P Benussi

Azienda Ospedaliera Universitaria Integrata Verona, Verona, Veneto, Italy

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Publications (33)32.3 Total impact

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    ABSTRACT: PURPOSE: The authors sought to evaluate the incremental value of introducing coronary angiography with multidetector computed tomography (MDCT-CA) compared with the conventional diagnostic workup in managing patients with suspected coronary artery disease (CAD) workup. MATERIALS AND METHODS: A total of 531 consecutive patients underwent MDCT-CA between April 2008 and August 2010. For each patient the pretest probability of CAD was obtained by using the Morise score as well as the diagnostic performance of the exercise test and of MDCT-CA, considering conventional coronary angiography (CCA) as the gold standard. Based on these results, we calculated the posttest likelihood of CAD after stress testing, comparing the incremental diagnostic value for each category of cardiovascular risk with data obtained with MDCT-CA. The conventional diagnostic workup (without MDCT-CA) was then compared with the modified workup (including MDCT-CA). RESULTS: The diagnostic performance of the exercise test for identifying patients with significant lesions had a sensitivity and specificity of 20% and 88%, respectively, with positive (PPV) and negative (NPV) predictive value of 41% and 72%, respectively. Taking CA as the gold standard, MDCT-CA had 93% sensitivity, 89% specificity, 88% PPV and 93% NPV compared with CCA in evaluating significant stenoses in the per-patient analysis. The overall diagnostic accuracy of MDCT-CA was 91%. The exercise tests provided no significant incremental diagnostic value compared with cardiovascular history in patients with a low to intermediate risk. Comparison of the diagnostic accuracy of these protocols showed improved performance results for the modified protocol. CONCLUSIONS: MDCT-CA is the reference modality for the noninvasive exclusion of critical CAD. It provides a very high incremental diagnostic value compared with exercise testing in patients with a low to intermediate risk of CAD. The use of diagnostic protocols based on MDCT-CA ensures improved diagnostic performance compared with those involving conventional exercise electrocardiograms.
    La radiologia medica 06/2012; 117(6):939-952. · 1.37 Impact Factor
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    ABSTRACT: This study was done to compare the parameters of left ventricular (LV) function obtained by multidetector computed tomography coronary angiography (MDCT-CA) using 64-slice equipment with those obtained using twodimensional echocardiography (2D-SE) considered as reference standard. Between April 2008 and September 2009, 116 consecutive patients were studied with both techniques. We analysed the parameters commonly sampled in echocardiography and related them with those retrieved with MDCT-CA: septal thickness, posterior wall thickness, diameter of ascending aorta, diameter and volumes in end-systolic and end-diastolic phase, ejection fraction, stroke volume, cardiac output and heart mass. Good correlation was found measuring septal thickness (r=0.470; p=0.001), and diameters of the ascending aorta. Correlation between systolic and diastolic diameters obtained with the two techniques was good. Poor correlation was attained measuring thickness of the posterior wall (r=0.243; p=0.104). MDCT-CA consistently overestimated the average volumes; diastolic and systolic volumes showed significant correlation (r=0.0456; p= 0.002; r=0.640; p<0.001). Ejection fraction agreement showed a significant correlation (r=0.626; p<0.001). MDCT-CA provides parameters of cardiac function comparable to those found in echocardiography. MDCT-CA although used primarily for coronary noninvasive imaging can provide additional information on ventricular function useful to the diagnostic workup of cardiac patients.
    La radiologia medica 06/2011; 116(4):505-20. · 1.37 Impact Factor
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    ABSTRACT: Anomalies of the coronary arteries are congenital and in most of the cases asymptomatic, although they may present with severe symptoms such as angina pectoris or cardiac arrest. Multidetector CT coronary angiography (MDCT-CA) permits, through curved multiplanar reconstructions and three-dimensional reformatting, noninvasive visualisation of the coronary tree and its variants and anomalies, providing a more accurate alternative to conventional coronary angiography (CCA). The purpose of this pictorial essay is to describe the main variants and anomalies of the coronary arteries using MDCT imaging with multiplanar and three-dimensional reconstructions.
    La radiologia medica 02/2010; 115(5):679-92. · 1.37 Impact Factor
  • Radiologia Medica - RADIOL MED. 01/2010; 115(5):679-692.
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    ABSTRACT: Multidetector-row computed tomography coronary angiography (MDCT-CA) produces high-level radiation dose because of submillimetre slice thickness and short scan time. As a result, manufacturers have produced different dose-saving protocols that may, however, reduce image quality and thus diagnostic accuracy. The aim of our study was to assess the diagnostic quality of MDCT-CA using different dose-saving protocols. Between April and August 2008, we examined 65 patients with 64-slice MDCT-CA: 6/65 using the step-and-shoot dose-saving protocol, 45/65 the cardiac dose right protocol and 14/65 using a standard protocol. Image quality was evaluated on a per-patient and per-segment basis, and the effective dose of each protocol was recorded. In the per-patient analysis, image quality was excellent in 100% of the step-and-shoot protocols, in 91.1% of the cardiac dose right protocols and in 85.8% of the standard protocols. Effective dose to the patient considering the whole study (i.e. scout, calcium score, triggering and MDCT-CA) was 20.49 mSv in the standard protocol, 14.8 mSv in the cardiac dose right protocol and 6.63 mSv in the step-and-shoot protocol. The radiologist should apply the appropriate protocol in relation to the clinical indications, type of patient and information required in order to spare as much dose as possible while maintaining high image quality.
