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Giordani AS, Baritussio A, Marcolongo R, Caforio ALP. Letter to the Editor: Response to "Diagnostic yield, safety and therapeutic consequences of myocardial biopsy in clinically suspected fulminant myocarditis unweanable from mechanical circulatory support". Ann Intensive Care 2024; 14:5. [PMID: 38194020 PMCID: PMC10776506 DOI: 10.1186/s13613-023-01232-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 12/18/2023] [Indexed: 01/10/2024] Open
Affiliation(s)
- A S Giordani
- Cardiology, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - A Baritussio
- Cardiology, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - R Marcolongo
- Cardiology, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - A L P Caforio
- Cardiology, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, Via Giustiniani 2, 35128, Padua, Italy.
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2
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Giordani AS, Candelora A, Fiacca M, Cheng C, Barberio B, Baritussio A, Marcolongo R, Iliceto S, Carturan E, De Gaspari M, Rizzo S, Basso C, Tarantini G, Savarino EV, Alp C. Myocarditis and inflammatory bowel diseases: A single-center experience and a systematic literature review. Int J Cardiol 2023; 376:165-171. [PMID: 36738845 DOI: 10.1016/j.ijcard.2023.01.071] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 01/06/2023] [Accepted: 01/24/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Myocarditis and inflammatory bowel diseases (IBD) are rare conditions, but may coexist. Myocarditis in IBD may be infective, immune-mediated, or due to mesalamine toxicity. A gap of knowledge exists on the clinical features of patients that present myocarditis in association with IBD, especially for endomyocardial biopsy-proven cases. Our aims are: 1) to describe the clinical characteristics of patients with an associated diagnosis of myocarditis and IBD in a single-center hospital, 2) to perform a systematic review of the literature of analogous cases. METHODS We retrospectively analyzed data of patients followed up at the outpatient Cardio-immunology and Gastroenterology Clinic of Padua University Hospital, to identify those with an associated diagnosis of myocarditis and IBD. In addition, a systematic review of the literature was conducted. We performed a qualitative analysis of the overall study population. RESULTS The study included 104 patients (21 from our single center cohort, 83 from the literature review). Myocarditis in IBD more frequently affects young (median age 31 years) males (72%), predominantly with infarct-like presentation (58%), within an acute phase of the IBD (67%) and with an overall benign clinical course (87%). Nevertheless, a not negligible quote of patients may present giant cell myocarditis, deserve immunosuppression and have a chronic, or even fatal course. Histological evidence of mesalamine hypersensitivity is scarce and its incidence may be overestimated. CONCLUSIONS Our study shows that myocarditis in association with IBD, if correctly managed, may have a spontaneous benign course, but predictors of worse prognosis must be promptly recognized.
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Affiliation(s)
- A S Giordani
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua and Azienda Ospedale Università di Padova, Padua, Italy
| | - A Candelora
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua and Azienda Ospedale Università di Padova, Padua, Italy
| | - M Fiacca
- Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua and Azienda Ospedale Università di Padova, Padua, Italy
| | - C Cheng
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua and Azienda Ospedale Università di Padova, Padua, Italy
| | - B Barberio
- Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua and Azienda Ospedale Università di Padova, Padua, Italy
| | - A Baritussio
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua and Azienda Ospedale Università di Padova, Padua, Italy
| | - R Marcolongo
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua and Azienda Ospedale Università di Padova, Padua, Italy
| | - S Iliceto
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua and Azienda Ospedale Università di Padova, Padua, Italy
| | - E Carturan
- Cardiovascular Pathology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua and Azienda Ospedale Università di Padova, Padua, Italy
| | - M De Gaspari
- Cardiovascular Pathology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua and Azienda Ospedale Università di Padova, Padua, Italy
| | - S Rizzo
- Cardiovascular Pathology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua and Azienda Ospedale Università di Padova, Padua, Italy
| | - C Basso
- Cardiovascular Pathology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua and Azienda Ospedale Università di Padova, Padua, Italy
| | - G Tarantini
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua and Azienda Ospedale Università di Padova, Padua, Italy
| | - E V Savarino
- Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua and Azienda Ospedale Università di Padova, Padua, Italy
| | - Caforio Alp
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua and Azienda Ospedale Università di Padova, Padua, Italy.
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3
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Marcolongo R, Giordani A, Brunetti M, Gregori D, Lorenzoni G, Iliceto S, Baritussio A, Caforio ALP. Acute idiopathic pericarditis: the importance of guideline-based treatment to avoid recurrence. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Acute pericarditis (AP) usually resolves with first-line treatment, but it may recur. Recurrences are attributed to a deranged immunity, but it is unclear if they may also be related to inappropriate treatment.
Purpose
The aim of our study was to clarify the potential role of inappropriate treatment on relapse episodes in AP.
Methods
Consecutive patients prospectively followed-up over 20 years at Padua University Cardio-immunology outpatient clinic were included. Clinical and instrumental findings were recorded at diagnosis and at each follow-up. Spectrum, appropriateness, efficacy and side effects of therapies received by patients before and after referral to our centre were considered. The distribution of recurrence-free survival probability was estimated using Kaplan-Meier method; impact of the covariates of interest on the outcome was assessed using Cox univariate analysis models.
Results
The study included 144 patients (57% male, mean age 50 years, 143 Caucasian and 1 African). 139 patients had AP, which was recurrent in 63; 5 had constrictive pericarditis. Etiology was idiopathic/presumed-viral in 112 patients, bacterial in 1, secondary to pericardial injury in 26, to Dressler syndrome in 2, and to a systemic immune-mediated disease in 3. At diagnosis, 68% were in NYHA class I; 9% developed cardiac tamponade; 84% received non-steroidal-anti-inflammatory drugs (NSAIDs), 54% colchicine and 19% corticosteroids. Treatment was not in line with ESC guidelines in 31% of patients for NSAIDs, in 12% for steroids and in 28% for colchicine, requiring readjustment. All patients with constrictive pericarditis underwent uncomplicated pericardiectomy. No patient was dead at last follow-up. Estimated recurrence-free-survival probability was 86% at 1st year, 58% at 5th, 52% at 10th. Variables which tended to be associated with a higher risk of recurrence were: cardiac tamponade at diagnosis, left heart failure, concomitant immune-mediated diseases, history of recurrence, inappropriate treatment with colchicine, inappropriate treatment with NSAIDs, III or IV NYHA class at diagnosis. Treatment of acute/recurrent forms before referral did not appear in line with the international recommendations in terms of daily dosage or duration, or both, in 43 patients for NSAIDs, in 17 for corticosteroids and in 39 for colchicine, which was omitted despite the absence of contraindications (Table 1). Following treatment adjustment to international guidelines, 107 patients with relapsing pericarditis obtained complete remission; only 13 (9%) of our AP patients showed a truly treatment-refractory form that required a second-line therapy.
Conclusion
When treated according to international guidelines, pericarditis has usually a favorable course, even in its most adverse presentations. Treatment inaccuracies seems to account, at least in part, to disease recurrences.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- R Marcolongo
- University of Padua, Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health , Padova , Italy
| | - A Giordani
- University of Padua, Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health , Padova , Italy
| | - M Brunetti
- University of Padua, Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health , Padova , Italy
| | - D Gregori
- University of Padua, Statistics, Department of Cardiac, Thoracic, Vascular Sciences and Public Health,University of Padua , Padova , Italy
| | - G Lorenzoni
- University of Padua, Statistics, Department of Cardiac, Thoracic, Vascular Sciences and Public Health,University of Padua , Padova , Italy
| | - S Iliceto
- University of Padua, Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health , Padova , Italy
| | - A Baritussio
- University of Padua, Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health , Padova , Italy
| | - A L P Caforio
- University of Padua, Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health , Padova , Italy
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4
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Martini M, Zupa F, Mancuso D, Baritussio A, Famoso G, Perazzolo Marra M, Iliceto S, Rigato I. P392 A MULTIMODALITY IMAGING DIAGNOSIS OF A CHALLENGING CASE OF CONCOMITANT GROUP 1 PULMONARY HYPERTENSION AND PARADOXICALLY LOW–FLOW, LOW–GRADIENT AORTIC STENOSIS. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
A 76 year old woman was admitted to our hospital for self–limiting dyspnoea (NYHA class III) in oxygen dependence and frequent lipothymia following Valsalva manoeuvres. She was previously admitted to a Spoke Centre for heart failure (HF) with preserved ejection fraction (EF) and a new diagnosis of “pre–capillary pulmonary hypertension (PH)”. Despite a diagnosis of PH of unclear aetiology, she was started on macitentan without being reassessed for functional capacity due to Covid emergency; because of worsening symptoms, she was admitted to our Hub Centre. Resting ECG showed right axis deviation, right ventricle (RV) hypertrophy, first–degree atrioventricular block and right bundle branch block. Transthoracic echocardiography (TTE) showed reduced left ventricular (LV) volume with preserved EF (diastolic volume= 37 ml, EF = 88%), severe right atrial and RV dilation with flattening of the interventricular septum, estimated pulmonary artery systolic pressure (PASP) of 124 mmHg, and moderate calcific aortic stenosis (peak aortic velocity 3.3 m/s, mean gradient 25 mmHg, valve area 1.1 cm2). Right and left heart catheterization showed severe pre–capillary PH (mean pulmonary pressure 60 mmHg, mean wedge 11 mmHg, pulmonary vascular resistance 14.41 WU), a severe aortic valve stenosis (aortic valve area 0.68 cmq and peak–to–peak gradient 25 mmHg, slight reduction of cardiac index 2.04 l/min/mq) and no significant coronary artery disease. The degree of aortic stenosis was considered as moderate–severe by integrating data of transesophageal echocardiography (planimetric area 1cm2) and assessment of calcium score (1615 Agatson units). Pneumological causes, chronic thromboembolic PH, rheumatologic diseases, HIV infection, paraneoplastic origin and veno–occlusive disease were all ruled out as potential PH causes and a diagnosis of Idiopathic pulmonary arterial hypertension (IPAH) was finally made. The Heart Team established the best therapeutic option was a transcatheter aortic valve replacement (TAVI) allowing better haemodynamic tolerability of PH therapy. The patient underwent TAVI and was started on PH therapy; a complete atrio–ventricular block developed after the procedure, requiring permanent pacemaker (PM) implantation. Unfortunately, few days later, the patient died following pacemaker’s lead dislocation.
Conclusion
PH has a diverse aetiology, and prognosis is generally poor, especially in patients with severe comorbidities.
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Affiliation(s)
- M Martini
- UNITÀ OPERATIVA DI CARDIOLOGIA, DIPARTIMENTO DI SCIENZE CARDIO TORACO VASCOLARI E SANITÀ PUBBLICA, UNIVERSITÀ DEGLI STUDI DI PADOVA, PADOVA
| | - F Zupa
- UNITÀ OPERATIVA DI CARDIOLOGIA, DIPARTIMENTO DI SCIENZE CARDIO TORACO VASCOLARI E SANITÀ PUBBLICA, UNIVERSITÀ DEGLI STUDI DI PADOVA, PADOVA
| | - D Mancuso
- UNITÀ OPERATIVA DI CARDIOLOGIA, DIPARTIMENTO DI SCIENZE CARDIO TORACO VASCOLARI E SANITÀ PUBBLICA, UNIVERSITÀ DEGLI STUDI DI PADOVA, PADOVA
| | - A Baritussio
- UNITÀ OPERATIVA DI CARDIOLOGIA, DIPARTIMENTO DI SCIENZE CARDIO TORACO VASCOLARI E SANITÀ PUBBLICA, UNIVERSITÀ DEGLI STUDI DI PADOVA, PADOVA
| | - G Famoso
- UNITÀ OPERATIVA DI CARDIOLOGIA, DIPARTIMENTO DI SCIENZE CARDIO TORACO VASCOLARI E SANITÀ PUBBLICA, UNIVERSITÀ DEGLI STUDI DI PADOVA, PADOVA
| | - M Perazzolo Marra
- UNITÀ OPERATIVA DI CARDIOLOGIA, DIPARTIMENTO DI SCIENZE CARDIO TORACO VASCOLARI E SANITÀ PUBBLICA, UNIVERSITÀ DEGLI STUDI DI PADOVA, PADOVA
| | - S Iliceto
- UNITÀ OPERATIVA DI CARDIOLOGIA, DIPARTIMENTO DI SCIENZE CARDIO TORACO VASCOLARI E SANITÀ PUBBLICA, UNIVERSITÀ DEGLI STUDI DI PADOVA, PADOVA
| | - I Rigato
- UNITÀ OPERATIVA DI CARDIOLOGIA, DIPARTIMENTO DI SCIENZE CARDIO TORACO VASCOLARI E SANITÀ PUBBLICA, UNIVERSITÀ DEGLI STUDI DI PADOVA, PADOVA
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5
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Baroni G, Pergola V, Dellino C, Aruta P, Cecchetto A, Baritussio A, Fiorencis A, Di Michele S, Mastro F, Tarzia V, Gerosa G, Iliceto S, Mele D. P104 FEASIBILITY AND ROLE OF ECHOCONTRAST EVALUATION IN PATIENTS WITH LVAD. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Background
Advanced heart failure is a clinical syndrome characterized by persistent or progressive symptoms of heart failure despite optimal medical therapy. Left ventricular assist device (LVAD) brings survival benefits and improvement in quality of life, compared with conventional medical treatments. Development of Right ventricle failure in patients with LVAD has a direct effect on mortality and hospitalization.
