Marco Paterni

Università di Pisa, Pisa, Tuscany, Italy

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Publications (88)290.15 Total impact

  • Eugenio Picano, Marco Paterni
    International Journal of Molecular Sciences 05/2015; 16(5):10121-10133. DOI:10.3390/ijms160510121 · 2.34 Impact Factor
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    ABSTRACT: Context Hyperglycemia is associated with a higher carotid intima-media thickness (IMT), however it is not established whether this increase reflects early atherosclerotic changes or adaptive remodeling responding to hyperglycemia-induced alteration in mechanical properties of the arterial wall. Objective Aim of this study was to compare carotid geometry and circumferential wall stress between patients with type 2 diabetes mellitus (T2DM) and healthy controls, and to evaluate the associations between chronic glucose exposure and measures of arterial structure and function. Design Case-control and cross-sectional study Setting Institutional practice Participants One hundred thirty-three T2DM patients free of cardiovascular complications and 133 healthy controls with normal glucose metabolism, matched for sex, age, body mass index Main Outcome Measures Common carotid artery (CCA) IMT, luminal diameter, wave speed (WS) and local pulse pressure (PP) Results As compared to controls, T2DM patients had higher (P<0.0001) CCA IMT (640±81 vs 709±118 μ m), luminal diameter (6.12±0.67 vs 6.69±0.56 mm) and brachial PP (47±7 vs 57±12 mmHg), whereas luminal radius to IMT ratio (4.8±0.7 vs 4.8±0.8, P=0.57) and circumferential wall stress (49.0±8.3 vs 50.6±10.3 kPa, P=0.26) were comparable between the two groups. In T2DM patients, glycosylated hemoglobin was independently related to CCA WS and local PP, but not to IMT that was determined by age, local PP and luminal diameter. Conclusions This study suggests that increase in IMT associated with a higher glucose exposure might reflect an adaptive remodeling counteracting raise in pulsatile strain and preventing increment in circumferential wall stress caused by luminal enlargement of stiff arteries.
    Journal of Clinical Endocrinology &amp Metabolism 07/2014; DOI:10.1210/jc.2014-2028 · 6.31 Impact Factor
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    ABSTRACT: The purpose of this work is twofold: (i) to develop a CAD system for the assessment of emphysema by digital chest radiography and (ii) to test it against CT imaging. The system is based on the analysis of the shape of lung silhouette as imaged in standard chest examination. Postero-anterior and lateral views are processed to extract the contours of the lung fields automatically. Subsequently, the shape of lung silhouettes is described by polyline approximation and the computed feature-set processed by a neural network to estimate the probability of emphysema. Images of radiographic studies from 225 patients were collected and properly annotated to build an experimental dataset named EMPH. Each patient had undergone a standard two-views chest radiography and CT for diagnostic purposes. In addition, the images (247) from JSRT dataset were used to evaluate lung segmentation in postero-anterior view. System performances were assessed by: (i) analyzing the quality of the automatic segmentation of the lung silhouette against manual tracing and (ii) measuring the capabilities of emphysema recognition. As to step i, on JSRT dataset, we obtained overlap percentage (Ω) 92.7±3.3%, Dice Similarity Coefficient (DSC) 95.5±3.7% and average contour distance (ACD) 1.73±0.87mm. On EMPH dataset we had Ω=93.1±2.9%, DSC=96.1±3.5% and ACD=1.62±0.92mm, for the postero-anterior view, while we had Ω=94.5±4.6%, DSC=91.0±6.3% and ACD=2.22±0.86mm, for the lateral view. As to step ii, accuracy of emphysema recognition was 95.4%, with sensitivity and specificity 94.5% and 96.1% respectively. According to experimental results our system allows reliable and inexpensive recognition of emphysema on digital chest radiography.
