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ABSTRACT: Cardiovascular remodeling in chronic kidney disease (CKD) is responsible for the high mortality found in this condition. A total of 89 consecutive outpatients with stage III CKD and 52 patients with stage II CKD with similar degree of traditional atherosclerotic risk factors underwent routine echocardiographic and carotid Doppler examination, evaluating vascular and cardiac remodeling (intima-media thickness [IMT] and left ventricular mass index [LVMi]), and its relation with arterial stiffness, determined in the same examination, using an echo-tracking technique. Also the absolute values of LVMi and IMT were statistically similar between the 2 groups, their determinants were completely different, only in stage III the markers of renal impairment and arterial stiffness being independent predictors of cardiac and vascular modifications. We concluded that macroanatomical measurements do not fully describe cardiovascular remodeling in this setting. Arterial stiffness echo-tracking derived could add valuable information, being an easy-to-perform parameter during a routine examination.
Angiology 05/2011; 62(8):662-8. · 1.51 Impact Factor
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Chiara Lestuzzi,
Alessandra Bearz,
Christos Lafaras,
Renata Gralec, Eugenio Cervesato,
Witold Tomkowski,
Marzia DeBiasio,
Elda Viel,
Theodoros Bishiniotis,
Dimitrios N Platogiannis,
Angela Buonadonna,
Lucia Tartuferi,
Rita Piazza,
Salvatore Tumolo,
Massimiliano Berretta,
Francesco Santini,
Massimo Imazio
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ABSTRACT: Local (intrapericardial) chemotherapy has been reported to be useful for the treatment of neoplastic pericardial disease, but it has never been compared to systemic chemotherapy, a combination of the two and simple pericardial drainage or sclerosis.
We analyzed the clinical and echocardiographic data of 119 patients, suffering of neoplastic pericarditis due to lung cancer (97 with non-small-cell), comparing the outcomes of four different treatment strategies (extended catheter drainage/sclerosis, systemic chemotherapy, local chemotherapy, and combined - local plus systemic - chemotherapy) at the last available follow-up or at the change of therapy after a treatment failure. The outcomes (based on semiquantitative evaluation of pericardial disease) were classified as complete, partial, no response and progressing disease.
A complete response was achieved in 37/53 of patients with combined, in 12/22 with local, in 5/27 with systemic chemotherapy, respectively, and in 4/17 after drainage/sclerosis (p<0.001). Overall response was achieved in 51/53 with combined, 18/22 and 16/27 with local or systemic chemotherapy, respectively, and in 5/17 with drainage/sclerosis only (p<0.001). Survival was significantly better after combined chemotherapy (p<0.001) and 12/53 patients (23%) in this subgroup survived more than 1 year. The overall response rate was higher with intrapericardial cisplatinum than with other agents (98% vs 80%, χ(2)=7.69, p<0.01).
Local chemotherapy, alone or with systemic chemotherapy, is effective in treating pericardial metastases from lung carcinoma, leading to a good control of pericardial effusion in 92% of cases, and to complete disappearance of effusion and masses in 65%. Combined therapy is significantly better than any other treatment. Pericardiocentesis and intrapericardial chemotherapy should be used whenever possible in lung cancer neoplastic pericardial disease, not only in case of tamponade.
Lung cancer (Amsterdam, Netherlands) 11/2010; 72(3):340-7. · 3.14 Impact Factor
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ABSTRACT: This study sought to assess the effect of hydroxymethylglutaryl coenzyme-A reductase inhibitors (statins) on the progression of rheumatic aortic valve stenosis.
The possible role of statins in slowing the progression of degenerative aortic valve stenosis (AS) is still debated. No information about the role of statin treatment in patients with rheumatic AS is available yet.
From our 1988 to 2008 echocardiographic database, we retrospectively identified all patients with rheumatic AS, with a baseline peak aortic velocity >or=1.5 m/s and at least 2 echocardiographic studies >or=2 years apart. Exclusion criteria were: severe aortic regurgitation, bicuspid aortic valve, and left ventricular ejection fraction <40%.
The study population consisted of 164 patients (30 treated with statins) followed up for 8.5 +/- 4.2 years. Peak aortic velocity at baseline was not different in patients treated with statins versus untreated patients (2.3 +/- 0.8 m/s vs. 2.3 +/- 0.7 m/s, p = 0.84). There were no significant differences in sex, age, or follow-up duration between the 2 groups. Progression of AS severity was slower in patients receiving statins compared with untreated patients (annual change of peak aortic velocity: 0.05 +/- 0.07 m/s/year vs. 0.12 +/- 0.11 m/s/year, p = 0.001). An annual rate of peak velocity progression >or=0.1 m/s was found in 10% of statin-treated patients and in 49% of untreated patients (p < 0.0001).
