[Show abstract][Hide abstract] ABSTRACT: Background: Assessing and grading congestion in patients with heart failure (HF) is an unmet clinical need. Early diagnosis of subclinical congestion is key to ensure prompt and effective treatment, and to prevent recurrent hospitaliza- tions for worsening HF. Pulmonary blood volume (PBV) has been advocated as a quantitative and non-invasive magnetic resonance (MR) imaging measure of heart failure in animal research.
Purpose: The aim of this study was to prospectively assess the feasibility and the prognostic value of PBV in a cohort of NYHA functional class I and II HF outpatients.
Methods: 44 consecutive asymptomatic or mildly symptomatic patients (34 men, 60±12 years) and 31 age- and sex-matched healthy controls underwent contrast- enhanced cardiac MR on a 1.5 Tesla scanner. PBV was calculated as the prod- uct of stroke volume index and number of cardiac cycles for an intravenous bolus of gadolinium contrast to pass through the pulmonary circulation, as de- termined by cardiac-gated first-pass perfusion imaging. The prognostic value of PBVI was calculated by univariate Kaplan-Meier survival analysis and multivari- ate Cox proportional-hazard regression analysis.
Results: Compared to healthy controls, PBV indexed to body surface area (PBVI,ml/m2) and pulmonary transit time (PTT, s), were both significantly higher in HF outpatients (mean±SD: 317±112 vs. 379±146, p=0.03; 6.6±1.8 vs. 8.4±2.9, p=0.004). PBVI was also found to significantly correlate with severity of diastolic dysfunction as assessed by Doppler echocardiography. During a median follow- up period of 40±27 months, 13 patients (29%) reached the combined primary end-point of cardiovascular death, HF hospitalization or sustained ventricular ar- rhythmias/appropriate ICD intervention. Using a cut-off point of PBVI >541 ml/m2, corresponding to 2SD above the mean of healthy controls, Kaplan-Meier event- free survival rates were significantly higher in patients below (81%) as compared with patients above (14%) this cut-off (p=0.02). After multivariate adjustment for right and left ventricular ejection fraction, PTT and pulmonary artery pressure, PBVI remained an independent predictor of the composite end-point (χ2=5.76, p=0.01).
Conclusions: PBVI by contrast-enhanced MR is a novel imaging technique use- ful to quantitatively determine pulmonary intravascular blood pool. Compared to healthy controls, HF outpatients showed an increased amount of blood in the pul- monary vasculature and a longer PTT. Further studies are warranted to validate PBVI as a non-invasive method to assess and grading congestion, and confirm its prognostic role in the setting of congestive HF.
European Heart Journal 09/2015; 36(Abstract Supplement):1040. · 15.20 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Conclusion:
Obese children feature increased LA size, which emerged to be mainly correlated to, and possibly driven by IR, suggesting an increased CVD risk. What is Known: • Left atrial and ventricular alterations have been reported in obese adults, and they represent predisposing factors for cardiovascular disease. • There is some evidence suggesting that obese children show increased left ventricular mass and also increased atrial size, although with conflicting results. What is New: • Obese normotensive children showed a moderately increased atrial size, subtle alterations in left cardiac diastolic function, and ventricular mass. • An association between insulin resistance and left cardiac changes was found, although its mechanism remains to be determined.
