Vincenzo Guido - Profile on Academia.edu (original) (raw)
Papers by Vincenzo Guido
European Journal of Echocardiography, 2003
Patients 5
<b>Copyright information:</b>Taken from "Distal left circumflex coronary artery ... more <b>Copyright information:</b>Taken from "Distal left circumflex coronary artery flow reserve recorded by transthoracic Doppler echocardiography: a comparison with Doppler-wire"http://www.cardiovascularultrasound.com/content/5/1/22Cardiovascular Ultrasound 2007;5():22-22.Published online 16 Jun 2007PMCID:PMC1910594. A: TTDE before adenosine. B: TTDE after adenosine. C: DW recording. D: coronary angiography with site of DW recording (arrow). .
Patients 4
<b>Copyright information:</b>Taken from "Distal left circumflex coronary artery ... more <b>Copyright information:</b>Taken from "Distal left circumflex coronary artery flow reserve recorded by transthoracic Doppler echocardiography: a comparison with Doppler-wire"http://www.cardiovascularultrasound.com/content/5/1/22Cardiovascular Ultrasound 2007;5():22-22.Published online 16 Jun 2007PMCID:PMC1910594. A: TTDE before adenosine. B: TTDE after adenosine. C: DW recording. D: coronary angiography with site of DW recording (arrow). .
Patients 3
<b>Copyright information:</b>Taken from "Distal left circumflex coronary artery ... more <b>Copyright information:</b>Taken from "Distal left circumflex coronary artery flow reserve recorded by transthoracic Doppler echocardiography: a comparison with Doppler-wire"http://www.cardiovascularultrasound.com/content/5/1/22Cardiovascular Ultrasound 2007;5():22-22.Published online 16 Jun 2007PMCID:PMC1910594. A: TTDE before adenosine. B: TTDE after adenosine. C: DW recording. D: coronary angiography with site of DW recording (arrow). .
Patients 1
<b>Copyright information:</b>Taken from "Distal left circumflex coronary artery ... more <b>Copyright information:</b>Taken from "Distal left circumflex coronary artery flow reserve recorded by transthoracic Doppler echocardiography: a comparison with Doppler-wire"http://www.cardiovascularultrasound.com/content/5/1/22Cardiovascular Ultrasound 2007;5():22-22.Published online 16 Jun 2007PMCID:PMC1910594. A: TTDE before adenosine. B: TTDE after adenosine. C: DW recording. D: coronary angiography with site of DW recording (arrow). .
Color flow mapping of the coronary artery on the lateral wall (arrow)
<b>Copyright information:</b>Taken from "Distal left circumflex coronary artery ... more <b>Copyright information:</b>Taken from "Distal left circumflex coronary artery flow reserve recorded by transthoracic Doppler echocardiography: a comparison with Doppler-wire"http://www.cardiovascularultrasound.com/content/5/1/22Cardiovascular Ultrasound 2007;5():22-22.Published online 16 Jun 2007PMCID:PMC1910594.
Plan of section of LCx branches made by the four-chamber view
<b>Copyright information:</b>Taken from "Distal left circumflex coronary artery ... more <b>Copyright information:</b>Taken from "Distal left circumflex coronary artery flow reserve recorded by transthoracic Doppler echocardiography: a comparison with Doppler-wire"http://www.cardiovascularultrasound.com/content/5/1/22Cardiovascular Ultrasound 2007;5():22-22.Published online 16 Jun 2007PMCID:PMC1910594. .
[Role of multimodality imaging in the clinical evaluation of hypertrophic cardiomyopathy]
Giornale italiano di cardiologia, 2019
Sarcomeric hypertrophic cardiomyopathy is the most common cardiovascular genetic disease. Clinica... more Sarcomeric hypertrophic cardiomyopathy is the most common cardiovascular genetic disease. Clinical evaluation and comprehensive echocardiography are crucial for the diagnosis and early evaluation of the hypertrophic phenotype, but multimodality imaging approach is often required to better define diagnosis and differential diagnosis from phenocopies. This review aims to assess the role of multimodality imaging and, in particular, advanced echocardiography and cardiac magnetic resonance in relation to differential diagnosis and preclinical diagnosis, identification of different phenotypes, and assessment of disease progression and risk of sudden cardiac death. A multimodality imaging approach is also crucial for the selection of patients amenable to surgical or percutaneous septal myectomy and for guiding both procedures.
![Research paper thumbnail of [ANMCO/SICI-GISE/SIC/SIECVI/SIRM Consensus document: Appropriateness of multimodality imaging in cardiovascular disease]](https://attachments.academia-assets.com/95672637/thumbnails/1.jpg)
](Giornale italiano di cardiologia, 2020
The complexity of cardiovascular diseases has led to an extensive use of technological instrument... more The complexity of cardiovascular diseases has led to an extensive use of technological instruments and the development of multimodality imaging. This extensive use of different cardiovascular imaging tests in the same patient has increased costs and waiting times.The concept of appropriateness has changed over time. Appropriateness criteria address the need for specific cardiovascular imaging tests in well-defined clinical scenarios, and define the kind of cardiovascular imaging that is appropriated for each clinical scenario in different stages of the disease. The concept of appropriateness criteria has replaced the old idea of appropriate use criteria and reflects the increasing effort of the international Scientific Societies to create and review in a critical way the management of diagnostic tests used by clinicians.The aim of this Italian consensus document is to address the use of multimodality imaging in the diagnosis and management of the major cardiovascular clinical scenar...
