Benedetta Natali - Academia.edu (original) (raw)

Papers by Benedetta Natali

European Heart Journal

Purpose Amelioration of therapies and increased survival in heart failure (HF) is leading to a gr... more Purpose Amelioration of therapies and increased survival in heart failure (HF) is leading to a growing number of patients affected by advanced HF, with an overall 1-year prognosis ranging from 25 to 75%. The gold standard treatment for end stage HF is heart transplantation (Htx), but lack of organs donors remains an important limitation. Marginal hearts can potentially improve and be utilized after a re-evaluation by “aggressive” assessment of donor left ventricular dysfunction, with an important increase of utilization rates (from 38–59%) in the latest years. In our study we analysed if recipients of marginal donor hearts, selected by dipyridamole stress echocardiography, had different outcome compared to recipients with acceptable donor hearts. Methods Data collected from 2006 and 2014 of patients who received orthotopic Htx were retrospectively analysed. Clinical, laboratory and instrumental features were evaluated and patients with homogenous baseline characteristics were select...

European Heart Journal Supplements

We report the clinical case of a 75 year–old man, previous smoker with mild lower extremity art... more We report the clinical case of a 75 year–old man, previous smoker with mild lower extremity arterial disease, that presented a sudden and intensive chest pain. The emergency medical system documented an anterior STEMI quickly complicated by out–of–hospital cardiac arrest from a shockable rhythm, treated with DC–shock with rapid ROSC and recovery of consciousness. The patient was transported to the local hospital where coronary angiography showed extensive intraluminal thrombosis of ostial Cx and ostial LAD treated with thrombus aspiration and balloon angioplasty. During the procedure the patient was supported with inotropic agents, mechanical ventilation and IABP for a cardiogenic shock. After few hours he was transferred to level II hospital, equipped with all mechanical circulatory supports (MCS) and on–site cardiac surgery, where he was assisted with vaso–inotropic drugs, Impella CP and continuous renal replacement (CRRT). After 3 days for a refractory cardiogenic shock (stage ...

Background: Previous cross-sectional studies have demonstrated that fat-free mass (FFM) is an imp... more Background: Previous cross-sectional studies have demonstrated that fat-free mass (FFM) is an important determinant of left ventricular mass (LVM) in athletes. However, cross-sectional investigations have not the ability to detect the dynamic adaptation occurring with training. We hypothesized that LVM adapts concurrently with the increase of FFM induced by exercise conditioning. We sought to study the relationship between the variations of LVM and of FFM occurring in top-level soccer players during the season. Methods: Twenty-three male top-level athletes were recruited. LVM was assessed by echocardiography and FFM by dual-energy X-ray absorptiometry. Serial measurements were performed pre-season, after 1 month, at midand endseason, and after 2 months of detraining. Results: LVM significantly increased at mid-season versus pre-season values, reaching the highest value at the end of the season (p< 0.05). While body weight did not vary during the study period, FFM significantly in...

Alvino, Angela Malandrino, Paola Palmitesta, Alessandro Zorzi, Domenico Corrado, Marco Bonifazi F... more Alvino, Angela Malandrino, Paola Palmitesta, Alessandro Zorzi, Domenico Corrado, Marco Bonifazi Flavio D'Ascenzi, Antonio Pelliccia, Benedetta Maria Natali, Valerio Zacà, Matteo Cameli, Federico Highly Trained Female Athletes Morphological and Functional Adaptation of Left and Right Atria Induced by Training in Print ISSN: 1941-9651. Online ISSN: 1942-0080 Copyright © 2014 American Heart Association, Inc. All rights reserved. TX 75231 is published by the American Heart Association, 7272 Greenville Avenue, Dallas, Circulation: Cardiovascular Imaging published online January 27, 2014; Circ Cardiovasc Imaging. http://circimaging.ahajournals.org/content/early/2014/01/27/CIRCIMAGING.113.001345 World Wide Web at: The online version of this article, along with updated information and services, is located on the http://circimaging.ahajournals.org/content/suppl/2014/01/27/CIRCIMAGING.113.001345.DC1.html Data Supplement (unedited) at:

European Heart Journal, 2021

Background Antibody-mediated rejection of the transplanted heart is still currently diagnosed by ... more Background Antibody-mediated rejection of the transplanted heart is still currently diagnosed by endomyocardial biopsy whereas clinical elements, anti-Human Leukocite Antigens (HLA) antibody and graft dysfunction represents supplementary components. Purpose The aim of the study was to identify though a non-invasive imaging technique, such as advanced transthoracic echocardiography, early signs of altered cardiac function in patients with anti-HLA antibodies and no histological signs of antibody-mediated rejection. Methods The study population included 117 heart transplanted patients, in whom both acute and chronic rejection was excluded. They were divided into two groups “HLA+`' (45 patients) and “HLA−” (72 patients), based on the presence and the absence of circulating anti-HLA antibodies, respectively. The echocardiographic exam was performed within one week from the biopsy, including Speckle Tracking analysis. Results Deceleration Time of E wave was the strongest traditional ...