Purpose
evaluation of clinical safety and feasibility of echocontrast in patients implanted with 3 different types of LVAD; improvement in the visualization of heart structures; intra and inter–operator agreement of RV assesement with and without contrast. Methods 43 patients were implanted with LVAD, 7 patients (16%) with Jarvik 2000, 31 (72%) with HeartMAte 3, 5 (12%) with (HeartWAre HVAD). Nine patients (21%) had contraindication or refused contrast. In 3 (7%) patients was technically challenging to obtain apical images at all levels. Two (5%) patients lost their follow–up. Our final population was of 29 (67%) patients (mean age 65±7 y; 100% Male). We assessed the reproducibility of these measurements between two different expert blind operators
Results
Total 329 (64%) of 516 RV wall segments were available for qualitative analysis without contrast vs 451 (87%) with contrast (p < 0.001) with a significant improvement of the evaluability of regional contractility (especially due to the better evaluation of medial and apical segments of lateral and anterior walls) and FAC (41% vs 90%, p < 0.001). Evaluation of TAPSE, TR and sPAP was similar with and without contrast (p=NS). All the RV parameters showed little inter–operator variability when measured with contrast. TAPSE, FAC, and RWMA showed an excellent reproducibility (ICC >0.86) while it was good for 2D–baseline derived parameters (ICC = 0.74) showing improvement of inter operator reproducibility in the evaluation of regional contractility in the contrast echocardiography modality.
Conclusion
EC is safe with all the types of LVAD examined. Accurate and reproducible visualization of RV is imperative for reliability of information, a routine use of EC could play a pivotal role in interpreting RV features. EC improves RV morphologic and functional judgment allowing greater accuracy and precision in the assessment of both global and regional RV functions. This finding may have important clinical improvement, especially in the future for analysis focused in RV prognostic role in LVAD patients.
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Affiliation(s)
| | | | | | - P Aruta
- AOPD, PADOVA; PADOVA, PADOVA
| | | | | | | | | | | | | | | | | | - D Mele
- AOPD, PADOVA; PADOVA, PADOVA
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6
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Williams MGL, Dastidar A, Liang K, Johnson TW, Baritussio A, Strange JW, Joshi N, Dorman S, De Garate E, Spagnoli L, Fiori E, Lawton CB, Biglino G, Plein S, Bucciarelli-Ducci C. Sex and age differences in patients with acute coronary syndrome and non-obstructive coronary arteries: presentation and outcome. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Aims
A substantial number of patients present with acute coronary syndrome (ACS) and non-obstructive coronary arteries. Sex and age differences in these patients are not well understood. This study aims to evaluate the impact of sex and age on clinical presentation and outcome in patients with ACS and non-obstructive coronary arteries, with either an ischaemic or non-ischaemic cause.
Methods and results
Consecutive patients with an ACS and non-obstructive coronary arteries (n=719) from a single tertiary centre underwent comprehensive cardiovascular magnetic resonance (CMR) imaging with late gadolinium enhancement (LGE). The primary endpoint was all-cause mortality. CMR was performed at a median time of 30 days after presentation and identified a diagnosis in 74% of patients. Patients with an ischaemic or non-ischaemic aetiology (n=529) on CMR were followed prospectively. All-cause mortality was 11% over a median follow up of 4.9 years, with no significant difference between sexes (11% versus 11% p=0.732). Women were more likely to have an ischaemic aetiology on CMR (40% v 31%, p=0.037). Age group (HR 1.48, p=0.002), log peak troponin (HR 0.78, p=0.033) and LVEF (HR 0.98, p=0.032) were independent predictors of mortality. Men aged >60 years with a non-ischaemic aetiology on their CMR were at higher risk of death than women >60 years (p=0.003).
Conclusions
There is no difference in all-cause mortality between sexes in patients presenting with ACS and non-obstructive coronary arteries but increasing age is an important predictor of mortality in both sexes.
Funding Acknowledgement
Type of funding sources: None. Sex differences in CMR diagnosisSex, age and mortality
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Affiliation(s)
- M G L Williams
- Bristol Heart Institute, Cardiology, Bristol, United Kingdom
| | - A Dastidar
- Bristol Heart Institute, Cardiology, Bristol, United Kingdom
| | - K Liang
- Bristol Heart Institute, Cardiology, Bristol, United Kingdom
| | - T W Johnson
- Bristol Heart Institute, Cardiology, Bristol, United Kingdom
| | - A Baritussio
- Bristol Heart Institute, Cardiology, Bristol, United Kingdom
| | - J W Strange
- Bristol Heart Institute, Cardiology, Bristol, United Kingdom
| | - N Joshi
- Bristol Heart Institute, Cardiology, Bristol, United Kingdom
| | - S Dorman
- Bristol Heart Institute, Cardiology, Bristol, United Kingdom
| | - E De Garate
- Bristol Heart Institute, Cardiology, Bristol, United Kingdom
| | - L Spagnoli
- Bristol Heart Institute, Cardiology, Bristol, United Kingdom
| | - E Fiori
- Bristol Heart Institute, Cardiology, Bristol, United Kingdom
| | - C B Lawton
- Bristol Heart Institute, Cardiology, Bristol, United Kingdom
| | - G Biglino
- University of Bristol, Bristol, United Kingdom
| | - S Plein
- University of Leeds, Department of Biomedical Imaging Science, Leeds, United Kingdom
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7
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Brunetti G, Cardaioli F, De Lazzari M, Cipriani A, Cecere AG, Cecchetto A, Baritussio A, Giorgi B, Motta R, De Conti G, Tarantini G, Cacciavillani L, Iliceto S, Perazzolo Marra M. Left ventricular thrombosis following apical myocardial infarction: may CMR strain analysis tell us something? Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab090.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Left ventricular thrombosis (LVT) is a possible complication following myocardial infarction (MI). Besides infarct size, risk factors for LVT include ST-elevated MI (STEMI), anterior and apical location, reduced left ventricular ejection fraction (LVEF) and the presence of microvascular obstruction. Echocardiography quantified myocardial strain has been associated with LVT following MI. Recently, global longitudinal strain, calculated with feature tracking (FT) - CMR, emerged as an independent predictor of major cardiovascular events following MI. Anyway, the relationship between abnormalities on FT-CMR and LVT following MI is still unexplored. Aim of our study is to investigate the possible association between abnormal strain on FT-CMR and LVT following apical STEMI.
Methods
We performed a retrospective analysis including all patients with a previous apical STEMI, who underwent CMR at our Institute between August 2013 and October 2020. Patients with ongoing anticoagulant therapy were excluded. Differences in global and segmental strain on CMR between patients with and without LVT were tested in a propensity-matched sample, using LVEF, age, gender, time from MI diagnosis and number of LV segments with transmural late gadolinium enhancement (LGE) as covariates to assign propensity score. Furthermore, difference in terms of apical to global radial strain percentual deviation (AGD), calculated as [(Global Radial Strain – Apical Radial Strain)/Global Radial Strain] * 100, was tested.
Results
Of 356 patients with apical STEMI undergoing CMR at our center, 37 (10.4%) were diagnosed with LVT. After performing a propensity score matching, we obtained a sample of 36 pairs, with a mean age of 65 (SD 11) years, and a median EF of 35% (IQR 27-42); 59 (82%) of them were male. A significant difference in terms of apical radial strain was found between the two groups, with a median strain of 10.75 (IQR 6.8–16.5) in patients without LVT compared to a value of 5.25 (IQR 2.7–9-6) in patients with LVT (p = 0.007). No differences were found in terms of global longitudinal, radial and circumferential strain (p = 0.19, p= 0.2 and p= 0.49 respectively) and segmental circumferential and longitudinal strain. When considering the AGD parameter, a significant difference was found between the two groups, with a median deviation of 12% (IQR -20; +48) in patients without LVT and 51% (IQR +47; +75) in patients with LVT (p= 0.0003). Furthermore, an AGD value of 26% was found to be the most accurate in terms of sensitivity and specificity applying a Receiver Operating Characteristic (ROC) curve analysis (AUC 0.74; CI 0.62-0.85).
Conclusions
Among patients with transmural MI involving LV apex, reduced apical radial strain on FT-CMR is associated with the presence of LV thrombosis. Furthermore, among patients developing LV thrombi, a greater apical radial strain deviation from the global one was found, with a threshold value of 26% at ROC curve analysis.
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Affiliation(s)
- G Brunetti
- University of Padua, Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova, Italy
| | - F Cardaioli
- University of Padua, Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova, Italy
| | - M De Lazzari
- University of Padua, Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova, Italy
| | - A Cipriani
- University of Padua, Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova, Italy
| | - AG Cecere
- University of Padua, Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova, Italy
| | - A Cecchetto
- University of Padua, Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova, Italy
| | - A Baritussio
- University of Padua, Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova, Italy
| | - B Giorgi
- University of Padua, Radiology Unit, Department of Medicine, Institute of Radiology, University of Padua , Padova, Italy
| | - R Motta
- University of Padua, Radiology Unit, Department of Medicine, Institute of Radiology, University of Padua , Padova, Italy
| | - G De Conti
- University of Padua, Radiology Unit, Department of Medicine, Institute of Radiology, University of Padua , Padova, Italy
| | - G Tarantini
- University of Padua, Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova, Italy
| | - L Cacciavillani
- University of Padua, Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova, Italy
| | - S Iliceto
- University of Padua, Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova, Italy
| | - M Perazzolo Marra
- University of Padua, Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padova, Italy
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8
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Williams MGL, Dastidar A, Liang K, Johnson TW, Baritussio A, Strange JW, Joshi N, Dorman S, Dr Garate E, Spagnoli L, Fiori E, Lawton CB, Biglino G, Plein S, Bucciarelli-Ducci C. Sex and age differences in patients with a working diagnosis of myocardial infarction with non-obstructive coronary arteries (MINOCA): presentation and outcome. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab090.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Rosetrees Trust James Tudor Foundation
Background Myocardial infarction with non-obstructive coronary arteries (MINOCA) is an increasingly recognised working diagnosis. Sex and age differences in MINOCA are not well understood.
Purpose This study aims to evaluate the impact of sex and age in patients with MINOCA due to ischaemic and non-ischaemic causes on clinical presentation and outcome.
Methods and Results Consecutive patients with a working diagnosis of MINOCA (n = 719) from a single tertiary centre who underwent comprehensive cardiovascular magnetic resonance (CMR) imaging with late gadolinium enhancement (LGE) were followed prospectively. The primary endpoint was all-cause mortality. CMR was performed at a median time of 30 days after presentation and identified a diagnosis in 74% of patients. Men were more likely to have a non-ischaemic cause on CMR (55% v. 41%, p < 0.001) and less likely to have a normal/non-specific scan (21% v. 32%, p = 0.001, figure 1). All-cause mortality was 9.5% over a median follow up of 4.9 years, with no significant difference between sexes (8.7% versus 10.1% p = 0.456). Age group (HR 1.61, p < 0.001) and LVEF (HR 0.98, p = 0.020) were independent predictors of mortality. Men aged >60 years with a non-ischaemic aetiology on their CMR were at higher risk of death than women with non-ischaemic causes >60 years (p = 0.003, figure 2).
Conclusions There is no difference in all-cause mortality between sexes in MINOCA but increasing age is the most important predictor of mortality in both sexes.
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Affiliation(s)
- MGL Williams
- Bristol Heart Institute, Cardiology, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - A Dastidar
- Bristol Heart Institute, Department of Cardiology, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - K Liang
- Bristol Heart Institute, Department of Cardiology, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - TW Johnson
- Bristol Heart Institute, Department of Cardiology, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - A Baritussio
- Bristol Heart Institute, Department of Cardiology, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - JW Strange
- Bristol Heart Institute, Department of Cardiology, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - N Joshi
- Bristol Heart Institute, Department of Cardiology, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - S Dorman
- Bristol Heart Institute, Department of Cardiology, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - E Dr Garate
- Bristol Heart Institute, Department of Cardiology, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - L Spagnoli
- Bristol Heart Institute, Department of Cardiology, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - E Fiori
- Bristol Heart Institute, Department of Cardiology, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - CB Lawton
- Bristol Heart Institute, Department of Cardiology, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - G Biglino
- University of Bristol, Bristol, United Kingdom of Great Britain & Northern Ireland
| | - S Plein
- University of Leeds, Department of Biomedical Imaging Science, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - C Bucciarelli-Ducci
- Bristol Heart Institute, Department of Cardiology, Bristol, United Kingdom of Great Britain & Northern Ireland
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9
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Previtero M, Simeti G, Lorenzoni G, Torresan F, Jozsa C, Castiello T, Palermo C, Aruta P, Baritussio A, Cecchetto A, Gregori D, Iliceto S, Di Salvo G, Pergola V. Feasibility and reproducibility of right ventricle stress echocardiography and its capability to assess the right ventricle contractile reserve of patient with at least trivial tricuspid regurgitation. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
BACKGROUND. Stress echocardiography (SE) is widely used for the assessment of left ventricular (LV) function, diagnostic and prognostic stratification of patients with coronary artery disease and for assessment of mitral and aortic valve disease. However, the assessment of the right ventricle (RV) in general, and in particular in regard to the contractile reserve of the RV in patients with tricuspid valve (TV) disease is an area that has not been previously explored in adult patients. The physiology and function of the RV is different than that of the LV and the use of SE provides the possibility to test both systolic and diastolic function of the RV in response to increased loading conditions. This can potentially be used to assess the RV function prior to surgery and to predict which subset of patients may benefit from intervention on the TV before the RV displays signs of failure
PURPOSE. We therefore propose a study to investigate the potential use of SE for the assessment of RV function in adult patients. The aim is to evaluate the feasibility of RV SE in any patients with more than trivial tricuspid regurgitation (TR) and to assess the presence and degree of RV contractile reserve.
