- 6 vs 14 +/- 4 mm Hg, p < 0.0001), and improved left atrial pump volume (19 +/- 3 vs 26 +/- 12 ml, p < 0.02) without variations in left atrial reservoir and conduit volume. The restoration of preload reserve and improvement of the atrial contribution to left ventricular diastolic filling were demonstrated by the Doppler mitral flow pattern, which moved from a restrictive to a normal pattern. Furthermore mitral regurgitation decreased in all patients (9 +/- 4.6 vs 4.6 +/- 3.4 cm2, p < 0.0001). Dobutamine increased cardiac output (2.1 +/- .5 vs 2.8 +/- .6 L/min/m2), but the effects on pulmonary wedge pressure and mitral regurgitation were variable and unpredictable. Left atrial reservoir and conduit volumes increased, whereas left atrial pump volume did not change (19 +/- 13 vs 22 +/- 14 ml, p = NS). Furthermore Doppler mitral flow showed a persistent restrictive pattern. CONCLUSIONS In patients with advanced congestive heart failure both nitroprusside and dobutamine improve cardiac output, with different adaptations of left ventricular performance and left atrial function. Nitroprusside seems to restore both atrial and ventricular pump function better. Careful echo-Doppler monitoring during drug infusion provides information relevant to the clinical treatment of individual patients.


Journal of Heart and Lung Transplantation | 2000

Invasive and non-invasive determinants of pulmonary hypertension in patients with chronic heart failure

Soccorso Capomolla; Oreste Febo; Gianpaolo Guazzotti; Marco Gnemmi; Andrea Mortara; G. Riccardi; Angelo Caporotondi; Mariella Franchini; GianDomenico Pinna; Roberto Maestri; Franco Cobelli

BACKGROUND In patients with chronic heart failure, pulmonary hypertension is an important predictive marker of adverse outcome. Its invasive and non-invasive determinants have not been evaluated. OBJECTIVE This study was performed to evaluate hemodynamic determinants of pulmonary hypertension in chronic heart failure and to compare the predictive value of Doppler indices with that of invasively measured hemodynamic indices. METHODS Right heart catheterization and transthoracic echo-Doppler were simultaneously performed in 259 consecutive patients with chronic heart failure (ejection fraction 24% +/- 7%) who were in sinus rhythm and receiving optimized medical therapy. Systolic pulmonary artery pressure (sPAP), cardiac index, transpulmonary gradient pressure, and pulmonary wedge pressure (PWP) were measured invasively. Left atrial and ventricular systolic and diastolic volumes, the ratio of maximal early to late diastolic filling velocities (E/A ratio), deceleration time (DT) and atrial filling fraction (AFF) of transmitral flow, systolic fraction of forward pulmonary venous flow (SFpvf), and mitral regurgitation were quantified by echo-Doppler. RESULTS Patients with pulmonary hypertension had greater left atrial systolic and diastolic dysfunction, more left ventricular diastolic abnormalities, and greater hemodynamic impairment. The correlations between systolic left ventricular indices, mitral regurgitation, and sPAP were generally poor. Among invasive and non-invasive measurements, PWP (r = 0.89, p < 0.0001) and SFpvf (r = -0.68, p < 0.0001) showed the strongest correlation with sPAP. When we compared all patients with those without mitral regurgitation, the correlations between E/A ratio (r = 0.56 vs r = 0. 74, p < 0.002), SFpvf (r = -0.68 vs r = -0.84, p < 0.03), and systolic pulmonary artery pressure were significantly stronger. Multivariate analysis revealed that PWP was the strongest invasive independent predictor of systolic pulmonary artery pressure in patients with (R(2) = 0.87, p < 0.0001) and without (R(2) = 0.90, p < 0.0001) mitral regurgitation. A PWP > or= 18 mm Hg (odds ratio [95% CL], 142 (41-570) was strongly associated with systolic pulmonary hypertension. Among non-invasive variables DT, SFpvf, and AFF were identified as independent predictors of sPAP in patients with (R(2) = 0.56, p < 0.0001) and without (R(2) = 0.78, p < 0.0001) mitral regurgitation. A DT < 130 (odds ratio [95% CL], 3.5 (1.3-8.5), SFfvp < 40% (odds ratio [95% CL], 333 (41-1,007), and AFF < 30% (odds ratio [95% CL], 2 (1.3-7) most strongly predicted systolic pulmonary hypertension. CONCLUSIONS The results of this study indicate that in patients with chronic heart failure, venous pulmonary congestion is an important determinant of systolic pulmonary artery hypertension. Hemodynamic and Doppler determinants showed similar predictive power in identifying systolic pulmonary artery hypertension.


