Sabina Gallina

Università degli Studi G. d'Annunzio Chieti e Pescara, Chieta, Abruzzo, Italy

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Publications (126)272.41 Total impact

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    ABSTRACT: Functional mitral regurgitation (FMR) is a common complication of left ventricle (LV) dysfunction and remodelling. Recently, it has been recognized as an independent prognostic factor in both ischaemic and non-ischaemic LV dysfunctions. In this review article, we discuss the mechanisms through which cardiac dyssynchrony is involved in FMR pathophysiologic cascade and how cardiac resynchronization therapy (CRT) can have therapeutic effects on FMR by reverting specific dyssynchrony pathways. We analyse recent clinical trials focusing on CRT impact on FMR in 'real-world' patients, the limits and future perspectives that could eventually generate new predictors of CRT response in terms of FMR reduction. Finally, we propose a practical diagnostic and therapeutic strategy for the management of symptomatic patients with severe LV dysfunction and concomitant 'prognostic' FMR.
    No preview · Article · Feb 2016 · European Heart Journal Cardiovascular Imaging

  • No preview · Article · Jan 2016 · International journal of cardiology
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    ABSTRACT: Assessment of left ventricular (LV) systolic function is the cornerstone of the echocardiographic examination. There are many echocardiographic parameters that can be used for clinical and research purposes, each one with its pros and cons. The LV ejection fraction is the most used one due to its feasibility and predictability, but it also has many limits, related to both the imaging technique used for calculation and to the definition itself. LV longitudinal function is expression of subendocardial fibers contraction. Because the subendocardium is often involved early in many pathological processes, its analysis has been a fertile field for the development of sensitive parameters. Longitudinal function can be evaluated in many ways, such as M-mode echocardiography, tissue Doppler imaging, and speckle tracking echocardiography. This latter is a relatively new tool to assess LV function through measurement of myocardial strain, with a high temporal and spatial resolution and a better inter- and intra-observer reproducibility compared to Doppler strain. It is angle independent, not affected by translation cardiac movements, and can assess simultaneously the entire myocardium along all the three-dimensional geometrical (longitudinal, circumferential, and radial) axes. Speckle tracking echocardiography also allows the analysis of LV torsion. The aim of this paper was to review the main echocardiographic parameters of LV systolic function and to describe its pros and cons.
    No preview · Article · Dec 2015 · Heart Failure Reviews
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    ABSTRACT: We describe a case of a 35-year-old man presented at the emergency room of our institution with acute onset of dyspnea and dizziness. He was a body builder and had been using Xenadrine EFX for weight loss reduction. The laboratory analyses were normal. A chest radiograph showed an enlarged cardiac silhouette with clear lung fields. Transtoracic two-dimensional color Doppler echocardiography revealed a diffuse hypokinesia with a marked decreased in systolic function and a high teledyastolic diameter. This case document the possible relation to use of Xenadrine EFX for weight loss and the recurrence of dilated cardiomyopathy.
    No preview · Article · Dec 2015 · International journal of immunopathology and pharmacology

  • No preview · Article · Dec 2015 · European Heart Journal Cardiovascular Imaging
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    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.
    Full-text · Article · Sep 2015 · European Heart Journal
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    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.
    Full-text · Article · Aug 2015 · European Journal of Pediatrics
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    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.
    No preview · Article · Apr 2015 · European Journal of Clinical Investigation
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    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.
    Full-text · Article · Dec 2014 · European Heart Journal – Cardiovascular Imaging
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    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.
    No preview · Article · Dec 2014 · Giornale italiano di cardiologia (2006)
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    Full-text · Chapter · Nov 2014
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    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.
    Full-text · Article · Sep 2014 · European Heart Journal: Acute Cardiovascular Care
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    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.
    No preview · Article · Sep 2014 · Giornale italiano di cardiologia (2006)
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    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.
    Full-text · Article · May 2014 · European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery
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    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.
    Full-text · Article · Apr 2014 · International Journal of Molecular Sciences
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    ABSTRACT: High-intensity aerobic interval training (AIT) has been reported to be more effective than continuous aerobic training (CoAT) to improve metabolic health. The aim of our study was to investigate whether moderate-intensity AIT is more effective than CoAT on metabolic health, when applied to a walking training program. Thirty-two postmenopausal women (55.37 ±3.46 years) were investigated for body composition, plasma glucose, insulin, lipids, adiponectin, HOMA-IR, HOMA-AD, aerobic fitness, dietary habits and spontaneus physical activity, and randomly assigned to one of two different walking training programs: CoAT or AIT. CoAT and AIT elicited the same physiological benefits, including: reduction of plasma glucose, insulin, HOMA-IR and HOMA-AD, and increase of plasma HDL-C, adiponectin and aerobic fitness. An AIT scheme as part of an outdoor walking training program elicits the same physiological adaptations as a CoAT scheme, probably because walking does not promote exercise intensities that elicit greater effects. THE POSTED FULL-TEXT VERSION OF THE MANUSCRIPT IS THE FINAL ACCEPTED VERSION FOR PUBLICATION. THE FINAL PUBLISHED VERSION IS ©Human Kinetics AND CAN BE FOUND HERE: http://dx.doi.org/10.1123/JAPA.2013-0043
    Full-text · Article · Oct 2013 · Journal of Aging and Physical Activity

  • No preview · Conference Paper · Sep 2013
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    Dataset: jbrha2013

    Full-text · Dataset · Sep 2013
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    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).
    Preview · Article · Sep 2013 · Interactive Cardiovascular and Thoracic Surgery
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    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.
    No preview · Article · Aug 2013 · The Journal of Clinical Endocrinology and Metabolism

Publication Stats

2k Citations
272.41 Total Impact Points

Institutions

  • 1992-2015
    • Università degli Studi G. d'Annunzio Chieti e Pescara
      • • Department of Neuroscience & Imaging
      • • Institute for Advanced Biomedical Technologies ITAB
      Chieta, Abruzzo, Italy
  • 2008
    • Sapienza University of Rome
      Roma, Latium, Italy
    • Università di Pisa
      Pisa, Tuscany, Italy
  • 2007
    • University of Catania
      • Department of Surgery (CHIR)
      Catania, Sicily, Italy
  • 1999
    • Università degli Studi del Sannio
      Benevento, Campania, Italy