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Pasero D, Pistidda L, Piredda D, Liperi C, Cossu A, Esposito R, Muroni A, Mereu C, Rum C, Branca GP, Mulas F, Puci M, Sotgiu G, Terragni P. Lung (extracorporeal CO 2 removal) and renal (continuous renal replacement therapy) support: the role of ultraprotective strategy in Covid 19 and non-Covid 19 ARDS. A case-control study. J Anesth Analg Crit Care 2024; 4:27. [PMID: 38671540 PMCID: PMC11055375 DOI: 10.1186/s44158-024-00164-4] [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] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Preliminary studies suggest that moderate ARDS and acute renal failure might benefit from extracorporeal CO2 removal (ECCO2R) coupled with CRRT. However, evidence is limited and potential for this coupled treatment may need to be explored. The aim of the present study was to evaluate whether a protective driving pressure was obtained applying low-flow ECCO2-R plus CRRT in patients affected by moderate ARDS with COVID-19 compared to an historical group without COVID-19. METHODS A case-control study has been conducted comparing a group of consecutive moderate ARDS patients presenting AKI and affected by COVID-19, who needed low-flow ECCO2-R plus CRRT to achieve an ultra-protective ventilatory strategy, with historical group without COVID-19 that matched for clinical presentation and underwent the same ultra-protective treatment. VT was set at 6 mL/kg predicted body weight then ECCO2R was assessed to facilitate ultra-protective low VT ventilation to preserve safe Pplat and low driving pressure. RESULTS ECCO2R+CRRT reduced the driving pressure from 17 (14-18) to 11.5 (10-15) cmH2O (p<0.0004) in the fourteen ARDS patients by decreasing VT from 6.7 ml/kg PBW (6.1-6.9) to 5.1 (4.2-5.6) after 1 hour (p <0.0001). In the ARDS patients with COVID-19, the driving pressure reduction was more effective from baseline 18 (14-24) cmH2O to 11 (10-15) cmH2O (p<0.004), compared to the control group from 15 (13-17) to 12(10-16) cmH2O (p< 0.03), after one hour. ECCO2R+CRRT did not affected 28 days mortality in the two groups, while we observed a shorter duration of mechanical ventilation (19 {7-29} vs 24 {22-38} days; p=0.24) and ICU length of stay (19 {7-29} vs 24 {22-78} days; p=0.25) in moderate ARDS patients with COVID-19 compared to control group. CONCLUSIONS In moderate ARDS patients with or without COVID-19 disease, ECCO2R+CRRT may be and effective supportive treatment to reach protective values of driving pressure unless severe oxygenation defects arise requiring ECMO therapy initiation.
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Affiliation(s)
- Daniela Pasero
- Anesthesia and General Intensive Care Unit, AOU Sassari, Sassari, Italy.
- Department of Medicine, Surgery and Pharmacy, University of Sassari, A.O.U Sassari, Viale San Pietro 43, 07100, Sassari, Italy.
| | - Laura Pistidda
- Anesthesia and General Intensive Care Unit, AOU Sassari, Sassari, Italy
- Department of Medicine, Surgery and Pharmacy, University of Sassari, A.O.U Sassari, Viale San Pietro 43, 07100, Sassari, Italy
| | - Davide Piredda
- Anesthesia and General Intensive Care Unit, AOU Sassari, Sassari, Italy
| | - Corrado Liperi
- Anesthesia and General Intensive Care Unit, AOU Sassari, Sassari, Italy
| | - Andrea Cossu
- Anesthesia and General Intensive Care Unit, AOU Sassari, Sassari, Italy
| | | | - Angela Muroni
- Anesthesia and General Intensive Care Unit, AOU Sassari, Sassari, Italy
| | - Cristiano Mereu
- Anesthesia and General Intensive Care Unit, AOU Sassari, Sassari, Italy
| | - Carlino Rum
- Anesthesia and General Intensive Care Unit, AOU Sassari, Sassari, Italy
| | | | - Franco Mulas
- Anesthesia and General Intensive Care Unit, AOU Sassari, Sassari, Italy
| | - Mariangela Puci
- Department of Medicine, Surgery and Pharmacy, University of Sassari, A.O.U Sassari, Viale San Pietro 43, 07100, Sassari, Italy
- Clinical Epidemiology and Medical Statistics Unit, University of Sassari, Sassari, Italy
| | - Giovanni Sotgiu
- Department of Medicine, Surgery and Pharmacy, University of Sassari, A.O.U Sassari, Viale San Pietro 43, 07100, Sassari, Italy
- Clinical Epidemiology and Medical Statistics Unit, University of Sassari, Sassari, Italy
| | - Pierpaolo Terragni
- Anesthesia and General Intensive Care Unit, AOU Sassari, Sassari, Italy
- Department of Medicine, Surgery and Pharmacy, University of Sassari, A.O.U Sassari, Viale San Pietro 43, 07100, Sassari, Italy
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2
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Cirillo C, Monda E, Esposito R, Colonna D, Falcone C, Irrissuto F, Cirillo A, Fusco A, Verrillo F, Diana G, Rubino M, Caiazza M, Sarubbi B, Limongelli G, Russo MG. Prevalence and Clinical Significance of Intraventricular Conduction Disturbances in Hospitalized Children. J Cardiovasc Dev Dis 2024; 11:129. [PMID: 38667747 PMCID: PMC11050792 DOI: 10.3390/jcdd11040129] [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] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/18/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024] Open
Abstract
Introduction: Data on the prevalence and clinical significance of interventricular conduction disturbances (IVCDs) in children are scarce. While incomplete right bundle branch blocks (IRBBBs) seem to be the most frequent and benign findings, complete bundle blocks and fascicular blocks are often seen in children with congenital/acquired cardiac conditions. This study aims to delineate the prevalence and the diagnostic accuracy of IVCD in children admitted to a paediatric cardiology unit. Methods: Children admitted to the paediatric cardiology unit between January 2010 and December 2020 who had an ECG were included in the study. IVCDs were diagnosed according to standard criteria adjusted for age. Results: Three thousand nine hundred and ninety-three patients were enrolled. The median age was 3.1 years (IQR: 0.0-9.2 years), and 52.7% were males. IVCDs were present in 22.5% of the population: 17.4% of the population presented with IRBBBs, 4.8% with a complete right bundle branch block (CRBBB), 0.1% with a complete left bundle branch block (CLBBB), 0.2% with a left anterior fascicular block (LAFB) and 0.2% with a combination of CRBBB and LAFB. Also, 26% of children with congenital heart disease had an IVCD, and 18% of children with an IVCD had previous cardiac surgery. The overall sensitivity of IVCD in detecting a cardiac abnormality was 22.2%, with a specificity of 75.5%, a PPV of 83.1% and an NPV of 15.1%, but the values were higher for CLBBB and LAFB. Conclusions: IVCDs were present in one-fifth of children admitted to the cardiology unit. IRBBB was the most frequent disturbance, while CRBBB, CLBBB and fascicular blocks were much rarer, though they had a higher predictive value for cardiac abnormalities.
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Affiliation(s)
- Chiara Cirillo
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy; (C.C.)
| | - Emanuele Monda
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy; (C.C.)
| | - Raffaella Esposito
- Paediatric Cardiology Unit, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy
| | - Diego Colonna
- Adult Congenital Heart Diseases Unit, Monaldi Hospital, 80131 Naples, Italy
| | - Cristina Falcone
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy; (C.C.)
| | - Federica Irrissuto
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy; (C.C.)
| | - Annapaola Cirillo
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy; (C.C.)
| | - Adelaide Fusco
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy; (C.C.)
| | - Federica Verrillo
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy; (C.C.)
| | - Gaetano Diana
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy; (C.C.)
| | - Marta Rubino
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy; (C.C.)
| | - Martina Caiazza
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy; (C.C.)
| | - Berardo Sarubbi
- Adult Congenital Heart Diseases Unit, Monaldi Hospital, 80131 Naples, Italy
| | - Giuseppe Limongelli
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy; (C.C.)
| | - Maria Giovanna Russo
- Paediatric Cardiology Unit, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy
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Polverino F, Mirra D, Yang CX, Esposito R, Spaziano G, Rojas-Quintero J, Sgambato M, Piegari E, Cozzolino A, Cione E, Gallelli L, Capuozzo A, Santoriello C, Berrino L, de- Torres JP, Hackett TL, Polverino M, D’Agostino B. Similar programmed death ligand 1 (PD-L1) expression profile in patients with mild COPD and lung cancer. Sci Rep 2022; 12:22402. [PMID: 36575294 PMCID: PMC9792927 DOI: 10.1038/s41598-022-26650-9] [Citation(s) in RCA: 4] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 12/19/2022] [Indexed: 12/28/2022] Open
Abstract
Programmed Death Ligand 1 (PD-L1) is crucial in regulating the immunological tolerance in non-small cell lung cancer (NSCLC). Alveolar macrophage (AM)-derived PD-L1 binds to its receptor, PD-1, on surveilling lymphocytes, leading to lymphocyte exhaustion. Increased PD-L1 expression is associated with cigarette smoke (CS)-exposure. However, the PD-L1 role in CS-associated lung diseases associated with NSCLC, such as chronic obstructive pulmonary disease (COPD), is still unclear. In two different cohorts of ever smokers with COPD or NSCLC, and ever and never smoker controls, we evaluated PD-L1 expression: (1) via cutting-edge digital spatial proteomic and transcriptomic profiling (Geomx) of formalin-fixed paraffin-embedded (FFPE) lung tissue sections (n = 19); and (2) via triple immunofluorescence staining of bronchoalveolar lavage (BAL) AMs (n = 83). PD-L1 mRNA expression was also quantified in BAL AMs exposed to CS extract. PD-L1 expression was increased in the bronchiolar wall, parenchyma, and vascular wall from mild-moderate (GOLD 1-2) COPD patients compared to severe-very severe (GOLD 3-4) COPD patients and controls. Within all the COPD patients, PD-L1 protein expression was associated with upregulation of genes involved in tumor progression and downregulation of oncosuppressive genes, and strongly directly correlated with the FEV1% predicted, indicating higher PD-L1 expression in the milder vs. more severe COPD stages. In bronchioles, PD-L1 levels were strongly directly correlated with the number of functionally active AMs. In BAL, we confirmed that AMs from patients with both GOLD 1-2 COPD and NSCLC had the highest and similar, PD-L1 expression levels versus all the other groups, independently from active cigarette smoking. Intriguingly, AMs from patients with more severe COPD had reduced AM PD-L1 expression compared to patients with mild COPD. Acute CS extract stimulation increased PD-L1 mRNA expression only in never-and not in ever-smoker AMs. Lungs from patients with mild COPD and NSCLC are characterized by a similar strong PD-L1 expression signature in bronchioles and functionally active AMs compared to patients with severe COPD and controls. Active smoking does not affect PD-L1 levels. These observations represent a new resource in understanding the innate immune mechanisms underlying the link between COPD and lung cancer onset and progression and pave the way to future studies focused on the mechanisms by which CS promotes tumorigenesis and COPD.
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Affiliation(s)
- F. Polverino
- grid.39382.330000 0001 2160 926XPulmonary and Critical Care Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX 77030 USA
| | - D. Mirra
- grid.9841.40000 0001 2200 8888University of Campania “Luigi Vanvitelli”, Caserta, Italy
| | - C. X. Yang
- grid.17091.3e0000 0001 2288 9830University of British Columbia, Vancouver, Canada
| | - R. Esposito
- grid.9841.40000 0001 2200 8888University of Campania “Luigi Vanvitelli”, Caserta, Italy
| | - G. Spaziano
- grid.9841.40000 0001 2200 8888University of Campania “Luigi Vanvitelli”, Caserta, Italy
| | - J. Rojas-Quintero
- grid.39382.330000 0001 2160 926XPulmonary and Critical Care Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX 77030 USA
| | - M. Sgambato
- grid.9841.40000 0001 2200 8888University of Campania “Luigi Vanvitelli”, Caserta, Italy
| | - E. Piegari
- grid.9841.40000 0001 2200 8888University of Campania “Luigi Vanvitelli”, Caserta, Italy
| | - A. Cozzolino
- grid.9841.40000 0001 2200 8888University of Campania “Luigi Vanvitelli”, Caserta, Italy
| | - E. Cione
- grid.7778.f0000 0004 1937 0319University of Calabria, Rende, Italy
| | - L. Gallelli
- grid.411489.10000 0001 2168 2547University of Catanzaro, Catanzaro, Italy
| | | | | | - L. Berrino
- grid.9841.40000 0001 2200 8888University of Campania “Luigi Vanvitelli”, Caserta, Italy
| | - J. P. de- Torres
- grid.410356.50000 0004 1936 8331Queen’s University, Hamilton, Canada
| | - T. L. Hackett
- grid.17091.3e0000 0001 2288 9830University of British Columbia, Vancouver, Canada
| | | | - B. D’Agostino
- grid.9841.40000 0001 2200 8888University of Campania “Luigi Vanvitelli”, Caserta, Italy
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Kosior M, Benitez Mora M, Esposito R, Piscopo F, Alfano M, Albero G, Capra E, Lange Consiglio A, Gasparrini B. 225 Co-incubation with extracellular vesicles from follicular fluid of the breeding season improves the developmental competence of buffalo oocytes collected during the non-breeding season. Reprod Fertil Dev 2022. [DOI: 10.1071/rdv35n2ab225] [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: 12/07/2022] Open
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5
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De Landro G, Amoroso O, Russo G, D'Agostino N, Esposito R, Emolo A, Zollo A. Author Correction: Decade-long monitoring of seismic velocity changes at the Irpinia fault system (southern Italy) reveals pore pressure pulsations. Sci Rep 2022; 12:16039. [PMID: 36163421 PMCID: PMC9512923 DOI: 10.1038/s41598-022-20912-2] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- G De Landro
- Department of Physics "E. Pancini", University of Naples 'Federico II', Naples, Italy.
| | - O Amoroso
- Department of Physics "E.R. Caianiello", University of Salerno, Fisciano, SA, Italy
| | - G Russo
- Department of Physics "E. Pancini", University of Naples 'Federico II', Naples, Italy
| | - N D'Agostino
- National Institute of Geophysics and Volcanology, Rome, Italy
| | - R Esposito
- Formerly Department of Physics "E. Pancini", University of Naples 'Federico II', Naples, Italy
| | - A Emolo
- Department of Physics "E. Pancini", University of Naples 'Federico II', Naples, Italy
| | - A Zollo
- Department of Physics "E. Pancini", University of Naples 'Federico II', Naples, Italy
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6
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Giordano M, Santoro G, Gaio G, Cappelli Bigazzi M, Esposito R, Marzullo R, Di Masi A, Palladino MT, Russo MG. Novel echocardiographic score to predict duct-dependency after percutaneous relief of critical pulmonary valve stenosis/atresia. Echocardiography 2022; 39:724-731. [PMID: 35466466 PMCID: PMC9322398 DOI: 10.1111/echo.15358] [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: 01/12/2022] [Revised: 02/07/2022] [Accepted: 04/10/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives This study aimed to identify clinical, hemodynamic, or echocardiographic predictive features of persistent duct‐dependency of pulmonary circulation (PDDPC) after effective percutaneous relief of pulmonary atresia with the intact ventricular septum (PA‐IVS) or critical pulmonary stenosis (CPS). Methods From 2010 to 2021, 55 neonates with PA‐IVS or CPS underwent percutaneous right ventricle (RV) decompression at our Institution. After successfully relief of critical obstruction, 27 patients (group I) showed PDDPC, whereas RV was able to support the pulmonary circulation in the remaining 28 patients (group II). Clinical, hemodynamic, and echocardiographic features of these two groups were compared. Results No significant difference in clinical and hemodynamic data was found between the groups, although the group I had a lower oxygen saturation at hospital admission. However, tricuspid valve (TV) diameter <8.8 mm, TV z‐score ←2.12, tricuspid/mitral valve annular ratio <.78, pulmonary valve diameter <6.7 mm, pulmonary valve z‐score ←1.17, end‐diastolic RV area <1.35 cm2, end‐systolic right atrium area >2.45 cm2, percentage amount of interatrial right‐to‐left shunt >69.5%, moderate/severe tricuspid regurgitation, RV systolic pressure >42.5 mmHg, tricuspid E/E′ ratio >6.6 showed each significant predictive value of PDDPC. These parameters were used to build a composite echocardiographic score (PDDPC‐score), assigning one point each above the respective cut‐off value. A score ≥4.00 showed high sensitivity (100%) and specificity (86%) in predicting PDDPC. Conclusion Clinical and hemodynamic features fail to predict the short‐term fate of the pulmonary circulation after successful treatment of PA‐IVS/CPS. However, a simple, composite echocardiographic score is useful to predict PDDPC and could be crucial in the management of this frail subset of patients.