METHODS. We enrolled 81 patients undergoing a phisical or dobutamine SE for CV risk stratification or chest pain. Inclusion criteria were age≥ 18 years, normal baseline RV function (FAC> 35%, TAPSE> 16 mm). Exclusion criteria were presence of RV dysfunction, pulmonary stress hypertension, positive stress test for left myocardial ischemia, presence of moderate or severe valvular disease, grade III or higher diastolic dysfunction at baseline, severe respiratory, renal or hepatic dysfunction. We evaluated the average values of TAPSE, fractional area change (FAC), S wave, sPAP (pulmonary systolic blood pressure), RV strain during baseline and at the peak of the effort. We also assessed the reproducibility of these measurement between two different expert operators (blind analysis).
RESULTS. We were able to measure the RV parameters both during baseline and at the peak of the effort in all patients, demonstrating an excellent feasibility. Differences in parameters collected at baseline and at peak were assessed using paired Wilcoxon signed rank test. All variables showed a statistical significant increase (p < 0.001) at peak compared to the baseline. Average percentage increases at peak were 31.1% for TAPSE, 24,8% for FAC, 50,6% for S wave, 55,2% for PAPS and 39.8 % for RV strain. Bland-Altman method was used to evaluate the agreement between measurements collected by two separate operators and it showed good Intraclass Correlation Coefficients (Figure).
CONCLUSIONS. RV SE proved to be feasible and showed little inter-operator variability in patients with at least trivial TR. It provided valuable informations about RV contractile reserve that may help stratifying the risk of RV failure in patients undergoing TV surgery.
Abstract Figure
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Affiliation(s)
- M Previtero
- University of Padova, Dpt of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua, Italy
| | - G Simeti
- University of Padova, Dpt of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua, Italy
| | - G Lorenzoni
- University of Padova, Dpt of Statistic, Padua, Italy
| | - F Torresan
- University of Padova, Dpt of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua, Italy
| | - C Jozsa
- Croydon University Hospital, Cardiology Unit, Croydon, United Kingdom of Great Britain & Northern Ireland
| | - T Castiello
- Croydon University Hospital, Cardiology Unit, Croydon, United Kingdom of Great Britain & Northern Ireland
| | - C Palermo
- University of Padova, Dpt of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua, Italy
| | - P Aruta
- University Hospital of Padova, Department of Cardiology, Padua, Italy
| | - A Baritussio
- University Hospital of Padova, Department of Cardiology, Padua, Italy
| | - A Cecchetto
- University Hospital of Padova, Department of Cardiology, Padua, Italy
| | - D Gregori
- University of Padova, Dpt of Statistic, Padua, Italy
| | - S Iliceto
- University of Padova, Dpt of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua, Italy
| | - G Di Salvo
- University of Padova, Department of Women"s and Children"s Health, Padua, Italy
| | - V Pergola
- University Hospital of Padova, Department of Cardiology, Padua, Italy
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10
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Baritussio A, Cheng C, Fachin F, Vacirca F, Marcolongo D, Brunetti M, Seguso M, Gallo N, Tarantini G, Perazzolo Marra M, Iliceto S, Rizzo S, Basso C, Marcolongo R, Caforio A. Predictors of death, heart transplantation and relapse in clinically suspected and biopsy-proven myocarditis in the pre-immunosuppression era. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Myocarditis is an infectious or autoimmune inflammatory disease of the myocardium; diagnosis relies on the exclusion of an acute coronary syndrome, and is confirmed by endomyocardial biopsy (EMB). Prognosis is highly variable, outcome predictors are not well defined.
Purpose
To identify clinical, imaging and immunological predictors of death, heart transplantation (HTx) and relapse in patients with myocarditis in the pre-immunosuppression era.
Methods
From 1993 to 2012 we consecutively enrolled 466 patients (68% male, mean age 37±17 years), 216 with clinically suspected and 250 with EMB-proven myocarditis. All patients underwent coronary angiogram and transthoracic echocardiogram, 44% of patients underwent cardiac magnetic resonance (CMR). Circulating auto-antibodies were measured in patients' sera by indirect immunofluorescence. All patients were prospectively followed-up at the local Cardio-immunology outpatient clinic.
Results
After a median follow-up of 50 months (IQR 25–75), 366 patients (79%) were alive, while 42 (9%) were dead or underwent HTx; 58 were lost to follow-up. Ten-year survival free from death or HTx was overall 83%, but was lower in patients with EMB-proven myocarditis (76% vs 94% in patients with clinically suspected myocarditis, p<0.001). On univariate analysis, predictors of death and HTx were female gender (p=0.003), previous myocarditis (p=0.03), heart failure on presentation and advanced NYHA class (p<0.001, respectively), histological diagnosis of giant-cell myocarditis (p=0.002), positivity for anti-heart antibodies (AHA, p=0.04), anti-cardiac endothelial cell (AECA, p=0.002) and anti-nucleus antibodies (ANA, p=0.003). On multivariate analysis, female gender (HR 2.69, p=0.02), lower left ventricular ejection fraction on echocardiogram (p<0.001), positivity for high-titre organ-specific AHA (HR 4.1, p=0.02) and for ANA (HR 5.1, p<0.001) were independent predictors of death and HTx. Seventy-seven patients had relapsing myocarditis; on univariate analysis, young age (p<0.001), previous myocarditis (p<0.001), symptoms preceding diagnosis (p=0.004), positivity for anti-intercalated disk autoantibody (AIDA, p=0.02), and presence of diffuse late gadolinium enhancement (LGE) on CMR (p<0.001) were predictors of relapse. On multivariate analysis young age (p=0.02) and previous myocarditis (HR 8.4, p<0.001) were independent predictors of relapse. Predictors of death, HTx and relapse, respectively, did not differ when considering separately patients with EMB-proven myocarditis and those with clinically suspected myocarditis.
Conclusions
In the pre-immunosuppressive era, young age and a previous episode of myocarditis were independent predictors of relapse, female gender, left ventricular dysfunction at presentation and high-titre organ-specific AHA and ANA were independent predictors of death and HTx, suggesting that autoimmune features in myocarditis predict worse prognosis.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- A Baritussio
- University of Padova, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua, Italy
| | - C Cheng
- University of Padova, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua, Italy
| | - F Fachin
- University of Padova, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua, Italy
| | - F Vacirca
- University of Padova, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua, Italy
| | - D Marcolongo
- University of Padova, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua, Italy
| | - M Brunetti
- University of Padova, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua, Italy
| | - M Seguso
- University of Padova, Department of Laboratory Medicine, Padua, Italy
| | - N Gallo
- University of Padova, Department of Laboratory Medicine, Padua, Italy
| | - G Tarantini
- University of Padova, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua, Italy
| | - M Perazzolo Marra
- University of Padova, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua, Italy
| | - S Iliceto
- University of Padova, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua, Italy
| | - S Rizzo
- University of Padova, Cardiac Pathology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua, Italy
| | - C Basso
- University of Padova, Cardiac Pathology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua, Italy
| | - R Marcolongo
- University of Padova, Hematology and Clinical Immunology, Department of Medicine, Padua, Italy
| | - A.L.P Caforio
- University of Padova, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua, Italy
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11
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Caforio A, Lorenzoni G, Cheng C, Baritussio A, Marcolongo D, Brunetti M, Vacirca F, Fachin F, Tarantini G, Basso C, Iliceto S, Marcolongo R, Gregori D. Predictors of death and heart transplantation in biopsy-proven myocarditis: a machine-learning approach. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Risk stratification for death and heart transplantation (HTx) in myocarditis is complex. A random forest (RF) is a tree-based machine learning technique (MLT) which is being increasingly used for clinical data analysis; it allows the detection of complex relationships between the outcome of interest and the covariates, overcoming the limits of traditional statistical analysis (i.e. regression approaches). Purpose To assess the potential role of clinical and diagnostic features at presentation as predictors of death and HTx in biopsy (Bx)-proven myocarditis using RF. Methods From January 1993 to August 2019, we consecutively enrolled 357 patients with Bx-proven myocarditis (65% male, median age 39 years, interquartile range (IQR) 26–51). An RF approach for survival data was used. Variables included in the analysis were: histology type by Bx, NYHA, type of presentation (infarct-like, arrhythmia, heart failure), viral genome detection on Bx, serum antiheart (AHA), antiintercalated disk (AIDA), anticardiac endothelial cells (AECA), antinuclear (ANA) autoantibodies, immunosuppressive therapy, cardiac catheterisation (left ventricular enddiastolic volume (LVEDV), mean capillary wedge pressure, right and left ventricular enddiastolic pressure) and 2-D echocardiographic measures (LVEDV, left ventricular ejection fraction (LVEF) at presentation and at follow-up, right ventricular fractional area change (FAC%), right ventricular diastolic area). Results The median follow-up time was of 1352 days (IQR 423.25–2535.75). At the end of follow-up, 42 patients were dead or transplanted. The 1-year, 5-year, and 10-year survival probabilities were of 0.928, 0.854, and 0.817, respectively. The most relevant predictors of death or HTx identified by the RF algorithm (according to the variable importance measure) were histological type, NYHA, clinical presentation, LVEF, and FAC%. Among the circulating auto-antibodies AECA were found to be the most important. Histological type was the strongest predictor of death/HT (100% relative importance, (RI)), giant cell myocarditis having a lower survival probability compared to other types. The next stronger predictors were advanced (III-IV) NYHA and heart failure presentation with lower survival probabilities (90% and 84% RI respectively). AECA-positive patients had lower survival probability compared to AECA negative ones (20% RI). The RF algorithm revealed an excellent predictive performance in the correct identification of all alive patients, with only 5 dead patients being misclassified (balanced accuracy 94%).
Conclusions
Autoimmune features, i.e Giant cell myocarditis and AECA, as well as severity of heart failure and of left ventricular disfunction at presentation were the strongest predictors of dismal prognosis. Our RF approach provides a new automated powerful tool for accurate risk stratification for death/HTx in Bx-proven myocarditis.
Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Budget Integrato per la Ricerca dei Dipartimenti (BIRD, year 2019), Padova University, Padova, Italy (project Title: Myocarditis: genetic background, predictors of dismal prognosis and of response to immunosuppressive therapy.)
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Affiliation(s)
| | | | | | | | | | | | | | - F Fachin
- University of Padua, Padua, Italy
| | | | - C Basso
- University of Padua, Padua, Italy
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12
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Alderighi C, Baritussio A, Ozden Tok O, Perazzolo Marra M, Iliceto S, Bucciarelli-Ducci C. Insight form cardiovascular magnetic resonance on cardiac sarcoidosis: a single centre experience. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Clinically manifest cardiac sarcoidosis (CS) has a prevalence of 5%, but is more frequent in autoptic series (25%). Diagnosis is multiparametric and relies on clinical criteria and imaging findings, although a certain diagnosis, especially in the case of isolated CS (ICS), can only be based on endomyocardial biopsy. Cardiovascular magnetic resonance (CMR) has a comprehensive role in the assessment of CS: left ventricular (LV) dysfunction and extent of late gadolinium enhancement (LGE)are important predictors of prognosis, T2 mapping provides information on disease activity and global longitudinal strain (GLS) analysis can uncover subclinical LV impairment.
Purpose
To assess the prevalence of CS by CMR in patients with biopsy-proven extracardiacsarcoidosis (ECS); to describe the imaging characteristics of patients with ECS and those with high clinical suspicionof ICS; to investigate the contribution of more recent techniques to the diagnosis of CS alongside traditional LGE assessment.
Methods
We retrospectively enrolled 84 patients (66% males, mean age 59±13 years) referred to our centreforsuspected CS (biopsy-proven ECS, n=61; clinical presentation suggestive of CS,, n=23). CMR was performed on a 1.5T scanner, with a protocol comprehensive of biventricular functional assessment and post-contrast images; T2-STIR images (n=30), native myocardial T1 mapping (n=24) and T2 mapping (n=19) were also performed in selected patients. Tissue tracking analysis was perfomed in all patients using a dedicated software.