This is the first observation of a positive effect of statin treatment in reducing the progression of rheumatic AS. The underlying mechanisms remain to be clarified.
Journal of the American College of Cardiology 06/2009; 53(20):1874-9. · 14.16 Impact Factor
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ABSTRACT: We reviewed transthoracic (TTE) and transesophageal (TEE) echocardiograms of 100 consecutive patients: 63 male, 37 female, mean age 50 years (range 16–83 years), 32 with neoplastic disease, 18 aortic disease, 28 mitral valve disease, and 22 with other diseases. Absence or presence of mitral regurgitation (defined as mild, moderate, or severe) was assessed. TEE showed mild mitral regurgitation in 26 patients where TTE was negative. The overall estimate of regurgitant lesion severity was concordant at TEE and TTE in 64% of cases. The overall estimate of regurgitant lesion severity was also greater by one grade in 1% of cases at TTE, and in 35% of cases at TEE. Maximal digitized jet areas were 3.60 ± 6.35 cm2at TTE and 3.04 ± 3.79 cm2at TEE (P = NS). Correlation was r= 0.69 (TEE = 0.41 TTE + 1.55; P< 0.001). TEE yielded a higher prevalence of mitral regurgitation than TTE with a trend toward greater overall estimate of mitral regurgitation at the semi-quantitative analysis. TTE and TEE showed similar mean results at the quantitative assessment of maximal jet areas. However, a highly significant random variability was observed in quantifying mitral regurgitation at TEE. (ECHOCARDIOGRAPHY, Volume 8, November 1991)
Echocardiography 08/2007; 8(6):619 - 626. · 1.24 Impact Factor
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ABSTRACT: To investigate the influence of changes in loading conditions on Doppler echocardiography determination of left ventricular ejection dynamics (peak aortic flow velocity and mean acceleration), pulsed Doppler was performed on 20 patients from apical 5-chamber view. Doppler aortic flow velocity curves and hemodynamic values (left ventricular pressure, wedge pressure, and cardiac output) and the first derivative of ventricular pressure (dPIdt) by tip-transducer catheter were simultaneously recorded at baseline and during intravenous infusion of nitroglycerin as well as at baseline and immediately following left ventriculography. During nitroglycerin infusion, the hemodynamic values were reduced and peakdPIdt remained constant, Doppler aortic peak velocity and mean acceleration decreased significantly compared with baseline (0.87 ± 0.11 mlsec vs 1.01 ± 0.14 mlsec and 8.86 ± 1.68 ml sec2 vs 10.17 ± 1.88 mlsec2 respectively; bothP < 0.001). After ventriculography, the hemodynamic values increased and peak dPIdt was still constant, Doppler aortic peak velocity and mean acceleration increased significantly compared with baseline (1.15 ± 0.17 mlsec vs 0.98 ± 0.16 mlsec and 11.44 ± 2.06 mlsec2 vs 9.79 ± 1.88 mlsec2 respectively;both P < 0.001). In conclusion, left ventricular ejection dynamics, as evaluated by pulsed Doppler echocardiography, is modified by mild changes in loading conditions. Therefore, when serially evaluating the inotropic state of the left ventricle by the Doppler aortic flow velocity pattern, the potential influence of loading conditions should be takeninto account.
Echocardiography 08/2007; 11(3):207 - 213. · 1.24 Impact Factor
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ABSTRACT: A new echocardiographic severity index of aortic valve stenosis has been recently introduced: the ejection fraction-velocity ratio (EFVR), which is a simple ratio ejection fraction/4Vmax2. This nonflow corrected index demonstrated an excellent accuracy in quantifying the effective orifice area (EOA) in native aortic valves. There is no information about the reliability of EFVR in assessing aortic EOA in patients with bioprostheses.
In 141 consecutive patients with aortic bioprostheses (85 males, mean age 74 +/- 9 years), EOA was calculated by both continuity equation (CE) and EFVR.
The correlation between CE and EFVR was highly significant (r = 0.88; P < 0.0001). The area under the receiver operating characteristic (ROC) curve was 0.97 (considering a positive case CE < 1.0 cm2, best cutoff of EFVR was <1.06). Using CE as gold standard and a cutoff of 1.0 for both indexes, EFVR showed good sensitivity (80%) and specificity (98%). Also in a subgroup of 46 patients with moderate or severe mitral regurgitation, the EFVR had a good diagnostic accuracy (sensitivity 89%, specificity 97%). In 91 patients with ejection fraction < or = 50%, the EFVR confirmed good sensitivity (79%) and specificity (97%).
