Nicola Galea - Academia.edu (original) (raw)
Papers by Nicola Galea
Journal of Cardiovascular Magnetic Resonance, 2016
ABSTRACT PURPOSE Many systemic congenital disorders are associated with aortic abnormalities and ... more ABSTRACT PURPOSE Many systemic congenital disorders are associated with aortic abnormalities and MR Angiography could be considered for screening of this population. Our aim was to evaluate the feasibility of unenhanced MR angiography (UMRA) with steady-state free procession (SSFP) sequences for measurement of thoracic aorta diameters and detecting abnormalities, in comparison with standard contrast enhanced MR angiography (CEMRA), in a population of young patients with suspected congenital aortic anomalies. METHOD AND MATERIALS 70 consecutive young patients with suspected aortic abnormalities underwent UMRA and CEMRA in the same examination session. UMRA was performed using breath-hold ECG-gated SSFP sequences covering the whole chest volume in axial and coronal planes. CEMRA was performed with breath-hold 3D Flash sequences in oblique sagittal plane after administration of gadobenate dimeglumine (MultiHance, Bracco) at a dose of 0.1 mmol/kg. Assessment of image quality (3-point scale: insufficient, good, optimal) and measurement of Aortic diameter on both MR techniques was performed at the annulus, sinuses of Valsalva, sinotubular junction, ascending aorta, proximal and distal aortic arch and hiatus. The qualitative scores achieved with UMRA and CEMRA were compared using Wilcoxon’s signed ranked test. Bland-Altman analysis was used to determine inter-sequence agreement for measurements of all aortic diameters. The time for sequence acquisition was calculated. RESULTS Qualitative assessment revealed a better image quality of CEMRA at arch and descending aorta, whereas UMRA was better on aortic root, due to cardiosincronization. Bland-Altman analysis revealed high agreement between UMRA and CEMRA measurements at the ascending, arch and descending aorta (p<0.01). Disagreement in aortic diameters was noted at the level of the sinotubular junction, aortic root and annulus (p=0.10). Globally, UMRA required shorter acquisition times than CEMRA (1’23” vs. 9’34”). CONCLUSION UMRA performed with SSFP sequences allows reliable measurements of aortic diameters in comparison with standard CEMRA allowing shorter study times and avoiding discomfort and risk due to contrast agent administration. CLINICAL RELEVANCE/APPLICATION UMRA is a reliable method for aortic measurement and detection of vascular anomalies;faster,safer and cheaper than CEMRA, that is preferable to assess dubious abnormalities and atherosclerotic disease
ABSTRACT PURPOSE Pulmonary arterial hypertension (PAH) is a progressive disease of pulmonary arte... more ABSTRACT PURPOSE Pulmonary arterial hypertension (PAH) is a progressive disease of pulmonary arteries, characterized by elevated pulmonary vascular resistances, which results in severe right ventricular (RV) dysfunction due to increased RV afterload and myocardial remodeling. The aim of this study was to examine the relationship between morphological adaptive changes in myocardial remodeling (“concentric” vs “eccentric” hypertrophy), right ventricular ejection fraction (RVEF), presence of myocardial fibrosis (late enhancement, LE) and survival in patients with PH. METHOD AND MATERIALS 83 consecutive patients with PAH (56 idiopathic, 9 CHD-related, 16 secondary) underwent to clinical setting (NYHA class), right heart catheterization, cardiac magnetic resonance imaging, and 6-min walk testing at the baseline. MRI protocol included short axis and horizontal long axis cine-SSFP imaging and LE acquisitions after contrast-administration (0.1 mmol/kg Gd-BOPTA) in order to measure volumes and detect fibrosis.Population was divided in groups on the basis of median value of RV mass/diastolic volume ratio (Gr1 RV M/V<0.60, Gr2 RV M/V>0.60), RVEF ( RVEF<34%:GrA, >34%:GrB) and LE presence (y/n) and followed-up for deaths (average of 4.3+1.6 years). RESULTS Higher RV M/V ratio is associated to lower RV systolic and diastolic volume (respectively p=0,006 and <0,005) but similar RV mass (p=ns) compared to pts with RV M/V ratio below 0.60. Despite no significant differences in clinical status, effort capacity (6MWT) and hemodynamics between the two groups, Gr2 patients have a lower mortality according to Kaplan-Mayer curve (mean survivor time Gr1: 925dys, Gr2: 1339dys, p=0.008). Similarly, baseline RVEF was predictor of mortality (p= 0.002). DE was demonstrated in 74/85 pts and predominantly confined to RV insertion points (70/74). Multivariate analysis excluded negative impact of other CMR parameters as prognostic indicators of death in our population, including LE presence. CONCLUSION In PAH patients, RV hypertrophy and mild diastolic volume increase (high mass/volume ratio and high RVEF) is associated to low rate of deaths, suggesting a favorable prognostic role of this parameter. LE is observed in most PAH pts, but in our population a correlation with survival interval was not demonstrated. CLINICAL RELEVANCE/APPLICATION The type of RV remodelling (concentric vs eccentric hypertrophy) could be the expression of adequacy of adaptation in PAH, and have significant prognostic impact.