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Affiliation(s)
- Mario Giordano
- Paediatric Cardiology Unit, University of Campania "Luigi Vanvitelli", A.O.R.N. "Ospedali dei Colli", Naples, Italy
| | - Giuseppe Santoro
- Paediatric Cardiology Unit, University of Campania "Luigi Vanvitelli", A.O.R.N. "Ospedali dei Colli", Naples, Italy.,Paediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Gianpiero Gaio
- Paediatric Cardiology Unit, University of Campania "Luigi Vanvitelli", A.O.R.N. "Ospedali dei Colli", Naples, Italy
| | - Maurizio Cappelli Bigazzi
- Paediatric Cardiology Unit, University of Campania "Luigi Vanvitelli", A.O.R.N. "Ospedali dei Colli", Naples, Italy.,Invasive Cardiology Unit, University of Campania "Luigi Vanvitelli", A.O.R.N. "Ospedali dei Colli", Naples, Italy
| | - Raffaella Esposito
- Paediatric Cardiology Unit, University of Campania "Luigi Vanvitelli", A.O.R.N. "Ospedali dei Colli", Naples, Italy
| | - Raffaella Marzullo
- Paediatric Cardiology Unit, University of Campania "Luigi Vanvitelli", A.O.R.N. "Ospedali dei Colli", Naples, Italy
| | - Antonio Di Masi
- Paediatric Cardiology Unit, University of Campania "Luigi Vanvitelli", A.O.R.N. "Ospedali dei Colli", Naples, Italy
| | - Maria Teresa Palladino
- Paediatric Cardiology Unit, University of Campania "Luigi Vanvitelli", A.O.R.N. "Ospedali dei Colli", Naples, Italy
| | - Maria Giovanna Russo
- Paediatric Cardiology Unit, University of Campania "Luigi Vanvitelli", A.O.R.N. "Ospedali dei Colli", Naples, Italy
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Moro F, Bertoldo V, Avesani G, Moruzzi MC, Mascilini F, Bolomini G, Caliolo G, Esposito R, Moroni R, Zannoni GF, Fagotti A, Manfredi R, Scambia G, Testa AC. Fusion imaging in preoperative assessment of extent of disease in patients with advanced ovarian cancer: feasibility and agreement with laparoscopic findings. Ultrasound Obstet Gynecol 2021; 58:916-925. [PMID: 33847427 DOI: 10.1002/uog.23650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/19/2021] [Accepted: 03/30/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Fusion imaging is an emerging technique that combines real-time ultrasound examination with images acquired previously using other modalities, such as computed tomography (CT), magnetic resonance imaging and positron emission tomography. The primary aim of this study was to evaluate the feasibility of fusion imaging in patients with suspicion of ovarian or peritoneal cancer. Secondary aims were: to compare the agreement of findings on fusion imaging, CT alone and ultrasound imaging alone with laparoscopic findings, in the assessment of extent of intra-abdominal disease; and to evaluate the time required for the fusion imaging technique. METHODS Patients with clinical and/or radiographic suspicion of advanced ovarian or peritoneal cancer who were candidates for surgery were enrolled prospectively between December 2019 and September 2020. All patients underwent a CT scan and ultrasound and fusion imaging to evaluate the presence or absence of the following abdominal-cancer features according to the laparoscopy-based scoring model (predictive index value (PIV)): supracolic omental disease, visceral carcinomatosis on the liver, lesser omental carcinomatosis and/or visceral carcinomatosis on the lesser curvature of the stomach and/or spleen, involvement of the paracolic gutter(s) and/or anterior abdominal wall, involvement of the diaphragm and visceral carcinomatosis on the small and/or large bowel (regardless of rectosigmoid involvement). The feasibility of the fusion examination in these patients was evaluated. Agreement of each imaging method (ultrasound, CT and fusion imaging) with laparoscopy (considered as reference standard) was calculated using Cohen's kappa coefficient. RESULTS Fifty-two patients were enrolled into the study. Fusion imaging was feasible in 51 (98%) of these patients (in one patient, it was not possible for technical reasons). Two patients were excluded because laparoscopy was not performed, leaving 49 women in the final analysis. Kappa values for CT, ultrasound and fusion imaging, using laparoscopy as the reference standard, in assessing the PIV parameters were, respectively: 0.781, 0.845 and 0.896 for the great omentum; 0.329, 0.608 and 0.847 for the liver surface; 0.472, 0.549 and 0.756 for the lesser omentum and/or stomach and/or spleen; 0.385, 0.588 and 0.795 for the paracolic gutter(s) and/or anterior abdominal wall; 0.385, 0.497 and 0.657 for the diaphragm; and 0.336, 0.410 and 0.469 for the bowel. The median time needed to perform the fusion examination was 20 (range, 10-40) min. CONCLUSION Fusion of CT images and real-time ultrasound imaging is feasible in patients with suspicion of ovarian or peritoneal cancer and improves the agreement with surgical findings when compared with ultrasound or CT scan alone. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- F Moro
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
| | - V Bertoldo
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
| | - G Avesani
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Rome, Italy
| | - M C Moruzzi
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
| | - F Mascilini
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
| | - G Bolomini
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
| | - G Caliolo
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Rome, Italy
| | - R Esposito
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
| | - R Moroni
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Direzione Scientifica, Rome, Italy
| | - G F Zannoni
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
- Istituto di Anatomia Patologica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Fagotti
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
- Università Cattolica del Sacro Cuore, Dipartimento Scienze della Vita e di Sanità Pubblica, Rome, Italy
| | - R Manfredi
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Rome, Italy
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - G Scambia
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
- Università Cattolica del Sacro Cuore, Dipartimento Scienze della Vita e di Sanità Pubblica, Rome, Italy
| | - A C Testa
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
- Università Cattolica del Sacro Cuore, Dipartimento Scienze della Vita e di Sanità Pubblica, Rome, Italy
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Moro F, Bertoldo V, Avesani G, Moruzzi MC, Mascilini F, Bolomini G, Caliolo G, Esposito R, Moroni R, Zannoni GF, Fagotti A, Manfredi R, Scambia G, Testa AC. Fusion imaging in preoperative assessment of extent of disease in patients with advanced ovarian cancer: feasibility and agreement with laparoscopic findings. Ultrasound Obstet Gynecol 2021; 60:256-268. [PMID: 33847427 DOI: 10.1002/uog.24805] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 10/07/2021] [Accepted: 10/13/2021] [Indexed: 05/25/2023]
Abstract
OBJECTIVES Fusion imaging is an emerging technique that combines real-time ultrasound examination with images acquired previously using other modalities, such as computed tomography (CT), magnetic resonance imaging and positron emission tomography. The primary aim of this study was to evaluate the feasibility of fusion imaging in patients with suspicion of ovarian or peritoneal cancer. Secondary aims were: to compare the agreement of findings on fusion imaging, CT alone and ultrasound imaging alone with laparoscopic findings, in the assessment of extent of intra-abdominal disease; and to evaluate the time required for the fusion imaging technique. METHODS Patients with clinical and/or radiographic suspicion of advanced ovarian or peritoneal cancer who were candidates for surgery were enrolled prospectively between December 2019 and September 2020. All patients underwent a CT scan and ultrasound and fusion imaging to evaluate the presence or absence of the following abdominal-cancer features according to the laparoscopy-based scoring model (predictive index value (PIV)): supracolic omental disease, visceral carcinomatosis on the liver, lesser omental carcinomatosis and/or visceral carcinomatosis on the lesser curvature of the stomach and/or spleen, involvement of the paracolic gutter(s) and/or anterior abdominal wall, involvement of the diaphragm and visceral carcinomatosis on the small and/or large bowel (regardless of rectosigmoid involvement). The feasibility of the fusion examination in these patients was evaluated. Agreement of each imaging method (ultrasound, CT and fusion imaging) with laparoscopy (considered as reference standard) was calculated using Cohen's kappa coefficient. RESULTS Fifty-two patients were enrolled into the study. Fusion imaging was feasible in 51 (98%) of these patients (in one patient, it was not possible for technical reasons). Two patients were excluded because laparoscopy was not performed, leaving 49 women in the final analysis. Kappa values for CT, ultrasound and fusion imaging, using laparoscopy as the reference standard, in assessing the PIV parameters were, respectively: 0.781, 0.845 and 0.896 for the great omentum; 0.329, 0.608 and 0.847 for the liver surface; 0.472, 0.549 and 0.756 for the lesser omentum and/or stomach and/or spleen; 0.385, 0.588 and 0.795 for the paracolic gutter(s) and/or anterior abdominal wall; 0.385, 0.497 and 0.657 for the diaphragm; and 0.336, 0.410 and 0.469 for the bowel. The median time needed to perform the fusion examination was 20 (range, 10-40) min. CONCLUSION Fusion of CT images and real-time ultrasound imaging is feasible in patients with suspicion of ovarian or peritoneal cancer and improves the agreement with surgical findings when compared with ultrasound or CT scan alone. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- F Moro
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
| | - V Bertoldo
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
| | - G Avesani
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Rome, Italy
| | - M C Moruzzi
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
| | - F Mascilini
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
| | - G Bolomini
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
| | - G Caliolo
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Rome, Italy
| | - R Esposito
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
| | - R Moroni
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Direzione Scientifica, Rome, Italy
| | - G F Zannoni
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
- Istituto di Anatomia Patologica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Fagotti
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
- Università Cattolica del Sacro Cuore, Dipartimento Scienze della Vita e di Sanità Pubblica, Rome, Italy
| | - R Manfredi
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Rome, Italy
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - G Scambia
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
- Università Cattolica del Sacro Cuore, Dipartimento Scienze della Vita e di Sanità Pubblica, Rome, Italy
| | - A C Testa
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy
- Università Cattolica del Sacro Cuore, Dipartimento Scienze della Vita e di Sanità Pubblica, Rome, Italy
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9
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Kosior M, Esposito R, Piscopo F, Calabria A, Albero G, Longobardi V, Del Prete C, Gasparrini B. 103 Seasonal effects on follicular metabolome in Italian Mediterranean buffalo. Reprod Fertil Dev 2021; 34:288. [PMID: 35231239 DOI: 10.1071/rdv34n2ab103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- M Kosior
- University of Naples Federico II, Naples, Italy
| | - R Esposito
- University of Naples Federico II, Naples, Italy
| | - F Piscopo
- University of Naples Federico II, Naples, Italy
| | - A Calabria
- University of Naples Federico II, Naples, Italy
| | - G Albero
- University of Naples Federico II, Naples, Italy
| | | | - C Del Prete
- University of Naples Federico II, Naples, Italy
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10
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Bolomini G, Moruzzi MC, Moro F, Lavecchia D, Esposito R, Scambia G, Testa AC. Repeat twisting of ovary in young woman with ribbon-like contralateral ovary and absence of contralateral Fallopian tube. Ultrasound Obstet Gynecol 2021; 58:491-492. [PMID: 33206438 DOI: 10.1002/uog.23543] [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] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 10/16/2020] [Accepted: 11/06/2020] [Indexed: 06/11/2023]
Affiliation(s)
- G Bolomini
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - M C Moruzzi
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - F Moro
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - D Lavecchia
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - R Esposito
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - G Scambia
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- Dipartimento Scienze della Vita e Sanità pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A C Testa
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- Dipartimento Scienze della Vita e Sanità pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
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11
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Malagoli A, Albini A, Mandoli GE, Baggiano A, Vinco G, Bandera F, D'Andrea A, Esposito R, D'Ascenzi F, Sorrentino R, Santoro C, Benfari G, Contorni F, Cameli M. Multimodality imaging of the ischemic right ventricle: an overview and proposal of a diagnostic algorithm. Int J Cardiovasc Imaging 2021; 37:3343-3354. [PMID: 34114150 DOI: 10.1007/s10554-021-02309-w] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/04/2021] [Indexed: 10/21/2022]
Abstract
Right ventricular (RV) involvement is frequently detected in patients presenting with acute left ventricular myocardial infarction. The ischemic right ventricle carries a dismal outcome by predisposing the heart to arrhythmic events and mechanical or hemodynamic complications. A comprehensive RV evaluation by multimodality imaging could guide clinical practice but has always been a conundrum for the imagers. Two-dimensional echocardiography is the best first-line tool due to its availability of bedside capabilities. More advanced imaging techniques provide a more comprehensive evaluation of the complex RV geometry but are mostly reserved for the post-acute setting. Three-dimensional echocardiography has improved the evaluation of RV volumes and function. The recent application of speckle-tracking echocardiography to the right ventricle appears promising, allowing the earlier detection of subtle RV dysfunction. Cardiac magnetic resonance imaging is considered the gold standard for the RV assessment. Cardiac multidetector computed tomography could be a reliable alternative. The aim of this review is to focus on the growing importance of multimodality imaging of the ischemic right ventricle and to propose a diagnostic algorithm, in order to reach a comprehensive assessment of this too frequently neglected chamber.
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Affiliation(s)
- A Malagoli
- Division of Cardiology, Nephro-Cardiovascular Department, Baggiovara Hospital, University of Modena and Reggio Emilia, Modena, Italy.
| | - A Albini
- Division of Cardiology, Nephro-Cardiovascular Department, Policlinico University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - G E Mandoli
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
| | - A Baggiano
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - G Vinco
- Department of Medicine, University of Verona, Verona, Italy
| | - F Bandera
- Cardiology University Department, Heart Failure Unit, Department of Biomedical Sciences for Health, IRCCS, Policlinico San Donato, San Donato Milanese, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milano, Milan, Italy
| | - A D'Andrea
- Division of Cardiology, Umberto I' Hospital Nocera Inferiore (Salerno), Luigi Vanvitelli University, Caserta, Italy
| | - R Esposito
- Department of Advanced Biomedical Science, Federico II University Hospital Naples, Naples, Italy
| | - F D'Ascenzi
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
| | - R Sorrentino
- Department of Advanced Biomedical Science, Federico II University Hospital Naples, Naples, Italy
| | - C Santoro
- Department of Advanced Biomedical Science, Federico II University Hospital Naples, Naples, Italy
| | - G Benfari
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - F Contorni
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
| | - M Cameli
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
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12
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Pota V, Passavanti MB, Coppolino F, Di Zazzo F, De Nardis L, Esposito R, Fiore M, Mangoni di Santostefano GSRC, Aurilio C, Sansone P, Pace MC. Septic shock due to Escherichia coli meningoencephalitis treated with immunoglobulin-M-enriched immunoglobulin preparation as adjuvant therapy: a case report. J Med Case Rep 2021; 15:138. [PMID: 33775244 PMCID: PMC8005330 DOI: 10.1186/s13256-021-02731-7] [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: 08/07/2019] [Accepted: 02/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Gram-negative bacteria are an uncommon etiology of spontaneous community-acquired adult meningitis and meningoencephalitis. Escherichia coli is a Gram-negative bacterium that is normally present in the intestinal microbial pool. Some Escherichia coli strains can cause diseases in humans and animals, with both intestinal and extraintestinal manifestations (extraintestinal pathogenic Escherichia coli) such as urinary tract infections, bacteremia with sepsis, and, more rarely, meningitis. Meningitis continues to be an important cause of mortality throughout the world, despite progress in antimicrobial chemotherapy and supportive therapy. The mortality rate fluctuates between 15% and 40%, and about 50% of the survivors report neurological sequelae. The majority of Escherichia coli meningitis cases develop as a result of hematogenous spread, with higher degrees of bacteremia also being related to worse prognosis. Cases presenting with impaired consciousness (that is, coma) are also reported to have poorer outcomes. CASE PRESENTATION We describe the case of a 48-year-old caucasian woman with meningoencephalitis, with a marked alteration of consciousness on admission, and septic shock secondary to pyelonephritis caused by Escherichia coli, treated with targeted antimicrobial therapy and immunoglobulin-M-enriched immunoglobulin (Pentaglobin) preparation as adjuvant therapy. CONCLUSION Despite the dramatic presentation of the patient on admission, the conflicting data on the use of immunoglobulins in septic shock, and the lack of evidence regarding their use in adult Escherichia coli meningoencephalitis, we obtained a remarkable improvement of her clinical condition, accompanied by partial resolution of her neurological deficits.
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Affiliation(s)
- V Pota
- Dept of Women, Child, General and Specialist Surgery, University of Campania "L. Vanvitelli", Naples, Italy.
| | - M B Passavanti
- Dept of Women, Child, General and Specialist Surgery, University of Campania "L. Vanvitelli", Naples, Italy
| | - F Coppolino
- Dept of Women, Child, General and Specialist Surgery, University of Campania "L. Vanvitelli", Naples, Italy
| | - F Di Zazzo
- Dept of Women, Child, General and Specialist Surgery, University of Campania "L. Vanvitelli", Naples, Italy
| | - L De Nardis
- Dept of Women, Child, General and Specialist Surgery, University of Campania "L. Vanvitelli", Naples, Italy
| | - R Esposito
- Dept of Women, Child, General and Specialist Surgery, University of Campania "L. Vanvitelli", Naples, Italy
| | - M Fiore
- Dept of Women, Child, General and Specialist Surgery, University of Campania "L. Vanvitelli", Naples, Italy
| | | | - C Aurilio
- Dept of Women, Child, General and Specialist Surgery, University of Campania "L. Vanvitelli", Naples, Italy
| | - P Sansone
- Dept of Women, Child, General and Specialist Surgery, University of Campania "L. Vanvitelli", Naples, Italy
| | - M C Pace
- Dept of Women, Child, General and Specialist Surgery, University of Campania "L. Vanvitelli", Naples, Italy
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13
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Luciano F, Santoro C, Capone V, Casciano O, Canonico ME, Fedele T, Orefice S, Fiorillo L, Esposito R. Usefulness of myocardial work assessment for the understanding of mechanisms underlying sacubitril/valsartan efficacy in patients with heart failure and reduced ejection fraction. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.129] [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
Sacubitril/valsartan has shown the ability in reducing the risk of death and of hospitalization in patients with HF (heart failure) and is recommended in patients with heart failure with reduced ejection fraction (HFrEF) who remain symptomatic despite conventional therapies. Strain imaging derived myocardial work (MW) is an emerging tool for the evaluation of left ventricular (LV) mechanics by incorporating both systolic deformation and afterload burden in the analysis.
Aim of the study
To evaluate in a prospective fashion the impact of sacubitril/valsartan therapy in HF patients on MW derived parameters in relation with standard echocardiographic indices.
Methods
We recruited thirteen HF patients with indication to sacubitril/valsartan therapy according to current guidelines. Sacubitril/valsartan therapy titrated at the maximum tolerated dose. A comprehensive echo-Doppler exam, including speckle tracking derived assessment of global longitudinal strain (GLS) (in absolute value), was performed before and after a three months therapy with sacubitril/valsartan. Parameters of MW such as global work index (GWI), global constructive work (GCW) global wasted work (GWW) and global work efficiency (GWE) were calculated according to standardized procedures. Patients with more than mild aortic and mitral stenosis and/or regurgitation were excluded. Other exclusion criteria included permanent and/or persistent atrial fibrillation and inadequate echo images.
Results
The 13 patients (M/F = 11/2, age: 57 ± 8.2 years, aetiology: idiopathic in 3 patients, ischaemic in 7 patients and chemotherapy related cardiotoxicity in 3 patients, NYHA Class: II in 7 and III in 6 patients). All patients tolerated sacubitril/valsartan therapy. After the three months therapy an improvement of LVEF (from 32.3 ± 2% to 36.2± 6%, p = 0.015), GLS (from 9.8 ± 1% to 11.6 ± 2%, p = 0.019), GWI (from 845.0 ± 175.0 mmHg% to 1091.6 ± 336.8 mmHg%, p = 0.003), GCW (from 993.4± 211.6 mmHg% to 1262.7 ± 404 mmHg%, p = 0.002) and GWE (from 77 ± 11% to 81 ± 10%, p = 0.002) was observed, without significant changes in GWW (from 190 ± 121 mmHg% to 211 ± 145 mmHg%, p = 0.307). We also found a positive correlation between the magnitude of LVEF improvement and the baseline values of GCW (r = 0.66, p = 0.014). This relation remained significant even after adjusting for the extent of systolic blood pressure reduction (r = 0.54, p = 0.033).
