Walter Serra - Academia.edu (original) (raw)
Papers by Walter Serra
Clinics and Practice, 2015
Electric external cardioversion (EEC) for permanent atrial fibrillation (AF) carries a risk of th... more Electric external cardioversion (EEC) for permanent atrial fibrillation (AF) carries a risk of thromboembolic events (TE). The use of transesophageal echocardiography (TEE) to guide the management of atrial fibrillation may be considered a clinically effective alternative strategy to conventional therapy for patients in whom elective cardioversion is planned. Therapeutic anticoagulation with novel oral anticoagulants (NOAC) is recommended for 3 to 4 weeks before and an anticoagulation life-long therapy is recommended after EEC to reduce TE, in patients with high CHA2DS2-VASc score; however, only few data are currently available about safety of short-term anticoagulation with NOAC in the setting of EEC. Patients with increased risk of thromboembolism have not been adequately studied and the monitoring of anticoagulant effects can also have important benefits in case of drug interactions. We report a case of a 68-year old man with AF from September 2014. Moderate depression of global left ventricular systolic function was detected by echocardiographic exam. On the basis of a high thromboembolic risk, an anticoagulant therapy with rivaroxaban, at the dose of 20 mg/day, was started. TEE showed a thrombus in the left atrial appendage. This case demonstrates the utility of performing TEE prior than EEC in patients with hypokinetic cardiomyopathy other than AF in therapy with NOAC. We underline the presence of significant pharmacodynamic interference of rivaroxaban with other drugs such as oxcarbazepine.
L’ipertensione polmonare nella sclerodermia sistemica (SS) è associata ad una sopravvivenza < ... more L’ipertensione polmonare nella sclerodermia sistemica (SS) è associata ad una sopravvivenza < 20% a 5 anni e il suo precoce riconoscimento è indispensabile per migliorare la prognosi. Ipertensione polmonare è un termine atto a descrivere un aumento della pressione nei vasi arteriosi polmonari superiore a 35mm/Hg di sistolica (PAPs) e di 25mm/Hg di media (PAPm) o > 30m/Hg dopo sforzo al cateterismo cardiaco. Obiettivo dello studio Valutare la presenza di vasculopatia polmonare in pazienti con sclerodermia accertata in classe NYHA I-II ^ mediante: -La funzione polmonare a riposo e la capacità di esercizio fisico massimale e sub-massimale. -I valori di PAPs, PAPm,PVR ottenuti con doppler cardiaco e la relazione tra valori di PAP e di funzione ventricolare destra con la classe NYHA e CPET. Materiali e metodi Dal Novembre 2005 al settembre 2007 sono stati arruolati 19 p.ti affetti da sclerodermia di età compresa fra 28 e 75 anni, (9 II^ NYHA-10 I^NYHA), coinvolgimento polmonare e P...
Minerva cardioangiologica, 1991
In this paper, we report the cases of 4 male patients (mean age 32.7 yr) with right-ventricular d... more In this paper, we report the cases of 4 male patients (mean age 32.7 yr) with right-ventricular dysplasia, that occurred in familial form. Diagnosis was possible according to the clinical features and to the electrocardiographic, echocardiographic and scintigraphic criteria; at Holter monitoring recorded ventricular arrhythmias with left bundle branch block configuration, associated to sinus arrhythmias (sino-auricular block). In two patients a sustained ventricular tachycardia was recorded. The patients are living and a fourteen-year-old subject is without heart disease. From our data we conclude that: the most serious clinical features occur in extensive form with right atrial and left-ventricle involvement; the clinical features were manifested at a young age and then got worse. A dominant autosomic inheritance is observed (only males were affected).
