Michele Oppizzi

Università Vita-Salute San Raffaele, Milano, Lombardy, Italy

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Publications (62)255.65 Total impact

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    ABSTRACT: Renal dysfunction is common in heart failure. Recent evidence suggests a pivotal role for systemic venous congestion and functional tricuspid regurgitation (FTR) in the pathophysiology of renal dysfunction. We investigated the role of FTR as a determinant of renal dysfunction and a predictor of long-term prognosis in chronic systolic heart failure patients. Four hundred and thirteen consecutive patients (mean age 74.2 ± 11 years) with chronic heart failure and left ventricular ejection fraction below 50% were enrolled. The FTR severity was quantified by transthoracic echocardiography. Renal function was evaluated with the estimated glomerular filtration rate measured by the simplified Modification of Diet in Renal Disease formula. The association between moderate/severe FTR and renal dysfunction, and its impact on heart failure episodes and overall mortality were also assessed. The median follow-up was 36 months (range 1-144 months). Through multivariate analysis, the interaction between moderate/severe FTR with tricuspid annular plane systolic excursion less than 16 mm was found to be an independent determinant of renal dysfunction [odds ratio 1.2, 95% confidence interval (CI) 1.1-1.5, P = 0.04]. Moderate/severe FTR (hazard ratio 1.3, 95% CI 1.2-2.7, P = 0.02) and tricuspid annular plane systolic excursion below 16 mm (hazard ratio 1.2, 95% CI 1.0-3.7, P = 0.01) were significantly related to the heart failure episodes. Moreover, the Kaplan-Meier analysis showed a worse outcome in patients with moderate/severe FTR (log-rank test 8.6, P = 0.003). The combination of significant FTR and right ventricular dysfunction, but not FTR and right ventricular dysfunction alone, is independently associated with renal dysfunction. The presence of significant FTR is related to an excess event rate of heart failure and has significant impact on outcome.
    Journal of Cardiovascular Medicine 08/2015; DOI:10.2459/JCM.0000000000000312 · 1.51 Impact Factor
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    ABSTRACT: Background:This observational study was designed to evaluate the prevalence of coronary microvascular dysfunction (CMD) in asymptomatic patients affected by systemic sclerosis (SSc), stratifying the results according to the limited (lcSSc) and the diffuse (dcSSc) forms of the disease.Methods and Results:We enrolled 19 consecutive asymptomatic patients with dcSSc (n=7) or lcSSc (n=12). In all subjects, coronary flow reserve (CFR) was assessed by measuring diastolic coronary flow velocities in the left anterior descending artery by pulsed wave Doppler at baseline and after dipyridamole infusion (0.84 mg·kg−1·6 min−1). Wall motion score index was evaluated at baseline and during stress. We enrolled 20 healthy subjects as controls. Mean CFR was 1.96±0.62 in patients and 2.69±0.47 in controls (P<0.001). Abnormal values of CFR (≤2) were significantly more prevalent in patients than in controls (10/19 vs. 0/20; P<0.001) and in the dcSSc subgroup than in the lcSSc subgroup (6/7 vs. 4/12; P=0.05). An inverse relationship between disease duration (from time of onset of Raynaud’s phenomenon) and CFR value was observed in the lcSSc group (correlation coefficient −0.583; P=0.046). Neither patients nor controls had wall motion abnormalities during dipyridamole administration.Conclusions:A blunted CFR, most likely because of CMD, is more frequent in patients affected by the dcSSc form in the early stages of the disease, whereas it seems to appear later in lcSSc.