European Journal of Preventive Cardiology | 2015

The 6-minute walking test and all-cause mortality in patients undergoing a post-cardiac surgery rehabilitation program

Maria Teresa La Rovere; Gian Domenico Pinna; Roberto Maestri; Francesca Olmetti; Vincenzo Paganini; G. Riccardi; Roberto Riccardi; Claudio Goggi; Marco Ranucci; Oreste Febo

Background The 6-minute walking test (6mWT) is used to prescribe physical activity in cardiac surgery patients. The clinical value of a pre-discharge 6mWT and its association with outcome is not well defined. Design and methods We retrospectively analyzed data from 313 patients (age 66 ± 11 years, 23% females, left ventricular ejection fraction (LVEF) 52 ± 11%, Hb 10.5 ± 1.3 g/dl, serum albumin 3.9 ± 0.4 mg/dl) who were admitted to our rehabilitation institute following cardiac surgery. A 6mWT was performed at entry and at discharge and expressed as % of theoretical predicted values calculated on the basis of individual age, height, weight and sex. The endpoint was represented by all-cause mortality. The predictive value of 6mWT was tested in univariate and multivariate analysis. Results A pre-discharge 6mWT was completed by 284 out of 313 patients. Two patients died in hospital. During a median of 23 months, mortality was 9% (26/284) and 44% (12/27) (p < 0.0001) in patients who did or did not perform the pre-discharge 6mWT. The distance covered at the pre-discharge 6mWT as a continuous variable of % predicted values was a significant predictor of subsequent mortality (Hazard Ratio (HR) 0.97 (95% CI 0.96–0.99), p = 0.0019). After adjustment for all preselected covariates, the pre-discharge 6mWT (HR 0.97 (95% CI 0.95–0.99), p = 0.0038) and LVEF (HR 0.93 (95% CI 0.90–0.96), p < 0.0001) remained significantly associated with the outcome. Conclusions In recent cardiac surgery patients, the pre-discharge 6mWT is not only a valid measurement of the impact of cardiac rehabilitation but also provides outcome information offering the possibility to identify patients who may need more intensive follow-up.


The Cardiology | 1988

Relationships between Anaerobic Threshold and Exercise Hemodynamic Pattern in Patients with Previous Myocardial Infarction

Cristina Opasich; F. Cobelli; G. Riccardi; Roberto Aquilani; Giuseppe Specchia

UNLABELLED In 78 male class I and II NYHA patients with previous myocardial infarction, the relationships between ventilatory anaerobic threshold levels and hemodynamic patterns during a maximal symptom-limited stress test in the supine position were studied. Among the 36 patients with abnormal exercise wedge values, 11 showed an anaerobic threshold (AT) less than 35% of the maximal predicted VO2(mpVO2) (group A) and 23 showed an AT of 36-50% mpVO2 (group B). In 2 patients, the AT was greater than 50% mpVO2. Among the 42 patients with normal exercise wedge pressure, 13 showed an AT of 36-50% mpVO2 (group C), whereas in 29 patients, the AT was greater than 50% mpVO2 (group D). The mean value of AT in group A was significantly lower than in group B (8.6 +/- 0.7 vs. 11.7 +/- 0.5 ml/kg.min; p less than 0.05). No difference was found in the mean of the AT between groups B and C, while the mean value of AT in group D was significantly higher than in group C (16.9 +/- 0.4 vs. 12.9 +/- 0.6 ml/kg.min; p less than 0.005). No significant differences between groups C and D were found in the invasive and noninvasive parameters considered. Groups C and D were statistically different from groups A and B for pulmonary capillary pressures, total pulmonary resistances, stroke indexes, heart rates, arteriovenous O2 differences, total systemic resistances and lactate concentrations. Total pulmonary resistances and heart rates were statistically higher and stroke indexes were statistically lower in group A than in group B. IN CONCLUSION (1) patients with normal exercise wedge values show a higher AT than patients with abnormal exercise wedge values. (2) Patients with normal exercise hemodynamic patterns classified according to their AT show no difference in hemodynamics; in these patients the level of AT seems to be related to peripheral determinants. (3) Patients with abnormal exercise hemodynamic patterns classified according to their AT level show different hemodynamics and different responses in ventricular function; in these patients the level of AT seems to be related to the cardiac impairment.


