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Ciampi Q, Pepi M, Antonini-Canterin F, Barbieri A, Barchitta A, Faganello G, Miceli S, Parato VM, Tota A, Trocino G, Abbate M, Accadia M, Alemanni R, Angelini A, Anglano F, Anselmi M, Aquila I, Aramu S, Avogadri E, Azzaro G, Badano L, Balducci A, Ballocca F, Barbarossa A, Barbati G, Barletta V, Barone D, Becherini F, Benfari G, Beraldi M, Bergandi G, Bilardo G, Binno SM, Bolognesi M, Bongiovi S, Bragato RM, Braggion G, Brancaleoni R, Bursi F, Dessalvi CC, Cameli M, Canu A, Capitelli M, Capra ACM, Carbonara R, Carbone M, Carbonella M, Carrabba N, Casavecchia G, Casula M, Chesi E, Cicco S, Citro R, Cocchia R, Colombo BM, Colonna P, Conte M, Corrado G, Cortesi P, Cortigiani L, Costantino MF, Cozza F, Cucchini U, D’Angelo M, Da Ros S, D’Andrea F, D’Andrea A, D’Auria F, De Caridi G, De Feo S, De Matteis GM, De Vecchi S, Del Giudice C, Dell’Angela L, Paoli LD, Dentamaro I, Destefanis P, Di Bella G, Di Fulvio M, Di Gaetano R, Di Giannuario G, Di Gioia A, Di Martino LFM, Di Muro C, Di Nora C, Di Salvo G, Dodi C, Dogliani S, Donati F, Dottori M, Epifani G, Fabiani I, Ferrara F, Ferrara L, Ferrua S, Filice G, Fiorino M, Forno D, Garini A, Giarratana GA, Gigantino G, Giorgi M, Giubertoni E, Greco CA, Grigolato M, Marra WG, Holzl A, Iaiza A, Iannaccone A, Ilardi F, Imbalzano E, Inciardi RM, Inserra CA, Iori E, Izzo A, La Rosa G, Labanti G, Lanzone AM, Lanzoni L, Lapetina O, Leiballi E, Librera M, Conte CL, Monaco ML, Lombardo A, Luciani M, Lusardi P, Magnante A, Malagoli A, Malatesta G, Mancusi C, Manes MT, Manganelli F, Mantovani F, Manuppelli V, Marchese V, Marinacci L, Mattioli R, Maurizio C, Mazza GA, Mazza S, Melis M, Meloni G, Merli E, Milan A, Minardi G, Monaco A, Monte I, Montresor G, Moreo A, Mori F, Morini S, Moro C, Morrone D, Negri F, Nipote C, Nisi F, Nocco S, Novello L, Nunziata L, Perini AP, Parodi A, Pasanisi EM, Pastorini G, Pavasini R, Pavoni D, Pedone C, Pelliccia F, Pelliciari G, Pelloni E, Pergola V, Perillo G, Petruccelli E, Pezzullo C, Piacentini G, Picardi E, Pinna G, Pizzarelli M, Pizzuti A, Poggi MM, Posteraro A, Privitera C, Rampazzo D, Ratti C, Rettegno S, Ricci F, Ricci C, Rolando C, Rossi S, Rovera C, Ruggieri R, Russo MG, Sacchi N, Saladino A, Sani F, Sartori C, Scarabeo V, Sciacqua A, Scillone A, Scopelliti PA, Scorza A, Scozzafava A, Serafini F, Serra W, Severino S, Simeone B, Sirico D, Solari M, Spadaro GL, Stefani L, Strangio A, Surace FC, Tamborini G, Tarquinio N, Tassone EJ, Tavarozzi I, Tchana B, Tedesco G, Tinto M, Torzillo D, Totaro A, Triolo OF, Troisi F, Tusa M, Vancheri F, Varasano V, Venezia A, Vermi AC, Villari B, Zampi G, Zannoni J, Zito C, Zugaro A, Picano E, Carerj S. Stress Echocardiography in Italian Echocardiographic Laboratories: A Survey of the Italian Society of Echocardiography and Cardiovascular Imaging. J Cardiovasc Echogr 2023; 33:125-132. [PMID: 38161775 PMCID: PMC10756319 DOI: 10.4103/jcecho.jcecho_48_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 09/07/2023] [Indexed: 01/03/2024] Open
Abstract
Background The Italian Society of Echography and Cardiovascular Imaging (SIECVI) conducted a national survey to understand the volumes of activity, modalities and stressors used during stress echocardiography (SE) in Italy. Methods We analyzed echocardiography laboratory activities over a month (November 2022). Data were retrieved through an electronic survey based on a structured questionnaire, uploaded on the SIECVI website. Results Data were obtained from 228 echocardiographic laboratories, and SE examinations were performed in 179 centers (80.6%): 87 centers (47.5%) were in the northern regions of Italy, 33 centers (18.4%) were in the central regions, and 61 (34.1%) in the southern regions. We annotated a total of 4057 SE. We divided the SE centers into three groups, according to the numbers of SE performed: <10 SE (low-volume activity, 40 centers), between 10 and 39 SE (moderate volume activity, 102 centers) and ≥40 SE (high volume activity, 37 centers). Dipyridamole was used in 139 centers (77.6%); exercise in 120 centers (67.0%); dobutamine in 153 centers (85.4%); pacing in 37 centers (21.1%); and adenosine in 7 centers (4.0%). We found a significant difference between the stressors used and volume of activity of the centers, with a progressive increase in the prevalence of number of stressors from low to high volume activity (P = 0.033). The traditional evaluation of regional wall motion of the left ventricle was performed in all centers, with combined assessment of coronary flow velocity reserve (CFVR) in 90 centers (50.3%): there was a significant difference in the centers with different volume of SE activity: the incidence of analysis of CFVR was significantly higher in high volume centers compared to low - moderate - volume (32.5%, 41.0% and 73.0%, respectively, P < 0.001). The lung ultrasound (LUS) was assessed in 67 centers (37.4%). Furthermore for LUS, we found a significant difference in the centers with different volume of SE activity: significantly higher in high volume centers compared to low - moderate - volume (25.0%, 35.3% and 56.8%, respectively, P < 0.001). Conclusions This nationwide survey demonstrated that SE was significantly widespread and practiced throughout Italy. In addition to the traditional indication to coronary artery disease based on regional wall motion analysis, other indications are emerging with an increase in the use of LUS and CFVR, especially in high-volume centers.
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Affiliation(s)
- Quirino Ciampi
- Cardiology Division, Fatebenefratelli Hospital, Benevento, Italy
| | - Mauro Pepi
- Cardiology Division, Centro Cardiologico Monzino, IRCCS, Milano, Italy
| | - Francesco Antonini-Canterin
- Department of Rehabilitative Cardiology, Rehabilitative Hospital High Speciality, Motta di Livenza, TV, Italy
| | - Andrea Barbieri
- Department of Biomedical, Metabolic and Neural Sciences, Cardiology Division, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Agata Barchitta
- Semi Intensive Care Department, Padova University Hospital, Padova, Italy
| | | | - Sofia Miceli
- Geriatric Division, University Hospital Renato Dulbecco, Catanzaro, Italy
| | - Vito Maurizio Parato
- Cardiology Division, Madonna del Soccorso Hospital, San Benedetto del Tronto, AP, Italy
| | - Antonio Tota
- Cardiology Division, Polyclinic Hospital, Bari, Italy
| | - Giuseppe Trocino
- Non Invasive Cardiac Imaging Department, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Massimiliana Abbate
- Cardiology Vanvitelli Division, AORN dei Colli, Monaldi Hospital, Napoli, Italy
| | - Maria Accadia
- Cardiology Division, Del Mare Hospital, Ponticelli, NA, Italy
| | - Rossella Alemanni
- Cardiac Surgery Division, Casa Sollievo Della Sofferenza Hospital, San Giovanni Rotondo, Italy
| | | | | | - Maurizio Anselmi
- Cardiology Division, Fracastoro Hospital, San Bonifacio, VR, Italy
| | - Iolanda Aquila
- Cardiology Division, University Hospital Mater Domini, Catanzaro, Italy
| | - Simona Aramu
- Cardiology Division, San Martino Hospital, Oristano, Italy
| | - Enrico Avogadri
- Department of Rehabilitative Cardiology, SS Trinità Hospital, Fossano, CN, Italy
| | | | - Luigi Badano
- Department of Medicine and Surgery, University MIlano-Bicocca, Integrated Cardiovascular Diagnosi Unit, Istituto Auxologico Italiano, IRCCS, Italy
| | - Anna Balducci
- Pediatric Cardiology Division, Polyclinico S. Orsola-Malpighi IRCCS Hospital, Bologna, Italy
| | | | | | | | - Valentina Barletta
- Cardiology 2 Division, Cardiac Vascular Thoracic Department, Pisa University Hospital, Pisa, Italy
| | - Daniele Barone
- Cardiology Division, S. Andrea Hospital, La Spezia, Pisa, Italy
| | - Francesco Becherini
- Cardiology and Cardiovascular Medicine Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | | | | | | | | | | | - Massimo Bolognesi
- Center for Internal Medicine and Sports Cardiology, Local Health Unit of Romagna, Cesena, FC, Italy
| | - Stefano Bongiovi
- Cardiology Division, Immacolata Concezione Civil Hospital, Piove di Sacco, PD, Italy
| | - Renato Maria Bragato
- Echocardiography and Emergency Cardiovascular Care Division, Humanitas Clinical and Research Centre, Rozzano, Italy
| | - Gabriele Braggion
- Cardiology Division, Santa Maria Regina Degli Angeli Hospital, Adria, RO, Italy
| | | | - Francesca Bursi
- Department of Health Sciences, Cardiology Division, University of Milan, San Paolo Hospital, ASST Santi Paolo e Carlo, Milano, Italy
| | | | - Matteo Cameli
- Cardiology Division, Polyclinic Le Scotte Hospital, Siena, Italy
| | - Antonella Canu
- Cardiology Division, Santissima Annunziata Hospital, Siena, Italy
| | - Mariano Capitelli
- Internal Medicine Division, Pavullo Hospital, Pavullo nel Frignano, MO, Italy
| | | | - Rosa Carbonara
- Cardiology Division, Maugeri Institute IRCCS, Bari, Italy
| | - Maria Carbone
- Emergency Medicine Division, St. Anna and St. Sebastiano Hospital, Caserta, Italy
| | - Marco Carbonella
- Cardiology Division, SS Maria Addolorata Hospital, Eboli, SA, Italy
| | - Nazario Carrabba
- Cardiology Division, Careggi University Hospital, Firenze, Italy
| | - Grazia Casavecchia
- Cardiology Division, University Hospital Ospedali Riuniti, Foggia, Italy
| | - Margherita Casula
- Cardiology Division, Nostra Signora di Bonaria Hospital, San Gavino Monreale, SU, Italy
| | - Elena Chesi
- Neonatology Division, S. Maria Nuova Hospital, Reggio Emilia, Italy
| | - Sebastiano Cicco
- Department of Precision and Regenerative Medicine and Ionian Area, Unit of Internal Medicine “G. Baccelli” and Unit of Hypertension “A.M. Pirrelli”, University of Bari Aldo Moro Medical School, AUOC Policlinico di Bari, Bari, Italy
| | - Rodolfo Citro
- Echocardiography Division, University Hospital San Giovanni di Dio e Ruggi d’Aragona, Salerno, Italy
| | | | | | - Paolo Colonna
- Cardiology Division, Polyclinic Hospital, Bari, Italy
| | - Maddalena Conte
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | | | - Pietro Cortesi
- Cardioncology Division, IRCCS Istituto Romagnolo per lo Studio dei Tumori “Dino Amadori”, Meldola, FC, Italy
| | | | | | - Fabiana Cozza
- Cardiology Division, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Umberto Cucchini
- Cardiology Division, San Bassiano Hospital, Bassano Del Grappa, VI, Italy
| | - Myriam D’Angelo
- Cardiology Division, Bonino Pulejo IRCCS Hospital, Messina, Italy
| | - Santina Da Ros
- Division of Cardiology, Riuniti Padova Sud Hospital, Monselice, PD, Italy
| | | | | | - Francesca D’Auria
- Vascular - Endovascular Surgery Division, University Hospital San Giovanni di Dio e Ruggi d’Aragona, Salerno, Italy
| | - Giovanni De Caridi
- Vascular Surgery Division, University Hospital Polyclinic G. Martino, University of Messina, Messina, Italy
| | - Stefania De Feo
- Cardiology Division, P Pederzoli Hospital, Peschiera del Garda, VR, Italy
| | | | - Simona De Vecchi
- Cardiology Division, Major University Hospital of Charity, Novara, Italy
| | | | - Luca Dell’Angela
- Cardiology Division, Gorizia-Monfalcone Hospital, Gorizia, Italy
| | | | - Ilaria Dentamaro
- Cardiology Division, Miulli Hospital, Acquaviva delle Fonti, BA, Italy
| | - Paola Destefanis
- Cardiology Division, San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Gianluca Di Bella
- Cardiology Division, University Hospital Polyclinic G. Martino, University of Messina, Messina, Italy
| | | | | | | | - Angelo Di Gioia