    Circulation Journal 02/2015; 79(4). DOI:10.1253/circj.CJ-14-1114 · 3.69 Impact Factor
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    ABSTRACT: Background and aim of the study: The study aim was to evaluate whether, in patients with severe mitral regurgitation (MR), tricuspid valve remodeling was independent of the degree of functional tricuspid regurgitation (FTR) present. Whether any differences in the analysis remodeling, as assessed by two-dimensional (2D) and three-dimensional (3D) echocardiography, can be demonstrated was also addressed. Methods: A total of 188 patients (mean age 63.5 +/- 16.0 years) with severe organic or functional MR with or without associated FTR, and 30 normal controls (mean age 59.2 +/- 15 years) were enrolled in the study. Subsequently, both 2D and 3D transthoracic anatomic and functional parameters of the tricuspid valve were analyzed. Results: Patients and controls differed in all 2D and 3D parameters of tricuspid valve remodeling, except for the 2D end-diastolic annular diameter and circularity indices. The patients were then allocated to either group A (trivial/mild FTR) or group B (moderate/severe FTR). Significant differences were identified between groups A and B compared to controls in all tricuspid valve remodeling indices, except for the diastolic 2D annular diameter and circularity indices. Groups A and B had similar 2D and 3D parameters of tricuspid valve remodeling. The right ventricular end-diastolic diameter (RVEDD) (beta = 0.24, 95% CI: 0.11 to 0.22, p = 0.02) and fractional area change (beta = -0.48, 95% CI: -0.24 to 0.09, p = 0.0001, R-2 = 0.22) were independent predictors of the tenting area, whereas the RVEDD was the only independent predictor of the diastolic 3D tricuspid annular area (beta = 0.53, 95% CI: 1.2 to 2.7, p = 0.0001, R-2 = 0.28). Conclusion: In patients with severe MR, tricuspid valve remodeling was also demonstrated in those with trivial/mild FTR, but was better characterized by 3D echocardiography. Tricuspid valve remodeling and right ventricular dilation were the main determinants of tricuspid valve regurgitation.
    The Journal of heart valve disease 03/2014; 23(2):200-8. · 0.73 Impact Factor
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    ABSTRACT: The aim of this study is to evaluate the role of contrast transesophageal echocardiography (cTEE) in the diagnostic characterization of acute aortic syndromes (AAS) [aortic dissection, intramural hematoma, penetrating ulcer]. We enrolled 66 non-consecutive patients with clinical suspicion of AAS. Standard transesophageal echocardiography and cTEE were performed prior to gated-CT angiography, which has been assumed as reference standard. cTEE was obtained with a single bolus of contrast agent injection. The definitive diagnosis of AAS was made in 48 patients by gated-CT angiography: 22 aortic dissections, 15 intramural hematomas and 11 penetrating aortic ulcers. Standard TEE and cTEE correctly diagnosed AAS in 87 and 100 % (P = 0.03) cases respectively. Standard TEE correctly diagnosed aortic dissection in 20/22 (91 %) and cTEE in 22/22 (100 %) (P = 0.5) cases. cTEE was superior than standard TEE in the visualization of false lumen entry tear (22/22 vs. 16/22, P = 0.03). Standard TEE correctly diagnosed intramural hematoma in 11/15 and cTEE 15/15 (P = 0.12) cases. Microtears were identified in 3 patients by cTEE an in 1 patient by standard TEE (P = 0.4). The presence of focal contrast enhancement was identified in 4 and 0 patients by cTEE and standard TEE respectively (P = 0.06). Both standard and cTEE correctly diagnosed penetrating aortic ulcer in 11/11 (100 %) (P = 1.0) cases. cTEE provides additional value over standard TEE in the diagnosis and in the anatomic and functional characterization of AAS.
    The international journal of cardiovascular imaging 09/2013; 30(1). DOI:10.1007/s10554-013-0290-y · 2.32 Impact Factor
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    International journal of cardiology 05/2013; 168(3). DOI:10.1016/j.ijcard.2013.04.162 · 6.18 Impact Factor
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    ABSTRACT: We describe the case of a young pregnant woman with moderate mitral regurgitation who was admitted to our department for dyspnea. The patient was treated with low-dose diuretic therapy and ventilatory support. At follow-up echocardiographic evaluation, a progressive improvement of mitral regurgitation and pulmonary artery pressure was observed. The most significant hemodynamic changes occurring during pregnancy are reviewed and discussed in the setting of associated mitral regurgitation.
    Giornale italiano di cardiologia (2006) 02/2013; 14(2):135-7. DOI:10.1714/1218.13526
  • Michele Oppizzi · Marco Ancona · Rachele Contri
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    ABSTRACT: Patients with coronary artery disease undergoing major surgery are at increased risk of perioperative myocardial ischemia/infarction. Cardiac complications are a major cause of in-hospital morbidity and mortality. This chapter focuses on echo-guided treatment of myocardial ischemia and its consequences.