Journal of the American Society of Echocardiography, 2013
The ratio of tricuspid regurgitation velocity (TRV) to the time-velocity integral of the right ve... more The ratio of tricuspid regurgitation velocity (TRV) to the time-velocity integral of the right ventricular outflow tract (TVIRVOT) has been studied as a reliable measure to distinguish elevated from normal pulmonary vascular resistance (PVR). The equation TRV/TVIRVOT × 10 + 0.16 (PVRecho) has been shown to provide a good noninvasive estimate of PVR. However, its role in patients with significantly elevated PVR (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 6 Wood units [WU]) has not been conclusively evaluated. The aim of this study was to establish the validity of the TRV/TVIRVOT ratio as a correlate of PVR. The role of TRV/TVIRVOT was also compared with that of a new ratio, TRV(2)/TVIRVOT, in patients with markedly elevated PVR (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;6 WU). Data from five validation studies using TRV/TVIRVOT as an estimate of PVR were compared with invasive PVR measurements (PVRcath). Multiple linear regression analyses were generated between PVRcath and both TRV/TVIRVOT and TRV(2)/TVIRVOT. Both PVRecho and a new derived regression equation based on TRV(2)/TVIRVOT: 5.19 × TRV(2)/TVIRVOT - 0.4 (PVRecho2) were compared with PVRcath using Bland-Altman analysis. Logistic models were generated, and cutoff values for both TRV/TVIRVOT and TRV(2)/TVIRVOT were obtained to predict PVR &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 6 WU. One hundred fifty patients remained in the final analysis. Linear regression analysis between PVRcath and TRV/TVIRVOT revealed a good correlation (r = 0.76, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .0001, Z = 0.92). There was a better correlation between PVRcath and TRV(2)/TVIRVOT (r = 0.79, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .0001, Z = -0.01) in the entire cohort as well as in patients with PVR &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 6 WU. Moreover, PVRecho2 compared better with PVRcath than PVRecho using Bland-Altman analysis in the entire cohort and in patients with PVR &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 6 WU. TRV(2)/TVIRVOT and TRV/TVIRVOT both predicted PVR &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 6 WU with good sensitivity and specificity. TRV/TVIRVOT is a reliable method to identify patients with elevated PVR. In patients with TRV/TVIRVOT &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.275, PVR is likely &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 6 WU, and PVRecho2 derived from TRV(2)/TVIRVOT provides an improved noninvasive estimate of PVR compared with PVRecho.
Journal of the American College of Cardiology, 2013
Cardiovascular ultrasound, 2005
Supravalvular mitral stenosis is a rare condition characterized by an abnormal ridge, with one or... more Supravalvular mitral stenosis is a rare condition characterized by an abnormal ridge, with one or two orifices, covering and obstructing the mitral valve. Preoperative diagnosis is difficult with transtoracic echo (TTE), angiography and magnetic resonance imaging (MRI). In this case, a 36-year-old male, was admitted to our Heart department: He experienced progressive dyspnea on effort and at rest. Diagnosis was made by transesophageal echocardiography which showed, on apical 4-chamber section, an annular structure attached since a membrane to the atrial wall anterior mitral valve leaflet and just proximal to the posterior mitral leaflet. Pre-operative identification of the supravalvular mitral ring is the target for obtaining good surgical results. Cineangiography and MRI both failed in reaching this objective, whereas, transesophageal echocardiography is the best method to identify this congenital heart disease. Using TEE the identification is not only possible but also easier.
Giornale italiano di cardiologia, 1988
Right-sided staphylococcal endocarditis has been described in drug-addict, but not in association... more Right-sided staphylococcal endocarditis has been described in drug-addict, but not in association with an Acquired Immunodeficiency Syndrome. A case of a 26 years old drug-addict woman with AIDS related complex is reported. Antibiotic therapy, produced a favourable evolution on the illness. This case support the usefulness of two-dimensional echocardiography for detecting one of the possible complications associated with AIDS.
Acta bio-medica : Atenei Parmensis, 2011
Chronic thromboembolic pulmonary hypertension (CTEPH) caused by intraluminal thrombus organizatio... more Chronic thromboembolic pulmonary hypertension (CTEPH) caused by intraluminal thrombus organization and fibrous stenosis or complete obliteration of pulmonary arteries, is a not rare but life-threatening complication of acute pulmonary embolism. The prognosis of medically treated patients with CTEPH is poor and worsens as pulmonary hypertension exacerbates. We describe the case of a 43-years old with a history of progressive shortness of breath, hemoptysis, chest discomfort and syncope. Echocardiographic and imaging studies showed changes consistent with chronic thromboembolic pulmonary hypertension. Further work-up showed only moderate increase of homocysteine level with negative features for lupus and others primary thrombophilic disease. The patient was managed adequately with thrombolytic and inotropic therapy; oral anticoagulation was started with improvement of his clinical status and was screened for pulmonary thrombo endarterectomy, but he refused. The case presented despite ...
IJC Metabolic & Endocrine, 2014
ABSTRACT An increased risk of restrictive valvular heart disease (VHD) has been widely reported i... more ABSTRACT An increased risk of restrictive valvular heart disease (VHD) has been widely reported in patients with Parkinson's disease (PD), as a possible consequence of the chronic use of ergot-derived dopamine agonists (EDA), such as pergolide and cabergoline. An aspect that remains poorly investigated is the extent of reversibility of the valvular dysfunction after drug discontinuation.