    La radiologia medica 09/2009; 114(8):1196-213. · 1.37 Impact Factor
  • Radiologia Medica - RADIOL MED. 01/2009; 114(8):1196-1213.
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    ABSTRACT: Acute and severe ischaemia is followed by depression of myocardial contractility during reperfusion; return to full recovery might take a long time. This phenomenon, termed myocardial stunning, has been extensively demonstrated in experimental studies and in different clinical settings. The beneficial effects of calcium antagonists in preventing post-ischaemic myocardial stunning have been tested in experimental studies, showing that when administered before or during ischaemia, they inhibit post-ischaemic myocardial dysfunction. The present study was undertaken to verify the possible occurrence of myocardial stunning following transient ischaemia induced by coronary angioplasty. The aim was also to evaluate the possible protective effects of calcium antagonists (nisoldipine) and nitrates against myocardial stunning in patients with coronary artery disease undergoing routine coronary angioplasty (PCTA) with prolonged inflation. The study included 25 patients, aged between 40 and 69 years, with exercise-induced angina and single vessel disease. The stenosis was severe (80% to subtotal occlusion), localized on the left anterior descending artery, but without collaterals at coronary angiogram. All patients had normal left ventricular (LV) overall function and normal systolic thickening of the anterior wall supplied by the diseased artery. Our data suggest that post-ischaemic myocardial stunning is not only an experimental curiosity, but that it does occur in different clinical settings. Calcium antagonists (i.e. nisoldipine), when added before or during ischaemia, seem to prevent myocardial stunning. These findings confer a potential role to these agents in the treatment of post-ischaemic myocardial dysfunction.
    European Heart Journal 08/1993; 14 Suppl A:14-21. · 14.72 Impact Factor
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    ABSTRACT: The beneficial effects of calcium-channel blockers against myocardial stunning have been tested in experimental studies, showing that, when added before or during ischemia, a protective effect against postischemia stunning is achieved. The present study was undertaken to test and compare the protective effect of calcium antagonists [nisoldipine (NIS) and nifedipine (NIF)] and nitrates (NIT) against myocardial stunning in patients with coronary artery disease undergoing percutaneous transluminal coronary angioplasty (PTCA) with prolonged inflation as PTCA represents a model of induced acute and severe ischemia for a brief period and might cause myocardial stunning. The study included 30 patients between the ages of 42 and 67 years, all with exercise-induced angina and single-vessel disease, with severe stenosis (80% to subtotal occlusion) localized on the left anterior descending artery and with the absence of collaterals on the coronary angiograms. Moreover, all patients had normal left ventricular (LV) overall function, as well as normal systolic thickening of the anterior wall, supplied by the diseased artery. Patients were randomized to a pre-PTCA treatment with NIT, 80-120 mg/day (10 patients), NIF, 40-60 mg/day (10 patients), and NIS, 10-20 mg/day (10 patients). Pre-PTCA treatment was initiated 7 days before the procedure and continued after. During the PTCA, at the first balloon inflation, an additional dose of 300 micrograms of NIT was injected into the left anterior descending artery through the balloon catheter in the patients in the NIT group, as well as 0.2 mg of NIF in NIF group patients and 0.05 mg of NIS in NIS group patients.(ABSTRACT TRUNCATED AT 250 WORDS)
    Journal of Cardiovascular Pharmacology 02/1992; 20 Suppl 5:S18-24. · 2.11 Impact Factor
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    ABSTRACT: An attempt was made to assess noninvasively the patency of aorto-coronary bypass grafts by two-dimensional echocardiography (2-D echo) in 21 patients who underwent myocardial revascularization. Fifteen patients had one graft while the other six had two grafts. All 21 patients underwent angiography 6-18 months after operation. A day before angiography a 2-D echo was performed with the aim of visualizing the bypass grafts. In 18 patients with 23 grafts (13 with 1 graft and 5 with 2 grafts) it was possible to visualize the tract of the graft by 2-D echo; 16 were judged patent on 2-D echo and confirmed by selective angiography, while 5 grafts were considered occluded both on 2-D echo and angiography. The other 2 grafts were considered to be occluded on 2-D echo but angiographic control displayed their patency. In 3 patients 2-D echo failed to visualize grafts that were patent angiographically. These data must be considered preliminary and need validation in a larger number of patients. However it is reasonable to conclude that 2-D echo has a reliable capacity to predict graft patency. Such an application may be of value in sequential control of patients with aorto-coronary bypass surgery, especially when combined with other clinical and/or technical data.