Results
Based on CMR findings, 35 patients (42%) with ECS did not show cardiac involvement (SS), 26 (31%) showed both cardiac and systemic involvement (CS-SS) and 23 (27%) had evidence of ICS (ICS). 43% of patients had history of arrhythmias, but life-threatening tachyarrhythmiaswere more frequent in patients with CS (p=0.02).Patients with CS had significantly lower LVEF (p<0,01), larger LV volumes (p<0,01) and greater LV mass (p<0,01). GLS values were impaired in all the groups but significantly more in patients with CS (p<0,01). With regards to LGE distribution, ICS patients showed a higher number of segments involved (p=0,011) as compared to CS patients. T2-STIRimages were positive in 3 out of 30 patients; T2 mapping detected myocardial oedema in 1 patient with negative T2- STIR and was positive in 7 who did not undergo traditional oedema evaluation. T1 mapping mainly confirmed the results provided by LGE, but was altered in 1 patient who could not receive gadolinium.
Conclusions
CMR findings consistent with CS were found in 49 patients referred for suspected CS. Patients with cardiac involvement, particularly if isolated, had significantly lower LVEF, greater LV volumes and more impaired GLS. Patients with SS, despite a normal LV function, showed mildly impaired GLS, subtending subclinical cardiac involvement.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- C Alderighi
- Bristol Royal Infirmary, Bristol, United Kingdom
| | - A Baritussio
- University of Padova, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy
| | - O Ozden Tok
- Bahcelievler Memorial Hospital, Istanbul, Turkey
| | - M Perazzolo Marra
- University of Padova, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy
| | - S Iliceto
- University of Padova, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy
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13
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Vijiiac AE, Muraru D, Jarjour F, Kupczynska K, Palermo C, Cecchetto A, Baritussio A, Aruta P, Dorobantu M, Badano LP. P798 Right atrial phasic function and correlation with right ventricular function in patients with reduced left ventricular ejection fraction and no pulmonary hypertension:insights from 3D echocardiography. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The right atrium (RA) is a highly dynamic chamber with 3 mechanical functions (reservoir, conduit, booster pump) and prognostic implications in heart failure (HF) and pulmonary hypertension (PH). However, RA function and its interplay with the right ventricular (RV) performance in patients (pts) with reduced left ventricular ejection fraction (LVEF) and without PH remain to be clarified.
Methods
We used three-dimensional echocardiography to study 55 pts (61 ± 14 years, 43 men) with LVEF < 40% no more than mild tricuspid regurgitation (TR), and maximum velocity of the TR jet < 3 m/s. We measured the three-dimensional RA total, passive, active ejection volumes (EV) and the respective emptying fractions (EF). In addition, we compared RV volumes and ejection fraction (RVEF) between patients with normal and abnormal RA function.
Results
Mean LVEF was 30 ± 7%. Mean echo-derived pulmonary vascular resistance was 1.64 ± 0.54 Wood units. 28 pts (51%) had reduced RA reservoir function (total EF = 34 ± 9%), 34 pts (62%) had reduced RA conduit function (passive EF = 15 ± 4%), and 10 pts (18%) had reduced RA pump function (active EF = 11 ± 3%). Pts with reduced RA reservoir function showed larger RV end-systolic volume (RVESV 124 ± 48ml vs. 90 ± 32ml; p = 0.004) and lower RVEF (38 ± 8% vs. 46 ± 6%; p < 0.001) than pts with normal RA function. Pts with reduced RA conduit function showed smaller RV stroke volume (RVSV 65 ± 19 ml vs. 80 ± 22ml; p = 0.009). Pts with impaired RA pump function showed larger RVESV (142 ± 45ml vs. 99 ± 41ml; p = 0.02) and lower RVEF (36 ± 6% vs. 43 ± 8%; p = 0.006).
RVESV was positively correlated with total (r2 = 0.47, p < 0.001), passive (r2 = 0.29, p = 0.03) and active (r2 = 0.39, p = 0.003) RAEV, while it was negatively correlated with total (r2=-0.41, p = 0.002), passive (r2=-0.34, p = 0.01) and active (r2=-0.31, p = 0.02) RAEF. RVSV showed a positive correlation with both total (r2 = 0.4, p = 0.002) and passive (r2 = 0.41, p = 0.002) RAEV. Finally, RVEF was positively correlated with total (r2 = 0.51, p < 0.001), passive (r2 = 0.47, p < 0.001), and active (r2 = 0.36, p = 0.007) RAEF.
Conclusions
RA dysfunction is not uncommon in pts with reduced LVEF, even in the absence of PH. In these pts, RA function is associated with significant changes in RV function. The RA acts as a dynamic modulator of RV pump function by redistributing RV filling and ejection force among reservoir, conduit and pump functions in the setting of altered hemodynamics. The clinical and prognostic significance of RA function in pts with reduced LVEF warrant further studies.
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Affiliation(s)
- A E Vijiiac
- Emergency Clinical Hospital Floreasca, Cardiology Department, Bucharest, Romania
| | - D Muraru
- University of Padova, Department of cardiac, vascular and thoracic sciences and public health, Padua, Italy
| | - F Jarjour
- University of Padova, Department of cardiac, vascular and thoracic sciences and public health, Padua, Italy
| | - K Kupczynska
- University of Padova, Department of cardiac, vascular and thoracic sciences and public health, Padua, Italy
| | - C Palermo
- University of Padova, Department of cardiac, vascular and thoracic sciences and public health, Padua, Italy
| | - A Cecchetto
- University of Padova, Department of cardiac, vascular and thoracic sciences and public health, Padua, Italy
| | - A Baritussio
- University of Padova, Department of cardiac, vascular and thoracic sciences and public health, Padua, Italy
| | - P Aruta
- University of Padova, Department of cardiac, vascular and thoracic sciences and public health, Padua, Italy
| | - M Dorobantu
- Emergency Clinical Hospital Floreasca, Cardiology Department, Bucharest, Romania
| | - L P Badano
- University of Padova, Department of cardiac, vascular and thoracic sciences and public health, Padua, Italy
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14
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Previtero M, Bottigliengo D, Guta AC, Ochoa-Jimenez RC, Figliozzi S, Palermo C, Baritussio A, Cecchetto A, Aruta P, Iliceto S, Badano LP, Muraru D. 47 Identification of threshold values to define right chamber enlargement consistent with severe tricuspid regurgitation. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Right ventricle (RV), tricuspid anulus (TA) and right atrium (RA) dilatation, are listed among the supportive signs to grade severe tricuspid regurgitation (TR) according to current EACVI and ESC guidelines. However, at present, there is no cut-off value to define RV, RA and TA dilatation associated to severe TR.
Purpose
Accordingly, we sought to identify the threshold values of RV, RA and TA size associated to severe TR.
Methods
302 patients (59 ± 13 years, 54 % women) with functional TR underwent three- (3D) and two-dimensional (2D) echocardiography to obtain: 3D RV end diastolic volume (RVEDVi) indexed for body surface area (BSA), 3D RV end systolic volume indexed for BSA (RVESVi), 3D RA max volume indexed for BSA (3DRAi), 2D RA systolic volume indexed for BSA (3DRAi), 2D RV basal diameter (2DRVd), 2D RV basal diameter indexed for BSA (2DRVdi), 2D TA measured in the apical 4-chamber view and 2D TA measured in the apical 4-chamber view indexed for BSA. To identify the threshold values of the parameters that discriminate patients with right chamber enlargement associated to severe TR, we selected the probability which returns the best sum of sensitivity and specificity on the ROC curve of the model.
Results
According to EACVI multiparametric approach, 50/302 pts (17%) were found to have severe TR. As shown in Figure, 3DRAi > 45 ml/m2 and 2DRAi > 45 ml/m2 identified patients with RA enlargement associated to severe TR. RVEDVi and RVESVi did not show any predictive value for severe TR. Conversely, 2DRVd > 52 mm (or >30 mm/m2) was associated to severe TR. 2DTA > 42 mm ( or >24 mm/m2) was the selected threshold value for TA dilatation.
Conclusions
Our study provided the threshold values to define the right chamber and TA dilatation associated to severe TR. Implementation of those values in current guidelines can help clinicians to improve their accuracy to identify patients with severe TR.
Abstract 47 Figure.
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Affiliation(s)
- M Previtero
- University of Padova, Dpt of Cardiac, Thoracic and Vascular Sciences, Padua, Italy
| | | | - A C Guta
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - R C Ochoa-Jimenez
- Mount Sinai Medical Center, Internal Medicine Department, New York, United States of America
| | - S Figliozzi
- University of Padova, Dpt of Cardiac, Thoracic and Vascular Sciences, Padua, Italy
| | - C Palermo
- University of Padova, Dpt of Cardiac, Thoracic and Vascular Sciences, Padua, Italy
| | - A Baritussio
- University of Padova, Dpt of Cardiac, Thoracic and Vascular Sciences, Padua, Italy
| | - A Cecchetto
- University of Padova, Dpt of Cardiac, Thoracic and Vascular Sciences, Padua, Italy
| | - P Aruta
- University of Padova, Dpt of Cardiac, Thoracic and Vascular Sciences, Padua, Italy
| | - S Iliceto
- University of Padova, Dpt of Cardiac, Thoracic and Vascular Sciences, Padua, Italy
| | - L P Badano
- Italian Institute for Auxology IRCCS, San Luca Hospital, University Milano-Bicocca, Milan, Italy
| | - D Muraru
- Italian Institute for Auxology IRCCS, San Luca Hospital, University Milano-Bicocca, Milan, Italy
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Previtero M, Guta AC, Ochoa-Jimenez RC, Palermo C, Bottigliengo D, Figliozzi S, Baritussio A, Cecchetto A, Aruta P, Iliceto S, Badano LP, Muraru D. P764 Right ventricular basal diameter, but not volume, can predict severe tricuspid regurgitation. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
According to current EACVI guidelines, right ventricle (RV), tricuspid anulus (TA) and right atrium (RA) dilatation are supportive signs to identify severe functional tricuspid regurgitation (TR) by echocardiography. However, the ranking by which those parameters should be considered to identify severe TR remains to be clarified.
Purpose
Accordingly, the aim of this study is to compare RV, RA and TA association with severe TR and to rank them in order of importance to predict severe TR.
Methods
302 patients (59 ± 13 years, 54 % women) with functional TR underwent two- and three-dimensional echocardiography. Using the nonparameteric Variable Importance (VIMP) software package, we assessed the relative importance of 6 differerent parameters (indexed by body surface area) to identify severe TR: 3D RV end diastolic volume (RVEDVi), 3D RV end systolic volume (RVESVi), 3D RA max volume (3DRAi), 2D RA systolic volume (3DRAi), 2D RV basal diameter (2DRVdi) and 2D TAi measured in the apical 4-chamber view.
Results
According to EACVI multiparametric approach, 50/302 pts (17%) were found to have severe TR. 3DRAi (VIMP = 0.075) was the most important predictor of severe TR. 2DRVdi (VIMP= 0.005) was the second most important parameter and was the only parameter of RV dilation (RVEDVi= -0.0011 and RVESVi= -0.0012) associated to severe TR. Also, 2DRAi (VIMP= 0.023), and 2D TAi (VIMP= 0.004) showed good predictive ability.
Conclusions
Among the various right heart structures undergoing remodeling in patients with functional TR, RA dilation was the most important predictor of severe TR. Also the RV basal diameter, but not the volumes, was a predictor of severe TR. This underlines the importance of the shape, more than the volume of the RV as a predictor of severe TR.
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Affiliation(s)
- M Previtero
- University of Padova, Dpt of Cardiac, Thoracic and Vascular Sciences, Padua, Italy
| | - A C Guta
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - R C Ochoa-Jimenez
- Mount Sinai Medical Center, Internal Medicine Department, New York, United States of America
| | - C Palermo
- University of Padova, Dpt of Cardiac, Thoracic and Vascular Sciences, Padua, Italy
| | | | - S Figliozzi
- University of Padova, Dpt of Cardiac, Thoracic and Vascular Sciences, Padua, Italy
| | - A Baritussio
- University of Padova, Dpt of Cardiac, Thoracic and Vascular Sciences, Padua, Italy
| | - A Cecchetto
- University of Padova, Dpt of Cardiac, Thoracic and Vascular Sciences, Padua, Italy
| | - P Aruta
- University of Padova, Dpt of Cardiac, Thoracic and Vascular Sciences, Padua, Italy
| | - S Iliceto
- University of Padova, Dpt of Cardiac, Thoracic and Vascular Sciences, Padua, Italy
| | - L P Badano
- Italian Institute for Auxology IRCCS, San Luca Hospital, University Milano-Bicocca, Milan, Italy
| | - D Muraru
- Italian Institute for Auxology IRCCS, San Luca Hospital, University Milano-Bicocca, Milan, Italy
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16
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Previtero M, Guta AC, Ochoa-Jimenez RC, Figliozzi S, Palermo C, Baritussio A, Cecchetto A, Aruta P, Iliceto S, Badano LP, Muraru D. 38 Prognostic validation of partition values obtained with conventional two-dimensional and doppler echocardiography to grade tricuspid regurgitation severity. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Morbidity and mortality associated with severe tricuspid regurgitation (TR) have prompted interest in new corrective transcatheter procedures. However, to properly select patients for interventional procedures, and to assess their effectiveness, a reliable and reproducible grading system of TR severity is mandatory. However, the cut-off values used by current guidelines to differentiate among mild, moderate and severe TR lack clinical validation.