The International Journal of Cardiovascular Imaging, 2021

Right ventricular failure (RVF) after left ventricular assist device (LVAD) implant is associated... more Right ventricular failure (RVF) after left ventricular assist device (LVAD) implant is associated with increasing morbidity and mortality. The aim of this study was to identify the best predictors of RVF post LVAD-implant among biochemical, haemodynamic and echocardiographic parameters. From 2009 to 2019, 38 patients who underwent LVAD implantation at our centre were prospectively enrolled. Preoperative clinical, laboratory, echocardiographic and haemodynamic parameters were reported. Overall, eight patients (21%) developed RVF over time, which revealed to be strongly related to overall mortality. Pulmonary artery pulsatility index (PAPi) resulted to be the most significant right heart catheterization index in discriminating RVF vs no RVF patients [(1.32 ± 0.26 vs. 3.95 ± 3.39 respectively) p = 0.0036]. Regarding transthoracic echocardiography, RVF was associated with reduced free wall right ventricular longitudinal strain (fw-RVLS) (− 7.9 ± 1.29 vs. − 16.14 ± 5.83) (p < 0.009), ...

European Heart Journal, 2020

Background The electrocardiographic (ECG) definition of Brugada syndrome (BS) can be challenging ... more Background The electrocardiographic (ECG) definition of Brugada syndrome (BS) can be challenging because benign ECG abnormalities, such as right bundle branch block (RBBB), may mimic pathological ECG characteristics of BrS. However, although myocardial delay and deformation can be quantified by advanced imaging, it has not yet been used to differentiate between BrS and RBBB. Purpose The aim of this study was to characterize the electro-mechanical behavior of the heart of patients with type-1 BrS and subjects with isolated complete RBBB in order to differentiate these conditions. Methods In this two-center study, 66 subjects were analyzed by standard and speckle-tracking echocardiography (STE): 22 type-1 BrS, 24 isolated complete RBBB, and 20 healthy subjects. The participants were not treated by any drug potentially influencing myocardial conduction. Results Standard echocardiographic parameters did not differ among the groups. STE demonstrated that right ventricular (RV) mechanical...

The international journal of cardiovascular imaging, Jan 7, 2017

Right ventricular (RV) evaluation represents one of the major clinical tasks in the follow-up of ... more Right ventricular (RV) evaluation represents one of the major clinical tasks in the follow-up of repaired tetralogy of Fallot patients (rToF) with pulmonary valve regurgitation, as both severe RV dilatation and dysfunction are key factors in defining the need of pulmonary valve replacement. The aim of our study was to report the diagnostic accuracy of echocardiography in the identification of rToF patients with severely dilated and/or depressed RV as compared to cardiac magnetic resonance (CMR). Among our patients with rToF, a subgroup of 95 (17.6 ± 6.8 years; 60% male), who underwent right ventricular qualitative and quantitative evaluation with CMR following echocardiographic suspicion of severe dilation/dysfunction, were included in the analysis. When comparing echocardiographic RV functional parameters to CMR findings, we found no association between CMR-ejection fraction (EF) and either tricuspid annulus plane systolic excursion (TAPSe) nor tissue Doppler systolic tricuspid exc...

ASAIO journal (American Society for Artificial Internal Organs : 1992), Jan 12, 2017

Right ventricular failure (RVF) is a significant issue when considering left ventricular assist d... more Right ventricular failure (RVF) is a significant issue when considering left ventricular assist device (LVAD) implantation in pediatrics. The aim of this study was to evaluate the effects of LVAD on right ventricular (RV) function in children. We retrospectively reviewed clinical and echocardiographic data of children who underwent Berlin Heart EXCOR LVAD focusing on RV function before and after implantation (1, 3, and 6 month follow-up). An isolated LVAD was used in 27 patients. Median age was 11 months (interquartile range [IQR]: 5-24 months), with a median weight of 6.3 kg (IQR: 5-9 kg). Median time on ventricular assist device (VAD) support was 147 days (IQR: 86-210 days). Twenty patients were successfully bridged to OHT (74%), six patients died (22%), and also heart function recovered in one patient (4%). Before LVAD implantation, nine patients (33%) showed a RV fractional area change (RVFAC) less than or equal to 30%. After implantation, mean RVFAC increased up until the 3 mon...