ABSTRACT PURPOSE Ulcerative coronary plaque typically requires prompt treatment. However, the pre... more ABSTRACT PURPOSE Ulcerative coronary plaque typically requires prompt treatment. However, the presence of a mild calcification can sometimes mimic ulcerative plaque at CT Angiography (CTA). The aim of this study was to evaluate the diagnostic benefit of prospective ECG-gated Calcium Scoring (CS) prior to ECG-gated Coronary CTA in the differentiation of calcified from ulcerative plaque. METHOD AND MATERIALS 137 consecutive patients with suspected coronary artery disease underwent a pre-contrast prospective CS scan followed post-contrast (iomeprol-400, 400 mgI/ml; Bracco) by retrospectively ECG-gated coronary CTA (Siemens Sensation Cardiac 64, detector collimation 64×0.6mm). Images were independently analyzed in two phases (post-contrast images only and then both pre- and post-contrast images together) by two experienced radiologists in terms of the detection of coronary plaques, their classification as calcified, mixed or soft, their differentiation as ulcerative or non-ulcerative, and the presence and quantification of stenosis. The findings from the first and second evaluations were then compared. Patients positive at CTA for coronary stenosis (>50% of the vessel caliber) or with ulcerative plaque underwent coronary Angiography (CA). RESULTS Readers 1 and 2 detected 271 (161 calcified; 78 mixed; 32 soft) and 275 (161 calcified; 78 mixed; 36 soft) coronary plaques, respectively. Seven and nine plaques (readers 1 and 2, respectively) were initially considered ulcerative based on the post-contrast scan alone but were correctly characterized as non-ulcerative after evaluating the pre- and post-contrast scans together. Comparison with CA was obtained in 47 patients with 72 plaques. CONCLUSION The diagnostic accuracy of coronary CTA for plaque characterization could be improved by the use of a pre-contrast CS scan, without a significant increase of radiation dose. CLINICAL RELEVANCE/APPLICATION At CTA sometimes the presence of a mild calcification within a coronary plaque can look like an ulcerative coronary plaque. CS prior to Coronary CTA can be crucial in coronary plaques characterization
Imaging of the Cardiovascular System, Thorax, and Abdomen, 2016
ABSTRACT PURPOSE Recent multi-detector Computed Tomography(MDCT)scanners thanks to a significant ... more ABSTRACT PURPOSE Recent multi-detector Computed Tomography(MDCT)scanners thanks to a significant increment of temporal resolution are considered a valid non-invasive tool for characterizing atherosclerotic plaque in coronary artery disease. Nevertheless coronary calcium remains a problem that prevents acceptance of MDCT as an alternative to invasive angiography.“Blooming”artifacts due to the presence of vascular calcium have also been linked to cardiac motion.Our pourpose was to determine whether plaque composition and motion related artifacts influence the diagnostic performance of 64-cCTA and DS-cCTA. METHOD AND MATERIALS MDCT examinations were performed in 129 patients. Ninety-four patients underwent 64-cCTA [Somaton Sensation, Siemens]and 35 underwent DS-cCTA[Somaton Definition]; 70 mL of 400mgI/mL;[Bracco]at 5 ml/s). Of these, 129 patients, 23 underwent both techniques because of stent follow-up. All patients also underwent QCA within 3 days of the 64-cCTA or DS-cCTA examination. All coronary segments were analyzed by two radiologists in terms of the technical adequacy of the procedure (i.e. presence/absence of cardiac motion artifacts), the presence and grade of coronary stenosis, and the composition of detected plaques. RESULTS Visualization of the entire coronary tree was achieved in all 35 patients who underwent DS-cCTA and in 92 of 94 patients who underwent 64-cCTA. The image quality was significantly higher at DS-cCTA(Wilcoxon’s test p=0.008).The sensitivity, specificity and overall accuracy for the detection of significant(>70%)stenosis was 0.76, 0.88 and 0.87, respectively for 64-cCTA and 0.84, 0.91 and 0.90, respectively, for DS-cCTA. The