Alessandro Dal Monte

Publications (4)10.06 Total impact

• Article: Pacing transmural scar tissue reduces left ventricle reverse remodeling after cardiac resynchronization therapy.

  Donato Mele, Eustachio Agricola, Alessandro Dal Monte, Maurizio Galderisi, Antonello D'Andrea, Fausto Rigo, Rodolfo Citro, Elisabetta Chiodi, Giuseppe Marchese, Patrizia Della Valentina, Alice Calabrese, Roberto Ferrari
  [show abstract] [hide abstract]
  ABSTRACT: BACKGROUND: In patients with ischemic heart failure undergoing cardiac resynchronization therapy (CRT) the underlying myocardial substrate at the left ventricle (LV) pacing site may affect CRT response. However, the effect of delivering the pacing stimulus remote, adjacent to or over LV transmural scar tissue (TST) identified by echocardiography is still unknown. METHODS: First, 35 patients with healed myocardial infarction (57±11 years) were prospectically studied to demonstrate the capability of echocardiographic end-diastolic wall thickness (EDWT) to identify LV-TST as defined by delayed enhancement magnetic resonance imaging (DE-MRI). Subsequently, in 136 patients (65±10 years) who underwent CRT, EDWT was retrospectively evaluated at baseline. The LV catheter placement was defined over, adjacent to and remote from TST if pacing was delivered at a scarred segment, at a site 1 segment adjacent to or remote from scarred segments. CRT response was defined as LV end-systolic volume (ESV) decrease by at least 10% after 6months. RESULTS: A EDWT≤5mm identified TST at DE-MRI with 92% sensitivity and 96% specificity. In the 76 CRT responders, less overall and posterolateral TST segments and more segments paced remote from TST areas were found. At the multivariate regression analysis, the number of TST segments and scar/pacing relationship showed a significant association with CRT response. CONCLUSIONS: In addition to LV global scar burden, CRT response relates also to the myocardial substrate underlying pacing site as evaluated by standard echocardiography. This information may expand the role of echocardiography to guide pacing site avoiding pacing at TST areas.
  International journal of cardiology 01/2012; · 7.08 Impact Factor
• Article: [Perivalvular leak assessment and closure: role of real-time three-dimensional transesophageal echocardiography].

  Donato Mele, Eustachio Agricola, Alessandro Dal Monte, Marco Bruno Ancona, Roberto Ferrari
  [show abstract] [hide abstract]
  ABSTRACT: Perivalvular leak following implant of aortic or mitral prosthetic valves or rings is a relatively common complication, sometimes leading to significant clinical and hemodynamic consequences, such as severe valvular insufficiency, heart failure and hemolysis. In these cases, a second surgical operation, which typically involves the replacement of the dehiscent prosthesis, is the procedure of choice, but sometimes it cannot be performed. The alternative to reoperation can be the percutaneous closure of the perivalvular leak guided by transesophageal echocardiography before and during the closure procedure. In this review, the current role of echocardiography in the study of perivalvular leaks, with particular reference to guiding percutaneous transcatheter closure, is discussed. Also, the advantages and limitations of conventional two-dimensional and real-time three-dimensional transesophageal echocardiography are compared.
  Giornale italiano di cardiologia (2006) 01/2012; 13(1):38-46.
• Article: Echocardiographic myocardial scar burden predicts response to cardiac resynchronization therapy in ischemic heart failure.

  Donato Mele, Eustachio Agricola, Maurizio Galderisi, Fausto Rigo, Rodolfo Citro, Alessandro Dal Monte, Patrizia Della Valentina, Alice Calabrese, Roberto Ferrari
  [show abstract] [hide abstract]
  ABSTRACT: Because echocardiography is routinely applied for left ventricle (LV) evaluation before cardiac resynchronization therapy (CRT), it is important to know whether echocardiographic assessment of myocardial scar burden may also help to predict CRT response in patients with drug-refractory systolic heart failure of ischemic origin. Seventy-one patients with ischemic heart failure who underwent CRT were retrospectively analyzed. The number of LV scar segments was evaluated in each patient, defining transmural scar as an end-diastolic wall thickness < or = 5 mm associated with increased acoustic reflectance. CRT response was defined by LV end-systolic volume decrease by at least 10% after 6 months of treatment. The role of pacing site with respect to scar location was also assessed. Thirty-nine patients (55%) were responders and 32 patients (45%) were nonresponders to CRT. At baseline, responders had a lower number of scar segments (1.7 +/- 1.6 vs 3.5 +/- 2.5, P = .001). The number of scar segments was significantly associated with CRT response and correlated significantly with end-systolic volume variation (r = 0.57, P = .0001). The presence of 3 or more scar segments allowed the identification of nonresponders with a sensitivity of 62% and specificity of 71%. In responders, the pacing stimulus was more frequently delivered remote from scar segments, whereas in nonresponders it was more often delivered over the scar segments. Echocardiographic evaluation of transmural scar burden predicts CRT response after 6 months of treatment and should be performed in all candidates for CRT with ischemic heart failure before biventricular pacemaker implantation.
  Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography 05/2009; 22(6):702-8. · 2.98 Impact Factor
• Article: [Beyond dyssynchrony: what are the factors determining the response to cardiac resynchronization therapy?].

  Donato Mele, Tiziano Toselli, Alessandro Dal Monte, Gabriele Guardigli, Claudio Ceconi, Roberto Ferrari
  [show abstract] [hide abstract]
  ABSTRACT: Although cardiac resynchronization therapy is currently used for treatment of refractory heart failure in patients with low ejection fraction and cardiac dyssynchrony, there is a substantial number of non-responders. This indicates that, in addition to cardiac dyssynchrony, there are other factors affecting response to cardiac resynchronization therapy. Pre-implant identification of these factors appears of crucial importance in order to finalize the resynchronization treatment to those patients who have the highest probability of a positive response. In this review the main non-dyssynchrony determinants of response to cardiac resynchronization therapy are presented and discussed.
  Giornale italiano di cardiologia (2006) 06/2008; 9(5):320-37.