Arianna Bocelli’s research while affiliated with Ospedale Pediatrico Meyer Firenze and other places

Background: Assessment of left ventricular circumferential (LVcirc) systolic function by standard echocardiography can be performed by estimating midwall fractional shortening (mFS) and stress-corrected mFS (ScmFS). Their determination is based on spherical or cylindrical LV geometric models, which often yield discrepant values. We developed a new model based on a more realistic truncated ellipsoid (TE) LV shape, and explored the concordance between models among hypertensive patients. We also compared the relationships of different mFS and ScmFS estimates with indexes of LVcirc systolic strain. Methods: In 364 hypertensive subjects, mFS was determined using the spherical (mFSspher), cylindrical (mFScyl), and TE model (mFSTE). Corresponding values of ScmFSspher, ScmFScyl, and ScmFSTE were obtained. Global circumferential strain (GCS) and systolic strain rate (GCSR) were also measured by speckle tracking. Results: The three models showed poor concordance for the estimation of mFS, with average differences ranging between 11% and 30% and wide limits of agreement. Similar results were found for ScmFS, where reclassification rates for the identification of abnormal LVcirc systolic function ranged between 18% and 29%. When tested against strain indexes, mFSTE and ScmFSTE showed the best correlations (R=0.81 and R=0.51, p<0.0001 for both) with GCS and GCSR. Multivariable analysis confirmed that mFSTE and ScmFSTE showed the strongest independent associations with LVcirc strain measures. Conclusions: Substantial discrepancies in LVcirc midwall systolic indexes exist between different models, supporting the need of model-specific normative data. The use of the TE model might provide indexes that show the best associations with established strain measures of LVcirc systolic function.

Controversial data exist about the long-term results of aortic coarctation (AC) repair. This study explored the prevalence and predictors of left ventricular (LV) hypertrophy, late hypertension, and hypertensive response to exercise in 48 subjects (age, 15.1 ± 9.7 years) currently followed in the authors' tertiary care hospital after successful AC repair. Data on medical history, clinical examination, rest and exercise echocardiography, and ambulatory blood pressure monitoring were collected. The time from AC repair to follow-up evaluation was 12.9 ± 9.2 years. The prevalence of LV hypertrophy ranged from 23 to 38 %, based on the criteria used to identify LV hypertrophy, and that of concentric geometry was 17 %. One sixth of the patients without residual hypertension experienced late-onset hypertension. One fourth of those who remained normotensive without medication showed a hypertensive response to exercise. Age at AC repair was the strongest independent predictor of LV hypertrophy, defined using indexation either for body surface area (odds ratio [OR], 1.03; p = 0.0090) or for height(2.7) (OR 1.02; p = 0.029), and it was the only predictor of late hypertension (OR 1.06; p = 0.0023) and hypertensive response to exercise (OR 1.09; p = 0.029). The risk of LV hypertrophy was 25 % for repair at the age of 3.4 years but rose to 50 and 75 % for repair at the ages of 5.9 and 8.4 years, respectively. Similar increases were found for the risk of late-onset hypertension and hypertensive response to exercise. A considerable risk of LV hypertrophy, late hypertension, and hypertensive response to exercise exists after successful AC repair. Older age at intervention is the most important predictor of these complications.

Moderate-to-high blood concentrations of ethanol acutely impair conventional echocardiographic measures of left ventricular (LV) performance, but the effects of low concentrations are unclear. This study explored the acute effects of low blood concentrations of ethanol on sensitive and load-independent indices of LV and right ventricular (RV) function. This is a crossover experimental study conducted in 64 young healthy volunteers. Participants were asked to drink a light dose of Italian red wine equivalent to 0.5 mg/kg of ethanol, and an equal volume of fruit juice in separate experiments. The following measurements were taken at baseline and 60 minutes after the challenges: tissue Doppler mitral annulus systolic velocity (S') and excursion (MAPSE), early diastolic velocity (E'), its ratio to late diastolic velocity (E'/A'), and the ratio of mitral-to-myocardial early diastolic velocities (E/E'); and tricuspid annulus systolic velocity (tricuspid S') and amplitude (TAPSE), early diastolic velocity (tricuspid E'), and its ratio to late diastolic velocity (tricuspid E'/A'). Blood ethanol concentration after wine intake was 0.48 ± 0.06 g/l. Compared with the control challenge, ethanol yielded a decrease in all measures of LV function (S', -9.7%; E', -11.2%; E'/A', -13.4%; MAPSE, -8.8%; p < 0.05 for all). Among indices of RV function, increases in tricuspid E'/A' ratio and TAPSE were observed (+24.5% and +9.0%, respectively; p < 0.05 for both). Low blood concentrations of ethanol acutely impair LV function and increase some indices of RV function in young healthy individuals.