    Medical Engineering & Physics 04/2012; 35(1). DOI:10.1016/j.medengphy.2012.03.011 · 1.84 Impact Factor
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    ABSTRACT: Computed tomography (CT) is the benchmark for diagnosis emphysema, but is costly and imparts a substantial radiation burden to the patient. To develop a computer-aided procedure that allows recognition of emphysema on digital chest radiography by using simple descriptors of the lung shape. The procedure was tested against CT. Patients (N=225), who had undergone postero-anterior and lateral digital chest radiographs and CT for diagnostic purposes, were studied and divided in a derivation (N=118) and in a validation sample (N=107). CT images were scored for emphysema using the picture-grading method. Simple descriptors that measure the bending characteristics of the lung profile on chest radiography were automatically extracted from the derivation sample, and applied to train a neural network to assign a probability of emphysema between 0 and 1. The diagnostic performance of the procedure was described by the area under the receiver operating characteristic curve (AUC). AUC was 0.985 (95% confidence interval, 0.965-0.998) in the derivation sample, and 0.975 (95% confidence interval, 0.936-0.998) in the validation sample. At a probability cutpoint of 0.55, the procedure yielded 92% sensitivity and 96% specificity in the derivation sample; 90% sensitivity and 97% specificity in the validation sample. False negatives on chest radiography had trace or mild emphysema on CT. The computer-aided procedure is simple and inexpensive, and permits quick recognition of emphysema on digital chest radiographs.
    European journal of radiology 11/2011; 80(2):e169-75. DOI:10.1016/j.ejrad.2010.08.021 · 2.16 Impact Factor
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    ABSTRACT: Awareness of radiological risk is low among doctors and patients. An educational/decision tool that considers each patient' s cumulative lifetime radiation exposure would facilitate provider-patient communication. The purpose of this work was to develop user-friendly software for simple estimation and communication of radiological risk to patients and doctors as a part of the SUIT-Heart (Stop Useless Imaging Testing in Heart disease) Project of the Tuscany Region. We developed a novel software program (PC-platform, Windows OS fully downloadable at considering reference dose estimates from American Heart Association Radiological Imaging 2009 guidelines and UK Royal College of Radiology 2007 guidelines. Cancer age and gender-weighted risk were derived from Biological Effects of Ionising Radiation VII Committee, 2006. With simple input functions (demographics, age, gender) the user selects from a predetermined menu variables relating to natural (e.g., airplane flights and geo-tracked background exposure), professional (e.g., cath lab workers) and medical (e.g., CT, cardiac scintigraphy, coronary stenting) sources. The program provides a simple numeric (cumulative effective dose in milliSievert, mSv, and equivalent number of chest X-rays) and graphic (cumulative temporal trends of exposure, cancer cases out of 100 exposed persons) display. A simple software program allows straightforward estimation of cumulative dose (in multiples of chest X-rays) and risk (in extra % lifetime cancer risk), with simple numbers quantifying lifetime extra cancer risk. Pictorial display of radiation risk may be valuable for increasing radiological awareness in cardiologists.
    European journal of radiology 08/2011; 81(11):3563-7. DOI:10.1016/j.ejrad.2011.05.039 · 2.16 Impact Factor
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    ABSTRACT: We evaluated the ability of the phosphodiesterase-5 inhibitor vardenafil to increase prostate microcirculation during power Doppler ultrasound. We also evaluated the results of contrast and vardenafil enhanced targeted biopsies compared to those of standard 12-core random biopsies to detect cancer. Between May 2008 and January 2010, 150 consecutive patients with prostate specific antigen more than 4 ng/ml at first diagnosis with negative digital rectal examination and transrectal ultrasound, and no clinical history of prostatitis underwent contrast enhanced power Doppler ultrasound (bolus injection of 2.4 ml SonoVue® contrast agent), followed by vardenafil enhanced power Doppler ultrasound (1 hour after oral administration of vardenafil 20 mg). All patients underwent standard 12-core transrectal ultrasound guided random prostate biopsy plus 1 further sampling from each suspected hypervascular lesion detected by contrast and vardenafil enhanced power Doppler ultrasound. Prostate cancer was detected in 44 patients (29.3%). Contrast and vardenafil enhanced power Doppler ultrasound detected suspicious, contrast enhanced and vardenafil enhanced areas in 112 (74.6%) and 110 patients (73.3%), and was diagnostic for cancer in 32 (28.5%) and 42 (38%), respectively. Analysis of standard technique, and contrast and vardenafil enhanced power Doppler ultrasound findings by biopsy core showed significantly higher detection using vardenafil vs contrast enhanced power Doppler ultrasound and standard technique (41.2% vs 22.7% and 8.1%, p <0.005 and <0.001, respectively). The detection rate of standard plus contrast or vardenafil enhanced power Doppler ultrasound was 10% and 11.7% (p not significant). Vardenafil enhanced power Doppler ultrasound enables excellent visualization of the microvasculature associated with cancer and can improve the detection rate compared to contrast enhanced power Doppler ultrasound and the random technique.
    The Journal of urology 06/2011; 185(6):2126-31. DOI:10.1016/j.juro.2011.02.014 · 3.75 Impact Factor
  • Journal of Hypertension 01/2011; 29:e325. DOI:10.1097/00004872-201106001-00936 · 4.22 Impact Factor
  • International Journal of Psychophysiology 09/2008; 69(3):223-223. DOI:10.1016/j.ijpsycho.2008.05.065 · 2.65 Impact Factor
  • The Journal of Clinical Endocrinology and Metabolism 09/2008; 93(9):3325-32. · 6.31 Impact Factor
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    ABSTRACT: An independent association between obesity and preclinical carotid atherosclerosis has been demonstrated, however, the pathophysiological links were not clearly established. Body composition (BC) influences systemic hemodynamics and may participate in the remodeling of common carotid artery (CCA), independently of risk factors. This study evaluated the association between CCA structure and BC in a large population of healthy subjects. This was a cross-sectional study. The study was conducted at 19 European centers. The study included 627 healthy subjects (252 men, age 30-60 yr, body mass index 17-40 kg/m2). CCA luminal diameter and intima-media thickness were measured on digitized ultrasound images. Acoustic properties of CCA wall were evaluated by digital densitometric analysis and described in terms of mean gray level. BC was assessed by electrical bioimpedance. Insulin sensitivity (euglycemic hyperinsulinemic clamp) and plasma adiponectin levels were measured. Associations between CCA structure, age, BC, and metabolic and atherosclerotic risk factors were analyzed by multivariate regression models. Independent factors affecting CCA diameter were fat-free mass and waist girth (standardized r = 0.44 and 0.12; P < 0.01 and < 0.0001; R2 = 0.35); independent correlates of intima-media thickness were age, CCA diameter, systolic blood pressure, and low-density lipoprotein-cholesterol (standardized r = 0.39, 0.25, 0.10, and 0.14; P < 0.005-0.0001; R2 = 0.40). The mean gray level of carotid wall was independently associated with age and waist girth (standardized r = 0.23 and 0.12; P < 0.0001 and = 0.001; R2 = 0.30). Findings of this cross-sectional study suggest that BC modulates CCA diameter, and may induce adaptive changes in carotid wall thickness, independently of metabolic and atherosclerotic factors. Central adiposity modifies the acoustic properties of carotid wall.
    Journal of Clinical Endocrinology &amp Metabolism 08/2008; 93(9):3325-32. DOI:10.1210/jc.2007-2484 · 6.31 Impact Factor
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    ABSTRACT: Regular endurance exercise has been shown to reduce the age-related increase in arterial stiffness that is thought to contribute to cardiovascular risk. The aim of this study was to evaluate the influence of age and habitual physical activity on carotid artery wall thickness and stiffness in a population of young to middle-age subjects at low cardiovascular risk. The study population consisted of 432 healthy subjects (166 men; mean+/-SD age, 43+/-8 years; range, 30 to 60 years) free of carotid atherosclerosis and with low coronary heart disease risk, as determined by the Framingham prediction score sheet. All subjects underwent B-mode ultrasonography of the extracranial carotid arteries and physical activity assessment by actigraph, an accelerometer capable of monitoring the intensity and duration of body movements. The intima-media thickness of the common carotid artery was measured on ultrasound images, along with systodiastolic changes in luminal diameter, and indices of carotid stiffness were calculated. Intima-media thickness and carotid stiffness increased with age in both men and women (r=0.24 to 0.52, P<0.001). The magnitude of objectively assessed daily physical activity was negatively related to indices of carotid stiffness (r from -0.20 to -0.25, P<0.001) but not to intima-media thickness. In multivariate regression analyses that included several cardiovascular risk factors such as obesity, blood pressure, plasma lipids, and smoking habits, age and physical activity were independently related to carotid stiffness. This study provides cross-sectional evidence that habitual physical activity is inversely related to the age-dependent increase in carotid wall stiffness in a young to middle-age population at low risk.
