S. Comenale Pinto

Second University of Naples, Caserta, Campania, Italy

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Publications (11)61.69 Total impact


  • No preview · Article · Dec 2014 · European Heart Journal – Cardiovascular Imaging
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    ABSTRACT: Purpose: 3D echocardiography (3DE) enables fast 3D acquisition but subsequent manual navigation to find 2D diagnostic planes can be time consuming. We have developed and validated an automated machine learning-based technique to find apical 2-, 3- and 4-chamber (A2C, A3C, A4C) views that enables fast volume navigation and analysis. Methods: 3DE volumes were acquired (Philips iE33: X3-1 and X5-1 probes) from 30 healthy volunteers and 36 clinical patients with suspected valve disease and coronary heart disease. 66 end diastolic volumes were used to assess the accuracy of apical standard view finding by our method against manual plane finding. To do this, dedicated software was developed with a machine learning approach and a 3-fold cross validation of results was performed. Results: Automatic A4C view detection was possible in 60/66 (91%) of volumes; detection failures were due to suboptimal myocardium wall integrity or lack of right ventricle in the scan. A2C and A3C views were extracted from the A4C view using the known geometrical relationships between apical standard views (A2C to A3C: 30°~40° and A2C to A4C: 90° of rotation over the left ventricle long axis, as shown in the Figure). In average, our method accurately found the heart apex and mitral valve centre with a 7.1 ± 5.7 mm and 7.2 ± 5.3 mm error, respectively. Conclusions: In order to automate clinical workflow, we have developed a new and fully automatic machine learning strategy for apical standard view finding which performed well (91% detection accuracy) on volunteer and clinical 3D echocardiograms.
    Full-text · Article · Dec 2014 · European Heart Journal Cardiovascular Imaging
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    ABSTRACT: Purpose: With the advent of percutaneous transcatheter device closures in congenital heart defects and the emergence of percutaneous left atrial appendage closure, there is an increasingly important role for echocardiographic guidance and control of device position and function. Disc occluder devices frequently present as an unexplained ‘figure-of-8’ on echocardiography. The aim of this study was to clarify this ‘figure-of-8’ display and to relate its morphology to transducer position and device type. Methods: A mathematical model was developed to resemble disc occluder geometry and to allow a numerical simulation of the echocardiographic appearance. In addition, we developed an in vitro set-up for echocardiographic analysis of various disc occluders and various transducer positions. Results: In the mathematical model of an epitrochoid curve (closely resembling disc occluder geometry) a ‘figure-of-8’ display is obtained when emphasizing points with tangent vector perpendicular to the direction of ultrasound waves. Decreasing imaging depth results in a more asymmetric ‘figure-of-8’, with small upper part and wide lower part. Clinical and in vitro data are in close agreement with these results (Figure 1). Furthermore a ‘figure-of-8’ display is only obtained in a coronal imaging position, and is similar for different commercially available disc occluder types. Conclusions: The ‘figure-of-8’ display in the ultrasound image of a disc occluder is an imaging artifact due to the specific ‘epitrochoidal’ geometry of a deployed device and its interaction with ultrasound waves. The morphology of the ‘figure-of-8’ depends on transducer position, i.e. imaging depth, and is similar for different device types.
    Full-text · Poster · Dec 2013
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    R. Ancona · S. Comenale Pinto · P. Caso · M. G. Coppola · R. Calabro
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    ABSTRACT: Background: Right ventricular (RV) function plays an important role in determining cardiac symptoms in several diseases. It has been demonstrated that the new imaging modality of three-dimensional echocardiography (3DE) is interchangeable to cardiac magnetic resonance in reproducibility and accuracy. Speckle Tracking is a sensitive tool to quantitatively assess regional deformation properties. Purpose: To obtain normal reference ranges for RV volumes, RV EF, by 3DE (TomTec) and RV deformation properties by Speckle Tracking and intra and inter-observer reproducibility. Methods: 60 subjects, 32 males and 28 females, aged 25±7 yrs, without any cardiovascular disease, were included. By E9GE we measured RV maximum and minimum volumes by tracing RV endocardial borders during enddiastolic (largest RV volume) and end-systolic (smallest RV volume) phases, in apical 4-chamber, short-axis, and coronal views. Volumes were indexed for body surface. By Speckle tracking we measured 2D longitudinal systolic RV Strain (S) and Strain rate (SR) in apical 4-chambers view, at level of RV free wall (basal, medium and apical segments). A reproducibility study was performed to compare the intra and inter-observer variability. Results: We have reported references range in young people for volumes and EF (3D RV end-diastolic:33±11ml/mq; end-systolic volume:16±6ml/mq; 3D RVEF 67±8%). RV systolic 2D S values in young people were for apical segment -24,59±4,8%, for medium -29,69±4,78%, for basal -30,1±5,88% and RV systolic 2D SR were for apical -1,44±0,25 S-1, for medium: -1,78±0,37 S-1, for basal:-2±0,4 S-1. Inter and intraobserver variability coefficients were 8% and 7% for 3D volumes and 8% and 4% for S-SR measurements, respectively. Conclusions: The present study provides normal reference values for RV volumes and RVEF by 3DE and normal longitudinal RV deformation values in young people. 3DE is an alternative imaging modality for quantification of RV volumes and EF, showing improved accuracy and lower interobserver and intraobserver variability compared to 2D echocardiography; it overcomes the limitations due to the complex anatomy of the RV.