- Cardiology Division, St. Giuliano Hospital, Giugliano in Campania, NA, Italy
| | | | | | - Concetta Di Nora
- Cardiology Division, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Giovanni Di Salvo
- Pediatric Cardiology and Congenital Heart Disease Division, Padova University Hospital, Padova, Italy
| | - Claudio Dodi
- Cardiology Division, San Antonino Clinic, Piacenza, Italy
| | - Sarah Dogliani
- Cardiology Division, SS. Annunziata Civil Hospital, Savigliano, Italy
| | - Federica Donati
- Pascia Center, Polyclinic, University Hospital Modena Polyclinic, Modena, Italy
| | - Melissa Dottori
- Cardiology Division, Marche University Hospital, Ancona, Italy
| | - Giuseppe Epifani
- Internal Medicine Division, Camberlingo Hospital, Francavilla Fontana, BR, Italy
| | - Iacopo Fabiani
- Cardiology and Cardiovascular Medicine Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Francesca Ferrara
- Internal Medicine Division, University Hospital Modena Polyclinic, Modena, Italy
| | - Luigi Ferrara
- Cardiology Division, Villa Dei Fiori Clinic, Acerra, Italy
| | | | - Gemma Filice
- Cardiology Division, Annunziata Hospital, Cosenza, Italy
| | - Maria Fiorino
- Cardiology Division, ARNAS Civico Hospital, Cremona, Italy
| | - Davide Forno
- Cardiology Division, Maria Vittoria Hospital, Torino, Italy
| | | | | | - Giuseppe Gigantino
- Cardiology Division, University Hospital San Giovanni di Dio e Ruggi d’Aragona, Salerno, Italy
| | - Mauro Giorgi
- Cardiology Division, Molinette Hospital - Città della Salute e della Scienza, Torino, Italy
| | | | | | | | | | - Anna Holzl
- Internal Medicine Division, Quisisana Clinic, Italy
| | - Alessandra Iaiza
- Cardiac Surgery Division, San Camillo-Fornalinini Hospital, Roma, Italy
| | - Andrea Iannaccone
- Internal Medicine Division, Ordine Mauriziano Hospital, Torino, Italy
| | - Federica Ilardi
- Cardiology Division, Federico II University Hospital, Napoli, Italy
| | - Egidio Imbalzano
- Internal Medicine Division, University Hospital Polyclinic G. Martino, University of Messina, Messina, Italy
| | | | | | - Emilio Iori
- Cardiology Division, New Civil Hospital, Sassuolo, Italy
| | - Annibale Izzo
- Cardiology Division, St. Anna and St. Sebastiano Hospital, Caserta, Italy
| | | | | | | | - Laura Lanzoni
- Cardiology Division, Sacro Cuore Don Calabria IRCCS Hospital, Verona, Italy
| | | | - Elisa Leiballi
- Cardiology and Rehabilitative Division, Azienda Sanitaria Friuli Occidentale (ASFO), Health Care, Sacile (Pd), Italy
| | | | - Carmenita Lo Conte
- Cardiology Division, St. Ottone Frangipane Hospital, Ariano Irpino, AV, Italy
| | - Maria Lo Monaco
- Cardiology Division, Humanitas Gavazzeni Hospital, Bergamo, Italy
| | - Antonella Lombardo
- Cardiology Division, Fondazione Policlinico A. Gemelli-IRCCS, Università Cattolica, Roma, Italy
| | | | - Paola Lusardi
- Cardiology and Cardiac Surgery Division, Maria Pia Hospital, Torino, Italy
| | - Antonio Magnante
- Cardiology Division, Madonna delle Grazie Hospital, Matera, Italy
| | - Alessandro Malagoli
- Division of Cardiology, Nephro Cardiovascular Department, Baggiovara Hospital, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | | | - Fiore Manganelli
- Cardiology Division, St. Giuseppe Moscati Hospital, Avellino, Italy
| | - Francesca Mantovani
- Cardiology Division, Azienda USL- IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Valeria Marchese
- Cardiology Division, St. Maria della Speranza Hospital, Battipaglia, SA, Italy
| | - Lina Marinacci
- Cardiology Division, Civil Hospital, Città di Castello, Italy
| | - Roberto Mattioli
- Cardiology Division, IRCCS Multimedica Hospital, Sesto San Giovanni, Italy
| | - Civelli Maurizio
- Cardiology Division, European Institute of Oncology, Milano, Italy
| | - Giuseppe Antonio Mazza
- Pediaric Cardiology Division, Regina Margherita Hospital - Città Della Salute e Della Scienza, Torino, Italy
| | - Stefano Mazza
- Cardiology Division, Maggiore St. Andrea Hospital, Vercelli, Italy
| | - Marco Melis
- Cardiology Division, Brotzu Hospital, Cagliari, Italy
| | - Giulia Meloni
- Center for Prevention, Diagnosis and Therapy of Arterial Hypertension and Cardiovascular Complications, St. Camillo Hospital, Sassari, Italy
| | - Elisa Merli
- Cardiology Division, Degli Infermi Hospital, Faenza, RA, Italy
| | - Alberto Milan
- Internal Medicine 4 Division, Molinette Hospital - Città della Salute e Della Scienza, Torino, Italy
| | | | - Antonella Monaco
- Cardiology Outpatient Clinic, Cardiology Outpatient Clinic, Civitanova Marche, MC, Italy
| | - Ines Monte
- Cardiology Division, University Hospital Polyclinic “G.Rodolico-S. Marco”, University of Catania, Catania, Italy
| | | | - Antonella Moreo
- De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Fabio Mori
- Non-invasive Cardiovascular Diagnostic Division, Careggi University Hospital, Firenze, Italy
| | - Sofia Morini
- Cardiology Division, Riuniti della Valdichiana Hospital, Montepulciano, SI, Italy
| | - Claudio Moro
- Cardiology Division, Pio XI Hospital, Desio, MB, Italy
| | | | - Francesco Negri
- Cardiology Division, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Carmelo Nipote
- Cardiology Division, Civil Hospital, Sant’Agata di Militello, ME, Italy
| | - Fulvio Nisi
- Anesthesia and Intensive Care Division, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy
| | - Silvio Nocco
- Cardiology Division, Sirai Hospital, Carbonia, CI, Italy
| | - Luigi Novello
- Geriatric Division, Valdagno Hospital, Arzignano, VI, Italy
| | - Luigi Nunziata
- Cardiology Division, St. Maria della Pietà Hospital, Nola, NA, Italy
| | | | - Antonello Parodi
- Cardiology Division, Padre Antero Micone Hospital, Genova, Italy
| | | | - Guido Pastorini
- Cardiology Division, Regina Montis Regalis Hospital, Mondovì, CN, Italy
| | - Rita Pavasini
- Cardiology Division, University Hospital of Ferrara, Italy
| | - Daisy Pavoni
- Cardiology Division, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Chiara Pedone
- Cardiology Division, Maggiore Hospital, Bologna, Italy
| | | | | | | | - Valeria Pergola
- Cardiology Division, Padova University Hospital, Padova, Italy
| | | | | | - Chiara Pezzullo
- Cardiology Division, G.B. Grassi Hospital, Lido di Ostia, Italy
| | - Gerardo Piacentini
- Fetal and Neonatal Cardiology Unit - Fatebenefratelli Isola Tiberina Gemelli Isola Hospital, Roma, Italy
| | - Elisa Picardi
- Cardiology Division, Civic Hospital, Chivasso, Italy
| | - Giovanni Pinna
- Neonatology and Neonatal Intensive Care Division, San Camillo-Fornalinini Hospital, Roma, Italy
| | | | - Alfredo Pizzuti
- Cardiology Outpatient Clinic, Koelliker Hospital, Torino, Italy
| | - Matteo Maria Poggi
- Interdisciplinary Internal Medicine Division, Careggi University Hospital, Firenze, Italy
| | - Alfredo Posteraro
- Cardiology Division, St. Giovanni Evangelista Hospital, Tivoli, Italy
| | | | - Debora Rampazzo
- Cardiology Division, Madonna della Navicella Hospital, Chioggia, Italy
| | - Carlo Ratti
- Cardiology Division, St. Maria Bianca Hospital, Mirandola, Italy
| | | | - Fabrizio Ricci
- Cardiology Division, Ss. Annunziata Hospital, Chieti, Italy
| | - Caterina Ricci
- Cardiology Outpatient Clinic, Casa della Salute “Regina Margherita”, Castelfranco Emilia, MO, Italy
| | | | | | - Chiara Rovera
- Cardiology Division, Civic Hospital, Chivasso, Italy
| | | | | | - Nicola Sacchi
- Medical Division, St. Agostino Hospital, Castiglione del Lago, PG, Italy
| | | | - Francesca Sani
- Cardiology Division, St. Giovanni di Dio Hospital, Firenze, Italy
| | - Chiara Sartori
- Cardiology Division, Santi Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Virginia Scarabeo
- Cardiology Division, Camposampiero Hospital, Camposampiero, PD, Italy
| | - Angela Sciacqua
- Geriatric Division, University Hospital Renato Dulbecco, Catanzaro, Italy
| | - Antonio Scillone
- Intensive Cardiac Rehabilitation Unit, Villa del Sole Clinic, Cosenza, Italy
| | | | - Alfredo Scorza
- Cardiology Division, Riuniti Anzio-Nettuno Hospital, Anzio, RM, Italy
| | | | | | - Walter Serra
- Cardiology Division, University Hospital, Parma, Italy
| | | | | | - Domenico Sirico
- Pediatric Cardiology and Congenital Heart Disease Division, Padova University Hospital, Padova, Italy
| | - Marco Solari
- Cardiology Division, St. Giuseppe Hospital, Empoli, FI, Italy
| | | | - Laura Stefani
- Sports Medicine Division, Careggi University Hospital, Firenze, Italy
| | - Antonio Strangio
- Cardiology Division, St. Giovanni di Dio Hospital, Crotone, Italy
| | - Francesca Chiara Surace
- Pediatric Cardiac Surgery and Cardiology Division, Marche University Hospital, Ancona, Italy
| | - Gloria Tamborini
- Cardiology Division, Centro Cardiologico Monzino, IRCCS, Milano, Italy
| | - Nicola Tarquinio
- Internal Medicine Division, IRCCS INRCA Hospital, Osimo AN, Italy
| | | | | | - Bertrand Tchana
- Pediatric Cardiology Division, University Hospital, Parma, Italy
| | | | - Monica Tinto
- Cardiology Division, Mater Salutis Hospital, Legnago, VR, Italy
| | - Daniela Torzillo
- Internal Medicine Division, L. Sacco Hospital, University of Milan, Italy
| | - Antonio Totaro
- Department of Cardiovascular Sciences, Responsible Research Hospital, Campobasso, Italy
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, Campobasso, Italy
| | | | - Federica Troisi
- Cardiology Division, Miulli Hospital, Acquaviva delle Fonti, BA, Italy
| | - Maurizio Tusa
- Cardiology Division, St. Donato Polyclinic, San Donato Milanese, Milan, Italy
| | | | - Vincenzo Varasano
- Internal and Emergency Medicine Division, Civil Hospital, Policoro MT, Italy
| | - Amedeo Venezia
- Geriatric Division, Miulli Hospital, Acquaviva delle Fonti, BA, Italy
| | | | - Bruno Villari
- Cardiology Division, Fatebenefratelli Hospital, Benevento, Italy
| | | | - Jessica Zannoni
- Cardiology Division, St. Donato Polyclinic, San Donato Milanese, Milan, Italy
| | - Concetta Zito
- Cardiology Division, University Hospital Polyclinic G. Martino, University of Messina, Messina, Italy
| | | | - Eugenio Picano
- CNR, Institute of Clinical Physiology, Biomedicine Department, Pisa, Italy
| | - Scipione Carerj
- Cardiology Division, University Hospital Polyclinic G. Martino, University of Messina, Messina, Italy