International journal of cardiology, Jan 27, 2017

Little is known about the adaptation of the right ventricle (RV) to endurance exercise in childre... more Little is known about the adaptation of the right ventricle (RV) to endurance exercise in children. The aim of this study was to assess the effects of 5months of intensive training on RV morphology and function in preadolescent endurance athletes. Ninety-four children were evaluated in this study. Fifty-seven male competitive swimmers (aged 10.8±0.2years) were evaluated before (baseline) and after 5months of the training (peak-training), and compared to 37 age- and sex-matched non-athlete children evaluated at baseline and after 5months of natural growth. All subjects were asymptomatic, with negative family history for cardiomyopathies. At baseline no differences were found between athletes and controls for indexed RV outflow tract (RVOT) (18.5±2.7 vs. 16.8±5.0mm/m(2), p=0.18) and RV basal end-diastolic diameter (EDD) (24.9±4.1 vs. 23.6±3.0mm/m(2), p=0.15). After 5months, indexed RVOT and RV basal EDD significantly increased in athletes (20.2±2.9mm/m(2) and 25.4±3.3mm/m(2), p<0.0...

European Heart Journal – Cardiovascular Imaging, 2015

Conflicting evidence exists concerning right ventricular (RV) morphological and functional remode... more Conflicting evidence exists concerning right ventricular (RV) morphological and functional remodelling in trained athletes, with a very few longitudinal data prospectively investigating the RV changes. The aim of this study was to assess the morphological and functional RV changes occurring during the competitive season in young athletes engaged in the most popular team sports. Methods and results Twenty-nine top-level athletes (age: 20.9 + 6.7 years), practicing basketball and volleyball, were evaluated at pre-season, mid-season, and end-season time-points, using tissue Doppler imaging and 2D speckle-tracking echocardiography. RV basal and mid-cavity end-diastolic diameters (EDDs; overall P ¼ 0.011 and P , 0.0001, respectively), and RV diastolic area (overall P , 0.0001) increased during the season. Conversely, RV outflow tract did not vary (overall P ¼ 0.96). During the season, no significant differences were observed in RV diastolic functional indexes and in RV fractional area change (overall P ¼ 0.35). Global RV longitudinal strain did not significantly change (overall P ¼ 0.52), although apical longitudinal strain significantly increased (overall P ¼ 0.017). In association, left ventricular (LV) volume and mass increased during the season (overall P ¼ 0.007). On multivariate analysis, LV mass was the only independent predictor of RVEDD at pre-season (b ¼ 0.69, P , 0.0001) and at end-season (b ¼ 0.82, P , 0.0001). Conclusions Right ventricular chamber size increases during the competitive season in top-level athletes, with no significant changes in the outflow tract. RV morphological adaptation in top-level athletes practicing team sports is not associated with a reduction in RV function or in myocardial deformation and occurs in close association with changes on the left ventricle, suggesting a physiological remodelling of the right ventricle.

International Journal of Sports Medicine, 2012

Left atrial (LA) enlargement and improved myocardial diastolic properties are a component of athl... more Left atrial (LA) enlargement and improved myocardial diastolic properties are a component of athlete's heart. We performed a longitudinal study involving adolescent athletes to investigate the impact of training on LA remodelling and diastolic function. 21 competitive adolescent soccer players were enrolled and engaged in an 8-month training program. Echocardiographic analysis was performed at baseline, after 4 and 8 months. We assessed diastolic function by Doppler tissue imaging and we analyzed LA adaptations by 2D speckle-tracking echocardiography. After 4 months, LA mean volume index significantly increased (Δ=5.47 ± 4.38 mL/m2, p ≤ 0.0001). After 8 months, a further increase occurred (Δ=8.95 ± 4.47 mL/m2, p ≤ 0.0001). A higher E velocity (p=0.001; p=0.001), a greater E/A ratio (p=0.002; p=0.0009), a higher e' peak (p= 0.005; p=0.001), and a greater e'/a' ratio (p=0.01; p=0.0006) were observed at 4 and at 8 months, respectively. E/e' ratio significantly decreased after 8 months (p ≤ 0.005). Global peak atrial longitudinal strain and global peak atrial contraction strain values significantly decreased after 8 months (p=0.0004, p=0.01, respectively). An 8-month training program is associated with LA dimensional and functional training-specific adaptations in competitive adolescent soccer players. Myocardial diastolic properties can improve after training also in subjects already presenting with features of athlete's heart.

