Roberto Favilli - Academia.edu (original) (raw)

Papers by Roberto Favilli

Research paper thumbnail of Correlation of Left Atrial Strain and Doppler Measurements with Invasive Measurement of Left Ventricular End-Diastolic Pressure in Patients Stratified for Different Values of Ejection Fraction

Echocardiography (Mount Kisco, N.Y.), Jan 23, 2015

This study aimed at exploring the correlation of left atrial longitudinal function by speckle tra... more This study aimed at exploring the correlation of left atrial longitudinal function by speckle tracking echocardiography (left atrial strain) and Doppler measurements (E/E' ratio) with direct measurements of left ventricular (LV) end-diastolic pressure (LVEDP) in patients stratified for different values of ejection fraction. The study population was 80 stable patients with sinus rhythm undergoing cardiac catheterization. This population was selected in order to have four groups of 20 patients each with different LV ejection fraction (>55%, 45-54%, 30-44%, and <30%). LVEDP was obtained during cardiac catheterization; peak atrial longitudinal strain (PALS) and mean E/E' ratio were measured in all subjects. Similar correlations with LVEDP of global PALS and E/E' ratio were recorded in patients with preserved (r = -0.79 vs. r = 0.72, respectively; P < 0.0001 for both) or mildly reduced ejection fraction (r = -0.75 vs. r = 0.73, respectively; P < 0.0001 for both). ...

Research paper thumbnail of Incessant ventricular tachycardia and concomitant recurrent left ventricular thrombus: to ablate or not to ablate?

Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, Jan 4, 2015

Research paper thumbnail of Effects of levosimendan without loading dose on systolic and diastolic function in patients with end-stage heart failure

Cardiology Journal, 2011

Levosimendan (L) is used in clinical practice for the treatment of severe heart failure (HF); it ... more Levosimendan (L) is used in clinical practice for the treatment of severe heart failure (HF); it has inotropic and vasodilatory effects, without increasing myocardial oxygen consumption. In acute HF, levosimendan improves hemodynamic parameters; previous studies have demonstrated that it has favorable effects on left ventricular (LV) diastolic function. The aim of our study was to evaluate the effect of on LV long-axis function that represents the earlier marker of diastolic dysfunction. We enrolled 41 patients (age 62 ± 12 years) admitted to our Department for acute HF, NYHA class IV and severe LV dysfunction. Twenty-six patients were treated with L (0.1 μg/kg/min ev for 24 h without loading dose) and 15 patients were treated with standard therapy (C). We evaluated clinical, blood exams and echocardiographic parameters at baseline and one week after L or C treatment. Baseline demographic, clinical and biochemical data were similar in both groups. After one week, the L group had shown a significant improvement in NYHA class and a reduction of pro-B-type natriuretic peptide (pro-BNP). In echocardiographic study, we observed an improvement in LV longitudinal function (p 〈 0.05) and LV ejection fraction (p 〈 0.05) with a reduction of E/E&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; (p 〈 0.05) in the L group. We divided the L group into ischemic and non- -ischemic patients and we demonstrated a significant increase in systolic function in the former. No differences were found between subgroups in diastolic function. L therapy, without loading dose, improves NYHA class and ventricular function in patients with acute HF; we believe that these prolonged hemodynamic effects are due to active metabolities of L.

Research paper thumbnail of Influence of aetiology on long-term effects of resynchronization on cardiac structure and function in patients treated with β-blockers

Journal of Cardiovascular Medicine, 2011

Cardiac resynchronization therapy (CRT) elicits more beneficial effects on left-ventricular (LV) ... more Cardiac resynchronization therapy (CRT) elicits more beneficial effects on left-ventricular (LV) structure and function, and long-term clinical outcomes in nonischemic heart failure patients. Rates of β-blocker use in recent heart failure trials are higher than in CRT trials and this may influence the response to CRT. This study examined the long-term effects of CRT on LV structure and function in New York Heart Association class III-IV β-blocker-treated patients. One hundred and four (41 ischemic and 63 nonischemic) CRT patients, who were receiving β-blockers before and throughout 12 months following device implantation, were retrospectively selected. Variations in echocardiographic parameters recorded before, and 6 and 12 months after CRT were analyzed. Selected patients were all stable on β-blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (97%) and diuretics (97%) before implantation. CRT was associated with significant improvements in LV morphological and systo-diastolic functional parameters at 6 months, with further improvements between 6 and 12 months seen in nonischemic patients only. Accordingly, rates of echocardiographic response to CRT were similar at 6 months but significantly higher in nonischemic patients after 1 year. The degree of reduction in LV diameters and volumes, and of increase in ejection fraction, was significantly larger in nonischemic patients at both 6 and 12 months. In addition, a significant reduction in LV mass and severity of mitral regurgitation was more evident in nonischemic patients both 6 and 12 months following CRT. Ischemic aetiology of heart failure is associated with less favorable long-term effects of CRT on LV structure and function despite the systematic use of β-blockers.

