Publications by authors named "Federica Agnello"

6 Publications

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Efficacy and safety of aspirin for cardiovascular risk prevention in younger and older age: an updated systematic review and meta-analysis.

Thromb Haemost 2021 Oct 12. Epub 2021 Oct 12.

Cardiology Unit, University of Catania, Catania, Italy.

Aims - The efficacy and safety of aspirin for primary cardiovascular disease (CVD) prevention is controversial. The aim of this study was to investigate the merits of aspirin in subjects with no overt CVD, with a focus on age as a treatment modifier. Methods and results - Randomized trials comparing aspirin use versus no aspirin use or placebo were included. The primary efficacy outcome was all-cause death. The primary safety outcome was major bleeding. Subgroups analyses were conducted to investigate the consistency of the effect sizes in studies including younger and older individuals, using a cut-off of 65 years. A total of 21 randomized trials including 173,810 individuals at a mean follow-up of 5.3 years were included. Compared with control, aspirin did not reduce significantly the risk of all-cause death (risk ratio 0.96, 95% CI 0.92-1.00, p=0.057). Major adverse cardiovascular events were significantly reduced by 11%, paralleled by significant reductions in myocardial infarction and transient ischemic attack. Major bleeding, intracranial hemorrhage, and gastrointestinal bleeding were significantly increased by aspirin. There was a significant age interaction for death (p for interaction=0.007), with aspirin showing a statistically significant 7% relative benefit on all-cause death in studies including younger patients. Conclusions - The use of aspirin in subjects with no overt cardiovascular disease was associated with a neutral effect on all-cause death and a modest lower risk of major cardiovascular events at the price of an increased risk in major bleeding. The benefit of aspirin might be more pronounced in younger individuals.
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October 2021

Severe Aortic Valve Stenosis: Symptoms, Biochemical Markers, and Global Longitudinal Strain.

J Cardiovasc Echogr 2020 Jul-Sep;30(3):154-161. Epub 2020 Nov 9.

Division of Cardiology, Department of Cardio-Thoracic-Vascular and Transplants, A.O.U. "Policlinico-Vittorio Emanuele", University of Catania, Italy.

Background: According to the actual guidelines regarding severe aortic valve stenosis (AS), symptoms are the most important trigger for aortic valve replacement (AVR). However, the objective analysis of cardiological clinic can be confused, considering the aging population this disease affects and the comorbidities.

Objectives: Looking for an objective marker of disease, useful for scheduling the correct AVR, we researched the relation between some biochemical markers of left ventricular (LV) dysfunction and its global longitudinal strain.

Materials And Methods: We analyzed 74 consecutive patients (82 ± 4 years) with severe AS. We identified 61 patients with symptoms (angina, dyspnea, and syncope) and 13 asymptomatic patients. The clinical and echocardiographic parameters were compared between these two groups. LV ejection fraction (LVEF), LV global longitudinal strain (LVGLS), NT-pro-B-type brain natriuretic peptide (BNP), troponin T (TNT), creatine kinase-MB (CPK-MB), and myoglobin were determined at the time of evaluation.

Results: Compared with the asymptomatic group, patients in the symptomatic group had a lower LVGLS ( = 0.002) and an increased pro-BNP ( = 0.0002). LVGLS showed a good correlation with pro-BNP as a marker of myocardial damage, with a linear increase of pro-BNP in patients with a linear decrease of LVGLS ( = 0.43). Despite the normal value of LVEF > 50% in asymptomatic patients, some of them (46%) have an early dysfunction of LVGLS. No other statistically significant difference emerged from the biochemical analysis, in TNT ( = 0.29), CPK-MB ( = 0.36), and myoglobin ( = 0.38).

Conclusions: Pro-BNP and LVGLS can be considered an objective marker of clinical severity of AS disease, useful for management and scheduling of AVR, especially in asymptomatic patients.
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November 2020

Suitability for elderly with heart disease of a QR code-based feedback of drug intake: Overcoming limitations of current medication adherence telemonitoring systems.

Int J Cardiol 2021 03 9;327:209-216. Epub 2020 Dec 9.

Division of Cardiology, Policlinico Hospital, University of Catania, Catania, Italy.

Background: Current medication adherence telemonitoring systems have several limitations prompting the need for simpler, low-cost and widely applicable tools. To meet these needs, we propose a novel method consisting in sending a digital feedback of medication intake by just reading a pre-defined Quick Response (QR) code attached on the pills box.

Methods: To assess the potential clinical applicability of the proposed QR code-based task, its feasibility was tested among elderly with heart diseases. The primary endpoint was the learning success defined as a correct execution of all QR code-based digital task steps within 10 min. Study outcomes were compared between patients 65-75 years old (younger cohort) and those aged >75 years (older cohort) admitted to the Cardiology ward of a tertiary center.

Results: A total of 262 patients were included: 128 (48.9%) were younger and 134 (51.1%) older. Despite a baseline low smartphone use in the overall population (41.2%), patients learning success of the digital task was as high as 75.6%, with lower rates among older vs. younger (67.9% vs. 83.6%, p = 0.005). After adjustment no significant independent association between age and success in learning the QR code-based task was found. Differently, increasing age was a negative independent predictor of smartphone use. The learning time was overall small, but longer in the older group (126 ± 100 vs. 100 ± 60 s, p = 0.03).

Conclusions: The QR code-based digital task was highly feasible for elderly with heart diseases suggesting its potential large-scale clinical application and encouraging the investigation of QR code-based systems for medication adherence telemonitoring.
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March 2021

Prevention of contrast-induced acute kidney injury in patients undergoing percutaneous coronary intervention.

Kardiol Pol 2020 10 29;78(10):967-973. Epub 2020 Jul 29.

Division of Cardiology, A.O.U. Policlinico “G. Rodolico­‑San Marco,” University of Catania, Catania, Italy.

Intravascular administration of contrast media is an irreplaceable step of percutaneous coronary intervention. Since the latter is a very common procedure, contrast‑induced acute kidney injury (CI‑AKI) has become one of the most frequent causes of acute nephropathy, and a relevant prognostic impact of CI‑AKI has been observed. Some patient comorbidities and procedural characteristics have been identified as key risk factors of CI‑AKI. In this review, we discuss current evidence and future research directions on CI‑AKI prevention in patients undergoing percutaneous coronary intervention.
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October 2020