    Stroke 09/2007; 38(9):2549-55. DOI:10.1161/STROKEAHA.107.484949 · 6.02 Impact Factor
  • Artery Research 09/2007; 1(2):70-70. DOI:10.1016/j.artres.2007.07.009
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    ABSTRACT: In the hypertensive heart, epicardial arteries are not enlarged, despite increased total coronary flow related to augmented cardiac workload, wall stress, and left ventricular (LV) mass. The aims of this study were to assess the impact of different hemodynamic factors and LV mass on baseline left main coronary artery (LMA) size in hypertensive LV hypertrophy (LVH) and physiologic LVH, used as a pressure-independent model of hypertrophy. In 104 subjects without coronary disease (26 normotensive subjects without LVH, 15 athletes with physiologic LVH, and 63 untreated hypertensive subjects [28 without and 35 with LVH]), LMA size and coronary flow reserve (CFR) were measured by transesophageal echocardiography, and LV mass, volumes, stroke work, and wall stress were measured by transthoracic echocardiography. The LMA area in normotensive control subjects, athletes, and hypertensive subjects without and with LVH was 13.2 +/- 4.2, 17.5 +/- 2.9, 10.1 +/- 3.2 and 13.1 +/- 3.9 mm(2). In normotensive control subjects, LMA size increased with body surface area, rate-pressure product, stroke work, and LV mass or wall thickness (r = 0.39, 0.39, 0.47 and 0.67 or 0.62, P < .05-0.01). In athletes with physiologic LVH, LMA area increased with CFR (0.65, P < .01). In the whole hypertensive population, LMA lumen increased with LV mass (r = 0.40, P < .01), and decreased with office systolic blood pressure (r = -0.48, P < .01). In the hypertensive LVH, baseline LMA area is not increased and is inversely related to office systolic blood pressure. In the physiologic LVH, increase in baseline LMA size seems to reflect effect of high-flow stimuli.
    American Journal of Hypertension 03/2007; 20(3):279-84. DOI:10.1016/j.amjhyper.2006.07.003 · 3.40 Impact Factor
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    ABSTRACT: Several abnormalities of the shape of lung fields (depression and flattening of the diaphragmatic contours, increased retrosternal space) are indicative of emphysema and can be accurately imaged by digital chest radiography. In this work, we aimed at developing computational descriptors of the shape of the lung silhouette able to capture the alterations associated with emphysema. We analyzed two-sided digital chest radiographs from a sample of 160 patients with chronic obstructive pulmonary disease (COPD), 60 of which were affected by emphysema, and from 160 subjects with normal lung function. Two different description schemes were considered: a first one based on lung-silhouette curvature features, and a second one based on a minimal-polyline approximation of the lung shape. Both descriptors were employed to recognize alterations of the lung shape using classifiers based on multilayer neural networks of the feed-forward type. Results indicate that pulmonary emphysema can be reliably diagnosed or excluded by using digital chest radiographs and a proper computational aid. Two-sided chest radiographs provide more accurate discrimination than single-view analysis. The minimal-polyline approximation provided significantly better results than those obtained from curvature-based features. Emphysema was detected, in the entire dataset, with an accuracy of about 90% (sensitivity 88%, specificity 90%) by using the minimal-polyline approximation.