The EFVR, a simple and not time-consuming index, demonstrated a good diagnostic accuracy in assessing EOA also in patients with aortic bioprostheses. The presence of moderate to severe mitral regurgitation or left ventricular dysfunction does not reduce significantly the reliability of this new index. The EFVR can be taken into consideration in the clinical practice, at least when CE measurements are technically difficult.
Echocardiography 02/2006; 23(2):97-102. · 1.24 Impact Factor
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Bogdan A Popescu,
Franco Macor,
Francesco Antonini-Canterin,
Pantaleo Giannuzzi,
Pier L Temporelli,
Enzo Bosimini,
Francesco Gentile,
Aldo P Maggioni,
Luigi Tavazzi,
Rita Piazza,
Luigi Ascione,
Ioana Stoian, Eugenio Cervesato,
Gian L Nicolosi
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ABSTRACT: To evaluate the existence, timing, and determinants of post-infarction left atrial remodeling, we studied a subgroup of 514 patients from the Third Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico Echo Substudy who underwent 4 serial 2-dimensional echocardiograms up to 6 months after acute myocardial infarction. This study is the first to demonstrate, in a large series of patients, the existence of early and late left atrial remodeling after low-risk acute myocardial infarction and the relation of left atrial remodeling to left ventricular remodeling.
The American Journal of Cardiology 06/2004; 93(9):1156-9. · 3.37 Impact Factor
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ABSTRACT: To date, there is no proved medical therapy able to significantly reduce the degenerative process of biologic prosthetic aortic valves. It has recently been suggested that statins may reduce the progression of native aortic valve stenosis. We examined the effect of statin treatment on bioprosthetic aortic valve degeneration and found a beneficial effect of statins in slowing bioprosthetic degeneration.
The American Journal of Cardiology 01/2004; 92(12):1479-82. · 3.37 Impact Factor
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ABSTRACT: Hypertension and aortic stenosis represent 2 different models of left ventricular systolic overload. Previous studies have observed different remodeling patterns in these conditions. There is, however, little information about patients with coexisting aortic stenosis and hypertension. Echocardiography was performed in 193 consecutive patients with symptomatic aortic stenosis (113 males, 80 females; mean age, 68+/-9 years). The prevalence of systemic hypertension was assessed. Left ventricular mass index and relative wall thickness were measured from M-mode echocardiography. Four different left ventricular remodeling patterns were identified: normal remodeling, concentric remodeling, concentric hypertrophy, and eccentric hypertrophy. A history of hypertension was present in 62 patients (32%), whereas 131 patients were normotensive. No significant differences were found between hypertensive and normotensive patients with respect to age, male/female ratio, mean New York Heart Association class, distribution of symptoms, left ventricular systolic and diastolic function, and remodeling patterns. In hypertensive patients, however, symptoms were present with larger aortic valve areas and lower stroke work loss. Systemic hypertension is not rare in patients with symptomatic aortic stenosis (32% in our series). Left ventricular remodeling patterns are quite similar in hypertensive and normotensive aortic stenosis. Our results suggest that symptoms of aortic stenosis develop with larger valve area and lower stroke work loss in hypertensive patients, probably because of the additional overload due to hypertension itself. It could suggest that in patients with coexisting hypertension and aortic stenosis, hypertension should be treated more aggressively to delay the occurrence of symptoms, and these patients should be followed-up more closely.
Hypertension 07/2003; 41(6):1268-72. · 6.21 Impact Factor
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Franco Macor,
Matteo Cassin,
Cristina Pitzorno,
Erica Dall'Armellina,
Elisa Carniel,
Fortunato Marcianò,
Ermanno Dametto,
Sandro Bitto,
Giovanni Martin,
Francesco Antonini-Canterin, Eugenio Cervesato,
Claudio Burelli,
Gian Luigi Nicolosi
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ABSTRACT: The management of patients with acute chest pain is a common and difficult challenge for clinicians. In our emergency department (ED) a systematic protocol that involves the use of the exercise test for the management of patients with chest pain of suspected cardiac origin is presently running. The aim of the present study was to evaluate the feasibility of such a test in this setting, in terms of the safety and satisfactory follow-up of these patients discharged home.
Patients with chest pain lasting < or = 24 hours, aged > 18 years, without a history of trauma or of any other evident medical cause of chest pain and without high-risk characteristics were included in the present study. These patients, defined as low-risk patients for acute coronary events on admission, were evaluated in the ED area and submitted to serial ECG and blood sampling for the determination of the creatine kinase-MB mass and troponin I serum levels on admission and at 6 and 12 hours after admission. A symptom-limited maximal exercise was performed in the patients with a negative clinical observation and typical chest pain or atypical chest pain but multiple coronary risk factors.
In the year 2000, 1370 patients were evaluated in the ED for chest pain. In 150 (11%) an exercise test was performed. The test was positive in 24 patients (16%). The criteria for a positive test were only clinical in 3 patients, only ECG in 13 patients, and both in 8 patients. Inconclusive tests were observed in 27 patients (18%) and the test was negative in 99 patients (66%). There were no complications during the exercise test. At a median follow-up of 237 days (range 11-443 days), 11 clinical events were recorded (4 acute coronary syndromes and 7 revascularization procedures). Patients with a non-negative exercise test had a significantly shorter event-free survival (p < 0.005).
The exercise test performed in selected patients coming to the ED with acute chest pain is safe and useful for further risk assessment.
Italian heart journal: official journal of the Italian Federation of Cardiology 03/2003; 4(2):92-8.
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The American Journal of Cardiology 02/2003; 91(1):99-101. · 3.37 Impact Factor
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The American Journal of Cardiology 10/2002; 90(6):665-8. · 3.37 Impact Factor
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ABSTRACT: Low energy intracardiac cardioversion may be considered the elective, alternative method for the acute restoration of sinus rhythm when direct current cardioversion fails or is contraindicated. Transesophageal cardioversion is a further alternative method for the recovery of sinus rhythm and obviates the potential complications of the low energy intracardiac cardioversion venous approach.
The present prospective study including 30 patients (21 males, 9 females, mean age 65.1 years, range 52-76 years), with persistent atrial fibrillation (mean duration 4.3 months), was undertaken in order to further evaluate, with regard to transesophageal cardioversion: 1) the acute efficacy, 2) the patient acceptance of the procedure, 3) the preferable choice among direct current cardioversion, low energy intracardiac cardioversion and transesophageal cardioversion, 4) the time required to perform the procedure, 5) the incidence of complications, and 6) the persistence of sinus rhythm after 1 month.
Sinus rhythm was acutely restored in 29 patients (96.7%). Discomfort induced by the electrical shock was minimal or mild in most patients (75.8%). Transesophageal cardioversion was usually preferred by patients who had been previously submitted to direct current cardioversion or low energy intracardiac cardioversion. The mean total time required to perform the procedure was 107.9 min. No complications related to the procedure occurred. In spite of adequate pharmacological prophylaxis of atrial fibrillation only 41.4% of patients were in sinus rhythm 1 month after successful transesophageal cardioversion.
Transesophageal cardioversion may be considered a very effective, well accepted and non-time consuming procedure for the short-term restoration of sinus rhythm. The incidence of complications is low.
Italian heart journal: official journal of the Italian Federation of Cardiology 07/2002; 3(6):354-9.
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Francesco Antonini-Canterin,
Guoqian Huang, Eugenio Cervesato,
Pompilio Faggiano,
Daniela Pavan,
Rita Piazza,
Claudio Burelli,
Matteo Cassin,
Franco Macor,
Fabio Zardo,
Gian Luigi Nicolosi
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ABSTRACT: In addition to the conventional "flow-corrected" parameters (continuity equation and aortic valve resistance), new and simpler Doppler echocardiographic indexes of the severity of aortic stenosis have recently been introduced. These measures can be classified as "function-corrected" indexes (fractional shortening-velocity ratio and ejection fraction-velocity ratio) and "pressure-corrected" indexes (percent stroke work loss). Little information however is available about the diagnostic accuracy of each of these parameters in identifying patients with severe aortic stenosis in low-flow states, in which the diagnosis and clinical decision-making are more difficult and challenging.
We analyzed 161 patients with aortic stenosis (96 males, 65 females, mean age 68 +/- 9 years) and a low cardiac output (thermodilution cardiac index < or = 2.5 l/min/m2). All patients underwent both cardiac catheterization and echocardiography within 48 hours one of the other. The invasive Gorlin valve area was used as gold standard (severe aortic stenosis = Gorlin < or = 0.8 cm2). Echocardiographic indexes were assessed by an investigator who was unaware of the hemodynamic findings.
The mean Gorlin aortic valve area was 0.7 +/- 0.3 cm2; cardiac catheterization allowed the identification of 129 patients with severe aortic stenosis and of 32 with mild-to-moderate aortic stenosis. The diagnostic accuracy of the Doppler gradient alone was low (sensitivity 55%). The best linear correlation with the Gorlin value was found using the "function-corrected" ejection fraction-velocity ratio (r = 0.85). Similarly, the best combination of sensitivity and specificity in identifying patients with severe aortic stenosis, as assessed by cardiac catheterization, was observed using the ejection fraction-velocity ratio (sensitivity 87%, specificity 88%).