    Echocardiography for Intensivists, 01/2013: pages 249-255; , ISBN: 978-88-470-2582-0
  • Michele Oppizzi · Marco Ancona
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    ABSTRACT: Sudden hypotension associated with new-onset cardiac murmur may be due to different causes, including mechanical complications of ST-segment elevation myocardial infarction, acute mitral insufficiency during infective endocarditis, acute aortic regurgitation by aortic dissection, prosthetic valve thrombosis, and dynamic left ventricular outflow obstruction. Transthoracic and transesophageal echocardiography allow a rapid diagnosis at the bedside.
    Echocardiography for Intensivists, 01/2013: pages 355-366; , ISBN: 978-88-470-2582-0
  • Chapter: Chest Pain
    Michele Oppizzi · Rachele Contri
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    ABSTRACT: Patients with chest pain represent a heterogeneous group in terms of diagnosis, prognosis, and treatment. Echocardiography is widely used in the emergency department to perform the differential diagnosis of chest pain, to stratify the risk, to determine the prognosis, and to guide the choice between medical and surgical therapy.
    Echocardiography for Intensivists, 01/2013: pages 297-312; , ISBN: 978-88-470-2582-0
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    Journal of the American College of Cardiology 11/2012; 60(21):e37. DOI:10.1016/j.jacc.2012.05.064 · 15.34 Impact Factor
  • World Congress of Cardiology Scientific Sessions; 05/2012
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    ABSTRACT: The prognostic role of tricuspid regurgitation (TR) associated with organic left-sided valvular heart disease is well known. However, no data are available regarding the prognostic value of functional TR (FTR) in patients with functional mitral regurgitation (FMR) and left ventricular (LV) dysfunction. The purpose of this study was to evaluate the prognostic role of FTR for occurrence of heart failure (HF) and mortality in patients with FMR. We enrolled 373 consecutive patients (mean age 68±11 years) with LV dysfunction and at least mild FMR and with or without FTR, both quantitated by echocardiography. The median follow-up was 32 months (range 1-120 months); 132 (35.4%) and 97 patients developed HF or died, respectively. The incidence of HF at 3 and 6 years was 36±2% and 55±4%, respectively. Moderate to severe FTR [hazard ratio (HR) 1.4, 95% confidence interval (CI) 1.1-2.1, P = 0.01) was an independent determinant of HF. The incidence of HF was 41±5, 46±7, 57±7, and 65±8% for patients without, and with mild, moderate, and severe FTR respectively (P = 0.03). At 3 and 6 years the survival free of all-cause mortality was 77.5±2% and 60±3%, respectively. Moderate to severe FTR (HR 1.6, 95% CI 1.2-2.1, P = 0.01) was an independent determinant of overall mortality. At 6 years, survival free of all-cause mortality was 69±2.5, 67±2.1, 51±2.5, and 40±4.8% for patients without, and with mild, moderate, and severe FTR, respectively (P = 0.004). Moderate or more FTR is independently associated with worse survival and a high incidence of HF episodes in patients with FMR.
    European Journal of Heart Failure 05/2012; 14(8):902-8. DOI:10.1093/eurjhf/hfs063 · 6.58 Impact Factor
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    Journal of the American College of Cardiology 03/2012; 59(13). DOI:10.1016/S0735-1097(12)61138-3 · 15.34 Impact Factor
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    ABSTRACT: Although the prognostic impact of a moderate degree of ischemic mitral regurgitation (IMR) is well known, there are no data regarding the potential role of a mild degree of IMR. The aim of this study was to evaluate the impact of a mild degree (effective regurgitant orifice area < 20 mm(2)) of IMR on left ventricular (LV) remodeling and heart failure (HF). A retrospective study was conducted in 35 patients with mild IMR that were propensity matched with 35 patients without IMR (controls). The population was evaluated between 3 and 6 months after first myocardial infarction and at 6 and 12 months, measuring LV volumes, ejection fraction, and the degree of mitral regurgitation. HF events requiring hospitalization were recorded. The two groups were similar at baseline. During follow-up, patients with IMR showed significant increases in LV end-diastolic and end-systolic volumes and no change in ejection fractions, whereas controls did not show significant changes in volumes but did show increases in ejection fractions. Patients with IMR showed significantly higher end-systolic volumes at 6 months (P = .003) and 12 months (P = .007) and significantly higher end-diastolic volumes at 6 months (P = .048) and 12 months (P = .03) and lower ejection fractions at 6 months (P = .0001) and 12 months (P = .002) compared with controls. Patients with IMR experienced a significantly higher incidence of HF than controls (62% vs 23%, P = .001). At 6 months, in six patients mitral regurgitation degree changed from mild to moderate, and in one patient from mild to severe. Interestingly, 71.5% of patients who experienced increases in mitral regurgitation degree had no coronary revascularization (P = .04). Mild IMR affects the LV remodeling process, increases its degree over time, and determines a higher rate of HF.
    Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography 12/2011; 24(12):1376-82. DOI:10.1016/j.echo.2011.09.006 · 3.99 Impact Factor
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    ABSTRACT: Cardiac stem cell therapy is a field of scientific research with the goal to translate into clinical benefit the initial findings obtained in basic research laboratories. We have moved into clinical trials in different disease categories: acute myocardial infarction, chronic stable angina refractory to conventional therapy and heart failure. So far we have faced with contradictory results. Some previous studies suggested that bone marrow cell injection may improve myocardial perfusion and left ventricular function in patients with chronic myocardial ischemia. In this paper we present a brief review about stem cell use in clinical cardiology and describe our research protocol evaluating the effects of direct intramyocardial injection of autologous bone marrow cells (CD34+ selected cells versus all mononuclear cells) in patients with chronic myocardial ischemia. Preliminary results show that this procedure seems to be safe and generally well tolerated by patients. An improvement in symptoms, in the first 6 months, appears to be achieved in approximately 50% of patients, with concomitant improvement of quantitative scintigraphic stress test imaging. Before drawing any definitive conclusions, we need to wait for the end of enrollment and unblinding of study randomization.
    Giornale italiano di cardiologia (2006) 03/2011; 12(3):198-211.
  • International journal of cardiology 02/2011; 146(3):426-8. DOI:10.1016/j.ijcard.2010.10.096 · 6.18 Impact Factor
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    ABSTRACT: The introduction of three-dimensional echocardiography and its evolution from time-consuming and cumbersome off-line reconstruction to real-time volumetric technique (real-time three-dimensional echocardiography) are one of the most significant advances in ultrasound imaging of the heart of the past decade. This imaging modality currently provides realistic views of cardiac valves capable of demonstrating the anatomy of various heart valve diseases in a unique, noninvasive manner. In addition, real-time three-dimensional echocardiography offers completely new views of the valves and surrounding structures, and allows accurate quantification of severity of valve disease. This article reviews the advantages of real-time three-dimensional echocardiography in assessing heart valves and shows also technological limitations in order to provide the scientific basis for its clinical use.
    Giornale italiano di cardiologia (2006) 07/2010; 11(7-8):540-8.
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    ABSTRACT: To assess long-term prognosis in patients with functional mitral regurgitation (FMR) and left ventricular (LV) dysfunction, receiving current standard pharmacological therapy. We prospectively enrolled 404 consecutive patients (mean age 70.2 +/- 10 years) with ischaemic (76.5%) and non-ischaemic (23.5%) LV dysfunction (ejection fraction 34.4 +/- 10.8%) and at least mild MR. Results are reported at 4 years' follow-up. Survival free of all-cause mortality was 53% and cardiac death was 74%. Survival free of all-cause mortality was 50% (95% CI 35-72) for patients with moderate MR, 49% (95% CI 27-65) for severe MR, and 64% (95% CI 47-78) for mild MR (P = 0.03). Survival free of cardiac death was 57% (95% CI 38-74) for patients with moderate MR, 55% (95% CI 30-77) for severe MR, and 94% (95% CI 59-98) for mild MR (P = 0.003). Moderate-to-severe MR [relative risk (RR) 2.7, 95% CI 1.2-6.1, P = 0.003] was an independent predictor of cardiac death but not of all-cause mortality. Survival free of heart failure (HF) was 32%. Survival free of HF was 20% (95% CI 17-35) for patients with moderate MR, 18% (95% CI 15-32) for severe MR, and 62% (95% CI 45-72) for mild MR (P = 0.0001). Moderate-to-severe MR (RR 3.2, 95% CI 1.9-5.2, P = 0.0001) was an independent predictor of HF. The mortality and morbidity of patients with LV dysfunction and FMR remain high despite current standard pharmacological therapy. Moderate-to-severe MR is an independent predictor of cardiac death and HF.