accuracy of both techniques was predominantly dependant on plaque composition and in both cases decreased progressively with an increase in plaque compositional density. Nevertheless, the accuracy of DS-cCTA was significantly higher than that of 64-cCTA for all types of plaque: soft plaque 0.95 vs 0.97(p=0.04); mixed plaque 0.94 vs 0.97(p=0.045); predominantly calcified 0.68 vs 0.77(p=0.032). CONCLUSION The presence of coronary calcified plaques significantly affects the diagnostic accuracy of MDCT and this is more evident at 64-cCTA than at DS-cCTA.The increased temporal resolution of DS-cCTA allows higher technical adequacy and greater diagnostic accuracy. CLINICAL RELEVANCE/APPLICATION The diagnostic accuracy of MDCT strongly reflects plaque composition and is negatively affected by calcification.
Journal of Cardiovascular Magnetic Resonance, 2016
The Journal of clinical endocrinology and metabolism, Jan 10, 2016
Visceral adiposity plays a significant role in cardiovascular risk. PDE5 inhibitors (PDE5i) can i... more Visceral adiposity plays a significant role in cardiovascular risk. PDE5 inhibitors (PDE5i) can improve cardiac function and insulin sensitivity in type 2 diabetes patients (T2DM). To investigate whether PDE5i affect visceral adipose tissue (VAT), specifically epicardial fat (EAT), and what mechanism is involved, using microarray-based profiling of pharmacologically modulated miRNAs. Randomized, double-blind, placebo-controlled study in T2DM. Patients & Intervention: 59 diabetic patients were randomized to receive 100 mg/d sildenafil or placebo for 12 weeks. Fat biopsies were collected in a subgroup of patients. In a parallel protocol, db/db mice were randomized to 12 weeks of sildenafil or vehicle, and VAT was collected. Main Outcomes and Measures: Anthropometric and metabolic parameters, EAT quantification through cardiac magnetic resonance imaging (CMR), array of 2005 circulating miRNAs, qPCR and flow cytometry of VAT. Compared to placebo, sildenafil reduced waist circumference (...
PloS one, 2015
Previous studies evaluating the progression of the necrotic wave in relation to heart rate were c... more Previous studies evaluating the progression of the necrotic wave in relation to heart rate were carried out only in animal models of ST-elevated myocardial infarction (STEMI). Aim of the study was to investigate changes of myocardial salvage in relation to different heart rates at hospital admission in timely reperfused patients with STEMI by using cardiovascular magnetic resonance (CMR). One hundred-eighty-seven patients with STEMI successfully and timely treated with primary coronary angioplasty underwent CMR five days after hospital admission. According to the heart rate at presentation, patients were subcategorized into 5 quintiles: <55 bpm (group I, n = 44), 55-64 bpm (group II, n = 35), 65-74 bpm (group III, n = 35), 75-84 bpm (group IV, n = 37), ≥85 bpm (group V, n = 36). Area at risk, infarct size, microvascular obstruction (MVO) and myocardium salvaged index (MSI) were assessed by CMR using standard sequences. Lower heart rates at presentation were associated with a bigg...
Expert Review of Clinical Immunology, 2015
Raynaud phenomenon (RP) is the hallmark of Systemic Sclerosis (SSc). Visceral RP has also been pr... more Raynaud phenomenon (RP) is the hallmark of Systemic Sclerosis (SSc). Visceral RP has also been proposed in SSc patients. Cardiac Raynaud&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s phenomenon (C-RP) was evaluated in a few clinical studies both as cold-induced transient myocardial ischaemia and as presence of advanced myocardial fibrosis and contraction band necrosis in autopsied patients. Until today numerous techniques, such as scintigraphy and myocardial contrast echocardiography, have been used to evaluate C-RP. In this case report for the first time we have used Cardiac Magnetic Resonance (CMR) after cold test to demonstrate the presence of the C-RP. In addition we have shown that therapy with Iloprost can be used to reduce episodes of C-RP.