Conclusion
Three months sacubitril/valsartan therapy significantly improves standard and advanced indices of LV systolic function. This improvement is due to the increase of constructive work more than to the reduction of wasted work and the increase of LVEF can be predicted by the global constructive work levels at baseline. MW assessment may help to understand the mechanisms underlying the sacubitril/valsartan therapy efficacy in HF patients.
Abstract Figure.
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Affiliation(s)
- F Luciano
- Federico II University of Naples, Naples, Italy
| | - C Santoro
- Federico II University of Naples, Naples, Italy
| | - V Capone
- Federico II University of Naples, Naples, Italy
| | - O Casciano
- Federico II University of Naples, Naples, Italy
| | - ME Canonico
- Federico II University of Naples, Naples, Italy
| | - T Fedele
- Federico II University of Naples, Naples, Italy
| | - S Orefice
- Federico II University of Naples, Naples, Italy
| | - L Fiorillo
- Federico II University of Naples, Naples, Italy
| | - R Esposito
- Federico II University of Naples, Naples, Italy
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Santoro C, Soloperto R, Casciano O, Esposito R, Lembo M, Canonico M, Arpino G, Giuliano M, De Placido S, Esposito G. Right ventricular dysfunction parallels left ventricular functional involvement in women with breast cancer experiencing subclinical cardiotoxicity. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.187] [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
Cancer therapy related cardiac toxicity disease (CRCTD) of the left ventricle (LV)can influence the outcome of oncologic patients. Little is known on CRCTD related right ventricular (RV)dysfunction even though RV involvement has been proven to be a remarkable prognosticator in heart failure.
Purpose
To analyse parallel changes in LV and RV function occurring during the course of cancer therapy in women affected by breast cancer by using both standard and speckle tracking echocardiography.
Methods
Fifty Her-2 positive breast cancer women (age = 53.6 ± 11.7 years) underwent sequential cancer therapy protocol including anthracycline (ANT) epirubicine + cyclophosphamide (4 cycles) followed by a total amount of 18 cycles with trastuzumab (TRZ) + paclitaxel. A complete echo-Doppler exam, including LV and RV global longitudinal strain (GLS)as well as RV septal and free wall longitudinal strain (SLS and FWLS respectively) assessment, was performed at baseline, after ANT end and after TRZ completion. Patients with overt heart failure and LV ejection fraction < 50%, coronary artery disease,atrial fibrillation, hemodinamically significant valve disease and inadequate echo were excluded. Overt CRCTD was defined according guidelines and both subclinical LV and RV CRCTD as a LV and RV GLS drop from baseline >15%.
Results
None of the patients experienced overt CTCRD but 6 patients (14%) showed subclinical LV dysfunction and 33 (66%) had a significant drop of RV longitudinal function.The comparison of standard echo-Doppler exam at baseline and after ANT and TRZ completion did not show significant changes of LV and RV systolic and diastolic parameters. Conversely, a progressive significant reduction of RV GLS (p < 0.002 after TRZ), SLS and FWLS and, with a lower extent, of LV GLS (p < 0.02 after TRZ) was observed after ANT and TRZ completion (Figure). Percentage reduction in RV GLS (DRV GLS) from baseline to ANT end correlated with LV GLS both at EC end (r=-0.40, p = 0.006) and after TRZ completion (r=-0.62, p < 0.0001).
Conclusions
Detrimental cardiac effects of cancer therapy involve both LV and RV systolic longitudinal function. Progressive RV dysfunction is evident through ANT and TRZ treatment. Early RV dysfunction parallels LV involvement and predicts subsequent LV subclinical dysfunction. A comprehensive LV and RV longitudinal function assessment might better predict the onset of CRCTD in breast cancer patients.
Abstract Figure.
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Affiliation(s)
- C Santoro
- Federico II University of Naples, Naples, Italy
| | - R Soloperto
- Federico II University Hospital, Advanced biomedical science, Naples, Italy
| | - O Casciano
- Federico II University Hospital, Advanced biomedical science, Naples, Italy
| | - R Esposito
- Federico II University Hospital, Advanced biomedical science, Naples, Italy
| | - M Lembo
- Federico II University Hospital, Advanced biomedical science, Naples, Italy
| | - M Canonico
- Federico II University Hospital, Advanced biomedical science, Naples, Italy
| | - G Arpino
- Federico II University Hospital, Advanced biomedical science, Naples, Italy
| | - M Giuliano
- Federico II University of Naples, Naples, Italy
| | | | - G Esposito
- Federico II University of Naples, Naples, Italy
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15
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Lembo M, Santoro C, Casciano O, Capone V, Fedele T, Luciano F, Canonico M, Buonauro A, Esposito R, Galderisi M. Impact of diastolic blood pressure on speckle tracking derived myocardial work components in a population of normotensive and untreated hypertensive patients. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Arterial hypertension deeply influences left ventricular (LV) mechanics and global longitudinal strain (GLS). The effect of blood pressure (BP), in particular systolic BP burden, on speckle tracking derived myocardial work (MW) was demonstrated in both hypertensive and healthy subjects.
Purpose
Aim of our study was to evaluate the impact of diastolic BP (DBP) on MW components in a population of newly-diagnosed, never treated hypertensive patients and healthy subjects.
Methods
The study population included 105 newly-diagnosed, never treated hypertensive patients (M/F= 62/43; age=46.1±13.0 years, BP=145.1±10/89.8±7.4 mmHg), and 105 healthy normotensive subjects (BP=121.6±9.8/73.7±7.4mmHg), matched for age and sex. All participants underwent standard echo exam, including GLS evaluation (in absolute value). Cuff BP was employed as a surrogate of LV peak pressure for the assessment of global work index (GWI), global constructive work (GCW), global wasted work (GWW) and global work efficiency (GWE). Exclusion criteria were diabetes mellitus, coronary artery disease, overt heart failure, valve heart disease, primary cardiomyopathies, atrial fibrillation and inadequate echo imaging. The study population was divided into two groups according to DBP threshold of normalcy defined by 2018 ESH/ESC guidelines: the first group including individuals with normal DBP (n=135, DBP<90mmHg) and the second group including patients with abnormal DBP (n=75, DBP ≥90 mmHg).
Results
The two groups were comparable for sex prevalence, age and heart rate. Body mass index (BMI), systolic and mean BP were higher in the group with abnormal DBP (all p<0.0001). Among echo data, no significant intergroup difference was found in LV mass index, relative wall thickness, ejection fraction and diastolic parameters. GLS was lower in patients with abnormal DBP (20.4±1.9 vs. 22.1±2.1%, p<0.0001). GWI (2443.0±403.1 vs. 2277.3±359.6 mmHg%, p<0.002), GCW (2733.5±406.0 vs. 2556.9±405.6 mmHg%, p=0.003) and GWW (112.8±84.4 vs. 76.8±45.1 mmHg%, p<0.0001) were significantly higher in patients with abnormal DBP, whereas GWE (95.3±2.8 vs. 96.2±1.7%, p<0.002) was lower in this group. In the pooled population, DBP was positively related to GWI, GCW (both r=0.30, p<0.0001) and GWW (r=0.26, p<0.0001), while negatively correlated with GLS (r=−0.37, p<0.0001) and GWE (r=−0.21, p<0.002). By separate multiple linear regression analyses, GWI (β=0.45, p<0.0001), GCW (β=0.47, p<0.0001), GWW (β=0.20, p=0.007) and GWE (β=−0.15, p<0.05) were all independently associated with DBP, after adjusting for male sex, age, BMI, heart rate, GLS and E/e' ratio.
Conclusions
In a population of untreated hypertensive patients and healthy subjects, increased DBP affects longitudinal function and MW. In particular, elevated diastolic BP induces an increase of wasted work which is only partially balanced by the increased constructive work, thus provoking a clear reduced efficiency of myocardial mechanics.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- M Lembo
- University Hospital Federico II, Naples, Italy
| | - C Santoro
- University Hospital Federico II, Naples, Italy
| | - O Casciano
- University Hospital Federico II, Naples, Italy
| | - V Capone
- University Hospital Federico II, Naples, Italy
| | - T Fedele
- University Hospital Federico II, Naples, Italy
| | - F Luciano
- University Hospital Federico II, Naples, Italy
| | - M Canonico
- University Hospital Federico II, Naples, Italy
| | - A Buonauro
- University Hospital Federico II, Naples, Italy
| | - R Esposito
- University Hospital Federico II, Naples, Italy
| | - M Galderisi
- University Hospital Federico II, Naples, Italy
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16
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Santoro C, Soloperto R, Casciano O, Esposito R, Luciano F, Canonico M, Lembo M, Arpino G, De Placido S, Galderisi M. Right ventricular dysfunction parallels left ventricular functional involvement in women with breast cancer experiencing subclinical cardiotoxicity. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0143] [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
Cancer therapy related cardiac toxicity disease (CRCTD) of the left ventricle (LV)can influence the outcome of oncologic patients. Little is known on CRCTD related right ventricular (RV)dysfunction even though RV involvement has been proven to be a remarkable prognosticator in heart failure.
Purpose
To analyse parallel changes in LV and RV function occurring during the course of cancer therapy in women affected by breast cancer by using both standard and speckle tracking echocardiography.
Methods
Fifty Her-2 positive breast cancer women (age = 53.6±11.7 years) underwent sequential cancer therapy protocol including anthracycline (ANT) epirubicine + cyclophosphamide (4 cycles) followed by a total amount of 18 cycles with trastuzumab (TRZ) + paclitaxel. A complete echo-Doppler exam, including LV and RV global longitudinal strain (GLS)as well as RV septal and free wall longitudinal strain (SLS and FWLS respectively) assessment, was performed at baseline, after ANT end and after TRZ completion. Patients with overt heart failure and LV ejection fraction <50%, coronary artery disease,atrial fibrillation, hemodinamically significant valve disease and inadequate echo were excluded. Overt CRCTD was defined according guidelines and both subclinical LV and RV CRCTD as a LV and RV GLS drop from baseline >15%.
Results
None of the patients experienced overt CTCRD but 6 patients (14%) showed subclinical LV dysfunction and 33 (66%) had a significant drop of RV longitudinal function.The comparison of standard echo-Doppler exam at baseline and after ANT and TRZ completion did not show significant changes of LV and RV systolic and diastolic parameters. Conversely, a progressive significant reduction of RV GLS (p<0.002 after TRZ), SLS and FWLS and, with a lower extent, of LV GLS (p<0.02 after TRZ) was observed after ANT and TRZ completion (Figure). Percentage reduction in RV GLS (DRV GLS) from baseline to ANT end correlated with LV GLS both at EC end (r=−0.40, p=0.006) and after TRZ completion (r=−0.62, p<0.0001).
Conclusions
Detrimental cardiac effects of cancer therapy involve both LV and RV systolic longitudinal function. Progressive RV dysfunction is evident through ANT and TRZ treatment. Early RV dysfunction parallels LV involvement and predicts subsequent LV subclinical dysfunction. A comprehensive LV and RV longitudinal function assessment might better predict the onset of CRCTD in breast cancer patients.
LV and RV strain during cancer therapy
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- C Santoro
- University Hospital Federico II, Naples, Italy
| | - R Soloperto
- University Hospital Federico II, Naples, Italy
| | - O Casciano
- University Hospital Federico II, Naples, Italy
| | - R Esposito
- University Hospital Federico II, Naples, Italy
| | - F Luciano
- University Hospital Federico II, Naples, Italy
| | - M Canonico
- University Hospital Federico II, Naples, Italy
| | - M Lembo
- University Hospital Federico II, Naples, Italy
| | - G Arpino
- University Hospital Federico II, Naples, Italy
| | | | - M Galderisi
- University Hospital Federico II, Naples, Italy
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17
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Canonico M, Fiorillo L, Santoro C, Lembo M, Esposito L, Capone V, Casciano O, Esposito R, Galderisi M. Prominent involvement of basal left ventricular longitudinal strain in patients with monoclonal gammopathy of undetermined significance. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2139] [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
In cardiac amyloidosis the application of Speckle Tracking Echocardiography allows to identify a specific left ventricular (LV) longitudinal strain (LS) pattern characterized by “apical sparing”, with a prominent involvement of basal and middle segments and normal LS of apical cap. The pattern of regional LS has been never investigated in monoclonal gammopathy of undetermined significance (MGUS), a condition which can predispose to cardiac amyloidosis.
Purpose
To compare LV regional LS patterns and LS base-to-apex behaviour of patients affected by MGUS in comparison with healthy subjects.
Methods
We enrolled 40 patients affected by MGUS (M/F=20/20; age 62.6±13.8 years), asymptomatic for cardiac symptoms, and a control group of 40 healthy subjects, matched for sex and age. Nineteen (47%) MGUS patients showed prevalent free K light chain and 21 (53%) had prevalent free λ light chain. Participants underwent standard echo-Doppler exam, including Speckle Tracking of the three apical views. Global longitudinal strain (GLS), the average LS of six basal (BLS), six middle (MLS), and six apical (ALS) segments (considered in absolute values) and relative regional strain ratio RRSR [=ALS/(BLS+MLS)] were computed. Exclusion criteria were overt heart failure, LV ejection fraction <53%, coronary artery and congenital heart disease, moderate to severe valvular disease, primary cardiomyopathies, atrial fibrillation and inadequate echo imaging.
Results
The two groups were comparable for body mass index, blood pressure and heart rate. LV mass index, relative wall thickness, left atrial volume index and Doppler-derived LV diastolic parameters did not differ significantly between the two groups. LV ejection fraction was also similar in MGUS and healthy controls. GLS resulted significantly lower in MGUS group than in controls (20.5±3.0 vs. 22.4±2.0%, p<0.02). BLS (17.1±3.7 vs. 19.2±2.2%, p=0.004), MLS (24.9±3.8 vs. 27.1±3.6%, p<0.01) and ALS (25.1±3.8 vs. 27.1±3.5%, p<0.01) were significantly lower in MGUS than in controls. The intergroup difference of RRSR (0.60±0.05 vs. 0.58±0.04) did not achieve the statistical significance (p=0.26) and none of the MGUS patients had RRSR>1. The figure depicts a LS bull'eye of a MGUS patient showing the prominent involvement of LV basal segments.
Conclusions
In presence of a normal LV ejection fraction, MGUS patients show a subclinical LV longitudinal systolic dysfunction. This is testified by a reduction of GLS and of regional LS which involves mainly LV basal segments, without substantial changes of relative regional strain ratio. LV regional longitudinal dysfunction could be useful to monitor LV myocardial mechanics during follow-up of MGUS patients.
LS bull's eye in a MGUS patient
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | - L Fiorillo
- University Hospital Federico II, Naples, Italy
| | - C Santoro
- University Hospital Federico II, Naples, Italy
| | - M Lembo
- University Hospital Federico II, Naples, Italy
| | - L Esposito
- University Hospital Federico II, Naples, Italy
| | - V Capone
- University Hospital Federico II, Naples, Italy
| | - O Casciano
- University Hospital Federico II, Naples, Italy
| | - R Esposito
- University Hospital Federico II, Naples, Italy
| | - M Galderisi
- University Hospital Federico II, Naples, Italy
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18
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Giordano C, De Santo N, Pluvio M, Di Leo V, Capodicasa G, Cirillo D, Esposito R, Damiano M. Protein requirement of patients on CAPD: A study on nitrogen balance. Int J Artif Organs 2020. [DOI: 10.1177/039139888000300105] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This work was presented in part at the 12th Annual Contractor's Conference of the National Institutes of Arthritis, Metabolism and Digestive Diseases, Bethesda, USA, January 15, 1979 and the Congress of the International Society for Artificial Internal Organs at the symposium on CAPD, New York Hilton, New York, April 19, 1979.
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Affiliation(s)
- C. Giordano
- Chair of Nefrology 1st Faculty of Medicine and Surgery University of Naples Naples, Italy
| | - N.G. De Santo
- Chair of Nefrology 1st Faculty of Medicine and Surgery University of Naples Naples, Italy
| | - M. Pluvio
- Chair of Nefrology 1st Faculty of Medicine and Surgery University of Naples Naples, Italy
| | - V.A. Di Leo
- Chair of Nefrology 1st Faculty of Medicine and Surgery University of Naples Naples, Italy
| | - G. Capodicasa
- Chair of Nefrology 1st Faculty of Medicine and Surgery University of Naples Naples, Italy
| | - D. Cirillo
- Chair of Nefrology 1st Faculty of Medicine and Surgery University of Naples Naples, Italy
| | - R. Esposito
- Chair of Nefrology 1st Faculty of Medicine and Surgery University of Naples Naples, Italy
| | - M. Damiano
- Chair of Nefrology 1st Faculty of Medicine and Surgery University of Naples Naples, Italy
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19
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Abstract
This article reports findings of a mail survey of 519 managers in blindness services on their preferences for management training seminars. Top and mid-level managers, as well as aspirants and people with partial managerial roles in the education and rehabilitation sectors, provided data on preferred topics, fees and timing for seminars, work settings, and prior training. Results show diversity in topic preferences: “Strategic Planning & Needs Assessment,” and “Program Evaluation” are most popular. Preferences vary somewhat according to management level; there is little or no variation by region; public versus private auspices; education versus rehabilitation; or time in present position. Implications of the results are discussed.
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Affiliation(s)
| | - M. Nelipovich
- Office for the Blind, Wisconsin Division of Vocational Rehabilitation
| | - R. Esposito
- Midwest Regional Center, American Foundation for the Blind
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20
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Sorrentino R, Capone V, Esposito L, Lo Iudice F, De Roberto AM, Lembo M, Santoro C, Esposito R, Canonico ME, Galderisi M. P1288 Male gender and left atrial volume index predict non valvular atrial fibrillation recurrence. The NeAfi echo registry. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.734] [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
In non-valvular atrial fibrillation (AF) patients, risk stratification scores such as CHA2DS2VASc and HASBLED allow the prediction of thromboembolic and bleeding risks, respectively. However, no risk score for the prediction of AF recurrence has been yet validated.