Cardiogenetics, 2014
ABSTRACT 600799) is frequently associated with concomitant diseases, including congenital heart d... more ABSTRACT 600799) is frequently associated with concomitant diseases, including congenital heart disease. 6% of patients with PAH show a family history of the disease [hereditary PAH (HPAH)], with the major genetic determinants of HPAH being heterozygous germline mutations in the bone morphogenetic protein type II receptor (BMPR2). We present the case of a 38-year-old woman of Indian descent; initially admitted with progressive dyspnea [New York Heart Association (NYHA) class III]. The results of the proband’s clinical assessments are presented here. Cardiac catheterization confirmed idiopathic PAH with severe right ventricular hypertrophy associated with pulmonary arteriopathy. Initial treatment comprised the dual endothelin receptor antagonist, bosentan, furosemide, warfarin and intravenous infusion of prostaglandin I2 (PGI2) for 3 days. Despite this, the patient died of pulmonary hemorrhagic edema and cardiogenic shock after 6 days of intensive care. After relatives’ consent, post mortem assessments confirmed a diagnosis of PAH; the heart displayed significant right ventricular hypertrophy and it was particularly noted that the right atrial appendage had undergone extreme dilation. Pulmonary arteriopathy was characterized by medial hypertrophy, arterialization of muscular arteries and muscularization of non-muscularized muscularized distal arteries. Molecular genetic analyses revealed the presence of cis-mutations in the BMPR2 gene (p.Cys123Arg and p.Arg332X). Cosegregation studies were not available. Our findings suggest that mutations of the BMPR2 gene gave rise to the onset of PAH in this patient and that the severity of the onset and progression could be attributed to the presence of multiple mutations in a genedosage manner.
Journal of Clinical & Experimental Cardiology, 2010
Journals »». A Accounting & Marketing Addiction Research & Therapy Advances in Automobile... more Journals »». A Accounting & Marketing Addiction Research & Therapy Advances in Automobile Engineering Advances in Pharmacoepidemiology & Drug Safety Advances in Robotics & Automation Aeronautics & Aerospace ...
Respiratory Care, 2013
BACKGROUND: Patients with congestive heart failure or COPD may share an increased response in min... more BACKGROUND: Patients with congestive heart failure or COPD may share an increased response in minute ventilation (V E ) to carbon dioxide output (V CO 2 ) during exercise. The goal of this study was to ascertain whether the V E /V CO 2 slope and V E /V CO 2 intercept can discriminate between subjects with congestive heart failure and those with COPD at equal peak oxygen uptake (V O 2 ). METHODS: We studied 46 subjects with congestive heart failure (mean age 61 ؎ 9 y) and 46 subjects with COPD (mean age 64 ؎ 8 y) who performed a cardiopulmonary exercise test. RESULTS: The V E /V CO 2 slope was significantly higher in subjects with congestive heart failure compared with those with COPD (39.5 ؎ 9.5 vs 31.8 ؎ 7.4, P < .01) at peak V O 2 < 16 mL/kg/min, but not > 16 mL/kg/min (28.3 ؎ 5.3 vs 28.9 ؎ 6.6). The V E /V CO 2 intercept was significantly higher in both subgroups of subjects with COPD compared with the corresponding values in the subjects with congestive heart failure (3.60 ؎ 1.7 vs ؊0.16 ؎ 1.7 L/min, P < .01; 3.63 ؎ 2.7 vs 0.87 ؎ 1.5 L/min, P < .01). According to receiver operating characteristic curve analysis, when all subjects with peak V O 2 < 16 mL/kg/min were considered, subjects with COPD had a higher likelihood to have the V E /V CO 2 intercept > 2.14 L/min (0.92 sensitivity, 0.96 specificity). Regardless of peak V O 2 , the end-tidal pressure of CO 2 (P ETCO 2 ) at peak exercise was not different in subjects with congestive heart failure (P ؍ .42) and was significantly higher in subjects with COPD (P < .01) compared with the corresponding unloaded P ETCO 2 . CONCLUSIONS: The ventilatory response to V CO 2 during exercise was significantly different between subjects with congestive heart failure and those with COPD in terms of the V E /V CO 2 slope with moderate-to-severe reduction in exercise capacity and in terms of the V E /V CO 2 intercept regardless of exercise capacity.
