Pietro Palermo, MD Centro Cardiologico Monzino, IRCCS, Via Parea, 4, 20138 Milan, Italy. E-mail: ... more Pietro Palermo, MD Centro Cardiologico Monzino, IRCCS, Via Parea, 4, 20138 Milan, Italy. E-mail: pietro.palermo@ccfm.it 1 „George Emil Palade" University of Medicine, Pharmacy, Science and Technology, Targu Mures, Romania. 2 Department of Cardiology, IInd Clinic of Internal Medicine, Emergency Clinical County Hospital, Targu Mures, Romania 3 Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifi co (IRCCS), Milan, Italy Abstract: In patients presenting cardiovascular, pulmonary, muscular and metabolic diseases, exercise testing continues to be a predictive and diagnosis source of information. Diagnosis and assessment of coronary artery disease (known or suspected) encompass clinical and risk factors evaluation and well-defi ned non-invasive and invasive tests. Cardiopulmonary exercise test (CPET) is an evidence-based evaluation technique in Europe, USA and other countries. It consists in applying, directly supervised by a physician, a standardized increm...
Despite important advancements in acute myocardial infarction (AMI) management, it continues to r... more Despite important advancements in acute myocardial infarction (AMI) management, it continues to represent a leading cause of mortality worldwide. Fast and reliable AMI diagnosis can significantly reduce mortality in this high-risk population. Diagnosis of AMI has relied on biomarker evaluation for more than 50 years. The upturn of high-sensitivity cardiac troponin testing provided extremely sensitive means to detect cardiac myocyte necrosis, but this increased sensitivity came at the cost of a decrease in diagnostic specificity. In addition, although cardiac troponins increase relatively early after the onset of AMI, they still leave a time gap between the onset of myocardial ischemia and our ability to detect it, thus precluding very early management of AMI. Newer biomarkers detected in processes such as inflammation, neurohormonal activation, or myocardial stress occur much earlier than myocyte necrosis and the diagnostic rise of cardiac troponins, allowing us to expand biomarker ...
This study was performed to elucidate the level of adherence to antihypertensive treatment in adu... more This study was performed to elucidate the level of adherence to antihypertensive treatment in adult subjects attending a family medicine clinic in a city in central Romania. A cross-sectional, retrospective study was performed on a cohort of hypertensive adults. A total of 525 participants were selected from 1,714 adults attending a single urban family medicine practice. Assessment of adherence to therapy was performed by a chart review of prescription and clinical records over a 4-year study period. The results showed that 69.8% of the patients had high adherence (>80% with therapy); 20.3% had medium adherence (20%-79%); and 9.9% had low adherence (<20%). A positive association was found ( = 0.01) between low adherence and male gender. A significant positive association ( = 0.02) was found between total cardiovascular risk and level of adherence. We found that 54.7% of the high adherence subjects had well-controlled blood pressure, and chronic kidney disease was associated wi...
Background: Pseudoaneurysm of the mitral-aortic intervalvular fibrosa (P-MAIVF) is an unusual com... more Background: Pseudoaneurysm of the mitral-aortic intervalvular fibrosa (P-MAIVF) is an unusual complication related to various injuries or conditions which involve the mitro-aortic region; it communicates with the left ventricular outflow tract and is associated with a high-risk of redoubtable complications or sudden death. The cerebral and splenic localizations are frequently seen as manifestations of systemic embolism in infective endocarditis. Currently, there are no specific recommendations related to the diagnosis, management, treatment, or further evolution of patients with P-MAIVF and concomitant splenic infarction. This paper presents the case of a 43-year-old Caucasian woman with a late diagnosis of mixed bicuspid aortic valve disease, affected by an under-detected and undertreated episode of infective endocarditis leading to asymptomatic P-MAIVF. Prime clinical and imagistic diagnosis of splenic infarction indicated further extended investigations were required to clarify t...
Background An intrapericardial organized haematoma secondary to chronic type A aortic dissection ... more Background An intrapericardial organized haematoma secondary to chronic type A aortic dissection is an extremely rare cause of right heart failure. Imaging studies are essential in recognising and diagnosis of this distinctive medical condition and guiding the anticipated treatment. Case presentation A 70-year-old male patient was admitted for progressive symptoms of right heart failure. His cardiovascular history exposed an aortic valve replacement 22 years before with a Medtronic Hall 23 tilting valve with no regular follow-up. Classical signs of congestion were recognized at physical examination. Transthoracic two-dimensional echocardiography and thoraco-abdominal computed tomography angiography, as essential parts of multimodality imaging algorithm, established the underlying cause of right heart failure. Under total cardiopulmonary bypass and cardiac arrest, surgical removal of the haematoma and proximal repair of the ascending aorta with a patient-matched vascular graft were s...
Introduction. Cardiovascular risk factors, pre-existing comorbidities, molecular factors, and the... more Introduction. Cardiovascular risk factors, pre-existing comorbidities, molecular factors, and the direct effects of second- and third-generation BCR-ABL1 tyrosine kinase inhibitors on the vascular endothelium contribute to the progression of cardiovascular (CV) events, especially atherothrombotic conditions. The study objective was to evaluate comorbidities, the cardiovascular risk profile, and events throughout the chronic myeloid leukaemia disease course. Methods. Retrospective data from adults who experienced haematology treatment at a single centre were continuously updated and followed throughout the disease course. A total of 43 subjects conforming with the inclusion and exclusion criteria of the study protocol were finally recruited. The median disease course was 77.0 ± 17.5 months. Statistical analyses were performed. Results. More than three CV risk factors were identified in 41.9% of cases. Almost half of the cases had relevant comorbidities (Charlson Comorbidity Index (CC...
