Giovanni Antonelli

Publications (6)16.4 Total impact

• Article: Detection of Early Left Ventricular and Atrial Dysfunction in Overweight Patients with Preserved Ejection Fraction: A Speckle Tracking Analysis.

  Maria Caputo, Rossella Urselli, Valerio Zacà, Eugenia Capati, Margherita Padeletti, Silvia De Nicola, Romina Navarri, Giovanni Antonelli, Claudia Nucci, Elisa Giacomin, Sergio Mondillo
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  ABSTRACT: BACKGROUND: Little remains known about the role of overweight to promote progressive atrial and ventricular myocardial dysfunction. Aim of this study was to investigate the potential influence of overweight on left ventricular (LV) and atrial (LA) function, as assessed by speckle tracking strain analysis, in patients at low-to-moderate global cardiovascular risk. METHODS: Seventy patients presenting 1 or more cardiovascular risk factor, with preserved ejection fraction, were enrolled. Peak atrial longitudinal strain (PALS) and Peak ventricular longitudinal strain (PVLS) were calculated by averaging values observed in all LV or LA segments, in four- and two-chamber views (global PALS and global PVLS), using a commercially available semiautomated two-dimensional (2D) strain software. RESULTS: Global PALS was similar in the 2 groups, while global PVLS was significantly lower in the overweight group as compared to normal weight (-17.2 ± 3.3 vs. -18.7 ± 2.8, P < 0.05). Univariate analysis of correlation showed a significantly correlation between global PALS and PVLS (r = -0.43, P < 0.01), as well as with E/A ratio (r = 0.40, P < 0.01) and with LV mass index (r = -0.34, P < 0.05). In multivariate linear regression analysis, these parameters were confirmed as independent predictors of PALS. CONCLUSION: In subjects at low-to-moderate cardiovascular risk, overweight is a key determinant of the reduction of global LV longitudinal function as assessed by 2D strain.
  Echocardiography 01/2013; · 1.24 Impact Factor
• Article: The E/e' ratio in the gray zone as predictor of left atrial dysfunction in patients with normal left ventricular ejection fraction: a speckle tracking study.

  Piercarlo Ballo, Maria Caputo, Giovanni Antonelli, Amato Santoro, Matteo Cameli, Raffaella De Vito, Susanna Benincasa, Romina Navarri, Elisa Giacomin, Alfredo Zuppiroli, Sergio Mondillo
  International journal of cardiology 05/2012; 158(2):329-30. · 7.08 Impact Factor
• Article: Left ventricular twisting as determinant of diastolic function: a speckle tracking study in patients with cardiac hypertrophy.

  Amato Santoro, Maria Caputo, Giovanni Antonelli, Matteo Lisi, Margherita Padeletti, Flavio D'Ascenzi, Matteo Cameli, Elisa Giacomin, Sergio Mondillo
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  ABSTRACT: Left ventricular hypertrophy (LVH) can develop in response to training with morphological changes in the heart and to pathological increase in afterload such as in essential hypertension. Deformation analysis using two-dimensional (2D) strain echocardiography can detect early systolic function abnormalities in patients with LVH. The aim of this study was to characterize left ventricular twisting (LVT) modifications, in professional athletes, compared with control subjects and with patients with hypertensive cardiopathy. Seventy-six patients were enrolled: 37 professional athletes with cardiac hypertrophy (group A), 22 patients with early hypertensive cardiopathy (group B) cross-matched for LV mass index, and 17 healthy controls (group C), with no evidence of cardiac hypertrophy. All patients had no concomitant cardiac disease. All patients were investigated at rest using transthoracic echocardiography. LVT was obtained with speckle tracking analysis, using dedicated software. LVT was reduced in group A compared to group B and C (group A: 8.0° ± 2.4°; group C: 10.3° ± 2.3°; group B: 16.0° ± 4.2°; P < 0.01). In overall population, LVT showed a significant correlation with transmitral flow pattern (r =-0.58, P < 0.01) and with age (r =-0.57, P < 0.01). LVT showed the best predictive value to diagnose diastolic dysfunction (AUC: 0.86, P < 0.0001). 2D strain can identify specific patterns of myocardial deformation in professional athletes, controls, and patients with early hypertensive cardiopathy. In our study LVT showed a parallel trend with modifications of diastolic function and could represent a promising tool to differentiate functional cardiac hypertrophy from hypertensive cardiac hypertrophy.
  Echocardiography 08/2011; 28(8):892-8. · 1.24 Impact Factor
• Article: Anemia correction by erythropoietin reduces BNP levels, hospitalization rate, and NYHA class in patients with cardio-renal anemia syndrome.