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Ciampi Q, Pepi M, Antonini-Canterin F, Barbieri A, Barchitta A, Faganello G, Miceli S, Parato VM, Tota A, Trocino G, Abbate M, Accadia M, Alemanni R, Angelini A, Anglano F, Anselmi M, Aquila I, Aramu S, Avogadri E, Azzaro G, Badano L, Balducci A, Ballocca F, Barbarossa A, Barbati G, Barletta V, Barone D, Becherini F, Benfari G, Beraldi M, Bergandi G, Bilardo G, Binno SM, Bolognesi M, Bongiovi S, Bragato RM, Braggion G, Brancaleoni R, Bursi F, Dessalvi CC, Cameli M, Canu A, Capitelli M, Capra ACM, Carbonara R, Carbone M, Carbonella M, Carrabba N, Casavecchia G, Casula M, Chesi E, Cicco S, Citro R, Cocchia R, Colombo BM, Colonna P, Conte M, Corrado G, Cortesi P, Cortigiani L, Costantino MF, Cozza F, Cucchini U, D’Angelo M, Ros SD, D’Andrea F, D’Andrea A, D’Auria F, De Caridi G, De Feo S, De Matteis GM, De Vecchi S, Giudice CD, Dell’Angela L, Paoli LD, Dentamaro I, Destefanis P, Di Fulvio M, Di Gaetano R, Di Giannuario G, Di Gioia A, Di Martino LFM, Di Muro C, Di Nora C, Di Salvo G, Dodi C, Dogliani S, Donati F, Dottori M, Epifani G, Fabiani I, Ferrara F, Ferrara L, Ferrua S, Filice G, Fiorino M, Forno D, Garini A, Giarratana GA, Gigantino G, Giorgi M, Giubertoni E, Greco CA, Grigolato M, Marra WG, Holzl A, Iaiza A, Iannaccone A, Ilardi F, Imbalzano E, Inciardi R, Inserra CA, Iori E, Izzo A, Rosa GL, Labanti G, Lanzone AM, Lanzoni L, Lapetina O, Leiballi E, Librera M, Conte CL, Monaco ML, Lombardo A, Luciani M, Lusardi P, Magnante A, Malagoli A, Malatesta G, Mancusi C, Manes MT, Manganelli F, Mantovani F, Manuppelli V, Marchese V, Marinacci L, Mattioli R, Maurizio C, Mazza GA, Mazza S, Melis M, Meloni G, Merli E, Milan A, Minardi G, Monaco A, Monte I, Montresor G, Moreo A, Mori F, Morini S, Moro C, Morrone D, Negri F, Nipote C, Nisi F, Nocco S, Novello L, Nunziata L, Perini AP, Parodi A, Pasanisi EM, Pastorini G, Pavasini R, Pavoni D, Pedone C, Pelliccia F, Pelliciari G, Pelloni E, Pergola V, Perillo G, Petruccelli E, Pezzullo C, Piacentini G, Picardi E, Pinna G, Pizzarelli M, Pizzuti A, Poggi MM, Posteraro A, Privitera C, Rampazzo D, Ratti C, Rettegno S, Ricci F, Ricci C, Rolando C, Rossi S, Rovera C, Ruggieri R, Russo MG, Sacchi N, Saladino A, Sani F, Sartori C, Scarabeo V, Sciacqua A, Scillone A, Scopelliti PA, Scorza A, Scozzafava A, Serafini F, Serra W, Severino S, Simeone B, Sirico D, Solari M, Spadaro GL, Stefani L, Strangio A, Surace FC, Tamborini G, Tarquinio N, Tassone EJ, Tavarozzi I, Tchana B, Tedesco G, Tinto M, Torzillo D, Totaro A, Triolo OF, Troisi F, Tusa M, Vancheri F, Varasano V, Venezia A, Vermi AC, Villari B, Zampi G, Zannoni J, Zito C, Zugaro A, Di Bella G, Carerj S. Organization and Activity of Italian Echocardiographic Laboratories: A Survey of the Italian Society of Echocardiography and Cardiovascular Imaging. J Cardiovasc Echogr 2023; 33:1-9. [PMID: 37426716 PMCID: PMC10328129 DOI: 10.4103/jcecho.jcecho_16_23] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 02/28/2023] [Accepted: 02/28/2023] [Indexed: 07/11/2023] Open
Abstract
Background The Italian Society of Echocardiography and Cardiovascular Imaging (SIECVI) conducted a national survey to understand better how different echocardiographic modalities are used and accessed in Italy. Methods We analyzed echocardiography laboratory activities over a month (November 2022). Data were retrieved via an electronic survey based on a structured questionnaire, uploaded on the SIECVI website. Results Data were obtained from 228 echocardiographic laboratories: 112 centers (49%) in the northern, 43 centers (19%) in the central, and 73 (32%) in the southern regions. During the month of observation, we collected 101,050 transthoracic echocardiography (TTE) examinations performed in all centers. As concern other modalities there were performed 5497 transesophageal echocardiography (TEE) examinations in 161/228 centers (71%); 4057 stress echocardiography (SE) examinations in 179/228 centers (79%); and examinations with ultrasound contrast agents (UCAs) in 151/228 centers (66%). We did not find significant regional variations between the different modalities. The usage of picture archiving and communication system (PACS) was significantly higher in the northern (84%) versus central (49%) and southern (45%) centers (P < 0.001). Lung ultrasound (LUS) was performed in 154 centers (66%), without difference between cardiology and noncardiology centers. The evaluation of left ventricular (LV) ejection fraction was evaluated mainly using the qualitative method in 223 centers (94%), occasionally with the Simpson method in 193 centers (85%), and with selective use of the three-dimensional (3D) method in only 23 centers (10%). 3D TTE was present in 137 centers (70%), and 3D TEE in all centers where TEE was done (71%). The assessment of LV diastolic function was done routinely in 80% of the centers. Right ventricular function was evaluated using tricuspid annular plane systolic excursion in all centers, using tricuspid valve annular systolic velocity by tissue Doppler imaging in 53% of the centers, and using fractional area change in 33% of the centers. When we divided into cardiology (179, 78%) and noncardiology (49, 22%) centers, we found significant differences in the SE (93% vs. 26%, P < 0.001), TEE (85% vs. 18%), UCA (67% vs. 43%, P < 0001), and STE (87% vs. 20%, P < 0.001). The incidence of LUS evaluation was similar between the cardiology and noncardiology centers (69% vs. 61%, P = NS). Conclusions This nationwide survey demonstrated that digital infrastructures and advanced echocardiography modalities, such as 3D and STE, are widely available in Italy with a notable diffuse uptake of LUS in the core TTE examination, a suboptimal diffusion of PACS recording, and conservative use of UCA, 3D, and strain. There are significant differences between northern and central-southern regions and echocardiographic laboratories that pertain to the cardiac unit. This inhomogeneous distribution of technology represents one of the main issues that must be solved to standardize the practice of echocardiography.
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Affiliation(s)
- Quirino Ciampi
- Cardiology Division, Fatebenefratelli Hospital, Benevento, Italy
| | - Mauro Pepi
- Cardiology Division, Centro Cardiologico Monzino, IRCCS, Milano, Italy
| | | | - Andrea Barbieri
- Department of Biomedical, Cardiology Division, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Agata Barchitta
- Semi Intensive Care Department, Semi-Intensive Care Unit, Padova University Hospital, Padova, Italy
| | | | - Sofia Miceli
- Geriatric Division, University Hospital Mater Domini, Catanzaro, Italy
| | - Vito Maurizio Parato
- Cardiology Division, Madonna del Soccorso Hospital, San Benedetto del Tronto, AP, Italy
| | - Antonio Tota
- Cardiology Division, Polyclinic Hospital, Bari, Italy
| | - Giuseppe Trocino
- Non Invasive Cardiac Imaging Department, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Massimiliana Abbate
- Cardiology Vanvitelli Division, AORN dei Colli, Monaldi Hospital, Napoli, Italy
| | - Maria Accadia
- Cardiology Division, Del Mare Hospital, Ponticelli, NA, Italy
| | - Rossella Alemanni
- Cardiac Surgery Division, Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Italy
| | | | | | - Maurizio Anselmi
- Cardiology Division, Fracastoro Hospital, San Bonifacio, VR, Italy
| | - Iolanda Aquila
- Cardiology Division, University Hospital Mater Domini, Catanzaro, Italy
| | - Simona Aramu
- Cardiology Division, San Martino Hospital, Oristano, Italy
| | - Enrico Avogadri
- Department of Cardiology, SS Trinità Hospital, Fossano, CN, Italy
| | | | - Luigi Badano
- Integrated Cardiovascular Diagnostic Division, Auxologico San Luca IRCCS Hospital, Milano, Italy
| | - Anna Balducci
- Pediatric Cardiology Division, Polyclinico S. Orsola-Malpighi IRCCS Hospital, Bologna, Italy
| | | | | | | | - Valentina Barletta
- Cardiology 2 Department, Cardiac Vascular Thoracic Department, Pisa University Hospital, Pisa, Italy
| | - Daniele Barone
- Cardiology Division, S. Andrea Hospital, La Spezia, Italy
| | - Francesco Becherini
- Cardiology and Cardiovascular Medicine Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | | | | | | | | | | | - Massimo Bolognesi
- Center for Internal Medicine and Sports Cardiology, Local Health Unit of Romagna, Cesena, FC, Italy
| | - Stefano Bongiovi
- Cardiology Division, Immacolata Concezione Civil Hospital, Piove di Sacco, PD, Italy
| | - Renato Maria Bragato
- Echocardiography and Emergency Cardiovascular Care Division, Humanitas Clinical and Research Centre, Rozzano, MI, Italy
| | - Gabriele Braggion
- Cardiology Division, Santa Maria Regina degli Angeli Hospital, Adria, RO, Italy
| | | | - Francesca Bursi
- Department of Health Science, Cardiology Division, University of Milan, San Paolo Hospital, ASST Santi Paolo e Carlo, Milano, Italy
| | | | - Matteo Cameli
- Cardiology Division, Polyclinic Le Scotte Hospital, Siena, Italy
| | - Antonella Canu
- Cardiology Division, Santissima Annunziata Hospital, Sassari, Italy
| | - Mariano Capitelli
- Internal Medicine Division, Pavullo Hospital, Pavullo Nel Frignano, MO, Italy
| | | | - Rosa Carbonara
- Cardiology Division, Maugeri Institute IRCCS, Bari, Italy
| | - Maria Carbone
- Emergency Medicine Division, St Anna and St Sebastiano Hospital, Caserta, Italy
| | - Marco Carbonella
- Cardiology Division, SS Maria Addolorata Hospital, Eboli, SA, Italy
| | - Nazario Carrabba
- Cardiology Division, Careggi University Hospital, Firenze, Italy
| | - Grazia Casavecchia
- Cardiology Division, University Hospital Ospedali Riuniti, Foggia, Italy
| | - Margherita Casula
- Cardiology Division, Nostra Signora di Bonaria Hospital, San Gavino Monreale, SU, Italy
| | - Elena Chesi
- Neonatology Division, S. Maria Nuova Hospital, Reggio Emilia, Italy
| | - Sebastiano Cicco
- Department of Precision and Regenerative Medicine and Ionian Area, Unit of Internal Medicine “G. Baccelli” and Unit of Hypertension “A.M. Pirrelli”, University of Bari Aldo Moro Medical School, AUOC Policlinico di Bari, Bari, Italy
| | - Rodolfo Citro
- Echocardiography Division, University Hospital San Giovanni di Dio e Ruggi d’Aragona, Salerno, Italy
| | | | | | - Paolo Colonna
- Cardiology Division, Polyclinic Hospital, Bari, Italy
| | - Maddalena Conte
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | | | - Pietro Cortesi
- Cardioncology Division, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, FC, Italy
| | | | | | - Fabiana Cozza
- Cardiology Division, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Umberto Cucchini
- Cardiology Division, San Bassiano Hospital, Bassano Del Grappa, VI, Italy
| | - Myriam D’Angelo
- Cardiology Division, Bonino Pulejo IRCCS Hospital, Messina, Italy
| | - Santina Da Ros
- Division of Cardiology, Riuniti Padova Sud Hospital, Monselice, PD, Italy
| | | | | | - Francesca D’Auria
- Vascular - Endovascular Surgery Division, University Hospital San Giovanni di Dio e Ruggi d’Aragona, Salerno, Italy
| | - Giovanni De Caridi
- Vascular Surgery Division, University Hospital Polyclinic G.Martino, University of Messina, Messina, Italy
| | - Stefania De Feo
- Cardiology Division, P Pederzoli Hospital, Peschiera del Garda, VR, Italy
| | | | - Simona De Vecchi
- Cardiology Division, Major University Hospital of Charity, Novara, Italy
| | | | - Luca Dell’Angela
- Cardiology Division, Gorizia-Monfalcone Hospital, Gorizia, Italy
| | | | - Ilaria Dentamaro
- Cardiology Division, Miulli Hospital, Acquaviva delle Fonti, BA, Italy
| | - Paola Destefanis
- Cardiology Division, San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Maria Di Fulvio
- Cardiology-ICCU Division, Ss. Annunziata Hospital, Chieti, Italy
| | | | | | - Angelo Di Gioia
- Cardiology Division, St Giuliano Hospital, Giugliano in Campania, NA, Italy
| | | | | | - Concetta Di Nora
- Cardiology Division, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Giovanni Di Salvo
- Pediatric Cardiology and Congenital Heart Disease Division, Padova University Hospital, Padova, Italy
| | - Claudio Dodi
- Cardiology Division, San Antonino Clinic, Piacenza, Italy
| | - Sarah Dogliani
- Cardiology Division, SS. Annunziata Civil Hospital, Savigliano, CN, Italy
| | | | - Melissa Dottori
- Cardiology Division, Marche University Hospital, Ancona, Italy
| | - Giuseppe Epifani
- Internal Medicine Division, Camberlingo Hospital, Francavilla Fontana, BR, Italy
| | - Iacopo Fabiani
- Cardiology and Cardiovascular Medicine Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Francesca Ferrara
- Internal Medicine Division, University Hospital Modena Polyclinic, Modena, Italy
| | - Luigi Ferrara
- Cardiology Division, Villa Dei Fiori Clinic, Acerra, NA, Italy