Echocardiography-a Journal of Cardiovascular Ultrasound and Allied Techniques | 1998

Peak summation left ventricular filling pattern in patients with chronic heart failure: Frequency and complementary value of pulmonary venous flow in its hemodynamic interpretation

Soccorso Capomolla; Oreste Febo; G. Riccardi; Paolo Parziale; GianDomenico Pinna; Cristina Opasich; Franco Cobelli; Luigi Tavazzi

In patients with chronic heart failure (CHF) and a “peak summation” left ventricular pattern, no hemodynamic and prognostic information can be drawn from Doppler examination of mitral flow. In 263 consecutive patients with CHF who were undergoing simultaneous right heart catheterization and echo‐Doppler examination, we prospectively determined (1) the frequency of the peak summation left ventricular filling pattern and (2) the incremental information contributed by pulmonary venous flow velocity patterns in providing noninvasive hemodynamic profile estimation. Isovolumic relaxation time of mitral flow, peak systolic (X), diastolic forward (Y), reverse (Z) flow velocity, and systolic fraction (X/X + Y) of pulmonary venous flow were measured. Forty‐six of 263 (17%) patients had a peak summation left ventricular filling pattern. This subgroup showed more clinical deterioration (New York Heart Association functional class III‐IV, 57% vs 49%; P < 0.01) and left atrial dysfunction (left atrial ejection fraction, 31% vs 39%; P < 0.001). However, 40% of these patients had a pulmonary wedge pressure of> 18 mmHg and a cardiac index of < 2.2 L/min/m2. The systolic fraction of peak velocities of pulmonary venous flow showed a good correlation with pulmonary wedge pressure (r = ‐0.70, P < 0.05). The correlation was stronger in patients without mitral regurgitation (r = ‐0.81, P < 0.05). A systolic fraction of < 40% was accurate (sensitivity, 100%; specificity, 95%) in identifying patients with a pulmonary wedge pressure of < 18 mmHg. In patients without mitral regurgitation, this variable was also correlated with cardiac index (r = ‐0.65, P < 0.05) and predicted a cardiac index of < 2.2 L/min/m2 (sensitivity, 91% specificity, 71%). In conclusion, a peak summation left ventricular filling pattern is common in patients with CHF. Pulmonary venous flow provides useful information about the hemodynamic profile of these patients.


Archive | 1987

Beurteilung von Gallopamil (D 600) bei Patienten mit chronisch stabiler Angina pectoris —, Ergebnisse einer plazebokontrollierten Einfachblindstudie

Specchia G; F. Cobelli; L. Tavazzi; S. De Servi; Maurizio Ferrario; S. Ghio; C. Opasich; G. Riccardi

Die antianginosen Effekte von Kalziumantagonisten beruhen auf verschiedenen Wirkmechanismen, die entweder in einer Verringerung des myokardialen Sauerstoffverbrauchs und/ oder einer Verbesserung der Sauerstoffzufuhr zum Myokard bestehen, je nach Affinitat fur spezifische Wirkorte und Unterschieden in der Pathogenese der Myokardischamie.


Archive | 1989

Assessment of gallopamil (D 600) in patients with chronic stable angina pectoris Results of a placebo-controlled single-blind study

Specchia G; F. Cobelli; L. Tavazzi; S. De Servi; Maurizio Ferrario; S. Ghio; C. Opasich; G. Riccardi

The anti-anginal effects of calcium antagonists are due to a reduction of myocardial oxygen uptake and/or an improvement of oxygen supply to the myocardium, depending on the affinity of the drug to specific sites of action and differences in the pathogenesis of the myocardial ischaemia.


European Heart Journal | 1988

Does the study of anaerobic metabolism give quantitative information on left ventricular dysfunction during exercise

C. Opasich; F. Cobelli; G. Riccardi; M. T. La Rovere; G. Calsamiglia; Specchia G


European Heart Journal | 1988

The effects of physical training in post-myocardial infarction patients with exercise-induced silent ischaemia.

C. Opasich; G. Riccardi; Assandri J; G. Calsamiglia; R. Forni; M. T. La Rovere; F. Cobelli; S. De Servi; Specchia G

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F. Cobelli

Erasmus University Rotterdam

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C. Opasich

Research Medical Center

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Oreste Febo

Erasmus University Rotterdam

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Roberto Tramarin

Erasmus University Rotterdam

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