  Alberto Palazzuoli, Ilaria Quatrini, Anna Calabrò, Giovanni Antonelli, Maria Caputo, Maria S Campagna, Beatrice Franci, Ranuccio Nuti
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  ABSTRACT: Little is known about the effect of anemia correction with erythropoietin (EPO) on B-type natriuretic peptide (BNP) levels, NYHA class, and hospitalization rate. The aim of the study was to investigate, in patients with cardio-renal anemia syndrome, the effects of EPO on hemochrome and renal function parameters and BNP levels. We also analyzed the effect of EPO therapy on hospitalization rate and NYHA class after 12 months in comparison with a population undergoing to standard therapy. We performed a randomized double-blind controlled study of correction of the anemia with subcutaneous α (group A n = 13) or β (group B n = 14) EPO for 12 months in addition to standard therapy with oral iron in 27 subjects. Control group (n = 25 patients) received only oral iron. Significant increase in hemoglobin (Hb), hematocrit (Hct), and red blood cells (RBC) were revealed in EPO groups at 12 months; Hb, group A 12.3 ± 0.6; group B 11.7 ± 0.8; control group 10.6 ± 0.5 g/dl P < 0.0001; Hct group A 34.2 ± 2.3, group B 34 ± 2, control group 32.3 ± 1.8% P < 0.01; RBC, group A 3.9 ± 0.2, group B 3.8 ± 0.2, control group 3.3 ± 0.2, (P < 0.0001). Plasma BNP levels in EPO groups were significantly reduced after 12 months (group A: 335 ± 138 vs. group B: 449 ± 274 pg/ml control group 582 ± 209 pg/ml (P < 0.01). After 12 months of treatment, hospitalization rate and NYHA class were reduced in EPO groups with respect to control group (P < 0.05). Finally, an inverse correlation was observed between BNP and Hb levels in EPO Groups (r = -0.70 P < 0.001). EPO treatment reduces BNP levels and hospitalization rate in patients with cardio-renal anemia syndrome. The correction of anemia by EPO treatment appears able to improve clinical outcome in this subset of patients with heart failure.
  Clinical and Experimental Medicine 03/2011; 11(1):43-8. · 1.58 Impact Factor
• Article: Anemia in Cardio-Renal Syndrome: clinical impact and pathophysiologic mechanisms.

  Alberto Palazzuoli, Giovanni Antonelli, Ranuccio Nuti
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  ABSTRACT: Anemia is a disease that is often associated with heart failure (HF) and renal insufficiency (RI). This unfavorable triad of conditions has been called Cardio-Renal-Anemia Syndrome (CRS). The association of HF, RI, and anemia is poorly reported in multicenter clinical trials, so the pathophysiologic mechanisms and treatment options need to be better defined. When CRS patients develop anemia, a "perfect storm" often occurs: HF and RI cause anemia which will worsen the first two conditions. Anemia appears to be the result of complex interactions between cardiac performance, bone marrow homeostasis, renal dysfunction, and various drug side effects. However, neurohormonal and inflammatory activities play a key role in the beginning and progression of the disease. As a consequence, endogenous erythropoietin activity dysfunction with inadequate production and tissue resistance occurs. Despite the advances of therapy in the neurohormonal activation blockade, mortality and hospitalization in HF still remain unacceptably high, suggesting that specific comorbidity treatments could have a significant positive prognostic impact. Anemia should be recognized as one of the novel targets in HF treatment.
  Heart Failure Reviews 02/2011; 16(6):603-7. · 3.20 Impact Factor
• Article: Natriuretic peptides in heart failure: where we are, where we are going.

  Alberto Palazzuoli, Giovanni Antonelli, Ilaria Quatrini, Ranuccio Nuti
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  ABSTRACT: Tremendous advances have been made in understanding the pathophysiology and treatment of congestive heart failure (CHF). However, diagnosis still remains difficult, even with a comprehensive physical examination. Symptoms such as dyspnea are non-specific and poorly sensitive indicators for early CHF that can be largely undetected. The discovery of natriuretic peptides (BNP) as diagnostic biomarkers has been one of the most critical advances for heart failure diagnosis. Therefore, both B-type and N-terminal pro-B-type have potential role in the diagnosis of heart failure, as well as in prognostic risk assessment. A single determination of BNP at any time during the progression of chronic HF provides a clinically useful tool for risk stratification. The hypothesis that repeated measurements might carry prognostic information beyond a single measure was confirmed in different settings. One of the main interests is given to the values of repeated determinations for monitoring progression of disease, and for the evaluation of the clinical effects of medical therapy. Nevertheless, despite thousands of papers describing their potential utility, current guidelines have not endorsed the highest level of recommendation for their use, in part, because the application in clinical practice is often limited for the absence of well codified cut off. Recently, European guidelines emphasized the role of natriuretic peptides as potential laboratory markers. In the near future, algorithm building will take into consideration clinical and echocardiographic parameters as well as NP measurements, and this may lead to a correct diagnosis and identification of patients at high risk. The purpose of this review is to discuss the clinical approaches and future applications of natriuretic peptides in heart failure and coronary disease.
  Internal and Emergency Medicine 02/2011; 6(1):63-8. · 2.06 Impact Factor