Research paper thumbnail of Unusual evolutionary electrocardiogram pattern in a white patient with apical hypertrophic cardiomyopathy

Journal of Cardiovascular Medicine, 2008

We report the case of a 85-year-old white woman diagnosed with apical hypertrophic cardiomyopathy... more We report the case of a 85-year-old white woman diagnosed with apical hypertrophic cardiomyopathy, in whom we observed an unusual progression of initial T waves inversion to a nearly normal electrocardiogram (EKG) to giant negative T waves and back to a nearly normal EKG.

Research paper thumbnail of Recovery from cardiomyopathy after abstinence from cocaine

The Lancet, 2007

Recovery from cardiomyopathy after abstinence from cocaine. By - Dr Valerio Zacà MD, Stefano Lung... more Recovery from cardiomyopathy after abstinence from cocaine. By - Dr Valerio Zacà MD, Stefano Lunghetti MD, Piercarlo Ballo MD, Marta Focardi MD, Roberto Favilli MD, Sergio Mondillo MD.

Research paper thumbnail of Neurohumoral improvement and torsional dynamics in patients with heart failure after treatment with levosimendan

IJC Heart & Vasculature, 2014

Research paper thumbnail of Subclinical myocardial dysfunction in Rett syndrome

European Heart Journal - Cardiovascular Imaging, 2011

Rett syndrome (RTT) is a rare neurodevelopmental disorder frequently linked to methyl-CpG-binding... more Rett syndrome (RTT) is a rare neurodevelopmental disorder frequently linked to methyl-CpG-binding protein 2 (MeCP2) gene mutations. RTT is associated with a 300-fold increased risk of sudden cardiac death. Rhythm abnormalities and cardiac dysautonomia do not to fully account for cardiac mortality. Conversely, heart function in RTT has not been explored to date. Recent data indicate a previously unrecognized role of MeCP2 in cardiomyocytes development. Besides, increased oxidative stress markers (OS) have been found in RTT. We hypothesized that (i) RTT patients present a subclinical biventricular dysfunction and (ii) the myocardial dysfunction correlate with OS.

Research paper thumbnail of Acute and Long-Term Efficacy and Safety of Sildenafil for the Treatment of Chronic Thromboembolic Pulmonary Hypertension in a Heart Transplant Recipient

Pharmacology, 2011

We report on the successful treatment with sildenafil of a unique case of severe chronic thromboe... more We report on the successful treatment with sildenafil of a unique case of severe chronic thromboembolic pulmonary hypertension which developed as a late complication in a 71-year-old heart transplant recipient, with focus on the potential therapeutic challenges encountered in the management of such a peculiar association of clinical conditions.

Research paper thumbnail of Effects of ω-3 PUFAs Supplementation on Myocardial Function and Oxidative Stress Markers in Typical Rett Syndrome

Mediators of Inflammation, 2014

Rett syndrome (RTT) is a devastating neurodevelopmental disorder with a 300-fold increased risk r... more Rett syndrome (RTT) is a devastating neurodevelopmental disorder with a 300-fold increased risk rate for sudden cardiac death. A subclinical myocardial biventricular dysfunction has been recently reported in RTT by our group and found to be associated with an enhanced oxidative stress (OS) status. Here, we tested the effects of the naturally occurring antioxidants -3 polyunsaturated fatty acids ( -3 PUFAs) on echocardiographic parameters and systemic OS markers in a population of RTT patients with the typical clinical form. A total of 66 RTT girls were evaluated, half of whom being treated for 12 months with a dietary supplementation of -3 PUFAs at high dosage (docosahexaenoic acid ∼71.9 ± 13.9 mg/kg b.w./day plus eicosapentaenoic acid ∼115.5 ± 22.4 mg/kg b.w./day) versus the remaining half untreated population. Echocardiographic systolic longitudinal parameters of both ventricles, but not biventricular diastolic measures, improved following -3 PUFAs supplementation, with a parallel decrease in the OS markers levels. No significant changes in the examined echocardiographic parameters nor in the OS markers were detectable in the untreated RTT population. Our data indicate that -3 PUFAs are able to improve the biventricular myocardial systolic function in RTT and that this functional gain is partially mediated through a regulation of the redox balance.