IMAGE SECTION Section Editor: Giant Vegetation of the Mitral Valve Simulating Primary Cardiac Tumor
Echocardiography
A case of a giant vegetation of the mitral valve causing sudden death of the patient is reported.... more A case of a giant vegetation of the mitral valve causing sudden death of the patient is reported. The case underlines that urgent removal of a big mass must always be considered because of the risk of sudden death or catastrophic embolism. Echocardiographic differential diagnosis of a mass is discussed and is crucial for the choice of the strategy. (ECHOCARDIOGRAPHY, Volume 21, February 2004) mitral valve, endocarditis, mass, transesophageal, echocardiography
Additional predictive value of heart rate variability in high-risk patients surviving an acute myocardial infarction
Cardiologia (Rome, Italy)
The aim of this study was to investigate the usefulness of heart rate variability (HRV) in predic... more The aim of this study was to investigate the usefulness of heart rate variability (HRV) in predicting cardiac mortality in patients with a recent acute myocardial infarction at high risk of events. Time- and frequency-domain HRV was assessed on 24-hour pre-discharge Holter recording of 81 patients (mean age 65 +/- 10 years, 76.5% males) with 1) a recent acute myocardial infarction, and 2) left ventricular ejection fraction < 40% and/or a number of premature ventricular beats > or = 10/hour. There were 15 total cardiac deaths (18.5%) in a follow-up time of 29 +/- 15 months (range 6 to 48 months), with sudden death occurring in 11 patients (13.6%). Median values of low frequency (LF) were lower in patients with, compared to those without, total (p = 0.04) and sudden (p = 0.02) cardiac death. Similarly the low frequency/high frequency (LF/HF) ratio was lower in patients with fatal events (p = 0.03 and p = 0.02, respectively). Furthermore, mean of the standard deviations of all RR...
European Journal of Echocardiography, 2003
Aims: Recording coronary arteries' flow by transthoracic Doppler echocardiography (TTDE) is a new... more Aims: Recording coronary arteries' flow by transthoracic Doppler echocardiography (TTDE) is a new task. Despite several studies concerning the left anterior descending artery (LAD) exist, the same for posterior descending coronary artery (PD) do not. Reported feasibility is not more than 76%. The aim of the study was to try to improve feasibility by using an additional two-dimensional view as a guide. Methods and Results: PD flow recording was performed in 35 consecutive unselected patients under the guidance of the usual two-dimensional modified view [a two-chamber view (2-C)], and with a new four-chamber modified view (4-C). A semi-quantitative growing-quality score (from 0 to 3 points) to the trace was given. Contrast enhancement was used if PD was not visualized without it. The overall feasibility was 80%. A good or very good velocity signal (TTDE score !2) was observed in 48% of patients without contrast enhancement. Time for first visualization of PD was short and significantly lower in 2-C than in 4-C (66 AE 39 vs 90 AE 70 s, respectively, P < 0:05). Conclusions: TTDE recording of PD flow gained better feasibility being guided by two views. Maximal time for first visualization of PD was less than 3 min.
High Blood Pressure & Cardiovascular Prevention, 2003
Aim: To assess the usefulness of ambulatory blood pressure monitoring (ABPM) in the prognostic st... more Aim: To assess the usefulness of ambulatory blood pressure monitoring (ABPM) in the prognostic stratification of patients with a recent myocardial infarction. Method: The study population included 75 patients consecutively admitted at our institution for acute ST-segment elevation myocardial infarction (STEMI). All patients underwent ABPM 3 weeks after discharge and were subsequently followed for 12 months. Results: The age (Y), mean 24-hour diastolic blood pressure (mDBP) and mean 24-hour beat-to-beat interval (mBBI) values were found to be independent predictors of the combined endpoint of cardiac death and symptomatic left ventricular dysfunction during the follow-up period. A prognostic index was then developed from such variables, according to the formula (mDBP + mBBI/10)-Y. This index, when considered as a categorical variable, in its 'low' figures (cut-off <88), showed a significant prognostic value (p < 0.0001). The predictive value of the index for the combined endpoint was higher than left ventricular ejection fraction (50% versus 36%).
Drug Investigation, 1993
Patients with chronic heart failure show a high incidence of complex ventricular ectopic activity... more Patients with chronic heart failure show a high incidence of complex ventricular ectopic activity and high mortality, with an average sudden death rate of 46%. Given the close relationship between ventricular ectopic activity and left ventricular function, it is difficult to determine whether the ventricular ectopic activity has independent prognostic significance in patients with chronic heart failure. Notwithstanding, several large scale clinical studies have shown that left ventricular dysfunction is the first independent prognostic index in patients with ischaemic or dilative idiopathic cardiomyopathy. Therefore, potentially reversible causes of arrhythmia should be diagnosed and if necessary corrected. Electrophysioiogical testing and noninvasive techniques are used for evaluating arrhythmia mechanisms and establishing drug efficacy. Empirical therapy of potentially malignant ventricular arrhythmias in patients with ischaemic or dilative idiopathic cardiomyopathy has proved unsatisfactory because of both the inadequate control obtained and the increasing evidence that antiarrhythmic drugs are arrhythmogenic. In selected groups of patients, however, empirical therapy with amiodarone may reduce the frequency and complexity of the ventricular ectopic activity and incidence of sudden death. The use of drugs with an indirect antiarrhythmic action, such as /3-blockers and angiotensin converting enzyme (ACE) inhibitors, has been shown to decrease the mortality and incidence of sudden cardiac death in some groups of patients with chronic heart failure. A further step forward in the treatment of patients at high risk of sudden death is represented by nonpharmacological therapy, i.e. excision of aneurysm, surgical or electrical ablation of arrhythmogenic foci, and use of automatic implantable cardioverter defibrillators.
Journal of the American Society of Echocardiography, 2008
The assessment of myocardial viability by wall motion (WM) analysis on dobutamine echocardiograph... more The assessment of myocardial viability by wall motion (WM) analysis on dobutamine echocardiography is subjective and provides suboptimal results. The aim of this study was to test the hypothesis that the prediction of functional recovery after revascularization can be improved by combining strain rate (SR) imaging, an objective method to quantify regional function, and levosimendan, a positive inotropic and vasodilator agent with no adrenergic effects. Methods: Thirty postinfarction patients (mean age, 65 Ϯ 13 years) underwent, off drug, dobutamine (5-40 g/kg/min) and then levosimendan (24 g/kg in 10 minutes) echocardiography before percutaneous coronary intervention. WM score, peak systolic SR (SRs), end-systolic strain (Ses), and postsystolic strain (Sps) were assessed in all segments. Regional left ventricular functional recovery was identified by Ն1-point improvement in WM as assessed using the standard 16-segment model. Results: Of 215 segments with abnormal resting function, 102 (47%) showed improvement in WM 8 months after revascularization. Functional recovery was predicted in 60 segments with dobutamine and in 76 segments with levosimendan (sensitivity, 59% vs 75%; P ϭ .026), while failure to recover was identified in 93 segments with dobutamine and 90 segments with levosimendan (specificity, 82% vs 80%, P ϭ NS). Overall there was significant agreement between the 2 tests (ϭ 0.73; P Ͻ .0001). Peak SRs in segments with functional recovery improved significantly (P ϭ .001) with both dobutamine and levosimendan (from Ϫ1.36 Ϯ 0.41 to Ϫ1.87 Ϯ 0.59 and Ϫ1.99 Ϯ 0.49, respectively) but did not change in regions with unchanged WM at follow-up. There were no significant differences in Ses and Sps between rest and pharmacologic tests, with either dobutamine or levosimendan. Of note, an increment in peak SRs Ͼ Ϫ0.29 s Ϫ1 after levosimendan had the highest specificity (93%) for predicting segmental functional recovery at follow-up (P ϭ .001). Conclusion: The combination of a newer quantitative echocardiographic technique (SR analysis) and a newer pharmacologic agent (levosimendan) improves the sensitivity of viability assessment compared with conventional dobutamine echocardiography.
Journal of the American College of Cardiology, 2004
Background: Chromogranin A (CgA) is widely distributed throughout the neurendocrine system and ma... more Background: Chromogranin A (CgA) is widely distributed throughout the neurendocrine system and may, due to its long in vivo and in vitro half-life, be an attractive candidate for assessment of neuroendocrine activity in congestive heart failure (CHF). Recently, increased plasma levels of CgA have been found in patients with CHF and related to the severity of symptoms and prognosis. The effect of physical exercise on circulating CgA levels in patients with CHF is unknown. Moreover, the relation between CgA levels and invasive hemodynamic indices remains to be established. Methods: 22 patients with chronic CHF (NYHA class II-IV) performed supine bicycle testing with breath-to-breath analysis for assessment of peak oxygen uptake (VO 2 max). Venous blood samples for CgA analysis were drawn at baseline, at peak exercise, and 1 hour post-exercise. Plasma levels of CgA were determined by radioimmunoassay. Echocardiography and left-and right cardiac catheterization were performed in all patients. 10 healthy age-and sex matched volunteers served as controls. Results: CHF patients had reduced peak VO 2 compared to controls (13.6 ± 5.4 vs 31.5 ± 10.0 ml/kg/min, p<0.001). The baseline level of CgA was elevated in patients compared to controls (24.3 ± 14.4 vs. 18.7 ± 1.5 ng/ml, p< 0.05). Baseline levels of CgA correlated positively with arteriovenous O 2 difference (r = 0.62, p = 0.02) and negatively with LVEF (r =-0.70, p< 0.001). CgA did not correlate significantly with pulmonary capillary wedge pressure, right atrial pressure, stroke volume, cardiac index or peak VO 2. Whereas CgA levels increased significantly from baseline to peak exercise in control subjects (from 18.7 ± 1.5 to 22.0 ± 3.6 ng/ml, p< 0.05), the CgA response to exercise was blunted in CHF patients (from 24.3 ± 14.4 to 24.4 ± 15.6 ng/ml, p = ns). Conclusion: CgA levels are elevated in patients with CHF and are related to left ventricular systolic function and arteriovenous O 2-difference. The CgA response to exercise is blunted in CHF, suggesting widespread baseline neuroendocrine activation in CHF. In contrast to catecholamines, circulating CgA concentrations are not affected by physical activity in patients with CHF.
International Journal of Cardiology, 2010
Background: The association between inflammatory status and thrombosis in patients with atrial fi... more Background: The association between inflammatory status and thrombosis in patients with atrial fibrillation (AF) is unclear. We studied the correlation between inflammation and the risk of thrombogenesis in patients with AF and the relationship of inflammation with other factors associated with thrombotic risk. Methods: We studied 150 consecutive patients (69 men, age 65 ± 12 years) with persistent non-valvular AF who had transesophageal echocardiography prior to cardioversion. Patients underwent also measurements of high-sensitivity C-reactive protein, fibrinogen, D-dimer, and hematocrit levels. Results: Patients were divided into two groups according to the presence (n = 52) or absence (n = 98) of dense spontaneous echo contrast (SEC) in left atrium or left atrial appendage. The two groups were similar for age, sex, and major clinical risk factors. Patients with dense SEC had significantly larger left atrium diameter (p = 0.007), lower left atrial appendage mean velocity (p b 0.0001), and higher levels of C-reactive protein (p = 0.003), Ddimer (p = 0.008), and fibrinogen (p = 0.006). At multivariate analysis, only left atrial appendage velocity (odds ratio: 19.11; 95% confidence interval 4.2-80.9) and C-reactive protein (odds ratio: 3.41; 95% confidence interval 1.2-9.8) were significantly associated with thrombus and/or dense SEC. However, there was no relationship between C-reactive protein levels and left atrial appendage velocity (p =0.24, r = −0.09). Conclusions: Our results show that left atrial appendage velocity and C-reactive protein are independently associated with the risk of thromboembolism in AF. Thus, blood stasis and inflammation appear to constitute two major distinct components of thrombogenesis.
Inflammation and markers of thromboembolic risk on transoesophageal echocardiography in atrial fibrillation
Heart Rhythm, 2005
European Journal of Heart Failure, 2007
Background: Dobutamine echocardiography is commonly used to detect contractile reserve in ischaem... more Background: Dobutamine echocardiography is commonly used to detect contractile reserve in ischaemic left ventricular (LV) systolic dysfunction, although its sensitivity and specificity are not optimal. We tested the hypothesis that echocardiography with levosimendan could identify contractile reserve in patients with a non-diagnostic dobutamine test. Methods: Twenty-two patients with LV ejection fraction b 40% and non-diagnostic dobutamine echocardiography underwent levosimendan challenge (24 μg/kg in 10 min) prior to coronary angioplasty or surgery. Results: Contractile reserve was identified by levosimendan in 10 patients (Gr. A) but was not seen in 12 patients (Gr. B). With levosimendan, LV ejection fraction increased and wall motion score index decreased significantly in Gr. A, but only slightly in Gr. B. Similarly, mean mitral annular plane excursion and peak systolic mitral annular motion velocity increased significantly in Gr. A only. Six months after revascularisation, contractile reserve was seen in 8/10 Gr. A patients but in only 2/12 Gr. B patients (80% vs 17%, p = 0.011). LV ejection fraction, wall motion score index, mean mitral annular plane excursion and peak systolic mitral annular motion velocity were significantly higher in Gr. A than in Gr. B. Conclusion: Levosimendan echocardiography can identify contractile reserve in a sizeable proportion of patients with chronic ischaemic LV dysfunction and a non-diagnostic dobutamine test.
European Heart Journal, 1999
Aims This single-blinded, randomized, placebo-controlled study was designed and undertaken to ass... more Aims This single-blinded, randomized, placebo-controlled study was designed and undertaken to assess the efficacy of intravenous atropine administration on haemodynamic impairment induced by head-up tilt testing in patients with vasovagal syncope. Methods and Results One hundred and thirteen consecutive patients (62 male and 51 female, mean age 46•3 years) with recurrent syncope, no evidence of cardiac, neurological or metabolic disease and a positive head-up tilt test were included in the study. Within 2 weeks of the first head-up tilt test all patients underwent a second tilt test. During this second test, all patients were randomized to receive a bolus of either atropine (0•02 mg. kg 1) or placebo (isotonic saline solution). The administration of atropine or placebo was performed at the onset of the haemodynamic modifications (heart rate and/or blood pressure fall) in conjunction with typical vasovagal prodromal symptoms. Treatment was taken as effective when symptoms aborted and the test was completed. In 29 of 113 patients the second tilt test was negative and these patients were excluded from final data analysis. Forty-one patients received placebo, which was effective in nine cases (21•9%). Atropine was administered to 43 patients and was effective in 30 cases (69•7%, P<0•01 vs placebo). The effects of treatment were analysed further to consider the haemodynamic patterns of tilt-induced vasovagal reflex. In the cardio-inhibitory form, placebo was never effective (15 cases), while atropine was effective in 15 of 18 cases (83•3%, P<0•001 vs placebo). In the vasodepressor form, placebo was effective in nine of 26 patients (34•6%), while atropine was effective in 15 of 25 cases (60•0%, no significant difference vs placebo). Conclusions Atropine is fully effective in the cardioinhibitory form of tilt-induced vasovagal reflex, but is limited in the vasodepressor form.
European Journal of Echocardiography, 2003
Patients 5
<b>Copyright information:</b>Taken from "Distal left circumflex coronary artery ... more <b>Copyright information:</b>Taken from "Distal left circumflex coronary artery flow reserve recorded by transthoracic Doppler echocardiography: a comparison with Doppler-wire"http://www.cardiovascularultrasound.com/content/5/1/22Cardiovascular Ultrasound 2007;5():22-22.Published online 16 Jun 2007PMCID:PMC1910594. A: TTDE before adenosine. B: TTDE after adenosine. C: DW recording. D: coronary angiography with site of DW recording (arrow). .
Patients 4
<b>Copyright information:</b>Taken from "Distal left circumflex coronary artery ... more <b>Copyright information:</b>Taken from "Distal left circumflex coronary artery flow reserve recorded by transthoracic Doppler echocardiography: a comparison with Doppler-wire"http://www.cardiovascularultrasound.com/content/5/1/22Cardiovascular Ultrasound 2007;5():22-22.Published online 16 Jun 2007PMCID:PMC1910594. A: TTDE before adenosine. B: TTDE after adenosine. C: DW recording. D: coronary angiography with site of DW recording (arrow). .
Patients 3
<b>Copyright information:</b>Taken from "Distal left circumflex coronary artery ... more <b>Copyright information:</b>Taken from "Distal left circumflex coronary artery flow reserve recorded by transthoracic Doppler echocardiography: a comparison with Doppler-wire"http://www.cardiovascularultrasound.com/content/5/1/22Cardiovascular Ultrasound 2007;5():22-22.Published online 16 Jun 2007PMCID:PMC1910594. A: TTDE before adenosine. B: TTDE after adenosine. C: DW recording. D: coronary angiography with site of DW recording (arrow). .
Patients 1
<b>Copyright information:</b>Taken from "Distal left circumflex coronary artery ... more <b>Copyright information:</b>Taken from "Distal left circumflex coronary artery flow reserve recorded by transthoracic Doppler echocardiography: a comparison with Doppler-wire"http://www.cardiovascularultrasound.com/content/5/1/22Cardiovascular Ultrasound 2007;5():22-22.Published online 16 Jun 2007PMCID:PMC1910594. A: TTDE before adenosine. B: TTDE after adenosine. C: DW recording. D: coronary angiography with site of DW recording (arrow). .
Color flow mapping of the coronary artery on the lateral wall (arrow)
<b>Copyright information:</b>Taken from "Distal left circumflex coronary artery ... more <b>Copyright information:</b>Taken from "Distal left circumflex coronary artery flow reserve recorded by transthoracic Doppler echocardiography: a comparison with Doppler-wire"http://www.cardiovascularultrasound.com/content/5/1/22Cardiovascular Ultrasound 2007;5():22-22.Published online 16 Jun 2007PMCID:PMC1910594.
Plan of section of LCx branches made by the four-chamber view
<b>Copyright information:</b>Taken from "Distal left circumflex coronary artery ... more <b>Copyright information:</b>Taken from "Distal left circumflex coronary artery flow reserve recorded by transthoracic Doppler echocardiography: a comparison with Doppler-wire"http://www.cardiovascularultrasound.com/content/5/1/22Cardiovascular Ultrasound 2007;5():22-22.Published online 16 Jun 2007PMCID:PMC1910594. .
[Role of multimodality imaging in the clinical evaluation of hypertrophic cardiomyopathy]
Giornale italiano di cardiologia, 2019
Sarcomeric hypertrophic cardiomyopathy is the most common cardiovascular genetic disease. Clinica... more Sarcomeric hypertrophic cardiomyopathy is the most common cardiovascular genetic disease. Clinical evaluation and comprehensive echocardiography are crucial for the diagnosis and early evaluation of the hypertrophic phenotype, but multimodality imaging approach is often required to better define diagnosis and differential diagnosis from phenocopies. This review aims to assess the role of multimodality imaging and, in particular, advanced echocardiography and cardiac magnetic resonance in relation to differential diagnosis and preclinical diagnosis, identification of different phenotypes, and assessment of disease progression and risk of sudden cardiac death. A multimodality imaging approach is also crucial for the selection of patients amenable to surgical or percutaneous septal myectomy and for guiding both procedures.
Giornale italiano di cardiologia, 2020
The complexity of cardiovascular diseases has led to an extensive use of technological instrument... more The complexity of cardiovascular diseases has led to an extensive use of technological instruments and the development of multimodality imaging. This extensive use of different cardiovascular imaging tests in the same patient has increased costs and waiting times.The concept of appropriateness has changed over time. Appropriateness criteria address the need for specific cardiovascular imaging tests in well-defined clinical scenarios, and define the kind of cardiovascular imaging that is appropriated for each clinical scenario in different stages of the disease. The concept of appropriateness criteria has replaced the old idea of appropriate use criteria and reflects the increasing effort of the international Scientific Societies to create and review in a critical way the management of diagnostic tests used by clinicians.The aim of this Italian consensus document is to address the use of multimodality imaging in the diagnosis and management of the major cardiovascular clinical scenar...
IMAGE SECTION Section Editor: Giant Vegetation of the Mitral Valve Simulating Primary Cardiac Tumor
Echocardiography
A case of a giant vegetation of the mitral valve causing sudden death of the patient is reported.... more A case of a giant vegetation of the mitral valve causing sudden death of the patient is reported. The case underlines that urgent removal of a big mass must always be considered because of the risk of sudden death or catastrophic embolism. Echocardiographic differential diagnosis of a mass is discussed and is crucial for the choice of the strategy. (ECHOCARDIOGRAPHY, Volume 21, February 2004) mitral valve, endocarditis, mass, transesophageal, echocardiography
Additional predictive value of heart rate variability in high-risk patients surviving an acute myocardial infarction
Cardiologia (Rome, Italy)
The aim of this study was to investigate the usefulness of heart rate variability (HRV) in predic... more The aim of this study was to investigate the usefulness of heart rate variability (HRV) in predicting cardiac mortality in patients with a recent acute myocardial infarction at high risk of events. Time- and frequency-domain HRV was assessed on 24-hour pre-discharge Holter recording of 81 patients (mean age 65 +/- 10 years, 76.5% males) with 1) a recent acute myocardial infarction, and 2) left ventricular ejection fraction < 40% and/or a number of premature ventricular beats > or = 10/hour. There were 15 total cardiac deaths (18.5%) in a follow-up time of 29 +/- 15 months (range 6 to 48 months), with sudden death occurring in 11 patients (13.6%). Median values of low frequency (LF) were lower in patients with, compared to those without, total (p = 0.04) and sudden (p = 0.02) cardiac death. Similarly the low frequency/high frequency (LF/HF) ratio was lower in patients with fatal events (p = 0.03 and p = 0.02, respectively). Furthermore, mean of the standard deviations of all RR...
European Journal of Echocardiography, 2003
Aims: Recording coronary arteries' flow by transthoracic Doppler echocardiography (TTDE) is a new... more Aims: Recording coronary arteries' flow by transthoracic Doppler echocardiography (TTDE) is a new task. Despite several studies concerning the left anterior descending artery (LAD) exist, the same for posterior descending coronary artery (PD) do not. Reported feasibility is not more than 76%. The aim of the study was to try to improve feasibility by using an additional two-dimensional view as a guide. Methods and Results: PD flow recording was performed in 35 consecutive unselected patients under the guidance of the usual two-dimensional modified view [a two-chamber view (2-C)], and with a new four-chamber modified view (4-C). A semi-quantitative growing-quality score (from 0 to 3 points) to the trace was given. Contrast enhancement was used if PD was not visualized without it. The overall feasibility was 80%. A good or very good velocity signal (TTDE score !2) was observed in 48% of patients without contrast enhancement. Time for first visualization of PD was short and significantly lower in 2-C than in 4-C (66 AE 39 vs 90 AE 70 s, respectively, P < 0:05). Conclusions: TTDE recording of PD flow gained better feasibility being guided by two views. Maximal time for first visualization of PD was less than 3 min.
High Blood Pressure & Cardiovascular Prevention, 2003
Aim: To assess the usefulness of ambulatory blood pressure monitoring (ABPM) in the prognostic st... more Aim: To assess the usefulness of ambulatory blood pressure monitoring (ABPM) in the prognostic stratification of patients with a recent myocardial infarction. Method: The study population included 75 patients consecutively admitted at our institution for acute ST-segment elevation myocardial infarction (STEMI). All patients underwent ABPM 3 weeks after discharge and were subsequently followed for 12 months. Results: The age (Y), mean 24-hour diastolic blood pressure (mDBP) and mean 24-hour beat-to-beat interval (mBBI) values were found to be independent predictors of the combined endpoint of cardiac death and symptomatic left ventricular dysfunction during the follow-up period. A prognostic index was then developed from such variables, according to the formula (mDBP + mBBI/10)-Y. This index, when considered as a categorical variable, in its 'low' figures (cut-off <88), showed a significant prognostic value (p < 0.0001). The predictive value of the index for the combined endpoint was higher than left ventricular ejection fraction (50% versus 36%).
Drug Investigation, 1993
Patients with chronic heart failure show a high incidence of complex ventricular ectopic activity... more Patients with chronic heart failure show a high incidence of complex ventricular ectopic activity and high mortality, with an average sudden death rate of 46%. Given the close relationship between ventricular ectopic activity and left ventricular function, it is difficult to determine whether the ventricular ectopic activity has independent prognostic significance in patients with chronic heart failure. Notwithstanding, several large scale clinical studies have shown that left ventricular dysfunction is the first independent prognostic index in patients with ischaemic or dilative idiopathic cardiomyopathy. Therefore, potentially reversible causes of arrhythmia should be diagnosed and if necessary corrected. Electrophysioiogical testing and noninvasive techniques are used for evaluating arrhythmia mechanisms and establishing drug efficacy. Empirical therapy of potentially malignant ventricular arrhythmias in patients with ischaemic or dilative idiopathic cardiomyopathy has proved unsatisfactory because of both the inadequate control obtained and the increasing evidence that antiarrhythmic drugs are arrhythmogenic. In selected groups of patients, however, empirical therapy with amiodarone may reduce the frequency and complexity of the ventricular ectopic activity and incidence of sudden death. The use of drugs with an indirect antiarrhythmic action, such as /3-blockers and angiotensin converting enzyme (ACE) inhibitors, has been shown to decrease the mortality and incidence of sudden cardiac death in some groups of patients with chronic heart failure. A further step forward in the treatment of patients at high risk of sudden death is represented by nonpharmacological therapy, i.e. excision of aneurysm, surgical or electrical ablation of arrhythmogenic foci, and use of automatic implantable cardioverter defibrillators.
Journal of the American Society of Echocardiography, 2008
The assessment of myocardial viability by wall motion (WM) analysis on dobutamine echocardiograph... more The assessment of myocardial viability by wall motion (WM) analysis on dobutamine echocardiography is subjective and provides suboptimal results. The aim of this study was to test the hypothesis that the prediction of functional recovery after revascularization can be improved by combining strain rate (SR) imaging, an objective method to quantify regional function, and levosimendan, a positive inotropic and vasodilator agent with no adrenergic effects. Methods: Thirty postinfarction patients (mean age, 65 Ϯ 13 years) underwent, off drug, dobutamine (5-40 g/kg/min) and then levosimendan (24 g/kg in 10 minutes) echocardiography before percutaneous coronary intervention. WM score, peak systolic SR (SRs), end-systolic strain (Ses), and postsystolic strain (Sps) were assessed in all segments. Regional left ventricular functional recovery was identified by Ն1-point improvement in WM as assessed using the standard 16-segment model. Results: Of 215 segments with abnormal resting function, 102 (47%) showed improvement in WM 8 months after revascularization. Functional recovery was predicted in 60 segments with dobutamine and in 76 segments with levosimendan (sensitivity, 59% vs 75%; P ϭ .026), while failure to recover was identified in 93 segments with dobutamine and 90 segments with levosimendan (specificity, 82% vs 80%, P ϭ NS). Overall there was significant agreement between the 2 tests (ϭ 0.73; P Ͻ .0001). Peak SRs in segments with functional recovery improved significantly (P ϭ .001) with both dobutamine and levosimendan (from Ϫ1.36 Ϯ 0.41 to Ϫ1.87 Ϯ 0.59 and Ϫ1.99 Ϯ 0.49, respectively) but did not change in regions with unchanged WM at follow-up. There were no significant differences in Ses and Sps between rest and pharmacologic tests, with either dobutamine or levosimendan. Of note, an increment in peak SRs Ͼ Ϫ0.29 s Ϫ1 after levosimendan had the highest specificity (93%) for predicting segmental functional recovery at follow-up (P ϭ .001). Conclusion: The combination of a newer quantitative echocardiographic technique (SR analysis) and a newer pharmacologic agent (levosimendan) improves the sensitivity of viability assessment compared with conventional dobutamine echocardiography.
Journal of the American College of Cardiology, 2004
Background: Chromogranin A (CgA) is widely distributed throughout the neurendocrine system and ma... more Background: Chromogranin A (CgA) is widely distributed throughout the neurendocrine system and may, due to its long in vivo and in vitro half-life, be an attractive candidate for assessment of neuroendocrine activity in congestive heart failure (CHF). Recently, increased plasma levels of CgA have been found in patients with CHF and related to the severity of symptoms and prognosis. The effect of physical exercise on circulating CgA levels in patients with CHF is unknown. Moreover, the relation between CgA levels and invasive hemodynamic indices remains to be established. Methods: 22 patients with chronic CHF (NYHA class II-IV) performed supine bicycle testing with breath-to-breath analysis for assessment of peak oxygen uptake (VO 2 max). Venous blood samples for CgA analysis were drawn at baseline, at peak exercise, and 1 hour post-exercise. Plasma levels of CgA were determined by radioimmunoassay. Echocardiography and left-and right cardiac catheterization were performed in all patients. 10 healthy age-and sex matched volunteers served as controls. Results: CHF patients had reduced peak VO 2 compared to controls (13.6 ± 5.4 vs 31.5 ± 10.0 ml/kg/min, p<0.001). The baseline level of CgA was elevated in patients compared to controls (24.3 ± 14.4 vs. 18.7 ± 1.5 ng/ml, p< 0.05). Baseline levels of CgA correlated positively with arteriovenous O 2 difference (r = 0.62, p = 0.02) and negatively with LVEF (r =-0.70, p< 0.001). CgA did not correlate significantly with pulmonary capillary wedge pressure, right atrial pressure, stroke volume, cardiac index or peak VO 2. Whereas CgA levels increased significantly from baseline to peak exercise in control subjects (from 18.7 ± 1.5 to 22.0 ± 3.6 ng/ml, p< 0.05), the CgA response to exercise was blunted in CHF patients (from 24.3 ± 14.4 to 24.4 ± 15.6 ng/ml, p = ns). Conclusion: CgA levels are elevated in patients with CHF and are related to left ventricular systolic function and arteriovenous O 2-difference. The CgA response to exercise is blunted in CHF, suggesting widespread baseline neuroendocrine activation in CHF. In contrast to catecholamines, circulating CgA concentrations are not affected by physical activity in patients with CHF.
International Journal of Cardiology, 2010
Background: The association between inflammatory status and thrombosis in patients with atrial fi... more Background: The association between inflammatory status and thrombosis in patients with atrial fibrillation (AF) is unclear. We studied the correlation between inflammation and the risk of thrombogenesis in patients with AF and the relationship of inflammation with other factors associated with thrombotic risk. Methods: We studied 150 consecutive patients (69 men, age 65 ± 12 years) with persistent non-valvular AF who had transesophageal echocardiography prior to cardioversion. Patients underwent also measurements of high-sensitivity C-reactive protein, fibrinogen, D-dimer, and hematocrit levels. Results: Patients were divided into two groups according to the presence (n = 52) or absence (n = 98) of dense spontaneous echo contrast (SEC) in left atrium or left atrial appendage. The two groups were similar for age, sex, and major clinical risk factors. Patients with dense SEC had significantly larger left atrium diameter (p = 0.007), lower left atrial appendage mean velocity (p b 0.0001), and higher levels of C-reactive protein (p = 0.003), Ddimer (p = 0.008), and fibrinogen (p = 0.006). At multivariate analysis, only left atrial appendage velocity (odds ratio: 19.11; 95% confidence interval 4.2-80.9) and C-reactive protein (odds ratio: 3.41; 95% confidence interval 1.2-9.8) were significantly associated with thrombus and/or dense SEC. However, there was no relationship between C-reactive protein levels and left atrial appendage velocity (p =0.24, r = −0.09). Conclusions: Our results show that left atrial appendage velocity and C-reactive protein are independently associated with the risk of thromboembolism in AF. Thus, blood stasis and inflammation appear to constitute two major distinct components of thrombogenesis.
Inflammation and markers of thromboembolic risk on transoesophageal echocardiography in atrial fibrillation
Heart Rhythm, 2005
European Journal of Heart Failure, 2007
Background: Dobutamine echocardiography is commonly used to detect contractile reserve in ischaem... more Background: Dobutamine echocardiography is commonly used to detect contractile reserve in ischaemic left ventricular (LV) systolic dysfunction, although its sensitivity and specificity are not optimal. We tested the hypothesis that echocardiography with levosimendan could identify contractile reserve in patients with a non-diagnostic dobutamine test. Methods: Twenty-two patients with LV ejection fraction b 40% and non-diagnostic dobutamine echocardiography underwent levosimendan challenge (24 μg/kg in 10 min) prior to coronary angioplasty or surgery. Results: Contractile reserve was identified by levosimendan in 10 patients (Gr. A) but was not seen in 12 patients (Gr. B). With levosimendan, LV ejection fraction increased and wall motion score index decreased significantly in Gr. A, but only slightly in Gr. B. Similarly, mean mitral annular plane excursion and peak systolic mitral annular motion velocity increased significantly in Gr. A only. Six months after revascularisation, contractile reserve was seen in 8/10 Gr. A patients but in only 2/12 Gr. B patients (80% vs 17%, p = 0.011). LV ejection fraction, wall motion score index, mean mitral annular plane excursion and peak systolic mitral annular motion velocity were significantly higher in Gr. A than in Gr. B. Conclusion: Levosimendan echocardiography can identify contractile reserve in a sizeable proportion of patients with chronic ischaemic LV dysfunction and a non-diagnostic dobutamine test.
European Heart Journal, 1999
Aims This single-blinded, randomized, placebo-controlled study was designed and undertaken to ass... more Aims This single-blinded, randomized, placebo-controlled study was designed and undertaken to assess the efficacy of intravenous atropine administration on haemodynamic impairment induced by head-up tilt testing in patients with vasovagal syncope. Methods and Results One hundred and thirteen consecutive patients (62 male and 51 female, mean age 46•3 years) with recurrent syncope, no evidence of cardiac, neurological or metabolic disease and a positive head-up tilt test were included in the study. Within 2 weeks of the first head-up tilt test all patients underwent a second tilt test. During this second test, all patients were randomized to receive a bolus of either atropine (0•02 mg. kg 1) or placebo (isotonic saline solution). The administration of atropine or placebo was performed at the onset of the haemodynamic modifications (heart rate and/or blood pressure fall) in conjunction with typical vasovagal prodromal symptoms. Treatment was taken as effective when symptoms aborted and the test was completed. In 29 of 113 patients the second tilt test was negative and these patients were excluded from final data analysis. Forty-one patients received placebo, which was effective in nine cases (21•9%). Atropine was administered to 43 patients and was effective in 30 cases (69•7%, P<0•01 vs placebo). The effects of treatment were analysed further to consider the haemodynamic patterns of tilt-induced vasovagal reflex. In the cardio-inhibitory form, placebo was never effective (15 cases), while atropine was effective in 15 of 18 cases (83•3%, P<0•001 vs placebo). In the vasodepressor form, placebo was effective in nine of 26 patients (34•6%), while atropine was effective in 15 of 25 cases (60•0%, no significant difference vs placebo). Conclusions Atropine is fully effective in the cardioinhibitory form of tilt-induced vasovagal reflex, but is limited in the vasodepressor form.