Journal of Cardiovascular Magnetic Resonance, 2015
Journal of Cardiovascular Magnetic Resonance, 2015
Journal of Cardiovascular Magnetic Resonance, 2015
Imaging Cardiovascolare TC e RM, 2012
La radiologia medica, 2013
Purpose The aim of this work was to compare the prevalence of right ventricle involvement in a po... more Purpose The aim of this work was to compare the prevalence of right ventricle involvement in a population of patients with myocardial infarction as detected by cardiac magnetic resonance (CMR), clinical presentation, electrocardiographic (ECG) and echocardiographic criteria. Materials and methods A total of 97 consecutive patients, admitted to our institution for acute myocardial infarction, underwent a standard CMR examination within 5 days after the event. The presence of myocardial oedema and late enhancement of the right ventricle were compared to infarct location (anterior vs. inferior), clinical data, ECG, echocardiography results and other CMR findings. The results were analysed statistically using the Student's t test for independent samples and the K statistic. Results Among the 97 patients included in the study, a diagnosis of right ventricular infarction was established in 12, 14 and 24 cases on the basis of the clinical data, the ECG and echocardiography, respectively. CMR demonstrated myocardial oedema and late enhancement of the right ventricle in 48 and 32 cases, respectively. The right ventricle was involved in 46 % of patients with inferior myocardial infarction (15/32) and in 30 % with anterior myocardial infarction (17/56), correlating to a worsening of both right and left ventricular performance (p = 0.001-0.05). Conclusions The right ventricle is frequently involved in myocardial infarction, correlating to a worse functional impairment of both ventricles and a worse prognosis. This finding, which is often underestimated by traditional cardiological tests, is well revealed by CMR, with potential clinical and therapeutic impact.
Insights into Imaging, 2013
Cardiovascular CT and MR Imaging, 2013
Radiology, 2013
To optimize intravoxel incoherent motion (IVIM) diffusion-weighted (DW) imaging by estimating the... more To optimize intravoxel incoherent motion (IVIM) diffusion-weighted (DW) imaging by estimating the effects of diffusion gradient polarity and breathing acquisition scheme on image quality, signal-to-noise ratio (SNR), IVIM parameters, and parameter reproducibility, as well as to investigate the potential of IVIM in the detection of hepatic fibrosis. In this institutional review board-approved prospective study, 20 subjects (seven healthy volunteers, 13 patients with hepatitis C virus infection; 14 men, six women; mean age, 46 years) underwent IVIM DW imaging with four sequences: (a) respiratory-triggered (RT) bipolar (BP) sequence, (b) RT monopolar (MP) sequence, (c) free-breathing (FB) BP sequence, and (d) FB MP sequence. Image quality scores were assessed for all sequences. A biexponential analysis with the Bayesian method yielded true diffusion coefficient (D), pseudodiffusion coefficient (D*), and perfusion fraction (PF) in liver parenchyma. Mixed-model analysis of variance was used to compare image quality, SNR, IVIM parameters, and interexamination variability between the four sequences, as well as the ability to differentiate areas of liver fibrosis from normal liver tissue. Image quality with RT sequences was superior to that with FB acquisitions (P = .02) and was not affected by gradient polarity. SNR did not vary significantly between sequences. IVIM parameter reproducibility was moderate to excellent for PF and D, while it was less reproducible for D*. PF and D were both significantly lower in patients with hepatitis C virus than in healthy volunteers with the RT BP sequence (PF = 13.5% ± 5.3 [standard deviation] vs 9.2% ± 2.5, P = .038; D = [1.16 ± 0.07] × 10(-3) mm(2)/sec vs [1.03 ± 0.1] × 10(-3) mm(2)/sec, P = .006). The RT BP DW imaging sequence had the best results in terms of image quality, reproducibility, and ability to discriminate between healthy and fibrotic liver with biexponential fitting.
