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Agostoni P, Mapelli M, Salvioni E, Mattavelli I, Banfi C, Bonomi A, Biondi ML, Rovai S, Tamborini G, Muratori M, Ghulam Ali S, Ghilardi S, De Martino F, Vignati C, Palermo P, Gugliandolo P, Elia D, Moscucci F, Cassandro R, Andreini D, Mancini E, Harari S. Symptomatic post COVID patients have impaired alveolar capillary membrane function and high VE/VCO 2. Respir Res 2024; 25:82. [PMID: 38331869 PMCID: PMC10851544 DOI: 10.1186/s12931-023-02602-3] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 11/12/2023] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Post COVID-19 syndrome is characterized by several cardiorespiratory symptoms but the origin of patients' reported symptomatology is still unclear. METHODS Consecutive post COVID-19 patients were included. Patients underwent full clinical evaluation, symptoms dedicated questionnaires, blood tests, echocardiography, thoracic computer tomography (CT), spirometry including alveolar capillary membrane diffusion (DM) and capillary volume (Vcap) assessment by combined carbon dioxide and nitric oxide lung diffusion (DLCO/DLNO) and cardiopulmonary exercise test. We measured surfactant derive protein B (immature form) as blood marker of alveolar cell function. RESULTS We evaluated 204 consecutive post COVID-19 patients (56.5 ± 14.5 years, 89 females) 171 ± 85 days after the end of acute COVID-19 infection. We measured: forced expiratory volume (FEV1) 99 ± 17%pred, FVC 99 ± 17%pred, DLCO 82 ± 19%, DM 47.6 ± 14.8 mL/min/mmHg, Vcap 59 ± 17 mL, residual parenchymal damage at CT 7.2 ± 3.2% of lung tissue, peakVO2 84 ± 18%pred, VE/VCO2 slope 112 [102-123]%pred. Major reported symptoms were: dyspnea 45% of cases, tiredness 60% and fatigability 77%. Low FEV1, Vcap and high VE/VCO2 slope were associated with persistence of dyspnea. Tiredness was associated with high VE/VCO2 slope and low PeakVO2 and FEV1 while fatigability with high VE/VCO2 slope. SPB was fivefold higher in post COVID-19 than in normal subjects, but not associated to any of the referred symptoms. SPB was negatively associated to Vcap. CONCLUSIONS In patients with post COVID-19, cardiorespiratory symptoms are linked to VE/VCO2 slope. In these patients the alveolar cells are dysregulated as shown by the very high SPB. The Vcap is low likely due to post COVID-19 pulmonary endothelial/vasculature damage but DLCO is only minimally impaired being DM preserved.
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Affiliation(s)
- Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milan, Italy.
- Department of Clinical Sciences and Community Health, University of Milan, Via Parea, 4, 20138, Milan, Italy.
| | - Massimo Mapelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Via Parea, 4, 20138, Milan, Italy
| | | | | | | | - Alice Bonomi
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | | | - Sara Rovai
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | | | | | | | | | - Fabiana De Martino
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Unità Funzionale di Cardiologia, Casa di Cura Tortorella, Salerno, Italy
| | | | | | | | - Davide Elia
- U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria, MultiMedica IRCCS, Milan, Italy
| | - Federica Moscucci
- DAI Internal Medicine and Medical Specialities, Policlinico Umberto I, Rome, Italy
| | - Roberto Cassandro
- U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria, MultiMedica IRCCS, Milan, Italy
| | - Daniele Andreini
- Division of University Cardiology, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | | | - Sergio Harari
- Department of Clinical Sciences and Community Health, University of Milan, Via Parea, 4, 20138, Milan, Italy
- U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria, MultiMedica IRCCS, Milan, Italy
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Muratori M, Fusini L, Tamborini G, Gripari P, Ghulam Ali S, Mantegazza V, Garlasche' A, Fabbiocchi F, Agrifoglio M, Bartorelli AL, Pontone G, Pepi M. Outcomes of Transcatheter Aortic Valve Replacement Patients With Different Transvalvular Flow-Gradient Patterns. Am J Cardiol 2023; 209:173-180. [PMID: 37858597 DOI: 10.1016/j.amjcard.2023.09.095] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 09/10/2023] [Accepted: 09/25/2023] [Indexed: 10/21/2023]
Abstract
Low-flow low-gradient (LF-LG) aortic stenosis (AS) may occur with preserved or depressed left ventricular ejection fraction (LVEF). Both situations represent the most challenging subset of patients to manage and generally have a poor prognosis. Few and controversial data exist on the outcomes of these patients compared with normal flow-high gradient (NF-HG) AS after transcatheter aortic valve replacement (TAVR). We sought to characterize different transvalvular flow-gradient patterns and to examine their prognostic value after TAVR. We enrolled 1,208 patients with severe AS and categorized as follow: 976 patients NF-HG (mean aortic pressure gradient [MPG] ≥40 mm Hg), 107 paradoxical LF-LG (pLF-LG, MPG <40 mm Hg, LVEF ≥50%, stroke volume index <35 ml/m2), and 125 classical LF-LG (cLF-LG) (MPG <40 mm Hg, LVEF <50%, stroke volume index <35 ml/m2). When compared with NF-HG and pLF-LG, cLF-LG had a worse symptomatic status (New York Heart Association III to IV 86% vs 62% and 67%, p <0.001), a higher prevalence of eccentric hypertrophy and a higher level of LV global afterload reflected by a higher valvuloarterial impedance. Valvular function after TAVR was excellent over time in all patients. While 30-day mortality (p = 0.911) did not differ significantly among groups, cLF-LG had a lower 5-year survival rate (LF-LG 50% vs pLF-LG 62% and NF-HG 68%, p <0.05). cLF-LG was associated with a hazard ratio for mortality of 2.41 (95% confidence interval 1.65 to 3.52, p <0.001). In conclusion, TAVR is an effective procedure regardless of transvalvular flow-gradient patterns. However, special care should be given to characterized hemodynamic of AS, as patients with pLF-LG had similar survival rates than patients with NF-HG, whereas cLF-LG is associated with a twofold increased risk of mortality at 5-year follow-up.
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Affiliation(s)
- Manuela Muratori
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Laura Fusini
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy; Department of Electronics, Information and Biomedical Engineering, Politecnico di Milano, Milan, Italy.
| | - Gloria Tamborini
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Paola Gripari
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Sarah Ghulam Ali
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Valentina Mantegazza
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy; Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Anna Garlasche'
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Franco Fabbiocchi
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Marco Agrifoglio
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy; Department of Surgical, Dental and Biomedical Sciences, University of Milan, Milan, Italy
| | - Antonio L Bartorelli
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Gianluca Pontone
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy; Department of Surgical, Dental and Biomedical Sciences, University of Milan, Milan, Italy
| | - Mauro Pepi
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
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3
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Mapelli M, Mattavelli I, Paolillo S, Salvioni E, Magrì D, Galotta A, De Martino F, Mantegazza V, Vignati C, Esposito I, Dell’Aversana S, Paolillo R, Capovilla T, Tamborini G, Nepitella AA, Filardi PP, Agostoni P. Effects of sacubitril/valsartan on exercise capacity: a prognostic improvement that starts during uptitration. Eur J Clin Pharmacol 2023; 79:1173-1184. [PMID: 37368004 PMCID: PMC10427709 DOI: 10.1007/s00228-023-03527-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 06/15/2023] [Indexed: 06/28/2023]
Abstract
PURPOSE Sacubitril/valsartan is a mainstay of the treatment of heart failure with reduced ejection fraction (HFrEF); however, its effects on exercise performance yielded conflicting results. Aim of our study was to evaluate the impact of sacubitril/valsartan on exercise parameters and echocardiographic and biomarker changes at different drug doses. METHODS We prospectively enrolled consecutive HFrEF outpatients eligible to start sacubitril/valsartan. Patients underwent clinical assessment, cardiopulmonary exercise test (CPET), blood sampling, echocardiography, and completed the Kansas City Cardiomyopathy Questionnaire (KCCQ-12). Sacubitril/valsartan was introduced at 24/26 mg b.i.d. dose and progressively uptitrated in a standard monthly-based fashion to 97/103 mg b.i.d. or maximum tolerated dose. Study procedures were repeated at each titration visit and 6 months after reaching the maximum tolerated dose. RESULTS Ninety-six patients completed the study, 73 (75%) reached maximum sacubitril/valsartan dose. We observed a significant improvement in functional capacity across all study steps: oxygen intake increased, at peak exercise (from 15.6 ± 4.5 to 16.5 ± 4.9 mL/min/kg; p trend = 0.001), while minute ventilation/carbon dioxide production relationship reduced in patients with an abnormal value at baseline. Sacubitril/valsartan induced positive left ventricle reverse remodeling (EF from 31 ± 5 to 37 ± 8%; p trend < 0.001), while NT-proBNP reduced from 1179 [610-2757] to 780 [372-1344] pg/ml (p trend < 0.0001). NYHA functional class and the subjective perception of limitation in daily life at KCCQ-12 significantly improved. The Metabolic Exercise Cardiac Kidney Index (MECKI) score progressively improved from 4.35 [2.42-7.71] to 2.35% [1.24-4.96], p = 0.003. CONCLUSIONS A holistic and progressive HF improvement was observed with sacubitril/valsartan in parallel with quality of life. Likewise, a prognostic enhancement was observed.
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Affiliation(s)
- Massimo Mapelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | | | - Stefania Paolillo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | | | - Damiano Magrì
- Department of Clinical and Molecular Medicine, University “La Sapienza”, Rome, Italy
| | | | - Fabiana De Martino
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Casa di Cura Tortorella, Salerno, Italy
| | - Valentina Mantegazza
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | - Carlo Vignati
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | - Immacolata Esposito
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Simona Dell’Aversana
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Roberta Paolillo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Teresa Capovilla
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- University of Trieste, Trieste, Italy
| | | | - Alessandro Alberto Nepitella
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Policlinico Universitario D. Casula, Cardiologia – AOU Cagliari Cagliari, Italy
| | | | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
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Mantegazza V, Muratori M, Fusini L, Garlaschè A, Ghulam Ali S, Gripari P, Ferrari C, Bartorelli AL, Vignati C, Agostoni P, Pontone G, Pepi M, Tamborini G. Predictors of Prognosis in Patients With Secondary Mitral Regurgitation Undergoing Mitral Valve Transcatheter Edge-to-Edge Repair. J Am Soc Echocardiogr 2023; 36:1011-1014. [PMID: 37088165 DOI: 10.1016/j.echo.2023.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 04/13/2023] [Indexed: 04/25/2023]
Affiliation(s)
- Valentina Mantegazza
- Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy.
| | | | - Laura Fusini
- Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | | | | | | | | | - Antonio L Bartorelli
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Carlo Vignati
- Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | | | - Mauro Pepi
- Centro Cardiologico Monzino IRCCS, Milan, Italy
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5
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Muratori M, Mancini ME, Tamborini G, Mushtaq S, Annoni A, Fusini L, Celeste F, Baggiano A, Fazzari F, Mantegazza V, Pontone G, Pepi M. Approach to the Patient with Acute Aortic Syndromes in Light of the New Consensus Statement on Multimodality Imaging in Thoracic Aortic Diseases. J Cardiovasc Echogr 2023; 33:109-116. [PMID: 38161779 PMCID: PMC10756317 DOI: 10.4103/jcecho.jcecho_36_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: 07/26/2023] [Accepted: 09/12/2023] [Indexed: 01/03/2024] Open
Abstract
Acute aortic syndromes comprise a range of interrelated conditions including aortic dissection, intramural hematoma, penetrating atherosclerotic ulcer, and contained or not contained aortic aneurysm rupture. These syndromes are potentially life threatening; therefore, a rapid and accurate diagnosis is crucial. A new Clinical Consensus Statement on Aortic and Peripheral Vascular Disease has recently been published, and we will try to highlight the main innovations in the document.
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Affiliation(s)
| | | | | | | | | | - Laura Fusini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | | | | | | | | | | | - Mauro Pepi
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
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6
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Lo Iacono F, Maragna R, Guglielmo M, Chiesa M, Fusini L, Annoni A, Babbaro M, Baggiano A, Carerj ML, Cilia F, Del Torto A, Formenti A, Mancini ME, Marchetti F, Muratori M, Mushtaq S, Penso M, Pirola S, Tassetti L, Volpe A, Guaricci AI, Fontana M, Tamborini G, Treibel T, Moon J, D A Corino V, Pontone G. Identification of subclinical cardiac amyloidosis in aortic stenosis patients undergoing transaortic valve replacement using radiomic analysis of computed tomography myocardial texture. J Cardiovasc Comput Tomogr 2023; 17:286-288. [PMID: 37130761 DOI: 10.1016/j.jcct.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/05/2023] [Accepted: 04/12/2023] [Indexed: 05/04/2023]
Affiliation(s)
- Francesca Lo Iacono
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Italy
| | - Riccardo Maragna
- Department of perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Marco Guglielmo
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Mattia Chiesa
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Italy; Department of perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy; Bioinformatics and Artificial Intelligence Facility, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Laura Fusini
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Italy; Department of perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Andrea Annoni
- Department of perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Mario Babbaro
- Department of perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Andrea Baggiano
- Department of perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Maria Ludovica Carerj
- Department of perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy; Diagnostic and Interventional Radiology Unit, Department of Biomedical Sciences and Morphological and Functional Imaging, "G. Martino" University Hospital Messina, Messina, Italy
| | - Francesco Cilia
- Department of perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Alberico Del Torto
- Department of perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Alberto Formenti
- Department of perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Maria Elisabetta Mancini
- Department of perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Francesca Marchetti
- Department of perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Manuela Muratori
- Department of perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Saima Mushtaq
- Department of perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Marco Penso
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Italy; Department of perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Sergio Pirola
- Department of perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Cardiac Surgery, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Luigi Tassetti
- Department of perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Alessandra Volpe
- Department of perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Andrea Igoren Guaricci
- Institute of Cardiovascular Disease, Department of Interdisciplinary Medicine, University Hospital "Policlinico" of Bari, Bari, Italy
| | - Marianna Fontana
- National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom
| | - Gloria Tamborini
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Thomas Treibel
- Institute of Cardiovascular Science, University College London, London, United Kingdom; Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - James Moon
- Institute of Cardiovascular Science, University College London, London, United Kingdom; Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Valentina D A Corino
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Italy; Department of perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Gianluca Pontone
- Department of perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.
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7
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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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Baessato F, Fusini L, Muratori M, Tamborini G, Ghulam Ali S, Mantegazza V, Baggiano A, Mushtaq S, Pepi M, Patti G, Pontone G. Echocardiography vs. CMR in the Quantification of Chronic Mitral Regurgitation: A Happy Marriage or Stormy Divorce? J Cardiovasc Dev Dis 2023; 10:jcdd10040150. [PMID: 37103029 PMCID: PMC10145831 DOI: 10.3390/jcdd10040150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/27/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023] Open
Abstract
Quantification of chronic mitral regurgitation (MR) is essential to guide patients’ clinical management and define the need and appropriate timing for mitral valve surgery. Echocardiography represents the first-line imaging modality to assess MR and requires an integrative approach based on qualitative, semiquantitative, and quantitative parameters. Of note, quantitative parameters, such as the echocardiographic effective regurgitant orifice area, regurgitant volume (RegV), and regurgitant fraction (RegF), are considered the most reliable indicators of MR severity. In contrast, cardiac magnetic resonance (CMR) has demonstrated high accuracy and good reproducibility in quantifying MR, especially in cases with secondary MR; nonholosystolic, eccentric, and multiple jets; or noncircular regurgitant orifices, where quantification with echocardiography is an issue. No gold standard for MR quantification by noninvasive cardiac imaging has been defined so far. Only a moderate agreement has been shown between echocardiography, either with transthoracic or transesophageal approaches, and CMR in MR quantification, as supported by numerous comparative studies. A higher agreement is evidenced when echocardiographic 3D techniques are used. CMR is superior to echocardiography in the calculation of the RegV, RegF, and ventricular volumes and can provide myocardial tissue characterization. However, echocardiography remains fundamental in the pre-operative anatomical evaluation of the mitral valve and of the subvalvular apparatus. The aim of this review is to explore the accuracy of MR quantification provided by echocardiography and CMR in a head-to-head comparison between the two techniques, with insight into the technical aspects of each imaging modality.