    Preview · Article · Aug 2013 · European Heart Journal
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    ABSTRACT: Purpose: We evaluated the utility of 2D Strain-Strain rate (S-SR) and 3D echocardiography (3DE) to quantitatively assess RV (right ventricle), LV (left ventricle) and RA (right atrium) function in ARVC patients (pts), with apparently normal LV and in their relatives with apparently normal RV. Methods: We studied 115 subjects:35 pts with ARVC (GroupA),40 relatives (GroupB) and 40 controls (GroupC). By E9GE we measured LV ejection fraction (EF%), LV diameters and volumes, RV dimension, fractional area change (FAC%), RVOT fractional shortening (RVOTfs%), RA volume. By DTI we measured E', A' and S waves of tricuspidal annulus. We measured 2D longitudinal systolic S-SR in apical 4 and 2-chambers views, at level of LV segments (4 basal,4 mid,4 apical), RV segments (1 basal,1 mid,1apical) and atrial walls and circumferential and radial peak systolic LV 2D S-SR in short axis views. By 3DE with volumetric probe we measured RA, RV volumes and RVEF. Results: No significant differences were found between relatives and controls for RV dimensions, RVFAC (50±12 vs 51±11%), RVOTfs (64,8±13 vs 65,3±14%), 2DRA max volumes (20,3±4,5 vs 8,7±6ml/mq), 3DRV end-diastolic (31±10,5 vs 33±11ml/mq) and end-systolic Volume (15±4 vs 16±6ml/mq), and for RA S-SR. Instead differences were present between Group A and C for RV dimensions, 3DRV end-diastolic (52,8±9ml/mq) and end-systolic volume (27±6,8ml/mq), FAC (27,8±12,1%), RVOTfs (27,2±16%), 3D RVEF (49±7,4%), 2DRA volume (25,6±10,4ml/mq). At TVI of tricuspidal valve E'/A' ratio was inverted in pts and in 32/40 ARVC relatives. No significant differences were found for 3DRA volume (GroupA:27,9±5; GroupB: 27,4±5,6; GroupC:28±10ml/mq). RV 2DSR-S were significantly lower in pts (SR=-1,37±0,37S-1;S=-12,45±4,4%,p< 0.001) and in 28/40 (70%) subjects of GroupB (S=-18,5±4,8%; SR=-1,54±0,4S-1,p< 0.002) compared with controls (S=-26,6±8,1%, SR=-2,37±0,51 S-1). LV 2DSR and S were significantly lower in GroupA compared to controls (longitudinal:SR=-1,01±0,21 vs -1,53±0,49 S-1;S=-15,2±4,3% vs -20,59±4,47%, circumferential:SR=-1,18±0,33 vs -1,62±0,4 S-1;S=-15,12±3,9 vs -21±5,1%; radial:SR=1,19±0,26 vs 1,58±0,3 S-1, S=16,25±8,9 vs 46,3±9,2%, p< 0.003) without differences for GroupB (longitudinalSR=1,49±0,45S-1,S=19,59±4,1%,circumferentialSR=-1,59±0,4S-1;S=-20,8±5%;radial SR=1,56±0,29S-1;S=45,9±9%). Conclusions: 2DS-SR shows early RV dysfunction in asymptomatic ARVC relatives, when standard and 3DE doesn't show any impairment and it's useful in the objective quantitative assessment of regional hypokinesia. It enables to show early LV dysfunction in ARVC pts, when standard echocardiography doesn't show any impairment.
    Preview · Article · Aug 2013 · European Heart Journal
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    ABSTRACT: Background: The aim of this study was to assess systolic left atrial (LA) reservoir function in patients with mitral stenosis (MS) using two-dimensional (2D) strain (ε) and strain rate imaging and its prognostic value in predicting atrial fibrillation (AF) at 4-year follow-up. Methods: One hundred one asymptomatic patients with pure rheumatic MS and 70 healthy controls were evaluated using standard Doppler echocardiography (mitral valve area, mean gradient, systolic pulmonary pressure, LA width, LA volumes, and LA ejection fraction) and 2D speckle-tracking. Results: LA width, volumes, and systolic pulmonary pressure were significantly increased (P < .0001), and LA 2D ε and strain rate were significantly impaired in patients with MS (P < .0001). At 4-year follow-up, 20 patients (20%) showed AF on standard electrocardiography or 24-hour Holter electrocardiography. Patients with MS who had AF were older than those who did not, without significant differences in LA dimensions, volumes, ejection fraction, and compliance index. Instead, atrial myocardial systolic 2D ε was significantly impaired in patients with events. On multivariate analysis (age, LA volume, planimetric mitral area, average annular Ea, and LA strain) the best predictor of AF was average LA peak systolic ε (coefficient, 0.43; SE, 0.098; P < .01), with an area under the receiver operating characteristic curve of 0.761 (SE, 0.085; 95% confidence interval, 0.587-0.888, P = .002) for a cutoff value of 17.4%. Conclusions: The results of 2D ε imaging are abnormal in patients with asymptomatic MS and predict AF at 4-year follow-up.