Journal of the American Society of Echocardiography, 2011
Background: Because of the shortage of donor hearts, the criteria for acceptance have been consid... more Background: Because of the shortage of donor hearts, the criteria for acceptance have been considerably expanded. Abnormal results on pharmacologic stress echocardiography are associated with significant coronary artery disease and/or occult cardiomyopathy on verification by cardiac autopsy. The aim of this study was to establish the feasibility of an approach based on pharmacologic stress echocardiography as a gatekeeper for extended heart donor criteria. donors (mean age, 56 6 6 years; 21 men) were initially enrolled. After legal declaration of brain death, marginal donors underwent rest echocardiography, and if the results were normal, dipyridamole (0.84 mg/kg over 6 min, n = 25) or dobutamine (up to 40 mg/ kg/min, n = 3) stress echocardiography.
International Journal of Cardiology, 2011
Background: Prostaglandin E1 (PGE1) is a potent vasodilating drug, which has been used in treatme... more Background: Prostaglandin E1 (PGE1) is a potent vasodilating drug, which has been used in treatment of primary pulmonary hypertension. However intravenous PGE1 infusion may be of benefit and also has been proposed as a therapeutic tool in patients with end-stage heart failure.
Clinics and Practice, 2015
Electric external cardioversion (EEC) for permanent atrial fibrillation (AF) carries a risk of th... more Electric external cardioversion (EEC) for permanent atrial fibrillation (AF) carries a risk of thromboembolic events (TE). The use of transesophageal echocardiography (TEE) to guide the management of atrial fibrillation may be considered a clinically effective alternative strategy to conventional therapy for patients in whom elective cardioversion is planned. Therapeutic anticoagulation with novel oral anticoagulants (NOAC) is recommended for 3 to 4 weeks before and an anticoagulation life-long therapy is recommended after EEC to reduce TE, in patients with high CHA2DS2-VASc score; however, only few data are currently available about safety of short-term anticoagulation with NOAC in the setting of EEC. Patients with increased risk of thromboembolism have not been adequately studied and the monitoring of anticoagulant effects can also have important benefits in case of drug interactions. We report a case of a 68-year old man with AF from September 2014. Moderate depression of global left ventricular systolic function was detected by echocardiographic exam. On the basis of a high thromboembolic risk, an anticoagulant therapy with rivaroxaban, at the dose of 20 mg/day, was started. TEE showed a thrombus in the left atrial appendage. This case demonstrates the utility of performing TEE prior than EEC in patients with hypokinetic cardiomyopathy other than AF in therapy with NOAC. We underline the presence of significant pharmacodynamic interference of rivaroxaban with other drugs such as oxcarbazepine.
L’ipertensione polmonare nella sclerodermia sistemica (SS) è associata ad una sopravvivenza < ... more L’ipertensione polmonare nella sclerodermia sistemica (SS) è associata ad una sopravvivenza < 20% a 5 anni e il suo precoce riconoscimento è indispensabile per migliorare la prognosi. Ipertensione polmonare è un termine atto a descrivere un aumento della pressione nei vasi arteriosi polmonari superiore a 35mm/Hg di sistolica (PAPs) e di 25mm/Hg di media (PAPm) o > 30m/Hg dopo sforzo al cateterismo cardiaco. Obiettivo dello studio Valutare la presenza di vasculopatia polmonare in pazienti con sclerodermia accertata in classe NYHA I-II ^ mediante: -La funzione polmonare a riposo e la capacità di esercizio fisico massimale e sub-massimale. -I valori di PAPs, PAPm,PVR ottenuti con doppler cardiaco e la relazione tra valori di PAP e di funzione ventricolare destra con la classe NYHA e CPET. Materiali e metodi Dal Novembre 2005 al settembre 2007 sono stati arruolati 19 p.ti affetti da sclerodermia di età compresa fra 28 e 75 anni, (9 II^ NYHA-10 I^NYHA), coinvolgimento polmonare e P...
Minerva cardioangiologica, 1991
In this paper, we report the cases of 4 male patients (mean age 32.7 yr) with right-ventricular d... more In this paper, we report the cases of 4 male patients (mean age 32.7 yr) with right-ventricular dysplasia, that occurred in familial form. Diagnosis was possible according to the clinical features and to the electrocardiographic, echocardiographic and scintigraphic criteria; at Holter monitoring recorded ventricular arrhythmias with left bundle branch block configuration, associated to sinus arrhythmias (sino-auricular block). In two patients a sustained ventricular tachycardia was recorded. The patients are living and a fourteen-year-old subject is without heart disease. From our data we conclude that: the most serious clinical features occur in extensive form with right atrial and left-ventricle involvement; the clinical features were manifested at a young age and then got worse. A dominant autosomic inheritance is observed (only males were affected).