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Affiliation(s)
- Francesca Baessato
- Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, 80636 Munich, Germany
- Department of Cardiology, Regional Hospital S. Maurizio, 39100 Bolzano, Italy
| | - Laura Fusini
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
- Department of Electronics, Information and Biomedical Engineering, Politecnico di Milano, 20133 Milan, Italy
- Department of Translational Medicine, University of Eastern Piedmont, 28100 Novara, Italy
- Correspondence:
| | - Manuela Muratori
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Gloria Tamborini
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Sarah Ghulam Ali
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Valentina Mantegazza
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Andrea Baggiano
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Saima Mushtaq
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Mauro Pepi
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Giuseppe Patti
- Department of Translational Medicine, University of Eastern Piedmont, 28100 Novara, Italy
- Division of Cardiology, Maggiore della Carità Hospital, 28100 Novara, Italy
| | - Gianluca Pontone
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 2012 Milan, Italy
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Mantegazza V, Gripari P, Tamborini G, Muratori M, Fusini L, Ghulam Ali S, Garlaschè A, Pepi M. 3D echocardiography in mitral valve prolapse. Front Cardiovasc Med 2023; 9:1050476. [PMID: 36704460 PMCID: PMC9871497 DOI: 10.3389/fcvm.2022.1050476] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 12/20/2022] [Indexed: 01/11/2023] Open
Abstract
Mitral valve prolapse (MVP) is the leading cause of mitral valve surgery. Echocardiography is the principal imaging modality used to diagnose MVP, assess the mitral valve morphology and mitral annulus dynamics, and quantify mitral regurgitation. Three-dimensional (3D) echocardiographic (3DE) imaging represents a consistent innovation in cardiovascular ultrasound in the last decades, and it has been implemented in routine clinical practice for the evaluation of mitral valve diseases. The focus of this review is the role and the advantages of 3DE in the comprehensive evaluation of MVP, intraoperative and intraprocedural monitoring.
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Affiliation(s)
- Valentina Mantegazza
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy,Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy,*Correspondence: Valentina Mantegazza ✉
| | - Paola Gripari
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Gloria Tamborini
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Manuela Muratori
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Laura Fusini
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy,Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Sarah Ghulam Ali
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Anna Garlaschè
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Mauro Pepi
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
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10
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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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Salvioni E, Mapelli M, Mattavelli I, Banfi C, De Martino F, Vignati C, Mancini E, Harari S, Rovai S, Tamborini G, Agostoni P. 841 ASSOCIATION BETWEEN CARDIORESPIRATORY SYMPTOMS AND LUNG FUNCTION IN PATIENTS WITH LONG-COVID SIGNS. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Background
Many patients recovered from COVID-19 infection present a variety of symptoms which limits overall quality of life, as reduced exercise performance, dysfunctional breathing, cough, dyspnea, weakness and anxiety. This condition has been named long COVID. The origin of this symptomatology is still unclear. This study has the aim to analyse the relation between symptoms and respiratory function, focusing on the alveolar capillary membrane.
Methods
Consecutive patients with long COVID 19 symptoms after 6 months were included. Patients underwent full clinical evaluation, laboratory tests, echocardiography, thoracic CT scan, spirometry including alveolar capillary membrane diffusion by means of combined carbon dioxide and nitric oxide lung diffusion (DLCO/DLNO) and cardiopulmonary exercise test. We measured surfactant derive protein B (immature form) as blood marker of alveolar capillary function. A questionnaire allowed to evaluate symptoms.
Results
We evaluated 204 post COVID-19 patients (age 56.5±14.5 y, 89 females (44%), BMI 25.7±4.0, 6% active smokers) referring to our hospital 171±85 days after the end of acute COVID-19 infection (Fig. 1). None of spirometry data was associated with long COVID 19 referred symptoms. SPB was not associated to differences in any of the referred symptoms. Subjects with lower capillary volume (VCap) have more frequently dyspnea, tiredness, fatigability and hair loss (Fig.2). CT scan lung damage correlated with SPB and membrane diffusion but not with VCap, exercise performance or VE/VCO2 slope.
The strongest correlation of SPB were with lung parenchyma damage and Vcap.
Conclusions
Our data suggest that a relevant reduction of alveolar capillary membrane function plays a central role in the long COVID cardiorespiratory symptoms.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Sara Rovai
- Centro Cardiologico Monzino
- Università Degli Studi Di Milano
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12
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Mattavelli I, Mapelli M, Salvioni E, Paolillo S, De Martino F, Vignati C, Magrì D, Mantegazza V, Tamborini G, Capovilla T, Agostoni P. 848 SACUBITRIL/VALSARTAN IMPROVES EXERCISE PERFORMANCE IN PATIENTS WITH REDUCED EJECTION FRACTION: A DOSE AND TIME DEPENDENT EFFECT. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Background
Sacubitril/Valsartan therapy has become a cornerstone of heart failure with reduced ejection fraction (HFrEF) pharmacological therapy due to its positive prognostic impact. However, conflicting results have emerged on the effects of sacubitril/valsartan on exercise performance assessed by cardiopulmonary exercise test (CPET).
Aim of the study
The aim of this study was to prospectively evaluate the effects of sacubitril/valsartan on prognostically significant CPET parameters in a larger population of HFrEF patients at different drug doses.
Methods
We prospectively enrolled HFrEF outpatients eligible to start sacubitril/valsartan according to 2016 ESC Guidelines in 3 Heart Failure Units. Patients underwent CPET at baseline (before sacubitril/valsartan treatment), after 1, 2, 3 months (respectively after a month taking the 24/26–49/51–97/103mg doses), and 6 months after the maximum tolerated dose was reached (end-study). The subjective impression of disease-related limitation was assessed using the 12-item Kansas City Cardiomyopathy Questionnaire (KCCQ).
Results
113 patients were enrolled (age 64.5±9.7, 81% males). Peak oxygen intake (peakVO2) improved at each step from 15.0±4.5 mL/min/kg at baseline to 16.5±4.9 mL/min/kg at end study visit, corresponding to 61.5±16.0 and 67.9±17.4% of predicted, respectively (p<0.05). Minute ventilation/carbon dioxide production relationship (VE/VCO2 slope) reduced from 39.6±5.5 to 35.9±7.1 (p = 0.005) in the 39 patients (42%) with pathological VE/VCO2≥34 at baseline. KCCQ improved significantly since the first visit with an overall summary score increase from 47.9±11.1 to 52.6±9.8 (p<0.001).
Conclusions
These findings suggest that sacubitril/valsartan benefits on exercise capacity are immediately evident at the lowest dose and progressively improve as the dose increases.
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13
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Mantegazza V, Muratori M, Ghulam Ali S, Garlasche' A, Gripari P, Fusini L, Vignati C, De Martino F, Agostoni P, Ferrari C, Bartorelli AL, Pontone G, Pepi M, Tamborini G. Utility and futility of MitraClip implantation in secondary mitral regurgitation in a real-world population: the role of 3D transthoracic echocardiography. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Two recent prospective trials have been published, reporting opposite results on the efficacy and utility of the MitraClip (MC) procedure in patients with secondary mitral regurgitation (SMR). A ratio between the effective regurgitant orifice area (EROA) and left ventricular end-diastolic volume (LVEDV) ≥0.150 by two-dimensional (2D) transthoracic echocardiography (TTE) has been proposed to identify patients with disproportionate SMR, who would benefit from MC.
Purpose
To assess the prognostic role of clinical and echocardiographic parameters in a real-world population of SMR patients undergoing the MC procedure at our Institute.
Methods
Ninety-two patients underwent MC implantation. We retrospectively reviewed their clinical, and laboratory data, as well as 2D and three-dimensional (3D) TTE, and intraoperative transoesophageal echocardiography (Figure 1). The primary endpoint was a composite of cardiovascular death and/or hospitalisation for heart failure within 12-months follow-up.
Results
Thirty-one patients reached the endpoint (EP+), 61 did not (EP−). Demographics and anti-remodelling drugs were similar in EP+ and EP. Among comorbidities and laboratory data, EP+ significantly differed from EP− in smoking history, and extracardiac artery disease prevalence (65% vs. 39%, and 39% vs. 16%, respectively); EuroScoreII (12.2% vs. 5.2%); NYHA class ≥3 (94% vs. 69%); haemoglobin (12±2 vs. 13±2 g/dL), and brain natriuretic peptide levels (855 [426–1500] vs. 357 [170–902] pg/mL). At 2D TTE no significant difference emerged, including the SMR grade, except for the tricuspid annular plane systolic excursion (Figure 2). Biventricular 3D ejection fraction was significantly lower in EP+ vs. EP− (Figure 2). Residual intraoperative SMR grade after MC deployment was 1.9±0.6 in EP+ vs. 1.3±0.5 in EP− (p<0.001).
Conclusion
The proposed cut-off for EROA/LVEDV ratio may be suboptimal for predicting the MC utility in real-world populations. Rather, prognosis may be more influenced by the patient's pre-operative clinical status, right ventricular systolic function, 3D left ventricular ejection fraction, and by the success of the procedure.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- V Mantegazza
- IRCCS Centro Cardiologico Monzino , Milan , Italy
| | - M Muratori
- IRCCS Centro Cardiologico Monzino , Milan , Italy
| | - S Ghulam Ali
- IRCCS Centro Cardiologico Monzino , Milan , Italy
| | - A Garlasche'
- IRCCS Centro Cardiologico Monzino , Milan , Italy
| | - P Gripari
- IRCCS Centro Cardiologico Monzino , Milan , Italy
| | - L Fusini
- IRCCS Centro Cardiologico Monzino , Milan , Italy
| | - C Vignati
- IRCCS Centro Cardiologico Monzino , Milan , Italy
| | - F De Martino
- IRCCS Centro Cardiologico Monzino , Milan , Italy
| | - P Agostoni
- IRCCS Centro Cardiologico Monzino , Milan , Italy
| | - C Ferrari
- IRCCS Centro Cardiologico Monzino , Milan , Italy
| | | | - G Pontone
- IRCCS Centro Cardiologico Monzino , Milan , Italy
| | - M Pepi
- IRCCS Centro Cardiologico Monzino , Milan , Italy
| | - G Tamborini
- IRCCS Centro Cardiologico Monzino , Milan , Italy
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14
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Fusini L, Muratori M, Tamborini G, Gripari P, Ghulam Ali S, Cefalu' C, Fabbiocchi F, Galli S, Roberto M, Agrifoglio M, Pontone G, Bartorelli AL, Pepi M. Do valve type and post-ballooning affect transprosthetic gradients in patients undergoing transcatheter aortic valve-in-valve procedure? Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Valve-in-Valve transcatheter aortic valve implantation (ViV-TAVI) is an appealing treatment option for patients with degenerated aortic bioprosthetic valves. However, high post-procedural transprosthetic gradients are very common after ViV-TAVI than after TAVI for native-valve aortic stenosis.
Aim
We sought to evaluate transprosthetic gradients (ΔP) and hemodynamic outcome in patients undergoing ViV-TAVI according to valve type and balloon post-dilation (balloon-expandable vs self-expandable with and without post-dilation).
Material and methods
We retrospectively analyzed 111 patients undergoing ViV-TAVI. A balloon-expandable valve was used in 35 patients (32%, Group 1), a self-expandable valve in 76 cases of which 39 (35%, Group 2) without balloon post-dilation and 37 (33%, Group 3) with balloon post-dilation. A comprehensive transthoracic echocardiography (TTE) was performed in all patients at baseline, at discharge and at 6-months follow-up.
Results
Successful ViV-TAVI was performed in 110 patients (99%). Baseline peak and mean ΔP, left ventricular volumes, ejection fraction, and pulmonary artery systolic pressure were similar among groups. A significant improvement in all echocardiographic parameters was observed in all groups over time (Table 1). In particular, a significant reduction in postprocedural gradients was observed at discharge and at 6-months follow-up compared to baseline in all groups. Immediately after ViV-TAVI procedure, the lowest value of mean ΔP was observed in Group 3 (12±7 mmHg) compared to both Group 1 (20±9 mmHg) and Group 2 (17±8 mmHg, p=0.001). This result was confirmed at 6-months follow-up (p=0.012). Rate of small valve size (≤23 mm) implanted was similar among groups (Group 1: 78%, Group 2: 60%, Group 3: 62%, p=0.123). Similar 1-year all-cause mortality was observed among groups (9%, 13%, 0%, respectively, p=0.135).
Conclusions
In patients with failed surgical aortic prosthesis, ViV-TAVI is an effective option and is associated with sustained improved hemodynamics in all patients. Anyway, the choice of prosthetic valve type and implantation technique are relevant on residual transprosthetic gradients and should be taken into account for a better long-term outcome.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- L Fusini
- Centro Cardiologico Monzino IRCCS , Milan , Italy
| | - M Muratori
- Centro Cardiologico Monzino IRCCS , Milan , Italy
| | - G Tamborini
- Centro Cardiologico Monzino IRCCS , Milan , Italy
| | - P Gripari
- Centro Cardiologico Monzino IRCCS , Milan , Italy
| | - S Ghulam Ali
- Centro Cardiologico Monzino IRCCS , Milan , Italy
| | - C Cefalu'
- Centro Cardiologico Monzino IRCCS , Milan , Italy
| | - F Fabbiocchi
- Centro Cardiologico Monzino IRCCS , Milan , Italy
| | - S Galli
- Centro Cardiologico Monzino IRCCS , Milan , Italy
| | - M Roberto
- Centro Cardiologico Monzino IRCCS , Milan , Italy
| | - M Agrifoglio
- Centro Cardiologico Monzino IRCCS , Milan , Italy
| | - G Pontone
- Centro Cardiologico Monzino IRCCS , Milan , Italy
| | | | - M Pepi
- Centro Cardiologico Monzino IRCCS , Milan , Italy
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15
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Penso M, Frappampina A, Cosentino N, Tamborini G, Celeste F, Ianniruberto M, Ravagnani P, Troiano S, Marenzi G, Pepi M. Outcomes and mechanical complications of acute myocardial infarction during the second wave pandemic in a Milan HUB center for cardiac emergencies. Front Cardiovasc Med 2022; 9:950952. [PMID: 36262205 PMCID: PMC9573996 DOI: 10.3389/fcvm.2022.950952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 09/15/2022] [Indexed: 11/15/2022] Open
Abstract
Aims COVID-19 has dramatically impacted the healthcare system. Evidence from previous studies suggests a decline in in-hospital admissions for acute myocardial infarction (AMI) during the pandemic. However, the effect of the pandemic on mechanical complications (MC) in acute ST-segment elevation myocardial infarction (STEMI) has not been comprehensively investigated. Therefore, we evaluated the impact of the pandemic on MC and in-hospital outcomes in STEMI during the second wave, in which there was a huge SARS-CoV-2 diffusion in Italy. Methods and results Based on a single center cohort of AMI patients admitted with STEMI between February 1, 2019, and February 28, 2021, we compared the characteristics and outcomes of STEMI patients treated during the pandemic vs. those treated before the pandemic. In total, 479 STEMI patients were included, of which 64.5% were during the pandemic. Relative to before the pandemic, primary percutaneous coronary intervention (PCI) declined (87.7 vs. 94.7%, p = 0.014) during the pandemic. Compared to those admitted before the pandemic (10/2019 to 2/2020), STEMI patients admitted during the second wave (10/2020 to 2/2021) presented with a symptom onset-to-door time greater than 24 h (26.1 vs. 10.3%, p = 0.009) and a reduction of primary PCI (85.2 vs. 97.1%, p = 0.009). MC occurred more often in patients admitted during the second wave of the pandemic than in those admitted before the pandemic (7.0 vs. 0.0%, p = 0.032). In-hospital mortality increased during the second wave (10.6 vs. 2.9%, p = 0.058). Conclusion Although the experience gained during the first wave and a more advanced hub-and-spoke system for cardiovascular emergencies persists, late hospitalizations and a high incidence of mechanical complications in STEMI were observed even in the second wave.
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Affiliation(s)
- Marco Penso
- Centro Cardiologico Monzino IRCCS, Milan, Italy,Department of Electronics, Information and Biomedical Engineering, Politecnico di Milano, Milan, Italy,*Correspondence: Marco Penso,
| | | | | | | | | | | | | | | | | | - Mauro Pepi
- Centro Cardiologico Monzino IRCCS, Milan, Italy
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16
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Poggio P, Myasoedova V, Ravani A, Frigerio B, Gripari P, Mantegazza V, Valerio V, Moschetta D, Massaiu I, D'Ippolito C, Baldassarre D, Tamborini G, Medda E. Heritability and environmental influences on the onset of aortic valve sclerosis: a twin population study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Aortic valve sclerosis (AVSc) is the earliest manifestation of a life-threatening cardiovascular disorder, namely aortic valve stenosis (AS). AVSc is also recognized as a red flag linked to worse cardiovascular outcomes in high-risk coronary artery disease patients. However, the genetic background of AVSc is still unknown.
Purpose
To examine whether the heritability and environmental contributions play a role in the onset of AVSc using a sample of Italian twins.
Methods
The present study is based on the classical twin design. Twins, aged 50 to 70 years, already enrolled in the Italian Twin Register, were contacted and invited to undergo a clinical, echocardiographic, and complete carotid artery ultrasound examination at the our Center, between July 2017 and December 2021. The presence of AVSc was recognized as non-uniform thickening with or without spotty calcified areas of the aortic valve leaflets without a significant transvalvular gradient (maximum aortic velocity <2.5 m/s). Twin zygosity was assessed through a questionnaire on physical similarity during childhood, known to be ∼95% accurate. Tetrachoric twin correlations by zygosity were estimated with Mx Software using liability threshold saturated models and incorporating age as a covariate. Liability-threshold structural equation modelling was performed to decompose the phenotypic variance into contributions due to additive genetic (A), common environmental (C), and unique environmental (E) effects.
Results
A total of 216 adult twins (66 monozygotic, MZ and 42 dizygotic pairs, DZ; mean age 59.9±6.2) were enrolled in the study. The estimated prevalence rate of AVSc in the total sample was 29.2%. As significant sex differences were detected (males 45.2% and females 22.7%, p<0.01), the additional twin analyses were performed as intra-sex analyses. Females showed a greater tetrachoric correlation in MZ twins (r=0.37) compared to DZ twins (r=0.23), suggesting the existence of a genetic influence. Genetic factors, under the best (AE) model, accounted for 38% of the variance in liability to AVSc with the remaining contribution due to unique environmental influences (E = 62%). The contribution of the common environment (C) to the goodness of fit was negligible. The male group was too small for statistical calculation.
Conclusion
To our knowledge, the present study is the first to document the involvement of genetic factors in the development of AVSc. Our data also warrant further studies to both validate the findings obtained and to better explore the heritability of AVSc. Furthermore, our results provide a first evidence that an echocardiographic screening in individuals with relatives affected by AVSc has a scientific rational basis.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Italian Ministry of Health
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Affiliation(s)
- P Poggio
- Cardiology Center Monzino IRCCS , Milan , Italy
| | | | - A Ravani
- Cardiology Center Monzino IRCCS , Milan , Italy
| | - B Frigerio
- Cardiology Center Monzino IRCCS , Milan , Italy
| | - P Gripari
- Cardiology Center Monzino IRCCS , Milan , Italy
| | | | - V Valerio
- Cardiology Center Monzino IRCCS , Milan , Italy
| | - D Moschetta
- Cardiology Center Monzino IRCCS , Milan , Italy
| | - I Massaiu
- Cardiology Center Monzino IRCCS , Milan , Italy
| | - C D'Ippolito
- Istituto Superiore di Sanità, Centre of reference for behavioural sciences and mental health , Rome , Italy
| | | | - G Tamborini
- Cardiology Center Monzino IRCCS , Milan , Italy
| | - E Medda
- Istituto Superiore di Sanità, Centre of reference for behavioural sciences and mental health , Rome , Italy
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17
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Fusini L, Muratori M, Tamborini G, Ghulam Ali S, Gripari P, Mantegazza V, Roberto M, Trabattoni P, Agrifoglio M, Bartorelli AL, Pontone G, Pepi M. Improving assessment of different flow state of aortic stenosis: implication for prognosis in patients undergoing transcatheter aortic valve replacement. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Low-flow low-gradient (LF-LG) aortic stenosis (AS) may occur with preserved or depressed left ventricular ejection fraction (EF), and both situations represent the most challenging subset of patients with AS to manage and generally have a poor prognosis with conservative therapy but a high operative mortality if treated surgically. Few and controversial data exist on the outcomes of these patients compared to normal-flow high-gradient (NF-HG) AS following transcatheter aortic valve replacement (TAVR).
Purpose
This study aims to better characterize patients with different transvalvular flow-gradient patterns undergoing TAVR and to examine the prognostic value of these flow state.
Methods
Overall, 1208 patients with severe symptomatic AS undergoing TAVR were categorized according to flow-gradient patterns as follow: 976 patients NF-HG (DPmean >40 mmHg), 107 paradoxical LF-LG (pLF-LG: DP mean <40 mmHg, EF >50%, and SVi <35 mL/m2), and 125 classical LF-LG (DP mean <40 mmHg, EF <50%, SVi <35 mL/m2).
Results
TAVR was feasible in all AS subtypes. When compared with NF-HG and pLF-LG, LF-LG had a worse symptomatic status (NYHA III–IV 86% vs 62% and 67%, respectively, p<0.001), a higher prevalence of eccentric hypertrophy (Figure 1, left), a higher level of LV global afterload reflected by a higher valvuloarterial impedance and a higher pulmonary pressure (Table). Valvular function after TAVR was excellent over time with respect to aortic pressure gradient (mean and peak) and aortic valve area regardless of flow state group. While intraoperative (p=0.935) and 30-day mortality (p=0.911) did not differ significantly among the 3 groups, LF-LG had a lower overall 5-year survival (LF-LG 50%, pLF-LG 65%, NF-HG 84%, p<0.001) (Figure 1, right). LF-LG AS was associated with a hazard ratio for 5-year mortality of 2.416 (95% CI: 1.658–3.520, p<0.001).
Conclusions
TAVR is an effective procedure in all patients with severe AS regardless of transvalvular flow-gradient patterns. However, special care should be given to characterized hemodynamic of AS, as patients with pLF-LG had similar survival rate than patients with NF-HG, whereas survival in LF-LG patients was 2-fold higher. Therefore, being able to identify patients less likely to improve after TAVR may help to guide treatment decision.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- L Fusini
- Centro Cardiologico Monzino IRCCS , Milan , Italy
| | - M Muratori
- Centro Cardiologico Monzino IRCCS , Milan , Italy
| | - G Tamborini
- Centro Cardiologico Monzino IRCCS , Milan , Italy
| | - S Ghulam Ali
- Centro Cardiologico Monzino IRCCS , Milan , Italy
| | - P Gripari
- Centro Cardiologico Monzino IRCCS , Milan , Italy
| | - V Mantegazza
- Centro Cardiologico Monzino IRCCS , Milan , Italy
| | - M Roberto
- Centro Cardiologico Monzino IRCCS , Milan , Italy
| | - P Trabattoni
- Centro Cardiologico Monzino IRCCS , Milan , Italy
| | - M Agrifoglio
- Centro Cardiologico Monzino IRCCS , Milan , Italy
| | | | - G Pontone
- Centro Cardiologico Monzino IRCCS , Milan , Italy
| | - M Pepi
- Centro Cardiologico Monzino IRCCS , Milan , Italy
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18
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Mapelli M, Zagni P, Calbi V, Fusini L, Twalib A, Ferrara R, Mattavelli I, Alberghina L, Salvioni E, Opira C, Kansiime J, Tamborini G, Pepi M, Agostoni P. Echocardiographic Screening for Rheumatic Heart Disease in a Ugandan Orphanage: Feasibility and Outcomes. Children 2022; 9:children9101451. [PMID: 36291389 PMCID: PMC9600298 DOI: 10.3390/children9101451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/10/2022] [Accepted: 09/19/2022] [Indexed: 11/16/2022]
Abstract
Background: Rheumatic heart disease (RHD) is a major cause of cardiovascular disease in developing nations, leading to more than 230,000 deaths annually. Most patients seek medical care only when long-term structural and hemodynamic complications have already occurred. Echocardiographic screenings ensure the early detection of asymptomatic subjects who could benefit from prophylaxis, monitoring and intervention, when appropriate. The aim of this study is to assess the feasibility of a screening program and the prevalence of RHD in a Ugandan orphanage. Methods: We performed an RHD-focused echocardiogram on all the children (5–14 years old) living in a north Ugandan orphanage. Exams were performed with a portable machine (GE Vivid-I). All the time intervals were recorded (minutes). Results: A total of 163 asymptomatic children were screened over 8 days (medium age 9.1; 46% male; 17% affected by severe motor impairment). The feasibility rate was 99.4%. An average of 20.4 exams were performed per day, with an average of 15.5 images collected per subject. Pathological mitral regurgitation (MR) was found in 5.5% of subjects, while at least two morphological features of RHD were found in 4.3%, leading to 1 “definite RHD” (0.6%) case and 13 “borderline RHD” cases (8.1%). Six congenital heart defects were also noted (3.7%): four atrial septal defects, one coronary artery fistula and one Patent Ductus Arteriosus. Conclusions: We demonstrated the feasibility of an echocardiographic screening for RHD in an orphanage in Uganda. A few factors, such as good clinical and hygienic care, the availability of antibiotics and closeness to a big hospital, may account for the low prevalence of the disease in our population.
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Affiliation(s)
- Massimo Mapelli
- Centro Cardiologico Monzino, IRCCs, Via Parea 4, 20138 Milan, Italy
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, 20122 Milan, Italy
- Correspondence: ; Tel.: +39-0258002930; Fax: +39-0258002266
| | - Paola Zagni
- Terapia Intensiva Neonatale, Ospedale Fatebenefratelli P.O. Macedonio Melloni, Via Macedonio Melloni 52, 20129 Milan, Italy
| | - Valeria Calbi
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milan, Italy
- Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milan, Italy
| | - Laura Fusini
- Centro Cardiologico Monzino, IRCCs, Via Parea 4, 20138 Milan, Italy
| | - Aliku Twalib
- Division of Paediatric Cardiology Uganda Heart Institute, Mulago Hospital and Complex, Kampala P.O. Box 37392, Uganda
| | - Roberto Ferrara
- Molecular Immunology Unit, Medical Oncology Department—Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, 20132 Milan, Italy
| | - Irene Mattavelli
- Centro Cardiologico Monzino, IRCCs, Via Parea 4, 20138 Milan, Italy
| | - Laura Alberghina
- Department of Neurorehabilitation Sciences, Istituto Auxologico Italiano, IRCCS, 20132 Milan, Italy
- Hospital Lacor, Gulu P.O. Box 180, Uganda
| | | | | | | | - Gloria Tamborini
- Centro Cardiologico Monzino, IRCCs, Via Parea 4, 20138 Milan, Italy
| | - Mauro Pepi
- Centro Cardiologico Monzino, IRCCs, Via Parea 4, 20138 Milan, Italy
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCs, Via Parea 4, 20138 Milan, Italy
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, 20122 Milan, Italy
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19
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Penso M, Ranalletta RA, Pepi M, Garlaschè A, Ali SG, Fusini L, Mantegazza V, Muratori M, Maragna R, Tamborini G. Comparison between Automatic and Semiautomatic System for the 3D Echocardiographic Multiparametric Evaluation of RV Function and Dimension. J Clin Med 2022; 11:jcm11154528. [PMID: 35956143 PMCID: PMC9369664 DOI: 10.3390/jcm11154528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 07/29/2022] [Accepted: 08/01/2022] [Indexed: 12/04/2022] Open
Abstract
Background: The right ventricle (RV) plays a pivotal role in cardiovascular diseases and 3-dimensional echocardiography (3DE) has gained acceptance for the evaluation of RV volumes and function. Recently, a new artificial intelligence (AI)–based automated 3DE software for RV evaluation has been proposed and validated against cardiac magnetic resonance. The aims of this study were three-fold: (i) feasibility of the AI-based 3DE RV quantification, (ii) comparison with the semi-automatic 3DE method and (iii) assessment of 2-dimensional echocardiography (2DE) and strain measurements obtained automatically. Methods: A total of 203 subject (122 normal and 81 patients) underwent a 2DE and both the semi-automatic and automatic 3DE methods for Doppler standard, RV volumes and ejection fraction (RVEF) measurements. Results: The automatic 3DE method was highly feasible, faster than 2DE and semi-automatic 3DE and data obtained were comparable with traditional measurements. Both in normal subjects and patients, the RVEF was similar to the two 3DE methods and 2DE and strain measurements obtained by the automated system correlated very well with the standard 2DE and strain ones. Conclusions: results showed that rapid analysis and excellent reproducibility of AI-based 3DE RV analysis supported the routine adoption of this automated method in the daily clinical workflow.
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Affiliation(s)
- Marco Penso
- Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (R.A.R.); (M.P.); (A.G.); (S.G.A.); (L.F.); (V.M.); (M.M.); (R.M.); (G.T.)
- Department of Electronics, Information and Biomedical Engineering, Politecnico di Milano, 20133 Milan, Italy
- Correspondence: ; Tel.: +39-3926930900
| | - Remo Antonio Ranalletta
- Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (R.A.R.); (M.P.); (A.G.); (S.G.A.); (L.F.); (V.M.); (M.M.); (R.M.); (G.T.)
| | - Mauro Pepi
- Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (R.A.R.); (M.P.); (A.G.); (S.G.A.); (L.F.); (V.M.); (M.M.); (R.M.); (G.T.)
| | - Anna Garlaschè
- Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (R.A.R.); (M.P.); (A.G.); (S.G.A.); (L.F.); (V.M.); (M.M.); (R.M.); (G.T.)
| | - Sarah Ghulam Ali
- Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (R.A.R.); (M.P.); (A.G.); (S.G.A.); (L.F.); (V.M.); (M.M.); (R.M.); (G.T.)
| | - Laura Fusini
- Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (R.A.R.); (M.P.); (A.G.); (S.G.A.); (L.F.); (V.M.); (M.M.); (R.M.); (G.T.)
- Department of Electronics, Information and Biomedical Engineering, Politecnico di Milano, 20133 Milan, Italy
| | - Valentina Mantegazza
- Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (R.A.R.); (M.P.); (A.G.); (S.G.A.); (L.F.); (V.M.); (M.M.); (R.M.); (G.T.)
| | - Manuela Muratori
- Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (R.A.R.); (M.P.); (A.G.); (S.G.A.); (L.F.); (V.M.); (M.M.); (R.M.); (G.T.)
| | - Riccardo Maragna
- Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (R.A.R.); (M.P.); (A.G.); (S.G.A.); (L.F.); (V.M.); (M.M.); (R.M.); (G.T.)
| | - Gloria Tamborini
- Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (R.A.R.); (M.P.); (A.G.); (S.G.A.); (L.F.); (V.M.); (M.M.); (R.M.); (G.T.)
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van Wijngaarden AL, Mantegazza V, Hiemstra YL, Volpato V, van der Bijl P, Pepi M, Palmen M, Delgado V, Ajmone Marsan N, Tamborini G, Bax JJ. Prognostic Impact of Extra-Mitral Valve Cardiac Involvement in Patients With Primary Mitral Regurgitation. JACC Cardiovasc Imaging 2022; 15:961-970. [PMID: 35033499 DOI: 10.1016/j.jcmg.2021.11.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 10/15/2021] [Accepted: 11/04/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND In patients with severe primary mitral regurgitation (MR), the indication for surgery is currently based on the presence of symptoms, left ventricular dilatation and dysfunction, atrial fibrillation, and pulmonary hypertension. OBJECTIVES The aim of this study was to evaluate the prognostic impact of the presence of extra-mitral valve cardiac involvement (including known risk factors but also severe left atrial [LA] dilatation and right ventricular [RV] dysfunction) in a large multicenter study of patients with primary MR. METHODS Patients with severe primary MR undergoing surgery were included and categorized according to the extent (highest) of cardiac involvement: group 0, no cardiac involvement; group 1, left ventricular involvement; group 2, LA involvement; group 3, pulmonary vasculature or tricuspid valve involvement; or group 4, RV involvement. The outcome was all-cause mortality. RESULTS A total of 1,106 patients were included (mean age 63 ± 12 years, 68% male). In total, 377 patients (34%) were classified in group 0, 239 (22%) in group 1, 213 (19%) in group 2, 180 (16%) in group 3, and 97 (9%) in group 4. Kaplan-Meier curve analysis revealed significantly worse survival (log-rank chi-square = 43.4; P < 0.001) with higher group. On multivariable analysis, age, male sex, chronic obstructive pulmonary disease, kidney function, and group of cardiac involvement were independently associated with all-cause mortality. For each increase in group, a 17% higher risk for all-cause mortality was observed (95% CI: 1.051-1.313; P = 0.005) during a median follow-up time of 88 months. CONCLUSIONS In patients with severe primary MR, a novel classification system based on extra-mitral valve cardiac involvement may help refine risk stratification and timing of surgery, particularly including severe LA dilatation and RV dysfunction in the assessment.