Purpose
To evaluate the mayor anthropometric and echocardiographic determinants of AF recurrence in non-valvular paroxysmal AF patients at 1 year follow-up.
Methods
Among 395 consecutive adult patients with non valvular AF enrolled in the Neapolitan Atrial Fibrillation (NeAfi) Echo registry, 177 (F/M = 87/90, age = 66.5± 11.9 years) had paroxismal AF and underwent 1-year follow-up. Fifteen patients had AF recurrence. Anthropometric parameters and blood pressure (BP) were recorded and CHA2DS2VASc and HASBLED scores were calculated. At baseline, patients underwent a comprehensive echo-Doppler exam, including quantification of left atrial (LA) size measurements, peak atrial longitudinal strain (PALS) and left ventricular (LV) global longitudinal strain (GLS). Binary logistic regression analysis was used to establish a mathematical model of the relationship between the variables and AF recurrence. The covariates for regression analysis were chosen as potential confounding factors based on their significance in independent T test analyses for continuous variables of chi-square for dichotomous variables, or on their biological plausibility.
Results
AF recurrence was higher in male than in female patients (14.4 vs 2.3%, p = 0.008). Patients with AF recurrence had similar body mass index, systolic and diastolic BP and heart rate compared to those without. The two groups were similar for LV end-systolic and end-diastolic volumes, ejection fraction, LV mass index, diastolic indexes, pulmonary artery systolic pressure and GLS. LA diameter (p = 0.235) and PALS (p = 0.375) were also similar between the two groups, whereas LA volume index (LAVi) was greater in patients experiencing AF recurrence (45.5 ± 15.7 vs. 36.7 ± 10.4 ml/m², p = 0.003). Binomial multiple regression analysis model explained 25% (Nagelkerke R²) of the variance in AF recurrence and correctly classified 95.0% of cases. Males were 8.9 times more likely to exhibit AF recurrence than females (p = 0.04). Greater LAVi was associated with an increased likelihood of exhibiting AF recurrence (OR = 1.07, p = 0.03), whereas CHA2DS2VASc >1 in men and >2 in women, HASBLED >3 and greater LA diameter or lower PALS did not add significant information to the model.
Conclusions
Male gender and, with a lower extent, LAVi appear to be major determinants of AF recurrence in non-valvular paroxysmal AF. The quantification of PALS does not seem to add valuable information in the prediction of recurrent AF.
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Affiliation(s)
| | - V Capone
- University Hospital Federico II, Naples, Italy
| | - L Esposito
- University Hospital Federico II, Naples, Italy
| | - F Lo Iudice
- University Hospital Federico II, Naples, Italy
| | | | - M Lembo
- University Hospital Federico II, Naples, Italy
| | - C Santoro
- University Hospital Federico II, Naples, Italy
| | - R Esposito
- University Hospital Federico II, Naples, Italy
| | | | - M Galderisi
- University Hospital Federico II, Naples, Italy
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21
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Casciano O, Luciano F, Cocozza S, Sorrentino R, Lembo M, Sellitto V, Santoro C, Esposito R, Rivellese A, Galderisi M. 433 Independent impact of metabolic syndrome on left ventricular longitudinal dysfunction in type 2 diabetes mellitus. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The risk of cardiovascular (CV) disease in type 2 diabetes mellitus (T2DM) is highly heterogeneous and an adequate risk stratification is needed. CV risk mainly depends on concomitant risk factors, combined in the metabolic syndrome (MetS). Echocardiography is an useful tool for diagnosis of cardiac organ damage and CV risk stratification in T2DM.
Purpose
To investigate the effects of MetS on left ventricular (LV) structure and function in patients with T2DM with normal LV ejection fraction (LVEF) and without overt coronary artery disease (CAD) and heart failure symptoms/signs.
Methods
We prospectively recruited 384 consecutive, uncomplicated T2DM patients. All patients underwent clinical exam, blood sampling and complete echo-Doppler exam, including determination of 2D-echo derived global longitudinal strain (GLS). LV mass index ≥45 g/m^2.7 in women and ≥49 g/m^2.7 in men was used to characterize LV hypertrophy. LV longitudinal dysfunction was assumed for GLS < 20% in absolute values. LV diastolic dysfunction was identified according to 2016 ASE/EACVI recommendations. MetS was defined according to NCEP-ATP III criteria. Significant CAD including previous myocardial infarction, LV systolic dysfunction (= LVEF <50%), hemodinamically significant valvular heart disease, primary cardiomyopathies, permanent atrial fibrillation, glomerular filtration rate <30 ml/min and inadequate echo images were exclusion criteria. The study population was divided according to presence of MetS.
Results
66% of the patients (254/384) met the criteria for MetS diagnosis. They had comparable age and heart rate with controls. Diabetic patients with MetS had higher glycated haemoglobin (HbA1c) (7.2 ± 1.3 vs. 6.9 ± 1.0%, p = 0.023) and uric acid (5.5 ± 1.4 vs. 4.9 ± 1.3 mg/dl, p = 0.001) than those without, and lower glomerular filtration rate (69.5 ± 15.0 vs 74.0 ± 12,1 ml/min, p = 0.004). MetS patients showed a higher LV mass index (p < 0.0001) and a greater prevalence of both LV hypertrophy (31.9 vs 12.5%, p < 0.0001) and diastolic dysfunction (52.6 vs. 32.8%, p = 0.007) (Figure). T2DM patients with MetS also had lower GLS (20.6 ± 2.1 vs. 21.9 ± 2.2%, p = 0.001), with a greater prevalence of LV longitudinal dysfunction (38.2 vs. 24.7%, p = 0.049) (Figure). After adjusting for age, T2DM duration, sex, HbA1c, uric acid, LV mass index and LV diastolic dysfunction by a multiple regression analysis in the pooled population, GLS reduction was independently associated with MetS (β coefficient = -0.184, p < 0.02) and LV mass index (β= -0.94, p = 0.04).
Conclusion
In patients with T2DM, the presence of MetS induces a greater prevalence not only of LV hypertrophy and diastolic dysfunction but also of LV longitudinal deformation impairment. GLS reduction in diabetic patients is associated with MetS independently of confounders including glycemic control and diabetic duration.
Abstract 433 Figure. Rate of LV alterations according to MetS
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Affiliation(s)
- O Casciano
- University Hospital Federico II, Naples, Italy
| | - F Luciano
- University Hospital Federico II, Naples, Italy
| | - S Cocozza
- University Hospital Federico II, Naples, Italy
| | | | - M Lembo
- University Hospital Federico II, Naples, Italy
| | - V Sellitto
- University Hospital Federico II, Naples, Italy
| | - C Santoro
- University Hospital Federico II, Naples, Italy
| | - R Esposito
- University Hospital Federico II, Naples, Italy
| | - A Rivellese
- University Hospital Federico II, Naples, Italy
| | - M Galderisi
- University Hospital Federico II, Naples, Italy
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22
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Canonico ME, Santoro C, Prastaro M, Sorrentino R, Luciano F, Lembo M, Esposito R, Galderisi M. P291 Additional value of myocardial work in detecting subclinical systolic dysfunction in patients with bicuspid aortic valve and left ventricular hypertrophy. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.145] [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
An impairment of speckle tracking derived left ventricular (LV) global longitudinal strain (GLS) has been observed in patients with bicuspid aortic valve (BAV) and referred to abnormalities of aortic elasticity properties. The impact of LV mass on myocardial deformation has still not been investigated. This issue can be now better addressed by myocardial work software, which incorporates both deformation and hemodynamic load in the analysis.
Aim of the study
To analyse the impact of both deformation and strain derived myocardial work in BAV patients with and without LV hypertrophy (LVH).
Methods
Sixty-five patients with BAV underwent a comprehensive echo exam, including speckle tracking derived calculation of GLS (in absolute value). Parameters of myocardial work such as global work index (GWI), global constructive work (GCW) global wasted work (GWW) and global work efficiency (GWE) were measured according to standardized procedures. Patients with reduced LV ejection fraction and with more than mild aortic stenosis and/or regurgitation were excluded. Other exclusion criteria included coronary artery disease, concomitant valvular heart disease, heart failure, primary cardiomyopathies, permanent and/or persistent atrial fibrillation and inadequate echo images. BAV patients were divided according to presence of LVH: 10 with LVH (LV mass index >47 g/m^2.7 in women and >50 g/m^2.7 in men) and 55 without LVH.
Results
The two groups were comparable for sex, age and heart rate whereas systolic blood pressure (p = 0.006) and pulse pressure (p = 0.002) were higher in patients with LVH, who also had higher relative diastolic wall thickness (p < 0.02). No significant difference in ejection fraction (p = 0.56), transmitral E/A ratio (p = 0.504) and E/e" (p = 0.311) was found between the two groups. GLS (19.1 ± 2.5 in LVH group and. 20.0 ± 2.4% in patients without LVH, p = 0.290), GWI (p = 0.356) and GCW (p = 0.396) did not differ significantly whereas GWW was higher (119.5 ± 72.9 vs. 72.3 ± 38.7 mmHg%, p = 0.003) and GWE lower (94.4 ± 3.0 vs. 92.2 ± 1.6%, p = 0.007) in BAV patients with LVH (Figure). In the pooled population, LV mass index was related with GWW (r = 0.26, p = 0.03) and GWE (r=-0.30, p < 0.01) but not with GLS (r=-0.22, p = 0.08). The relation between GWE and LV mass index remained significant even after adjusting for pulse pressure (partial r=-0.28, p < 0.02).
Conclusion
In patients with BAV, LVH plays a detrimental effect on LV systolic function which cannot be identified by ejection fraction and GLS assessment but is unmasked by the application of myocardial work. In presence of LVH, the wasted work of BAV patients is increased and myocardial efficiency is substantially reduced, it being negatively related to LV mass even after adjusting for a raw index of aortic stiffness such as pulse pressure.
Abstract P291 Figure. GLS, GWW and GWE according to LVH
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Affiliation(s)
| | - C Santoro
- University Hospital Federico II, Naples, Italy
| | - M Prastaro
- University Hospital Federico II, Naples, Italy
| | | | - F Luciano
- University Hospital Federico II, Naples, Italy
| | - M Lembo
- University Hospital Federico II, Naples, Italy
| | - R Esposito
- University Hospital Federico II, Naples, Italy
| | - M Galderisi
- University Hospital Federico II, Naples, Italy
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23
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Lembo M, Esposito R, Santoro C, Sorrentino R, Luciano F, Casciano O, Fiorillo L, La Mura L, Canonico M, Galderisi M. 1033 Prominent longitudinal strain involvement of left ventricular basal segments in native hypertensive patients without clear-cut hypertrophy. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.627] [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) global longitudinal strain (GLS) is able to detect an early subclinical dysfunction and it has been demonstrated to be a prognosticator in arterial hypertension. Information of regional longitudinal strain (LS) pattern has not been investigated in this clinical setting.
Purpose
We analyzed regional LV patterns of LS and base-to-apex behaviour of LS in newly diagnosed and never-treated hypertensive patients (HTN) without clear-cut LV hypertrophy (LVH).
Methods
166 HTN (M/F = 107/59; age 43.9 ± 14.3 years, blood pressure [BP] = 146.5± 10.7/90.1 ± 7.5 mmHg) and a control group of 94 healthy subjects (M/F = 58/36; age 41.2 ± 15.0 years) underwent standard echo-Doppler exam, including speckle tracking quantification of regional LS and GLS (considered in absolute values). The average LS of six basal (BLS), six middle (MLS), and six apical (ALS) segments and relative regional strain ratio - RRSR = [ALS/(BLS + MLS)] - were also computed. Exclusion criteria were LVH (LV mass index ≥45 g/m^2.7 in females and ≥49 g/m^2.7 in males), diabetes mellitus, coronary artery disease, overt heart failure, hemodynamically significant valve heart disease, primary cardiomyopathies, atrial fibrillation and inadequate echo imaging.
Results
The two groups were comparable for sex, age, heart rate and LV ejection fraction (EF). Body mass index (BMI), systolic (SBP), diastolic (DBP) and mean BP (MBP) (all p < 0.0001), LV mass index (p = 0.03), relative wall thickness (RWT) (p < 0.02) and E/e’ ratio (p < 0.01) were higher, and GLS lower (21.6 ± 2.0 vs. 22.2 ± 2.1%, p < 0.02) in HTN. By analyzing regional LS, BLS (18.2 ± 2.1% vs. 19.2 ± 2.1%, p < 0.0001) and MLS (20.7 ± 2.0 vs. 21.4 ± 2.1%, p = 0.007) resulted significantly lower in HTN, without significant difference in ALS (26.0 ± 3.6 vs. 25.9 ± 3.8%, p = 0.98). Accordingly, RRSR was higher in HTN (0.67 ± 0.09 vs. 0.64 ± 0.09, p < 0.01). Even after excluding patients with LV concentric remodeling (RWT > 0.42) (n = 34), BLS (p < 0.0001) and MLS (p < 0.002) were again lower and RRSR (p < 0.01) higher in HTN than in controls. In the pooled population, BLS negatively correlated with SBP (r=-0.22), DBP (r=-0.25) and MBP (r=-0.26) (Figure) (all p < 0.0001). By a multiple linear regression analysis, after adjusting for age, sex, BMI and RWT, the association between BLS and MBP remained significant (β coefficient=-0.23, p < 0.0001), with an additional significant impact of male sex (β=-0.33, p < 0.0001) (cumulative R²=0.18, SEE = 1.9%, p < 0.0001).
Conclusions
Besides normal LV EF, GLS is lower in HTN. LS dysfunction involves basal and, with a lower extent, middle myocardial segments, with a compensation of apical segments. RRSR appears to be significantly higher in HTN. These results are even confirmed in hypertensive patients with normal LV geometry. The association of BLS and BP appears to be independent on several confounders. Regional LS pattern might be useful to detect very early LV systolic abnormalities in arterial hypertension.
Abstract 1033 Figure. Relation between MBP and BLS
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Affiliation(s)
- M Lembo
- University Hospital Federico II, Naples, Italy
| | - R Esposito
- University Hospital Federico II, Naples, Italy
| | - C Santoro
- University Hospital Federico II, Naples, Italy
| | | | - F Luciano
- University Hospital Federico II, Naples, Italy
| | - O Casciano
- University Hospital Federico II, Naples, Italy
| | - L Fiorillo
- University Hospital Federico II, Naples, Italy
| | - L La Mura
- University Hospital Federico II, Naples, Italy
| | - M Canonico
- University Hospital Federico II, Naples, Italy
| | - M Galderisi
- University Hospital Federico II, Naples, Italy
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24
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Sorrentino R, Fiorillo L, Canonico ME, Lembo M, Luciano F, Santoro C, Esposito R, Borgia F, Galderisi M. P1782 Left ventricular deformation proprieties in aortic coarctation: insights from multilayer strain imaging. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.1138] [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
Patients with coarctation of the aorta (CoA) have proven impaired left ventricular (LV) myocardial deformation that will persist even after successful transcatheter intervention compared to normal controls. However, little is known about layer specific contraction in this clinical setting.
Purpose
To investigate multi-layer longitudinal strain in patients with repaired CoA, compared with a control group of healthy subjects.
Methods
In a case-control study, 13 CoA patients (F/M = 9/4, age = 15.1 ± 4.4 years) and 13 healthy age- and sex-matched controls, underwent a complete echocardiogram, including speckle tracking assessment for quantification of LV transmural global longitudinal strain (GLS), subendocardial longitudinal strain (LSsubendo), subepicardial longitudinal strain (LSsubepi), and myocardial longitudinal strain gradient (LSsubendo - LSsubpepi).
Results
CoA patients had similar blood pressure, heart rate, and body surface area in comparison with healthy controls. The two groups did not differ for ejection fraction and LV diastolic indices. Increased maximal gradient (>20 mmHg) in descending aorta was found in 9 (69.2%) CoA patients. In CoA population, 5 (38.5%) had LV concentric remodeling (RWT > 0.42) and 2 (15.4%) LV hypertrophy (Z score >2.0). LV mass index (92.4 ± 31.1 vs. 60.9 ± 12.5 g/m^2.7, p = 0.002), septal wall thickness (8.7 ± 2.0 vs 6.6 ± 0.9 mm p = 0.002), posterior wall thickness (8.2 ± 1.7 vs. 6.6 ± 1.4 mm, p = 0.02) and RWT (0.38 ± 0.06 vs. 0.27 ± 0.08, p < 0.001) were greater in CoA patients. By multi-layer deformation analysis, GLS (21.2 ± 1.9 vs. 22.9 ± 1.4%, p < 0.01), LSsubepi (19.3 ± 1.6 vs. 21.0 ± 1.6%, p < 0.01), LSsubendo (22.9 ± 1.8 vs. 25.4 ± 1.9%, p = 0.003) and longitudinal strain gradient (3.6 ± 1.1 vs. 4.7 ± 1.1, p < 0.02) were lower in CoA patients than in healthy controls. Separate sub-analyses in patients without LV hypertrophy, substantially confirmed the same results: GLS 20.9 ± 1.6 vs. 22.8 ± 0.9%, p = 0.004; LSsubepi 19.0 ± 1.4 vs. 21.1 ± 1.3%, p = 0.004; and LSsubendo 22.4 ± 1.2 vs. 25.3 ± 1.4%, p < 0.0001; strain gradient 3.4 ± 1.0 vs. 4.6 ± 1.1, p = 0.02. Notably, LSsubepi (18.6 ± 1.4 vs. 20.6 ± 1.0%, p = 0.03) and, with greater significance, LSsubendo (22.1 ± 1.1 vs. 24.7 ± 1.8%, p < 0.0001) were lower in CoA patients with increased aortic gradient versus those without significant gradient increase.
Conclusions
In CoA patients, layer specific strain imaging highlights an impairment of LV longitudinal deformation, which mainly involves LSsubendo and causes reduction of longitudinal strain gradient. This preferential impairment of subendocardium is particularly evident in patients with residual aortic gradient and is independent of LV hypertrophy.