    Medical Engineering & Physics 02/2007; 29(1):76-86. DOI:10.1016/j.medengphy.2006.02.001 · 1.84 Impact Factor
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  • High Blood Pressure & Cardiovascular Prevention 01/2005; 12(3). DOI:10.2165/00151642-200512030-00060
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    ABSTRACT: Aims of this study were to: (1) demonstrate whether quantitative myocardial contrast echocardiography could detect an index of myocardial blood flow reserve through the analysis of refilling curves generated by microbubble transit into myocardium both at rest and after vasodilatation induced by dipyridamole; and (2) explore with this method myocardial microcirculatory function in two different models (ie, patients with essential hypertension and control subjects). Two groups of strictly age-matched men were studied (case-control study): 12 patients who were adults (28.2 +/- 0.2 years) and asymptomatic with never-treated essential hypertension, a mild degree of left ventricular hypertrophy, and normal left ventricular function; and 12 control subjects. Quantitative myocardial contrast echocardiography was performed in all study participants. We used second-generation ultrasound microbubbles as echocardiography contrast agent. Real-time color-coded power modulation was performed with a phased-array system interfaced to a S3 transducer (1.3-3.6 MHz). In control subjects there was little increase in myocardial blood volume (30%) between basal and hyperemic status (P <.05); in patients with hypertension this parameter increased by 22% (P <.05). Myocardial blood velocity increased after dipyridamole by 270% in control subjects (P <.01), whereas for patients with hypertension this parameter increased only by 150% (P <.02). The index of myocardial blood flow reserve was significantly lower for patients with hypertension than in control subjects (3.3 +/- 0.3 vs 4.4 +/- 0.3, respectively; P <.01). Results of our study documented that myocardial microcirculation in young adult patients with hypertension showed an early impairment in the vasodilatation capacity of the resistance arterioles under dipyridamole-induced hyperemia, as demonstrated by a reduction of myocardial blood flow reserve. Myocardial blood velocity increased after dipyridamole induction in control subjects, whereas patients with hypertension showed a significantly lesser increase. Myocardial blood flow reserve was significantly lower for patients with hypertension because of an early impairment in vasodilatation capacity of resistance arterioles under dipyridamole-induced hyperemia.
    Journal of the American Society of Echocardiography 10/2004; 17(10):1037-43. DOI:10.1016/j.echo.2004.05.017 · 3.99 Impact Factor
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    ABSTRACT: In this paper, a new system for real time contour tracking is presented. If a rough contour of the desired structure is available on the first image of a sequence, the system can automatically outline the contours on the subsequent images at video rate. The method we used is based on a new edge detector which was obtained by the generalization of the first order absolute central moment operator. The new algorithm proved to be very robust to noise and fast enough to be implemented in real time. The contour tracking procedure was implemented on an integrated software/hardware platform composed of a personal computer equipped with a digital signal processing board. The system can capture an analog video signal with a resolution of 512×512 pixels, 25 frames/s, process the data and display the results in real time. A graphical user interface is also available to interact with the system. Tests on images of the descending thoracic aorta and of a carotid, recorded by echocardiography, are reported. The cross-sectional area of the aorta and the diameter of the carotid were computed in real time and plotted on the user interface. The system proved to be a useful tool for the investigation of vascular mechanisms.
    Real-Time Imaging 04/2004; DOI:10.1016/j.rti.2004.02.005 · 2.27 Impact Factor
  • Journal of Hypertension 01/2004; 22(Suppl. 2):S299. DOI:10.1097/00004872-200406002-01032 · 4.22 Impact Factor

Publication Stats

813 Citations
290.15 Total Impact Points


  • 1993–2014
    • Università di Pisa
      • Department of Clinical and Experimental Medicine
      Pisa, Tuscany, Italy
  • 2008–2012
    • INO - Istituto Nazionale di Ottica
      Florens, Tuscany, Italy
  • 1995–2007
    • National Research Council
      • Institute of Clinical Physiology IFC
      Roma, Latium, Italy