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Affiliation(s)
| | - Valentina Mantegazza
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Yasmine L Hiemstra
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Valentina Volpato
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Pieter van der Bijl
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Mauro Pepi
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Meindert Palmen
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Gloria Tamborini
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
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Corona S, Manganiello S, Pepi M, Tamborini G, Muratori M, Ali SG, Capra N, Naliato M, Alamanni F, Zanobini M. Bioprosthetic aortic valve replacement in patients aged 50 years old and younger: Structural valve deterioration at long-term follow-up. Retrospective study. Ann Med Surg (Lond) 2022; 77:103624. [PMID: 35637981 PMCID: PMC9142659 DOI: 10.1016/j.amsu.2022.103624] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/10/2022] [Accepted: 04/10/2022] [Indexed: 11/27/2022] Open
Abstract
Background Structural valve deterioration (SVD) remains the major determinant of bioprosthesis durability. The aim of this study was to investigate the SVD incidence, predictors and outcomes in patients aged 50 years and younger after bioprosthetic aortic valve replacement (bAVR). Methods We retrospectively analyzed 73 consecutive patients ≤50 years old who underwent bioprosthetic AVR at our center between 2005 and 2015. Median age at surgery was 44 (interquartile range [IQR]: 39-47) years. Follow-up was 93.2% complete at a median time of 7.2 (IQR: 5.5-9.5) years. Cumulative follow-up was 545.5 valve-years. Bioprosthesis SVD was determined by strict echocardiographic assessment. Results The overall survival-rate at 10/15 years and freedom from SVD at 10/12.5 years were 89.6 ± 5.2%/81.5 ± 9.1% and 73.5 ± 8.2%/41.9 ± 18.9%, respectively. SVD occurred at a median time of 8.2 (IQR: 6.0-9.9) years after bAVR. Age was not found as an independent predictor for SVD at the multivariable model, despite a higher rate of SVD in the age group ≤30 years. Freedom from reoperation due to SVD at 10/15 years was 71.3 ± 14.1%/13.6 ± 12.3%. Reoperation was performed at a median time of 10.0 (IQR: 8.9-11.9) years since first bAVR and was associated with a 100% 12-month survival. Conclusions In our study, the rate and time of SVD occurrence were comparable to those of other studies' older age groups. Strict echocardiographic monitoring of valve performance is mandatory to set the appropriate timing of eventual reoperation. This attitude can improve outcomes of bAVR in younger patients.
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Key Words
- AVR, Aortic Valve Replacement
- Aortic valve replacement
- Bioprosthesis
- EF, Ejection Fraction
- LV, Left Ventricle
- NYHA, New York Heart Association
- PASP, Pulmonary Artery Systolic Pressure
- PPM, Prosthesis-Patient Mismatch
- Reoperation
- SVD, Structural Valve Deterioration
- Structural valve deterioration
- TAVR, Transcatheter Aortic Valve Replacement
- TTE, Transthoracic Echocardiography
- bAVR, bioprosthetic Aortic Valve Replacement
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Affiliation(s)
- Silvia Corona
- Department of Cardiac Surgery, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Sabrina Manganiello
- Department of Cardiac Surgery, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Mauro Pepi
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Gloria Tamborini
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Manuela Muratori
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Sarah Ghulam Ali
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Nicolò Capra
- Department of Biostatistics, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Moreno Naliato
- Department of Cardiac Surgery, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Francesco Alamanni
- Department of Cardiac Surgery, Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Marco Zanobini
- Department of Cardiac Surgery, Centro Cardiologico Monzino, IRCCS, Milan, Italy
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22
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Gripari P, Pepi M, Fusini L, Tamborini G, Mancini ME, Andreini D, Pontone G, Saccocci M, Giambuzzi I, Alamanni F, Zanobini M. Cardiac tumors: imaging findings, clinical correlations and surgical treatment in a 15 years single-center experience. J Cardiovasc Surg (Torino) 2022; 63:212-221. [PMID: 34825795 DOI: 10.23736/s0021-9509.21.12052-x] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND The aims of this study were: to present the clinical and pathological characteristics of cardiac tumors in a single-center series of patients; to describe the association of imaging characteristics, clinical presentation and surgical treatment; to analyze if second level imaging tests, computed tomography (CT) and cardiac magnetic resonance (CMR); and to improve the diagnostic accuracy when compared to first-line imaging technique (transthoracic echocardiography [TTE]). METHODS We reviewed the medical and surgical records, TTE, CT and CMR examinations of 86 patients with a histological diagnosis of cardiac tumors between 2004 and 2019. RESULTS The majority were benign tumors (81%) with myxoma accounting for 66% of cases. Among malignancies, metastasis (8%) and primary tumors (10%) were equally recognized. Symptoms at presentation (45% of patients) were associated to larger diameters at TTE. Malignancies were larger (mean diameter 37±14 mm vs. 27±13 mm, P<0.01), more frequently exhibited irregular shape (67% vs. 17%, P<0.01), frayed or polylobulated surface (73% vs. 38%, P=0.035), heterogeneous aspect (67% vs. 32%, P=0.012). A maximum diameter >28 mm and a minimum diameter >19.5 mm emerged as possible cut-off values for the differentiation of benign and malignant tumors. The ability of TTE, CT and CMR features in identifying malignancies was moderate (diagnostic accuracy of 84%, 81%, 76% respectively). The mean survival time after surgery was 1.6±1.4 years in malignancies and 6.8±4.7 years in benign tumors. CONCLUSIONS Cardiac tumors are rare and mostly benign; their nature and clinics related to TTE appearance. CT and CMR may be used synergically with TTE. Surgery is curative in benign tumors, survival remains scarce in malignancies.
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Affiliation(s)
| | - Mauro Pepi
- Centro Cardiologico Monzino IRCCS, Milan, Italy
| | | | | | | | | | | | - Matteo Saccocci
- Division of Cardiac Surgery, Poliambulanza Foundation, Brescia, Italy
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Gennari M, Mastroiacovo G, Trabattoni P, Roberto M, Bonomi A, Bartorelli AL, Olivares P, Tamborini G, Muratori M, Pepi M, Polvani G, Agrifoglio M. The prognostic value of left ventricular dimensions at the time of transcatheter aortic valve replacement: A propensity‐matched analysis. J Card Surg 2022; 37:1887-1893. [DOI: 10.1111/jocs.16381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 01/17/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Marco Gennari
- Department of Cardiovascular Surgery IRCCS Centro Cardiologico Monzino Milan Italy
| | - Giorgio Mastroiacovo
- Department of Cardiovascular Surgery IRCCS Centro Cardiologico Monzino Milan Italy
| | - Piero Trabattoni
- Department of Cardiovascular Surgery IRCCS Centro Cardiologico Monzino Milan Italy
| | - Maurizio Roberto
- Department of Cardiovascular Surgery IRCCS Centro Cardiologico Monzino Milan Italy
| | - Alice Bonomi
- Department of Statistics IRCCS Centro Cardiologico Monzino Milan Italy
| | - Antonio L. Bartorelli
- Department of Biomedical and Clinical Sciences “Luigi Sacco” University of Milan Milan Italy
| | - Paolo Olivares
- Department of Interventional Cardiology IRCCS Centro Cardiologico Monzino Milan Italy
| | - Gloria Tamborini
- Department of Echocardiography IRCCS Centro Cardiologico Monzino Milan Italy
| | - Manuela Muratori
- Department of Echocardiography IRCCS Centro Cardiologico Monzino Milan Italy
| | - Mauro Pepi
- Department of Cardiac Imaging, IRCCS Centro Cardiologico Monzino Clinical Area Manager Milan Italy
| | - Gianluca Polvani
- Department of Cardiovascular Surgery IRCCS Centro Cardiologico Monzino Milan Italy
- Department of Surgical and Dental Biomedical Sciences University of Milan Milan Italy
| | - Marco Agrifoglio
- Department of Cardiovascular Surgery IRCCS Centro Cardiologico Monzino Milan Italy
- Department of Surgical and Dental Biomedical Sciences University of Milan Milan Italy
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Conte E, Agalbato C, Lauri G, Mushtaq S, Cia AD, Bonomi A, Guglielmo M, Baggiano A, Gaudenzi-Asinelli M, Colombo G, Sforza C, Agostoni P, Tamborini G, Assanelli E, Pontone G, Pepi M, Brucato A, Andreini D. Cardiac MRI after first episode of acute pericarditis: A pilot study for better identification of high risk patients. Int J Cardiol 2022; 354:63-67. [DOI: 10.1016/j.ijcard.2022.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/17/2022] [Accepted: 03/07/2022] [Indexed: 01/06/2023]
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Pasquali M, Fusini L, Italiano G, Maltagliati A, Tamborini G, Penso M, Andreini D, Redaelli A, Pappalardo O, Pepi M. Feasibility study of a mixed reality tool for real 3D visualization and planning of left atrial appendage occlusion. J Cardiovasc Comput Tomogr 2022; 16:460-462. [DOI: 10.1016/j.jcct.2022.02.010] [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] [Received: 01/17/2022] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 10/19/2022]
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Muratori M, Fusini L, Mancini ME, Tamborini G, Ghulam Ali S, Gripari P, Doldi M, Frappampina A, Teruzzi G, Pontone G, Montorsi P, Pepi M. The Role of Multimodality Imaging in Left-Sided Prosthetic Valve Dysfunction. J Cardiovasc Dev Dis 2022; 9:jcdd9010012. [PMID: 35050222 PMCID: PMC8778309 DOI: 10.3390/jcdd9010012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 12/27/2021] [Accepted: 12/29/2021] [Indexed: 12/10/2022] Open
Abstract
Prosthetic valve (PV) dysfunction (PVD) is a complication of mechanical or biological PV. Etiologic mechanisms associated with PVD include fibrotic pannus ingrowth, thrombosis, structural valve degeneration, and endocarditis resulting in different grades of obstruction and/or regurgitation. PVD can be life threatening and often challenging to diagnose due to the similarities between the clinical presentations of different causes. Nevertheless, identifying the cause of PVD is critical to treatment administration (thrombolysis, surgery, or percutaneous procedure). In this report, we review the role of multimodality imaging in the diagnosis of PVD. Specifically, this review discusses the characteristics of advanced imaging modalities underlying the importance of an integrated approach including 2D/3D transthoracic and transesophageal echocardiography, fluoroscopy, and computed tomography. In this scenario, it is critical to understand the strengths and weaknesses of each modality according to the suspected cause of PVD. In conclusion, for patients with suspected or known PVD, this stepwise imaging approach may lead to a simplified, more rapid, accurate and specific workflow and management.
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Affiliation(s)
- Manuela Muratori
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (M.M.); (M.E.M.); (G.T.); (S.G.A.); (P.G.); (M.D.); (A.F.); (G.T.); (G.P.); (P.M.); (M.P.)
| | - Laura Fusini
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (M.M.); (M.E.M.); (G.T.); (S.G.A.); (P.G.); (M.D.); (A.F.); (G.T.); (G.P.); (P.M.); (M.P.)
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, 20133 Milan, Italy
- Correspondence: ; Tel.: +39-02-5800-2011; Fax: +39-02-5800-2287
| | - Maria Elisabetta Mancini
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (M.M.); (M.E.M.); (G.T.); (S.G.A.); (P.G.); (M.D.); (A.F.); (G.T.); (G.P.); (P.M.); (M.P.)
| | - Gloria Tamborini
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (M.M.); (M.E.M.); (G.T.); (S.G.A.); (P.G.); (M.D.); (A.F.); (G.T.); (G.P.); (P.M.); (M.P.)
| | - Sarah Ghulam Ali
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (M.M.); (M.E.M.); (G.T.); (S.G.A.); (P.G.); (M.D.); (A.F.); (G.T.); (G.P.); (P.M.); (M.P.)
| | - Paola Gripari
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (M.M.); (M.E.M.); (G.T.); (S.G.A.); (P.G.); (M.D.); (A.F.); (G.T.); (G.P.); (P.M.); (M.P.)
| | - Marco Doldi
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (M.M.); (M.E.M.); (G.T.); (S.G.A.); (P.G.); (M.D.); (A.F.); (G.T.); (G.P.); (P.M.); (M.P.)
| | - Antonio Frappampina
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (M.M.); (M.E.M.); (G.T.); (S.G.A.); (P.G.); (M.D.); (A.F.); (G.T.); (G.P.); (P.M.); (M.P.)
| | - Giovanni Teruzzi
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (M.M.); (M.E.M.); (G.T.); (S.G.A.); (P.G.); (M.D.); (A.F.); (G.T.); (G.P.); (P.M.); (M.P.)
| | - Gianluca Pontone
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (M.M.); (M.E.M.); (G.T.); (S.G.A.); (P.G.); (M.D.); (A.F.); (G.T.); (G.P.); (P.M.); (M.P.)
| | - Piero Montorsi
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (M.M.); (M.E.M.); (G.T.); (S.G.A.); (P.G.); (M.D.); (A.F.); (G.T.); (G.P.); (P.M.); (M.P.)
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, 20122 Milan, Italy
| | - Mauro Pepi
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (M.M.); (M.E.M.); (G.T.); (S.G.A.); (P.G.); (M.D.); (A.F.); (G.T.); (G.P.); (P.M.); (M.P.)
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Fusini L, Muratori M, Tamborini G, Ali SG, Gripari P, Mantegazza V, Roberto M, Trabattoni P, Agrifoglio M, Bartorelli A, Alamanni F, Pontone G, Pepi M. 229 Long-term clinical and echocardiographic outcome following TAVR in patients with severe aortic stenosis and different transvalvular flow state. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab147.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aims
Haemodynamic classifications of severe aortic stenosis (AS) have important prognostic implications, with low flow state (defined on the basis of a stroke volume index, SVi<35 mL/m2) known to be a predictor of worse prognosis. As transcatheter aortic valve replacement (TAVR) has become widely used for patients with severe AS, issues were raised concerning its efficacy in patients with different haemodynamic classifications combining transvalvular flow state and pressure gradients. In fact, data on TAVR outcomes in patients with low gradient (LG) AS are limited and in some cases controversial. The aim of this study was to evaluate the efficacy and long-term clinical and echocardiographic outcome of TAVR in patients with different transvalvular flow-gradient patterns.
Methods
In this single centre study, 1078 patients (mean age 81±7 years) with severe symptomatic AS (AVA<1 cm2) undergoing TAVR were categorized according to flow-gradient patterns as follow: 867 patients (80%) with normal flow-high gradient (NF-HG: mean transaortic gradient DP mean>40 mmHg), 94 (9%) with paradoxical low flow LG (pLF-LG: DP mean<40 mmHg, ejection fraction EF > 50%, and SVi<35 mL/m2), and 117 (11%) classical LF-LG (DP mean<40 mmHg, EF < 50%, SVi<35 mL/m2).
Results
TAVR was feasible in all AS subtypes with similar rate of unsuccessful procedure (1.3% NF-HG, 1.1% pLF-LG, 0% LF-LG P=470). Valvular function after TAVR was excellent over time with respect to aortic pressure gradient (mean and peak) and aortic valve area regardless of flow state group (Figure A). Overall, intraoperative (P=957) and 30-day mortality (P=817) did not differ significantly among the 3 groups. Longer follow-up showed that, compared to NF-HG patients, pLF-LG had similar all-cause mortality rate [HR 1.35(0.95–1.90), P=0.094] up to 5 years and LF-LG had a significant higher mortality rate [HR 1.89(1.43–2.49), P<0.001],(Figure B). Moreover, LF-LG patients had higher rehospitalization for heart failure (NF-HG: 3%, pLF-LG: 6%, LF-LG 10%, P=0.001).
Conclusions
We provided evidence that TAVR is an effective procedure in all patients with severe AS regardless of transvalvular flow-gradient patterns. A careful haemodynamic classifications of severe AS is of utmost importance for identifying patients who benefits the most from TAVR procedure.
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Italiano G, Tamborini G, Fusini L, Mantegazza V, Doldi M, Celeste F, Gripari P, Muratori M, Lang RM, Pepi M. Feasibility and Accuracy of the Automated Software for Dynamic Quantification of Left Ventricular and Atrial Volumes and Function in a Large Unselected Population. J Clin Med 2021; 10:jcm10215030. [PMID: 34768549 PMCID: PMC8584703 DOI: 10.3390/jcm10215030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/22/2021] [Accepted: 10/26/2021] [Indexed: 11/24/2022] Open
Abstract
We aimed to evaluate the feasibility and accuracy of machine learning-based automated dynamic quantification of left ventricular (LV) and left atrial (LA) volumes in an unselected population. We enrolled 600 unselected patients (12% in atrial fibrillation) clinically referred for transthoracic echocardiography (2DTTE), who also underwent 3D echocardiography (3DE) imaging. LV ejection fraction (EF), LV, and LA volumes were obtained from 2D images; 3D images were analyzed using dynamic heart model (DHM) software (Philips) resulting in LV and LA volume–time curves. A subgroup of 140 patients also underwent cardiac magnetic resonance (CMR) imaging. Average time of analysis, feasibility, and image quality were recorded, and results were compared between 2DTTE, DHM, and CMR. The use of DHM was feasible in 522/600 cases (87%). When feasible, the boundary position was considered accurate in 335/522 patients (64%), while major (n = 38) or minor (n = 149) border corrections were needed. The overall time required for DHM datasets was approximately 40 seconds. As expected, DHM LV volumes were larger than 2D ones (end-diastolic volume: 173 ± 64 vs. 142 ± 58 mL, respectively), while no differences were found for LV EF and LA volumes (EF: 55% ± 12 vs. 56% ± 14; LA volume 89 ± 36 vs. 89 ± 38 mL, respectively). The comparison between DHM and CMR values showed a high correlation for LV volumes (r = 0.70 and r = 0.82, p < 0.001 for end-diastolic and end-systolic volume, respectively) and an excellent correlation for EF (r = 0.82, p < 0.001) and LA volumes. The DHM software is feasible, accurate, and quick in a large series of unselected patients, including those with suboptimal 2D images or in atrial fibrillation.