Abstract P1782 Figure. Multilayer strain in CoA vs. controls
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Affiliation(s)
| | - L Fiorillo
- University Hospital Federico II, Naples, Italy
| | | | - M Lembo
- University Hospital Federico II, Naples, Italy
| | - F Luciano
- University Hospital Federico II, Naples, Italy
| | - C Santoro
- University Hospital Federico II, Naples, Italy
| | - R Esposito
- University Hospital Federico II, Naples, Italy
| | - F Borgia
- University Hospital Federico II, Naples, Italy
| | - M Galderisi
- University Hospital Federico II, Naples, Italy
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25
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Esposito R, Sorrentino R, Ponsiglione A, Santoro C, Lembo M, Riccio E, Imbriaco M, Pisani A, Galderisi M. P678 Late gadolinium enhancement cardiac magnetic resonance and layer-specific longitudinal strain in treatment naive Anderson Fabry disease. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.356] [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: 11/12/2022] Open
Abstract
Abstract
Background
In Anderson-Fabry disease (AFD), the accumulation of glycosphingolipids in cardiomyocytes causes inflammation, hypertrophy and interstitial fibrosis which is first limited to the mid-myocardial layers, then spreads to transmural fibrosis. Speckle tracking echocardiography allows the estimation of layer-specific strain, differentiating longitudinal strain (LS) at subendocardium and subepicardium (LSsubendo and LSsubepi, respectively).
Purpose
To investigate the matching of functional and structural abnormalities in newly diagnosed, never treated AFD patients by comparing multi-layer LS and late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR).
Methods
Twenty newly diagnosed, never treated AFD patients (age = 37 ± 13 years; F/M =10/10) and 20 healthy controls, matched for age and sex, underwent comprehensive evaluation of target organs and a standard echo-Doppler exam, including assessment of relative diastolic wall thickness (RWT) and left ventricular mass index (LVMI). Left ventricular hypertrophy (LVH) was defined as LVMi > 47 g/m^2.7 in women and >50 g/m^2.7 in men. Speckle tracking echocardiography derived left ventricular transmural global longitudinal strain (GLS), LSsubendo, LSsubepi and LS gradient (LSsubendo - LSsubpepi) were also determined. CMR sequences including assessment of LGE were also performed.
Results
AFD patients had normal renal function and comparable body mass index, blood pressure, heart rate, ejection fraction and diastolic indices with healthy controls. LVMi (p = 0.006) and RWT (p < 0.02) were greater in AFD patients than in controls. GLS (p = 0.006), LSsubendo (p = 0.005) and LSsubepi (p < 0.001) were lower in AFD patients. By CMR, only four patients (F/M = 3/1), 3 with LVH (75%), exhibited focal LGE, always localized in the midwall. LGE was detected at basal lateral wall in three patients and at the septal insertional points with the right ventricle in the remaining one. AFD patients with LGE had higher LVMi than those without LGE (47.2 ± 11.0 vs. 34.5 ± 11.6 g/m^2.7, p = 0.04). There was no correspondence of LGE with both regional LS and layer specific LS impairment (Figure). However, AFD patients with LGE had higher LS gradient compared to those without LGE (5.8 ± 0.65 vs. 4.8 ± 0.66, p < 0.02).
Conclusions
Treatment naïve AFD patients show a reduction of longitudinal deformation, which involves both subendocardial and subepicardial layers. Patients with LGE present higher LV mass and increased LS gradient, without a correspondence of LGE with both regional and layer specific LS impairment. Accordingly, this impairment might due to myocardial inflammation occurring in the early disease stages more than to myocardial fibrosis itself.
Abstract P678 Figure. Multilayer bull"s eye and LGE-CMR in AFD
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Affiliation(s)
- R Esposito
- University Hospital Federico II, Naples, Italy
| | | | | | - C Santoro
- University Hospital Federico II, Naples, Italy
| | - M Lembo
- University Hospital Federico II, Naples, Italy
| | - E Riccio
- University Hospital Federico II, Naples, Italy
| | - M Imbriaco
- University Hospital Federico II, Naples, Italy
| | - A Pisani
- University Hospital Federico II, Naples, Italy
| | - M Galderisi
- University Hospital Federico II, Naples, Italy
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26
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Lembo M, Sorrentino R, Santoro C, Esposito R, Scalamogna M, Avvedimento M, Magliulo F, Franzone A, Cirillo P, Esposito G, Galderisi M. P753 Impact of transcatheter aortic valve implantation on concomitant mitral regurgitation in patients with severe aortic stenosis. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.417] [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
Severe aortic stenosis (AS) and functional mitral regurgitation (MR) frequently coexist. There is no consensus about the optimal therapeutic strategy for patients with combined valve disease. Evidence has shown that double valve surgery is associated with high complication rates and mortality, whereas MR severity may improve after transcatheter aortic valve implantation (TAVI).
Purpose
Aim of our study was to evaluate hemodynamic parameters and cardiac function in patients with severe AS and concomitant MR undergoing TAVI.
Methods
We prospectively enrolled consecutive TAVI patients with concomitant MR. Exclusion criteria were primary cardiomyopathies, prior valve surgery, permanent atrial fibrillation and inadequate echocardiographic imaging. Echo-Doppler assessment, including global longitudinal strain (GLS) and peak atrial longitudinal strain (PALS) (absolute value), was performed before TAVI and after 1-3 months. MR grading was assessed according to quantitative methods (vena contracta and/or PISA). Changes (Δ) of the main echo parameters before and after intervention were computed. On the basis of MR grading changes, the study population was divided in two groups: no improvement in MR grading (NIMR) and improvement in MR grading (IMR).
Results
Of 49 included patients (M/F = 20/29, age 80.7 ± 5.6 years), 23 had mild MR and 26 moderate to severe MR before TAVI. After the procedure, MR grading improved in 11 (IMR) and remained stable in 38 (NIMR) patients. The two groups were comparable for sex, age, body mass index, blood pressure and heart rate. After TAVI, both groups showed an improvement in GLS (17.8 ± 4.7 to 20.1 ± 4.4%, p < 0.0001 and 16.8 ± 3.8 to 19.0 ± 3.1%, p < 0.01, in NIMR and IMR respectively) and in PALS (20.4 ± 7.4 to 24.2 ± 7.3%, p < 0.0001 in NIMR and 19.5 ± 4.5 to 26.7 ± 6.1%, p < 0.001, in NIMR and IMR respectively), without significant changes in ejection fraction (p = 0.12). Only in IMR group, a significant decrease of systolic pulmonary arterial pressure (sPAP) (45.5 ± 10.6 to 36.3 ± 6.9 mmHg, p < 0.001) and left atrial volume index (54.9 ± 14.8 to 48.9 ± 13.3 ml/m², p < 0.01) was observed after TAVI. Changes of sPAP (ΔsPAP) (9.1 ± 6.4 vs. -0.07 ± 6.7, p < 0.0001) was higher and ΔPALS (-7.2 ± 5.1 vs. -3.8 ± 4.3, p < 0.03) lower in IMR compared with NIMR group (Figure). By a multiple linear regression analysis performed in the pooled population, after adjusting for ΔPALS, Δ aortic valve area and ΔGLS, the association between ΔsPAP and MR grading improvement remained significant (beta = 0.53, p < 0.001) (cumulative R²=0.31, SEE = 6.9 mmHg, p = 0.007).
Conclusion
Afterload reduction following TAVI may induce hemodynamic changes determining also a reduction in MR severity. This mechanism implies a reduction in left atrial pressure, whose PALS is a reliable marker, and a consequent reduction of post-capillary pulmonary hypertension. The association between MR improvement and ΔsPAP reduction is independent on echocardiographic confounders.
Abstract P753 Figure. ΔsPAP and ΔPALS in NIMR and IMR
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Affiliation(s)
- M Lembo
- University Hospital Federico II, Naples, Italy
| | | | - C Santoro
- University Hospital Federico II, Naples, Italy
| | - R Esposito
- University Hospital Federico II, Naples, Italy
| | | | | | - F Magliulo
- University Hospital Federico II, Naples, Italy
| | - A Franzone
- University Hospital Federico II, Naples, Italy
| | - P Cirillo
- University Hospital Federico II, Naples, Italy
| | - G Esposito
- University Hospital Federico II, Naples, Italy
| | - M Galderisi
- University Hospital Federico II, Naples, Italy
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27
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Esposito L, Sorrentino R, Capone V, Santoro C, Lembo M, Esposito R, Lo Iudice F, De Roberto AM, Tufano A, Galderisi M. P814 Independent association of body mass index and left atrial strain in patients with non valvular atrial fibrillation. The NeAfib-Echo registry. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.467] [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
Overweight and obesity are related to the risk of new-onset atrial fibrillation (AF). Peak atrial longitudinal strain (PALS) is an advanced echocardiographic parameter of left atrial (LA) function with a recognized diagnostic and prognostic role in both the general population and AF.
Purpose
To investigate the impact of body mass index (BMI) on LA function by utilizing standard and advanced echocardiography in patients with non-valvular AF.
Methods
In the NeAfib-Echo registry, 395 consecutive adult patients with non-valvular AF (F/M: 175/220; mean age 70.6 ± 11 years, BMI: 27.8 ± 5.6 kg/m²) were enrolled. 215 patients (54.1%) had permanent/persistent AF (prAF) and 178 (45.9%) had paroxysmal AF (pxAF). Anthropometric parameters and blood pressure (BP) were recorded and CHA2DS2VASc score was calculated. Patients underwent a complete echo-Doppler exam, including determination of PALS and left ventricular (LV) global longitudinal strain (GLS) (both reported in absolute values). The overall population was divided according to BMI tertiles: first tertile <25.3 Kg/m² (n = 127); second tertile 25.3-29 Kg/m² (n = 137); third tertile > 29.3 Kg/m² (n = 130).
Results
No significant difference of sex prevalence, age, systolic BP and heart rate was found among the three BMI tertiles, whereas diastolic BP was higher in the third tertile (p < 0.001). CHA2DS2VASc score did not significantly differ among tertiles. In the pooled population LV mass index (LVMi) (p = 0.001) progressively increased from the first to the third tertile (p < 0.001), whereas LA volume index, LV ejection fraction (EF), GLS and E/e" ratio were not significantly different among the three groups. PALS was lower in third tertile (14.3 ± 8.2%) versus both the first (19.0 ± 11.5%) and the second tertile (17.7 ± 10.6%) (p < 0.002). In separate sub-analyses according to AF type, PALS was significantly lower in the first than the third tertile in the PxAF group (p < 0.01) but not in patients with PrAF (p = 0.158). In the pooled population PALS was significantly related with BMI (r= -0.17, p < 0.001) (Figure) but also with age, heart rate, LVMi, LV EF, GLS, E/e’ ratio and pulmonary artery systolic pressure (PAPS). By a multilinear regression analysis, after adjusting for CHA2DS2VASc score, LV mass index, LV EF, E/e’ ratio and PAPs, BMI remained independently associated with PALS (standardized β coefficient = -0.127, p < 0.02) (cumulative R² =0.41, SEE = 8.5%, p < 0.0001).
Conclusions
In patients with non valvular AF, overweight and obesity exert a detrimental effect on LA function as testified by the gradual PALS reduction with the increase of BMI tertiles. BMI is associated with PALS independently of several confounders including CHA2DS2VASc. Besides CHA2DS2VASc score, BMI could be considered as an additional factor for evaluating cardiovascular risk in non valvular AF.
Abstract P814 Figure. Relation between BMI and PALS
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Affiliation(s)
- L Esposito
- University Hospital Federico II, Naples, Italy
| | | | - V Capone
- University Hospital Federico II, Naples, Italy
| | - C Santoro
- University Hospital Federico II, Naples, Italy
| | - M Lembo
- University Hospital Federico II, Naples, Italy
| | - R Esposito
- University Hospital Federico II, Naples, Italy
| | - F Lo Iudice
- University Hospital Federico II, Naples, Italy
| | | | - A Tufano
- University Hospital Federico II, Naples, Italy
| | - M Galderisi
- University Hospital Federico II, Naples, Italy
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Ilardi F, Santoro C, Lembo M, Dulgheru R, Esposito R, Sorrentino R, Marchetta S, Sellitto V, Lancellotti P, Esposito G, Galderisi M. P1404 Additional power of automated longitudinal strain during dobutamine stress echo for detecting inducible ischemia in left anterior descending artery stenosis. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.837] [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
Dobutamine stress echo (DSE) is a sensitive but subjective test of inducible ischemia. Speckle tracking allows now a quantitative assessment of regional wall motion, even during DSE.
Purpose
To investigate the feasibility and accuracy of global and regional longitudinal strain during DSE to detect significant CAD.
Methods
This is a prospective, observational study, including 88 patients undergoing DSE for suspected CAD. Thirthy-three patients with negative DSE were excluded from analysis. The remaining 50 patients (82% males, mean age 66.3 ± 8.2 years) with positive DSE underwent subsequent invasive coronary angiography (CA). Besides visual regional wall motion score index (WMSI), global longitudinal strain (GLS) and regional longitudinal strain (RLS) were determined at rest, at peak stress and at early recovery by a dedicated software (Automated Function Imaging) incorporated in a quoad-screen of the echo machine and activated by automatic quantification. Obstructive CAD was defined as >70% stenosis or intermediate stenosis combined with fractional flow reserve <0.80.
Results
The feasibility of DES regional longitudinal strain was 100% (n = 50/50) in the pooled population. Fifteen patients did not show coronary stenosis whereas obstructive CAD was detected in 35 patients (12 with multi-vessel disease). Among these patients, 18 patients had left anterior descending artery (LAD) stenosis, 18 left circumflex coronary artery (LCX) stenosis and 15 right coronary artery (RCA) stenosis. GLS reduction at peak stress (k = 0.253, p = 0.037) and WMSI increase at peak stress (k = 0.217, p = 0.04) showed mild but significant agreement with CA for detecting significant coronary stenosis, whereas the agreement of GLS at recovery (k=-0.087, p = 0.518) was poor. When single lesion territory was considered, GLS at peak stress (17.4 ± 5.5 vs 20.5 ± 4.4%, p = 0.034) and LAD longitudinal strain (= average of 8 myocardial segments: middle and apical posterior septum, basal, middle and apical anterior septum, basal, middle and apical anterior wall) at peak stress showed significantly lower values in the obstructed LAD regions than the territories perfused by non-obstructed coronary arteries (17.1 ± 7.6 vs 21.6 ± 5.5% p = 0.021). Conversely, in presence of significant LCX or RCA stenosis, visual regional wall motion of LCX and RCA territories were higher at peak stress (WMSI LCX = 1.80 ± 0.65 in presence of LCX stenosis vs. 1.38 ± 0.44 in absence of stenosis, p < 0.01; WMSI RCA = 1.89 ± 0.52 in presence of RCA stenosis vs. 1.42 ± 0.42 in absence of stenosis, p = 0.002), but RLS at peak stress showed a trend to increase, without achieving the statistical significance (RLS RCA: p = 0.128, RLS LCX: p = 0.103).
Conclusion
AFI-based strain quantitative analysis appears to be highly feasible during DSE. It appears also to be more accurate than the visual wall motion for the detection of myocardial ischemia in presence of LAD while the accuracy is suboptimal in patients with LCX and RCA stenosis.
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Affiliation(s)
- F Ilardi
- University Hospital Federico II, Naples, Italy
| | - C Santoro
- University Hospital Federico II, Naples, Italy
| | - M Lembo
- University Hospital Federico II, Naples, Italy
| | | | - R Esposito
- University Hospital Federico II, Naples, Italy
| | | | | | - V Sellitto
- University Hospital Federico II, Naples, Italy
| | | | - G Esposito
- University Hospital Federico II, Naples, Italy
| | - M Galderisi
- University Hospital Federico II, Naples, Italy
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Lembo M, Fazio V, Capone V, Esposito L, Sorrentino R, Santoro C, Esposito R, Galderisi M. P658 Impact of hyperuricemia on left ventricular longitudinal systolic function in uncomplicated hypertensive patients. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.338] [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
Hyperuricemia has been reported to accelerate the occurrence and worsening of cardiovascular disease, being a risk factor for coronary heart disease and cardiac mortality. Elevated uric acid (UA) is also associated with left ventricular (LV) hypertrophy and with LV diastolic dysfunction. The effect of hyperuricemia (HU) on LV systolic function is still unclear.
Purpose
Aim of our study was to evaluate the impact of elevated UA serum levels on LV systolic function, also evaluating longitudinal deformation, in a population of hypertensive patients.
Methods
We enrolled 160 treated hypertensive patients (M/F = 104/56, age 58.2 ± 13.3 years, blood pressure = 136.7 ± 16.8/81.3 ± 10.9 mmHg), who underwent standard echo-Doppler exam, including speckle tracking quantification of global longitudinal strain (GLS, considered in absolute value). HU was defined as UA≥7 mg/dL and the study population was divided in two groups: patients with (n = 63) and without (n = 97) HU. Exclusion criteria were coronary artery disease, overt heart failure, hemodynamically significant valve heart disease, primary cardiomyopathies, permanent atrial fibrillation and inadequate echo imaging.
Results
The two groups were comparable for sex prevalence, blood pressure and heart rate. Patients with HU were older and had higher body mass index (BMI) (both p < 0.0001). Prevalence of diabetes mellitus was higher in the group of patients with HU than in patients with normal UA (69% vs. 12% p < 0.0001). Fasting glycaemia was higher (p < 0.0001) and glomerular filtration rate (GFR) lower in HU hypertensives (both p < 0.0001). LV mass index (LVMi) was higher in patients with HU (p < 0.0001). Among diastolic parameters, transmitral E/A ratio (p < 0.0001) was lower, whereas E/e’ ratio (p < 0.0001), E velocity deceleration time and left atrial volume index (both p < 0.001) were higher in HU hypertensives. GLS resulted to be lower in patients with HU (20.8 ± 1.5 vs. 22.3 ± 2.2%, p < 0.0001). LV ejection fraction, despite still in normal range values, was also slightly lower in comparison with controls (60.6 ± 4.0 vs. 62.2 ± 3.9%, p < 0.01). Serum UA levels resulted to be negatively correlated with GLS (r=-0.28, p < 0.0001) (Figure), but not with ejection fraction. By a multiple linear regression analysis performed in the pooled hypertensive population, after adjusting for age, BMI, GFR, fasting glycaemia and LVMi, the association between UA levels and GLS remained significant (standardized beta coefficient =-0.25, p < 0.01), besides the significant impact of age (beta=-0.19 , p < 0.05).
Conclusions
In hypertensive patients with multiple cardiovascular risk factors, the presence of HU is associated with LV diastolic and systolic dysfunction. Serum UA levels and GLS resulted independently associated even after adjusting for several clinical and echo confounders. Acid uric might be considered as an independent marker of early LV dysfunction, able to identify hypertensive patients at increased risk for heart failure.
Abstract P658 Figure. Relation between uric acid and GLS
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Affiliation(s)
- M Lembo
- University Hospital Federico II, Naples, Italy
| | - V Fazio
- University Hospital Federico II, Naples, Italy
| | - V Capone
- University Hospital Federico II, Naples, Italy
| | - L Esposito
- University Hospital Federico II, Naples, Italy
| | | | - C Santoro
- University Hospital Federico II, Naples, Italy
| | - R Esposito
- University Hospital Federico II, Naples, Italy
| | - M Galderisi
- University Hospital Federico II, Naples, Italy
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Santoro C, Esposito M, Sorrentino R, Lembo M, Esposito R, Sellitto V, Luciano F, Galderisi M. P297 Left atrial volume index is the best predictor of post-capillary pulmonary hypertension in patients with pure mitral valve stenosis. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.150] [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
Mitral stenosis (MS) is characterized by a reduced mitral valve area (MVA) and an increased transmitral pressure gradient, with direct consequences on left atrial (LA) remodelling and pulmonary arterial systolic pressure (PASP). Post-capillary pulmonary hypertension (PH) has a main impact on the outcome in patients with MS.
Purpose
To evaluate determinants of post-capillary PH in patients with pure MS by using a combined approach of standard and advanced echocardiography.
Methods
From January 2018 to January 2019, 52 consecutive patients with MS were enrolled. Concomitant hemodynamically significant valve heart disease, primary PH, coronary artery and congenital heart diseases, primary cardiomyopathies, prosthetic valves and permanent/persistent atrial fibrillation were exclusion criteria. Twenty-three "pure" MS were selected (age: 63.9 ± 11.6 years, F/M= 17/6). Twenty-three healthy controls, matched by age and sex, were recruited as the control group. All participants underwent a complete echocardiographic examination, including determination of left ventricular ejection fraction (LVEF), speckle tracking derived global longitudinal strain (GLS, in absolute values), LA volume index (LAVi) and PASP. MS severity was assessed by continuous wave Doppler derived mean transmitral pressure gradient (MPG), pressure half time (PHT) and functional mitral valve area (MVA). Data were analysed offline by a dedicated workstation.
Results
No significant difference of body mass index, systolic and diastolic blood pressure was found between the two groups, while heart rate was higher in MR (p < 0.0001). In the pooled MS population, MPG was 5.7 ± 2.4 mmHg, PHT 127.7 ± 26.9 msec and MVA 1.76 ± 0.36 cm². Twelve patients (52.1%) had mild MS, 10 (43.5%) moderate MS and one (4.3%) severe MS. Patients with MS had larger LA volumes (LAVi = 45.0 ± 12.7 vs. 28.3 ± 7.3 ml/m², p < 0.0001), higher PASP (36.4 ± 8.9 vs. 30.4 ± 6.7 mmHg, p < 0.01), lower LVEF (58.5 ± 6.1 vs. 66.0 ± 3.5%. p < 0.0001) and lower GLS (18.8 ± 4.6 vs. 21.7 ± 2.5%, p < 0.01) than the healthy controls. By analyzing the MS group, LAVi had a significant univariate relation with MPG degree (r = 0.69, p < 0.002). PASP correlated with LAVi (r = 0.60, p = 0.003) and MPG (r = 0.51, p < 0.01) but not with PHT (r = 0.28, p = 0.54) and functional MVA (r=-0.31, p = 0.33). By a multlinear regression analysis, including heart rate, MPG, LVEF and GLS as potential determinants, LAVi (standardized beta coefficient =0.65, p= <0.02) and GLS (beta =-0.62, p = 0.03) were both independently associated with PASP degree, whereas the association of MPG and PASP was not significant (cumulative R²=0.47, SEE = 5.9 mmHg, p < 0.01) in the MS group.
Conclusions
In patients with pure MS, by using a multi-parametric echocardiographic approach, LA dilation appears to be the best predictor of post-capillary PH, independent on the magnitude of LV systolic dysfunction and valvular disease severity. Particular care should be devoted to determine LA size in this clinical setting.
Abstract P297 Figure. Relation between LAVi and PASP in MS
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Affiliation(s)
- C Santoro
- University Hospital Federico II, Naples, Italy
| | - M Esposito
- University Hospital Federico II, Naples, Italy
| | | | - M Lembo
- University Hospital Federico II, Naples, Italy
| | - R Esposito
- University Hospital Federico II, Naples, Italy
| | - V Sellitto
- University Hospital Federico II, Naples, Italy
| | - F Luciano
- University Hospital Federico II, Naples, Italy
| | - M Galderisi
- University Hospital Federico II, Naples, Italy
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31
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Fallace P, Aiese P, Bianco E, Bolognini I, Costa MP, Esposito R, Gallé F, Liguori G, Pandolfi R, Pasquarella C, Savino G, Valeriani F, Romano Spica V. Peer Education strategies for promoting prevention of doping in different populations. Ann Ig 2019; 31:556-575. [PMID: 31616900 DOI: 10.7416/ai.2019.2316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND In the field of doping prevention, alongside the traditional functions of repression and control of the phenomenon, educational aspects are becoming increasingly important. Article 18 of the World Anti doping Code obliges the signatories to invest in anti-doping education with the aim of preserving the spirit of sport. The educational commitment should involve young people in health promotion interventions for the prevention of risk behaviors. Therefore, our attention has focused on finding the mechanisms that lead people to make certain behavioral choices. MATERIAL AND METHODS In the context of preventive programs, to counter the doping phenomenon through health promotion programs, the most recognized method is peer education, particularly with adolescents. It is an educational method according to which some members of a group are empowered and trained to carry out specific activities with their peers. It is constituted as an example of equal relationship and finds its basis in cooperation and solidarity with the aim of increasing empowerment and a healthy development of the identity and collective dimension in young people. RESULTS Numerous experts - biologists / nutritionists, hygienists, sports coaches, psychologists, teachers of physical education in secondary schools and other stakeholders have actively participated in the co-construction of a training package aimed at activating cascade training processes on the knowledge and skills of peer education in contexts of youth aggregation, such as schools, gyms, sports associations, social gatherings of all kinds. The path allowed to define a peer education model capable of enabling the participants to activate health promotion interventions for the prevention of doping risk behaviors, each in their own setting. CONCLUSIONS In conclusion, we can say that prevention programs are the more effective the more they are addressed to young people and adolescents and provide interactive and action-oriented interventions. Successful initiatives aim to emphasize the development of life skills and to influence numerous determinants of behavior, including individual attitudes, knowledge, motivations, interpersonal relationships and social norms. If the aim is to act on the change of behavior, the efforts will be more successful if the content of the intervention will give due consideration to the context in which it applies and the target population, involving it and addressing its specific needs and values.
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Affiliation(s)
- P Fallace
- Prevention Department, ASL Napoli 2 Nord, Frattamaggiore, Italy - WDPP, Working Group Doping Prevention Project
| | - P Aiese
- Prevention Department, ASL Napoli 2 Nord, Frattamaggiore, Italy
| | - E Bianco
- Prevention Department, ASL Napoli 2 Nord, Frattamaggiore, Italy
| | - I Bolognini
- Prevention Department, ASL Napoli 2 Nord, Frattamaggiore, Italy
| | - M P Costa
- Prevention Department, ASL Napoli 2 Nord, Frattamaggiore, Italy
| | - R Esposito
- Prevention Department, ASL Napoli 2 Nord, Frattamaggiore, Italy
| | - F Gallé
- Department of Motor and Wellness Sciences, University of Naples "Parthenope", Naples, Italy
| | - G Liguori
- Department of Motor and Wellness Sciences, University of Naples "Parthenope", Naples, Italy - WDPP, Working Group Doping Prevention Project
| | - R Pandolfi
- Prevention Department, ASL Napoli 2 Nord, Frattamaggiore, Italy
| | - C Pasquarella
- Department of Medicine and Surgery, University of Parma, Italy - WDPP, Working Group Doping Prevention Project
| | - G Savino
- Ausl Modena and Antidoping Regional Center, Emilia-Romagna Region, Italy - WDPP, Working Group Doping Prevention Project
| | - F Valeriani
- Department of Movement, Human, and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - V Romano Spica
- Department of Movement, Human, and Health Sciences, University of Rome "Foro Italico", Rome, Italy - WDPP, Working Group Doping Prevention Project
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Romeo V, Sarno L, Volpe A, Ginocchio MI, Esposito R, Mainenti PP, Petretta M, Liuzzi R, D'Armiento M, Martinelli P, Brunetti A, Maurea S. US and MR imaging findings to detect placental adhesion spectrum (PAS) in patients with placenta previa: a comparative systematic study. Abdom Radiol (NY) 2019; 44:3398-3407. [PMID: 31435761 DOI: 10.1007/s00261-019-02185-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE To compare the performance US and MR in identifying placental adhesion spectrum (PAS) in placenta previa (PP) and to establish a potential method of image interpretation. METHODS US and MR examinations of 51 patients with PP were selected. The presence of imaging signs commonly used to detect PAS was assessed. Penalized logistic regression was performed considering histology as standard of reference; only signs statistically significant (p < 0.05) were considered for ROC and multivariate analysis. The probability of PAS according to the presence of US and/or MR signs was then assessed. RESULTS At univariate analysis, loss of retroplacental clear space, myometrial thinning (MT) and placenta lacunar spaces on US, intraplacental dark bands (IDBs), focal interruption of myometrial border (FIMB) and abnormal vascularity (AV) on MR were statistically significant (p < 0.01). Three diagnostic methods for PAS were then developed for both US and MR when at least one (Method 1), two (Method 2) or three (Method 3) imaging signs occurred, respectively. Method 2 for MR showed a significantly (p < 0.05) higher accuracy (91%) compared to the other methods. When MR IDBs and AV as well as IDBs and FIMB were present in combination with US MT the probability of PAS increased from 75 to 90% and from 80 to 91%, respectively. CONCLUSION MR demonstrated a higher diagnostic accuracy than US to detect PAS. However, since the combination of MR and US signs could improve the probability to detect PAS, a complementary diagnostic role of these techniques could be considered.
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Affiliation(s)
- V Romeo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via S. Pansini, 5, 80131, Naples, Italy.
| | - L Sarno
- Department of Neuroscience, Reproductive and Dentistry Sciences, University of Naples "Federico II", Via S. Pansini, 5, 80131, Naples, Italy
| | - A Volpe
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via S. Pansini, 5, 80131, Naples, Italy
| | - M I Ginocchio
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via S. Pansini, 5, 80131, Naples, Italy
| | - R Esposito
- Department of Neuroscience, Reproductive and Dentistry Sciences, University of Naples "Federico II", Via S. Pansini, 5, 80131, Naples, Italy
| | - P P Mainenti
- Institute of Biostructures and Bioimaging of the National Research Council (IBB-CNR), Naples, Italy
| | - M Petretta
- Department of Translational Medical Sciences, University of Naples "Federico II", Via S. Pansini, 5, 80131, Naples, Italy
| | - R Liuzzi
- Institute of Biostructures and Bioimaging of the National Research Council (IBB-CNR), Naples, Italy
| | - M D'Armiento
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via S. Pansini, 5, 80131, Naples, Italy
| | - P Martinelli
- Department of Neuroscience, Reproductive and Dentistry Sciences, University of Naples "Federico II", Via S. Pansini, 5, 80131, Naples, Italy
| | - A Brunetti
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via S. Pansini, 5, 80131, Naples, Italy
| | - S Maurea
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via S. Pansini, 5, 80131, Naples, Italy
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Buonauro A, Sorrentino R, Canora A, Bocchino ML, Esposito R, Santoro C, Fiorillo L, Sanduzzi Zamparelli A, Trimarco B, Galderisi M. P2775Evaluation of right ventricular function in patients with idiopathic and non-idiopathic interstitial pulmonary fibrosis: a speckle tracking echocardiography study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1092] [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
Pulmonary fibrosis (PF) is a heterogeneous group of diffuse parenchymal lung diseases, including idiopathic PF (IPF), which is the most frequent type in adults, and non-IPF. The impairment of right ventricular (RV) myocardial function of PF patients is not fully elucidated.
Purpose
To identify RV alterations in patients with interstitial PF and to evaluate possible differences between IPF and non-IPF by a combined assessment with standard and advanced echocardiography.
Methods
We enrolled 61 patients affected by interstitial PF (F/M: 16/45; age 67.9±8.1 years). 33 patients had IPF fibrosis and 28 non-IPF (bronchiolitis obliterans-organizing pneumonia and nonspecific interstitial pneumonia/fibrosis). Patients with coronary artery disease, overt heart failure, primary cardiomyopathies, other forms of diffuse parenchymal lung disease, history of pulmonary embolism and primary pulmonary hypertension were excluded. PF diagnosis was made by chest radiography, spirometry and chest high-resolution computed tomography. Lung cumulative damage was evaluated by diffusion capacity of the lung for carbon monoxide (DLco). Anthropometric parameters and blood pressure (BP) were recorded. All patients underwent a complete standard and advanced echo-Doppler exam including assessment of RV structure and function. RV global longitudinal strain (RVGLS), septal and lateral longitudinal strain (SLS and LLS respectively), were estimated by speckle tracking echocardiography (all strains were reported in absolute values).
Results
No significant difference was found in sex prevalence, systolic and diastolic BP and heart rate between the two groups, whereas IPF patients were older (65.2±8.1 vs. 70.1±7.6 years, p<0.01) than non-IPF. There was no difference in DLco between IPF and non-IPF patients. The two groups had similar left ventricular (LV) mass index, LV E/A ratio and E/e' ratio, and LV ejection fraction. RV diameters, tricuspid annulus plane systolic excursion (TAPSE) and pulmonary systolic artery pressure (PAPs) were not significantly different between the two groups, whereas IPF patients had lower RV GLS (20.2±3.1 vs. 23.0±3.6%, p=0.006), SLS (17.4±3.4 vs. 20.5±4.7%, p<0.01) and LLS (22.6±4.5 vs. 25.8±4.7%, p<0.02) compared to non-IPF patients. In the pooled population, DLco was related to RV GLS (r=0.51, p=0.004) and SLS (r=0.47, p<0.01), but not with age (p=0.121), TAPSE (p=0.532), and PAPs (p=0.875). In separate sub-analyses according to PF type, DLco was related to RVGLS in patients with IPF (r=0.52, p=0.03), but not in patients with non-IPF (r=0.41, p=0.16).
Conclusion
In patients with PF, RV systolic myocardial dysfunction is detectable by speckle tracking but not with standard echocardiography. In patients with IPF, RV dysfunction is associated with the degree of lung disease damage, as assessed by DLco.
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Affiliation(s)
- A Buonauro
- University Hospital Federico II, Naples, Italy
| | | | - A Canora
- University Hospital Federico II, Naples, Italy
| | | | - R Esposito
- University Hospital Federico II, Naples, Italy
| | - C Santoro
- University Hospital Federico II, Naples, Italy
| | - L Fiorillo
- University Hospital Federico II, Naples, Italy
| | | | - B Trimarco
- University Hospital Federico II, Naples, Italy
| | - M Galderisi
- University Hospital Federico II, Naples, Italy
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Cingolani A, Grottoli CF, Esposito R, Villa T, Rossi F, Perale G. Improving Bovine Bone Mechanical Characteristics for the Development of Xenohybrid Bone Grafts. Curr Pharm Biotechnol 2019; 19:1005-1013. [PMID: 30488794 DOI: 10.2174/1389201020666181129115839] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 06/19/2018] [Revised: 09/03/2018] [Accepted: 11/26/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND The further functionalization of natural existing biomaterials is a very efficient method to introduce additional advanced characteristics on a unique structural composition and architecture. OBJECTIVE As an example, different animal sources, if properly treated, can be used to develop bone xenograft active in hard tissues regeneration. In this sense, it is also important to consider that the selected process has to take into consideration the intrinsic variability of the base material itself and possibly being able to compensate for it. METHODS In this work we characterize cancellous bovine bone treated by deposition of polymer and collagen and we show that the added components not only lead to a more resistant and more hydrophilic material, but also reduce the conventional correlation between apparent density and elastic modulus, which, in general, is a major source of uncertainty and risk in xenografts usage. RESULTS Moreover, though intrinsically reinforcing the material, the deposition process leaves the specific open-porous structure, that allows cells proliferation and vessels ingrowth, basically unaltered. CONCLUSION The final material combines in a single piece and at the same time, mechanical resistance, homogeneous mechanical response and proper structural characteristics that allow further integration within the patient autochthonous tissues.
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Affiliation(s)
- Alberto Cingolani
- Department of Chemistry and Applied Bioscience ETH Zurich, Institute for Chemical and Bioengineering, Vladimir- Prelog-Weg 1-5/10, 8093 Zürich, Switzerland.,Industrie Biomediche Insubri SA (IBI), Via Cantonale 67, 6805 Mezzovico- Vira, Switzerland
| | | | - Raffaella Esposito
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering "G. Natta", Politecnico di Milano, 20133 Milan, Italy
| | - Tomaso Villa
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering "G. Natta", Politecnico di Milano, 20133 Milan, Italy
| | - Filippo Rossi
- Laboratory of Applied Physical Chemistry, Department of Chemistry, Materials and Chemical Engineering "G. Natta", Politecnico di Milano, 20133 Milan, Italy
| | - Giuseppe Perale
- Industrie Biomediche Insubri SA (IBI), Via Cantonale 67, 6805 Mezzovico- Vira, Switzerland.,Biomaterials Laboratory, Institute for Mechanical Engineering and Materials Technology, SUPSI - University of Applied Sciences and Arts of Southern Switzerland. Via Cantonale 2C, Galleria 2, 6928 Manno, Switzerland.,Department of Surgical Sciences, Orthopaedic Clinic-IRCCS A.O.U. San Martino, 16132 Genova, Italy
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Buonauro A, Sorrentino R, Esposito R, Nappi L, Lobasso A, Santoro C, Rivellese F, Sellitto V, Rossi FW, Liccardo B, Tufano A, Galderisi M, Paulis AD. Three-dimensional echocardiographic evaluation of the right ventricle in patients with uncomplicated systemic lupus erythematosus. Lupus 2019; 28:538-544. [PMID: 30885082 DOI: 10.1177/0961203319833786] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Our aim was to identify subclinical right ventricular (RV) alterations in systemic lupus erythematosus (SLE) by combining standard and three-dimensional echocardiography (3DE). Fifty SLE patients without concomitant cardiac disease and 50 healthy controls, matched for age and gender, were enrolled. Disease damage was evaluated by inflammatory markers and SLE damage index. All patients underwent an echo-Doppler examination with 3DE assessment of RV function, RV septal and lateral longitudinal strain. The two groups had comparable body mass index and blood pressure. RV transversal middle diameter and pulmonary arterial pressure were significantly higher in SLE compared to controls. By 3DE, RV end-systolic volume ( p = 0.037) was greater, whereas stroke volume ( p = 0.023), ejection fraction ( p < 0.0001) and septal and lateral longitudinal strain (both p < 0.0001) were lower in SLE. SLE damage index ≥ 1 was negatively associated with tricuspid annular plane systolic excursion (TAPSE) ( p < 0.002), tricuspid E/A ratio ( p = 0.003), RV ejection fraction ( p < 0.05), lateral longitudinal strain ( p < 0.0001) and septal longitudinal strain ( p = 0.04). By separate multivariate models, after adjusting for age, C reactive protein and proBNP, SLE damage index was independently associated with TAPSE ( p = 0.009) and RV lateral longitudinal strain ( p = 0.007). In conclusion, a subclinical RV systolic dysfunction is detectable in SLE by 3DE, RV lateral wall strain being a key parameter. RV dysfunction is associated with cumulative disease damage.
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Affiliation(s)
- A Buonauro
- 1 Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - R Sorrentino
- 1 Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - R Esposito
- 1 Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - L Nappi
- 2 Department of Translational Medical Sciences, Federico II University Hospital, Naples, Italy
| | - A Lobasso
- 2 Department of Translational Medical Sciences, Federico II University Hospital, Naples, Italy
| | - C Santoro
- 1 Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - F Rivellese
- 2 Department of Translational Medical Sciences, Federico II University Hospital, Naples, Italy.,3 Center for Basic and Clinical Immunology Research, Federico II University Hospital, Naples, Italy
| | - V Sellitto
- 1 Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - F W Rossi
- 2 Department of Translational Medical Sciences, Federico II University Hospital, Naples, Italy
| | - B Liccardo
- 2 Department of Translational Medical Sciences, Federico II University Hospital, Naples, Italy
| | - A Tufano
- 4 Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| | - M Galderisi
- 1 Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - A de Paulis
- 2 Department of Translational Medical Sciences, Federico II University Hospital, Naples, Italy.,3 Center for Basic and Clinical Immunology Research, Federico II University Hospital, Naples, Italy
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Lembo M, Esposito R, Sorrentino R, Petitto M, Santoro C, Fazio V, Trimarco B, De Simone G, Galderisi M. P600Impact of the use of left ventricular mass/end-diastolic volume ratio by 3D echocardiography on 2D derived global longitudinal strain and diastolic function in native hypertensive patients. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- M Lembo
- University Hospital Federico II, Naples, Italy
| | - R Esposito
- University Hospital Federico II, Naples, Italy
| | | | - M Petitto
- University Hospital Federico II, Naples, Italy
| | - C Santoro
- University Hospital Federico II, Naples, Italy
| | - V Fazio
- University Hospital Federico II, Naples, Italy
| | - B Trimarco
- University Hospital Federico II, Naples, Italy
| | - G De Simone
- University Hospital Federico II, Naples, Italy
| | - M Galderisi
- University Hospital Federico II, Naples, Italy
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Lembo M, Esposito R, Santoro C, Fazio V, De Roberto AM, Mancusi C, Trimarco B, De Simone G, Galderisi M. P2849Independent association between left ventricular midwall mechanics and global longitudinal strain in native hypertensive patients. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- M Lembo
- University Hospital Federico II, Naples, Italy
| | - R Esposito
- University Hospital Federico II, Naples, Italy
| | - C Santoro
- University Hospital Federico II, Naples, Italy
| | - V Fazio
- University Hospital Federico II, Naples, Italy
| | | | - C Mancusi
- University Hospital Federico II, Naples, Italy
| | - B Trimarco
- University Hospital Federico II, Naples, Italy
| | - G De Simone
- University Hospital Federico II, Naples, Italy
| | - M Galderisi
- University Hospital Federico II, Naples, Italy
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Sorrentino R, Cocozza S, Lembo M, Esposito R, Scalamogna M, Vaccaro A, Trimarco B, Galderisi M. P6488Impact of novel recommendations for the evaluation of left ventricular diastolic function in estimating filling pressures in the clinical practice. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - S Cocozza
- University Hospital Federico II, Naples, Italy
| | - M Lembo
- University Hospital Federico II, Naples, Italy
| | - R Esposito
- University Hospital Federico II, Naples, Italy
| | | | - A Vaccaro
- University Hospital Federico II, Naples, Italy
| | - B Trimarco
- University Hospital Federico II, Naples, Italy
| | - M Galderisi
- University Hospital Federico II, Naples, Italy
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Esposito R, Sorrentino R, Riccio E, Santoro C, Pellegrino AM, Lembo M, Losi M, Imbriaco M, Pisani A, Trimarco B, Galderisi M. P1260Prominent reduction of subepicardial strain and increase of transmural myocardial gradient in native Anderson-Fabry disease: a speckle tracking echocardiography study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- R Esposito
- University Hospital Federico II, Naples, Italy
| | | | - E Riccio
- University Hospital Federico II, Naples, Italy
| | - C Santoro
- University Hospital Federico II, Naples, Italy
| | | | - M Lembo
- University Hospital Federico II, Naples, Italy
| | - M Losi
- University Hospital Federico II, Naples, Italy
| | - M Imbriaco
- University Hospital Federico II, Naples, Italy
| | - A Pisani
- University Hospital Federico II, Naples, Italy
| | - B Trimarco
- University Hospital Federico II, Naples, Italy
| | - M Galderisi
- University Hospital Federico II, Naples, Italy
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Esposito R, Romano-Carratelli C, Lanzetti N, Hohenegger M, Pluvio M, Capodicasa G, Nuzzo I, Giordano C. Toxicity in Uremia 2. Correlation between PTH Levels and Impaired Aspecific Immunity. Int J Artif Organs 2018. [DOI: 10.1177/039139888801100306] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The role of PTH in depressing polynuclear leucocyte (PMN) phagocytosis in uremia was investigated. The hydrophobicity and phagocytic activity of normal PMN was tested in presence of uremic patients’ serum with low (Group A) or high (Group B) levels of plasma PTH. The PMN phagocytic index was lowered by serum of both groups, but more in presence of Group B serum (p A vs B < 0.002). Similarly, the contact angle of cells was affected more in presence of serum of patients with high PTH levels (p B vs A < 0.003; p B vs C < 0.002).
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Affiliation(s)
- R. Esposito
- Institute of Internal Medicine and Nephrology, 1st Faculty, University of Naples - Italy
| | | | - N. Lanzetti
- Institute of Internal Medicine and Nephrology, 1st Faculty, University of Naples - Italy
| | - M. Hohenegger
- Institute of General and Experimental Pathology, University of Wien - Austria
| | - M. Pluvio
- Institute of Internal Medicine and Nephrology, 1st Faculty, University of Naples - Italy
| | - G. Capodicasa
- Institute of Internal Medicine and Nephrology, 1st Faculty, University of Naples - Italy
| | - I. Nuzzo
- Institute of Internal Medicine and Nephrology, 1st Faculty, University of Naples - Italy
| | - C. Giordano
- Institute of Internal Medicine and Nephrology, 1st Faculty, University of Naples - Italy
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Esposito R, Manzo M, Hohenegger M, Pluvio M, Lanzetti N, Perna N, Romano-Carratelli C, Giordano C. Toxicity in Uremia 1. Correlation between PTH Levels and Depressed Cell Proliferation. Int J Artif Organs 2018. [DOI: 10.1177/039139888801100305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cell proliferation is significantly depressed in uremia; to assess the influence of PTH on it, normal lymphocytes were cultured in presence of uremic patients’ serum with low or high plasma PTH levels (Group A; PTH < 2.5 ng/ml; Group B: PTH > 12 ng/ml), and serum of normal subjects (Group C). Cell proliferation was lowered by serum from both groups (p A vs C < 0.004; p B vs C < 0.001). However, the depressing effect was more evident when group B serum was employed (p A vs B< 0.002).
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Affiliation(s)
- R. Esposito
- Institute of Internal Medicine and Nephrology, 1st Faculty, University of Naples - Italy
| | - M. Manzo
- Institute of Internal Medicine and Nephrology, 1st Faculty, University of Naples - Italy
| | - M. Hohenegger
- Institute of General and Experimental Pathology, University of Wien - Austria
| | - M. Pluvio
- Institute of Internal Medicine and Nephrology, 1st Faculty, University of Naples - Italy
| | - N. Lanzetti
- Institute of Internal Medicine and Nephrology, 1st Faculty, University of Naples - Italy
| | - N. Perna
- Institute of Internal Medicine and Nephrology, 1st Faculty, University of Naples - Italy
| | | | - C. Giordano
- Institute of Internal Medicine and Nephrology, 1st Faculty, University of Naples - Italy
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Giordano C, Esposito R, Mazzola G, Vecchio G, Pluvio M, Cirillo D, Capasso G, Buonanno G. L-Glutaminase and L-Asparaginase by Extracorporeal Route in Acute Lymphoblastic Leukemia Therapy. Int J Artif Organs 2018. [DOI: 10.1177/039139888100400510] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Use of L-asparaginase by the extracorporeal route in the therapy of acute lymphoblastic leukemia (ALL) has been proposed. Results, however, are not so satisfactory as i.v. administration of this enzyme, because the levels of L-asparagine do not fall for a sufficient length of time due to the antagonistic action of the L-asparagine-synthetase. To avoid the L-asparagine rebound we have utilized, by extracorporeal route, L-glutaminase together with L-asparaginase, in order to reduce L-asparagine and L-glutamine levels. We have therefore performed a series of experiments in vitro and in vivo either using L-asparaginase alone or together with L-glutaminase. Results show that, contrary to what happens when L-asparaginase is used alone, L-asparagine levels decrease and remain low even after 24 hours from the treatment, when L-glutaminase is added to the system. Thus a lowering of L-glutamine levels, which seems to play an important role in the therapy of ALL, is obtained.
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Affiliation(s)
- C. Giordano
- Nephrology 1st Faculty of Medicine University of Naples, Naples, Italy
| | - R. Esposito
- Nephrology 1st Faculty of Medicine University of Naples, Naples, Italy
| | - G. Mazzola
- Istituto di Chimica degli Ormoni Consiglio Nazionale delle Ricerche Via Mario Bianco 9, 20131 Milan, Italy
| | - G. Vecchio
- Istituto di Chimica degli Ormoni Consiglio Nazionale delle Ricerche Via Mario Bianco 9, 20131 Milan, Italy
| | - M. Pluvio
- Nephrology 1st Faculty of Medicine University of Naples, Naples, Italy
| | - D. Cirillo
- Nephrology 1st Faculty of Medicine University of Naples, Naples, Italy
| | - G.B. Capasso
- Nephrology 1st Faculty of Medicine University of Naples, Naples, Italy
| | - G. Buonanno
- Department of Hematology Ospedale S. Gennaro, Naples, Italy
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De Santo N, Manzo M, Raiola P, Lanzetti N, Capasso G, Ficociello R, Anastasio P, Esposito R. Failure of Blood Pressure to Increase following Erythropoietin Therapy in the Renoprival Status. Int J Artif Organs 2018. [DOI: 10.1177/039139889201500304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Two anephric patients in the course of one year erythropoietin therapy improved their anemic status without changes in Mean Arterial Blood Pressure. The discordant time course behaviour of hematocrit and blood pressure points to the importance of residual renal tissue for blood pressure to develop during erythropoietin therapy in the renoprival status.
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Affiliation(s)
- N.G. De Santo
- First Faculty of Medicine, University Federico II, Napoli - Italy
| | - M. Manzo
- First Faculty of Medicine, University Federico II, Napoli - Italy
| | - P. Raiola
- First Faculty of Medicine, University Federico II, Napoli - Italy
| | - N. Lanzetti
- First Faculty of Medicine, University Federico II, Napoli - Italy
| | - G. Capasso
- First Faculty of Medicine, University Federico II, Napoli - Italy
| | - R. Ficociello
- First Faculty of Medicine, University Federico II, Napoli - Italy
| | - P. Anastasio
- First Faculty of Medicine, University Federico II, Napoli - Italy
| | - R. Esposito
- First Faculty of Medicine, University Federico II, Napoli - Italy
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Alcidi G, Evola V, Sorrentino R, Esposito R, Santoro C, Lo Iudice F, Fazio V, Sellitto V, Novo G, Trimarco B, Galderisi M. P1450Effect of overweight and obesity on left ventricular longitudinal multi-layer strain: a speckle tracking two-dimensional echocardiographic study. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Gallo A, Bassi D, Esposito R, Moschini M, Cocconcelli PS, Masoero F. Relationships among ensiling, nutritional, fermentative, microbiological traits and contamination in corn silages addressed with partial least squares regression. J Anim Sci 2017; 94:4346-4359. [PMID: 27898868 DOI: 10.2527/jas.2016-0479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The objective of this work was to reduce the predictor dimensionality and to develop a model able to forecast contamination in corn silages. A survey on 33 dairy farms was performed, and samples from core, lateral, and apical parts of the feed-out face of corn silage bunkers were analyzed for chemical, biological (digestible and indigestible NDF), fermentative (pH, ammonia nitrogen, lactic acid, VFA, and ethanol), and microbiological (yeasts and molds) traits. Corn silage samples were analyzed for cell and spore counts by adoption of a molecular DNA-based method. A partial least squares (PLS) regression with a leave-one-out cross-validation method was used to reduce the dimensionality of the original predictors ( = 30) by projecting the independent variables into latent constructs. In a first step of the model development, the importance of independent variables in predicting contamination was assessed by plotting factor loadings of both dependent and independent variables on the first 2 components and by verifying for each predictor the variable influence on projection values adopting the Wold's criterion as well as the entity of standardized regression coefficients. Three ensiling characteristics (bunker type, presence of lateral wrap plastic film, and penetration resistance as a measurement of the ensiled mass density), a chemical trait (DM), 9 characterizations of the fermentative profile (pH, ammonia nitrogen, acetic acid, butyric acid, isobutyric acid, valeric acid, isovaleric acid, ethanol, and lactic acid), and 2 microbiological traits (yeasts and molds) were retained as important terms in the PLS model. Three reduced-variable PLS (rPLS) regressions-the first based on ensiling, chemical, fermentative, and microbiological retained important variables (rPLSecfm); the second based on chemical, fermentative, and microbiological retained important traits (rPLScfm); and the last based on only chemical and fermentative retained important variables (rPLScf)-were performed. The model that best fit the measurements was rPLSecfm. The rPLScfm and rPLScf models had similar regression performances but higher mean square errors of prediction than rPLSecfm. However, all tested models seemed adequate to rank corn silages for low, medium, and high risks of contamination. To avoid the visit on farm by trained people required to measure penetration resistance, the use of the rPLScf model is suggested as a useful tool to assess the risk of in corn silage.
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Lech P, Vatan A, Modas Daniel P, Tsai HR, Vidal Perez RC, Anwer S, Gorriz Magana J, Giavarini A, Katbeh A, Lo Iudice F, Hayashida A, Lembo M, Jamiel AM, Peacock K, Wong CY, Ministeri M, Woolf A, Carbone A, Ma G, Lee AF, Ripley DP, Karabag T, Arslan C, Yakisan T, Sak D, Galrinho A, Ramos R, Aguiar Rosa S, Viveiros Monteiro A, Branco LM, Morais L, Rodrigues I, Figueiredo L, Ferreira RC, Lin CC, Wu HY, Chen TY, Tsai WC, Castineiras Busto M, Pena Gil C, Trillo Nouche R, Lopez Otero D, Bandin Dieguez MA, Martinez Monzonis A, Gonzalez-Juanatey JR, Atef M, Hassan N, Aboulfotouh Y, Moharem-Elgamal S, Katta A, Seleem M, Meshaal M, Lopez Pais J, Monjas Garcia S, Mata Caballero R, Molina Blazquez L, Alcon Duran B, Alcocer Ayuga M, Fraile Sanz A, Saavedra Falero J, Alonso Martin JJ, Barosi A, Vanelli P, Cerchiello M, Islas Ramirez F, De Agustin A, Marcos Alberca P, Nombela L, Jimenez P, Fernandez Ortiz A, Luis Rodrigo J, Perez De Isla L, Macaya C, Petitto M, Schiano Lomoriello V, Imbriaco M, Trimarco B, Galderisi M, Kagiyama N, Hirohata AH, Yamamoto K, Yoshida K, Santoro C, Esposito R, Gerardi D, Sellitto V, Trimarco B, Galderisi M, Ahmed AM, Alharbi AS, Savis A, Bellsham-Revell H, Salih C, Simpson JM, Uebing U, Gatzoulis M, Li WL, Jaber W, Salerno G, Rea G, D'andrea A, Di Maio M, Limongelli G, Muto M, Pacileo G. Clinical Case Poster session 1P501The incremental value of advanced cardiovascular multi-modality imaging in the investigation of a cardiac massP502Metastatic adenocarsinoma involving the right ventricle and pulmonary artery leading right heart failureP503A malignant cause of angina in hypertrophic cardiomyopathyP504Dyspnea in a severe mitral stenotic gentleman with hypereosinophiliaP505After transcatheter aortic valve implantation be aware of infections, a case of fistulization from left ventricular outflow track to left atriumP506Myocardial infarction masking infective endocarditisP507Subendocardial abscess by contiguity of a valvular vegetationP508Real-time three-dimensional transesophageal echocardiography as compared to in vivo anatomy in a case of Candida parapsilosis native mitral valve endocarditisP509TAVI in prosthetic heart valve failure : echocardiography guided transcatether percuntaneous valve in valve implantation (VIV) for failed TAVI corevalve bioprosthesisP510Functional-anatomic matching between longitudinal strain pattern and late gadolinium enhancement of cardiac amyloidosis at presentationP511Heart failure due to masked systolic atrial contraction detected by pulmonary venous flow in a patient with ventricular pacingP512The detection of early left ventricular dysfunction by global longitudinal strain is helpful to keep in adjuvant therapy breast cancer patients till completionP513Forgotten cause of known disease: pulmonary hypertension caused by schistosomiasisP515Single coronary origin delineation by echocardiography alone in a patient with tetralogy of fallot changing the surgical planP516A rare complication after multiple valve repairP517Unusual cause of cyanosis in a young adult with cavopulmonary connectionsP518Abnormal flow in the main pulmonary artery in adult patients: a tale of 2 shuntsP519Unexpected TEE finding: mediastinal lipomatosis can fake an aortic intramural haematoma. Eur Heart J Cardiovasc Imaging 2016. [DOI: 10.1093/ehjci/jew247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Ujka K, Chiu DYY, Tayel H, Mostafa SHAIMA, Ramberg E, Walsh JL, Hassan M, Pavlyukova EN, Li L, Nemes A, Sorrentino R, Nemes A, Modas Daniel P, Bruno RM, Catuzzo B, Bastiani L, Tonacci A, D'angelo G, Mrakic-Sposta S, Vezzoli A, Giardini G, Pratali L, Kalra PA, Green D, Hughes J, Sinha S, Abidin N, Sabry SHAIMA, Mostafa SHERIN, Mohamed HAMODA, Aboelenein HESHAM, Olausson M, Joergensen TBS, Bhadwad P, Nepper ML, Binko TS, Petersen JR, Fornitz GG, Lamaa N, Sakr G, Abou Hassan OK, Jalkh K, Al Jaroudi W, Ismaeel H, Abd Alrahman T, Mazen A, Hegazy SH, Gladkih NN, Klein IR, Karpov RS, Craft MC, Winter JW, Hsu HH, Joseph NJ, Klas BK, Kutty SK, Domsik P, Kalapos A, Oszlanczi M, Orosz A, Valkusz Z, Forster T, Lengyel C, Santoro C, Esposito R, Pezzullo E, Buonauro A, Schiano-Lomoriello V, Cocozza S, Vaccaro A, Trimarco B, Galderisi M, Domsik P, Kalapos A, Oszlanczi M, Forster T, Ramos R, Teixeira PP, Barbosa C, Leal C, Morais E, Caveirinha D, Oliveira E, Figueiredo L, Ferreira RC. P260Right cardiac chambers remodeling in marathon and ultra-trail athletes detected by speckle-tracking echocardiographyP261Speckle tracking determination of tissue motion annular displacement: comparison with strain and ejection fraction, and association with outcomes in haemodialysis patientsP262Value of right ventricular 2D-speckle tracking parameters in predicting the TIMI flow grade of the RCA in patients with acute RV infarctionP263The correlation between left atrial deformation indices and the CHA2DS2 - VASc risk score in patients with atrial fibrillationP264Right atrial and ventricular function evaluated with speckle tracking in patients with acute pulmonary embolismP265Enhanced accuracy of a speckle tracking strain based artificial intelligence model to differentiate ischaemic myocardial disease and cardiomyopathyP266Detection of early left ventricular and left atrial dysfunction in type I diabetes mellitus using 2D speckle tracking echocardiographyP267Two-dimensional left ventricular global longitudinal strain dynamics after percutaneous coronary intervention in stable single-vessel coronary artery disease patientsP268Left ventricular twist, torsion and strain in the fetus by 3D echocardiography: feasibility and comparisons with 2DP269Left atrial deformation analysis in acromegaly - a three-dimensional speckle-tracking echocardiographic studyP270Impact of hemodialysis on three-dimensional left ventricular myocardial deformation in end-stage renal disease: relationships with preload reductionP271Right atrial function in noncompaction cardiomyopathy - a three-dimensional speckle-tracking echocardiographic studyP272CABG failure in the era of cardiac computed tomography - after 8 years half the patients have at least one graft affected. Eur Heart J Cardiovasc Imaging 2016; 17:ii45-ii48. [DOI: 10.1093/ehjci/jew236.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Boileve V, Schueler R, Hinojar R, Bando M, Lo Iudice F, Andersen OS, Nielsen KM, Merlo M, Dreyfus J, Attias D, Codogno I, Brochet E, Vahanian A, Messika-Zeitoun D, Kaplan S, Oeztuerk C, Weber M, Sinning JM, Welt A, Werner N, Nickenig G, Hammerstingl C, Fernandez-Golfin C, Gonzalez-Gomez A, Garcia Martin A, Casas E, Del Val D, Pardo A, Mejias A, Moya JL, Barrios V, Jimenez Nacher JJ, Zamorano JL, Yamada H, Amano R, Tamai R, Torii Y, Nishio S, Seno Y, Kusunose K, Sata M, Santoro C, Buonauro A, Ferrone M, Esposito R, Trimarco B, Petitto M, Galderisi M, Gude E, Andreassen AK, Broch K, Skulstad H, Smiseth OA, Remme EW, Damgaard DW, Jensen JM, Kraglund KL, Kim WY, Stolfo D, Gobbo M, Gabassi G, Barbati G, De Luca A, Korcova R, Secoli G, Pinamonti B, Sinagra G. Moderated Posters: A little bit of everythingP1190What causes mitral annulus dilatation-A three dimensional studyP1191Impact of interventional edge-to-edge repair with the MitraClip system on mitral valve geometry: Long-term results from a prospective single centre studyP1192Real live applications of three-dimensional echocardiographic quantification of the left atrial volumes using an automated adaptive analytics algorithmP1193Quantitative ultrasound evaluation of the changes on tissue characteristics of carotid plaques by lipid lowering therapyP1194Effort heart rate increase is an independent predictor of longitudinal function reserve in the trained heart: a stress echocardiography studyP1195Incremental value of strain imaging in classification of heart failure with normal ejection fractionP1196Multimodality work-up of young stroke patients is beneficialP1197Prognostic significance of the hemodynamic non-invasive assessment in patients with dilated cardiomyopathy. Eur Heart J Cardiovasc Imaging 2016. [DOI: 10.1093/ehjci/jew265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Wassmuth R, Hristova K, Monney P, Olander RFW, Rodriguez Munoz D, Huayan X, Pagourelias E, Loardi C, Moreno J, Miljkovic T, Takase H, Latet SC, Henquin R, America R, Carter-Storch R, Panelo ML, Fernandez-Golfin C, Cho IJ, Petrini J, Buonauro A, Liu B, Mapelli M, Tamulenaite E, De Chiara B, Minden H, Kostova V, Nesheva N, Katova TZ, Bojadzhiev L, Crisinel V, Reverdin S, Conti L, Mach F, Mueller H, Jeanrenaud X, Bochud M, Ehret G, Sundholm JKM, Ojala T, Andersson S, Sarkola T, Moya Mur JL, Berlot B, Fernandez-Golfin C, Moreno Planas J, Casas Rojo E, Garcia Martin A, Jimenez Nacher JJ, Hernandez-Madrid A, Franco Diez E, Matia Frances R, Zamorano JL, Zhigang YANG, Yingkun GUO, Jing CHEN, Duchenne J, Mirea O, Triantafyllis A, Michalski B, Vovas G, Delforge M, Van Cleemput J, Bogaert J, Voigt JU, Saccocci M, Tamborini G, Veglia F, Pepi M, Alamanni F, Zanobini M, Zuniga Sedano JJ, Alexanderson E, Martinez C, Bjelobrk M, Pavlovic K, Ilic A, Colakovic S, Dodic S, Tanaka T, Machii M, Nonaka D, Van Herck PL, Claeys MJ, Haine SE, Miljoen HP, Segers VF, Vandendriessche TR, De Winter BY, Hoymans VY, Vrints CJ, Lombardero M, Perea G, Miele MM, De Amicis DAV, Mannacio VAM, Dahl JS, Christensen NL, Soendergaard EV, Marcussen N, Moeller JE, Fernandez-Palomeque C, Garcia-Vega D, Mont-Girbau L, Pardo A, Izurieta C, Boretti I, Hinojar R, Gonzalez-Gomez A, Garcia Martin A, Casas E, Salido L, Barrios V, Ruiz S, Moya JL, Hernandez Antolin R, Jimenez Nacher JL, Zamorano JL, Chang HJ, Choi HH, Lee SY, Shim CY, Ha JW, Chung N, Ring M, Caidahl K, Eriksson MJ, Esposito R, Santoro C, Monteagudo JM, Trimarco B, Galderisi M, Zamorano JL, Baig S, Hayer M, Steeds R, Edwards N, Fusini L, Zagni P, Muratori M, Agostoni P, Tamborini G, Gripari P, Ghulam Ali S, Pepi M, Fiorentini C, Valuckiene Z, Jurkevicius R, Peritore A, Botta L, Belli O, Musca F, Casadei F, Russo C, Giannattasio C, Moreo A. Poster Session 6Assessment of morphology and functionP1222Multimodality imaging for left atrial appendage occluder sizingP1223Longitudinal left atrial strain is a main predictor for long term prognosis on atrial fibrillation after CABG operation patientsP1224Comparison of 2D and 3D left ventricular volumes measurements: results from the SKIPOGH II studyP1225Adjusting for thoracic circumference is superior to body surface area in the assessment of neonatal cardiac dimensions in foetal growth abnormalityP1226Maximal vortex suction pressure: an equivocal marker for optimization of atrio-ventricular delayP1227Volume-time curve of cardiac magnetic resonance assessed left ventricular dysfunction in coronary artery disease patients with type 2 diabetes mellitusP1228Thickness matters, but not in the same way for all strain parametersP1229Digging deeper in postoperative modifications of right ventricular function: impact of pericardial approach and cardioplegiaP1230Left atrial function evaluated by 2D-speckle tracking echocardiography in diabetes mellitus populationP1231The influence of arterial hypertension duration on left ventricular diastolic parameters in patients with well regulated arterial blood pressureP1232Investigation of factors affecting left ventricular diastolic dysfunction determined using mitral annulus velocityP1233High regulatory T-lymphocytes after ST-elevation myocardial infarction relate with adverse left ventricular remodelling assessed by 3D-echocardiographyP1234Prevalence of paradoxical low flow/low gradient severe aortic stenosis measure with 3 dimensional transesophageal echocardiographyP1235Coronary microvascular and diastolic dysfunctions after aortic valve replacement: comparison between mechanical and biological prosthesesP1236Normal-flow, low gradient aortic stenosis is common in a population of patients with severe aortic valve stenosis undergoing aortic valve replacementP1237Analysis of validity and reproducibility of calcium burden visual estimation by echocardiographyP12383D full automatic software in the evaluation of aortic stenosis severity in TAVI patients. Preliminary resultsP1239Differential impact of net atrioventricular compliance on clinical outcomes in patients with mitral stenosis according to cardiac rhythmP1240Aortic regurgitation affects the intima-media thickness of the right and left common carotid artery differentlyP1241Global longitudinal strain: an hallmark of cardiac damage in mitral valve regurgitation. Experience from the european registry of mitral regurgitationP1242Echocardiographic characterisation of Barlow's disease versus fibroelastic deficiencyP1243Echocardiographic screening for rheumatic heart disease in a ugandan orphanage - feasibility and outcomesP1244Alterations in right ventricular mechanics upon follow-up period in patients with persistent ischemic mitral regurgitation after inferoposterior myocardial infarctionP1245Ten-years conventional mitral surgery in patients with mitral regurgitation and left ventricular dysfunction: clinical and echocardiographic outcomes. Eur Heart J Cardiovasc Imaging 2016. [DOI: 10.1093/ehjci/jew266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Jung IH, Kurnicka K, Enache R, Nagy AI, Martins E, Cereda A, Vitiello G, Magda SL, Styczynski G, Lo Iudice F, De Barros Viegas H, Shahab F, Trunina I, Mata Caballero R, De Barros Viegas H, Marques A, Shimoni S, Generati G, Generati G, Bendix Salkvist Jorgensen T, Chen TE, Andrianova A, Fernandez-Golfin C, Corneli MC, Ali M, Seo HS, Kim MJ, Lichodziejewska B, Goliszek S, Dzikowska-Diduch O, Zdonczyk O, Kozlowska M, Kostrubiec M, Ciurzynski M, Palczewski P, Pruszczyk P, Popa E, Coman IM, Badea R, Platon P, Calin A, Beladan CC, Rosca M, Ginghina C, Popescu BA, Jurcut R, Venkateshvaran AI, Sola SC, Govind SC, Dash PK, Lund L, Manouras AI, Merkely B, Magne J, Aboyans V, Boulogne C, Lavergne D, Jaccard A, Mohty D, Casadei F, Spano F, Santambrogio G, Musca F, Belli O, De Chiara B, Bokor D, Giannattasio C, Corradi E, Colombo CA, Moreo A, Vicario ML, Castellani S, Cammelli D, Gallini C, Needleman L, Cruz BK, Maggi E, Marchionni N, Bratu VD, Mincu RI, Mihai CM, Gherghe AM, Florescu M, Cinteza M, Vinereanu D, Sobieraj P, Bielicki P, Krenke R, Szmigielski CA, Petitto M, Ferrone M, Esposito R, Vaccaro A, Buonauro A, Trimarco B, Galderisi M, Mendes L, Dores H, Melo I, Madeira V, Patinha J, Encarnacao C, Ferreia Santos J, Habib F, Soesanto AM, Sedyawan J, Abdurrazak G, Sharykin A, Popova NE, Karelina EV, Telezhnikova ND, Hernandez Jimenez V, Saavedra J, Molina L, Alberca MT, Gorriz J, L Pais J, Pavon I, Navea C, Alonso JJ, Mendes L, Sonia S, Madeira V, Encarnacao C, Patinha J, Melo I, Ferreia Santos J, Cruz I, Joao I, Gomes AC, Caldeira D, Lopes L, Fazendas P, Pereira H, Edri O, Edri O, Schneider N, Schneider N, Abaye N, Abaye N, Goerge J, Goerge J, Gandelman G, Gandelman G, Bandera F, Alfonzetti E, Guazzi M, Bandera F, Villani S, Ferraro O, Alfonzetti E, Guazzi M, Ramberg E, Bhardwaj P, Nepper ML, Binko TS, Olausson M, Fink-Jensen T, Andersen AM, Roland J, Gleerup Fornitz G, Ong K, Suri RM, Enrique-Sarano M, Michelena HI, Burkhart HM, Gillespie SM, Cha S, Mankad SV, Saidova MA, Bolotova MN, Salido Tahoces L, Izurieta C, Villareal G, Esteban A, Urena Vacas A, Ayala A, Jimenez Nacher JJ, Hinojar Baydes R, Gonzalez Gomez A, Garcia A, Mestre JL, Hernandez Antolin R, Zamorano Gomez JJ, Perea G, Covelli Y, Henquin R, Ronderos R, Hepinstall MJ, Cassidy CS, Pellikka PA, Pislaru SV, Kane G. P569Diastolic dyssynchrony is associated with exercise intolerance in hypertensive patients with left ventricular hypertrophyP570Echocardiographic pattern of acute pulmonary embolism, analysis of consecutive 511 patientsP571Clinical significance of ventricular interdependence and left ventricular function in patients with pulmonary hypertension receiving specific vasodilator therapyP572Haemodynamic characteristics and ventricular mechanics in post-capillary and combined pre- and post-capillary pulmonary hypertensionP573Relationship between hematological response and echocardiographic features in patients with light chains systemic amyloidosisP574Myocardial changes in patients with anorexia nervosaP575Giant cell arteritis presenting as fever of unknown origin: role of clinical history, early positron emission tomography and ultrasound screeningP576Subclinical systolic dysfunction in systemic sclerosis is not influenced by standard rheumatologic therapy - a 4D echocardiographic studyP577Cardiac index correlates with the degree of hepatic steathosis in obese patients with obstructive sleep apneaP578Myocardial mechanics in top-level endurance athletes: a three-dimensional speckle tracking studyP579The athlete heart: what happens to myocardial deformation in physiological adaptation to sportsP580Association between left ventricle intrinsic function and urine protein-creatinine ratio in preeclampsia before and after deliveryP581Dilatation of the aorta in children with bicuspid aortic valveP582Cardiovascular functional abnormalities in patients with osteogenesis imperfectaP583Dobutamine stress test fast protocol: diagnostic accuracy and securityP584Prognostic value of non-positive exercise echocardiography in the patients submitted to percutaneous coronary interventionP585The use of myocardial strain imaging in the detection of coronary artery disease during stress echocardiographyP586Preserved O2 extraction exercise response in heart failure patients with chronotropic insufficiency: evidence for a central cardiac rather than peripheral oxygen uptake limitationP587Major determinant of O2 artero-venous difference at peak exercise in heart failure and healthy subjectsP588Stress echocardiography with contrast perfusion analysis for a more sensitive test for ischemic heart diseaseP589Assessment of mitral annular physiology in myxomatous mitral disease with 3D transesophageal echocardiography: comparison between early severe mitral regurgitation and decompensated groupP590Three-dimensional transesophageal echocardiographic assessment of the mitral valve geometry in patients with mild, moderate and severe chronic ischemic mitral regurgitationP591Left atrial appendage closure. Multimodality imaging in device size selectionP592Contributions of three-dimensional transesophageal echocardiography in the evaluation of aortic atherosclerotic plaquesP593Agitated blood-saline is superior to agitated air-saline for echocardiographic shunt studies. Eur Heart J Cardiovasc Imaging 2016; 17:ii102-ii109. [DOI: 10.1093/ehjci/jew248.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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