European Journal of Pediatrics 08/2015; DOI:10.1007/s00431-015-2608-3 · 1.89 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Human response to different physiologic stimuli and cardiovascular adaptation to various pathologies seem to be gender specific. Sex-steroid hormones have been postulated as the major contributors towards these sex-related differences. This review will discuss current evidence on gender differences in cardiovascular function and remodelling, and will present the different role of the principal sex-steroid hormones on female heart. Starting from a review of sex hormones synthesis, receptors and cardiovascular signaling, we will summarize the current knowledge concerning the role of sex hormones on the regulation of our daily activities throughout the life, via the modulation of autonomic nervous system, excitation-contraction coupling pathway and ion channels activity. Many unresolved questions remain even if estrogen effects on myocardial remodeling and function have been extensively studied. So this work will focus attention also on the controversial and complex relationship existing between androgens, progesterone and female heart. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
European Journal of Clinical Investigation 04/2015; 45(6). DOI:10.1111/eci.12447 · 2.73 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Introduction: The increase of left auricular volume (LAV) is a robust cardiovascular event predictor. Despite that echochardiography is more often used, cardiac MRI is considered more accurate. Our objetives are to validate "fast" LAV measures by MRI vs the considered gold standard (GS) and to compare Echo and MRI in a wide spectrum of patients.
Methods: In a non-selected popullation with MRI study previously realized, we measured LAV by biplane method (BPMR) and by area-length in 4 chamber view (ALMR) and compared them with biplane (BPe) and discs method (MDDe) in 4 chamber view in echo. To validate MRI measurements, we measured LAV in short axis slices (Simpson Method, SM) in a group of patients and considered it the GS.
Results: 186 patients were included (mean age 51 ± 17 age; 123 male; 14 in AF) with clinical indication of cardiac MRI (Philips 1,5 T). In 24 patients SM was calculated. 29% of cardiac MRI were considered normal. Mean underlying pathologies were myocardiopathy (27%), Ischemic myocardiopathy (17%), myopericarditis (10%), prior to AF ablation (4%), valvular disease (6%) and miscellaneous (7%). Excellent correlation was obtained between "fast" MRI measurements and SM in MRI (SM vs BPMR interclass correlation coefficient ICC=0.965 and SM vs ALMR, ICC=0.958; P<0.05) with low interobserver variability (ICC=0.983 for SM; ICC=0.949 for BPMR; ICC=0.931 for ALMR). "Fast" measurements by MRI showed stadistical correlation between them (CCI=0.910) (Figure). Correlation between Echo and MRI measures was only moderate. (BPRM vs BPe CCI=0,469 mean difference -30 ml; ALMR vs MDDe ICC=0,456 mean difference -24 mL).
Conclusions: ‘fast’ LAV measures by MRI are comparable with the MRI GS and also between them. Echo values seem to underestimate compared to MRI, so its use may not be suitable.
[Show abstract][Hide abstract] ABSTRACT: Pulmonary embolism is a major health problem. Clinical presentation may vary from cardiovascular emergency with high mortality risk to mild or atypical illness, and the diagnosis is not always easy. However, the timeliness of diagnosis and prognostic stratification are crucial because immediate treatment and thromboembolic prophylaxis are highly effective. Echocardiography can play a key role in pulmonary embolism regarding different aspects: diagnosis, risk stratification, and follow-up but sometimes it is not properly used. Therefore, it is important for a physician to know exactly how to utilize echocardiography in pulmonary embolism. The purpose of this paper is to review the role of echocardiography as part of the diagnosis, management and follow-up of acute pulmonary embolism in the light of current literature.
Giornale italiano di cardiologia (2006) 12/2014; 15(12):685-99. DOI:10.1714/1718.18772
[Show abstract][Hide abstract] ABSTRACT: Lung ultrasonography is an emerging, user-friendly and easy-to-use technique that can be performed quickly at the patient's bedside to evaluate several pathologic conditions affecting the lung. Ultrasound lung comets (ULCs) are an echographic sign of uncertain biophysical characterisation mostly attributed to water-thickened subpleural interlobular septa, but invariably associated with increased extravascular lung water. ULCs have thus been proposed as a complementary tool for the assessment and monitoring of acute heart failure and are now entering into statements in international recommendation documents. Adding lung ultrasonography to conventional echocardiography allows for performing an integrated cardiopulmonary ultrasound examination, and this is an important opportunity for the cardiologist. The technique allows the simultaneous gathering of considerable information about the heart and the lungs to investigate acute and chronic cardio-pulmonary conditions within a non-invasive, radiation-free, single-probe, all-in-one examination. We have here reviewed the pertinent literature on the physical origin of ULCs and on their role and importance in intensive and acute cardiac care settings. We also here propose a new algorithm aimed at implementing evaluation in the diagnostic work-up of patients with suspected acute heart failure.