| | | | - Gemma Filice
- Cardiology Division, Annunziata Hospital, Cosenza, Italy
| | - Maria Fiorino
- Cardiology Division, ARNAS Civico Hospital, Palermo, Italy
| | - Davide Forno
- Cardiology Division, Maria Vittoria Hospital, Torino, Italy
| | | | | | - Giuseppe Gigantino
- Cardiology Division, University Hospital San Giovanni di Dio e Ruggi d’Aragona, Salerno, Italy
| | - Mauro Giorgi
- Cardiology Division, Molinette Hospital - Città della Salute e della Scienza, Torino, Italy
| | | | | | | | | | - Anna Holzl
- Internal Medicine Division, Quisisana Clinic, Ferrara, Italy
| | - Alessandra Iaiza
- Cardiac Surgery Division, San Camillo-Fornalinini Hospital, Roma, Italy
| | - Andrea Iannaccone
- Internal Medicine Division, Ordine Mauriziano Hospital, Torino, Italy
| | - Federica Ilardi
- Cardiology Division, Federico II University Hospital, Napoli, Italy
| | - Egidio Imbalzano
- Internal Medicine Division, University Hospital Polyclinic G.Martino, University of Messina, Messina, Italy
| | | | | | - Emilio Iori
- Cardiology Division, New Civil Hospital, Sassuolo, MO, Italy
| | - Annibale Izzo
- Cardiology Division, St Anna and St Sebastiano Hospital, Caserta, Italy
| | | | | | | | - Laura Lanzoni
- Cardiology Division, Sacro Cuore Don Calabria IRCCS Hospital, Verona, Italy
| | | | - Elisa Leiballi
- Cardiological and Cardio Oncological Rehabilitation Department, Sacile (PN) CRO (PN) Hospital, Sacile (PN), Italy
| | | | - Carmenita Lo Conte
- Cardiology Division, St Ottone Frangipane Hospital, Ariano Irpino, AV, Italy
| | - Maria Lo Monaco
- Cardiology Division, Humanitas Gavazzeni Hospital, Bergamo, Italy
| | - Antonella Lombardo
- Cardiology Division, Fondazione Policlinico A. Gemelli-IRCCS, Università Cattolica, Roma, Italy
| | | | - Paola Lusardi
- Cardiology and Cardiac Surgery Division, Maria Pia Hospital, Torino, Italy
| | - Antonio Magnante
- Cardiology Division, Madonna delle Grazie Hospital, Matera, Italy
| | - Alessandro Malagoli
- Division of Cardiology, Nephro-Cardiovascular Department, Baggiovara Hospital, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | | | - Fiore Manganelli
- Cardiology Division, St Giuseppe Moscati Hospital, Avellino, Italy
| | - Francesca Mantovani
- Cardiology Division, Azienda USL- IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Valeria Marchese
- Cardiology Division, St Maria della Speranza Hospital, Battipaglia, SA, Italy
| | - Lina Marinacci
- Cardiology Division, Civil Hospital, Città di Castello, PG, Italy
| | - Roberto Mattioli
- Cardiology Division, IRCCS Multimedica Hospital, Sesto San Giovanni, MI, Italy
| | - Civelli Maurizio
- Cardiology Division, European Institute of Oncology, Milano, Italy
| | - Giuseppe Antonio Mazza
- Pediaric Cardiology Division, Regina Margherita Hospital - Città della Salute e della Scienza, Torino, Italy
| | - Stefano Mazza
- Cardiology Division, Maggiore St Andrea Hospital, Vercelli, Italy
| | - Marco Melis
- Cardiology Division, Brotzu Hospital, Cagliari, Italy
| | - Giulia Meloni
- Center for Prevention, Diagnosis and Therapy of Arterial Hypertension and Cardiovascular Complications, St Camillo Hospital, Sassari, Italy
| | - Elisa Merli
- Cardiology Division, Degli Infermi Hospital, Faenza, RA, Italy
| | - Alberto Milan
- Internal Medicine 4 Department, Molinette Hospital - Città della Salute e della Scienza, Torino, Italy
| | | | - Antonella Monaco
- Cardiology Outpatient Clinic, Cardiology Outpatient Clinic, Civitanova Marche, MC, Italy
| | - Ines Monte
- Cardiology Division, University Hospital Polyclinic “G.Rodolico-S. Marco”, University of Catania, Catania, Italy
| | | | - Antonella Moreo
- De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Fabio Mori
- Non-invasive Cardiovascular Diagnostic Division, Careggi University Hospital, Firenze, Italy
| | - Sofia Morini
- Cardiology Division, Riuniti della Valdichiana Hospital, Montepulciano, SI, Italy
| | - Claudio Moro
- Cardiology Division, Pio XI Hospital, Desio, MB, Italy
| | | | - Francesco Negri
- Cardiology Division, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Carmelo Nipote
- Cardiology Division, Civil Hospital, Sant’Agata di Militello, ME, Italy
| | - Fulvio Nisi
- Anesthesia and Intensive Care Division, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy
| | - Silvio Nocco
- Cardiology Division, Sirai Hospital, Carbonia, CI, Italy
| | - Luigi Novello
- Geriatric Division, Valdagno Hospital, Arzignano, VI, Italy
| | - Luigi Nunziata
- Cardiology Division, St Maria della Pietà Hospital, Nola, NA, Italy
| | | | - Antonello Parodi
- Cardiology Division, Padre Antero Micone Hospital, Genova, Italy
| | | | - Guido Pastorini
- Cardiology Division, Regina Montis Regalis Hospital, Mondovì, CN, Italy
| | - Rita Pavasini
- Cardiology Division, St Anna University Hospital, Ferrara, Italy
| | - Daisy Pavoni
- Cardiology Division, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Chiara Pedone
- Cardiology Division, Maggiore Hospital, Bologna, Italy
| | | | | | | | - Valeria Pergola
- Cardiology Division, Padova University Hospital, Padova, Italy
| | | | | | - Chiara Pezzullo
- Cardiology Division, G.B. Grassi Hospital, Lido di Ostia, RM, Italy
| | - Gerardo Piacentini
- Fetal and Neonatal Cardiology Unit - Fatebenefratelli Isola Tiberina Gemelli Isola Hospital, Roma, Italy
| | - Elisa Picardi
- Cardiology Division, Civic Hospital, Chivasso, TO, Italy
| | - Giovanni Pinna
- Neonatology and Neonatal Intensive Care Division, San Camillo-Fornalinini Hospital, Roma, Italy
| | | | - Alfredo Pizzuti
- Cardiology Outpatient Clinic, Koelliker Hospital, Torino, Italy
| | - Matteo Maria Poggi
- Interdisciplinary Internal Medicine Division, Careggi University Hospital, Firenze, Italy
| | - Alfredo Posteraro
- Cardiology Division, St Giovanni Evangelista Hospital, Tivoli, RM, Italy
| | | | - Debora Rampazzo
- Cardiology Division, Madonna della Navicella Hospital, Chioggia, VE, Italy
| | - Carlo Ratti
- Cardiology Division, St Maria Bianca Hospital, Mirandola, MO, Italy
| | - Sara Rettegno
- Cardiology Division, Hospital, Moncalieri, TO, Italy
| | - Fabrizio Ricci
- Cardiology Division, Ss. Annunziata Hospital, Chieti, Italy
| | - Caterina Ricci
- Cardiology Outpatient Clinic, Casa della Salute “Regina Margherita”, Castelfranco Emilia, MO, Italy
| | | | | | - Chiara Rovera
- Cardiology Division, Civic Hospital, Chivasso, TO, Italy
| | | | | | - Nicola Sacchi
- Medical Division, St Agostino Hospital, Castiglione del Lago, PG, Italy
| | | | - Francesca Sani
- Cardiology Division, St Giovanni di Dio Hospital, Firenze, Italy
| | - Chiara Sartori
- Cardiology Division, Santi Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Virginia Scarabeo
- Cardiology Division, Camposampiero Hospital, Camposampiero, PD, Italy
| | - Angela Sciacqua
- Geriatric Division, University Hospital Mater Domini, Catanzaro, Italy
| | - Antonio Scillone
- Intensive Cardiac Rehabilitation Unit, Villa del Sole Clinic, Cosenza, Italy
| | | | - Alfredo Scorza
- Cardiology Division, Riuniti Anzio-Nettuno Hospital, Anzio, RM, Italy
| | | | | | - Walter Serra
- Cardiology Division, University Hospital, Parma, Italy
| | | | | | - Domenico Sirico
- Pediatric Cardiology and Congenital Heart Disease Division, Padova University Hospital, Padova, Italy
| | - Marco Solari
- Cardiology Division, St Giuseppe Hospital, Empoli, FI, Italy
| | | | - Laura Stefani
- Sports Medicine Division, Careggi University Hospital, Firenze, Italy
| | - Antonio Strangio
- Cardiology Division, St Giovanni di Dio Hospital, Crotone, Italy
| | - Francesca Chiara Surace
- Pediatric Cardiac Surgery and Cardiology Division, Marche University Hospital, Ancona, Italy
| | - Gloria Tamborini
- Cardiology Division, Centro Cardiologico Monzino, IRCCS, Milano, Italy
| | - Nicola Tarquinio
- Internal Medicine Division, IRCCS INRCA Hospital, Osimo AN, Italy
| | | | | | - Bertrand Tchana
- Pediatric Cardiology Division, University Hospital, Parma, Italy
| | | | - Monica Tinto
- Cardiology Division, Mater Salutis Hospital, Legnago, VR, Italy
| | - Daniela Torzillo
- Internal Medicine Division, L. Sacco Hospital, University of Milan, Italy
| | - Antonio Totaro
- Cardiology Division, Gemelli Molise Hospital, Campobasso, Italy
| | | | - Federica Troisi
- Cardiology Division, Miulli Hospital, Acquaviva delle Fonti, BA, Italy
| | - Maurizio Tusa
- Cardiology Division, St Donato Polyclinic, San Donato Milanese MI, Italy
| | | | - Vincenzo Varasano
- Internal and Emergency Medicine Division, Civil Hospital, Policoro MT, Italy
| | - Amedeo Venezia
- Geriatric Division, Miulli Hospital, Acquaviva delle Fonti, BA, Italy
| | | | - Bruno Villari
- Cardiology Division, Fatebenefratelli Hospital, Benevento, Italy
| | | | - Jessica Zannoni
- Cardiology Division, St Donato Polyclinic, San Donato Milanese MI, Italy
| | - Concetta Zito
- Cardiology Division, University Hospital Polyclinic G.Martino, University of Messina, Messina, Italy
| | - Antonello Zugaro
- Department of Cardiology, Intensive Care Unit, St Salvatore Hospital, L’Aquila, Italy
| | - Gianluca Di Bella
- Cardiology Division, University Hospital Polyclinic G.Martino, University of Messina, Messina, Italy
| | - Scipione Carerj
- Cardiology Division, University Hospital Polyclinic G.Martino, University of Messina, Messina, Italy
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Rigatelli G, Zuin M, Braggion G, Lanza D, Aggio S, Adami A, Roncon L. Changing of Left Atrial Function Index in Symptomatic Patients with Patent Foramen Ovale After Device Closure. Turk Kardiyol Dern Ars 2022; 50:175-181. [DOI: 10.5543/tkda.2022.21027] [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] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Kukavica D, Braggion G, Pontone G. Dissecting haematoma of the interventricular septum. Eur Heart J Cardiovasc Imaging 2021; 22:e161. [PMID: 34179942 DOI: 10.1093/ehjci/jeab129] [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: 11/12/2022] Open
Affiliation(s)
- Deni Kukavica
- Department of Molecular Cardiology, Istituti Clinici Scientifici Maugeri, IRCCS, 27100 Pavia, Italy.,Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Gabriele Braggion
- Department of Cardiology, Adria General Hospital, 45011 Rovigo, Italy
| | - Gianluca Pontone
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Via C. Parea 4, 20138 Milan, Italy
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Zuin M, Rigatelli G, Braggion G, Bacich D, Nguyen T. Cavitation in left ventricular assist device patients: a potential early sign of pump thrombosis. Heart Fail Rev 2019; 25:965-972. [PMID: 31691065 DOI: 10.1007/s10741-019-09884-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 10/25/2022]
Abstract
Mechanical ventricular support with left ventricular assist device (LVAD) has emerged as a durable and safe therapy, both as bridge-to-transplant (BTT) or destination therapy (DT), in patients with advanced heart failure (HF). However, the occurrence of pump thrombosis (PT) still represents a serious complication, especially when LVADs of first or second generation are implanted. During the latest years, some investigations have recognized the occurrence of cavitation, evidenced through transthoracic echocardiography (TTE), as a potential early and indirect sign of PT. In the present manuscript, we reviewed the available data on the occurrence of cavitation in LVAD patients as an early potential marker of PT, also presenting the hemodynamic mechanisms involved.
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Affiliation(s)
- Marco Zuin
- Section of Internal and Cardiopulmonary Medicine, Faculty of Medicine, University of Ferrara, Ferrara, Italy
| | - Gianluca Rigatelli
- Cardiovascular Diagnosis and Endoluminal Interventions Unit, Rovigo General Hospital, Rovigo, Italy.
| | | | - Daniela Bacich
- Department of Cardiology, Porto Viro Hospital, Porto Viro, Rovigo, Italy
| | - Thach Nguyen
- Cardiovascular Research, Methodist Hospital, Merrillville, IN, USA
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Rigatelli G, Zuin M, Adami A, Aggio S, Lanza D, d’Elia K, Braggion G, Russo M, Mazza A, Roncon L. Left atrial enlargement as a maker of significant high-risk patent foramen ovale. Int J Cardiovasc Imaging 2019; 35:2049-2056. [DOI: 10.1007/s10554-019-01666-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 07/11/2019] [Indexed: 02/05/2023]
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Affiliation(s)
- Gianluca Rigatelli
- Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy
| | - Daniela Bacich
- Department of Cardiology, Porto Viro Hospital, Porto Viro, Rovigo
| | - Marco Zuin
- Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy
| | | | - Fabio Dell’Avvocata
- Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy
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Bacich D, Braggion G, Faggian G. Hypoplasia of the posterior mitral leaflet: A rare cause of mitral regurgitation in adulthood. Echocardiography 2017; 34:949-950. [PMID: 28386957 DOI: 10.1111/echo.13537] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Hypoplasia of the posterior mitral valve leaflet (PMVL) is a rare congenital heart disease, usually presenting in infancy and childhood with severe mitral regurgitation, either in isolation or associated with other cardiac lesions. We report a case of a 69-year-old woman with recent-onset exertional dyspnea and severe mitral regurgitation. Two- and three-dimensional transesophageal echocardiography showed severe hypoplasia of the PMVL, confirmed by surgical inspection.
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Affiliation(s)
- Daniela Bacich
- Cardiology Unit, Madonna della Salute Hospital, Porto Viro, Italy
| | | | - Giuseppe Faggian
- Division of Cardiac Surgery, University of Verona, Verona, Italy
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Rigatelli G, Dell'Avvocata F, Giordan M, Viceconte N, Osanna RA, Braggion G, Aggio S, Cardaioli P, Chen JP. Usefulness of intracardiac echocardiography with a mechanical probe for catheter-based interventions: a 10-year prospective registry. J Clin Ultrasound 2014; 42:534-543. [PMID: 24898198 DOI: 10.1002/jcu.22177] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 04/04/2014] [Accepted: 05/06/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND The clinical outcome benefit of intracardiac echocardiography (ICE) with a mechanical probe during congenital heart disease interventions has not been fully investigated. We reported the long-term results of a prospective registry of interatrial shunt closure guided by mechanical ICE. METHODS We enrolled 537 patients (mean age 48 ± 19.0 years, 378 females) submitted to ICE-aided procedures in a prospective registry over a 10-year period (September 2003-September 2013). All patients underwent transesophageal echocardiography (TEE) before the planned procedure. We evaluated (1) structure identification capability, (2) fossa ovale and interatrial septum component measurement, (3) procedure monitoring capability, (4) procedural and fluoroscopy times, and radiograph dose, (5) probe-related complications. RESULTS ICE was successfully performed and was able to correctly identify the structures previously assessed by TEE in all patients. In 24 patients (4.5%), ICE allowed better anatomy definition than TEE. In 35 other patients (6.5%), ICE identified structures not observed by TEE, which led to change indications to interventions or the operative technique to be used. In 131 patients (24.4%), ICE evaluation led to change the planned device to be implanted. There was only one probe-related complication (0.2%). CONCLUSIONS Mechanical ICE may offer a valid alternative to conventional TEE in guiding congenital heart disease interventional procedures.
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Affiliation(s)
- Gianluca Rigatelli
- Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy
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Rigatelli G, Dell’Avvocata F, Cardaioli P, Giordan M, Braggion G, Aggio S, L’Erario R, Chinaglia M. Improving migraine by means of primary transcatheter patent foramen ovale closure: long-term follow-up. Am J Cardiovasc Dis 2012; 2:89-95. [PMID: 22720197 PMCID: PMC3371619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Accepted: 02/09/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE We sought to assess the long-term faith of migraine in patients with high risk anatomic and functional characteristics predisposing to paradoxical embolism submitted to patent foramen ovale (PFO) transcatheter closure. METHODS In a prospective single-center non randomized registry from January 2004 to January 2010 we enrolled 80 patients (58 female, mean age 42±2.7 years, 63 patients with aura) submitted to transcatheter PFO closure in our center. All patients fulfilled the following criteria: basal shunt and shower/curtain shunt pattern on transcranial Doppler and echocardiography, presence of interatrial septal aneurysm (ISA) and Eustachian valve, 3-4 class MIDAS score, coagulation abnormalities, medication-refractory migraine with or without aura. Migraine Disability Assessment Score (MIDAS) was used to assess the incidence and severity of migraine before and after mechanical closure. High risk features for paradoxical embolism included all of the following. RESULTS Percutaneous closure was successful in all cases (occlusion rate 91.2%), using a specifically anatomically-driven tailored strategy, with no peri-procedural or in-hospital complications; 70/80 of patients (87.5%) reported improved migraine symptomatology (mean MIDAS score decreased 33.4±6.7 to 10.6±9.8, p<0.03) whereas 12.5% reported no amelioration: none of the patients reported worsening of the previous migraine symptoms. Auras were definitively cured in 61/63 patients with migraine with aura (96.8%). CONCLUSIONS Transcatheter PFO closure in a selected population of patients with severe migraine at high risk of paradoxical embolism resulted in a significant reduction in migraine over a long-term follow-up.
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Affiliation(s)
- Gianluca Rigatelli
- Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General HospitalRovigo, Italy
| | - Fabio Dell’Avvocata
- Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General HospitalRovigo, Italy
| | - Paolo Cardaioli
- Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General HospitalRovigo, Italy
| | - Massimo Giordan
- Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General HospitalRovigo, Italy
| | - Gabriele Braggion
- Division of Cardiology, Echocardiography Lab, Rovigo General HospitalRovigo, Italy
| | - Silvio Aggio
- Division of Cardiology, Echocardiography Lab, Rovigo General HospitalRovigo, Italy
| | - Roberto L’Erario
- Department of Neuroscience, Rovigo General HospitalRovigo, Italy
| | - Mauro Chinaglia
- Department of Neuroscience, Rovigo General HospitalRovigo, Italy
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Rigatelli G, Dell'Avvocata F, Cardaioli P, Braggion G, Giordan M, Mazza A, Fraccaro C, Chinaglia M, Chen JP. Long-term results of the amplatzer cribriform occluder for patent foramen ovale with associated atrial septal aneurysm: impact on occlusion rate and left atrial functional remodelling. Am J Cardiovasc Dis 2011; 2:68-74. [PMID: 22254216 PMCID: PMC3257157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Accepted: 11/29/2011] [Indexed: 05/31/2023]
Abstract
BACKGROUND Treatment of patients with concomitant patent foramen ovale (PFO) and atrial septal aneurysm (ASA) poses a number of challenges; while some authors have suggested the off-label use of the Amplatzer Cribriform Occluder in such anatomy, the long-term outcomes of this strategy is unknown. Our study aimed to assess the long-term impact on closure rate, left atrial functional remodelling, and clinical outcomes of off-label implantation of Amplatzer ASD Cribriform Occluder in patients with PFO and ASA. METHODS We prospectively enrolled 160 consecutive patients with previous stroke (mean age 36 ± 9.5 years, 109 females), significant PFO and ASA. All patients were treated with Amplatzer Cribriform Occluder to ensure the most complete possible coverage of the ASA. Residual shunt and LA passive and active emptying, LA conduit function, and LA ejection fraction were computed before and after 6 months from the procedure and then yearly. All patients underwent successful transcatheter closure (mean ratio device/diameter of interatrial septum = 0.74). RESULTS Incomplete ASA coverage during intraprocedural intracardiac echocardiography was observed in 71 patients. During mean follow-up of 3.6 ± 1.8 years, when compared to patients with complete coverage, there were no differences in LA functional parameters and complete occlusion achieved in 150/160 patients (93.7%). No new cerebral ischemic events, aortic erosions or device thrombosis were recorded during the follow-up. CONCLUSIONS THE USE OF THE AMPLATZER ASD CRIBRIFORM TO TREAT PFO AND ASSOCIATED ASA SEEMS SAFE AND EFFECTIVE: relatively small Occluder devices are probably effective enough to promote left atrial functional remodelling.