In patients with aortic stenosis and a low cardiac output, the "function-corrected" ejection fraction-velocity ratio offers the better diagnostic accuracy, as compared with the cardiac catheterization valve area calculation.
Italian heart journal: official journal of the Italian Federation of Cardiology 04/2002; 3(4):248-55.
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ABSTRACT: The present study was designed: (1) to establish the effects of transesophageal echocardiography (TEE) on arterial oxygen saturation (SAO(2)%); (2) to verify the possible clinical consequences of this phenomenon; and (3) to study the possibility of predicting modifications of SAO(2)% by clinical or hemodynamic variables or by specific factors related to the TEE procedure. We prospectively studied 116 unselected patients, aged 61 +/- 12 years, who underwent diagnostic TEE for various clinical indications. Thirty-seven patients had mitral valve disease, 19 aortic valve disease, 14 combined mitroaortic disease, 8 congenital heart disease, and 38 other cardiovascular diseases. Eight patients were affected by chronic obstructive pulmonary disease. Ninety-seven patients were sedated by 4 +/- 2 mg of diazepam IV SAO(2)% (5-min average) (Ohmeda Biox 3700 pulse oxymeter finger probe), heart rate (HR), and blood pressure (BP) were considered during baseline transthoracic examination, after pharmacological sedation but before the introduction of the probe, and finally during TEE. Neither clinical complications nor major arrhythmias were observed. Baseline SAO(2)%, HR and BP were, respectively, 93.6 +/- 3.3%, 76 +/- 14 beats/min, and 129 +/- 20/75 +/- 10 mmHg. Pharmacological sedation did not modify SAO(2)%, HR, and BP (P > 0.1). During TEE a small but significant reduction in SAO(2)% by an average of 1.2 +/- 3.2% was observed (P < 0.005), as well as a small and significant increase in HR by an average of 3 +/- 10 beats/min (P < 0.01). BP did not change significantly (P > 0.1 for both systolic and diastolic). The changes of SAO(2)% and HR were not interrelated and were not related to the duration of the procedure and to any of the clinical and hemodynamic variables taken into consideration. TEE can induce a small but significant drop in SAO(2)% and a small increase in HR even without any clinical relevance. No clinical or hemodynamic variable or specific factors related to the TEE procedure were related to these changes.
Echocardiography 05/1997; 14(3):261-266. · 1.24 Impact Factor
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ABSTRACT: The present study was designed: (1) to establish the effects of transesophageal echocardiography (TEE) on arterial oxygen saturation (SAO2%); (2) to verify the possible clinical consequences of this phenomenon; and (3) to study the possibility of predicting modifications of SAO2% by clinical or hemodynamic variables or by specific factors related to the TEE procedure. We prospectively studied 116 unselected patients, aged 61 ± 12 years, who underwent diagnostic TEE for various clinical indications. Thirty-seven patients had mitral valve disease, 19 aortic valve disease, 14 combined mitroaortic disease, 8 congenital heart disease, and 38 other cardiovascular diseases. Eight patients were affected by chronic obstructive pulmonary disease. Ninety-seven patients were sedated by 4 ± 2 mg of diazepam IV SAO2% (5-min average) (Ohmeda Biox 3700 pulse oxymeter finger probe), heart rate (HR), and blood pressure (BP) were considered during baseline transthoracic examination, after pharmacological sedation but before the introduction of the probe, and finally during TEE. Neither clinical complications nor major arrhythmias were observed. Baseline SAO2%, HR and BP were, respectively, 93.6 ± 3.3%, 76 ± 14 beats/min, and 129 ± 20/75 ± 10 mmHg. Pharmacological sedation did not modify SAO2%, HR, and BP (P > 0.1). During TEE a small but significant reduction in SAO2% by an average of 1.2 ± 3.2% was observed (P < 0.005), as well as a small and significant increase in HR by an average of 3 ± 10 beats/min (P < 0.01). BP did not change significantly (P > 0.1 for both systolic and diastolic). The changes of SAO2% and HR were not interrelated and were not related to the duration of the procedure and to any of the clinical and hemodynamic variables taken into consideration. TEE can induce a small but significant drop in SAO2% and a small increase in HR even without any clinical relevance. No clinical or hemodynamic variable or specific factors related to the TEE procedure were related to these changes.
Echocardiography 04/1997; 14(3):261 - 265. · 1.24 Impact Factor