European Heart Journal: Acute Cardiovascular Care 09/2014; 4(2). DOI:10.1177/2048872614553166
[Show abstract][Hide abstract] ABSTRACT: Atrial fibrillation is the most common arrhythmia encountered in clinical practice. Cardiologists are often called upon to manage atrial fibrillation both in the acute urgent setting for the presence of hemodynamic compromise and electively for rhythm and/or heart rate control as well as for anti-remodeling strategies. In all these cases echocardiography is generally used. In particular, different echocardiographic techniques (transthoracic, transesophageal) and modalities (two-dimensional, three-dimensional, speckle tracking) can be indicated depending on the stage of the arrhythmia management and the need for cardioversion or interventional procedures. The purpose of this review is to clarify the current role of echocardiography, including specific techniques and modalities, in the managing process of atrial fibrillation.
Giornale italiano di cardiologia (2006) 09/2014; 15(9):494-507. DOI:10.1714/1640.17976
[Show abstract][Hide abstract] ABSTRACT: Left ventricular surgical remodelling (LVSR) can be targeted to volume reduction (VR), (independently of the final shape) or to conical shape (CS). The aim of this study was to evaluate the long-term clinical and echocardiographic results of these two surgical strategies.
From January 1988 to December 2012, 401 patients underwent LVSR: 107 in Group VR (1988-2001) and 294 in Group CS (1998-2012). The latter group of patients had lower ejection fraction (EF) and higher mitral and tricuspid regurgitation grade, with higher incidence of pulmonary hypertension. A propensity score model was built to adjust long-term results for preoperative and operative profiles.
Thirty-day mortality was 6.0%. Median follow-up interval time was 100 (3-300) months. Overall 20-year and event-free survival were 36.1 ± 7.8 and 19.4 ± 7.2, respectively. No differences were found regarding 10-year survival (Group VR: 55.1 ± 4.8 vs Group CS: 64.2 ± 4.2, P = 0.16) and event-free survival (Group VR: 41.1 ± 4.8 vs Group CS: 50.5 ± 4.8, P = 0.12). However, Group CS provided better 10-year freedom from cardiac deaths (74.5 ± 3.7 vs 60.4 ± 4.8, P = 0.03) and from cardiac events (55.6 ± 5.0 vs 45.0 ± 4.9, P = 0.04). After propensity score adjustment, all the main outcomes were significantly better in Group CS. Multivariate Cox analysis confirmed this result; furthermore, to avoid any bias related to improved experience, 30-day mortality being higher in Group VR, we excluded the first month from Cox analysis: left ventricle VR (independently of the final shape) was still confirmed as the wrong approach. At the follow-up, Group CS showed significant improvement in EF (+18 vs +8%), end-systolic volume index (-35 vs -20%) and sphericity index (-6 vs +9%).
LVSR should aim to provide a more physiological shape (conical) rather than simple VR.
European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 05/2014; 47(3). DOI:10.1093/ejcts/ezu186 · 3.30 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Asymmetric dimethylarginine (ADMA) is an endogenous nitric oxide synthase (NOS) inhibitor known as a mediator of endothelial dysfunction and atherosclerosis. Circulating ADMA levels are correlated with cardiovascular risk factors such as hypercholesterolemia, arterial hypertension, diabetes mellitus, hyperhomocysteinemia, age and smoking. We assessed the relationship between ADMA values and site-specific association of asymptomatic carotid atherosclerosis (intima-media thickness (CIMT) and plaque) in elderly subjects. One hundred and eighty subjects underwent a complete history and physical examination, determination of serum chemistries and ADMA levels, and carotid ultrasound investigation (CUI). All subjects had no acute or chronic symptoms of carotid atherosclerosis. Statistical analyses showed that high plasma levels of ADMA/SDMA were positively correlated to carotid atherosclerosis (CIMT and plaque) (p < 0.001), with significant site-specific association. Total cholesterol, low density lipoprotein cholesterol, triglycerides and C-reactive protein plasma concentrations were significantly associated with asymptomatic carotid atherosclerosis (p < 0.001). High serum concentrations of ADMA and SDMA were associated with carotid atherosclerotic lesions as measured by CIMT ad plaque and may represent a new marker of asymptomatic carotid atherosclerosis in elderly subjects.
International Journal of Molecular Sciences 04/2014; 15(4):6391-8. DOI:10.3390/ijms15046391 · 2.86 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background: Left ventricular surgical restoration (LVSR) has had volume reduction as principle purpose for several years. However, volume reduction is not effective when the final shape of LV is spherical rather than conical; in fact, according to Laplace law, a spherical shape increases wall tension and oxygen consumption. The aim of this study is to evaluate the long-term clinical and echocardiographic results of two surgical approaches: reshaping or volume reduction.
Methods: From January 1988 to February 2008, 308 patients underwent LVSR with the aim of volume reduction in 107 patients (Group A) or reshaping in 201 patients (Group B). The latter group was significantly older, with lower ejection fraction (EF), high prevalence of mitral (MR) and tricuspid regurgitation (TR). A propensity score model was built to adjust long-term results for pre- and operative profile.
Results: Thirty-day mortality was 7.8% without any difference between the two groups. Median follow up interval time was 100 months (66-134). No differences were found regarding propensity-adjusted 10-year survival (A: 55.1±4.8 vs B: 64.2±4.2, p=0.16) and propensity-adjusted event-free survival (A: 41.1±4.8 vs B: 50.5±4.8, p=0.12); However, when deaths or events were cardiac-related, LV reshaping provided better outcomes: propensity-adjusted 10-year freedom from cardiac deaths (A: 60.4±4.8 vs B: 74.5±3.7, p=0.03) and propensity-adjusted 10-year freedom from cardiac events (A: 45.0±4.9 vs B: 55.6±5.0, p=0.04). Multivariate Cox analysis confirmed this result. At follow up, patients undergoing ventricular reshaping showed an increase of EF significantly higher than other ones (18% vs 55, p<0.05).
Interactive Cardiovascular and Thoracic Surgery 09/2013; 17(suppl 2):S95-S95. DOI:10.1093/icvts/ivt372.107 · 1.16 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Context:Estrogen deficiency, systemic low-grade inflammation, and reduction of adrenal gland function have central roles in noncommunicable chronic disease (NCD) development. With angiotensin-converting enzyme (ACE) insertion/deletion (I/D) polymorphism, the deletion variant (DD) is related to higher levels of circulating angiotensin II, which might interact with all of these molecular pathways to increase NCD risk. On the other hand, physical exercise counteracts the occurrence of NCDs, potentially acting on the same pathways.Objectives:The aim of the study was to investigate the effects of walking training on adrenal steroid and cytokine levels and on cardiovascular parameters in postmenopausal women with ACE I/D genotypes.Methods:Thirty-six (DD = 15, II/ID = 21) sedentary postmenopausal women (mean age, 56 ± 4 y) participated in a 13-week program of walking training at moderate intensity. Heart rate, blood pressure, double product, TNF-α, dehydroepiandrosterone sulfate (DHEA-S), and cortisol were evaluated before and after the intervention program.Results:Before walking training, the ACE DD genotype showed significantly higher TNF-α (P = .007) and lower DHEA-S concentrations (P = .022) than the ACE II/ID individuals. After walking training, both subgroups significantly decreased TNF-α plasma levels and cortisol/DHEA-S ratio (P = .001 and P = .016, respectively) and significantly increased DHEA-S levels (P < .001). Moreover, all the cardiovascular parameters were significantly reduced in the ACE DD participants (P ≤ .05), whereas the ACE I-allele carriers showed a decrease in heart rate (P ≤ .05) and the double product (P ≤ .05).Conclusion:ACE I/D polymorphism is linked to different adrenal steroid and cytokine levels, and ACE I-allele carriers show a better adrenal activity and systemic inflammatory profile. The introduction of walking training positively influences the menopause immune-neuroendocrine changes, independent of ACE I/D genotype.
