Claudio Rapezzi passed away at the age of 71, leaving abruptly all his patients, friends, colleagues, and pupils. Rapezzi ‘was first and foremost a clinician who always put the patient first and could always be counted on to appropriately frame new discoveries’, as Frederick Ruberg wrote. He gave a substantial contribution to the advance in medical knowledge thanks to his unique qualities of curiosity, culture, and imaginative vision in each of the many fields his work touched: from the never-ending love for electrocardiography, manifested from his first publication1 up to its novel applications in cardiomyopathies, to the legacy he has left in cardiac amyloidosis with the ‘many ideas that we take for granted now, bone tracer cardiac imaging, tafamidis and so much more’, as Sharmila Dorbala has written, to the last Editorial on sex differences in this disease.2 Amyloid transthyretin cardiomyopathy (ATTR-CM) is emerging as an important cause of morbidity and mortality and a widely underdiagnosed disorder. One of the reasons for the recent interest on ATTR-CM is the availability of an algorithm for the non-invasive diagnosis of this condition. Indeed, the combination of an intense cardiac uptake of bone tracers and the absence of a monoclonal protein allows us to diagnose ATTR-CM without the need for the demonstration of amyloid deposits on tissue samples from the heart or an extracardiac site.1 In detail, cardiac uptake must be as intense as that of the sternum and ribs (Perugini Grade 2), or more intense than the sternum and ribs (Perugini Grade 3).3 The Perugini grading system is named after Enrica Perugini, the first author of a seminal paper published in 2005 by the research group from Bologna coordinated by Claudio Rapezzi.3 It was thus Prof. Rapezzi who introduced this very simple grading system and understood its relevance for the differential diagnosis between light-chain and ATTR-CM. Indeed, an international collaboration led by Rapezzi and the group of the National Amyloidosis Centre in London established in 2016 that ‘the combined findings of grade 2 or 3 myocardial radiotracer uptake on bone scintigraphy and the absence of a monoclonal protein in serum or urine had a specificity and positive predictive value for cardiac ATTR amyloidosis of 100%’,4 thus introducing the concept of a non-invasive diagnosis of ATTR-CM that is now adopted worldwide.5 Every diagnosis of ATTR-CM made without the need of a tissue biopsy is then an ideal tribute to the vision of Rapezzi. In the same years, the Phase 3 Safety and Efficacy of Tafamidis in Patients with Transthyretin Cardiomyopathy (ATTR-ACT) trial was evaluating the TTR stabilizer tafamidis in patients with ATTR-CM. The results of this trial, presented by Rapezzi during the 2018 European Society of Cardiology meeting in Munich, opened a new therapeutic avenue for patients with ATTR-CM from all over the world.6 Tafamidis still remains the only approved treatment for ATTR-CM, either variant or wild-type, with a demonstrated survival benefit confirmed even in a long-term extension study.7 Rapezzi also contributed greatly to spread the knowledge on ATTR-CM through multiple initiatives, ranging from a position statement of the European Society of Cardiology on the diagnosis and management of amyloid CM8 to other consensus documents,9–12 to talks and educational activities in many congresses, and the formation of many young clinicians and fellows, many of whom established new outpatient clinics devoted to amyloid CM.

10.1093/eurjpc/zwac242

Cite

Citations (0)

Editor’s presentation

European Journal of Preventive Cardiology (2017)

Massimo Piepoli

Presentation (obstetrics)

10.1177/2047487317741702

Cite

Citations (0)

Utility of remote monitoring for implantable device controls in the phase 1 of the first wave of COVID 19 pandemic

European Heart Journal Supplements (2021)

Massimo Bolognesi Leonardo Fortunati Rossi Alessia Zanni Andrea Biagi C Sticozzi

Backgrond: During the first outbreak of COVID 19 pandemic, Piacenza was particularly affected since it counted over one hundred daily access in emergency department, of patients (pz) with SARS COV2 virus. This fact led to a reorganization of hospital activity consisting in the formation of 7 department devoting COVID 19 care and in temporarily postponing scheduled activities of various disciplines to prevent the spread of virus. Also Our Division of cardiology has kept only urgent clinical and interventional activity. With the use of remote monitoring (RM), we were able to check implantable cardiac devices (ICD) almost scheduled and we called ICD recipients in office only for urgent troubles. Methods: In our study we evaluated all ICD recipients that had a scheduled follow up in our electrostimulation clinic on the period from 23th February 2020 to 18 th May 2020 Results: In office scheduled controls during the period considered, involved 216 patients. 85% out of them was followed also with MR;after postponing in office visits, we requested control transmissions. In total we received 441 scheduled and with alert transmissions. Regarding alert transmission: 3 of them signaled ERI (elective replacement indicator), so the replacement of device has been planned;3 of them indicated noise in Ventricular Fibrillation zone related to lead malfunction, so we planned reimplantation of new ventricular lead;12 recorded ventricular arrhythmias (only one patient was called to visit in office for recurrent ventricular arrhythmias);1 of them signaled long lasting atrial fibrillation so we called him to begin anticoagulant therapy. We performed phone triage before confirming in office visit. None of the scheduled transmissions detected troubles. Only 1,8% of patients followed by remote monitoring came in hospital in that period. Conclusions: RM during phase 1 of the first wave of COVID 19 outbreak allowed us to reduce in office visits and to call in hospital only patients with real needs, decreasing the spread of the virus and maintaining identification of clinical and technical troubles.