    European Journal of Heart Failure 05/2009; 11(6):581-7. DOI:10.1093/eurjhf/hfp051 · 6.58 Impact Factor
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    ABSTRACT: To evaluate the feasibility of mitral valve (MV) reconstruction protocol by real-time 3D echocardiography (RT3DE) in the assessment mitral regurgitant (MR) lesions, and to determine the accuracy of RT3DE compared with transthoracic (TTE) and transesophageal (TEE) echocardiographies using surgical findings as gold standard. Sixty-three consecutive patients (mean age 61.7+/-12.5 years, 35 men and 28 women) with severe organic MR were enrolled. Data were acquired in zoom and in full-volume modes from apical and/or parasternal windows. A volume rendered en-face view of MV and five serial longitudinal cut planes were reconstructed to visualize all segments of both leaflets. The feasibility of RT3D reconstruction was 94%. Compared with surgical diagnosis, the accuracy of RT3D was 91% for aetiology, 92% for mechanisms, 94% for prolapse, 88% for flail and 94% for defect location. Diagnostic accuracy was significant higher for RT3D than TTE for all end points except for flail lesion and similar to TEE but inferior to this for flail lesion. The accuracy, sensitivity and specificity were higher in patients with good-excellent than those with poor image quality regarding aetiology, mechanisms and defect location (all p=0.0001). RT3D imaging of MV is feasible and accurate in defining aetiology, mechanism and defect location in patients with MR and has incremental diagnostic value if TTE is inconclusive and similar diagnostic value of TEE except for flail lesion. RT3D, at least in patients with good acoustic window, may obviate the need for subsequent TEE and/or can be considered a complementary technique to study MV in patients with MR.
    International journal of cardiology 08/2008; 127(3):342-9. DOI:10.1016/j.ijcard.2007.05.010 · 6.18 Impact Factor
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    ABSTRACT: Chronic ischemic mitral regurgitation (IMR) is a common complication of myocardial infarction and severely affects cardiovascular mortality and morbidity. Multiple pathophysiologic mechanisms, such as left ventricular (LV) remodeling and dysfunction, annular dilation/dysfunction, and mechanical dyssynchrony, are involved in generating IMR, each of them having different weight. However, the prerequisite to initially creating regurgitation is the presence of local or global LV remodeling that alters the geometrical relationship between the ventricle and valve apparatus. In the wide spectrum of patients with chronic IMR, the assessment of some echocardiographic parameters, such as tethering pattern, leaflet motion, origin and direction of the regurgitant jets, allows one to identify different specific subgroups of patients subjected to different therapeutic approaches. The aim of medical and/or surgical therapy is to ameliorate heart failure symptoms, and improve LV remodeling and function and the intermediate/long-term outcome. The targets of surgical MV repair involve annulus, leaflets, chordae and ventricles. The restricted annuloplasty is the most commonly adopted surgical procedure that improves heart failure symptoms but not survival when compared to medical therapy and is also subject to a high incidence of late failure (approximately 30%). There are some preoperative echocardiographic predictors of failure that include valve (degree of valve remodeling, jet characteristics), ventricular (degree of remodeling, diastolic dysfunction) and surgical factors.
    European Heart Journal – Cardiovascular Imaging 04/2008; 9(2):207-21. DOI:10.1016/j.euje.2007.03.034 · 2.65 Impact Factor

Publication Stats

2k Citations
255.65 Total Impact Points

Institutions

  • 2015
    • Università Vita-Salute San Raffaele
      Milano, Lombardy, Italy
  • 2012
    • Università Telematica San Raffaele
      Milano, Lombardy, Italy
  • 2011
    • San Raffaele Scientific Institute
      Milano, Lombardy, Italy
  • 2004–2008
    • IRCCS Multimedica
      Milano, Lombardy, Italy
  • 1997–2005
    • Ospedale di San Raffaele Istituto di Ricovero e Cura a Carattere Scientifico
      Milano, Lombardy, Italy
  • 1999
    • University of Milan
      Milano, Lombardy, Italy