The Journal of Clinical Endocrinology and Metabolism 08/2013; 98(10). DOI:10.1210/jc.2013-2305 · 6.21 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This review article focuses on functional tricuspid regurgitation (FTR) that has long been a neglected and underestimated entity. FTR is defined as leakage of the tricuspid valve during systole in the presence of structurally normal leaflets and chordae. FTR may be secondary to several heart diseases, more commonly mitral valve disease, pulmonary hypertension, atrial fibrillation, cardiomyopathies, right ventricular dysplasia, and idiopathic annular dilatation. The reported prevalence of moderate or greater FTR is roughly 16%, but it rises up to 89% when considering FTR of any grade. According to the recommendations of the European Association of Echocardiography, two-dimensional transthoracic echocardiography (TTE) is the first-line imaging modality for the assessment of valvular regurgitation, whereas three-dimensional TTE may provide additional information in patients with complex valve lesions. Transesophageal echocardiography may be used when TTE results are inconclusive. The natural history of FTR is unfavorable, even in less than severe tricuspid regurgitation. Data from the literature suggest that moderate or greater FTR is a risk factor for worse survival. In addition, FTR of any grade may worsen over time, which makes it reasonable to consider the correction of FTR at an early stage, preferably at the time of mitral valve surgery. Tricuspid valve annuloplasty is the gold standard surgical treatment for FTR and is associated with a recurrence rate, defined as postoperative moderate or severe FTR, ranging from 2.5 to 5.5% at 1-year follow-up.
International journal of cardiology 05/2013; 168(2). DOI:10.1016/j.ijcard.2013.04.043 · 4.04 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Acute abdominal aortic thrombosis is a rare and potential fatal event, which occurs in adult subjects. We present the case of a 72-year-old-man, who referred to the emergency Department of our hospital because of persistent severe abdominal and perineal pain. Doppler ultrasounds and computerized tomography angiography revealed the acute thrombosis of the abdominal aorta. Immediate revascularization through aortic thrombo-endoarterectomy resolved the disease.
Journal of biological regulators and homeostatic agents 04/2013; 27(2):607-9. · 2.04 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to investigate the effects of acute pharmacological treatment on the plasma levels of l-arginine, asymmetrical dimethylarginine (ADMA), and symmetrical dimethylarginine (SDMA). We also investigated the related effects on endothelial nitric oxide synthase (eNOS) expression and activity and cytochrome c oxidase activity in the primary blood mononuclear cells (PBMCs) isolated from patients with acute congestive heart failure (ACHF). Compared to pre-treatment values, ADMA, SDMA, and l-arginine plasma levels were significantly higher after pharmacological treatment (ADMA, 0.82 versus 0.43 µM; SDMA, 1.52 versus 1.12 µM; l-arginine, 1.78 versus 1.29 µM; p < 0.01. In addition, the levels of eNOS expression and activity were decreased after pharmacological treatment, while cytochrome c oxidase activity resulted in higher O2-production. In the PBMCs isolated from patients with acute congestive heart failure (ACHF) and impaired renal function, higher SDMA and ADMA levels were more evident after therapy, as were reduced expression and activity of eNOS. Increased O2- produced after treatment may be involved in impaired recovery of cardiac function associated with higher plasma levels of SDMA.