European Journal of Cardio-Thoracic Surgery, 2012
Journal of Cardiovascular Magnetic Resonance, 2016
ABSTRACT PURPOSE Many systemic congenital disorders are associated with aortic abnormalities and ... more ABSTRACT PURPOSE Many systemic congenital disorders are associated with aortic abnormalities and MR Angiography could be considered for screening of this population. Our aim was to evaluate the feasibility of unenhanced MR angiography (UMRA) with steady-state free procession (SSFP) sequences for measurement of thoracic aorta diameters and detecting abnormalities, in comparison with standard contrast enhanced MR angiography (CEMRA), in a population of young patients with suspected congenital aortic anomalies. METHOD AND MATERIALS 70 consecutive young patients with suspected aortic abnormalities underwent UMRA and CEMRA in the same examination session. UMRA was performed using breath-hold ECG-gated SSFP sequences covering the whole chest volume in axial and coronal planes. CEMRA was performed with breath-hold 3D Flash sequences in oblique sagittal plane after administration of gadobenate dimeglumine (MultiHance, Bracco) at a dose of 0.1 mmol/kg. Assessment of image quality (3-point scale: insufficient, good, optimal) and measurement of Aortic diameter on both MR techniques was performed at the annulus, sinuses of Valsalva, sinotubular junction, ascending aorta, proximal and distal aortic arch and hiatus. The qualitative scores achieved with UMRA and CEMRA were compared using Wilcoxon’s signed ranked test. Bland-Altman analysis was used to determine inter-sequence agreement for measurements of all aortic diameters. The time for sequence acquisition was calculated. RESULTS Qualitative assessment revealed a better image quality of CEMRA at arch and descending aorta, whereas UMRA was better on aortic root, due to cardiosincronization. Bland-Altman analysis revealed high agreement between UMRA and CEMRA measurements at the ascending, arch and descending aorta (p<0.01). Disagreement in aortic diameters was noted at the level of the sinotubular junction, aortic root and annulus (p=0.10). Globally, UMRA required shorter acquisition times than CEMRA (1’23” vs. 9’34”). CONCLUSION UMRA performed with SSFP sequences allows reliable measurements of aortic diameters in comparison with standard CEMRA allowing shorter study times and avoiding discomfort and risk due to contrast agent administration. CLINICAL RELEVANCE/APPLICATION UMRA is a reliable method for aortic measurement and detection of vascular anomalies;faster,safer and cheaper than CEMRA, that is preferable to assess dubious abnormalities and atherosclerotic disease
ABSTRACT PURPOSE Pulmonary arterial hypertension (PAH) is a progressive disease of pulmonary arte... more ABSTRACT PURPOSE Pulmonary arterial hypertension (PAH) is a progressive disease of pulmonary arteries, characterized by elevated pulmonary vascular resistances, which results in severe right ventricular (RV) dysfunction due to increased RV afterload and myocardial remodeling. The aim of this study was to examine the relationship between morphological adaptive changes in myocardial remodeling (“concentric” vs “eccentric” hypertrophy), right ventricular ejection fraction (RVEF), presence of myocardial fibrosis (late enhancement, LE) and survival in patients with PH. METHOD AND MATERIALS 83 consecutive patients with PAH (56 idiopathic, 9 CHD-related, 16 secondary) underwent to clinical setting (NYHA class), right heart catheterization, cardiac magnetic resonance imaging, and 6-min walk testing at the baseline. MRI protocol included short axis and horizontal long axis cine-SSFP imaging and LE acquisitions after contrast-administration (0.1 mmol/kg Gd-BOPTA) in order to measure volumes and detect fibrosis.Population was divided in groups on the basis of median value of RV mass/diastolic volume ratio (Gr1 RV M/V<0.60, Gr2 RV M/V>0.60), RVEF ( RVEF<34%:GrA, >34%:GrB) and LE presence (y/n) and followed-up for deaths (average of 4.3+1.6 years). RESULTS Higher RV M/V ratio is associated to lower RV systolic and diastolic volume (respectively p=0,006 and <0,005) but similar RV mass (p=ns) compared to pts with RV M/V ratio below 0.60. Despite no significant differences in clinical status, effort capacity (6MWT) and hemodynamics between the two groups, Gr2 patients have a lower mortality according to Kaplan-Mayer curve (mean survivor time Gr1: 925dys, Gr2: 1339dys, p=0.008). Similarly, baseline RVEF was predictor of mortality (p= 0.002). DE was demonstrated in 74/85 pts and predominantly confined to RV insertion points (70/74). Multivariate analysis excluded negative impact of other CMR parameters as prognostic indicators of death in our population, including LE presence. CONCLUSION In PAH patients, RV hypertrophy and mild diastolic volume increase (high mass/volume ratio and high RVEF) is associated to low rate of deaths, suggesting a favorable prognostic role of this parameter. LE is observed in most PAH pts, but in our population a correlation with survival interval was not demonstrated. CLINICAL RELEVANCE/APPLICATION The type of RV remodelling (concentric vs eccentric hypertrophy) could be the expression of adequacy of adaptation in PAH, and have significant prognostic impact.