Triage

Pandemic

Source

Cite

Citations (0)

Origin of Respiratory Sinus Arrhythmia in Conscious Humans

Circulation (1997)

Massimo Piepoli Peter Sleight Stefano Leuzzi Felice Valle Giammario Spadacini

Background We investigated whether respiratory sinus arrhythmia (RSA) in healthy humans originated from central neuronal oscillations or from peripheral baroreceptors responding to respiratory changes in venous return. Methods and Results During subjects’ controlled breathing we used sinusoidal neck suction to influence RSA (spectral analysis of RR interval). In 11 subjects, 20-second apnea greatly reduced RSA, which was restored by neck suction at the frequency of respiration. Counteracting the respiration-induced cycles of carotid blood pressure decreased RSA in 13 subjects (from 2136±682 to 1372±561 ms 2 , P <.01). The critical phase of this neck suction was constant for each subject at around the phase shift (with regard to respiration-related fluctuations of blood pressure) best for smoothing respiratory (mechanical) changes in blood pressure. Suction of a nonbaroreceptor area (the thigh) did not affect RSA. In 4 subjects, to separate the effects of peripheral baroreceptor afferents from respiration-entrained central oscillation (15 breaths/min), we cycled the neck suction at 12 cycles/min. Increasing neck suction from −7 to −30 mm Hg increased the ratio of the power of the 12 cycles compared with the 15-cycle RSA oscillation in RR interval spectral analysis from 0.26 to 2.57. A 12-cycle/min suction of an area other than the neck had little effect on the RR interval spectrum. Conclusions RSA can be mimicked or reduced by stimulation of arterial baroreceptors with cycles of appropriately phased neck suction at the frequency of respiration. This suggests an important influence of the arterial baroreceptors in the generation of RSA in conscious humans.

Vagal Tone

Carotid sinus

10.1161/01.cir.95.7.1813

Cite

Citations (137)

2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease

European Heart Journal (2020)

Antonio Pelliccia Sanjay Sharma Sabiha Gati Maria Bäck Mats Börjesson

The ESC Guidelines represent the views of the ESC and were produced after careful consideration of the scientific and medical knowledge and the evidence available at the time of their publication.The ESC is not responsible in the event of any contradiction, discrepancy and/or ambiguity between the ESC Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies.Health professionals are encouraged to take the ESC Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic or therapeutic medical strategies; however, the ESC Guidelines do not override, in any way whatsoever, the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient's health condition and in consultation with that patient and, where appropriate and/or necessary, the patient's caregiver.Nor do the ESC Guidelines exempt health professionals from taking into full and careful consideration the relevant official updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient's case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations.It is also the health professional's responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription.

Sports medicine

10.1093/eurheartj/ehaa605

Cite

Citations (1,239)

2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS)

European Heart Journal (2019)

Stavros Konstantinides Guy Meyer Cecilia Becattini Héctor Bueno Geert-Jan Geersing

Guidelines summarize and evaluate available evidence with the aim of assisting health professionals in proposing the best management strategies for an individual patient with a given condition. Guidelines and their recommendations should facilitate decision making of health professionals in their daily practice. However, the final decisions concerning an individual patient must be made by the responsible health professional(s) in consultation with the patient and caregiver as appropriate.

Health Professionals

10.1093/eurheartj/ehz405

Cite

Citations (3,568)

2014 ESC Guidelines on the diagnosis and treatment of aortic diseases

European Heart Journal (2014)

Authors Task Force Members Raimund Erbel Victor Aboyans Cathérine Boileau Eduardo Bossone

The ESC Guidelines represent the views of the ESC and were produced after careful consideration of the scientific and medical knowledge and the evidence available at the time of their dating.The ESC is not responsible in the event of any contradiction, discrepancy and/or ambiguity between the ESC Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of health care or therapeutic strategies.Health professionals are encouraged to take the ESC Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic or therapeutic medical strategies; however, the ESC Guidelines do not override, in any way whatsoever, the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient's health condition and in consultation with that patient and, where appropriate and/or necessary, the patient's caregiver.Nor do the ESC Guidelines exempt health professionals from taking full and careful consideration of the relevant official updated recommendations or guidelines issued by the competent public health authorities in order to manage each patient's case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations.It is also the health professional's responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription.