Pietro Palermo, MD Centro Cardiologico Monzino, IRCCS, Via Parea, 4, 20138 Milan, Italy. E-mail: ... more Pietro Palermo, MD Centro Cardiologico Monzino, IRCCS, Via Parea, 4, 20138 Milan, Italy. E-mail: pietro.palermo@ccfm.it 1 „George Emil Palade" University of Medicine, Pharmacy, Science and Technology, Targu Mures, Romania. 2 Department of Cardiology, IInd Clinic of Internal Medicine, Emergency Clinical County Hospital, Targu Mures, Romania 3 Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifi co (IRCCS), Milan, Italy Abstract: In patients presenting cardiovascular, pulmonary, muscular and metabolic diseases, exercise testing continues to be a predictive and diagnosis source of information. Diagnosis and assessment of coronary artery disease (known or suspected) encompass clinical and risk factors evaluation and well-defi ned non-invasive and invasive tests. Cardiopulmonary exercise test (CPET) is an evidence-based evaluation technique in Europe, USA and other countries. It consists in applying, directly supervised by a physician, a standardized increm...
Despite important advancements in acute myocardial infarction (AMI) management, it continues to r... more Despite important advancements in acute myocardial infarction (AMI) management, it continues to represent a leading cause of mortality worldwide. Fast and reliable AMI diagnosis can significantly reduce mortality in this high-risk population. Diagnosis of AMI has relied on biomarker evaluation for more than 50 years. The upturn of high-sensitivity cardiac troponin testing provided extremely sensitive means to detect cardiac myocyte necrosis, but this increased sensitivity came at the cost of a decrease in diagnostic specificity. In addition, although cardiac troponins increase relatively early after the onset of AMI, they still leave a time gap between the onset of myocardial ischemia and our ability to detect it, thus precluding very early management of AMI. Newer biomarkers detected in processes such as inflammation, neurohormonal activation, or myocardial stress occur much earlier than myocyte necrosis and the diagnostic rise of cardiac troponins, allowing us to expand biomarker ...
This study was performed to elucidate the level of adherence to antihypertensive treatment in adu... more This study was performed to elucidate the level of adherence to antihypertensive treatment in adult subjects attending a family medicine clinic in a city in central Romania. A cross-sectional, retrospective study was performed on a cohort of hypertensive adults. A total of 525 participants were selected from 1,714 adults attending a single urban family medicine practice. Assessment of adherence to therapy was performed by a chart review of prescription and clinical records over a 4-year study period. The results showed that 69.8% of the patients had high adherence (>80% with therapy); 20.3% had medium adherence (20%-79%); and 9.9% had low adherence (<20%). A positive association was found ( = 0.01) between low adherence and male gender. A significant positive association ( = 0.02) was found between total cardiovascular risk and level of adherence. We found that 54.7% of the high adherence subjects had well-controlled blood pressure, and chronic kidney disease was associated wi...
Background: Pseudoaneurysm of the mitral-aortic intervalvular fibrosa (P-MAIVF) is an unusual com... more Background: Pseudoaneurysm of the mitral-aortic intervalvular fibrosa (P-MAIVF) is an unusual complication related to various injuries or conditions which involve the mitro-aortic region; it communicates with the left ventricular outflow tract and is associated with a high-risk of redoubtable complications or sudden death. The cerebral and splenic localizations are frequently seen as manifestations of systemic embolism in infective endocarditis. Currently, there are no specific recommendations related to the diagnosis, management, treatment, or further evolution of patients with P-MAIVF and concomitant splenic infarction. This paper presents the case of a 43-year-old Caucasian woman with a late diagnosis of mixed bicuspid aortic valve disease, affected by an under-detected and undertreated episode of infective endocarditis leading to asymptomatic P-MAIVF. Prime clinical and imagistic diagnosis of splenic infarction indicated further extended investigations were required to clarify t...
Background An intrapericardial organized haematoma secondary to chronic type A aortic dissection ... more Background An intrapericardial organized haematoma secondary to chronic type A aortic dissection is an extremely rare cause of right heart failure. Imaging studies are essential in recognising and diagnosis of this distinctive medical condition and guiding the anticipated treatment. Case presentation A 70-year-old male patient was admitted for progressive symptoms of right heart failure. His cardiovascular history exposed an aortic valve replacement 22 years before with a Medtronic Hall 23 tilting valve with no regular follow-up. Classical signs of congestion were recognized at physical examination. Transthoracic two-dimensional echocardiography and thoraco-abdominal computed tomography angiography, as essential parts of multimodality imaging algorithm, established the underlying cause of right heart failure. Under total cardiopulmonary bypass and cardiac arrest, surgical removal of the haematoma and proximal repair of the ascending aorta with a patient-matched vascular graft were s...
Introduction. Cardiovascular risk factors, pre-existing comorbidities, molecular factors, and the... more Introduction. Cardiovascular risk factors, pre-existing comorbidities, molecular factors, and the direct effects of second- and third-generation BCR-ABL1 tyrosine kinase inhibitors on the vascular endothelium contribute to the progression of cardiovascular (CV) events, especially atherothrombotic conditions. The study objective was to evaluate comorbidities, the cardiovascular risk profile, and events throughout the chronic myeloid leukaemia disease course. Methods. Retrospective data from adults who experienced haematology treatment at a single centre were continuously updated and followed throughout the disease course. A total of 43 subjects conforming with the inclusion and exclusion criteria of the study protocol were finally recruited. The median disease course was 77.0 ± 17.5 months. Statistical analyses were performed. Results. More than three CV risk factors were identified in 41.9% of cases. Almost half of the cases had relevant comorbidities (Charlson Comorbidity Index (CC...
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