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Affiliation(s)
- Gianluca Rigatelli
- Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General HospitalRovigo, Italy
| | - Fabio Dell'Avvocata
- Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General HospitalRovigo, Italy
| | - Paolo Cardaioli
- Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General HospitalRovigo, Italy
| | - Gabriele Braggion
- Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General HospitalRovigo, Italy
| | - Massimo Giordan
- Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General HospitalRovigo, Italy
| | - Alberto Mazza
- Division of Internal medicine, Rovigo General HospitalRovigo, Italy
| | - Chiara Fraccaro
- Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General HospitalRovigo, Italy
| | - Mauro Chinaglia
- Neuro-sciences department, Rovigo General HospitalRovigo, Italy
| | - Jack P Chen
- Saint Joseph's Heart and Vascular InstituteAtlanta, GA, USA
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Rigatelli G, Dell'Avvocata F, Cardaioli P, Giordan M, Braggion G, Aggio S, Chinaglia M, Mandapaka S, Kuruvilla J, Chen JP, Nanjundappa A. Permanent right-to-left shunt is the key factor in managing patent foramen ovale. J Am Coll Cardiol 2011; 58:2257-61. [PMID: 22078434 DOI: 10.1016/j.jacc.2011.06.064] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [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] [Received: 04/05/2011] [Revised: 05/24/2011] [Accepted: 06/16/2011] [Indexed: 10/15/2022]
Abstract
OBJECTIVES We sought to prospectively evaluate risk of stroke and impact of transcatheter patent foramen ovale (PFO) closure in patients with permanent right-to left shunt compared with those with Valsalva maneuver-induced right-to-left shunt. BACKGROUND Pathophysiology and properly management of PFO still remain far from being fully clarified: in particular, the contribution of permanent right-to-left shunt remains unknown. METHODS Between March 2006 and October 2010, we enrolled 180 (mean age 44 ± 10.9 years, 98 women) of 320 consecutive patients referred to our center for transcatheter PFO closure, who had spontaneous permanent right-to-left shunt on transcranial Doppler and transthoracic/transesophageal echocardiography. All patients fulfilled the standard current indications for transcatheter closure and underwent preoperative transesophageal echocardiography and brain magnetic resonance imaging, with subsequent intracardiac echocardiographic-guided transcatheter PFO closure. We compared the clinical echocardiographic characteristics of these patients (Permanent Group) with the rest of 140 patients with right-to-left shunt only during Valsalva maneuver (Valsalva Group). RESULTS Compared with the Valsalva Group patients, patients of the Permanent Group had increased frequency of multiple ischemic brain lesions on magnetic resonance imaging, previous recurrent stroke, previous peripheral arteries embolism, migraine with aura, and-more frequently-atrial septal aneurysm and prominent Eustachian valve. The presence of permanent shunt confers the highest risk of recurrent stroke (odds ratio: 5.9, 95% confidence interval: 2.0 to 12, p < 0.001). No differences were recorded between the 2 groups with regard to recurrence of ischemic events after the closure procedure. CONCLUSIONS Despite its small-sample nature, our study suggests that patients with permanent right-to-left shunt have potentially a higher risk of paradoxical embolism compared with those without.
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Affiliation(s)
- Gianluca Rigatelli
- Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Viale Tre Martiri, Rovigo, Italy.
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Rigatelli G, Ronco F, Cardaioli P, Dell'avvocata F, Braggion G, Giordan M, Aggio S. Incomplete aneurysm coverage after patent foramen ovale closure in patients with huge atrial septal aneurysm: effects on left atrial functional remodeling. J Interv Cardiol 2010; 23:362-7. [PMID: 20718907 DOI: 10.1111/j.1540-8183.2010.00586.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Large devices are often implanted to treat patent foramen ovale (PFO) and atrial septal aneurysm (ASA) with increase risk of erosion and thrombosis. Our study is aimed to assess the impact on left atrium functional remodeling and clinical outcomes of partial coverage of the approach using moderately small Amplatzer ASD Cribriform Occluder in patients with large PFO and ASA. METHODS We prospectively enrolled 30 consecutive patients with previous stroke (mean age 36 +/- 9.5 years, 19 females), significant PFO, and large ASA referred to our center for catheter-based PFO closure. Left atrium (LA) passive and active emptying, LA conduit function, and LA ejection fraction were computed before and after 6 months from the procedure by echocardiography. The preclosure values were compared to values of a normal healthy population of sex and heart rate matched 30 patients. RESULTS Preclosure values demonstrated significantly greater reservoir function as well as passive and active emptying, with significantly reduced conduit function and LA ejection fraction, when compared normal healthy subjects. All patients underwent successful transcatheter closure (25 mm device in 15 patients, 30 mm device in 6 patients, mean ratio device/diameter of the interatrial septum = 0.74). Incomplete ASA coverage in both orthogonal views was observed in 21 patients. Compared to patients with complete coverage, there were no differences in LA functional parameters and occlusion rates. CONCLUSIONS This study confirmed that large ASAs are associated with LA dysfunction. The use of relatively small Amplatzer ASD Cribriform Occluder devices is probably effective enough to promote functional remodeling of the left atrium.
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Affiliation(s)
- Gianluca Rigatelli
- Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy.
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Rigatelli G, Dell'avvocata F, Cardaioli P, Ronco F, Giordan M, Braggion G, Aggio S, Chinaglia M, Cheng JP, Nanjundappa A. Left atrial dysfunction in patients with patent foramen ovale and atrial septal aneurysm scheduled for transcatheter closure may play a role in aura genesis. J Interv Cardiol 2010; 23:370-6. [PMID: 20624202 DOI: 10.1111/j.1540-8183.2010.00563.x] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND It has been suggested that a left atrial (LA) dysfunction induced by large shunt and large atrial septal aneurysm (ASA) may act as a concurrent mechanism of arterial embolism in patients with patent foramen ovale (PFO) and prior stroke. We aimed to evaluate the potential contribution of this mechanism as trigger of migraine in patients with PFO. METHODS From January 2007 to September 2009, we prospectively enrolled subjects with migraine who underwent percutaneous PFO closure. Echocardiographic parameter of LA dysfunction was evaluated: pre- and postoperative values were compared to values of different sex and heart rate matched populations: 30 healthy patients, 21 migraine patients without PFO (MwoPFO), and a group of 25 PFO patients without migraine (PFOwoM). The Migraine Disability Assessment Score (MIDAS) was used to assess the incidence and severity of migraine. RESULTS Forty-five patients (38 females, mean age 38 +/- 6.7 years, mean MIDAS 35.8 +/- 4.7, and 28 patients with migraine with aura) fulfilled the inclusion criteria. After successful percutaneous closure (mean follow-up of 18.2 +/- 4.8 months), PFO closure remained complete in 95%; 35 of 45 patients reported resolution or amelioration of migraine (mean MIDAS score 12.3 +/- 8.8, P < 0.03). All patients with aura reported aura resolution. Preclosure values demonstrated significantly greater LA dysfunction, when compared with healthy and MwoPFO groups. Among patients in the study group, only patients with migraine with aura showed LA dysfunction comparable to PFOwoM patients. CONCLUSION This study suggests that LA dysfunction probably does not contribute to migraine itself but may play a role in the genesis of aura symptoms.
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Affiliation(s)
- Gianluca Rigatelli
- Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy.
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Rigatelli G, Dell'Avvocata F, Giordan M, Ronco F, Braggion G, Schenal N, Aggio S, Cardaioli P. Transcatheter patent foramen ovale closure in spite of interatrial septum hypertrophy or lipomatosis: a case series. J Cardiovasc Med (Hagerstown) 2010; 11:91-5. [PMID: 19829139 DOI: 10.2459/jcm.0b013e32832f4046] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Hypertrophy and lipomatosis of the interatrial septum have been thought to be contraindications for transcatheter patent foramen ovale (PFO) and atrial septal defect closure because of the limits of current devices and the risk of suboptimal results. No reports have been produced yet about PFO closure in patients with such conditions. We retrospectively assessed the safety and effectiveness of PFO closure in patients with hypertrophy or lipomatosis of fossa ovalis rims. METHODS We searched our database of 140 consecutive patients (mean age 43 +/- 15. 5 years, 98 female patients) who underwent transcatheter PFO closure for cases of hypertrophy or lipomatosis of the interatrial septum. All patients were screened with transesophageal echocardiography before the operation. All patients underwent intracardiac echocardiography study and attempted closure. RESULTS Ten patients (7.1%) underwent an attempt at transcatheter closure in the presence of hypertrophy of the rims (eight patients) or lipomatosis (two patients). All patients were aged more than 50 years and has multiple recurrent stroke events (nine patients) or need for a posterior cerebral surgical procedure (one patient) making closure mandatory. After intracardiac echocardiography study and measurements, two 25 mm Amplatzer and eight 25 mm Premere Occlusion System devices have been implanted successfully. On mean follow-up of 36.6 +/- 14.8 months, two patients had a small residual shunt: no recurrence of stroke or aortic erosion or device thrombosis was observed during this period. CONCLUSION Transcatheter PFO closure in the presence of hypertrophy or lipomatosis of fossa ovalis rims is not contraindicated per se: careful evaluation of rim thickness with intracardiac echocardiography and selection of soft and asymmetrically opening devices may allow for a safe and effective PFO closure, at least in patients with no severe atrial septal aneurysm.
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Affiliation(s)
- Gianluca Rigatelli
- Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy.
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Rigatelli G, Dell'Avvocata F, Ronco F, Cardaioli P, Giordan M, Braggion G, Aggio S, Chinaglia M, Rigatelli G, Chen JP. Primary Transcatheter Patent Foramen Ovale Closure Is Effective in Improving Migraine in Patients With High-Risk Anatomic and Functional Characteristics for Paradoxical Embolism. JACC Cardiovasc Interv 2010; 3:282-7. [DOI: 10.1016/j.jcin.2009.11.019] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2009] [Revised: 10/28/2009] [Accepted: 11/13/2009] [Indexed: 11/26/2022]
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Rigatelli G, Cardaioli P, Dell'Avvocata F, Giordan M, Braggion G, Chinaglia M, Roncon L. Transcatheter patent foramen ovale closure is effective in reducing migraine independently from specific interatrial septum anatomy and closure devices design. Cardiovascular Revascularization Medicine 2010; 11:29-33. [DOI: 10.1016/j.carrev.2008.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2008] [Revised: 03/27/2008] [Accepted: 04/15/2008] [Indexed: 11/25/2022]
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Rigatelli G, Aggio S, Cardaioli P, Braggion G, Giordan M, Dell'avvocata F, Chinaglia M, Rigatelli G, Roncon L, Chen JP. Left Atrial Dysfunction in Patients With Patent Foramen Ovale and Atrial Septal Aneurysm. JACC Cardiovasc Interv 2009; 2:655-62. [DOI: 10.1016/j.jcin.2009.05.010] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Revised: 04/24/2009] [Accepted: 05/03/2009] [Indexed: 11/15/2022]
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Rigatelli G, Dell'Avvocata F, Giordan M, Braggion G, Aggio S, Chinaglia M, Roncon L, Cardaioli P, Chen JP. Embolic implications of combined risk factors in patients with patent foramen ovale (the CARPE criteria): consideration for primary prevention closure? J Interv Cardiol 2009; 22:398-403. [PMID: 19515082 DOI: 10.1111/j.1540-8183.2009.00478.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Large patent foramen ovale (PFO), spontaneous right-to-left shunt, large atrial septal aneurysm (ASA), coagulation abnormalities, and prominent eustachian valve (EV) have all been independently suggested as risk factors for recurrent stroke. We sought to retrospectively evaluate risk of stroke and impact of transcatheter PFO closure in patients with concurrent large PFO, spontaneous right-to-left shunt, large ASA, coagulation abnormalities, and prominent EV. METHODS Between March 2006 and October 2008, 36 (mean age 44 +/- 10.9 years, 28 females) out of 120 consecutive patients referred to our center for transcatheter PFO closure had concomitant diagnosis of (a) large PFO on transcranial Doppler (TCD) and transesophageal echocardiography (TEE), (b) spontaneous right-to-left shunt on TCD, (c) large ASA, (d) prominent EV, and (e) coagulation abnormalities. All patients fulfilled the standard current indications for transcatheter closure and underwent preoperative TEE and brain magnetic resonance imaging (MRI), with subsequent intracardiac echocardiographic-guided transcatheter PFO closure. RESULTS Compared to the remaining PFO population in the same period, patients with all five concomitant features had more ischemic brain lesions on MRI, previous history of recurrent stroke, more frequently a history of venous thromboembolism, and more severe migraine with aura. The concomitance of all the features confers the highest risk of recurrent stroke (OR 9.9, 3.0-18 [95% CI], P < 0.001). CONCLUSIONS Despite its small sample size and nonrandomized retrospective nature, this is the first study to suggest that patients with concurrence of all the investigated characteristics have potentially a higher risk of stroke compared to controls. We thus propose the CARP criteria as a basis for further larger, longitudinal studies to assess the potential benefits of transcatheter closure in this patient subset in the absence of clinical recurrent stroke.