ABSTRACT PURPOSE Ulcerative coronary plaque typically requires prompt treatment. However, the pre... more ABSTRACT PURPOSE Ulcerative coronary plaque typically requires prompt treatment. However, the presence of a mild calcification can sometimes mimic ulcerative plaque at CT Angiography (CTA). The aim of this study was to evaluate the diagnostic benefit of prospective ECG-gated Calcium Scoring (CS) prior to ECG-gated Coronary CTA in the differentiation of calcified from ulcerative plaque. METHOD AND MATERIALS 137 consecutive patients with suspected coronary artery disease underwent a pre-contrast prospective CS scan followed post-contrast (iomeprol-400, 400 mgI/ml; Bracco) by retrospectively ECG-gated coronary CTA (Siemens Sensation Cardiac 64, detector collimation 64×0.6mm). Images were independently analyzed in two phases (post-contrast images only and then both pre- and post-contrast images together) by two experienced radiologists in terms of the detection of coronary plaques, their classification as calcified, mixed or soft, their differentiation as ulcerative or non-ulcerative, and the presence and quantification of stenosis. The findings from the first and second evaluations were then compared. Patients positive at CTA for coronary stenosis (>50% of the vessel caliber) or with ulcerative plaque underwent coronary Angiography (CA). RESULTS Readers 1 and 2 detected 271 (161 calcified; 78 mixed; 32 soft) and 275 (161 calcified; 78 mixed; 36 soft) coronary plaques, respectively. Seven and nine plaques (readers 1 and 2, respectively) were initially considered ulcerative based on the post-contrast scan alone but were correctly characterized as non-ulcerative after evaluating the pre- and post-contrast scans together. Comparison with CA was obtained in 47 patients with 72 plaques. CONCLUSION The diagnostic accuracy of coronary CTA for plaque characterization could be improved by the use of a pre-contrast CS scan, without a significant increase of radiation dose. CLINICAL RELEVANCE/APPLICATION At CTA sometimes the presence of a mild calcification within a coronary plaque can look like an ulcerative coronary plaque. CS prior to Coronary CTA can be crucial in coronary plaques characterization
Imaging of the Cardiovascular System, Thorax, and Abdomen, 2016
ABSTRACT PURPOSE Recent multi-detector Computed Tomography(MDCT)scanners thanks to a significant ... more ABSTRACT PURPOSE Recent multi-detector Computed Tomography(MDCT)scanners thanks to a significant increment of temporal resolution are considered a valid non-invasive tool for characterizing atherosclerotic plaque in coronary artery disease. Nevertheless coronary calcium remains a problem that prevents acceptance of MDCT as an alternative to invasive angiography.“Blooming”artifacts due to the presence of vascular calcium have also been linked to cardiac motion.Our pourpose was to determine whether plaque composition and motion related artifacts influence the diagnostic performance of 64-cCTA and DS-cCTA. METHOD AND MATERIALS MDCT examinations were performed in 129 patients. Ninety-four patients underwent 64-cCTA [Somaton Sensation, Siemens]and 35 underwent DS-cCTA[Somaton Definition]; 70 mL of 400mgI/mL;[Bracco]at 5 ml/s). Of these, 129 patients, 23 underwent both techniques because of stent follow-up. All patients also underwent QCA within 3 days of the 64-cCTA or DS-cCTA examination. All coronary segments were analyzed by two radiologists in terms of the technical adequacy of the procedure (i.e. presence/absence of cardiac motion artifacts), the presence and grade of coronary stenosis, and the composition of detected plaques. RESULTS Visualization of the entire coronary tree was achieved in all 35 patients who underwent DS-cCTA and in 92 of 94 patients who underwent 64-cCTA. The image quality was significantly higher at DS-cCTA(Wilcoxon’s test p=0.008).The sensitivity, specificity and overall accuracy for the detection of significant(>70%)stenosis was 0.76, 0.88 and 0.87, respectively for 64-cCTA and 0.84, 0.91 and 0.90, respectively, for DS-cCTA. The accuracy of both techniques was predominantly dependant on plaque composition and in both cases decreased progressively with an increase in plaque compositional density. Nevertheless, the accuracy of DS-cCTA was significantly higher than that of 64-cCTA for all types of plaque: soft plaque 0.95 vs 0.97(p=0.04); mixed plaque 0.94 vs 0.97(p=0.045); predominantly calcified 0.68 vs 0.77(p=0.032). CONCLUSION The presence of coronary calcified plaques significantly affects the diagnostic accuracy of MDCT and this is more evident at 64-cCTA than at DS-cCTA.The increased temporal resolution of DS-cCTA allows higher technical adequacy and greater diagnostic accuracy. CLINICAL RELEVANCE/APPLICATION The diagnostic accuracy of MDCT strongly reflects plaque composition and is negatively affected by calcification.
Journal of Cardiovascular Magnetic Resonance, 2016
The Journal of clinical endocrinology and metabolism, Jan 10, 2016
Visceral adiposity plays a significant role in cardiovascular risk. PDE5 inhibitors (PDE5i) can i... more Visceral adiposity plays a significant role in cardiovascular risk. PDE5 inhibitors (PDE5i) can improve cardiac function and insulin sensitivity in type 2 diabetes patients (T2DM). To investigate whether PDE5i affect visceral adipose tissue (VAT), specifically epicardial fat (EAT), and what mechanism is involved, using microarray-based profiling of pharmacologically modulated miRNAs. Randomized, double-blind, placebo-controlled study in T2DM. Patients & Intervention: 59 diabetic patients were randomized to receive 100 mg/d sildenafil or placebo for 12 weeks. Fat biopsies were collected in a subgroup of patients. In a parallel protocol, db/db mice were randomized to 12 weeks of sildenafil or vehicle, and VAT was collected. Main Outcomes and Measures: Anthropometric and metabolic parameters, EAT quantification through cardiac magnetic resonance imaging (CMR), array of 2005 circulating miRNAs, qPCR and flow cytometry of VAT. Compared to placebo, sildenafil reduced waist circumference (...
PloS one, 2015
Previous studies evaluating the progression of the necrotic wave in relation to heart rate were c... more Previous studies evaluating the progression of the necrotic wave in relation to heart rate were carried out only in animal models of ST-elevated myocardial infarction (STEMI). Aim of the study was to investigate changes of myocardial salvage in relation to different heart rates at hospital admission in timely reperfused patients with STEMI by using cardiovascular magnetic resonance (CMR). One hundred-eighty-seven patients with STEMI successfully and timely treated with primary coronary angioplasty underwent CMR five days after hospital admission. According to the heart rate at presentation, patients were subcategorized into 5 quintiles: <55 bpm (group I, n = 44), 55-64 bpm (group II, n = 35), 65-74 bpm (group III, n = 35), 75-84 bpm (group IV, n = 37), ≥85 bpm (group V, n = 36). Area at risk, infarct size, microvascular obstruction (MVO) and myocardium salvaged index (MSI) were assessed by CMR using standard sequences. Lower heart rates at presentation were associated with a bigg...
Expert Review of Clinical Immunology, 2015
Raynaud phenomenon (RP) is the hallmark of Systemic Sclerosis (SSc). Visceral RP has also been pr... more Raynaud phenomenon (RP) is the hallmark of Systemic Sclerosis (SSc). Visceral RP has also been proposed in SSc patients. Cardiac Raynaud&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s phenomenon (C-RP) was evaluated in a few clinical studies both as cold-induced transient myocardial ischaemia and as presence of advanced myocardial fibrosis and contraction band necrosis in autopsied patients. Until today numerous techniques, such as scintigraphy and myocardial contrast echocardiography, have been used to evaluate C-RP. In this case report for the first time we have used Cardiac Magnetic Resonance (CMR) after cold test to demonstrate the presence of the C-RP. In addition we have shown that therapy with Iloprost can be used to reduce episodes of C-RP.
Journal of Cardiovascular Magnetic Resonance, 2015
Journal of Cardiovascular Magnetic Resonance, 2015
Journal of Cardiovascular Magnetic Resonance, 2015
Imaging Cardiovascolare TC e RM, 2012
La radiologia medica, 2013
Purpose The aim of this work was to compare the prevalence of right ventricle involvement in a po... more Purpose The aim of this work was to compare the prevalence of right ventricle involvement in a population of patients with myocardial infarction as detected by cardiac magnetic resonance (CMR), clinical presentation, electrocardiographic (ECG) and echocardiographic criteria. Materials and methods A total of 97 consecutive patients, admitted to our institution for acute myocardial infarction, underwent a standard CMR examination within 5 days after the event. The presence of myocardial oedema and late enhancement of the right ventricle were compared to infarct location (anterior vs. inferior), clinical data, ECG, echocardiography results and other CMR findings. The results were analysed statistically using the Student's t test for independent samples and the K statistic. Results Among the 97 patients included in the study, a diagnosis of right ventricular infarction was established in 12, 14 and 24 cases on the basis of the clinical data, the ECG and echocardiography, respectively. CMR demonstrated myocardial oedema and late enhancement of the right ventricle in 48 and 32 cases, respectively. The right ventricle was involved in 46 % of patients with inferior myocardial infarction (15/32) and in 30 % with anterior myocardial infarction (17/56), correlating to a worsening of both right and left ventricular performance (p = 0.001-0.05). Conclusions The right ventricle is frequently involved in myocardial infarction, correlating to a worse functional impairment of both ventricles and a worse prognosis. This finding, which is often underestimated by traditional cardiological tests, is well revealed by CMR, with potential clinical and therapeutic impact.
Insights into Imaging, 2013
Cardiovascular CT and MR Imaging, 2013
Radiology, 2013
To optimize intravoxel incoherent motion (IVIM) diffusion-weighted (DW) imaging by estimating the... more To optimize intravoxel incoherent motion (IVIM) diffusion-weighted (DW) imaging by estimating the effects of diffusion gradient polarity and breathing acquisition scheme on image quality, signal-to-noise ratio (SNR), IVIM parameters, and parameter reproducibility, as well as to investigate the potential of IVIM in the detection of hepatic fibrosis. In this institutional review board-approved prospective study, 20 subjects (seven healthy volunteers, 13 patients with hepatitis C virus infection; 14 men, six women; mean age, 46 years) underwent IVIM DW imaging with four sequences: (a) respiratory-triggered (RT) bipolar (BP) sequence, (b) RT monopolar (MP) sequence, (c) free-breathing (FB) BP sequence, and (d) FB MP sequence. Image quality scores were assessed for all sequences. A biexponential analysis with the Bayesian method yielded true diffusion coefficient (D), pseudodiffusion coefficient (D*), and perfusion fraction (PF) in liver parenchyma. Mixed-model analysis of variance was used to compare image quality, SNR, IVIM parameters, and interexamination variability between the four sequences, as well as the ability to differentiate areas of liver fibrosis from normal liver tissue. Image quality with RT sequences was superior to that with FB acquisitions (P = .02) and was not affected by gradient polarity. SNR did not vary significantly between sequences. IVIM parameter reproducibility was moderate to excellent for PF and D, while it was less reproducible for D*. PF and D were both significantly lower in patients with hepatitis C virus than in healthy volunteers with the RT BP sequence (PF = 13.5% ± 5.3 [standard deviation] vs 9.2% ± 2.5, P = .038; D = [1.16 ± 0.07] × 10(-3) mm(2)/sec vs [1.03 ± 0.1] × 10(-3) mm(2)/sec, P = .006). The RT BP DW imaging sequence had the best results in terms of image quality, reproducibility, and ability to discriminate between healthy and fibrotic liver with biexponential fitting.
European Journal of Cardio-Thoracic Surgery, 2012