European journal of applied physiology, Jan 26, 2015

Although left atrial (LA) enlargement is a recognized component of athlete's heart, dynamic c... more Although left atrial (LA) enlargement is a recognized component of athlete's heart, dynamic cavity changes occurring during the training period remain to be elucidated. We aimed to investigate the adaptive changes of LA reservoir, conduit, and active volumes in elite athletes vs. controls and their response to different training loads. LA maximum, pre-P, and minimum volumes were assessed in 26 top-level athletes and 23 controls. In athletes, LA volumes were measured at pre-, mid-, end-training, and post-detraining time points using conventional 2D echocardiography. Athletes had larger maximum (27.5 ± 3.2 vs. 20.3 ± 5.8 mL/m(2), p = 0.001), pre-P (11.5 ± 0.9 vs. 9.8 ± 2.2 mL/m(2), p = 0.001), and minimum (6.6 ± 0.9 vs. 5.0 ± 1.2 mL/m(2), p < 0.001) LA indexed volumes, compared with controls. Total and passive emptying volume indices were also larger in athletes compared with controls (18.7 ± 3.1 vs. 15.3 ± 4.9 mL/m(2), p < 0.05 and 13.8 ± 2.9 vs. 10.5 ± 4.6 mL/m(2), p < ...

International journal of cardiology, Jan 15, 2015

The International Journal of Cardiovascular Imaging, 2015

European Journal of Preventive Cardiology, 2013

Clinical Physiology and Functional Imaging, 2013

Background: Heart rate variability (HRV) has been rarely applied in elite athletes prior to compe... more Background: Heart rate variability (HRV) has been rarely applied in elite athletes prior to competition. The aim of this study was to examine the changes in HRV in elite female volleyball players before a stressful match during play offs and to evaluate the impact on sport-specific performance. Methods: A short-term resting HRV analysis was applied right after the night sleep in ten female athletes 1 and 2 days prior to the match and the day of the competition. Results: Approaching the decisive match, RR interval, resting heart rate (HR), pNN50, rMSDD and SD1 did not significantly vary. SD2 significantly increased in comparison with first-day measurement (P<0Á05). HF% levels significantly decreased the prematch day and the match day (P<0Á05); however, no significant changes in LF/HF% ratio were observed. A gradual increase in VLF% and in LnVLF was observed, with a significant difference between first-day and matchday measurements (P<0Á01 and P<0Á05, respectively). The number of positive receptions was inversely correlated with LF/HFms 2 ratio, with LF/HF% ratio (R = À0Á98, P<0Á05 for both) and with resting HR (R = À0Á92, P<0Á05). Conclusions: Elite female athletes practising team sports exhibit a slight change in HRV prior to a decisive competition, without a pronounced variation of the autonomic nervous system activity. A day-today HRV measurement could be a useful tool to evaluate the impact of a competition on the autonomic nervous system in athletes, also considering the relationship between sympathetic activity and athletic performance.

Circulation: Cardiovascular Imaging, 2014

Background— Exercise is able to induce atrial remodeling in top-level athletes. However, evidence... more Background— Exercise is able to induce atrial remodeling in top-level athletes. However, evidence is mainly limited to men and based on cross-sectional studies. The aim of this prospective, longitudinal study was to investigate whether exercise is able to influence left and right atrial morphology and function also in female athletes. Methods and Results— Two-dimensional echocardiography was performed before season and after 16 weeks of intensive training in 24 top-level female athletes. Left and right atrial myocardial deformation was assessed by two-dimensional speckle-tracking echocardiography. Left atrial volume index (24.0±3.6 versus 26.7±6.9 mL/m 2 ; P <0.001) and right atrial volume index (15.66±3.09 versus 20.47±4.82 mL/m 2 ; P <0.001) significantly increased after training in female athletes. Left atrial global peak atrial longitudinal strain and peak atrial contraction strain significantly decreased after training in female athletes (43.9±9.5% versus 39.8±6.5%; P &lt...