Purpose
We aimed to obtain the threshold values of the currently recommended quantitative echocardiographic parameters used to grade TR severity using pts’ outcome as a reference.
Methods
296 pts, with at least mild TR and complete 2D, 3D and Doppler echocardiographic study, were enrolled and assessed for potential confounders: age, NYHA class, left ventricular ejection fraction, coexistent valvular heart disease and right ventricular (RV) systolic pressure. Average diameter of the vena contracta (VCavg), effective regurgitant orifice area (EROA), regurgitant volume (RVol) and regurgitant fraction (RF) were obtained to grade TR severity. Median follow-up was 47 (17-80) months. The primary composite endpoint was the occurrence of death of any cause or hospitalization for right heart failure (RHF). Survival curves for the composite endpoint were divided in quartiles at median follow-up. Cut-off values for the echo parameters were derived to grade mild (below the 1st quartile), moderate (between 1st and 3rd quartiles), and severe (above the 3r quartile) TR.
Results
33 deaths and 72 hospitalizations for RHF occurred. Event-free rate from death or RHF at the end of follow-up was 14%, 46% and 93% in pts with severe, moderate, and mild TR, respectively. Differences reached statistical significance early (at 1 month), and lasted during the whole follow-up period (Figure). The new threshold values for mild, moderate and severe TR are summarized in Table.
Conclusions
Partition values of quantitative echo-Doppler parameters used to grade mild, moderate and severe TR according to pts’ clinical outcome are significantly lower than those currently reported in guidelines. Further studies are needed to test if these new threshold values for severe TR will translate in earlier referral of pts to valve repair and improved prognosis.
Mild Moderate Severe VCavg <3 mm 3-6 mm >6 mm EROA <0.15 cm² 0.15-0.30 cm² >0.30 cm² R Vol <15 ml 15-30 ml >30 ml RF <25% 25-45% >45%
Abstract 38 Figure.
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Affiliation(s)
- M Previtero
- University of Padova, Dpt of Cardiac, Thoracic and Vascular Sciences, Padua, Italy
| | - A C Guta
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - R C Ochoa-Jimenez
- Mount Sinai Medical Center, Internal Medicine Department, New York, United States of America
| | - S Figliozzi
- University of Padova, Dpt of Cardiac, Thoracic and Vascular Sciences, Padua, Italy
| | - C Palermo
- University of Padova, Dpt of Cardiac, Thoracic and Vascular Sciences, Padua, Italy
| | - A Baritussio
- University of Padova, Dpt of Cardiac, Thoracic and Vascular Sciences, Padua, Italy
| | - A Cecchetto
- University of Padova, Dpt of Cardiac, Thoracic and Vascular Sciences, Padua, Italy
| | - P Aruta
- University of Padova, Dpt of Cardiac, Thoracic and Vascular Sciences, Padua, Italy
| | - S Iliceto
- University of Padova, Dpt of Cardiac, Thoracic and Vascular Sciences, Padua, Italy
| | - L P Badano
- Italian Institute for Auxology IRCCS, San Luca Hospital, University Milano-Bicocca, Milan, Italy
| | - D Muraru
- Italian Institute for Auxology IRCCS, San Luca Hospital, University Milano-Bicocca, Milan, Italy
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17
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Caforio A, Gianstefani S, Baritussio A, Marcolongo R, Seguso M, Gallo N, Plebani M, Izquierdo-Bajo A, Cheng CY, Iliceto S, Semenzato GP, Maier L, Hamzeh N. 1173Anti-heart and anti-intercalated disk autoantibodies: possible novel biomarkers of cardiac sarcoidosis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Sarcoidosis is an immune-mediated disease; cardiac involvement, a granulomatous form of myocarditis, is under-recognised and prognostically relevant, as it can present with significant morbidity and mortality. Anti-heart autoantibodies (AHA) and anti-intercalated disk autoantibodies (AIDA) are reliable autoimmune markers in non-sarcoidosis myocarditis forms.
Purpose
The aim of this study was to assess the potential role of serum AHA and AIDA in cardiac sarcoidosis.
Methods
This is a cross-sectional study on a series of 29 patients with biopsy proven extra-cardiac sarcoidosis and with biopsy-proven or clinically suspected cardiac involvement, who were tested for AHA and AIDA. Patients were recruited in two recruiting tertiary centres, in USA and Italy. AHA and AIDA were detected by indirect immunofluorescence on human myocardium and skeletal muscle. Controls included sera from patients with non-inflammatory cardiac disease (NICD) (n=160), with ischemic heart failure (IHF) (n=141) and normal blood donors (NBD) (n=270).
Results
The frequencies of AHA and of AIDA were higher in sarcoidosis (86%; 62%) than in NICD (8%; 4%), IHF (7%; 2%), NBD (9%; 0%) (p=0.0001; p=0.0001 respectively). Sensitivity and specificity were: 86% and 92% for positive AHA and 62% and 98% for positive AIDA, respectively (see figure).
Figure 1
Conclusions
The detection of serum AHA and AIDA in biopsy-proven or clinically suspected cardiac sarcoidosis supports the involvement of heart-specific autoimmunity in the majority of our cases and may provide a novel non invasive diagnostic marker.
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Affiliation(s)
- A Caforio
- Cardiology, Dept Cardiological Thoracic and Vascular Sciences, Padua University, Padova, Italy
| | - S Gianstefani
- Cardiology, Dept Cardiological Thoracic and Vascular Sciences, Padua University, Padova, Italy
| | - A Baritussio
- Cardiology, Dept Cardiological Thoracic and Vascular Sciences, Padua University, Padova, Italy
| | - R Marcolongo
- University of Padova, Hematology and Clinical Immunology, Department of Medicine, Padua, Italy
| | - M Seguso
- University of Padova, Department of Laboratory Medicine, Padua, Italy
| | - N Gallo
- University of Padova, Department of Laboratory Medicine, Padua, Italy
| | - M Plebani
- University of Padova, Department of Laboratory Medicine, Padua, Italy
| | - A Izquierdo-Bajo
- Cardiology, Dept Cardiological Thoracic and Vascular Sciences, Padua University, Padova, Italy
| | - C Y Cheng
- Cardiology, Dept Cardiological Thoracic and Vascular Sciences, Padua University, Padova, Italy
| | - S Iliceto
- Cardiology, Dept Cardiological Thoracic and Vascular Sciences, Padua University, Padova, Italy
| | - G P Semenzato
- University of Padova, Hematology and Clinical Immunology, Department of Medicine, Padua, Italy
| | - L Maier
- University of Denver, Department of Medicine, National Jewish Health, Denver, United States of America
| | - N Hamzeh
- University of Iowa, Division of Pulmonary, Critical Care and Occupational Medicine, Iowa City, United States of America
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18
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Gianstefani S, Cheng CY, Baritussio A, Seguso M, Gallo N, Leoni L, Rizzo S, Perazzolo Marra M, Tarantini G, Plebani M, Basso C, Marcolongo R, Caforio ALP, Iliceto S. P5563Biopsy proven myocarditis: clinical and instrumental predictors of adverse prognosis at presentation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Myocarditis is an insidious and potentially fatal illness with different clinical presentations and an unpredictable course. Prompt recognition of high risk patients is of paramount importance in preventing major adverse events.
Purpose
To identify predictors of dismal prognosis in a large cohort of patients with biopsy proven myocarditis.
Methods
Univariate analysis was used to identify predictors of death and heart transplant in a prospective cohort of 366 patients with biopsy proven myocarditis (aged 38±17, male 66%) using student's test and contingency tables as appropriate.
Results
At the time of follow up 46 patients (13%) were dead or received heart transplant (DHTX), 283 (77%) were alive (A) and 37 (10%) lost at follow up. Age at presentation was 33±20 y in DHTX v.s 39±15 in A cohort (p=0.057). Clinical features predicting adverse prognosis included female gender (p=0.002), heart failure at presentation (p=0.000), NYHA class II to IV (p=0.000). Clinical and radiographic signs of both left and right heart failure suggested worse outcome (p=0.000) as well as ongoing anticoagulation therapy (p=0.009). On ECG right (R) or left (L) axis deviation was a strong predictor of events (p=0.000). From an echocardiography perspective the presence of mild to severe mitral regurgitation (p=0.03), reduced left ventricular systolic function (FE) (p=0.000), reduced right ventricular fractional area change (FAC) (p=0.035) was strongly correlated to death or heart transplant. On cardiac catheterization the variables predicting unfavourable outcome included reduced left ventricular systolic pressure (LVSP) (p=0.000), reduced mean aortic pressure (mAP) (p=0.002), increased mean right atrial pressure (RAP) (p=0.001), FE on angiography (p=0.000). On cardiac biopsy (Bx) negative predictors were giant cell histology type (p=0.000) and PCR positive for viral genome (p=0.02) particularly for parvovirus B19 (p=0.04), adenovirus (p=0.04), and Epstein Barr virus (EBV) (p=0.03). See Tab 1
Table 1
Conclusion
Female gender, HF like presentation, reduced LV and RV systolic function, R or L axis deviation on ECG, presence of viral PCR or giant cell histology on Bx, reduced LVSP and mAP; increased RAP may be useful parameters to identify high risk patients on presentation. This may increase clinical efforts and surveillance in this subgroup in order to reduce the incidence of major adverse events.
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Affiliation(s)
- S Gianstefani
- University of Padova, Dept of Cardiac Thoracic and Vascular Sciences, Padua, Italy
| | - C Y Cheng
- University of Padova, Dept of Cardiac Thoracic and Vascular Sciences, Padua, Italy
| | - A Baritussio
- University of Padova, Dept of Cardiac Thoracic and Vascular Sciences, Padua, Italy
| | - M Seguso
- University of Padova, Department of Laboratory Medicine, Padua, Italy
| | - N Gallo
- University of Padova, Department of Laboratory Medicine, Padua, Italy
| | - L Leoni
- University of Padova, Dept of Cardiac Thoracic and Vascular Sciences, Padua, Italy
| | - S Rizzo
- University of Padova, Cardiovascular Pathology, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy
| | - M Perazzolo Marra
- University of Padova, Dept of Cardiac Thoracic and Vascular Sciences, Padua, Italy
| | - G Tarantini
- University of Padova, Dept of Cardiac Thoracic and Vascular Sciences, Padua, Italy
| | - M Plebani
- University of Padova, Department of Laboratory Medicine, Padua, Italy
| | - C Basso
- University of Padova, Cardiovascular Pathology, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy
| | - R Marcolongo
- University of Padova, Haematology and Clinical Immunology, Department of Medicine, Padua, Italy
| | - A L P Caforio
- University of Padova, Dept of Cardiac Thoracic and Vascular Sciences, Padua, Italy
| | - S Iliceto
- University of Padova, Dept of Cardiac Thoracic and Vascular Sciences, Padua, Italy
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19
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Caforio A, Marcolongo R, Cheng CY, Gianstefani S, Baritussio A, Seguso M, Gallo N, Leoni L, Rizzo S, Perazzolo Marra M, Tarantini GP, Plebani M, Basso CY, Iliceto S. P4651Biopsy-proven myocarditis: independent predictors of dismal prognosis, relapse and role of immunosuppressive therapy. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.1033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Biopsy-proven myocarditis may be infectious or autoimmune. Risk stratification in biopsy-proven myocarditis and the role of immunosuppressive therapy in autoimmune forms have not been completely defined.
Purpose
To identify clinical, instrumental and immunological predictors of death, cardiac transplantation and relapse in a prospective cohort of 314 biopsy-proven myocarditis patients, and describe the effect of immunosuppressive treatment on secondary outcome measures, e.g. left ventricular ejection fraction (LVEF), in a subgroup of 45 consecutive patients with biopsy-proven autoimmune myocarditis diagnosed in our Cardiology Clinic.
Methods
Univariate and multivariate Cox regression analysis were used to identify predictors of death, heart transplant, and relapse in a cohort of 314 patients with biopsy-proven myocarditis (male 75%, median age 37). Actuarial survival free from death or transplant was calculated by the Kaplan-Meier method.
Results
Actuarial survival free from death or heart transplantation was 83% at 5 years. Among the clinical, instrumental and immunological features at diagnosis, independent predictors of death or heart transplantation by multivariable analysis were a lower transthoracic echocardiographic biplane LVEF% (p=0.001) and high serum titre for anti-nucler (ANA) and anti-cardiac endothelial cell autoantibodies (AECA). The only independent predictor of relapse was previous history of myocarditis. Immunosuppressive therapy was associated with a significantly favorable effect on LVEF (LVEF pre-therapy 37% (26; 50 interquartile range) vs. LVEF post-therapy 59% (48; 65 interquartile range), respectively, p=0.000).
Conclusions
In biopsy-proven myocarditis left ventricular dysfunction at diagnosis and autoimmune pathogenesis are associated with dismal prognosis, immunosuppressive therapy with improved LVEF in autoimmune patients.
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Affiliation(s)
- A Caforio
- Cardiology,Dept Cardiological Thoracic and Vascular Sciences, Padua University, Padova, Italy
| | - R Marcolongo
- University of Padova, Hematology and Clinical Immunology, Department of Medicine, Padua, Italy
| | - C Y Cheng
- Cardiology,Dept Cardiological Thoracic and Vascular Sciences, Padua University, Padova, Italy
| | - S Gianstefani
- Cardiology,Dept Cardiological Thoracic and Vascular Sciences, Padua University, Padova, Italy
| | - A Baritussio
- Cardiology,Dept Cardiological Thoracic and Vascular Sciences, Padua University, Padova, Italy
| | - M Seguso
- University of Padova, Department of Laboratory Medicine, Padua, Italy
| | - N Gallo
- University of Padova, Department of Laboratory Medicine, Padua, Italy
| | - L Leoni
- Cardiology,Dept Cardiological Thoracic and Vascular Sciences, Padua University, Padova, Italy
| | - S Rizzo
- University of Padova, Cardiac pathology, Dept Cardiological Thoracic and Vascular Sciences, Padua, Italy
| | - M Perazzolo Marra
- Cardiology,Dept Cardiological Thoracic and Vascular Sciences, Padua University, Padova, Italy
| | - G P Tarantini
- Cardiology,Dept Cardiological Thoracic and Vascular Sciences, Padua University, Padova, Italy
| | - M Plebani
- University of Padova, Department of Laboratory Medicine, Padua, Italy
| | - C Y Basso
- University of Padova, Cardiac pathology, Dept Cardiological Thoracic and Vascular Sciences, Padua, Italy
| | - S Iliceto
- Cardiology,Dept Cardiological Thoracic and Vascular Sciences, Padua University, Padova, Italy
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20
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Cipponeri E, Vitturi N, Mariano V, Boscari F, Galasso S, Crepaldi C, Fadini GP, Vigili de Kreutzenberg S, Marescotti MC, Iori E, Cavallin F, Sartori L, Baritussio A, Avogaro A, Bruttomesso D. Vitamin D status and non-alcoholic fatty liver disease in patients with type 1 diabetes. J Endocrinol Invest 2019; 42:1099-1107. [PMID: 30847862 DOI: 10.1007/s40618-019-01031-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 02/27/2019] [Indexed: 12/22/2022]
Abstract
PURPOSE In patients with type 1 diabetes (T1D), the prevalence of non-alcoholic fatty liver disease (NAFLD) ranges from 10 to 53% and contrasting evidence suggests that vitamin D deficiency may favor liver fat accumulation. Here, we investigated the association between vitamin D status and NAFLD in adults with T1D. METHODS 220 consecutive adult T1D patients on multiple daily injections or continuous subcutaneous insulin infusion and not taking calcium or vitamin D supplements were included. Patient characteristics, 25(OH)D serum levels, and metabolic parameters were analyzed. Vitamin D status was defined as sufficiency ( ≥ 75 nmol/L; 30 ng/ml), insufficiency (50-75 nmol/L; 20-30 ng/ml), or deficiency ( < 50 nmol/L; 20 ng/ml). NAFLD was diagnosed at ultrasound examination and graded 0-3. RESULTS NAFLD was present in 57 patients (29.5%): 51 grade 1, 5 grade 2, and 1 grade 3. Median 25(OH)D levels were 53 nmol/L (IQR 38-70) in patients with NAFLD and 50 nmol/L (34-69) in patients without (p = 0.46). At multivariable analysis, NAFLD was not associated with 25(OH)D levels (p = 0.42) or vitamin D deficiency (p = 0.55), while BMI (OR 1.16, 95% CI 1.07-1.27) and serum triglycerides (OR 1.02, 95% CI 1.01-1.03) were independently associated with NAFLD. CONCLUSIONS Vitamin D status appears to have no link with low-grade NAFLD in patients with type 1 diabetes.
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Affiliation(s)
- E Cipponeri
- Division of Metabolic Diseases, Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - N Vitturi
- Division of Metabolic Diseases, Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - V Mariano
- Division of Metabolic Diseases, Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - F Boscari
- Division of Metabolic Diseases, Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - S Galasso
- Division of Metabolic Diseases, Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - C Crepaldi
- Division of Metabolic Diseases, Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - G P Fadini
- Division of Metabolic Diseases, Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - S Vigili de Kreutzenberg
- Division of Metabolic Diseases, Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - M C Marescotti
- Division of Metabolic Diseases, Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - E Iori
- Division of Metabolic Diseases, Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | | | - L Sartori
- Department of Medicine, Clinica Medica 1, University of Padova, Padova, Italy
| | - A Baritussio
- Department of Medicine, Clinica Medica 1, University of Padova, Padova, Italy
| | - A Avogaro
- Division of Metabolic Diseases, Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - D Bruttomesso
- Division of Metabolic Diseases, Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padova, Italy.
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21
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Mattesi G, Baritussio A, Vezzaro R, De Conti G, Aliberti C, Iliceto S, Perazzolo Marra M. P394The magnifying glass in hypertrophic cardiomyopathy. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez109.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- G Mattesi
- University of Padova, Division of Cardiology, Department of Cardiac Thoracic, Vascular Sciences and Public Health, Padua, Italy
| | - A Baritussio
- University of Padova, Division of Cardiology, Department of Cardiac Thoracic, Vascular Sciences and Public Health, Padua, Italy
| | - R Vezzaro
- University Hospital of Padova, Division of Radiology, azienda ospedaliera Padova, Padua, Italy
| | - G De Conti
- University Hospital of Padova, Division of Radiology, azienda ospedaliera Padova, Padua, Italy
| | - C Aliberti
- University Hospital of Padova, Division of Radiology, azienda ospedaliera Padova, Padua, Italy
| | - S Iliceto
- University of Padova, Division of Cardiology, Department of Cardiac Thoracic, Vascular Sciences and Public Health, Padua, Italy
| | - M Perazzolo Marra
- University of Padova, Division of Cardiology, Department of Cardiac Thoracic, Vascular Sciences and Public Health, Padua, Italy
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22
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Figliozzi S, Baritussio A, Alderighi C, Ruozi N, Aruta P, Badano LP, De Conti G, Perazzolo Marra M, Aliberti C, Iliceto S. 222A rare congenital valve abnormality unexpectedly detected in a patient with aortic dissection. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez107.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S Figliozzi
- University of Padova, Department of Cardiac Thoracic, Vascular Sciences and Public Health, Padua, Italy
| | - A Baritussio
- University of Padova, Department of Cardiac Thoracic, Vascular Sciences and Public Health, Padua, Italy
| | - C Alderighi
- University of Padova, Department of Cardiac Thoracic, Vascular Sciences and Public Health, Padua, Italy
| | - N Ruozi
- University of Padova, Department of Cardiac Thoracic, Vascular Sciences and Public Health, Padua, Italy
| | - P Aruta
- University of Padova, Department of Cardiac Thoracic, Vascular Sciences and Public Health, Padua, Italy
| | - L P Badano
- University of Padova, Department of Cardiac Thoracic, Vascular Sciences and Public Health, Padua, Italy
| | - G De Conti
- University Hospital of Padova, Division of Radiology, Azienda Ospedaliera di Padova, Padua, Italy
| | - M Perazzolo Marra
- University of Padova, Department of Cardiac Thoracic, Vascular Sciences and Public Health, Padua, Italy
| | - C Aliberti
- University Hospital of Padova, Division of Radiology, Azienda Ospedaliera di Padova, Padua, Italy
| | - S Iliceto
- University of Padova, Department of Cardiac Thoracic, Vascular Sciences and Public Health, Padua, Italy
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23
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Civera S, Baritussio A, Chemello E, Giorgi B, Quaia E, Sarais C, Iliceto S, Perazzolo Marra M. P376Conventional dyspnoea of unconventional etiology. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez109.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S Civera
- University of Padova, Division of Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua, Italy
| | - A Baritussio
- University Hospital of Padova, Division of Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua, Italy
| | - E Chemello
- University of Padova, Department of Radiology, Padua, Italy
| | - B Giorgi
- University Hospital of Padova, Department of Radiology, Padua, Italy
| | - E Quaia
- University of Padova, Department of Radiology, Padua, Italy
| | - C Sarais
- University Hospital of Padova, Division of Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua, Italy
| | - S Iliceto
- University of Padova, Division of Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua, Italy
| | - M Perazzolo Marra
- University of Padova, Division of Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua, Italy
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Ruocco A, De Lazzari M, Baritussio A, Rizzon G, Babuin L, Lacognata C, Zucchetta P, Giorgi B, Quaia E, Iliceto S, Perazzolo Marra M. P105A sustained VT during CMR scan. Physician does not fear much. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez110.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Ruocco
- University Hospital of Padova, Department of Cardio-Thorax-Vascular Sciences and Public Health, Padua, Italy
| | - M De Lazzari
- University Hospital of Padova, Department of Cardio-Thorax-Vascular Sciences and Public Health, Padua, Italy
| | - A Baritussio
- University Hospital of Padova, Department of Cardio-Thorax-Vascular Sciences and Public Health, Padua, Italy
| | - G Rizzon
- University Hospital of Padova, Radiology, Padua, Italy
| | - L Babuin
- University Hospital of Padova, Department of Cardio-Thorax-Vascular Sciences and Public Health, Padua, Italy
| | - C Lacognata
- University Hospital of Padova, Radiology, Padua, Italy
| | - P Zucchetta
- University Hospital of Padova, Nuclear Medicine, Padua, Italy
| | - B Giorgi
- University Hospital of Padova, Radiology, Padua, Italy
| | - E Quaia
- University Hospital of Padova, Radiology, Padua, Italy
| | - S Iliceto
- University Hospital of Padova, Department of Cardio-Thorax-Vascular Sciences and Public Health, Padua, Italy
| | - M Perazzolo Marra
- University Hospital of Padova, Department of Cardio-Thorax-Vascular Sciences and Public Health, Padua, Italy
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Alderighi C, Baritussio A, De Lazzari M, Collevecchio A, Giorgi B, Quaia E, Tarantini G, Berno T, Babuin L, Basso C, Iliceto S, Marra MP. P110Twin CMRs, the same diagnosis? Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez110.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- C Alderighi
- University of Padova, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy
| | - A Baritussio
- University of Padova, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy
| | - M De Lazzari
- University of Padova, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy
| | - A Collevecchio
- University of Padova, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy
| | - B Giorgi
- University of Padova, Division of Radiology Department of Medicine University, Padua, Italy
| | - E Quaia
- University of Padova, Division of Radiology Department of Medicine University, Padua, Italy
| | - G Tarantini
- University of Padova, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy
| | - T Berno
- University of Padova, Department of Medicine, Hematology Section and Clinical Immunology Branch, Padua, Italy
| | - L Babuin
- University of Padova, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy
| | - C Basso
- University of Padova, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy
| | - S Iliceto
- University of Padova, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy
| | - M P Marra
- University of Padova, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy
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Amadu A, Baritussio A, Dastidar A, De Garate E, Rodrigues J, Biglino G, Lyen S, Diab I, Duncan E, Nisbet A, Thomas G, Angelini G, Bucciarelli-Ducci C. Arrhythmogenic right ventricular cardiomyopathy (ARVC) mimics: the knot unravelled by cardiovascular MRI. Clin Radiol 2019; 74:228-234. [DOI: 10.1016/j.crad.2018.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 12/06/2018] [Indexed: 10/27/2022]
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Chirillo F, Cucchini U, Covolo E, Carasi M, Zadro M, Iavernaro A, Zasso A, Baritussio A, Bontorin M, Libardoni M, Galzignan E, Molon E, Cognolato D. P4465Coronary angiography and revascularization in patients with peripheral artery disease undergoing percutaneous transluminal angioplasty. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- F Chirillo
- General Hospital, Cardiology, Bassano del Grappa, Italy
| | - U Cucchini
- General Hospital, Cardiology, Bassano del Grappa, Italy
| | - E Covolo
- General Hospital, Cardiology, Bassano del Grappa, Italy
| | - M Carasi
- General Hospital, Cardiology, Bassano del Grappa, Italy
| | - M Zadro
- General Hospital, Cardiology, Bassano del Grappa, Italy
| | - A Iavernaro
- General Hospital, Cardiology, Bassano del Grappa, Italy
| | - A Zasso
- General Hospital, Cardiology, Bassano del Grappa, Italy
| | - A Baritussio
- General Hospital, Cardiology, Bassano del Grappa, Italy
| | - M Bontorin
- General Hospital, Cardiology, Bassano del Grappa, Italy
| | - M Libardoni
- General Hospital, Cardiology, Bassano del Grappa, Italy
| | - E Galzignan
- General Hospital, Vascular Surgery, Bassano del Grappa, Italy
| | - E Molon
- General Hospital, Vascular Surgery, Bassano del Grappa, Italy
| | - D Cognolato
- General Hospital, Vascular Surgery, Bassano del Grappa, Italy
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Abstract
The objective assessments of left ventricular (LV) and right ventricular (RV) ejection fractions (EFs) are the main important tasks of routine cardiovascular magnetic resonance (CMR). Over the years, CMR has emerged as the reference standard for the evaluation of biventricular morphology and function. However, changes in EF may occur in the late stages of the majority of cardiac diseases, and being a measure of global function, it has limited sensitivity for identifying regional myocardial impairment. On the other hand, current wall motion evaluation is done on a subjective basis and subjective, qualitative analysis has a substantial error rate. In an attempt to better quantify global and regional LV function; several techniques, to assess myocardial deformation, have been developed, over the past years. The aim of this review is to provide a comprehensive compendium of all the CMR techniques to assess myocardial deformation parameters as well as the application in different clinical scenarios.