    No preview · Article · Dec 2012 · Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography
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    ABSTRACT: Assessment of left and right systolic atrial reservoir function in asymptomatic mitral stenosis (MS) by strain and strain rate imaging (SRI) and their prognostic power at 3 year follow-up was the purpose of this study. There is clear indication to treat (by surgery or percutaneous valvotomy) symptomatic patients with MS, whereas for the asymptomatic ones, the question is much debated. So, we need new echocardiographic parameters helpful for the management of asymtomatic patients. Atrial reservoir function by SRI could help in evaluation of these patients. Fifty-three asymptomatic patients with MS and 53 healthy controls were evaluated by the standard echo-Doppler study [mitral valve (MV) area, mean gradient, systolic pulmonary pressure, left atrial (LA) width, LA volumes, LA compliance index] and by Doppler myocardial imaging (velocity, strain, and SR of both atria). The endpoint at 3 year follow-up was symptoms, hospitalization for cardiac cause, atrial fibrillation, thrombo-embolic events, valvular surgery, or percutaneous commissurotomy. LA width, volumes, and systolic pulmonary pressure were significantly increased in MS patients (P < 0.001). Atrial myocardial velocities and deformation indices were significantly compromised in MS patients (P < 0.0001). Significant correlation was found between atrial myocardial velocity and MV area (by pressure half-time method: P = 0.019, R = 0.41; by planimetric method: P = 0.016, R = 0.43). Peak systolic LA myocardial strain and SR were significantly correlated with atrial volumes (strain: P = 0.03, R = -0.28; SR: P = 0.0008, R = -0.42), with atrial compliance index (strain: P = 0.04, R = 0.26; SR: P = 0.04, R = 0.16), with atrial ejection fraction (strain: P < 0.0001, R = 0.56; SR: P = 0.03, R = 0.43). At 3 year follow-up, 22 (41%) patients had events. Comparing the MS patients who had events during the 3 year follow-up with those who did not, the former had bigger LA volumes, although these parameters did not reached a significant value, whereas atrial myocardial systolic SR was significantly impaired in patients with events. In multivariate analysis, the best predictor of adverse events was LA peak systolic SR average (P = 0.04; coefficient: 0.113; SE: 0.055; cut-off value of 1.69 s(-1) for LA peak systolic SR average) with a sensitivity of 88%, specificity of 80.6%, area under the receiver operating characteristic curve of 0.852 (SE: 0.048; 95% CI: 0.74-0.93, P = 0.0001). Atrial myocardial deformation properties, assessed by SRI, are abnormal in asymptomatic patients with rheumatic MS. The degree of this impairment is predictor of events in a 3 year follow-up. SRI could be helpful in decision-making of asymtomatic patients with MS.
    No preview · Article · Jun 2009 · European Heart Journal – Cardiovascular Imaging
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    ABSTRACT: We report a case of an asymptomatic patient in whom a right atrial mass was fortuitously documented by echocardiography few months after a transcatheter radiofrequency catheter ablation for recurrent AF. No masses were seen in the cardiac chambers before the ablative procedure, raising important diagnostic and decision-making issues. The patient was referred to the surgeon and a diagnosis of right atrial myxoma was made.
    Full-text · Article · Apr 2009 · Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace / Fondazione clinica del lavoro, IRCCS [and] Istituto di clinica tisiologica e malattie apparato respiratorio, Università di Napoli, Secondo ateneo
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    Full-text · Article · Dec 2006 · European Heart Journal – Cardiovascular Imaging
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    R. Ancona · P Caso · G Di Salvo · A D'Andrea · S. Comenale Pinto · V. Betancourt · S Severino · C. Calabro

    Full-text · Article · Dec 2006 · European Heart Journal – Cardiovascular Imaging
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    ABSTRACT: Anomalous origin of the left main coronary artery from the pulmonary artery, also known as Bland-White-Garland syndrome, is a rare malformation. Few patients survive past childhood without surgical repair, and up to 90% die suddenly at a mean age of 35 years. We describe a case of a 60-year-old patient with anomalous origin of the left main coronary artery from the pulmonary artery in which 2-dimensional and color flow Doppler visualization of the intercoronary (so-called "steal") collaterals was the first marker that alerted the examiner to the possibility of this diagnosis, subsequently guided step-by-step the echocardiographic approach.
    No preview · Article · Feb 2006 · Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography