Luciano Agati - Academia.edu (original) (raw)

Papers by Luciano Agati

Research paper thumbnail of Safety of intravenous high-dose dipyridamole echocardiography

The American Journal of Cardiology, 1992

Research paper thumbnail of MidTerm Efficacy of Beraprost, an Oral Prostacyclin Analog, in the Treatment of Distal CTEPH: A Case Control Study

Cardiology, 2006

Background: Prostanoids are a well-established therapy for pulmonary arterial hypertension (PAH),... more Background: Prostanoids are a well-established therapy for pulmonary arterial hypertension (PAH), and observational studies suggest their efficacy even in chronic thromboembolic pulmonary hypertension (CTEPH) patients. Objective: To compare the effects of 6 months of treatment with beraprost, an orally-active prostacyclin analog, in patients with distal CTEPH and PAH. Design: Case-control study. Population: Sixteen patients with severe pulmonary hypertension (NYHA II–IV),

Research paper thumbnail of Influence of residual perfusion within the infarct zone on the natural history of left ventricular dysfunction after acute myocardial infarction: A myocardial contrast echocardiographic study

Research paper thumbnail of Pulmonary Transit of Echocontrast Agents during Mechanical Ventilation: A Clinical Transthoracic Echocardiographic Study

In this study, we investigated whether the ultrasound contrast agents Levovist or Sono Vue inject... more In this study, we investigated whether the ultrasound contrast agents Levovist or Sono Vue injected intravenously during mechanical ventilation effectively pass through the pulmonary circulation. With echocardiography, we measured the time for the contrast to pass through the lungs; and the intensity of right and left ventricular cavity opacification at four time points: during spontaneous breathing (baseline), 5 minutes after the beginning of mechanical ventilation, and 5 minutes and 30 minutes after extubation. Forty patients undergoing elective peripheral neurosurgical procedures were prospectively and randomly enrolled: 20 patients received intravenous Levovist(r) 1 g and 20 patients received intravenous Sono Vue 1 mL, at the four pre-defined time points. After intravenous injection, both Levovist and Sono Vue effectively passed through the lungs and opacified the right and left ventricular cavities, at the four time points. Pulmonary transit times were similar and constant for the two contrast agents tested: 6 ± 2 seconds at baseline, 5 ± 2 seconds during mechanical ventilation, 7 ± 2 seconds at 5 minutes and 6 ± 2 seconds at 30 minutes after extubation with Levovist ; and 6 ± 4 seconds at baseline, 6 ± 3 seconds during mechanical ventilation, 6 ± 2 seconds at 5 minutes and 7 ± 3 seconds at 30 minutes after extubation with Sono Vue . In all patients, each of the four contrast injections achieved high-grade right and left ventricular chamber opacification. In conclusion, both the ultrasound contrast agents tested in this study, Levovist and Sono Vue , after intravenous injection pass through the pulmonary circulation during mechanical ventilation. Ultrasound contrast agents with these characteristics are suitable for intraoperative organ perfusion studies, with intravenous injection. (ECHOCARDIOGRAPHY, Volume 22, May 2005) ultrasound contrast agents, Levovist , Sono Vue , intraoperative organ perfusion, neuroanesthesia After intravenous injection in spontaneously breathing patients and anesthetized dogs, ultrasound contrast agents opacify the right ventricle, pass through the lungs, opacify the left ventricle and reliably depict systemic organ perfusion patterns, 1-5 and visualize tumor perfusion. 6 Intraoperative organ-perfusion studies with ultrasound contrast agents have so far been limited to intraarterial and intraaortic injection. In an earlier study, we found that This work was funded in part with departmental research funds, no corporate sponsorship has been received. Professor Luciano Agati is recipient of a research grant from Bracco Research, SA, Geneva, Switzerland.

Research paper thumbnail of Does coronary angioplasty after timely thrombolysis improve microvascular perfusion and left ventricular function after acute myocardial infarction?

American Heart Journal, 2007

Recent data show that percutaneous coronary intervention (PCI) in patients with stable postthromb... more Recent data show that percutaneous coronary intervention (PCI) in patients with stable postthrombolytic ST-segment elevation myocardial infarction (STEMI) is better than no PCI or ischemia-guided PCI. These results still have to find a pathophysiologic explanation. We hypothesized that complete mechanical recanalization of infarct-related artery improves clinical benefits of thrombolysis as a result of more preserved and better perfused coronary microcirculation. To test this hypothesis, we studied a selected STEMI population presenting very early after symptom onset in whom successful infarct-related artery reperfusion was obtained by thrombolysis followed or not by elective PCI within 24 hours, and we compared these 2 groups with those underwent primary PCI. This study analyzed 96 patients with STEMI randomized within 3 hours from symptom onset to primary PCI (group A, n = 36), tenecteplase followed within 24 hours by PCI (group B, n = 30), or to tenecteplase alone (group C, n = 30). Microvascular perfusion was assessed by myocardial contrast echocardiography. Regional contrast score, endocardial length and area of contrast defect on day 2 (T1) and at predischarge (T2), left ventricular end-diastolic volume, regional wall motion score, extent of wall motion abnormalities, and ejection fraction at T1, T2, and at 3 months' follow-up were calculated. Baseline clinical and angiographic characteristics were not statistically different between groups. The extent of microvascular damage and of myocardial salvage was similar in primary PCI-treated or in invasively treated patients after lytic administration. Conversely, group C patients, although treated very early with fibrinolytic therapy, showed higher extent of microvascular damage and infarct size and a more depressed left ventricular function after reperfusion and at follow-up. Our data suggest that early PCI after lysis is more effective in preserving myocardial perfusion and function than lysis alone and may be a helpful alternative when primary PCI is not available.

Research paper thumbnail of Use of myocardial contrast echocardiography in identifying patients with failed reperfusion after thrombolysis in acute myocardial infarction: Comparison with TIMI myocardial perfusion grade and clinical markers of reperfusion

Journal of The American College of Cardiology, 2003

To compare the prognostic value of dobutamine stress echocardiography iDSE) and dobutamine mvocar... more To compare the prognostic value of dobutamine stress echocardiography iDSE) and dobutamine mvocardial oerfusion imaaina (D-MPI). _", Methods: Retrospective analysis of 281 patients (pts) undergomg DSE and 140 pts underaoina D-MPI. Mean follow-uo: D-MPI was 28.5+-10 mo (100% f/u): DSE 21.3+-9.9 _ _ ,. mo (92% flu). +DSE was defined as reduction rn wall motion score in 22 segments rest to stress, +D-MPI as sum stress score 27. Soft events were cardiac hospitakzation, heart failure, revascularization. Hard events wsra MI. unstable angina or CV death. Results: D-MPI pts had a higher k-rcidence of MI (45 vs 33.2%), dtabetes (41.4 vs 29.3%). lipids (52.8 vs 42.1%) tobacco (74.3 vs 53.5%) and Ca++ channel blockers (33.6 YS 18.2%) (~~0.04) but lower b&blockers (25 vs 48.3%). At one year, there were

Research paper thumbnail of Tissue level perfusion after primary or rescue coronary angioplasty in acute myocardial infarction: A myocardial contrast echocardiography study

Journal of The American College of Cardiology, 2003

Research paper thumbnail of Tissue viability by contrast echocardiography

European Journal of Echocardiography, 2006

Residual tissue viability within the infarct area is one of the major determinants of regional fu... more Residual tissue viability within the infarct area is one of the major determinants of regional functional recovery after acute myocardial infarction, playing also a protective role against LV remodelling. However, viability and functional recovery are not synonymous: functional recovery is only one of the aspects of viability. Several studies have shown how important it is to maintain perfusion independently from functional recovery. In patients with an extensive endocardial necrosis and a preserved normal perfusion in the middle and epicardial myocardium layers, even though functional recovery does not occur, remodelling processes may be attenuated. Tissue viability may be detected using several different methods. Perfusion-based techniques (i.e. PET, SPECT, MRI and MCE) are more accurate in predicting global function and LV remodelling whereas inotropic reserve-based methods (i.e. DE) are more accurate in predicting functional recovery. Several studies support the hypothesis that either LV remodelling or the possibility of myocardial dysfunction to recover are strictly dependent on the extent of microvascular damage. To date, myocardial contrast echocardiography and magnetic resonance imaging have shown to be very effective techniques for assessing microvascular perfusion. Our initial experience showed a very close correlation between these two perfusional techniques. In particular by MCE, it has been demonstrated that the persistence of residual anterograde or retrograde blood flow within the infarct zone can maintain myocardial viability for a prolonged time span. The incidence of LV remodelling is significantly lower in dysfunctioning but still perfused segments than in non-perfused ones. Therefore MCE can be used to identify viable segments that may help to prevent infarct expansion and remodelling, and thus improve patient outcomes.

Research paper thumbnail of Transesophageal dipyridamole echocardiography for diagnosis of coronary artery disease

Journal of The American College of Cardiology, 1992

Research paper thumbnail of Serum Levels of Asymmetric Dimethylarginine and Apelin as Potential Markers of Vascular Endothelial Dysfunction in Early Rheumatoid Arthritis

Mediators of Inflammation, 2012

Objectives. Impaired endothelial function represents the early stage of atherosclerosis, which is... more Objectives. Impaired endothelial function represents the early stage of atherosclerosis, which is typically associated with systemic inflammatory diseases like rheumatoid arthritis (RA). As modulators of endothelial nitric oxide synthase expression, asymmetricdimethylarginine (ADMA) and apelin might be measured in the blood of RA patients to detect early atherosclerotic changes. We conducted a prospective, case-control study to investigate serum ADMA and apelin profiles of patients with early-stage RA (ERA) before and after disease-modifying antirheumatic drug (DMARD) therapy. Methods. We enrolled 20 consecutively diagnosed, treatment-naïve patients with ERA and 20 matched healthy controls. Serum ADMA and apelin levels and the 28-joint disease activity scores (DAS28) were assessed before and after 12 months of DMARDs treatment. All patients underwent ultrasonographic assessment for intima-media tickness (IMT) evaluation. Results. In the ERA group, ADMA serum levels were significantly higher than controls at baseline (P = 0.007) and significantly decreased after treatment (P = 0.012 versus controls). Baseline serum apelin levels were significantly decreased in this group (P = 0.0001 versus controls), but they were not significantly altered by treatment. IMT did not show significant changes. Conclusions. ERA is associated with alterations of serum ADMA and apelin levels, which might be used as biomarkers to detect early endothelial dysfunction in these patients.

Research paper thumbnail of Influence of residual perfusion within the infarct zone on the natural history of left ventricular dysfunction after acute myocardial infarction: A myocardial contrast echocardiographic study

Journal of the American College of Cardiology, 1994

Research paper thumbnail of Tissue-Type Plasminogen Activator Therapy Versus Primary Coronary Angioplasty: Impact on Myocardial Tissue Perfusion and Regional Function 1 Month After Uncomplicated Myocardial Infarction

Journal of the American College of Cardiology, 1998

Research paper thumbnail of The Extent of Microvascular Damage During Myocardial Contrast Echocardiography Is Superior to Other Known Indexes of Post-Infarct Reperfusion in Predicting Left Ventricular Remodeling

Journal of the American College of Cardiology, 2008

Objectives We sought to evaluate the value of the extent of microvascular damage as assessed with... more Objectives We sought to evaluate the value of the extent of microvascular damage as assessed with myocardial contrast echocardiography (MCE) in the prediction of left ventricular (LV) remodeling after ST-segment elevation myocardial infarction (STEMI) as compared with established clinical and angiographic parameters of reperfusion.

Research paper thumbnail of Stress echocardiography: Comparison of exercise, dipyridamole and dobutamine in detecting and predicting the extent of coronary artery disease

Journal of the American College of Cardiology, 1995

Objectives. This study was designed to compare exercise, dipyridamole and dobutamine eehocardiogr... more Objectives. This study was designed to compare exercise, dipyridamole and dobutamine eehocardiography in the same patients and to evaluate, by measuring physiologic and echocardiographic variables, the mechanisms by which exercise and dobutamine induce ischemia.

Research paper thumbnail of Reperfusion in Predicting Left Ventricular Remodeling: Results of the Echocardiography Is Superior to Other Known Indexes of Post-Infarct The Extent of Microvascular Damage During Myocardial Contrast

Research paper thumbnail of Severe oligozoospermia in a young man with chronic myeloid leukemia on long-term treatment with imatinib started before puberty

Fertility and Sterility, 2011

Objective: To report the effect of long-term treatment with the tyrosine kinase inhibitor imatini... more Objective: To report the effect of long-term treatment with the tyrosine kinase inhibitor imatinib started before the onset of puberty on semen parameters, bone mineral density, and hormone values. Design: Case report. Setting: University hospital. Patient(s): An 18-year-old man given treatment with imatinib for chronic myeloid leukemia. Intervention(s): Clinical, biochemical and dual-energy X-ray absorptiometry evaluations. Main Outcome Measure(s): Semen analysis, serum levels of gonadotropins, inhibin-B, and testosterone, bone mineral density, markers of skeletal homeostasis. Result(s): Semen analyses showed severe oligozoospermia after long-term administration of imatinib started before puberty. The inhibin-B/FSH ratio was reduced. A low bone mineral density for chronologic age was observed. Conclusion(s): This case study documents the potential risk of an impairment of semen parameters in patients undergoing a treatment with tyrosine kinase inhibitors before the complete maturation of the testis. (Fertil Steril Ò 2011;95:1120.e15-e17.

Research paper thumbnail of Relationship between location and size of myocardial infarction and their reciprocal influences on post-infarction left ventricular remodelling

European Heart Journal, 2011

Research paper thumbnail of 3D Echocardiographic Delineation of Mitral-Aortic Intervalular Fibrosa Pseudoaneurysm Caused by Bicuspid Aortic Valve Endocarditis

Echocardiography, 2011

Pseudoaneurysm of the mitral-aortic intervalvular fibrosa is a rare complication of infective end... more Pseudoaneurysm of the mitral-aortic intervalvular fibrosa is a rare complication of infective endocarditis of the aortic valve eventually resulting in coronary artery compression, stroke or rupture into the left atrium, aorta or pericardial space. A prompt diagnosis by either transthoracic or transesophageal echocardiography is mandatory to address the patient to cardiac surgery. We report the clinical case of a 25-year-old white man who was admitted to the emergency department for dyspnoea and fever. Echocardiographic examination showed a bicuspid aortic valve with a huge sessile vegetation and a pseudaneurysm of the mitral-aortic intervalvular fibrosa. In addition to conventional two-dimensional examination, three-dimensional echocardiography provided additional information of this complication, precisely delineating the lesions and addressing the cardiac surgeon in choosing the most appropriate operating strategy. Patient underwent then aortic root replacement and the pseudoaneurysm was closed by means of a bovine pericardial patch. (Echocardiography 2011;28:E1-E4)

Research paper thumbnail of Comparison of Immediate vs Early Invasive Strategy in Patients With First Acute Non-ST-Elevation Myocardial Infarction

Clinical Cardiology, 2010

Background: The best timing for coronary angiography (immediate vs early) in patients with acute ... more Background: The best timing for coronary angiography (immediate vs early) in patients with acute non-STelevation myocardial infarction (NSTEMI) is controversial. Hypothesis: Evaluate in NSTEMI patients the effects of an immediate compared to an early invasive strategy on microvascular damage, myocardial perfusion, and infarct size. Methods: We randomized 54 consecutive patients with first episode of NSTEMI: 27 patients (22 males, age 58.8 ± 9.4 years, group A) underwent immediate (≤6 hours) percutaneous coronary intervention (PCI) with a double bolus of eptifibatide, and 27 patients (24 males, age 59.7 ± 9.8 years, P = 0.72, group B) underwent early (7-72 hours) PCI with upstream eptifibatide. Microvascular damage was evaluated at predischarge by myocardial contrast echocardiography, and the contrast defect length was calculated.

Research paper thumbnail of Anti-endothelial cell antibodies in rheumatic heart disease

Clinical & Experimental Immunology, 2010

To evaluate the anti-endothelial cell antibodies (AECA), anti-cardiolipin antibodies (aCL) and se... more To evaluate the anti-endothelial cell antibodies (AECA), anti-cardiolipin antibodies (aCL) and serum mannose-binding lectin (MBL) profiles of a large cohort of Yemeni patients with rheumatic heart disease (RHD) and to correlate these findings with clinical features of the disease. Patients (n = 140) were recruited from Al-Thawra Hospital in Sana'a, Yemen. All had RHD diagnosed according to modified Jones' criteria. We also studied 140 sex-and agematched healthy blood donors from the same area. Echocardiography was performed according to the recommendations of the American Society of Echocardiography. Solid phase enzyme-linked immunosorbent assays (ELISAs) were used to measure AECA and aCL titres and serum MBL levels. Forty per cent of the patients were AECA-positive, but only 7·8% were positive for aCL antibodies. Serum MBL levels were significantly lower in the RHD group (median 4221 ng/ml versus 5166 ng/ml in healthy controls). AECA titres were correlated positively with patient age, duration of RHD and the severity of aortic stenosis, as determined by echocardiographic findings. In several autoimmune rheumatic diseases, such as systemic lupus erythematosus, vasculitis and scleroderma, AECA have been shown to play pathogenic roles by producing proinflammatory and procoagulant effects (increased expression of adhesion molecules and tissue factors, increased cytokine release) in endothelial cells. In RHD, these autoantibodies might represent a pathological link between activation of the valvular endothelium and valvular damage.

Research paper thumbnail of Safety of intravenous high-dose dipyridamole echocardiography

The American Journal of Cardiology, 1992

Research paper thumbnail of MidTerm Efficacy of Beraprost, an Oral Prostacyclin Analog, in the Treatment of Distal CTEPH: A Case Control Study

Cardiology, 2006

Background: Prostanoids are a well-established therapy for pulmonary arterial hypertension (PAH),... more Background: Prostanoids are a well-established therapy for pulmonary arterial hypertension (PAH), and observational studies suggest their efficacy even in chronic thromboembolic pulmonary hypertension (CTEPH) patients. Objective: To compare the effects of 6 months of treatment with beraprost, an orally-active prostacyclin analog, in patients with distal CTEPH and PAH. Design: Case-control study. Population: Sixteen patients with severe pulmonary hypertension (NYHA II–IV),

Research paper thumbnail of Influence of residual perfusion within the infarct zone on the natural history of left ventricular dysfunction after acute myocardial infarction: A myocardial contrast echocardiographic study

Research paper thumbnail of Pulmonary Transit of Echocontrast Agents during Mechanical Ventilation: A Clinical Transthoracic Echocardiographic Study

In this study, we investigated whether the ultrasound contrast agents Levovist or Sono Vue inject... more In this study, we investigated whether the ultrasound contrast agents Levovist or Sono Vue injected intravenously during mechanical ventilation effectively pass through the pulmonary circulation. With echocardiography, we measured the time for the contrast to pass through the lungs; and the intensity of right and left ventricular cavity opacification at four time points: during spontaneous breathing (baseline), 5 minutes after the beginning of mechanical ventilation, and 5 minutes and 30 minutes after extubation. Forty patients undergoing elective peripheral neurosurgical procedures were prospectively and randomly enrolled: 20 patients received intravenous Levovist(r) 1 g and 20 patients received intravenous Sono Vue 1 mL, at the four pre-defined time points. After intravenous injection, both Levovist and Sono Vue effectively passed through the lungs and opacified the right and left ventricular cavities, at the four time points. Pulmonary transit times were similar and constant for the two contrast agents tested: 6 ± 2 seconds at baseline, 5 ± 2 seconds during mechanical ventilation, 7 ± 2 seconds at 5 minutes and 6 ± 2 seconds at 30 minutes after extubation with Levovist ; and 6 ± 4 seconds at baseline, 6 ± 3 seconds during mechanical ventilation, 6 ± 2 seconds at 5 minutes and 7 ± 3 seconds at 30 minutes after extubation with Sono Vue . In all patients, each of the four contrast injections achieved high-grade right and left ventricular chamber opacification. In conclusion, both the ultrasound contrast agents tested in this study, Levovist and Sono Vue , after intravenous injection pass through the pulmonary circulation during mechanical ventilation. Ultrasound contrast agents with these characteristics are suitable for intraoperative organ perfusion studies, with intravenous injection. (ECHOCARDIOGRAPHY, Volume 22, May 2005) ultrasound contrast agents, Levovist , Sono Vue , intraoperative organ perfusion, neuroanesthesia After intravenous injection in spontaneously breathing patients and anesthetized dogs, ultrasound contrast agents opacify the right ventricle, pass through the lungs, opacify the left ventricle and reliably depict systemic organ perfusion patterns, 1-5 and visualize tumor perfusion. 6 Intraoperative organ-perfusion studies with ultrasound contrast agents have so far been limited to intraarterial and intraaortic injection. In an earlier study, we found that This work was funded in part with departmental research funds, no corporate sponsorship has been received. Professor Luciano Agati is recipient of a research grant from Bracco Research, SA, Geneva, Switzerland.

Research paper thumbnail of Does coronary angioplasty after timely thrombolysis improve microvascular perfusion and left ventricular function after acute myocardial infarction?

American Heart Journal, 2007

Recent data show that percutaneous coronary intervention (PCI) in patients with stable postthromb... more Recent data show that percutaneous coronary intervention (PCI) in patients with stable postthrombolytic ST-segment elevation myocardial infarction (STEMI) is better than no PCI or ischemia-guided PCI. These results still have to find a pathophysiologic explanation. We hypothesized that complete mechanical recanalization of infarct-related artery improves clinical benefits of thrombolysis as a result of more preserved and better perfused coronary microcirculation. To test this hypothesis, we studied a selected STEMI population presenting very early after symptom onset in whom successful infarct-related artery reperfusion was obtained by thrombolysis followed or not by elective PCI within 24 hours, and we compared these 2 groups with those underwent primary PCI. This study analyzed 96 patients with STEMI randomized within 3 hours from symptom onset to primary PCI (group A, n = 36), tenecteplase followed within 24 hours by PCI (group B, n = 30), or to tenecteplase alone (group C, n = 30). Microvascular perfusion was assessed by myocardial contrast echocardiography. Regional contrast score, endocardial length and area of contrast defect on day 2 (T1) and at predischarge (T2), left ventricular end-diastolic volume, regional wall motion score, extent of wall motion abnormalities, and ejection fraction at T1, T2, and at 3 months' follow-up were calculated. Baseline clinical and angiographic characteristics were not statistically different between groups. The extent of microvascular damage and of myocardial salvage was similar in primary PCI-treated or in invasively treated patients after lytic administration. Conversely, group C patients, although treated very early with fibrinolytic therapy, showed higher extent of microvascular damage and infarct size and a more depressed left ventricular function after reperfusion and at follow-up. Our data suggest that early PCI after lysis is more effective in preserving myocardial perfusion and function than lysis alone and may be a helpful alternative when primary PCI is not available.

Research paper thumbnail of Use of myocardial contrast echocardiography in identifying patients with failed reperfusion after thrombolysis in acute myocardial infarction: Comparison with TIMI myocardial perfusion grade and clinical markers of reperfusion

Journal of The American College of Cardiology, 2003

To compare the prognostic value of dobutamine stress echocardiography iDSE) and dobutamine mvocar... more To compare the prognostic value of dobutamine stress echocardiography iDSE) and dobutamine mvocardial oerfusion imaaina (D-MPI). _", Methods: Retrospective analysis of 281 patients (pts) undergomg DSE and 140 pts underaoina D-MPI. Mean follow-uo: D-MPI was 28.5+-10 mo (100% f/u): DSE 21.3+-9.9 _ _ ,. mo (92% flu). +DSE was defined as reduction rn wall motion score in 22 segments rest to stress, +D-MPI as sum stress score 27. Soft events were cardiac hospitakzation, heart failure, revascularization. Hard events wsra MI. unstable angina or CV death. Results: D-MPI pts had a higher k-rcidence of MI (45 vs 33.2%), dtabetes (41.4 vs 29.3%). lipids (52.8 vs 42.1%) tobacco (74.3 vs 53.5%) and Ca++ channel blockers (33.6 YS 18.2%) (~~0.04) but lower b&blockers (25 vs 48.3%). At one year, there were

Research paper thumbnail of Tissue level perfusion after primary or rescue coronary angioplasty in acute myocardial infarction: A myocardial contrast echocardiography study

Journal of The American College of Cardiology, 2003

Research paper thumbnail of Tissue viability by contrast echocardiography

European Journal of Echocardiography, 2006

Residual tissue viability within the infarct area is one of the major determinants of regional fu... more Residual tissue viability within the infarct area is one of the major determinants of regional functional recovery after acute myocardial infarction, playing also a protective role against LV remodelling. However, viability and functional recovery are not synonymous: functional recovery is only one of the aspects of viability. Several studies have shown how important it is to maintain perfusion independently from functional recovery. In patients with an extensive endocardial necrosis and a preserved normal perfusion in the middle and epicardial myocardium layers, even though functional recovery does not occur, remodelling processes may be attenuated. Tissue viability may be detected using several different methods. Perfusion-based techniques (i.e. PET, SPECT, MRI and MCE) are more accurate in predicting global function and LV remodelling whereas inotropic reserve-based methods (i.e. DE) are more accurate in predicting functional recovery. Several studies support the hypothesis that either LV remodelling or the possibility of myocardial dysfunction to recover are strictly dependent on the extent of microvascular damage. To date, myocardial contrast echocardiography and magnetic resonance imaging have shown to be very effective techniques for assessing microvascular perfusion. Our initial experience showed a very close correlation between these two perfusional techniques. In particular by MCE, it has been demonstrated that the persistence of residual anterograde or retrograde blood flow within the infarct zone can maintain myocardial viability for a prolonged time span. The incidence of LV remodelling is significantly lower in dysfunctioning but still perfused segments than in non-perfused ones. Therefore MCE can be used to identify viable segments that may help to prevent infarct expansion and remodelling, and thus improve patient outcomes.

Research paper thumbnail of Transesophageal dipyridamole echocardiography for diagnosis of coronary artery disease

Journal of The American College of Cardiology, 1992

Research paper thumbnail of Serum Levels of Asymmetric Dimethylarginine and Apelin as Potential Markers of Vascular Endothelial Dysfunction in Early Rheumatoid Arthritis

Mediators of Inflammation, 2012

Objectives. Impaired endothelial function represents the early stage of atherosclerosis, which is... more Objectives. Impaired endothelial function represents the early stage of atherosclerosis, which is typically associated with systemic inflammatory diseases like rheumatoid arthritis (RA). As modulators of endothelial nitric oxide synthase expression, asymmetricdimethylarginine (ADMA) and apelin might be measured in the blood of RA patients to detect early atherosclerotic changes. We conducted a prospective, case-control study to investigate serum ADMA and apelin profiles of patients with early-stage RA (ERA) before and after disease-modifying antirheumatic drug (DMARD) therapy. Methods. We enrolled 20 consecutively diagnosed, treatment-naïve patients with ERA and 20 matched healthy controls. Serum ADMA and apelin levels and the 28-joint disease activity scores (DAS28) were assessed before and after 12 months of DMARDs treatment. All patients underwent ultrasonographic assessment for intima-media tickness (IMT) evaluation. Results. In the ERA group, ADMA serum levels were significantly higher than controls at baseline (P = 0.007) and significantly decreased after treatment (P = 0.012 versus controls). Baseline serum apelin levels were significantly decreased in this group (P = 0.0001 versus controls), but they were not significantly altered by treatment. IMT did not show significant changes. Conclusions. ERA is associated with alterations of serum ADMA and apelin levels, which might be used as biomarkers to detect early endothelial dysfunction in these patients.

Research paper thumbnail of Influence of residual perfusion within the infarct zone on the natural history of left ventricular dysfunction after acute myocardial infarction: A myocardial contrast echocardiographic study

Journal of the American College of Cardiology, 1994

Research paper thumbnail of Tissue-Type Plasminogen Activator Therapy Versus Primary Coronary Angioplasty: Impact on Myocardial Tissue Perfusion and Regional Function 1 Month After Uncomplicated Myocardial Infarction

Journal of the American College of Cardiology, 1998

Research paper thumbnail of The Extent of Microvascular Damage During Myocardial Contrast Echocardiography Is Superior to Other Known Indexes of Post-Infarct Reperfusion in Predicting Left Ventricular Remodeling

Journal of the American College of Cardiology, 2008

Objectives We sought to evaluate the value of the extent of microvascular damage as assessed with... more Objectives We sought to evaluate the value of the extent of microvascular damage as assessed with myocardial contrast echocardiography (MCE) in the prediction of left ventricular (LV) remodeling after ST-segment elevation myocardial infarction (STEMI) as compared with established clinical and angiographic parameters of reperfusion.

Research paper thumbnail of Stress echocardiography: Comparison of exercise, dipyridamole and dobutamine in detecting and predicting the extent of coronary artery disease

Journal of the American College of Cardiology, 1995

Objectives. This study was designed to compare exercise, dipyridamole and dobutamine eehocardiogr... more Objectives. This study was designed to compare exercise, dipyridamole and dobutamine eehocardiography in the same patients and to evaluate, by measuring physiologic and echocardiographic variables, the mechanisms by which exercise and dobutamine induce ischemia.

Research paper thumbnail of Reperfusion in Predicting Left Ventricular Remodeling: Results of the Echocardiography Is Superior to Other Known Indexes of Post-Infarct The Extent of Microvascular Damage During Myocardial Contrast

Research paper thumbnail of Severe oligozoospermia in a young man with chronic myeloid leukemia on long-term treatment with imatinib started before puberty

Fertility and Sterility, 2011

Objective: To report the effect of long-term treatment with the tyrosine kinase inhibitor imatini... more Objective: To report the effect of long-term treatment with the tyrosine kinase inhibitor imatinib started before the onset of puberty on semen parameters, bone mineral density, and hormone values. Design: Case report. Setting: University hospital. Patient(s): An 18-year-old man given treatment with imatinib for chronic myeloid leukemia. Intervention(s): Clinical, biochemical and dual-energy X-ray absorptiometry evaluations. Main Outcome Measure(s): Semen analysis, serum levels of gonadotropins, inhibin-B, and testosterone, bone mineral density, markers of skeletal homeostasis. Result(s): Semen analyses showed severe oligozoospermia after long-term administration of imatinib started before puberty. The inhibin-B/FSH ratio was reduced. A low bone mineral density for chronologic age was observed. Conclusion(s): This case study documents the potential risk of an impairment of semen parameters in patients undergoing a treatment with tyrosine kinase inhibitors before the complete maturation of the testis. (Fertil Steril Ò 2011;95:1120.e15-e17.

Research paper thumbnail of Relationship between location and size of myocardial infarction and their reciprocal influences on post-infarction left ventricular remodelling

European Heart Journal, 2011

Research paper thumbnail of 3D Echocardiographic Delineation of Mitral-Aortic Intervalular Fibrosa Pseudoaneurysm Caused by Bicuspid Aortic Valve Endocarditis

Echocardiography, 2011

Pseudoaneurysm of the mitral-aortic intervalvular fibrosa is a rare complication of infective end... more Pseudoaneurysm of the mitral-aortic intervalvular fibrosa is a rare complication of infective endocarditis of the aortic valve eventually resulting in coronary artery compression, stroke or rupture into the left atrium, aorta or pericardial space. A prompt diagnosis by either transthoracic or transesophageal echocardiography is mandatory to address the patient to cardiac surgery. We report the clinical case of a 25-year-old white man who was admitted to the emergency department for dyspnoea and fever. Echocardiographic examination showed a bicuspid aortic valve with a huge sessile vegetation and a pseudaneurysm of the mitral-aortic intervalvular fibrosa. In addition to conventional two-dimensional examination, three-dimensional echocardiography provided additional information of this complication, precisely delineating the lesions and addressing the cardiac surgeon in choosing the most appropriate operating strategy. Patient underwent then aortic root replacement and the pseudoaneurysm was closed by means of a bovine pericardial patch. (Echocardiography 2011;28:E1-E4)

Research paper thumbnail of Comparison of Immediate vs Early Invasive Strategy in Patients With First Acute Non-ST-Elevation Myocardial Infarction

Clinical Cardiology, 2010

Background: The best timing for coronary angiography (immediate vs early) in patients with acute ... more Background: The best timing for coronary angiography (immediate vs early) in patients with acute non-STelevation myocardial infarction (NSTEMI) is controversial. Hypothesis: Evaluate in NSTEMI patients the effects of an immediate compared to an early invasive strategy on microvascular damage, myocardial perfusion, and infarct size. Methods: We randomized 54 consecutive patients with first episode of NSTEMI: 27 patients (22 males, age 58.8 ± 9.4 years, group A) underwent immediate (≤6 hours) percutaneous coronary intervention (PCI) with a double bolus of eptifibatide, and 27 patients (24 males, age 59.7 ± 9.8 years, P = 0.72, group B) underwent early (7-72 hours) PCI with upstream eptifibatide. Microvascular damage was evaluated at predischarge by myocardial contrast echocardiography, and the contrast defect length was calculated.

Research paper thumbnail of Anti-endothelial cell antibodies in rheumatic heart disease

Clinical & Experimental Immunology, 2010

To evaluate the anti-endothelial cell antibodies (AECA), anti-cardiolipin antibodies (aCL) and se... more To evaluate the anti-endothelial cell antibodies (AECA), anti-cardiolipin antibodies (aCL) and serum mannose-binding lectin (MBL) profiles of a large cohort of Yemeni patients with rheumatic heart disease (RHD) and to correlate these findings with clinical features of the disease. Patients (n = 140) were recruited from Al-Thawra Hospital in Sana'a, Yemen. All had RHD diagnosed according to modified Jones' criteria. We also studied 140 sex-and agematched healthy blood donors from the same area. Echocardiography was performed according to the recommendations of the American Society of Echocardiography. Solid phase enzyme-linked immunosorbent assays (ELISAs) were used to measure AECA and aCL titres and serum MBL levels. Forty per cent of the patients were AECA-positive, but only 7·8% were positive for aCL antibodies. Serum MBL levels were significantly lower in the RHD group (median 4221 ng/ml versus 5166 ng/ml in healthy controls). AECA titres were correlated positively with patient age, duration of RHD and the severity of aortic stenosis, as determined by echocardiographic findings. In several autoimmune rheumatic diseases, such as systemic lupus erythematosus, vasculitis and scleroderma, AECA have been shown to play pathogenic roles by producing proinflammatory and procoagulant effects (increased expression of adhesion molecules and tissue factors, increased cytokine release) in endothelial cells. In RHD, these autoantibodies might represent a pathological link between activation of the valvular endothelium and valvular damage.