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Affiliation(s)
- Gianpiero Italiano
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (G.T.); (L.F.); (V.M.); (M.D.); (F.C.); (P.G.); (M.M.); (M.P.)
- Correspondence:
| | - Gloria Tamborini
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (G.T.); (L.F.); (V.M.); (M.D.); (F.C.); (P.G.); (M.M.); (M.P.)
| | - Laura Fusini
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (G.T.); (L.F.); (V.M.); (M.D.); (F.C.); (P.G.); (M.M.); (M.P.)
| | - Valentina Mantegazza
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (G.T.); (L.F.); (V.M.); (M.D.); (F.C.); (P.G.); (M.M.); (M.P.)
| | - Marco Doldi
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (G.T.); (L.F.); (V.M.); (M.D.); (F.C.); (P.G.); (M.M.); (M.P.)
| | - Fabrizio Celeste
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (G.T.); (L.F.); (V.M.); (M.D.); (F.C.); (P.G.); (M.M.); (M.P.)
| | - Paola Gripari
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (G.T.); (L.F.); (V.M.); (M.D.); (F.C.); (P.G.); (M.M.); (M.P.)
| | - Manuela Muratori
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (G.T.); (L.F.); (V.M.); (M.D.); (F.C.); (P.G.); (M.M.); (M.P.)
| | - Roberto M. Lang
- Department of Medicine, University of Chicago Medical Center, Chicago, IL 60637, USA;
| | - Mauro Pepi
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (G.T.); (L.F.); (V.M.); (M.D.); (F.C.); (P.G.); (M.M.); (M.P.)
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Yedidya I, Mantegazza V, Namazi F, Lustosa R, Butcher SC, Milhorini Pio S, Vo NM, Tamborini G, Garlasche A, Pepi M, Bax JJ, Ajmone Marsan N, Delgado V. Prognostic value of three dimensional-vena contracta area in patients with secondary mitral regurgitation. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Effective regurgitant orifice area (EROA) is an important quantitative measurement for mitral regurgitation (MR) grading. Yet, the accuracy of this method is limited in patients with secondary mitral regurgitation (SMR). Three-dimensional (3D) color Doppler echocardiography allows for the direct assessment of the vena contracta area (VCA). The prognostic value of 3D-VCA in patients with secondary MR has not been investigated.
Purpose
The aim of the present study was to assess the association between 3D-VCA and prognosis of patients with SMR.
Methods
A total of 218 patients (69% men, median age 74 years) with significant SMR were retrospectively analyzed. 3D-VCA was measured offline with dedicated software, from restored 3D color Doppler full volume datasets of the mitral valve (Figure 1). The population was divided according to the American College of Cardiology expert recommendation for the grading of severe MR (VCA ≥50 mm2 and VCA <50 mm2). Patients were followed up for the combined end point of all-cause mortality or heart failure hospitalization.
Results
Of the total population, 63% had an ischemic etiology, 60% had atrial fibrillation and 25% cardiac resynchronization therapy. Patients with 3D-VCA ≥50 mm2 needed more diuretic therapy, had a larger left ventricle and atrium, and had more post-procedural residual MR. A total of 82% of patients underwent MitraClip device implantation, 17% had mitral valve repair and 1% had mitral valve replacement. During a median follow-up of 28 months, 130 (60%) met the combined end point (101 (46%) patients died and 81 (37%) were hospitalized due to heart failure). When dividing the population according to the cut-off of 3D-VCA, patients with a 3D-VCA≥50 mm2 had a worse prognosis compared with their counterparts (Figure 2). In a multivariable Cox regression analysis, 3D-VCA≥50 mm2 remained independently associated with the composite endpoint of all-cause mortality or heart failure hospitalization (HR=1.454, 95% CI 1.020–2.072, p=0.038).
Conclusion
In patients with SMR, a 3D-VCA ≥50 mm2 was independently associated with a combined endpoint of death or heart failure hospitalization.
Funding Acknowledgement
Type of funding sources: None. Figure 1. Method of 3D-VCA measurementFigure 2. Kaplan-Meier survival curve
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Affiliation(s)
- I Yedidya
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - V Mantegazza
- Centro Cardiologico Monzino, IRCCS, Cardiovascular Imaging, Milan, Italy
| | - F Namazi
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - R Lustosa
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - S C Butcher
- Leiden University Medical Center, Leiden, Netherlands (The)
| | | | - N M Vo
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - G Tamborini
- Centro Cardiologico Monzino, IRCCS, Cardiovascular Imaging, Milan, Italy
| | - A Garlasche
- Centro Cardiologico Monzino, IRCCS, Cardiovascular Imaging, Milan, Italy
| | - M Pepi
- Centro Cardiologico Monzino, IRCCS, Cardiovascular Imaging, Milan, Italy
| | - J J Bax
- Leiden University Medical Center, Leiden, Netherlands (The)
| | | | - V Delgado
- Leiden University Medical Center, Leiden, Netherlands (The)
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Mantegazza V, Volpato V, Mapelli M, Sassi V, Salvioni E, Mattavelli I, Tamborini G, Agostoni P, Pepi M. Cardiac reverse remodelling by 2D and 3D echocardiography in heart failure patients treated with sacubitril/valsartan: a prospective study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Left ventricular (LV) reverse remodelling induced by sacubitril/valsartan (S/V) has been shown in heart failure patients with reduced ejection fraction (HFrEF) by two-dimensional (2D) transthoracic echocardiography (TTE). Data about S/V effect on the right ventricle (RV) are scarce.
Aims
We aimed to evaluate S/V-induced changes in NT-proBNP levels, and cardiac remodelling indices by 2D and three-dimensional (3D) TTE in HFrEF patients, classifying patients according to aetiology.
Methods
We prospectively enrolled 51 HFrEF patients (24 ischaemic, 27 non-ischaemic). At baseline and at 6-months follow-up (6MFU) after S/V treatment optimization, we i) assessed NT-proBNP; ii) performed 2D TTE according to guidelines for the assessment of biventricular size and function, mitral regurgitation grade and LV diastolic function; and iii) performed 3D TTE, using the Dynamic HeartModel software for the evaluation of LV volumes and function, the 4D LV-Analysis software for the assessment of LV longitudinal strain, and the 4D RV-Analysis software for the assessment of RV volumes and function (Figure 1).
Results
In non-ischaemic patients, both 2D and 3D TTE showed an improvement in LV volumes and biventricular function, whereas only 3D detected a reduction in RV size at 6MFU vs baseline (Table 1). In ischaemic patients, only 3D TTE showed an improvement in biventricular size and LV function (Table 1). Finally, S/V induced a significant improvement in NT-proBNP (Table 1) and diastolic function both in ischaemic and non-ischaemic groups: patients with elevated left atrial pressure (as assessed by 2D parameters of diastolic function) decreased from 45% to 20% in ischaemic and from 40% to 10% in non-ischaemic patients (p<0.05).
Conclusions
S/V induced a significant improvement in NTproBNP and diastolic function in both aetiologic groups. A clinically significant improvement in biventricular function was shown only in non-ischaemic patients. 3D TTE may be advantageous to ascertain subtle changes in LV size and function, undetected by 2D imaging, and to evaluate RV dimensions and function, which have a major impact on HFrEF prognosis.
Funding Acknowledgement
Type of funding sources: None. Figure 1Table 1
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Affiliation(s)
- V Mantegazza
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - V Volpato
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - M Mapelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - V Sassi
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - E Salvioni
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - I Mattavelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - G Tamborini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - P Agostoni
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - M Pepi
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
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Vignati C, De Martino F, Muratori M, Salvioni E, Tamborini G, Bartorelli A, Pepi M, Alamanni F, Farina S, Cattadori G, Mantegazza V, Agostoni P. Rest and exercise oxygen uptake and cardiac output changes 6 months after successful transcatheter mitral valve repair. ESC Heart Fail 2021; 8:4915-4924. [PMID: 34551212 PMCID: PMC8712840 DOI: 10.1002/ehf2.13518] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/25/2021] [Accepted: 07/05/2021] [Indexed: 11/11/2022] Open
Abstract
Aims Changes in peak exercise oxygen uptake (VO2) and cardiac output (CO) 6 months after successful percutaneous edge‐to‐edge mitral valve repair (pMVR) in severe primary (PMR) and functional mitral regurgitation (FMR) patients are unknown. The aim of the study was to assess the efficacy of pMVR at rest by echocardiography, VO2 and CO (inert gas rebreathing) measurement and during cardiopulmonary exercise test with CO measurement. Methods and results We evaluated 145 and 115 patients at rest and 98 and 66 during exercise before and after pMVR, respectively. After successful pMVR, significant reductions in MR and NYHA class were observed in FMR and PMR patients. Cardiac ultrasound showed reverse remodelling (left ventricular end‐diastolic volume from 158 ± 63 mL to 147 ± 64, P < 0.001; ejection fraction from 51 ± 15 to 48 ± 14, P < 0.001; pulmonary artery systolic pressure (PASP) from 43 ± 13 to 38 ± 8 mmHg, P < 0.001) in the entire population. These changes were significant in PMR (n = 62) and a trend in FMR (n = 53), except for PASP, which decreased in both groups. At rest, CO and stroke volume (SV) increased in FMR with a concomitant reduction in arteriovenous O2 content difference [ΔC(a‐v)O2]. Peak exercise, CO and SV increased significantly in both groups (CO from 5.5 ± 1.4 L/min to 6.3 ± 1.5 and from 6.2 ± 2.4 to 6.7 ± 2.0, SV from 57 ± 19 mL to 66 ± 20 and from 62 ± 20 to 69 ± 20, in FMR and PMR, respectively), whereas peak VO2 was unchanged and ΔC(a‐v)O2 decreased. Conclusions These data confirm pMVR‐induced clinical improvement and reverse ventricular remodelling at a 6‐month analysis and show, in spite of an increase in CO, an unchanged exercise performance, which is achieved through a ‘more physiological’ blood flow distribution and O2 extraction behaviour. Direct rest and exercise CO should be measured to assess pMVR efficacy.
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Affiliation(s)
- Carlo Vignati
- Centro Cardiologico Monzino, IRCCS, Milan, Italy.,Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | | | | | | | | | - Antonio Bartorelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy.,Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Mauro Pepi
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Francesco Alamanni
- Centro Cardiologico Monzino, IRCCS, Milan, Italy.,Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | | | | | | | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milan, Italy.,Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
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Muratori M, Fusini L, Ghulam Ali S, Teruzzi G, Corrieri N, Gripari P, Mapelli M, Annoni A, Tamborini G, Rabbat MG, Pontone G, Alamanni F, Montorsi P, Pepi M. Detection of Mechanical Prosthetic Valve Dysfunction. Am J Cardiol 2021; 150:101-109. [PMID: 34020771 DOI: 10.1016/j.amjcard.2021.03.055] [Citation(s) in RCA: 3] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/29/2021] [Accepted: 03/30/2021] [Indexed: 01/01/2023]
Abstract
The long-term outcome of mechanical aortic and mitral prosthetic valve (A-PV, M-PV) dysfunction (PVD) remains a serious complication associated with high morbidity and mortality. We sought to evaluate the incremental diagnostic value of combined transthoracic echocardiography (TTE) and fluoroscopy (F) in patients with suspected PVD. A total of 354 patients (178 A-PV, 176 M-PV) were imaged by TTE and F within 5 days of hospital admission. PVD was confirmed by transesophageal echocardiography, computed tomography, effective thrombolysis, or surgical inspection. PVD was confirmed in 101 patients (57%) with M-PV and 99 (55%) with A-PV. Regardless of the mechanism of PVD, TTE shows good sensitivity and specificity, with accuracy of 80% for M-PV and 91% for A-PV. F shows high specificity, but low sensitivity with accuracy of 68% for M-PV and 78% for A-PV. The integration of TTE + F significantly improved accuracy both for M-PV (83%) and A-PV (96%). At ROC analysis, the combined model of TTE + F showed the highest area under the curve for the detection of PVD compared with TTE and F alone (p < 0.001). In conclusion, in patients with a clinical suspicion of PVD, the combined model of TTE + F offers incremental value over TTE or F alone. This multimodality imaging approach overcomes limitations of TTE or F alone and provides prompt identification of patients who may require further imaging assessment and/or closer follow up.
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Affiliation(s)
- Manuela Muratori
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy.
| | - Laura Fusini
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Sarah Ghulam Ali
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Giovanni Teruzzi
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Nicoletta Corrieri
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Paola Gripari
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Massimo Mapelli
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Andrea Annoni
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Gloria Tamborini
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Mark G Rabbat
- Division of Cardiology, Loyola University of Chicago, Chicago, IL; Edward Hines Jr. VA Hospital, Hines, IL
| | - Gianluca Pontone
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Francesco Alamanni
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | - Piero Montorsi
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | - Mauro Pepi
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
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Volpato V, Mantegazza V, Tamborini G, Gripari P, Muratori M, Fusini L, Zanobini M, Alamanni F, Pepi M. Tricuspid annular dilation in patients undergoing early mitral valve surgery: is it an old story? Int J Cardiovasc Imaging 2021; 37:2439-2446. [PMID: 33899135 DOI: 10.1007/s10554-021-02223-1] [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] [Received: 12/26/2020] [Accepted: 03/09/2021] [Indexed: 11/29/2022]
Abstract
Patients with mitral valve prolapse (MVP), undergoing early surgery for severe regurgitation, are usually characterized by a low degree of right chambers' remodeling. In this selected population, the mechanisms leading to tricuspid annular (TA) dilatation (TAD) are not well understood. In this setting, we aimed to evaluate, using three-dimensional echocardiography (3DE), how right chambers affect TA size and might contribute to functional tricuspid regurgitation (FTR) progression. We studied 159 patients treated with early isolated surgery for MVP, characterized by: sinus rhythm; normal biventricular function; normal or elevated pulmonary artery pressure; tricuspid regurgitation (TR) ≤ mild; no concomitant cardiac disease. All patients reached a 3-year echocardiographic follow-up. Based on two-dimensional echocardiography, patients were divided in Group 1 (N = 68, 43%, TAD, TA ≥ 21 mm/m2) and Group 2 (N = 91, 57%, no TAD, TA < 21 mm/m2). By 3DE, Group 1 showed larger TA size, right atrial (RA) volume and right ventricular (RV) conical remodeling compared to Group 2 (p < 0.05). The multivariate analysis revealed that RA volume, RV basal diameter and function were independently correlated to TA size (p < 0.05). At the 3-year follow-up there was a low incidence of FTR, with a trend towards FTR progression in Group 1 (p = 0.07). In patients undergoing early surgery for MVP, TAD seems to result from distinctive early-onset geometrical changes of the right chambers, preceding TR, RV dilatation and pulmonary hypertension at rest. An integrated approach, including right chambers' assessment by 3DE, might help to better recognized patients at higher risk for TAD and, potentially for FTR.
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Affiliation(s)
- Valentina Volpato
- Department of Cardiovascular Imaging - Centro, Cardiologico Fondazione Monzino IRCCS, via Carlo Parea 4, 20138, Milan, MI, Italy.
| | - Valentina Mantegazza
- Department of Cardiovascular Imaging - Centro, Cardiologico Fondazione Monzino IRCCS, via Carlo Parea 4, 20138, Milan, MI, Italy
| | - Gloria Tamborini
- Department of Cardiovascular Imaging - Centro, Cardiologico Fondazione Monzino IRCCS, via Carlo Parea 4, 20138, Milan, MI, Italy
| | - Paola Gripari
- Department of Cardiovascular Imaging - Centro, Cardiologico Fondazione Monzino IRCCS, via Carlo Parea 4, 20138, Milan, MI, Italy
| | - Manuela Muratori
- Department of Cardiovascular Imaging - Centro, Cardiologico Fondazione Monzino IRCCS, via Carlo Parea 4, 20138, Milan, MI, Italy
| | - Laura Fusini
- Department of Cardiovascular Imaging - Centro, Cardiologico Fondazione Monzino IRCCS, via Carlo Parea 4, 20138, Milan, MI, Italy
| | - Marco Zanobini
- Department of Cardiovascular Imaging - Centro, Cardiologico Fondazione Monzino IRCCS, via Carlo Parea 4, 20138, Milan, MI, Italy
| | - Francesco Alamanni
- Department of Cardiovascular Imaging - Centro, Cardiologico Fondazione Monzino IRCCS, via Carlo Parea 4, 20138, Milan, MI, Italy
| | - Mauro Pepi
- Department of Cardiovascular Imaging - Centro, Cardiologico Fondazione Monzino IRCCS, via Carlo Parea 4, 20138, Milan, MI, Italy
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Penso M, Pepi M, Fusini L, Muratori M, Cefalù C, Mantegazza V, Gripari P, Ali SG, Fabbiocchi F, Bartorelli AL, Caiani EG, Tamborini G. Predicting Long-Term Mortality in TAVI Patients Using Machine Learning Techniques. J Cardiovasc Dev Dis 2021; 8:jcdd8040044. [PMID: 33923465 PMCID: PMC8072967 DOI: 10.3390/jcdd8040044] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/19/2021] [Accepted: 04/13/2021] [Indexed: 12/27/2022] Open
Abstract
Background: Whereas transcatheter aortic valve implantation (TAVI) has become the gold standard for aortic valve stenosis treatment in high-risk patients, it has recently been extended to include intermediate risk patients. However, the mortality rate at 5 years is still elevated. The aim of the present study was to develop a novel machine learning (ML) approach able to identify the best predictors of 5-year mortality after TAVI among several clinical and echocardiographic variables, which may improve the long-term prognosis. Methods: We retrospectively enrolled 471 patients undergoing TAVI. More than 80 pre-TAVI variables were collected and analyzed through different feature selection processes, which allowed for the identification of several variables with the highest predictive value of mortality. Different ML models were compared. Results: Multilayer perceptron resulted in the best performance in predicting mortality at 5 years after TAVI, with an area under the curve, positive predictive value, and sensitivity of 0.79, 0.73, and 0.71, respectively. Conclusions: We presented an ML approach for the assessment of risk factors for long-term mortality after TAVI to improve clinical prognosis. Fourteen potential predictors were identified with the organic mitral regurgitation (myxomatous or calcific degeneration of the leaflets and/or annulus) which showed the highest impact on 5 years mortality.
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Affiliation(s)
- Marco Penso
- Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy; (M.P.); (L.F.); (M.M.); (C.C.); (V.M.); (P.G.); (S.G.A.); (F.F.); (A.L.B.); (G.T.)
- Correspondence: ; Tel.: +39-392-693-0900
| | - Mauro Pepi
- Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy; (M.P.); (L.F.); (M.M.); (C.C.); (V.M.); (P.G.); (S.G.A.); (F.F.); (A.L.B.); (G.T.)
| | - Laura Fusini
- Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy; (M.P.); (L.F.); (M.M.); (C.C.); (V.M.); (P.G.); (S.G.A.); (F.F.); (A.L.B.); (G.T.)
| | - Manuela Muratori
- Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy; (M.P.); (L.F.); (M.M.); (C.C.); (V.M.); (P.G.); (S.G.A.); (F.F.); (A.L.B.); (G.T.)
| | - Claudia Cefalù
- Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy; (M.P.); (L.F.); (M.M.); (C.C.); (V.M.); (P.G.); (S.G.A.); (F.F.); (A.L.B.); (G.T.)
| | - Valentina Mantegazza
- Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy; (M.P.); (L.F.); (M.M.); (C.C.); (V.M.); (P.G.); (S.G.A.); (F.F.); (A.L.B.); (G.T.)
| | - Paola Gripari
- Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy; (M.P.); (L.F.); (M.M.); (C.C.); (V.M.); (P.G.); (S.G.A.); (F.F.); (A.L.B.); (G.T.)
| | - Sarah Ghulam Ali
- Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy; (M.P.); (L.F.); (M.M.); (C.C.); (V.M.); (P.G.); (S.G.A.); (F.F.); (A.L.B.); (G.T.)
| | - Franco Fabbiocchi
- Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy; (M.P.); (L.F.); (M.M.); (C.C.); (V.M.); (P.G.); (S.G.A.); (F.F.); (A.L.B.); (G.T.)
| | - Antonio L. Bartorelli
- Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy; (M.P.); (L.F.); (M.M.); (C.C.); (V.M.); (P.G.); (S.G.A.); (F.F.); (A.L.B.); (G.T.)
- Department of Biomedical and Clinical Sciences “Luigi Sacco”, University of Milan, 20157 Milan, Italy
| | - Enrico G. Caiani
- Department of Electronics, Information and Biomedical Engineering, Politecnico di Milano, 20133 Milan, Italy;
| | - Gloria Tamborini
- Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy; (M.P.); (L.F.); (M.M.); (C.C.); (V.M.); (P.G.); (S.G.A.); (F.F.); (A.L.B.); (G.T.)
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Gennari M, Rigoni M, Mastroiacovo G, Trabattoni P, Roberto M, Bartorelli AL, Fabbiocchi F, Tamborini G, Muratori M, Fusini L, Pepi M, Muti P, Polvani G, Agrifoglio M. Proper Selection Does Make the Difference: A Propensity-Matched Analysis of Percutaneous and Surgical Cut-Down Transfemoral TAVR. J Clin Med 2021; 10:jcm10050909. [PMID: 33669044 PMCID: PMC7956334 DOI: 10.3390/jcm10050909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/17/2021] [Accepted: 02/18/2021] [Indexed: 11/22/2022] Open
Abstract
Background. Transcatheter aortic valve replacement (TAVR) is an established technique to treat severe symptomatic aortic stenosis patients with a wide range of surgical risk. Currently, the common femoral artery is the first choice as the main access route for the procedure. The objective of this observational study is to report our experience on percutaneous and surgical cut-down transfemoral TAVRs comparing the two approaches. Methods. From January 2014 to January 2019, five hundred eleven consecutive patients underwent TAVR for severe symptomatic aortic stenosis. We analyzed only elective transfemoral procedures. After propensity score-matching based on age, sex, EuroSCORE II, mean aortic gradient, and left ventricular ejection fraction, we obtained two homogeneous populations: surgical cut-down (n = 119) and percutaneous (n = 225), which were labeled Group 1 and Group 2, respectively. Results. The main findings were that there were no significant procedural outcome differences between the two groups, but Group 2 patients had a shorter length of hospital stay and were more frequently discharged home. At follow-up, Group 1 patients had lower survival rates. Conclusions. An accurate preoperative assessment of the femoral access is mandatory to achieve satisfactory outcomes with transfemoral TAVRs. Nevertheless, the percutaneous approach allows shorter in-hospital stay and the need for rehabilitation, thus potentially decreasing the costs of the procedure.
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Affiliation(s)
- Marco Gennari
- Department of Cardiovascular Surgery, IRCCS Centro Cardiologico Monzino, 20100 Milan, Italy; (G.M.); (P.T.); (M.R.); (M.A.)
- Correspondence: ; Tel.: +39-02-58-0022-96
| | - Marta Rigoni
- Department of Industrial Engineering, University of Trento, 38100 Trento, Italy;
- Department of Oncology and Health, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada;
| | - Giorgio Mastroiacovo
- Department of Cardiovascular Surgery, IRCCS Centro Cardiologico Monzino, 20100 Milan, Italy; (G.M.); (P.T.); (M.R.); (M.A.)
| | - Piero Trabattoni
- Department of Cardiovascular Surgery, IRCCS Centro Cardiologico Monzino, 20100 Milan, Italy; (G.M.); (P.T.); (M.R.); (M.A.)
| | - Maurizio Roberto
- Department of Cardiovascular Surgery, IRCCS Centro Cardiologico Monzino, 20100 Milan, Italy; (G.M.); (P.T.); (M.R.); (M.A.)
| | - Antonio L. Bartorelli
- Department of Biomedical and Clinical Sciences “Luigi Sacco”, University of Milan, 20100 Milan, Italy;
| | - Franco Fabbiocchi
- Department of Invasive Cardiology, IRCCS Centro Cardiologico Monzino, 20100 Milan, Italy;
| | - Gloria Tamborini
- Department of Cardiovascular Imaging, IRCCS Centro Cardiologico Monzino, 20100 Milan, Italy; (G.T.); (M.M.); (L.F.)
| | - Manuela Muratori
- Department of Cardiovascular Imaging, IRCCS Centro Cardiologico Monzino, 20100 Milan, Italy; (G.T.); (M.M.); (L.F.)
| | - Laura Fusini
- Department of Cardiovascular Imaging, IRCCS Centro Cardiologico Monzino, 20100 Milan, Italy; (G.T.); (M.M.); (L.F.)
| | - Mauro Pepi
- Clinical Area Director, IRCCS Centro Cardiologico Monzino, 20100 Milan, Italy;
| | - Paola Muti
- Department of Oncology and Health, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada;
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20100 Milan, Italy;
| | - Gianluca Polvani
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20100 Milan, Italy;
- Chief of Cardiovascular Surgery Department, IRCCS Centro Cardiologico Monzino, 20100 Milan, Italy
| | - Marco Agrifoglio
- Department of Cardiovascular Surgery, IRCCS Centro Cardiologico Monzino, 20100 Milan, Italy; (G.M.); (P.T.); (M.R.); (M.A.)
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20100 Milan, Italy;
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Fusini L, Muratori M, Ghulam Ali S, Gripari P, Cefalu" C, Junod D, Fabbiocchi F, Roberto M, Trabattoni P, Agrifoglio M, Bartorelli AL, Alamanni F, Pepi M, Tamborini G. Prosthesis-patient mismatch after aortic valve in valve procedure: incidence, predictors and clinical outcomes. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background. Transcatheter aortic valve-in-valve (TAVI ViV) implantation is an appealing treatment option for patients with degenerated bioprostheses. However, elevated residual gradients after TAVI ViV procedure are very common. These are an unwanted effects of prosthesis-patient mismatch (PPM). Currently, the actual incidenceof PPM, its predictors and its clinical outcomes have not been completely investigated.
Purpose. The aims of this study was to investigate the incidence, predictors and clinical outcome of PPM and therefore of elevated gradients after TAVI ViV.
Methods. 75 patients (age 78 ± 9 years, 36 male), who underwent TAVI-ViV due to failed aortic biological valve (60 stented, 15 stentless), were enrolled. Mechanism of bioprosthetic valve failure was stenosis (34 cases, 45%), regurgitation (24 cases, 32%) or combination (17 cases, 23%). Elevated residual gradients were defined as a mean DP> 20 mmHg. PPM was identified by the indexed effective orifice area (EOAi) measured by echocardiography (moderate PPM if 0.65 < EOAi < 0.85 cm²/m²; severe PPM if EOAi < 0.6 cm²/m²).
Results. ViV TAVI was feasible in all patients, 33 patients (44%) were implanted with a balloon-expandable valve and 42 (56%) with a self-expandable valve. Post-procedural post-ballooning was performed in 16 out of 42 patients (38%) receiving a self-expandable valve. Post-operative mean DP> 20 mmHg was found in 35 patients (48%). Moderate PPM was found in 24 cases (33%) and severe PPM in 15 (20%). A logistic regression analyses identified small size of surgical prosthesis (size < 23 mm) [OR: 6.061(2.127-17.267), p = 0.001] and failed stented valve [OR: 20.727(2.522-170.364), p = 0.005] as independent predictors for the occurrence PPM. Interestingly PPM did not affect early and 1 years mortality (1 years mortality 1.3 %), while mortality was higher in pts with stentless prostheses (9%)
Conclusions. PPM is a frequent finding after ViV procedures. Despite elevated residual gradients, TAVI ViV resolved prosthetic dysfunction and PPM did not affect mortality. Therefore, this procedure represents a promising new option for patients with failed biological prosthetic valves.
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Affiliation(s)
- L Fusini
- Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - M Muratori
- Centro Cardiologico Monzino IRCCS, Milan, Italy
| | | | - P Gripari
- Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - C Cefalu"
- Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - D Junod
- Centro Cardiologico Monzino IRCCS, Milan, Italy
| | | | - M Roberto
- Centro Cardiologico Monzino IRCCS, Milan, Italy
| | | | | | | | - F Alamanni
- Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - M Pepi
- Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - G Tamborini
- Centro Cardiologico Monzino IRCCS, Milan, Italy
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Pappalardo O, Pasquali M, Maltagliati A, Rossini G, Italiano G, Fusini L, Penso M, Tamborini G, Andreini D, Redaelli A, Pepi M. A platform for real-3d visualization and planning of left atrial appendage occlusion through mixed reality. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
In left atrial appendage occlusion (LAAO), pre-procedural computed tomography (CT) is pivotal to describe the complex and highly variable LAA anatomy and to guide the operator in accurate planning of the intervention. Multiplanar reconstruction and 3D rendering are used for the navigation and analysis of the 3D datasets but they share some limitations that are due to the use of 2D screens; Mixed Reality (MxR) technology aims at overcoming such limitations by allowing for real-3D visualizations with holographic replicas of anatomical models while preserving a sense of presence within the true physical environment by the operator.
Purpose
To develop and test a MxR platform that provides a more intuitive and informative tool for the morphological analysis during the planning phase of LAAO.
Methods
Patients (n = 4) were randomly selected among those referred for a CT scan prior to transcatheter aortic valve replacement, each one characterized by a specific LAA morphology (cauliflower, bilobular, chicken wing, wind-sock). CT scans were performed in diastole at 75% of the R-R interval on a 64-slice scanner, with in-plane resolution 0.38-0.64 mm and slice thickness 0.62 mm. Firstly, the acquisition was cropped to contain the left atrium, the circumflex artery, the left upper pulmonary ridge. Subsequently, an isosurface with high coincidence between the blood cavity border and the endocardium was identified by the user and processed using a marching cube algorithm to obtain the 3D model. Finally, the 3D model was optimized for a MxR platform that allows for moving, zooming and cutting the model, measuring the main LAA linear dimensions and simulating the implant of a virtual replica of a transcatheter occluder.
Results
The workflow was successfully applied for all the patients independently from the morphology. All the models were successfully uploaded in the MxR platform (Fig 1.a) and for all the patients the morphological analysis was performed (Fig 1.b) in less than 10 minutes.
The four different morphologies of the LAA were correctly identified allowing a very detailed holographic modeling of the structure, including the neck, the landing zone, the curvature and the position and size of lobes.
For both the identified ostium and landing planes, using a dedicated measuring tool (Fig. 1.c), the operator measured the minimum and maximum diameters, which were later used to define the size of the occluder device to be used in the virtual implant simulation (Fig. 1.d).
Conclusions
The tested MxR platform suggested the potential to overcome the limits of the standard technologies in planning of LAAO thanks to the real-3D perception, potentially leading to a more accurate and faster planning phase. Furthermore, the use of MxR technology may enhance the ability to predict the optimal device size and position within the anatomy to obtain LAA complete sealing.
Abstract Figure.
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Affiliation(s)
| | | | | | | | - G Italiano
- IRCCS Centro Cardiologico Monzino, Milan, Italy
| | - L Fusini
- IRCCS Centro Cardiologico Monzino, Milan, Italy
| | - M Penso
- IRCCS Centro Cardiologico Monzino, Milan, Italy
| | - G Tamborini
- IRCCS Centro Cardiologico Monzino, Milan, Italy
| | - D Andreini
- IRCCS Centro Cardiologico Monzino, Milan, Italy
| | - A Redaelli
- Politecnico di Milano, Dipartimento di Elettronica, Informazione e Bioingegneria, Milano, Italy
| | - M Pepi
- IRCCS Centro Cardiologico Monzino, Milan, Italy
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Italiano G, Tamborini G, Mantegazza V, Volpato V, Fusini L, Muratori M, Lang R, Pepi M. Feasibility and accuracy of the automated software for dynamic quantification of left ventricular and atrial volumes and function in a large unselected population. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Objective. Preliminary studies showed the accuracy of machine learning based automated dynamic quantification of left ventricular (LV) and left atrial (LA) volumes. We aimed to evaluate the feasibility and accuracy of machine learning based automated dynamic quantification of LV and LA volumes in an unselected population.
Methods. We enrolled 600 unselected patients (12% in atrial fibrillation) clinically referred for transthoracic echocardiography (2DTTE), who also underwent 3D echocardiography (3DE) imaging. LV ejection fraction (EF), LV and LA volumes were obtained from 2D images; 3D images were analysed using Dynamic Heart Model (DHM) software (Philips) resulting in LV and LA volume-time curves. A subgroup of 140 patients underwent also cardiac magnetic resonance (CMR) imaging. Average time of analysis, feasibility, and image quality were recorded and results were compared between 2DTTE, DHM and CMR.
Results. The use of DHM was feasible in 522/600 cases (87%). When feasible, the boundary position was considered accurate in 335/522 patients (64%), while major (n = 38) or minor (n = 149) borders corrections were needed. The overall time required for DHM datasets was approximately 40 seconds, resulting in physiologically appearing LV and LA volume–time curves in all cases. As expected, DHM LV volumes were larger than 2D ones (end-diastolic volume: 173 ± 64 vs 142 ± 58 mL, respectively), while no differences were found for LV EF and LA volumes (EF: 55%±12 vs 56%±14; LA volume 89 ± 36 vs 89 ± 38 mL, respectively). The comparison between DHM and CMR values showed a high correlation for LV volumes (r = 0.70 and r = 0.82, p < 0.001 for end-diastolic and end-systolic volume, respectively) and an excellent correlation for EF (r= 0.82, p < 0.001) and LA volumes.
Conclusions. The DHM software is feasible, accurate and quick in a large series of unselected patients, including those with suboptimal 2D images or in atrial fibrillation.
Table 1 DHM quality Adjustment Feasibility Good Suboptimal Minor Major Total of patients (n, %) 522/600 (87%) 327/522 (62%) 195/522 (28%) 149/522 (29%) 38/522 (6%) Normal subjects (n, %) 39/40 (97%) 23/39 (57%) 16/39 (40%) 9/39 (21%) 1/39 (3%) Atrial Fibrillation (n, %) 59/73 (81%)* 28/59 (47%) 31/59 (53%) 15/59 (25%) 6/59 (10%) Valvular disease (n, %) 271/312 (87%) 120/271 (%) 151/271 (%) 65/271 (24%) 16/271 (6%) Coronary artery disease (n, %) 47/58 (81%)* 26/47 (46%) 21/47 (37%) 16/47 (34%) 5/47 (11%) Miscellaneous (n, %) 24/25 (96%) 18/24 (75%) 6/24 (25%) 5/24 (21%) 3/24 (12%) Feasibility of DHM, image quality and need to adjustments in global population and in each subgroup. Abstract Figure 1
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Affiliation(s)
- G Italiano
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - G Tamborini
- Cardiology Center Monzino IRCCS, Milan, Italy
| | | | - V Volpato
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - L Fusini
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - M Muratori
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - R Lang
- University of Chicago Medical Center, Chicago, United States of America
| | - M Pepi
- Cardiology Center Monzino IRCCS, Milan, Italy
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Fusini L, Maltagliati AC, Alimento ML, Italiano G, Pepi M, Tamborini G, Galli CA. Comparison between two anticoagulant regimens to prevent thrombosis in atrial fibrillation: an analysis mediated by transesophageal echocardiography. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background. Atrial fibrillation (AF) is the most common cardiac arrhythmia causing left atrial appendage thrombosis (LAA-T) which can result in cerebral and systemic embolism. Nowadays, both vitamin K antagonists (VKA) and Direct Oral Anti Coagulants (DOAC) are effective for the prevention of ischaemic stroke in AF. Transesophageal echocardiography (TEE) is the best method to detect LAA-T in AF. However, data on the prevalence of LAA-T are lacking.
Purpose. The aim of the study was 1) to evaluate the prevalence of LAA-T in patients affected by AF, receiving different anticoagulation regimens and candidates to cardioversion or catheter ablation 2) to correlate the presence of LAA-T with clinical and echocardiographic data.
Methods. This is an observational, single-center study including 796 patients (73% male) with AF. TEE before cardioversion or catheter ablation was performed in all patients. Patients with mechanical prosthetic valve and severe mitral stenosis were excluded. Patients were divided in 2 groups according to anticoagulation regimen: Group 1 including patients on DOAC (dabigatran, rivaroxaban, apixaban, edoxaban) and Group 2 including patients on VKA at therapeutic dose.
Results
Group 1 included 369 patients (46%), Group 2 427 (54%). Age, CHA2DS2-VASc score, sex and pathology distribution (lone FA, hypertension, valve disease, ischemic cardiomyopathy, dilated cardiomyopathy, hypertrophic cardiomyopathy) were similar in the 2 groups. The overall prevalence of LAA-T was 43 cases (5%). Similar percentage of LAA-T was found regardless of anticoagulation regimen (Group 1: 16 cases, 4%; Group 2: 27 cases, 6%, p = 0.220). No difference in LAA-T prevalence was detected within Group 1 for different DOACs (p = 0.547). Patients with LAA-T were more frequently older (p = 0.023), female (p = 0.001), with higher CHA2DS2-VASc score (p = 0.002), affected by hypertrophic cardiomyopathy (p = 0.019), valve disease or bioprostetic valve (p = 0.001) regardless of anticoagulation regimen. A total of 697 patients (88%) were scheduled for cardioversion or catheter ablation. Cardioversion was successful in 667 patients (95%) without any ischemic event. Only 1 patient (0.1%) undergoing catheter ablation had a major ischemic event.
Conclusions
Efficacy of anticoagulation with VKA and DOAC is similar in preventing LAA-T in patients with AF. However, despite optimal adherence to a therapeutic regimen, several clinical factors (age, gender, high CHA2DS2-VASc score, hypertrophic cardiomyopathy and valvular disease) were associated with higher prevalence of LAA-T. TEE guided approach to cardioversion may prevent the risk of embolic events regardless of anticoagulation regimen used.
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Affiliation(s)
- L Fusini
- Centro Cardiologico Monzino IRCCS, Milan, Italy
| | | | - ML Alimento
- Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - G Italiano
- Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - M Pepi
- Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - G Tamborini
- Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - CA Galli
- Centro Cardiologico Monzino IRCCS, Milan, Italy
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Volpato V, Mantegazza V, Tamborini G, Gripari P, Muratori M, Italiano G, Fusini L, Pepi M. Role of the tricuspid annulus in functional tricuspid regurgitation development after early isolated mitral valve surgery: is it an old story? Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background. Functional Tricuspid Regurgitation (FTR) has been described as a common condition after isolated mitral valve (MV) surgery, affecting patients’ prognosis. Thus, in cases without significant tricuspid regurgitation (TR) but tricuspid annular (TA) dilatation, TV annuloplasty is currently recommended. Studies suggesting the currently used cut-off for definition of TA dilatation were based on 2D echocardiography (2DE) and included patients treated with MV surgery with heterogeneous MV disease, degree of cardiac remodeling and heart rhythm. As the management of severe MR has moved towards an earlier surgical treatment, few data are available about the incidence of FTR in the population undergoing early isolated MV surgery without TR, but 2DE satisfying criteria for TA dilatation.
Aims. To test, in patients treated with early isolated MV surgery for MV prolapse (MVP), without TR and either normal or dilated TA (i) if the currently used 2D TA cut-off is predictive of FTR and cardiac events development (ii) how right chambers’ remodeling assessed by 3D echocardiography (3DE) affects TA dimension.
Methods. We studied 159 patients (age 61 ± 11) treated with early isolated MV surgery between 2010 and 2017. Eligible patients were those with 3DE images; normal left and right ventricular (LV and RV) function; sinus rhythm; normal or elevated right ventricular systolic pulmonary artery pressure (sPAP); normal or dilated TA by 2DE; absent TR. The decision to not perform TV annuloplasty in patients with TA dilatation was based on the surgical inspection. All patients underwent a complete 2DE, 3DE analysis was performed using custom software, including LV, RV, left atrial (LA) and right atrial (RA) assessment. 3D TA dimension were obtained using MPR. Clinical and 2DE follow-up was performed at 36 ± 6 months after surgery, major adverse cardiac events (MACEs, including cardiac hospitalization, cardiac death, arrhythmias) and FTR were recorded.
Results. Based on 2DE TA dimensions, patients were divided in group 1 (N = 68, 43%, TA≥21 mm/m²) and group 2 (N= 91, 57%, normal TA). Patients in group 1 showed larger RA volume, RV basal diameter and TA area (p < 0.05) by 3DE compared to group 2 (Table). At the multivariate analysis, only the 3D RA volume, RV basal diameter and RV function were independently correlated to the TA area (p < 0.05). At the follow-up, no differences were noted between groups in FTR development and MACEs at the Kaplan-Meier analysis (Fig.). At the COX analysis, 2DE TA dilatation failed to result a predictor of cardiovascular events (model’s X2, p > 0.05).
Conclusions. In patients undergoing early MV surgery, the currently defined TA dilatation by 2DE may not necessarily evolve in FTR, and a larger cut-off may be needed. In this population, the evaluation of right chambers’ dimension and function may better define the probability to develop FTR.
Abstract Figure. Fig
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Affiliation(s)
- V Volpato
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - V Mantegazza
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - G Tamborini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - P Gripari
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - M Muratori
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - G Italiano
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - L Fusini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - M Pepi
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
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Mantegazza V, Volpato V, Gripari P, Ghulam Ali S, Fusini L, Italiano G, Muratori M, Pontone G, Tamborini G, Pepi M. Response to: 'Size of the shadow'. Heart 2021; 107:heartjnl-2020-318919. [PMID: 33509979 DOI: 10.1136/heartjnl-2020-318919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Valentina Mantegazza
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milano, Italy
| | - Valentina Volpato
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milano, Italy
| | - Paola Gripari
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milano, Italy
| | - Sarah Ghulam Ali
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milano, Italy
| | - Laura Fusini
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milano, Italy
| | - Gianpiero Italiano
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milano, Italy
| | - Manuela Muratori
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milano, Italy
| | - Gianluca Pontone
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milano, Italy
| | - Gloria Tamborini
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milano, Italy
| | - Mauro Pepi
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milano, Italy
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Italiano G, Fusini L, Mantegazza V, Tamborini G, Muratori M, Ghulam Ali S, Penso M, Garlaschè A, Gripari P, Pepi M. Novelties in 3D Transthoracic Echocardiography. J Clin Med 2021; 10:jcm10030408. [PMID: 33494387 PMCID: PMC7865963 DOI: 10.3390/jcm10030408] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/15/2021] [Accepted: 01/19/2021] [Indexed: 12/20/2022] Open
Abstract
Cardiovascular imaging is developing at a rapid pace and the newer modalities, in particular three-dimensional echocardiography, allow better analysis of heart structures. Identifying valve lesions and grading their severity represents crucial information and nowadays is strengthened by the introduction of new software, such as transillumination, which provide detailed morphology descriptions. Chambers quantification has never been so rapid and accurate: machine learning algorithms generate automated volume measurements, including left ventricular systolic and diastolic function, which is extremely important for clinical decisions. This review provides an overview of the latest innovations in the echocardiography field, and is helpful by providing a better insight into heart diseases.
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Volpato V, Mantegazza V, Tamborini G, Gripari P, Muratori M, Alamanni F, Zanobini M, Fusini L, Pepi M. Is 3D analysis of longitudinal strain useful to predict long-term cardiac events in patients undergoing early mitral valve surgery? Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
In patients with mitral valve prolapse (MVP) and significant mitral regurgitation (MR), the presence of reduced 3D left ventricular (LV) global longitudinal strain (GLS) has already been described. However, precise data about this finding in predicting long-term cardiac events are lacking, especially in patients after MV surgery. Particularly, few data are available about the role of 3D GLS in events prediction in patients diagnosed with Barlow or Fibro-Elastic-Deficiency (FED) disease.
Aim
To determinate whether 3D LV GLS may identify a subgroup of patients with MVP and severe MR at higher risk for cardiac events after MV surgery.
Methods
We studied 143 patients diagnosed with MVP with normal LV function, who underwent isolated MV surgery between 2011 and 2017 for severe MR. A comprehensive 2D transthoracic echocardiography (TTE) analysis was performed, degree of MR was obtained using the PISA method (Proximal Isovelocity Surface Area), degree of tricuspid regurgitation was visually estimated. 3D analysis using custom software provided measurement of left atrial (LA) and right atrial (RA) dimension, right ventricular (RV) dimension and function and LV size and function including global longitudinal strain (GLS). Cardiac events (including cardiac death, arrhythmia, hospitalization for heart failure, embolic events or arrhythmia) were recorded during a follow-up of 4.6±2 years.
Results
Study patients were diagnosed with Barlow or FED in 92 (65%) and 51 (35%) of cases, respectively. The baseline 3D analysis showed left chambers dilatation with normal LV function and normal GLS, normal right chambers and systolic pulmonary artery pressure (sPAP). Based on 3D GLS, patients were divided in Group 1 (N=84, 59%, normal GLS ≥−21%) and Group 2 (N=59, 41%, reduced GLS ≤−20%). No differences were noted at baseline between groups (Table 1). At the follow-up, 43 events were recorded, including 1 death, 12 hospitalizations (3 for heart failure, 3 for embolic events and 6 for atrial fibrillation – AF) and 30 minor arrhythmic events, mostly premature ventricular complex (PVCs) and AF. The Kaplan Meier analysis showed no differences in cardiac events between groups (Figure 1, A). Among patients with Barlow, a significant difference in events was detected between patients with reduced and normal GLS at the Kaplan Meier analysis (Figure 1, B). This finding was not found in FED patients.
Conclusions
Patients undergoing MV surgery for MVP with initial LV remodeling and normal function, seem to be characterized by a low rate of major cardiac events. Interestingly, only in the Barlow population, a reduced 3D LV GLS strain may detect cases at higher risk of minor cardiac events, mostly minor arrhythmia.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- V Volpato
- Cardiology Center Monzino IRCCS, Milan, Italy
| | | | - G Tamborini
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - P Gripari
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - M Muratori
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - F Alamanni
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - M Zanobini
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - L Fusini
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - M Pepi
- Cardiology Center Monzino IRCCS, Milan, Italy
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Trabattoni D, Gili S, Teruzzi G, Tamborini G. A severe right-to-left intracardiac shunt after NobleStitch failure: when a device is needed. Eur Heart J Case Rep 2020; 4:1-4. [PMID: 33204941 PMCID: PMC7649439 DOI: 10.1093/ehjcr/ytaa162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 02/24/2020] [Accepted: 05/19/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Transcatheter closure of patent foramen ovale (PFO) has been demonstrated to be superior to medical therapy in stroke prevention in selected patients. Beyond traditional permanent metallic devices, NobleStitch EL, a suture-based system, has been developed as a potential alternative. CASE SUMMARY A 50-year-old man underwent transcatheter closure of PFO with mild interatrial septal bulging and tunnel-like morphology with a NobleStitch device. A transthoracic echocardiography performed immediately after PFO closure showed residual shunt (RS), which persisted unchanged at staged controls, due to the inability of the delivery system to capture both the septum primum and the septum secundum. A second procedure was performed with the implantation of a Figulla Flex II 27/30 mm device, with no RS detectable at control echocardiography. DISCUSSION The NobleStitch device is interesting in its concept, but several pitfalls may be encountered during its deployment. Opposite to permanent metallic devices, RSs after the procedure are not expected to decrease over time and should be managed with a different approach.
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Affiliation(s)
| | - Sebastiano Gili
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea 4, Milan, Italy
| | - Giovanni Teruzzi
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea 4, Milan, Italy
| | - Gloria Tamborini
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea 4, Milan, Italy
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45
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Guglielmo M, Fusini L, Muscogiuri G, Baessato F, Loffreno A, Cavaliere A, Rizzon G, Baggiano A, Rabbat MG, Muratori M, Tamborini G, Danza LML, Del Torto A, Tonet E, Viani G, Mushtaq S, Conte E, Bonalumi G, Gripari P, Zanobini M, Andreini D, Alamanni F, Pepi M, Guaricci AI, Pontone G. T1 mapping and cardiac magnetic resonance feature tracking in mitral valve prolapse. Eur Radiol 2020; 31:1100-1109. [PMID: 32803414 DOI: 10.1007/s00330-020-07140-w] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 06/10/2020] [Accepted: 08/03/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVES T1 mapping (T1-map) and cardiac magnetic resonance feature tracking (CMR-FT) techniques have been introduced for the early detection of interstitial myocardial fibrosis and deformation abnormalities. We sought to demonstrate that T1-map and CMR-FT may identify the presence of subclinical myocardial structural changes in patients with mitral valve prolapse (MVP). METHODS Consecutive MVP patients with moderate-to-severe mitral regurgitation and comparative matched healthy subjects were prospectively enrolled and underwent CMR-FT analysis to calculate 2D global and segmental circumferential (CS) and radial strain (RS) and T1-map to determine global and segmental native T1 (nT1) values. RESULTS Seventy-three MVP patients (mean age, 57 ± 13 years old; male, 76%; regurgitant volume, 57 ± 21 mL) and 42 matched control subjects (mean age, 56 ± 18 years; male, 74%) were included. MVP patients showed a lower global CS (- 16.3 ± 3.4% vs. - 17.8 ± 1.9%, p = 0.020) and longer global nT1 (1124.9 ± 97.7 ms vs. 1007.4 ± 26.1 ms, p < 0.001) as compared to controls. Moreover, MVP patients showed lower RS and CS in basal (21.6 ± 12.3% vs. 27.6 ± 8.9%, p = 0.008, and - 13.0 ± 6.7% vs. - 14.9 ± 4.1%, p = 0.013) and mid-inferolateral (20.6 ± 10.7% vs. 28.4 ± 8.7%, p < 0.001, and - 12.8 ± 6.3% vs. - 16.5 ± 4.0%, p < 0.001) walls as compared to other myocardial segments. Similarly, MVP patients showed longer nT1 values in basal (1080 ± 68 ms vs. 1043 ± 43 ms, p < 0.001) and mid-inferolateral (1080 ± 77 ms vs. 1034 ± 37 ms, p < 0.001) walls as compared to other myocardial segments. Of note, nT1 values were significantly correlated with CS (r, 0.36; p < 0.001) and RS (r, 0.37; p < 0.001) but not with regurgitant volume. CONCLUSIONS T1-map and CMR-FT identify subclinical left ventricle tissue changes in patients with MVP. Further studies are required to correlate these subclinical tissue changes with the outcome. KEY POINTS • T1 mapping (T1-map) and cardiac magnetic resonance feature tracking (CMR-FT) techniques have been introduced for the early detection of interstitial myocardial fibrosis and deformation abnormalities. • In MVP patients, we demonstrated a longer global nT1 with associated reduced global circumferential (CS) and radial strain (RS) as compared to control subjects. • Among MVP patients, the mid-basal left ventricle inferolateral wall showed longer nT1 with reduced CS and RS as compared to other myocardial segments. Further studies are required to correlate these subclinical tissue changes with the outcome.
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Affiliation(s)
- Marco Guglielmo
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via C. Parea 4, 20138, Milan, Italy
| | - Laura Fusini
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via C. Parea 4, 20138, Milan, Italy
| | - Giuseppe Muscogiuri
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via C. Parea 4, 20138, Milan, Italy
| | - Francesca Baessato
- Divisione di Cardiologia, Dipartimento di Medicina, Università degli Studi, Verona, Italy
| | - Antonella Loffreno
- U.O.C. Cardiologia 1, Ospedale di Circolo e Fondazione Macchi, Università degli Studi, Varese, Italy
| | - Annachiara Cavaliere
- Dipartimento di Medicina, Istituto di Radiologia, Università degli Studi, Padua, Italy
| | - Giulia Rizzon
- Dipartimento di Medicina, Istituto di Radiologia, Università degli Studi, Padua, Italy
| | - Andrea Baggiano
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via C. Parea 4, 20138, Milan, Italy
| | - Mark G Rabbat
- Loyola University of Chicago, Chicago, IL, USA.,Edward Hines Jr. VA Hospital, Hines, IL, USA
| | - Manuela Muratori
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via C. Parea 4, 20138, Milan, Italy
| | - Gloria Tamborini
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via C. Parea 4, 20138, Milan, Italy
| | | | - Alberico Del Torto
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via C. Parea 4, 20138, Milan, Italy.,Department of Cardiovascular Sciences and Community Health, University of Milan, Milan, Italy
| | - Elisabetta Tonet
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, FE, Italy
| | - Giacomo Viani
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via C. Parea 4, 20138, Milan, Italy.,Department of Cardiovascular Sciences and Community Health, University of Milan, Milan, Italy
| | - Saima Mushtaq
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via C. Parea 4, 20138, Milan, Italy
| | - Edoardo Conte
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via C. Parea 4, 20138, Milan, Italy
| | - Giorgia Bonalumi
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via C. Parea 4, 20138, Milan, Italy
| | - Paola Gripari
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via C. Parea 4, 20138, Milan, Italy
| | - Marco Zanobini
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via C. Parea 4, 20138, Milan, Italy
| | - Daniele Andreini
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via C. Parea 4, 20138, Milan, Italy.,Department of Cardiovascular Sciences and Community Health, University of Milan, Milan, Italy
| | - Francesco Alamanni
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via C. Parea 4, 20138, Milan, Italy.,Department of Cardiovascular Sciences and Community Health, University of Milan, Milan, Italy
| | - Mauro Pepi
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via C. Parea 4, 20138, Milan, Italy
| | - Andrea I Guaricci
- Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital Policlinico of Bari, Bari, Italy
| | - Gianluca Pontone
- Centro Cardiologico Monzino IRCCS, Department of Cardiovascular Imaging, Via C. Parea 4, 20138, Milan, Italy.
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46
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Mantegazza V, Volpato V, Gripari P, Ghulam Ali S, Fusini L, Italiano G, Muratori M, Pontone G, Tamborini G, Pepi M. Multimodality imaging assessment of mitral annular disjunction in mitral valve prolapse. Heart 2020; 107:25-32. [PMID: 32723759 DOI: 10.1136/heartjnl-2020-317330] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/08/2020] [Accepted: 06/25/2020] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE Mitral annular disjunction (MAD) is an abnormality linked to mitral valve prolapse (MVP), possibly associated with malignant ventricular arrhythmias. We assessed the agreement among different imaging techniques for MAD identification and measurement. METHODS 131 patients with MVP and significant mitral regurgitation undergoing transthoracic echocardiography (TTE) and cardiac magnetic resonance (CMR) were retrospectively enrolled. Transoesophageal echocardiography (TOE) was available in 106 patients. MAD was evaluated in standard long-axis views (four-chamber, two-chamber, three-chamber) by each technique. RESULTS Considering any-length MAD, MAD prevalence was 17.3%, 25.5%, 42.0% by TTE, TOE and CMR, respectively (p<0.05). The agreement on MAD identification was moderate between TTE and CMR (κ=0.54, 95% CI 0.49 to 0.59) and good between TOE and CMR (κ=0.79, 95% CI 0.74 to 0.84). Assuming CMR as reference and according to different cut-off values for MAD (≥2 mm, ≥4 mm, ≥6 mm), specificity (95% CI) of TTE and TOE was 99.6 (99.0 to 100.0)% and 98.7 (97.4 to 100.0)%; 99.3 (98.4 to 100.0)% and 97.6 (95.8 to 99.4)%; 97.8 (96.2 to 99.3)% and 93.2 (90.3 to 96.1)%, respectively; sensitivity (95% CI) was 43.1 (37.8 to 48.4)% and 74.5 (69.4 to 79.5)%; 54.0 (48.7 to 59.3)% and 88.9 (85.2 to 92.5)%; 88.0 (84.5 to 91.5)% and 100.0 (100.0 to 100.0)%, respectively. MAD length was 8.0 (7.0-10.0), 7.0 (5.0-8.0], 5.0 (4.0-7.0) mm, respectively by TTE, TOE and CMR. Agreement on MAD measurement was moderate between TTE and CMR (ρ=0.73) and strong between TOE and CMR (ρ=0.86). CONCLUSIONS An integrated imaging approach could be necessary for a comprehensive assessment of patients with MVP and symptoms suggestive for arrhythmias. If echocardiography is fundamental for the anatomic and haemodynamic characterisation of the MV disease, CMR may better identify small length MAD as well as myocardial fibrosis.
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Affiliation(s)
- Valentina Mantegazza
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Valentina Volpato
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Paola Gripari
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Sarah Ghulam Ali
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Laura Fusini
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Gianpiero Italiano
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Manuela Muratori
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Gianluca Pontone
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Gloria Tamborini
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Mauro Pepi
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
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47
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Piazzese C, Carminati MC, Krause R, Auricchio A, Weinert L, Gripari P, Tamborini G, Pontone G, Andreini D, Lang RM, Pepi M, Caiani EG. 3D right ventricular endocardium segmentation in cardiac magnetic resonance images by using a new inter-modality statistical shape modelling method. Biomed Signal Process Control 2020. [DOI: 10.1016/j.bspc.2020.101866] [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: 10/25/2022]
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48
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Fusini L, Muratori M, Teruzzi G, Corrieri N, Innocenti E, Tamborini G, Mapelli M, Ghulam Ali S, Alamanni F, Montorsi P, Pepi M. P1579 Detection of mechanical prosthetic valve dysfunction: an integrated multimodality imaging approach. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Although the long-term outcome of mechanical mitral and aortic prosthetic valve (M-PV, Ao-PV), PV dysfunction (PVD) remains a very serious complication associated with high morbidity and mortality. PVD, in terms of thrombosis/pannus or paravalvular leak, is not associated with a peculiar clinical presentation. However, a prompt PVD detection is essential for referring the patient to the optimal treatment (clinical follow-up, thrombolysis, surgery). An integrated multimodality imaging approach, comprising several parameters by transthoracic echocardiography (TTE) and fluoroscopy (F), is mandatory to address the patient to the best therapeutic option.
Purpose
This study aims to evaluate the incremental diagnostic value of combined TTE + F over each imaging modality alone in pts with Ao-PV or M-PV symptomatic for dyspnea, embolic events, fever or haemolysis and therefore at high suspicion for PVD.
Methods
We enrolled 388 consecutive pts (62 ± 11y, 213 Ao-PV, 175 M-PV) suspected for PVD. All patients were imaged by TTE and F within 2 days after the admission to the hospital. TTE was defined positive for PVD in presence of intra/para-prosthetic regurgitation or high transprosthetic gradient (DP > 20 mmHg in Ao-PV, DP >10 mmHg in M-PV) combined with other altered Doppler parameters (for Ao-PV: DVI < 0.25, AT > 95ms; for M-PV: Peak Mitral Velocity > 2.2m/sec, VTIPrMV/VTILVO > 2.5, PHT > 130ms). A positive F for PVD was defined by leaflet/s restriction. In all pts, PVD was confirmed by transoesophageal echocardiography (TOE), positive response of thrombolysis (T), or surgical inspection (S).
Results
PVD was found in 46% (99/213) of Ao-PV and in 56% (98/175) of M-PV at TOE/T/S. Sensitivity (SE), specificity (SP), negative predictive value (NPV), positive predictive value (PPV) and diagnostic accuracy (ACC) for TTE, F and combined TTE + F are reported in Table. The integration of TTE + F data significantly improved ACC both for Ao-PV and M-PV. At ROC analysis, the combined model of TTE + F showed the highest AUC for the detection of PVD compared with TTE and F alone (Figure).
Conclusions
In patients with clinical suspicion of PVD, the combined model of TTE + F had a significant incremental value over TTE or F alone to diagnose PVD. This multimodality imaging approach allows to overcome limitations of TTE or F alone and consequently provides a prompt PVD detection even though TOE remains the gold standard to diagnose paravalvular leak and non-obstructive thrombosis.
Table Ao-PV: TTE(n = 211) Ao-PV: F(n = 204) Ao-PV: TTE + F(n = 202) MV-PV: TTE(n = 175) MV-PV: F(n = 159) MV-PV: TTE + F(n = 159) Sensitivity/Specificity 86(79-93)/89(84-95) 59(49-68)/99(97-100) 94(89-99)/88(81-94) 83(75-90)/78(68-87) 45(35-55)/98(95-100) 87(81-94)/75(64-86) ACC 88(83-92) 79(74-85) 91(87-95) 81(75-90) 67(59-74) 82(76-88) Comparison of diagnostic accuracy between TTE, F, and TTE + F for detecting PVD
Abstract P1579 Figure. ROC curves
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Affiliation(s)
- L Fusini
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - M Muratori
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - G Teruzzi
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - N Corrieri
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - E Innocenti
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - G Tamborini
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - M Mapelli
- Cardiology Center Monzino IRCCS, Milan, Italy
| | | | - F Alamanni
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - P Montorsi
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - M Pepi
- Cardiology Center Monzino IRCCS, Milan, Italy
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49
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Manfredonia L, Fusini L, Muratori M, Tamborini G, Gripari P, Mantegazza V, Volpato V, Italiano G, Lombardo A, Crea F, Pepi M. P734 Feasibility and accuracy of the new automated software dynamic heart model in an unselected population. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objective
Preliminary studies showed the accuracy of machine learning based automated dynamic quantification of left ventricular (LV) and left atrial (LA) volumes. We aimed to evaluate the feasibility and accuracy of this new Dynamic Heart Model (DHM) software in an unselected population undergoing transthoracic echocardiography (TTE). Methods. We enrolled 91 consecutive unselected patients (80% in sinus rhythm) referred for clinically indicated 2D TTE, who also underwent single 3D TTE image acquisition from the apical 4-chamber view. 2D images were analyzed to measure ejection fraction, LV and LA volumes; 3D images were analyzed using Dynamic Heart Model (DHM) software (Philips Healthcare), which automatically measures chamber volumes throughout the cardiac cycle, resulting in LV and LA volume-time curves. Average time of analysis, feasibility, image quality were recorded and results compared between the 2D and 3D techniques. Results. Quality of the 91 2D TTE images was graded as poor (N = 13), satisfactory (N = 45) and good (N = 33). The use of DHM was feasible in 79/91 cases (87%). The remaining 12 datasets could not be analyzed because of poor images (N = 10) or incorrect automated border detection (N = 2): in these cases, the software did not accurately identify endocardial borders due to LV cavity near obliteration or extreme LA enlargement. When feasible, the boundary position was considered accurate in 61/79 patients (77%), while minor manual correction of the LV/LA borders was needed in the remaining cases. In only 1 case the reconstruction was considered unreliable because it needed major corrections. The overall time required to obtain DHM data was approximately 45 seconds. In all cases in which DHM was used, not only shapes of LV and LA were very well defined, but also functional curves were physiologically plausible. Even in the 13 patients in whom the 2D image was suboptimal, the DHM was not only feasible but also accurate endocardial boundaries in 8 cases, without (N = 5) or with only minimal manual corrections (N = 3). As expected, 3D LV volumes were slightly hige than 2D ones ( EDV 153.9 ± 59.8 vs 121.4 ± 47.3 mL, respectively), while LV EF and LA volumes were similar (EF 58.8 ± 11.8 vs 59 ± 11.8% and LA volume 92 ± 39.3 vs 83.4 ± 32.1 mL, respectively). Conclusions. The new DHM software is quick, feasible and accurate in the majority of unselected patients, including those with suboptimal 2D images or in atrial fibrillation. Introduction of this automated analysis into clinical practice can reduce examination time, while providing reliable information not only on volumes but also on function of the left heart chambers.
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Affiliation(s)
- L Manfredonia
- Catholic University of the Sacred Heart, Rome, Italy
| | - L Fusini
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - M Muratori
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - G Tamborini
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - P Gripari
- Cardiology Center Monzino IRCCS, Milan, Italy
| | | | - V Volpato
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - G Italiano
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - A Lombardo
- Catholic University of the Sacred Heart, Rome, Italy
| | - F Crea
- Catholic University of the Sacred Heart, Rome, Italy
| | - M Pepi
- Cardiology Center Monzino IRCCS, Milan, Italy
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50
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Mantegazza V, Fusini L, Gripari P, Volpato V, Italiano G, Muratori M, Tamborini G, Guglielmo M, Pontone G, Pepi M. 1048 Evaluation of mitral annular disjunction in mitral valve prolapse: is echo imaging enough? Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
None
Background
The separation between the atrial wall-mitral valve (MV) junction and the left ventricular (LV) attachment (mitral annulus disjunction, MAD) is a recently discovered feature linked to MV prolapse (MVP). It is associated to higher complexity of MV lesions and is possibly responsible for mechanically induced fibrosis of the LV inferobasal wall and consequently for malignant ventricular events. MAD has been described in different studies evaluating the MV either by transthoracic (TTE) or transoesophageal (TOE) echocardiography or by cardiac magnetic resonance (CMR).
Purpose
The aim of the present study was to assess MAD and compare the ability of identifying and localizing MAD with different imaging techniques in a cohort of patients with MVP and severe mitral regurgitation eligible for surgery.
Methods
A total of 108 patients with MVP requiring surgery and undergoing CMR and TTE were enrolled in the study. Ninety of them underwent also intraoperative TOE. MAD was defined as any distance observed between the atrial wall-MV junction and the LV wall at end-systole. It was retrospectively assessed in the long axis views (4-, 3-, 2-chamber) and compared between the 3 imaging techniques.
Results
MAD was identified in 18 out of 108 patients at TTE (16.7%), in 15 among 90 patients undergoing TOE (16.7%) and in 42 patients at CMR (38.9%). Comparing data per patient regardless of MAD localization, a good correlation in identifying MAD was obtained between TTE and TOE (Kendall’s τ coefficient 0.83, p < 0.001); a lower but still significant correlation was observed between TTE and CMR (τ coefficient 0.46, p < 0.001) and between TOE and CMR (τ coefficient 0.39, p < 0.001). Higher Kendall rank correlation coefficients were obtained comparing data per view (TTE vs. TOE: τ coefficient 0.86, p < 0.001; TTE vs. CMR: τ coefficient 0.48, p < 0.001; TOE vs. CMR: τ coefficient 0.42, p < 0.001). Considering only patients with MAD (Figure 1), the agreement rate between TTE and TOE (14 patients) in identifying MAD in the same view was 95%, whereas a lower agreement was observed between TTE and CMR (79% in 16 patients) and between TOE and CMR (67% in 13 patients). MAD measured 7.5 ± 1.9 mm at TTE, 6.3 ± 1.7 mm at TOE and 6.9 ± 3.4 mm at CMR.
Conclusion
In surgical MVP patients, MAD showed a higher prevalence at CMR and a lower detection rate by echo imaging. Therefore, an integrated imaging approach could be necessary in the evaluation of MVP. This relatively mild separation of the atrial wall-MV junction and LV myocardium may probably be better recognized by CMR due to a higher spatial resolution. Echo is fundamental for the anatomic and haemodynamic characterization of the valvulopathy by itself, while CMR may better define MAD and myocardial fibrosis helping the physician in identifying PVM patients with higher arrhythmic risk independent of mitral regurgitation grade.
Abstract 1048 Figure 1
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Affiliation(s)
| | - L Fusini
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - P Gripari
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - V Volpato
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - G Italiano
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - M Muratori
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - G Tamborini
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - M Guglielmo
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - G Pontone
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - M Pepi
- Cardiology Center Monzino IRCCS, Milan, Italy
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