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Affiliation(s)
- Gianluca Rigatelli
- Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy.
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Rigatelli G, Cardaioli P, Giordan M, Dell'Avvocata F, Braggion G, Piergentili C, Roncon L, Faggian G. Transcatheter Intracardiac Echocardiography-Assisted Closure of Interatrial Shunts: Complications and Midterm Follow-Up. Echocardiography 2009; 26:196-202. [DOI: 10.1111/j.1540-8175.2008.00763.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Zanon F, Aggio S, Baracca E, Pastore G, Corbucci G, Boaretto G, Braggion G, Piergentili C, Rigatelli G, Roncon L. Ventricular-arterial coupling in patients with heart failure treated with cardiac resynchronization therapy: may we predict the long-term clinical response? European Journal of Echocardiography 2009; 10:106-11. [DOI: 10.1093/ejechocard/jen184] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Rigatelli G, Bortolazzi A, Cardaioli P, Dell'avvocata F, Giordan M, Braggion G, Roncon L. Intracardiac echocardiography-aided diagnosis of superior caval sinus defect in case of contraindications to non-invasive imaging tools. Minerva Cardioangiol 2008; 56:703-704. [PMID: 19092746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Rigatelli G, Dell'Avvocata F, Braggion G, Giordan M, Chinaglia M, Cardaioli P. Persistent venous valves correlate with increased shunt and multiple preceding cryptogenic embolic events in patients with patent foramen ovale: An intracardiac echocardiographic study. Catheter Cardiovasc Interv 2008; 72:973-6. [DOI: 10.1002/ccd.21761] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Rigatelli G, Cardaioli P, Dell'Avvocata F, Braggion G, Giordan M, Chinaglia M. Early post-procedural migraine attack predicts migraine resolution after patent foramen ovale transcatheter closure. Minerva Cardioangiol 2008; 56:461-465. [PMID: 18813181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
AIM In patients with patent foramen ovale-related migraine, the procedure of transcatheter closure itself is likely to cause a migraine attack. Our study is aimed to evaluate the incidence of migraine attacks immediately after closure procedure and their clinical and potential prognostic significance. METHODS We reviewed our database from January 2005 to April 2007 searching for patients with severe disabling migraine despite anti-headache therapy who were submitted to transcatheter closure of patent foramen ovale (PFO). Medical records of these patients were carefully reviewed in order to record migraine episodes immediately (0 to 6 h) after closure procedure. RESULTS Twenty-one patients with previous stroke and migraine underwent PFO closure: the procedure was successful in all of the patients with no perioperative and in-hospital complications. Ten patients (47.6%) experienced a migraine attack of mean duration 3.5+/-2.4 h immediately after the closure procedure. Those patients had the same procedure time compared with other patients, but had larger PFO: patients with migraine attack immediately after closure had higher rate of complete abolition of migraine in the follow-up. CONCLUSION Although more larger studies are needed to evaluate the exact relationships between migraine and PFO, in patients with a tight correlation between migraine and PFO, a prolonged opening of the PFO, as during closure procedure, may cause a migraine attack immediately after the closure. This fact can be considered a positive prognostic factor for migraine abolishment in the follow-up.
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Affiliation(s)
- G Rigatelli
- Unit of Adult Congenital and Structural Heart Disease, Cardiovascular Diagnosis and Interventions, Department of Neurosciences, Rovigo General Hospital, Rovigo, Italy.
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Abstract
BACKGROUND The possibility of nickel toxicity has been raised with interatrial shunt closure devices constructed of nitinol. This study is aimed to assess the potential adverse symptoms in terms of incidence, duration, and significance, in patients with interatrial shunt and nickel allergy who underwent nitinol device-based closure. METHODS We prospectively enrolled 46 consecutive patients (mean age 35 +/- 28.8 years, 30 female) over a 12-month period referred to our center for catheter-based closure of interatrial shunts. Patients were investigated for previous hypersensivity to nickel and were required to test potential nickel allergy with cutaneous patch test (TRUE test) before device implantation. Routinely, clinical visit with laboratory examinations, and TTE were scheduled at 1, 6, and 12 months. RESULTS Nine patients (19.5%, mean age 31.3 +/- 13.2 years) had proved symptomatic and instrumental nickel allergy as showed by cutaneous patch skin test but preferred to be implanted. All patients underwent successful transcatheter closure with an immediate occlusion rate of 100% without intraoperative complications. Between the 2nd and 3rd postoperative day, 8 out of 9 patients developed a sort of 'device syndrome' that included concurrent chest discomfort, exertional dyspnea and asthenia, and mild leukocytosis. The syndrome was treated with Prednison and Clopidogrel and in all was resolved after 1-week therapy. Interestingly, none of the patients without nickel allergy developed postclosure symptoms (P < .001). CONCLUSIONS In conclusion, nickel allergy is still a problematic issue in patients scheduled for transcatheter closure of intracardiac shunts; however, our brief study suggests that nickel allergy is not per se a contraindication to nitinol device closure.
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Affiliation(s)
- Gianluca Rigatelli
- Rovigo General Hospital, Cardiovascular Diagnosis and Endoluminal Interventions Service, Rovigo, Italy.
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Rigatelli G, Giordan M, Braggion G, Aggio S, Chinaglia M, Zattoni L, Milan T, Cardaioli P. Incidence of extracerebral paradoxical embolisms in patients with intracardiac shunts. Cardiovascular Revascularization Medicine 2007; 8:248-50. [DOI: 10.1016/j.carrev.2007.03.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2007] [Revised: 02/22/2007] [Accepted: 03/01/2007] [Indexed: 11/28/2022]
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Rigatelli G, Cardaioli P, Braggion G, Giordan M, Aggio S, Roncon L. ICE-guided patent foramen ovale (PFO) closure with lastest-generation devices: the ideal strategy for PFO-related migraine? J Cardiovasc Med (Hagerstown) 2007; 8:633-5. [PMID: 17667037 DOI: 10.2459/01.jcm.0000281705.69230.ff] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Previous studies have suggested that the closure of the patent foramen ovale (PFO) may reduce or resolve migrainous symptoms, but ideal indications, devices and techniques are far from being identified definitively. A 21-year-old woman was referred to our center for evaluation of severe migraine (more than two attacks per week, > 6 h in duration, inability to work, direct relationship with Valsalva manouvre and effort, presence of aura), migraine disability assessment questionnaire (MIDAS) score of 42 and a large PFO with no atrial septal aneurysm: on transesophageal echocardiography and instrumental data suggesting a close relationship between migraine and PFO. Having explained the off-label indications for transcatheter PFO closure in this particular case, the patient was recruited for our in-hospital study protocol for assessment for transcatheter closure of PFO to relieve severe migraine and the patient gave consent. A 9-Fr, 9-MHz UltraICE catheter (EP Technologies, Boston Scientific Corporation, San Jose, California, USA) was then inserted through the left femoral vein and a complete intracardiac study was carried out. A 25-mm Premere device was successfully implanted. The patient was discharged the day after being on 75 mg aspirin once a day for 6 months and, at 3-month follow-up, the patient was well with no further migraine attacks (MIDAS score 2). There was no evidence of thrombus formation on the surface of device and no shunt was detected on transesophageal echocardiograhy and transcranial Doppler. Although more clear-cut indications are required, this case study may be the stimulus and basis for further large prospective randomized studies to assess the effectiveness of PFO closure in treating migraine and the best implantation technique and device.
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Affiliation(s)
- Gianluca Rigatelli
- Interventional Cardiology Unit, Division of Cardiology, Rovigo General Hospital, Italy.
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Rigatelli G, Braggion G, Cardaioli P, Roncon L, Giordan M, Tranquillo M, Favero A, Zonzin P. Difficult atrial septal defect closure: intracardiac echocardiographic visualization of an unexpected caveat. Int J Cardiol 2007; 115:417-8. [PMID: 16787672 DOI: 10.1016/j.ijcard.2006.01.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2005] [Accepted: 01/09/2006] [Indexed: 10/24/2022]
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Rigatelli G, Rigateli G, Cardaioli P, Braggion G, Aggio S, Giordan M, Magro B, Nascimben A, Favaro A, Roncon L, Rincon L. Transesophageal Echocardiography and Intracardiac Echocardiography Differently Predict Potential Technical Challenges or Failures of Interatrial Shunts Catheter-Based Closure. J Interv Cardiol 2007; 20:77-81. [PMID: 17300409 DOI: 10.1111/j.1540-8183.2007.00219.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
We sought to prospectively assess the role of transesophageal (TEE) and intracardiac echocardiography (ICE) in detecting potential technical difficulties or failures in patients submitted to interatrial shunts percutaneous closure. We prospectively enrolled 46 consecutive patients (mean age 35+/-28, 8 years, 30 female) referred to our center for catheter-based closure of interatrial shunts. All patients were screened with TEE before the intervention. Patients who met the inclusion criteria underwent ICE study before the closure attempt (40 patients). TEE detected potential technical difficulties in 22.5% (9/40) patients, whereas ICE detected technical difficulties in 32.5% (13/40 patients). In patients with positive TEE/ICE the procedural success (92.4% versus 100% and, P = ns) and follow-up failure rate (7.7% versus 0%, P = ns) were similar to patients with negative TEE/ICE, whereas the fluoroscopy time (7 +/- 1.2 versus 5 +/- 0.7 minutes, P < 0.03), the procedural time (41 +/- 4.1 versus 30 +/- 8.2 minutes, P +/- 0.03), and technical difficulties rate (23.1% versus 0%, P = 0.013) were higher. Differences between ICE and TEE in the evaluation of rims, measurement of ASD or fossa ovalis, and detection of venous valve and embryonic septal membrane remnants impacted on technical challenges and on procedural and fluoroscopy times but did not influence the success rate and follow-up failure rate.
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Affiliation(s)
- Gianluca Rigatelli
- Rovigo General Hospital, Interventional Cardiology Unit, 18 Legnago, Verona, Italy.
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Rigatelli G, Cardaioli P, Braggion G, Giordan M, Fabio D, Aggio S, Roncon L, Chinaglia M. Resolution of migraine by transcatheter patent foramen ovale closure with premere occlusion system in a preliminary series of patients with previous cerebral ischemia. Catheter Cardiovasc Interv 2007; 70:429-33. [PMID: 17722021 DOI: 10.1002/ccd.21173] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [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: 11/10/2022]
Abstract
BACKGROUND Transcatheter closure of PFO with nitinol devices may be problematic in young patients with migraine due the risk of late erosions. Alternative devices with less amount of metal as the last generation devices may be preferable in such cases. We present the results of transcatheter closure of PFO with the last generation Premere Occlusion System device in a preliminary series of young adults with migraine and previous cerebral ischemia. METHODS During a 12-month period (January 31, 2006 to December 31, 2006) 26 patients (18 female and 8 male, mean age 40 +/- 3.7 years) with previous stroke and severe disabling migraine were referred to our center for transcatheter closure of PFO. Migraine disability assessment score (MIDAS) was used to assess MHA incidence and severity. Patients were selected for Premere occlusion system (absence of atrial septal aneurysm and length >15 mm) on the basis of presence/absence of right and left bulging atrial septal aneurysm and length of PFO channel (<15 mm or >15 mm) on transesophageal echocardiography. Transesophageal echocardiography and transcranial Doppler were performed at 1 month, transthoracic echocardiography and cerebral magnetic resonance imaging at 6 and 12 months. Cardiologic and neurological visit was scheduled at 1, 6, and 12 months with MIDAS questionnaire administration. RESULTS Ten patients (2 males, mean age 32 +/- 7.6 years, mean MIDAS score 38.9 +/- 5.8) underwent transcatheter PFO closure with the Premere occlusion system. Mean fossa ovalis diameters by ICE measurement was 20.6 +/- 3.1 mm. Thus, two 20-mm and eight 25-mm Premere devices were implanted. The procedure was successful in all of the patients with no perioperative and in-hospital complications. After a mean follow-up of 10.9 +/- 5.8 months, all patients were free from migraine symptoms (mean MIDAS score 2.9 +/- 1.9) with PFO complete closure in all patients on transesophageal and transcranial Doppler ultrasound. CONCLUSION While waiting for larger studies evaluating the impact of new generation devices in curing PFO-related migraine, this preliminary anecdotal series suggests that the Premere occlusion system may be an effective and safe device for young patients with previous cerebral ischemia and migraine at least in the midterm period.