Health Professionals

Contradiction

10.1093/eurheartj/ehu281

Cite

Citations (3,967)

Arterial Baroreceptors as Determinants of 0.1Hz and Respiration-Related Changes in Blood Pressure and Heart Rate Spectra

Studies in health technology and informatics (1997)

Luciano Bernardi Claudio Passino Giammario Spadacini Felice Valle Stefano Leuzzi

Although the so-called low-frequency (around 0.1Hz) components of heart rate variability are an accepted marker of sympathetic activity to the heart and the circulation, their origin remains elusive. In order to characterise the frequency response of the heart and the vessels to the stimulation of the arterial baroreceptors we applied the neck suction technique with a sinusoidal function at different frequencies, and studied the changes in the cardiovascular system. In all subjects the neck suction induced RR interval oscillations at both low- (0.10Hz) and high (0.20Hz) frequencies, but with greater response at 0.1Hz, while blood pressure and skin blood flow oscillations responded only at low frequency (low-pass behaviour). To assess whether this kind of response could have played a role in the genesis of spontaneous LF fluctuations we studied the changes induced by an impulsive neck suction during post-expiratory apnoea: if the LF were due to a resonance in the baroreceptor loop, a single perturbation of the cardiovascular system would have produced oscillations in the cardiovascular system similar to those observed spontaneously. We found that, after the suction, a damped oscillation (whose period was similar and correlated to that of the spontaneous LF) was generated in the cardiovascular system, suggesting that the LF could be indeed generated by a peripheral mechanisms, primarily involving the baroreceptors. In further support of this hypothesis, we also found that counteracting the respiratory fluctuations in blood pressure by appropriately timing a sinusoidal neck suction, we significantly reduced not only the respiratory fluctuations in RR interval, but also the LF. Nevertheless, during undisturbed apnoeas, we observed spontaneous oscillations in the LF range (though slower than those observed during breathing). This observation contrasts with the hypothesis that a resonance in the cardiovascular system is the only source of the LF fluctuations, (since after removing the effects of respiration the LF should disappear as well) and suggests the contemporary presence of other factors, such as a central oscillator, tuned at a similar frequency. In conclusion, the arterial baroreceptors exert a strong, though probably not exclusive influence on the cardiovascular fluctuations, through both sympathetic and vagal activity; the LF appears to be generated not only by a resonance in the cardiovascular system, but also by other independent factors, such as a central oscillator.

10.3233/978-1-60750-879-3-241

Cite

Citations (17)

Pre-participation cardiovascular evaluation for athletic participants to prevent sudden death: Position paper from the EHRA and the EACPR, branches of the ESC. Endorsed by APHRS, HRS, and SOLAECE

European Journal of Preventive Cardiology (2016)

Lluı́s Mont Antonio Pelliccia Sanjay Sharma Alessandro Biffi Mats Börjesson

Cardiovascular Health

Sudden Death

10.1177/2047487316676042

Cite

Citations (230)

ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM)

European Heart Journal (2008)

Kenneth Dickstein Alain Cohen-Solal G. Filippatos John J.V. McMurray Piotr Ponikowski

Guidelines and Expert Consensus Documents summarize and evaluate all currently available evidence on a particular issue with the aim of assisting physicians and other healthcare providers in selecting the best management strategies for a typical patient, suffering from a given condition, taking into account the impact on outcome, as well as the risk–benefit ratio of particular diagnostic or therapeutic means. Guidelines are no substitutes for textbooks. The legal implications of medical guidelines have been discussed previously. A great number of Guidelines and Expert Consensus Documents have been issued in recent years by the European Society of Cardiology (ESC) as well as by other societies and organizations. Because of the impact on clinical practice, quality criteria for development of guidelines have been established in order to make all decisions transparent to the user. The recommendations for formulating and issuing ESC Guidelines and Expert Consensus Documents can be found on the ESC Web Site in the guidelines section (www.escardio.org). In brief, experts in the field are selected and undertake a comprehensive review of the published evidence for management and/or prevention of a given condition. A critical evaluation of diagnostic and therapeutic procedures is performed, including assessment of the risk–benefit ratio. Estimates of expected health outcomes for larger societies are included, where data exist. The level of evidence and the strength of recommendation of particular treatment options are weighed and graded according to pre-defined scales, as outlined in Tables 1 and 2 . View this table: Table 1 Classes of recommendations View this table: Table 2 Levels of evidence The experts of the writing panels have provided disclosure statements of all relationships they may have which might be perceived as real or potential sources of conflicts of interest. These disclosure forms are kept on file at the European Heart House, headquarters of the ESC. Any changes in conflict of interest that arise …

Evidence-Based Medicine

10.1093/eurheartj/ehn309

Cite

Citations (2,664)