Frontiers in bioscience (Elite edition) 01/2013; E5(2):551-557. DOI:10.2741/E637
[Show abstract][Hide abstract] ABSTRACT: Objective:
We hypothesized that physical exercise in postmenopausal women could interfere with the molecular interrelationship of the immune-endocrine system and be effective even in women in whom training determined a reduction of spontaneous physical activity (SPA). For this reason, we investigated the effects of an aerobic program on plasma dehydroepiandrosterone sulfate (DHEA-S) and cytokine levels in relationship to SPA modification.
Thirty-two postmenopausal women (mean [SD] age, 56.38 [4.33] y) were enrolled in the study. Inclusion criteria were as follows: age younger than 65 years, body mass index higher than 18.5 and lower than 35 kg/m2, no pharmacological treatments, and no history of chronic, cardiovascular, or orthopedic diseases. Before and after 3 months of walking training at moderate intensity (40-50 min, 4 d/wk), they were evaluated for SPA, body composition, energy intake, and levels of plasma cytokines (tumor necrosis factor α [TNF-α], interleukin [IL]-1α, IL-1β, IL-2, IL-8, and IL-10), C-reactive protein, DHEA-S, cortisol, and estrogen.
At baseline, SPA did not correlate with either DHEA-S level or cytokine levels. There was negative correlation between DHEA-S and both TNF-α and IL-2. After the intervention program, 16 women showed increased SPA, and 16 women showed decreased SPA. Independent of these changes in SPA, both TNF-α levels and cortisol-to-DHEA-S ratio decreased, whereas DHEA-S levels increased.
In postmenopausal women, walking training, rather than SPA, influences DHEA-S and cytokine concentrations and their correlations, thus interfering with adrenal steroids and the inflammatory markers network. Physical exercise acts in parallel on menopausal neuroendocrine alterations and on the systemic inflammatory profile independent of SPA changes.
Menopause (New York, N.Y.) 12/2012; 20(4). DOI:10.1097/gme.0b013e31827425c9 · 3.36 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective - Several studies support, during menopause, an impact of endogenous sex hormone levels on thrombotic potential parameters. Fibrinogen plays several key roles in the maintenance of hemostasis and its levels seem to be a marker or mediator of CVD. The aim of our study was to assess the role of intensity of physical activity on fibrinogen levels in post-menopause women.
Design and Methods - Forty-five post-menopausal (57.88±5.15) non-obese healthy women without history of physical exercise and pharmacological treatment were recruited. Expert researchers assessed anthropometry, blood samples and weekly physical activity of participants. After 12 hour overnight fasting body composition were assessed by Electrical Bioimpedance (BIA) Tanita BC-418. Fibrinogen concentration (mg/dl) in plasma was measured with Human Fibrinogen ELISA quantification kit. Physical activity characteristics and mean intensity of daily physical activities (METs) assessed by SenseWear Pro 3 Armband.
Results - Cluster analysis on basal values of Fibrinogen showed the presence of two sub-groups: Group+ (n=18) and Group- (n=27). Group- (339.48±29 mg/dl) showed higher Fibrinogen values respect to Group+ (263.33±26 mg/dl). Student’s t-Test evidentiated that sub-groups were significantly different in (METs) (p=0.05), Waist Circumference (WC) (p=0.003), Waist to Hip ratio (W/H) (p=0.027) and Body Mass Index (BMI) (p=0.05) Logistic regression, showed that METs was the only significant predictor of sub-group membership (p=0.013)
Conclusion - In post-menopause, METs has a relationship with Fibrinogen plasma level. Beneficial effects of physical exercise on the prognosis are undoubtedly attributable to several factors even if spontaneous physical activity could be the first step to oppose high fibrinogen plasma level after menopause.
XXXII WORLD CONGRESS OF SPORTS MEDICINE, Rome; 09/2012