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Affiliation(s)
- A Scatteia
- Cardiac Magnetic Resonance Unit, Bristol Heart Institute, NIHR Bristol Biomedical Research Centre, University of Bristol, Bristol, UK.,Division of Cardiology, Ospedale Medico-Chirurgico Accreditato Villa dei Fiori, Acerra, Naples, Italy
| | - A Baritussio
- Cardiac Magnetic Resonance Unit, Bristol Heart Institute, NIHR Bristol Biomedical Research Centre, University of Bristol, Bristol, UK
| | - C Bucciarelli-Ducci
- Cardiac Magnetic Resonance Unit, Bristol Heart Institute, NIHR Bristol Biomedical Research Centre, University of Bristol, Bristol, UK.
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Moharem-Elgamal S, Pontecorboli G, Biglino G, Milano E, De Garate E, Harries I, Dastidar A, Baritussio A, Bucciarelli-Ducci C. P544Are rest perfusion images needed in stress perfusion CMR? Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Ghosh Dastidar A, De Garate E, Drobni Z, Baritussio A, Singhal P, Biglino G, Dorman S, Strange J, Baumbach A, Johnson T, Bucciarelli-Ducci C. P2122Prognostic risk stratification in myocardial infarction with non-obstructed coronaries (MINOCA) by conventional risk factors and cardiac magnetic resonance. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Baritussio A, Moharem-Elgamal S, Biglino G, De Garate E, Harries I, Ghosh Dastidar A, Bucciarelli-Ducci C. P5220Effects of true left bundle branch block on myocardial mechanics: a study by cardiovascular magnetic resonance. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p5220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Pontecorboli G, Lazzeroni D, Fierro N, Biglino G, Dastidar A, De Garate E, Singhal P, Baritussio A, Camici P, Bucciarelli-Ducci C. P4509Incremental value of CMR-derived mitral annular plane systolic excursion for atrial fibrillation risk stratification in patients with hypertrophic cardiomyopathy. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Dastidar AG, De Garate E, Singhal P, Rodrigues J, Baritussio A, Scatteia A, Nightingale A, Stuart AG, Bucciarelli-Ducci C. 5 Structural predictors of atrial fibrillation in hypertrophic cardiomyopathy using cardiac magnetic resonance imaging: Abstract 5 Table 1. Heart 2016. [DOI: 10.1136/heartjnl-2016-309668.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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De Garate E, Dastidar AG, Baritussio A, Scatteia A, Amadu A, Venuti G, Erdei T, Rodrigues J, Bucciarelli-Ducci C. 7 Clinical impact of cardiovascular magnetic resonance on the management of acutely hospitalised patients. Heart 2016. [DOI: 10.1136/heartjnl-2016-309668.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Dastidar AG, Rodrigues J, Johnson T, De Garate E, Singhal P, Baritussio A, Scatteia A, Strange J, Nightingale A, Baumbach A, Delgado V, Bucciarelli-Ducci C. 4 Troponin positive acute coronary syndromes and unobstructed coronary arteries: Improved diagnostic and clinical impact by performing cardiovascular magnetic resonance early after presentation. Heart 2016. [DOI: 10.1136/heartjnl-2016-309668.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Scatteia A, Vollema EM, Leung M, Marsan NA, Baritussio A, De Garate E, Dastidar AG, Rodrigues J, Bax JJ, Delgado V, Bucciarelli-Ducci C. 21 Feature tracking cardiac magnetic resonance to assess LV mechanics in different cardiac overload caused by aortic valve disease. Heart 2016. [DOI: 10.1136/heartjnl-2016-309668.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Angela S, Camaioni C, Bohnen S, Khanji MY, Hilbert S, Goetschalckx K, Calvieri C, Reinstadler SJ, Maestrini V, James S, Bastiaenen R, Reid AB, Amadu A, Pontone G, Alberto C, Manuel DL, Federico M, Francesca P, Bendetta G, Giorgio DC, Giuseppe T, Luisa C, Emanuele B, Domenico C, Sabino I, Martina PM, Morlon L, Vergé MP, Jais P, Roudaut R, Laurent F, Lafitte S, Cochet H, Réant P, Radunski UK, Lund GK, Senel M, Avanesov M, Tahir E, Stehning C, Adam G, Blankenberg S, Muellerleile K, Balawon A, Boubertakh R, Petersen SE, Spampinato R, Oebel S, Hindricks G, Bollmann A, Jahnke C, Paetsch I, Bogaert J, Desmet W, Toth A, Merkely B, Janssens S, Claus P, Preda MB, Perfetti A, Valaperta R, Secchi F, Fedele F, Martelli F, Lombardi M, Eitel C, Fuernau G, de Waha S, Desch S, Mende M, Metzler B, Schuler G, Thiele H, Eitel I, Mun HC, Kotwinski P, Rosmini S, Sanders J, Lloyd G, Dudley JP, Kellman P, Hugh EM, Manisty C, James CM, Waterhouse D, Murphy T, Kenny C, O'Hanlon R, Cox AT, Wijeyeratne Y, Colbeck N, Pakroo N, Ahmed H, Bunce N, Anderson L, Prasad S, Sharma S, Behr ER, Miller C, Jovanovic A, Woolfson P, Abidin N, Schmitt M, Rodrigues J, Dastidar AG, Baritussio A, Lawton C, Venuti G, Meloni G, Conti M, Bucciarelli-Ducci C, Andreini D, SoLbiati A, Guglielmo M, Mushtaq S, Baggiano A, Beltrama V, Rota C, Guaricci AI, Pepi M. ORAL AB QUICK FIRE I1496Myocardial substrates underlyng early ventricular arrhythmias in st-elevation acute myocardial infarction: the role of cardiac magnetic resonance1416Cardiac magnetic resonance predicts atrial fibrillation occurrence in patients with hypertrophic cardiomyopathy1469T1 and T2 mapping cardiovascular magnetic resonance to monitor inflammatory activity in patients with myocarditis1480Impact of electronic coaching on cardiovascular risk reduction in a high-risk primary prevention population – A cardiovascular magnetic resonance sub-study1598Anatomical and functional evaluation of postinterventional pulmonary vein stenosis by magnetic resonance imaging1364Reduced infarct-adjacent wall thickening and impaired restperfusion in the area at risk of successfully reperfused acute myocardial infarction1580Correlation between circulating microRNA 29 and diffuse myocardial fibrosis, assessed by T1 mapping, in patients affected by non ischemic dilative cardiomyopathy1435Association of Smoking with Myocardial Injury and Clinical Outcome in Patients Undergoing Mechanical Reperfusion for ST-Elevation Myocardial Infarction1640Assessing the risk of late cardiotoxicity in low risk breast cancer survivors receiving contemporary anthracycline treatment: a 6 year 100 patient study1511Risk stratification in sarcoidosis: Incidence of cardiac sarcoidosis in individuals diagnosed with extra-cardiac disease by cardiovascular magnetic resonance1334Patterns of late gadolinium enhancement in Brugada syndrome1591Detailed Left Atrial Assessment in Anderson Fabry Disease1634Role of cardiac magnetic resonance in the diagnosis of ARVC/D mimics1321Comparison of transtlioracic ecliocardiography versus cardiac magnetic for implantable cardioverter defibrillator therapy in primary prevention strategy dilated cardiomyopathy patients: Table 1. Eur Heart J Cardiovasc Imaging 2016. [DOI: 10.1093/ehjci/jew179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Scatteia A, Rodrigues J, Lyen S, De Gerate E, Baritussio A, Dastidar AG, Biglino G, Maceira A, Pennell D, Bucciarelli-Ducci C. 22 Intra-ventricular myocardial deformation strain analysis in healthy volunteers: regional variation and implications for regional myocardial disease processes. Heart 2016. [DOI: 10.1136/heartjnl-2016-309668.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Baritussio A, De Garate E, Dastidar AG, Ahmed N, Scatteia A, Rodrigues J, Lawton C, Nisbet A, Duncan E, Cripps T, Diab I, Thomas G, Bucciarelli-Ducci C. 2 Clinical application of cardiovascular magnetic resonance in patients with MR-conditional devices: safety, feasibility and clinical impact. Heart 2016. [DOI: 10.1136/heartjnl-2016-309668.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Baritussio A, Dastidar AG, Ahmed N, Rodrigues J, Frontera A, Lawton C, Augustine D, McAlindon E, Bucciarelli-Ducci C. 3 Clinical utility of cardiac MRI in young-middle aged patients with high-grade atrio-ventricular block. Heart 2016. [DOI: 10.1136/heartjnl-2016-309668.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Amadu AM, Baritussio A, Dastidar AG, Rodrigues JCL, Crivelli P, Meloni GB, Conti M, Bucciarelli-Ducci C. 1 Prevalence of extra-cardiac findings detected by cardiac MRI in inherited vs acquired cardiovascular diseases. Heart 2016. [DOI: 10.1136/heartjnl-2016-309668.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Greulich S, Meloni A, Nazir SA, Stefan Biesbroek P, Arenja N, Kammerlander AA, Sayeed A, Ricci F, Bernhardt P, Meierhofer C, Devos DG, Ruecker B, Burkhardt B, Kamphuis VP, De Lazzari M, Nederend I, Dux-Santoy L, Cavalcante JL, Rosmini S, Liu B, Fent G, Claessen G, Behar J, Oebel S, Baritussio A, Ranjit Arnold J, Kitterer D, Latus J, Henes J, Kurmann R, Gloekler S, Wahl A, Buss S, Katus H, Bobbo M, Lombardi M, Braun N, Alscher M, Sechtem U, Mahrholdt H, Neri M, Preziosi P, Grassedonio E, Schicchi N, Keilberg P, Pulini S, Facchini E, Positano V, Pepe A, Shetye A, Khan JN, Singh A, Kanagala P, Swarbrick D, Gulsin G, Graham-Brown M, Squire I, Gershlick A, McCann GP, Amier RP, Teunissen PF, Robbers LF, Beek AM, van Rossum AC, Hofman MB, van Royen N, Nijveldt R, Riffel JH, Djiokou CN, Andre F, Fritz T, Halder M, Thomas Z, Korosoglou G, Katus HA, Buss SJ, Schwaiger ML, Duca F, Aschauer S, Marzluf BA, Zotter-Tufaro C, Dalos D, Pfaffenberger S, Bonderman D, Mascherbauer J, Fridman Y, Hackman B, Kadakkal A, Maanja M, Daya HA, Wong TC, Schelbert EB, Barison A, Todiere G, Gaeta R, Galllina S, Emdin M, De Caterina R, Aquaro G, Buckert D, Dyckmanns N, Rottbauer W, Kühn A, Shehu N, Müller J, Stern H, Ewert P, Fratz S, Vogt M, De Groote K, Babin D, Demulier L, Taeymans Y, Westenberg JJ, Van Bortel L, Segers P, Achten E, De Schepper J, Rietzschel E, Geiger J, Makki M, Burkhardt B, Kellenberger CJ, Buechel ERV, Kellenberger C, Geiger J, Ruecker B, Buechel EV, Elbaz MS, Kroft LJ, van der Geest RJ, de Roos A, Blom NA, Westenberg JJ, Roest AA, Cipriani A, Susana A, Rizzo S, Giorgi B, Carmelo L, Bertaglia E, Bauce B, Corrado D, Thiene G, Marra MP, Basso C, Iliceto S, Roest A, van den Boogaard P, ten Harkel A, de Geus J, Kroft L, de Roos A, Westenberg J, Kale R, Teixido-Tura G, Maldonado G, Huguet M, Garcia-Dorado D, Evangelista A, Rodriguez-Palomares J, Rijal S, Schindler JT, Gleason TG, Lee JS, Schelbert EB, Bulluck H, Treibel TA, Bhuva A, Abdel-Gadir A, Culotta V, Merghani A, Maestrini V, Herrey AS, Kellman P, Manisty C, Moon JC, Hayer M, Baig S, Shah T, Rooney S, Edwards N, Steeds R, Garg P, Swoboda P, Dobson L, Musa T, Foley J, Haaf P, Greenwood J, Plein S, Schnell F, Bogaert J, Dymarkowski S, Pattyn N, Claus P, Van Cleemput J, Gerche AL, Heidbuchel H, Toth D, Reiml S, Panayiotou M, Claridge S, Jackson T, Sohal M, Webb J, O'Neill M, Brost A, Mountney P, Razavi R, Rhode K, Rinaldi CA, Arya A, Hilbert S, Bollmann A, Hindricks G, Jahnke C, Paetsch I, Dinov B, Perazzolo Marra M, Ghosh Dastidar A, Rodrigues J, Zorzi A, Susana A, Scatteia A, De Garate E, Mattesi G, Strange J, Corrado D, Bucciarelli-Ducci C, Jerosch-Herold M, Karamitsos TD, Francis JM, Bhamra-Ariza P, Sarwar R, Choudhury R, Selvanayagam JB, Neubauer S. ORAL AB AGORA1362Cardiac Involvement in Patients With Different Rheumatic Disorders1366Gender differences in the development of cardiac complications: a multicentric prospective study in a large cohort of thalassemia major patients1646Comparison of T1-mapping, T2-weighted and contrast-enhanced cine imaging at 3.0T CMR for diagnostic oedema assessment in ST-segment elevation myocardial infarction1375Evaluation of Tissue Changes in Remote Noninfarcted Myocardium after Acute Myocardial Infarction using T1-mapping1377Right ventricular long axis strain – The prognostic value of a novel parameter in non-ischemic dilated cardiomyopathy using standard cardiac magnetic resonance imaging1389The role of the right ventricular insertion point in heart failure patients with preserved ejection fraction: Insights from a cardiovascular magnetic resonance study1398Myocardial fibrosis associates with B-type natriuretic peptide levels and outcomes more than wall stress1478Prognostic Value of Pulmonary Blood Volume by Contrast-Enhanced Magnetic Resonance Imaging in Heart Failure Outpatients – The PROVE-HF Study1370Magnetic Resonance Adenosine Perfusion Imaging as Gatekeeper of Invasive Coronary1509Influence of non-invasive hemodynamic CMR parameters on maximal exercise capacity in surgically untreated patients with Ebstein's anomaly1356Proximal aortic stiffening in Turner patients is more pronounced in the presence