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Affiliation(s)
- Gianluca Rigatelli
- PFO-Related Syndromes Management Program, Cardiovascular Diagnosis and Interventions Service, Rovigo General Hospital, Italy.
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Rigatelli G, Roncon L, Braggion G, Giordan M, Chinaglia M, Cardaioli P, Zonzin P. Unpleasant findings during transcatheter closure of patent foramen ovale: the importance of venous Doppler ultrasound and femoro-iliac venography. Int J Cardiol 2006; 113:272-3. [PMID: 16318888 DOI: 10.1016/j.ijcard.2005.09.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2005] [Accepted: 09/18/2005] [Indexed: 10/25/2022]
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Zanon F, Baracca E, Pastore G, Aggio S, Rigatelli G, Dondina C, Marras G, Braggion G, Boaretto G, Cardaioli P, Galasso M, Zonzin P, Barold SS. Implantation of Left Ventricular Leads Using a Telescopic Catheter System. Pacing Clin Electro 2006; 29:1266-72. [PMID: 17100682 DOI: 10.1111/j.1540-8159.2006.00529.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Implantation procedures for cardiac resynchronization therapy (CRT) remain challenging with regard to coronary sinus (CS) cannulation and left ventricular (LV) lead positioning. Technologic advances in catheter design may facilitate CS cannulation and LV lead placement. AIMS To evaluate two different telescoping dual-catheter systems, RAPIDO Guiding Catheter System (Group R) and RAPIDO ADVANCE Guiding Catheter System (Group A) (Guidant Inc., St. Paul, MN, USA), during implantation of a CRT device. METHODS Seventy-four consecutive patients randomly received a CRT device using the R or A system. RESULTS An LV lead was successfully implanted in 74 patients (100%). (1) Median times for CS cannulation in groups R and A were 0.3 minutes (range from 0.05 to 14 minutes) and 0.5 minutes (range from 0.05 to 9 minutes), respectively (P = NS). (2) Median times for LV lead placement were 8 minutes (range from 0.8 to 100 minutes) and 3.5 minutes (range from 0.25 to 30 minutes), respectively, for groups R and A (P = 0.032). (3) Median total fluoroscopy times were 12.33 minutes (range from 5 to 70 minutes) and 14.33 minutes (range from 6 to 53 minutes) for groups R and A, respectively (P = NS). (4) Median procedural times for CRT implantation were 80 minutes (range from 40 to 200 minutes) and 75 minutes (range from 45 to 180 minutes) (P = NS) in groups R and A, respectively. There were no major complications. CONCLUSION CS cannulation and LV lead placement with a telescopic dual-catheter system is a safe and feasible approach that may reduce fluoroscopy and overall CRT implantation times. Our observations suggest that the RAPIDO ADVANCE System is faster than the RAPIDO System in terms of median time for LV lead positioning.
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Affiliation(s)
- Francesco Zanon
- Division of Cardiology, Rovigo General Hospital, Rovigo, Italy.
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Affiliation(s)
- Gianluca Rigatelli
- Interventional Cardiology Unit, Division of Cardiology, Rovigo General Hospital, Italy.
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Rigatelli G, Braggion G, Chinaglia M, Cardaioli P, Roncon L, Giordan M, Cuppini S, Aggio S, Bortolazzi A, Zonzin P. Setting Up a Multidisciplinary Program for Management of Patent Foramen Ovale-Mediated Syndromes. J Interv Cardiol 2006; 19:264-8. [PMID: 16724970 DOI: 10.1111/j.1540-8183.2006.00141.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND These days no codified multidisciplinary protocol has been reported to manage all the different patent foramen ovale (PFO)-mediated syndromes. We sought to propose a multidisciplinary program of diagnosis, treatment, and follow-up of all PFO-mediated syndromes based on an in-hospital multidisciplinary task force and to review the activities during the first year. METHODS From September 2004, we organized in our hospital, a 600-bed tertiary hospital, a management program for PFO-mediated syndromes based on a task force composed of cardiologists, neurologists, and internists. Different levels of protocols were created in order to cover diagnosis, treatment, and follow-up of PFO-mediated syndromes. We reviewed the activity of our program in the first year up to September 2005. RESULTS Thirty-five patients (23 female, mean age 65 +/- 24 years) were evaluated for suspected PFO-mediated syndromes: 20 for cryptogenic stroke, 2 for peripheral and coronary embolisms, 3 for platypnea-orthodeoxia, 9 for emicrania with aura, and 1 with hypoxiemia during neurosurgical intervention in the posterior cranial fossa. Diagnosis of PFO was confirmed in 25 patients. According to the multidisciplinary protocols, 15 patients failed to meet the requirements for transcatheter closure and were left in medical therapy whereas 11 patients (7 patients with PFO, 2 with multiperforated ASD, and 2 with a secundum ASD) underwent transcatheter closure. After a mean follow-up of 10.8 +/- 4.9 months, no recurrent PFO syndromes were noted in patients treated with devices. CONCLUSION The first year of our multidisciplinary program allowed a reasonable and potentially successful approach for correctly identifying patients with PFO-mediated syndromes until randomized studies are completed.
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Rigatelli G, Roncon L, Braggion G, Giordan M, Cardatoli P, Zonzin P, Chinaglia M. Deep venous thrombosis before patent foramen ovale closure. Am J Med 2006; 119:97-8. [PMID: 16431214 DOI: 10.1016/j.amjmed.2005.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2005] [Revised: 07/28/2005] [Accepted: 08/03/2005] [Indexed: 11/20/2022]
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Giordan M, Rigatelli G, Rinuncini M, Roncon L, Braggion G, Panin S, Bedendo E, Zonzin P. An uncommon coronary artery fistula. Cardiovasc Revasc Med 2005; 6:136-7. [PMID: 16275612 DOI: 10.1016/j.carrev.2005.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2005] [Accepted: 07/12/2005] [Indexed: 11/28/2022]
Affiliation(s)
- Massimo Giordan
- Interventional Cardiology Unit, Division of Cardiology, Rovigo General Hospital, Rovigo, Italy.
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Rigatelli G, Roncon L, Bedendo E, Docali G, Braggion G, Rinuncini M, Panin S, Zonzin P, Rigatelli G. Concomitant peripheral vascular and coronary artery disease: a new dimension for the global endovascular specialist? Clin Cardiol 2005; 28:231-5. [PMID: 15971457 PMCID: PMC6654401 DOI: 10.1002/clc.4960280506] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [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: 12/12/2022] Open
Abstract
BACKGROUND Early and accurate diagnosis of peripheral atherosclerosis is of paramount importance for global ma agement of patients with known coronary artery disease (CAD). HYPOTHESIS We sought to evaluate retrospectively the prevalence and clinical relevance of significant abdominal vessel stenosis or aneurysm (AVA) in patients undergoing coronary angiography. METHODS Medical records of consecutive patients who underwent coronary angiography at two public institutions over a 12-month period were evaluated. Angiographic results of patients who underwent diagnostic abdominal aorta angiography, based on clinical criteria, to evaluate abdominal vessels the same time as coronary angiography were analyzed. RESULTS During the study period, AVA was reported in 180 (35.7%) of 504 consecutive patients (335 men, mean age 68 +/- 13.8 years): renal artery stenosis was found in 13.1% of cases (66 patients), aortoiliac artery disease in 13.7% (69 patients and aortic aneurysmal disease in 8.9% (45 patients). Logistic regression analyses revealed > or = 3-vessel CAD (odds ratio [OR] 9.917, p = 0.002), age >65 years (OR 3.817, p = 0.036), > or =3 risk factors (OR 2.8, p = 0.048) as independent predictors of AVA. CONCLUSION Multiple vascular atherosclerotic distributions are frequent in elderly patients who have multivessel CAD and a high-risk profile, suggesting the usefulness of a more global and comprehensive cardiovascular approach.
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Affiliation(s)
- Gianluca Rigatelli
- Interventional Cardiology Unit, Division of Cardiology, Rovigo General Hospital, Rovigo, Italy.
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39
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Zanon F, Baracca E, Aggio S, Boaretto G, Rigatelli G, Cardano P, Rizzo V, Bortolazzi A, Braggion G, Galasso M, Zonzin P. A feasible technique for direct his-bundle pacing. Heart Rhythm 2005. [DOI: 10.1016/j.hrthm.2005.02.887] [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]
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40
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Zanon F, Baracca E, Aggio S, Bilato C, Tattan E, Braggion G, Roncon L, Bortolazzi A, Zonzin P. P-404 Interventriculardelay predicts long term clinical outcome in patients with congestive heart failure undergoing resynchronization therapy. Europace 2003. [DOI: 10.1016/eupace/4.supplement_2.b161-b] [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] [Indexed: 11/26/2022] Open
Affiliation(s)
- F. Zanon
- Division of Cardiology, General Hospital Rovigo
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Italy
| | - E. Baracca
- Division of Cardiology, General Hospital Rovigo
,
Italy
| | - S. Aggio
- Division of Cardiology, General Hospital Rovigo
,
Italy
| | - C. Bilato
- Division of Cardiology, General Hospital Rovigo
,
Italy
| | - E. Tattan
- Division of Cardiology, General Hospital Rovigo
,
Italy
| | - G. Braggion
- Division of Cardiology, General Hospital Rovigo
,
Italy
| | - L. Roncon
- Division of Cardiology, General Hospital Rovigo
,
Italy
| | - A. Bortolazzi
- Division of Cardiology, General Hospital Rovigo
,
Italy
| | - P. Zonzin
- Division of Cardiology, General Hospital Rovigo
,
Italy
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Guardigli G, Ansani L, Percoco GF, Toselli T, Spisani P, Braggion G, Antonioli GE. AV delay optimization and management of DDD paced patients with dilated cardiomyopathy. Pacing Clin Electrophysiol 1994; 17:1984-8. [PMID: 7845803 DOI: 10.1111/j.1540-8159.1994.tb03785.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [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: 01/27/2023]
Abstract
Ten DDD paced patients, suffering from dilated cardiomyopathy in the NYHA functional classes III or IV were studied by means of Doppler echocardiography at different programmed values of atrioventricular (AV) delay (200, 150, 120, 100, and 80 msec). The following variables were evaluated: LV diameter, ejection fraction, mitral and aortic flow velocity integrals, and stroke volume. During VDD pacing, a resting AV delay associated with the best diastolic filling and systolic function was identified and programmed individually. Shortening of the AV delay to about 100 msec was associated with a gradual and progressive improvement. Further decrease caused an impairment of systolic function. The patients were clinically and hemodynamically reevaluated after 2 months of follow-up. A reduction of NYHA class and an improvement of LV function were consistently found. The reported data suggest that programming of an optimal AV delay may improve myocardial function in DDD paced patients with congestive heart failure. This result may be the consequence of an optimization of left ventricular filling and a better use of the Frank-Starling law.
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Affiliation(s)
- G Guardigli
- Divisione di Cardiologia, Arcispedale S. Anna, Ferrara, Italy
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42
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Piazza G, Giron GP, Macchi C, Gritti G, Di Bello A, Marcon A, Braggion G, Marigo M, Valenti F. [Radiological aspects of iatrogenic lung diseases during surgical and resuscitation treatment (proceedings)]. Radiol Med 1977; 63:369-72. [PMID: 928842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Taboga V, Braggion G, Marchesin G. [Cholestasis caused by unnoticed anomaly of the right hepatic artery]. Acta Chir Ital 1969; 25:491-7. [PMID: 5381791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Aboga V, Braggion G, Marchesin G. [Gastro-jejunal mucosa prolapse]. Acta Chir Ital 1969; 25:399-405. [PMID: 5399556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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