Research paper thumbnail of Profiling cardiac resynchronization therapy patients: responders, non-responders and those who cannot respond—The good, the bad and the ugly?

The International Journal of Cardiovascular Imaging, 2011

Cardiac resynchronization therapy (CRT) is an effective option for the management of heart failur... more Cardiac resynchronization therapy (CRT) is an effective option for the management of heart failure (HF) patients with left ventricular systolic dysfunction and prolongation of the QRS interval. Unfortunately, a variable proportion of eligible patients fail to benefit from this treatment, the so-called &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;non-responders&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;. Despite intensive investigations aimed at identifying reliable diagnostic tools, additional to standard criteria, for the selection of responders, partly due to the complexity and multi-factorial nature of the mechanism underlying response, no conclusive evidence is currently available about which of the many variables assessed may predict individual response and should be included in selection criteria. Accordingly, even if labeled as a non-responder, a patient should receive a CRT device being the certain risk of withholding the treatment more consistent than the potential risk of being a non-responder. However, a possible third profile of patients along with responders and non-responders is emerging consisting of a limited subset of individuals, mainly among those with HF of ischemic aetiology, who simply do not possess the anatomical requisite for conventional biventricular pacing to be effective. Such patients may be referred to as those who cannot respond to CRT and their identification is potentially feasible by integrating non-invasive imaging findings and of clinical relevance in the definition of the therapeutic strategy. In conclusion, this review will provide an analysis of gathered data about the selection of candidates to CRT beyond responders and non-responders with the perspective of the potential characterization of patients who cannot respond to CRT.

Research paper thumbnail of Right-sided heart failure in carcinoid syndrome

International Journal of Cardiology, 2007

We reported the case of a 63-year-old man with a history of carcinoid syndrome evaluated for an e... more We reported the case of a 63-year-old man with a history of carcinoid syndrome evaluated for an exertional dyspnoea. Two-dimensional echocardiogram showed the characteristic right-sided cardiac valves involvement associated with this uncommon enterochromaffin malignancy.

Research paper thumbnail of Acute ST elevation myocardial infarction in pregnancy due to coronary vasospasm: A case report and review of literature

International Journal of Cardiology, 2007

Acute myocardial infarction during pregnancy is rare but may be associated with high risk complic... more Acute myocardial infarction during pregnancy is rare but may be associated with high risk complications. We present a very rare case about an acute myocardial infarction with anterior ST elevation in a 40-year-old woman, at 38th week of gestational period. The coronary arteriograms showed a diffuse left coronary vasospasm. The coronary arteriography at puerperium showed no organic narrowings. This is the first case with a well documented coronary artery vasospasm in pregnancy. Management should follow the usual principles of care for acute myocardial infarction. However, selection of diagnostic and therapeutic approaches may be greatly influenced by fetal safety.

Research paper thumbnail of Chest x rays illustrating successful resynchronisation therapy

Heart, 2005

Objective: To determine in women with surgically corrected tetralogy of Fallot the risk of pregna... more Objective: To determine in women with surgically corrected tetralogy of Fallot the risk of pregnancy for mother and fetus, whether fertility was compromised, and the recurrence risk of congenital heart disease. Design: Data were collected from 83 patients through interviews and review of medical records. Results: In 29 patients 63 pregnancies were observed, of which 13 ended in an abortion. Fifty successful pregnancies were observed in 26 patients. During six successful pregnancies (12%) complications (symptomatic right sided heart failure, arrhythmias, or both) occurred. Both patients who developed symptomatic heart failure had severe pulmonary regurgitation. No clear relation between offspring mortality, premature birth or being small for gestational age, and cardiac characteristics of the mother was identified. Fifty seven patients were childless (41 (72%) voluntarily). Recurrence risk for congenital heart disease was 2.2%. Infertility was uncommon. Conclusions: Although complications did occur in five of 26 (19%) of the patients with a corrected tetralogy of Fallot, pregnancy was generally well tolerated in this largest report so far. No obvious predictors for maternal events or child outcome were determined, except for a possible relation between severe pulmonary regurgitation and symptomatic heart failure. Pulmonary valve replacement before pregnancy may be considered for patients with severe pulmonary regurgitation.

Research paper thumbnail of Takotsubo cardiomyopathy in a Caucasian Italian woman: Case report

Cardiovascular Ultrasound, 2007

Background: Takotsubo cardiomyopathy is an acute cardiac syndrome characterized by transient LV r... more Background: Takotsubo cardiomyopathy is an acute cardiac syndrome characterized by transient LV regional wall motion abnormalities (with peculiar apical ballooning appearance), chest pain or dyspnea, ST-segment elevation and minor elevations of cardiac enzyme levels Case presentation: A 68-year-old woman was admitted to the Emergency Department because of sudden onset chest pain occurred while transferring her daughter, who had earlier suffered a major seizure, to the hospital. The EKG showed sinus tachycardia with ST-segment elevation in leads V2-V3 and ST-segment depression in leads V5-V6, she was, thus, referred for emergency coronary angiography. A pre-procedural transthoracic echocardiogram revealed regional systolic dysfunction of the LV walls with hypokinesis of the mid-apical segments and hyperkinesis of the basal segments. Coronary angiography showed patent epicardial coronary arteries; LV angiography demonstrated the characteristic morphology of apical ballooning with hyperkinesis of the basal segments and hypokinesis of the mid-apical segments. The post-procedural course was uneventful; on day 5 after admission the echocardiogram revealed full recovery of apical and mid-ventricular regional wall-motion abnormalities.

Research paper thumbnail of Usefulness of Left Ventricular Diastolic Dysfunction Assessed by Pulsed Tissue Doppler Imaging as a Predictor of Atrial Fibrillation Recurrence After Successful Electrical Cardioversion

The American Journal of Cardiology, 2011

The impact of left ventricular (LV) diastolic dysfunction on risk of atrial fibrillation (AF) rec... more The impact of left ventricular (LV) diastolic dysfunction on risk of atrial fibrillation (AF) recurrence is still unknown. The aim of this study was to assess the role of LV diastolic dysfunction in predicting AF recurrence after successful electrical cardioversion in patients with nonvalvular AF. In 51 patients with a first episode of nonvalvular AF undergoing successful electrical cardioversion, tissue Doppler echocardiography was performed to measure peak early diastolic mitral annulus velocity (E m ) and the ratio of mitral inflow to mitral annulus velocity at end-diastole (E/E m ). Clinical end points were recurrent persistent AF at 2-week follow-up (early AF recurrence [ERAF]) and at 1-year follow-up (including ERAF and late AF recurrence). Seventeen patients showed evidence of ERAF, whereas late AF recurrence occurred in another 5 patients. In time-independent analysis E/E m (odds ratio [OR] 1.746, p ‫؍‬ 0.0084) and indexed LV end-systolic volume (OR 1.083, p ‫؍‬ 0.040) were independent predictors of ERAF. Based on a logistic model risk of ERAF was 25% for an E/E m of 5.6 but increased to 50% for an E/E m of 8.1 and to 75% for an E/E m of 10.5. In time-dependent analysis E/E m emerged as the only predictor of ERAF (OR 1.757, p ‫؍‬ 0.0078). E/E m also independently predicted risk of recurrence at 1 year in time-independent (OR 1.757, p ‫؍‬ 0.0078) and time-dependent (OR 1.319, p ‫؍‬ 0.0003) analyses. In conclusion LV diastolic dysfunction independently predicts AF recurrence in patients with nonvalvular AF undergoing successful electrical cardioversion.

Research paper thumbnail of Cardiogenic shock complicating myocardial infarction and outcome following percutaneous coronary intervention

Acute Cardiac Care, 2008

Cardiogenic shock is the commonest cause of death in acute myocardial infarction (AMI). Although ... more Cardiogenic shock is the commonest cause of death in acute myocardial infarction (AMI). Although the syndrome of cardiogenic shock complicating AMI is common to all, the spectrum of underlying pathology is broad. While thrombolysis can be attempted with inotropic support or augmentation of blood pressure with an intra-aortic balloon pump, the greatest mortality benefit is seen after urgent coronary angiography and early revascularization. The long-term SHOCK Trial six-year follow-up results confirm durability of early revascularization over medical stabilization in shock patients. Indeed, cardiogenic shock is a catheter laboratory emergency. Percutaneous left ventricular assist devices may provide an advance in the management of patients with left ventricular dysfunction and cardiogenic shock.

Research paper thumbnail of Correlation of Left Atrial Strain and Doppler Measurements with Invasive Measurement of Left Ventricular End-Diastolic Pressure in Patients Stratified for Different Values of Ejection Fraction

Echocardiography (Mount Kisco, N.Y.), Jan 23, 2015

This study aimed at exploring the correlation of left atrial longitudinal function by speckle tra... more This study aimed at exploring the correlation of left atrial longitudinal function by speckle tracking echocardiography (left atrial strain) and Doppler measurements (E/E' ratio) with direct measurements of left ventricular (LV) end-diastolic pressure (LVEDP) in patients stratified for different values of ejection fraction. The study population was 80 stable patients with sinus rhythm undergoing cardiac catheterization. This population was selected in order to have four groups of 20 patients each with different LV ejection fraction (>55%, 45-54%, 30-44%, and <30%). LVEDP was obtained during cardiac catheterization; peak atrial longitudinal strain (PALS) and mean E/E' ratio were measured in all subjects. Similar correlations with LVEDP of global PALS and E/E' ratio were recorded in patients with preserved (r = -0.79 vs. r = 0.72, respectively; P < 0.0001 for both) or mildly reduced ejection fraction (r = -0.75 vs. r = 0.73, respectively; P < 0.0001 for both). ...

Research paper thumbnail of Incessant ventricular tachycardia and concomitant recurrent left ventricular thrombus: to ablate or not to ablate?

Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, Jan 4, 2015

Research paper thumbnail of Effects of levosimendan without loading dose on systolic and diastolic function in patients with end-stage heart failure

Cardiology Journal, 2011

Levosimendan (L) is used in clinical practice for the treatment of severe heart failure (HF); it ... more Levosimendan (L) is used in clinical practice for the treatment of severe heart failure (HF); it has inotropic and vasodilatory effects, without increasing myocardial oxygen consumption. In acute HF, levosimendan improves hemodynamic parameters; previous studies have demonstrated that it has favorable effects on left ventricular (LV) diastolic function. The aim of our study was to evaluate the effect of on LV long-axis function that represents the earlier marker of diastolic dysfunction. We enrolled 41 patients (age 62 ± 12 years) admitted to our Department for acute HF, NYHA class IV and severe LV dysfunction. Twenty-six patients were treated with L (0.1 μg/kg/min ev for 24 h without loading dose) and 15 patients were treated with standard therapy (C). We evaluated clinical, blood exams and echocardiographic parameters at baseline and one week after L or C treatment. Baseline demographic, clinical and biochemical data were similar in both groups. After one week, the L group had shown a significant improvement in NYHA class and a reduction of pro-B-type natriuretic peptide (pro-BNP). In echocardiographic study, we observed an improvement in LV longitudinal function (p 〈 0.05) and LV ejection fraction (p 〈 0.05) with a reduction of E/E&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; (p 〈 0.05) in the L group. We divided the L group into ischemic and non- -ischemic patients and we demonstrated a significant increase in systolic function in the former. No differences were found between subgroups in diastolic function. L therapy, without loading dose, improves NYHA class and ventricular function in patients with acute HF; we believe that these prolonged hemodynamic effects are due to active metabolities of L.

Research paper thumbnail of Influence of aetiology on long-term effects of resynchronization on cardiac structure and function in patients treated with β-blockers

Journal of Cardiovascular Medicine, 2011

Cardiac resynchronization therapy (CRT) elicits more beneficial effects on left-ventricular (LV) ... more Cardiac resynchronization therapy (CRT) elicits more beneficial effects on left-ventricular (LV) structure and function, and long-term clinical outcomes in nonischemic heart failure patients. Rates of β-blocker use in recent heart failure trials are higher than in CRT trials and this may influence the response to CRT. This study examined the long-term effects of CRT on LV structure and function in New York Heart Association class III-IV β-blocker-treated patients. One hundred and four (41 ischemic and 63 nonischemic) CRT patients, who were receiving β-blockers before and throughout 12 months following device implantation, were retrospectively selected. Variations in echocardiographic parameters recorded before, and 6 and 12 months after CRT were analyzed. Selected patients were all stable on β-blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (97%) and diuretics (97%) before implantation. CRT was associated with significant improvements in LV morphological and systo-diastolic functional parameters at 6 months, with further improvements between 6 and 12 months seen in nonischemic patients only. Accordingly, rates of echocardiographic response to CRT were similar at 6 months but significantly higher in nonischemic patients after 1 year. The degree of reduction in LV diameters and volumes, and of increase in ejection fraction, was significantly larger in nonischemic patients at both 6 and 12 months. In addition, a significant reduction in LV mass and severity of mitral regurgitation was more evident in nonischemic patients both 6 and 12 months following CRT. Ischemic aetiology of heart failure is associated with less favorable long-term effects of CRT on LV structure and function despite the systematic use of β-blockers.

Research paper thumbnail of Unusual evolutionary electrocardiogram pattern in a white patient with apical hypertrophic cardiomyopathy

Journal of Cardiovascular Medicine, 2008

We report the case of a 85-year-old white woman diagnosed with apical hypertrophic cardiomyopathy... more We report the case of a 85-year-old white woman diagnosed with apical hypertrophic cardiomyopathy, in whom we observed an unusual progression of initial T waves inversion to a nearly normal electrocardiogram (EKG) to giant negative T waves and back to a nearly normal EKG.

Research paper thumbnail of Recovery from cardiomyopathy after abstinence from cocaine

The Lancet, 2007

Recovery from cardiomyopathy after abstinence from cocaine. By - Dr Valerio Zacà MD, Stefano Lung... more Recovery from cardiomyopathy after abstinence from cocaine. By - Dr Valerio Zacà MD, Stefano Lunghetti MD, Piercarlo Ballo MD, Marta Focardi MD, Roberto Favilli MD, Sergio Mondillo MD.

Research paper thumbnail of Neurohumoral improvement and torsional dynamics in patients with heart failure after treatment with levosimendan

IJC Heart & Vasculature, 2014

Research paper thumbnail of Subclinical myocardial dysfunction in Rett syndrome

European Heart Journal - Cardiovascular Imaging, 2011

Rett syndrome (RTT) is a rare neurodevelopmental disorder frequently linked to methyl-CpG-binding... more Rett syndrome (RTT) is a rare neurodevelopmental disorder frequently linked to methyl-CpG-binding protein 2 (MeCP2) gene mutations. RTT is associated with a 300-fold increased risk of sudden cardiac death. Rhythm abnormalities and cardiac dysautonomia do not to fully account for cardiac mortality. Conversely, heart function in RTT has not been explored to date. Recent data indicate a previously unrecognized role of MeCP2 in cardiomyocytes development. Besides, increased oxidative stress markers (OS) have been found in RTT. We hypothesized that (i) RTT patients present a subclinical biventricular dysfunction and (ii) the myocardial dysfunction correlate with OS.

Research paper thumbnail of Acute and Long-Term Efficacy and Safety of Sildenafil for the Treatment of Chronic Thromboembolic Pulmonary Hypertension in a Heart Transplant Recipient

Pharmacology, 2011

We report on the successful treatment with sildenafil of a unique case of severe chronic thromboe... more We report on the successful treatment with sildenafil of a unique case of severe chronic thromboembolic pulmonary hypertension which developed as a late complication in a 71-year-old heart transplant recipient, with focus on the potential therapeutic challenges encountered in the management of such a peculiar association of clinical conditions.

Research paper thumbnail of Effects of ω-3 PUFAs Supplementation on Myocardial Function and Oxidative Stress Markers in Typical Rett Syndrome

Mediators of Inflammation, 2014

Rett syndrome (RTT) is a devastating neurodevelopmental disorder with a 300-fold increased risk r... more Rett syndrome (RTT) is a devastating neurodevelopmental disorder with a 300-fold increased risk rate for sudden cardiac death. A subclinical myocardial biventricular dysfunction has been recently reported in RTT by our group and found to be associated with an enhanced oxidative stress (OS) status. Here, we tested the effects of the naturally occurring antioxidants -3 polyunsaturated fatty acids ( -3 PUFAs) on echocardiographic parameters and systemic OS markers in a population of RTT patients with the typical clinical form. A total of 66 RTT girls were evaluated, half of whom being treated for 12 months with a dietary supplementation of -3 PUFAs at high dosage (docosahexaenoic acid ∼71.9 ± 13.9 mg/kg b.w./day plus eicosapentaenoic acid ∼115.5 ± 22.4 mg/kg b.w./day) versus the remaining half untreated population. Echocardiographic systolic longitudinal parameters of both ventricles, but not biventricular diastolic measures, improved following -3 PUFAs supplementation, with a parallel decrease in the OS markers levels. No significant changes in the examined echocardiographic parameters nor in the OS markers were detectable in the untreated RTT population. Our data indicate that -3 PUFAs are able to improve the biventricular myocardial systolic function in RTT and that this functional gain is partially mediated through a regulation of the redox balance.

Research paper thumbnail of Profiling cardiac resynchronization therapy patients: responders, non-responders and those who cannot respond—The good, the bad and the ugly?

The International Journal of Cardiovascular Imaging, 2011

Cardiac resynchronization therapy (CRT) is an effective option for the management of heart failur... more Cardiac resynchronization therapy (CRT) is an effective option for the management of heart failure (HF) patients with left ventricular systolic dysfunction and prolongation of the QRS interval. Unfortunately, a variable proportion of eligible patients fail to benefit from this treatment, the so-called &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;non-responders&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;. Despite intensive investigations aimed at identifying reliable diagnostic tools, additional to standard criteria, for the selection of responders, partly due to the complexity and multi-factorial nature of the mechanism underlying response, no conclusive evidence is currently available about which of the many variables assessed may predict individual response and should be included in selection criteria. Accordingly, even if labeled as a non-responder, a patient should receive a CRT device being the certain risk of withholding the treatment more consistent than the potential risk of being a non-responder. However, a possible third profile of patients along with responders and non-responders is emerging consisting of a limited subset of individuals, mainly among those with HF of ischemic aetiology, who simply do not possess the anatomical requisite for conventional biventricular pacing to be effective. Such patients may be referred to as those who cannot respond to CRT and their identification is potentially feasible by integrating non-invasive imaging findings and of clinical relevance in the definition of the therapeutic strategy. In conclusion, this review will provide an analysis of gathered data about the selection of candidates to CRT beyond responders and non-responders with the perspective of the potential characterization of patients who cannot respond to CRT.

Research paper thumbnail of Right-sided heart failure in carcinoid syndrome

International Journal of Cardiology, 2007

We reported the case of a 63-year-old man with a history of carcinoid syndrome evaluated for an e... more We reported the case of a 63-year-old man with a history of carcinoid syndrome evaluated for an exertional dyspnoea. Two-dimensional echocardiogram showed the characteristic right-sided cardiac valves involvement associated with this uncommon enterochromaffin malignancy.

Research paper thumbnail of Acute ST elevation myocardial infarction in pregnancy due to coronary vasospasm: A case report and review of literature

International Journal of Cardiology, 2007

Acute myocardial infarction during pregnancy is rare but may be associated with high risk complic... more Acute myocardial infarction during pregnancy is rare but may be associated with high risk complications. We present a very rare case about an acute myocardial infarction with anterior ST elevation in a 40-year-old woman, at 38th week of gestational period. The coronary arteriograms showed a diffuse left coronary vasospasm. The coronary arteriography at puerperium showed no organic narrowings. This is the first case with a well documented coronary artery vasospasm in pregnancy. Management should follow the usual principles of care for acute myocardial infarction. However, selection of diagnostic and therapeutic approaches may be greatly influenced by fetal safety.

Research paper thumbnail of Chest x rays illustrating successful resynchronisation therapy

Heart, 2005

Objective: To determine in women with surgically corrected tetralogy of Fallot the risk of pregna... more Objective: To determine in women with surgically corrected tetralogy of Fallot the risk of pregnancy for mother and fetus, whether fertility was compromised, and the recurrence risk of congenital heart disease. Design: Data were collected from 83 patients through interviews and review of medical records. Results: In 29 patients 63 pregnancies were observed, of which 13 ended in an abortion. Fifty successful pregnancies were observed in 26 patients. During six successful pregnancies (12%) complications (symptomatic right sided heart failure, arrhythmias, or both) occurred. Both patients who developed symptomatic heart failure had severe pulmonary regurgitation. No clear relation between offspring mortality, premature birth or being small for gestational age, and cardiac characteristics of the mother was identified. Fifty seven patients were childless (41 (72%) voluntarily). Recurrence risk for congenital heart disease was 2.2%. Infertility was uncommon. Conclusions: Although complications did occur in five of 26 (19%) of the patients with a corrected tetralogy of Fallot, pregnancy was generally well tolerated in this largest report so far. No obvious predictors for maternal events or child outcome were determined, except for a possible relation between severe pulmonary regurgitation and symptomatic heart failure. Pulmonary valve replacement before pregnancy may be considered for patients with severe pulmonary regurgitation.

Research paper thumbnail of Takotsubo cardiomyopathy in a Caucasian Italian woman: Case report

Cardiovascular Ultrasound, 2007

Background: Takotsubo cardiomyopathy is an acute cardiac syndrome characterized by transient LV r... more Background: Takotsubo cardiomyopathy is an acute cardiac syndrome characterized by transient LV regional wall motion abnormalities (with peculiar apical ballooning appearance), chest pain or dyspnea, ST-segment elevation and minor elevations of cardiac enzyme levels Case presentation: A 68-year-old woman was admitted to the Emergency Department because of sudden onset chest pain occurred while transferring her daughter, who had earlier suffered a major seizure, to the hospital. The EKG showed sinus tachycardia with ST-segment elevation in leads V2-V3 and ST-segment depression in leads V5-V6, she was, thus, referred for emergency coronary angiography. A pre-procedural transthoracic echocardiogram revealed regional systolic dysfunction of the LV walls with hypokinesis of the mid-apical segments and hyperkinesis of the basal segments. Coronary angiography showed patent epicardial coronary arteries; LV angiography demonstrated the characteristic morphology of apical ballooning with hyperkinesis of the basal segments and hypokinesis of the mid-apical segments. The post-procedural course was uneventful; on day 5 after admission the echocardiogram revealed full recovery of apical and mid-ventricular regional wall-motion abnormalities.

Research paper thumbnail of Usefulness of Left Ventricular Diastolic Dysfunction Assessed by Pulsed Tissue Doppler Imaging as a Predictor of Atrial Fibrillation Recurrence After Successful Electrical Cardioversion

The American Journal of Cardiology, 2011

The impact of left ventricular (LV) diastolic dysfunction on risk of atrial fibrillation (AF) rec... more The impact of left ventricular (LV) diastolic dysfunction on risk of atrial fibrillation (AF) recurrence is still unknown. The aim of this study was to assess the role of LV diastolic dysfunction in predicting AF recurrence after successful electrical cardioversion in patients with nonvalvular AF. In 51 patients with a first episode of nonvalvular AF undergoing successful electrical cardioversion, tissue Doppler echocardiography was performed to measure peak early diastolic mitral annulus velocity (E m ) and the ratio of mitral inflow to mitral annulus velocity at end-diastole (E/E m ). Clinical end points were recurrent persistent AF at 2-week follow-up (early AF recurrence [ERAF]) and at 1-year follow-up (including ERAF and late AF recurrence). Seventeen patients showed evidence of ERAF, whereas late AF recurrence occurred in another 5 patients. In time-independent analysis E/E m (odds ratio [OR] 1.746, p ‫؍‬ 0.0084) and indexed LV end-systolic volume (OR 1.083, p ‫؍‬ 0.040) were independent predictors of ERAF. Based on a logistic model risk of ERAF was 25% for an E/E m of 5.6 but increased to 50% for an E/E m of 8.1 and to 75% for an E/E m of 10.5. In time-dependent analysis E/E m emerged as the only predictor of ERAF (OR 1.757, p ‫؍‬ 0.0078). E/E m also independently predicted risk of recurrence at 1 year in time-independent (OR 1.757, p ‫؍‬ 0.0078) and time-dependent (OR 1.319, p ‫؍‬ 0.0003) analyses. In conclusion LV diastolic dysfunction independently predicts AF recurrence in patients with nonvalvular AF undergoing successful electrical cardioversion.

Research paper thumbnail of Cardiogenic shock complicating myocardial infarction and outcome following percutaneous coronary intervention

Acute Cardiac Care, 2008

Cardiogenic shock is the commonest cause of death in acute myocardial infarction (AMI). Although ... more Cardiogenic shock is the commonest cause of death in acute myocardial infarction (AMI). Although the syndrome of cardiogenic shock complicating AMI is common to all, the spectrum of underlying pathology is broad. While thrombolysis can be attempted with inotropic support or augmentation of blood pressure with an intra-aortic balloon pump, the greatest mortality benefit is seen after urgent coronary angiography and early revascularization. The long-term SHOCK Trial six-year follow-up results confirm durability of early revascularization over medical stabilization in shock patients. Indeed, cardiogenic shock is a catheter laboratory emergency. Percutaneous left ventricular assist devices may provide an advance in the management of patients with left ventricular dysfunction and cardiogenic shock.