of a bicuspid valve. A segmental functional MRI study1503Flow pattern and vascular distensibility of the pulmonary arteries in patients after repair of tetralogy of Fallot. Insights from 4D flow CMR1516Myocardial deformation characteristics of the systemic right ventricle after atrial switch operation for transposition of the great arteries1633Three-dimensional vortex formation in patients with a Fontan circulation: evaluation with 4D flow CMR1483Mitral valve prolapse: arrhythmogenic substrates by cardiac magnetic imaging1596Increased local wall shear stress after coarctation repair is associated with descending aorta pulse wave velocity: evaluation with CMR and 4D flow1636Three-dimensional wall shear stress assessed by 4Dflow CMR in bicuspid aortic valve disease1464Cardiac Amyloidosis and Aortic Stenosis – The Convergence of Two Aging Processes1630Blood T1 variability explained in healthy volunteers: an analysis on MOLLI, ShMOLLI and SASHA1408Myocardial deformation on CMR predicts adverse outcomes in carcinoid heart disease - a new marker of risk1492Myocardial Perfusion Reserve and Global Longitudinal Strain in Early Rheumatoid Arthritis1500Exercise CMR to differentiate athlete's heart from patients with early dilated cardiomyopathy1559Real-Time, x-mri guidance to optimise left ventricular lead placement for delivery of cardiac resynchronisation therapy1560The role of Cardiac magnetic resonance imaging in patients undergoing ablation for ventricular tachycardia- Defining the substrate and visualizing the outcome1590Impact of cardiovascular magnetic resonance on clinical management and decision-making of out of hospital cardiac arrest survivors with inconclusive coronary angiogram1561Detection of coronary stenosis at rest using Oxygenation-Sensitive Magnetic Resonance Imaging. Eur Heart J Cardiovasc Imaging 2016. [DOI: 10.1093/ehjci/jew181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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De Garate E, Dastidar AG, Singhal P, Venuti G, Amadu A, Baritussio A, Scatteia A, Lawton C, Rodrigues J, Bucciarelli-Ducci C. 6 Prevalence and CMR characteristics of apical HCM: Abstract 6 Table 1. Heart 2016. [DOI: 10.1136/heartjnl-2016-309668.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Affiliation(s)
- A Baritussio
- Bristol NIHR Cardiovascular Biomedical Research Unit (BRU), Bristol Heart Institute, Bristol, UK Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - A Ghosh Dastidar
- Bristol NIHR Cardiovascular Biomedical Research Unit (BRU), Bristol Heart Institute, Bristol, UK
| | - C Bucciarelli-Ducci
- Bristol NIHR Cardiovascular Biomedical Research Unit (BRU), Bristol Heart Institute, Bristol, UK
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Baritussio A, Marra MP, Ahmed N, Dastidar AG, Rodrigues J, Zorzi A, Susana A, Corrado D, Bucciarelli-Ducci C. 3 Role of cardiac magnetic resonance in non-traumatic out of hospital cardiac arrest survivors: a multi-centre study. Heart 2015. [DOI: 10.1136/heartjnl-2015-307845.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Amadu AM, Baritussio A, Dastidar AG, Rodrigues J, Hamilton M, Manghat N, Bucciarelli-Ducci C. 2 Role of cardiac magnetic resonance (CMR) in the identification of arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) phenocopies. Heart 2015. [DOI: 10.1136/heartjnl-2015-307845.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
A 51-year-old man with chronic alcoholic liver disease developed a severe haemolytic anaemia characterized by the presence of circulating burr-shaped cells (echinocytes). Several transfusions of packed red cells were ineffective in raising the haemoglobin concentration, showing that the abnormality was acquired by the transfused cells. Liver biopsies revealed haemochromatosis. Haematological parameters normalized four months after the patient stopped drinking alcohol, but burr cells were still present and erythrocyte life-span was still markedly shortened at one year follow-up. Since serum cholesterol, HDL-cholesterol, and Apo-AI and Apo-B lipoproteins were considerably decreased, the lipid composition of the red cell membrane was studied. Findings showed that echinocytosis occurred with no change in membrane cholesterol content, nor in cholesterol:phospholipid ratio, but with an alteration in the phosphatidylserine and phosphatidylinositol concentrations. While haemochromatosis was most likely the cause of the erythrocyte anomaly, alcohol intake was probably responsible for the acute onset of haemolytic anaemia with effects directly on the erythrocyte membrane as well as mediated by the progressive hepatic injury, with alterations in the plasma and successively in the intramembrane lipid composition.
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Affiliation(s)
- N Bizzaro
- Laboratorio di Patologia Clinica, Ospedale Civile, Venice, Italy
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48
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Bruttomesso D, Crazzolara D, Maran A, Costa S, Dal Pos M, Girelli A, Lepore G, Aragona M, Iori E, Valentini U, Del Prato S, Tiengo A, Buhr A, Trevisan R, Baritussio A. In Type 1 diabetic patients with good glycaemic control, blood glucose variability is lower during continuous subcutaneous insulin infusion than during multiple daily injections with insulin glargine. Diabet Med 2008; 25:326-32. [PMID: 18307459 DOI: 10.1111/j.1464-5491.2007.02365.x] [Citation(s) in RCA: 107] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
AIMS The superiority of continuous subcutaneous insulin infusion (CSII) over multiple daily injections (MDI) with glargine is uncertain. In this randomized cross-over study, we compared CSII and MDI with glargine in patients with Type 1 diabetes well controlled with CSII. The primary end-point was glucose variability. METHODS Thirty-nine patients [38.1 +/- 9.3 years old (mean +/- sd), diabetes duration 16.6 +/- 8.2 years, glycated haemoglobin (HbA(1c)) 7.6 +/- 0.8%], already on CSII for at least 6 months, were randomly assigned to CSII with lispro or MDI with lispro and glargine. After 4 months they were switched to the alternative treatment. During the last month of each treatment blood glucose variability was analysed using glucose standard deviation, mean amplitude of glycaemic excursions (MAGE), lability index and average daily risk range (ADRR). As secondary end-points we analysed blood glucose profile, HbA(1c), number of episodes of hypo- and hyperglycaemia, lipid profile, free fatty acids (FFA), growth hormone and treatment satisfaction. RESULTS During CSII, glucose variability was 5-12% lower than during MDI with glargine. The difference was significant only before breakfast considering glucose standard deviation (P = 0.011), significant overall using MAGE (P = 0.016) and lability index (P = 0.005) and not significant using ADRR. Although HbA(1c) was similar during both treatments, during CSII blood glucose levels were significantly lower, hyperglycaemic episodes were fewer, daily insulin dose was less, FFA were lower and treatment satisfaction was greater than during MDI with glargine. The frequency of hypoglycaemic episodes was similar during both treatments. CONCLUSIONS During CSII, glucose variability is lower, glycaemic control better and treatment satisfaction higher than during MDI with glargine.
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Affiliation(s)
- D Bruttomesso
- Department of Clinical and Experimental Medicine, Division of Metabolic Diseases, University of Padova, Padova, Italy.
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49
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Bruttomesso D, Costa S, Dal Pos M, Crazzolara D, Realdi G, Tiengo A, Baritussio A, Gagnayre R. Educating diabetic patients about insulin use: changes over time in certainty and correctness of knowledge. Diabetes & Metabolism 2006; 32:256-61. [PMID: 16799403 DOI: 10.1016/s1262-3636(07)70277-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
AIM Diabetic patients should understand their disease correctly and be sure of what they know, but certainty is rarely considered by educators. Furthermore little is known about how certainty changes with time after an educational intervention. To clarify this, in 38 patients with type 1 diabetes (0.3-36 years duration) we analysed the effect of a course on insulin use by administering a questionnaire before the course, after the course and 1 and 3 years later. METHODS Answers, accompanied by a subjective estimate of the degree of certainty, were assigned to mastered knowledge (certainty>or=90%, correctness>or=90%), hazardous knowledge (certainty>or=90%, correctness<or=50%), uncertain knowledge (certainty<or=50%, correctness>or=90%) and residual knowledge (total-[mastered+hazardous+uncertain]). Answers were then counted and changes in distribution among areas were analysed by the chi2 test. We also followed the fate of wrong answers. RESULTS The course increased mastered knowledge, while other types of knowledge decreased. With time mastered knowledge decreased, patients losing both correctness and certainty. The loss affected declarative knowledge, based purely on theory, more than procedural knowledge, which concerns the way things are done. Wrong answers, mostly given with high degree of certainty, were heterogeneous since some became correct after the course, some remained wrong, some became wrong after the course, some became mistaken after having been corrected earlier. CONCLUSIONS The analysis of certainty helps in evaluating patient's knowledge; programmes tending to improve procedural knowledge are more likely to have long lasting effects; wrong answers need to be considered on a individual basis.
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Affiliation(s)
- D Bruttomesso
- Department of Clinical and Experimental Medicine, University of Padova, Italy.
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50
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Bruttomesso D, Pianta A, Crazzolara D, Scaldaferri E, Lora L, Guarneri G, Mongillo A, Gennaro R, Miola M, Moretti M, Confortin L, Beltramello GP, Pais M, Baritussio A, Casiglia E, Tiengo A. Continuous subcutaneous insulin infusion (CSII) in the Veneto region: efficacy, acceptability and quality of life. Diabet Med 2002; 19:628-34. [PMID: 12147142 DOI: 10.1046/j.1464-5491.2002.00750.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIM To study the effect of continuous subcutaneous insulin infusion (CSII) on metabolic control and well-being in patients with Type 1 diabetes. METHODS Efficacy, safety and interference with everyday life associated with CSII were studied retrospectively in 138 diabetic patients from the Veneto region treated for 7.4 +/- 0.4 years. RESULTS Glycosylated haemoglobin decreased during the first year of CSII from 9.3 +/- 0.2% to 7.9 +/- 0.1% (P < 0.0001), and then remained unchanged. Serious hypoglycaemia decreased from 0.31 +/- 0.07/year to 0.09 +/- 0.02/year (P < 0.003), as did ketoacidosis (from 0.41 +/- 0.12/year to 0.11 +/- 0.03/year, P < 0.013). During the first year of therapy daily insulin requirement decreased from 49 +/- 1 to 42 +/- 2 U/day (P < 0.0001) and did not change thereafter. The number of out-patient consultations and hospital admissions per year also decreased significantly. CSII was associated with a progressive increase of body weight (P < 0.05) and with 0.2 +/- 0.04 infections/patient per year at the infusion site. Infection was rated as mild in 72%, moderate in 18%, severe in 10%. Patients reported that CSII improved metabolic control (71%), sense of well-being (41%), and allowed more freedom (40%). Quality of life, assessed using the DQOL, after 7 years of CSII was rated as good by patients (score of 73.0 +/- 1.8 on a scale from 0 to 100). CONCLUSIONS This retrospective analysis suggests that CSII improves metabolic control in Type 1 diabetic patients, reduces hypoglycaemic and ketoacidotic events, is well accepted, allows a good quality of life and decreases out-patient consultations and hospital admissions.
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Affiliation(s)
- D Bruttomesso
- Department of Clinical and Experimental Medicine, Cattedra di Malattie del Metabolismo, University of Padua, Via Giustiniani 2, 35128 Padua, Italy.
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