The assessment of the longitudinal component of left ventricular (LV) function is of major clinical importance for the early detection of LV contractile impairment. The aim of this study was to compare the impact of isolated type-2 diabetes, isolated hypertension, and co-existence of both on LV longitudinal systolic performance, with particular focus on their potential interaction effect. The study population included 163 consecutive patients: 84 patients with hypertension, 36 with diabetes, and 43 who have both hypertension and diabetes; 70 healthy controls were also recruited. Systolic mitral annulus velocity (S(m)) by Tissue Doppler and left atrioventricular plane displacement (AVPD) by M-mode were measured in all subjects. AVPD was similarly reduced in hypertensives (13.2±2.2mm) and diabetics (13.5±2.3mm) when compared with the controls (15.1±2.4mm), and further depressed in diabetic hypertensives (11.5±3.0mm). Similar results were found for S(m). General linear model analysis revealed no significant interaction terms between diabetes and hypertension. Normotensive diabetics and nondiabetic hypertensives show comparable depression in LV longitudinal systolic indices when compared with age- and gender-matched healthy controls; the co-existence of diabetes and hypertension leads to further impairment in LV longitudinal systolic function in an additive manner.

Moderate to high blood concentrations of ethanol have been shown to yield acute changes in cardiac electrophysiological properties, but the effect of low concentrations have never been assessed. The role of concomitant changes in clinical variables or cardiac dimensions is also still unknown. This study aimed at exploring the acute effects of low doses of ethanol, administered as Italian red wine, on conduction, depolarization, and repolarization electrocardiographic (ECG) intervals in a population of healthy subjects. Forty healthy young volunteers drank a low quantity of red wine (5 ml/kg), and an equal volume of fruit juice in separate experiments. Heart rate, P-wave duration, PR interval, QRS duration, QT interval, corrected QT interval, QT dispersion, and corrected QT dispersion were assessed at baseline and after 60 minutes from challenge. Mean blood ethanol concentration after drinking was 0.48 +/- 0.06 g/l. Compared to the control challenge, significant changes after red wine intake were observed in P-wave duration (from 101 +/- 11 to 108 +/- 14 milliseconds, p = 0.0006), PR interval (from 153 +/- 15 to 167 +/- 17 milliseconds, p < 0.0001), QT interval (from 346 +/- 28 to 361 +/- 24 milliseconds, p < 0.0001), and corrected QT interval (from 388 +/- 24 to 402 +/- 30 milliseconds, p = 0.0006). None of these changes showed correlations with modifications in clinical or echocardiographic variables. In multivariate analyses aimed at exploring predictors of ECG changes, none of the variables entered the final models. Low doses of red wine acutely slow cardiac conduction and prolong repolarization in normal individuals. These changes are poorly predictable. The potential arrhythmogenic impact of these effects is worthy of exploration.

To the Editor: In the recent interesting article by Foster et al,1 the standard method of indexing left ventricular (LV) mass to height2.7 was found to be inadequate to adjust for body size in a reference population that included healthy individuals from birth to 21 years of age. In particular, LV mass index (LVMI) was relatively independent of height in taller subjects but showed a strong residual correlation with height in subjects <100 cm tall, ie, in newborns, infants, and children in their first years of life. In contrast, a more complex method based on percentile curves provided adequate normalization to body size, with …

To explore the prognostic value of left ventricular (LV) longitudinal systolic dysfunction in patients with hypertension. In 156 hypertensive subjects, LV longitudinal systolic function was assessed by echocardiographic measurement of M-mode left atrioventricular plane displacement (AVPD) and Tissue Doppler (TD)-derived mitral annulus peak systolic velocity (Sm). Patients were followed for development of the following cardiovascular events: congestive heart failure requiring hospitalization, new-onset angina, nonfatal myocardial infarction, coronary revascularization procedures, transient ischemic attack, nonfatal stroke, and cardiovascular death. Over a follow-up of 23.3 +/- 5.4 months, 24 patients had 29 events. Both longitudinal systolic indices were predictive of outcome (hazard ratios: AVPD, 0.24, P < 0.001; Sm, 0.22; P < 0.001). AVPD < or = 11.4 mm (75.0% sensitivity and 53.8% specificity) and Sm < or = 8.9 cm/s (79.2% sensitivity and 61.4% specificity) were identified as the best cutoffs for the prediction of cardiovascular events (area under curve: AVPD, 0.66, P < 0.01; Sm, 0.71; P < 0.0001). Compared to conventional indices of circumferential systolic function, AVPD and Sm showed similar overall diagnostic performance, but higher sensitivity and lower specificity. Coexistence of longitudinal and circumferential systolic dysfunction was associated with the worst prognosis (P < 0.0001). Multivariate analysis confirmed an independent association of longitudinal indices with clinical outcome, incremental to circumferential systolic impairment, and other confounding variables. Longitudinal systolic dysfunction is an independent marker of cardiovascular risk in hypertensive patients. Despite similarity in predictive accuracy, longitudinal indices are more sensitive but less specific than circumferential indices for the prediction of cardiovascular events in these subjects.