    CardioVascular and Interventional Radiology 02/1988; 11(1):14-7. · 1.97 Impact Factor
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    ABSTRACT: The accuracy of two-dimensional echocardiography in the detection of intracardiac masses was verified in 334 patients who underwent cardiac catheterization in our laboratory over 21 consecutive months. A complete two-dimensional echocardiographic (2DE) examination was performed a day before catheterization. The presence or absence of a mass was verified at surgery in 77 patients who successively underwent mitral or aortic valve replacement (51), left ventricular aneurysmectomy with or without myocardial revascularization (25), and resection of atrial myxoma (2). In 32 patients 2DE revealed the presence of a mass-left or right atrial thrombi in 12, left atrial myxoma in 2, left ventricular thrombi in 16, and endocardial vegetations in 2. The other 45 patients were free of intracardiac masses on 2DE. Anatomic verification at surgery revealed the presence of an intracardiac mass in 34 patients. In 30 (true positives) of these, 2DE revealed the mass as well, and in 4 (false negatives) the presence of a mass had not been identified by 2DE. In 2 patients (false positives) the predicted mass was not found at surgery. Absence of a mass was correctly predicted by 2DE in 41 patients (true negatives). Thus 2DE detected intracardiac masses with sensitivity of 88.2% and a specificity of 95.3%. We recommend that 2DE be performed in all patients prior to hemodynamic study and/or cardiac surgery to enable safer management of patients with intracardiac masses during cardiac catheterization and/or cardiac surgery.
    CardioVascular and Interventional Radiology 02/1987; 10(3):157-61. · 1.97 Impact Factor
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    Zeitschrift für Kardiologie 02/1986; 75 Suppl 2:76-9. · 0.97 Impact Factor
  • Zeitschrift für Kardiologie 02/1986; 75 Suppl 2:146-54. · 0.97 Impact Factor
  • Bollettino della Società italiana di cardiologia 02/1980; Suppl:33-41.
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    ABSTRACT: In 20 patients, who had undergone a routine cardiac catheterization for the evaluation of anginal syndrome, some parameters of mechanical function of left ventricle (LV) were evaluated before and after left ventriculography was performed. Then, the same parameters were also measured, in identical technical conditions, after the administration of 20 mg of sublingual nifedipine (NIF). After NIF a significant decrease (P < 0.01) in left ventricular systolic and diastolic pressure, aortic diastolic pressure and left ventricular enddiastolic and endsystolic volumes was observed; while, heart rate, dP/dt max, stroke volume and ejection fraction were significantly increased (P < 0.01). Evaluation of LV segmental wall motion, after NIF, revealed no changes of wall motion in normal areas or in those with akinesis or dyskinesis; while, 68% of the areas with slight hypokinesis and 55% of those with severe hypokinesis were significantly improved after NIF (P < 0.005). Thus, we concluded that NIF does not cause a depression of LV mechanical function. The improvement of LV wall motion displayed by the areas with a transitory ischemic damage could be attributed to the reduction in preload and, more significantly, in afterload induced by NIF.
    Giornale italiano di cardiologia 01/1980; 10(4):424-30.
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    ABSTRACT: In 34 cases, corresponding to 3,7% of all patients underwent coronary arteriography for evaluation of anginal syndrome in our laboratory, it was observed a congenital coronary anomaly on their angiograms. The purpose of this paper is to verify the frequency of coronary anomalies and to evaluate relations existing between these anomalies and anginal syndrome. Coronary arteriograms, in 22 cases (2,44%), revealed exclusively; the presence of a coronary anomaly without occlusive coronary disease, which might per se justify angina. They were distributed as follows : 5 with coronary fistula, 2 with coronary aneurysms, 2 cases with single ostium and finally, 13 subjects with hypoplasia of one of the three major coronary arteries. One infant, 14 months old, had a hyperplasic left discending artery (LDA) draining in right ventricle cavity. Her ECG revealed signs of right ventricle overload. All the other cases had a typical angina syndrome with positive stress test. Left cineventriculography demonstrated left ventricle asynergy in 16 patients. We concluded that typical angina syndrome in our 22 patients, may be attributable to coronary anomalies observed at their coronary arteriograms.
    Annales de radiologie 06/1979; 22(4):285-8.
  • Bollettino della Società italiana di cardiologia 02/1978;
  • Bollettino della Società italiana di cardiologia 02/1978; 23(6):1096-103.
  • Bollettino della Società italiana di cardiologia 02/1978; 23(6):1109-16.
  • Bollettino della Società italiana di cardiologia 02/1978; 23(7):1163-8.
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    ABSTRACT: Maximal exercise test was performed in 15 patients with essential hypertension before and after 10 days of treatment with oral propranolol in daily doses of 320 mg. After the treatment, heart rate, and systolic and diastolic blood pressure significantly fell both at rest and after the test; a greater, though not significantly, workload was tolerated; a significant decrease was observed in the product of heart rate and systolic blood pressure, together with a marked reduction in electrocardiographic ischemic changes. Propranolol treatment, besides being an effective antihypertensive agent, improved ischemic changes induced by exercise and cardiac performance in hypertensive patients, also in the presence of left ventricular hypertrophy.
    European journal of cardiology 01/1978; 7(2-3):137-45.