Journal of the American Society of Echocardiography, 2013
The ratio of tricuspid regurgitation velocity (TRV) to the time-velocity integral of the right ve... more The ratio of tricuspid regurgitation velocity (TRV) to the time-velocity integral of the right ventricular outflow tract (TVIRVOT) has been studied as a reliable measure to distinguish elevated from normal pulmonary vascular resistance (PVR). The equation TRV/TVIRVOT × 10 + 0.16 (PVRecho) has been shown to provide a good noninvasive estimate of PVR. However, its role in patients with significantly elevated PVR (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 6 Wood units [WU]) has not been conclusively evaluated. The aim of this study was to establish the validity of the TRV/TVIRVOT ratio as a correlate of PVR. The role of TRV/TVIRVOT was also compared with that of a new ratio, TRV(2)/TVIRVOT, in patients with markedly elevated PVR (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;6 WU). Data from five validation studies using TRV/TVIRVOT as an estimate of PVR were compared with invasive PVR measurements (PVRcath). Multiple linear regression analyses were generated between PVRcath and both TRV/TVIRVOT and TRV(2)/TVIRVOT. Both PVRecho and a new derived regression equation based on TRV(2)/TVIRVOT: 5.19 × TRV(2)/TVIRVOT - 0.4 (PVRecho2) were compared with PVRcath using Bland-Altman analysis. Logistic models were generated, and cutoff values for both TRV/TVIRVOT and TRV(2)/TVIRVOT were obtained to predict PVR &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 6 WU. One hundred fifty patients remained in the final analysis. Linear regression analysis between PVRcath and TRV/TVIRVOT revealed a good correlation (r = 0.76, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .0001, Z = 0.92). There was a better correlation between PVRcath and TRV(2)/TVIRVOT (r = 0.79, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .0001, Z = -0.01) in the entire cohort as well as in patients with PVR &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 6 WU. Moreover, PVRecho2 compared better with PVRcath than PVRecho using Bland-Altman analysis in the entire cohort and in patients with PVR &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 6 WU. TRV(2)/TVIRVOT and TRV/TVIRVOT both predicted PVR &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 6 WU with good sensitivity and specificity. TRV/TVIRVOT is a reliable method to identify patients with elevated PVR. In patients with TRV/TVIRVOT &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.275, PVR is likely &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 6 WU, and PVRecho2 derived from TRV(2)/TVIRVOT provides an improved noninvasive estimate of PVR compared with PVRecho.
Journal of the American College of Cardiology, 2013
Cardiovascular ultrasound, 2005
Supravalvular mitral stenosis is a rare condition characterized by an abnormal ridge, with one or... more Supravalvular mitral stenosis is a rare condition characterized by an abnormal ridge, with one or two orifices, covering and obstructing the mitral valve. Preoperative diagnosis is difficult with transtoracic echo (TTE), angiography and magnetic resonance imaging (MRI). In this case, a 36-year-old male, was admitted to our Heart department: He experienced progressive dyspnea on effort and at rest. Diagnosis was made by transesophageal echocardiography which showed, on apical 4-chamber section, an annular structure attached since a membrane to the atrial wall anterior mitral valve leaflet and just proximal to the posterior mitral leaflet. Pre-operative identification of the supravalvular mitral ring is the target for obtaining good surgical results. Cineangiography and MRI both failed in reaching this objective, whereas, transesophageal echocardiography is the best method to identify this congenital heart disease. Using TEE the identification is not only possible but also easier.
Giornale italiano di cardiologia, 1988
Right-sided staphylococcal endocarditis has been described in drug-addict, but not in association... more Right-sided staphylococcal endocarditis has been described in drug-addict, but not in association with an Acquired Immunodeficiency Syndrome. A case of a 26 years old drug-addict woman with AIDS related complex is reported. Antibiotic therapy, produced a favourable evolution on the illness. This case support the usefulness of two-dimensional echocardiography for detecting one of the possible complications associated with AIDS.
Acta bio-medica : Atenei Parmensis, 2011
Chronic thromboembolic pulmonary hypertension (CTEPH) caused by intraluminal thrombus organizatio... more Chronic thromboembolic pulmonary hypertension (CTEPH) caused by intraluminal thrombus organization and fibrous stenosis or complete obliteration of pulmonary arteries, is a not rare but life-threatening complication of acute pulmonary embolism. The prognosis of medically treated patients with CTEPH is poor and worsens as pulmonary hypertension exacerbates. We describe the case of a 43-years old with a history of progressive shortness of breath, hemoptysis, chest discomfort and syncope. Echocardiographic and imaging studies showed changes consistent with chronic thromboembolic pulmonary hypertension. Further work-up showed only moderate increase of homocysteine level with negative features for lupus and others primary thrombophilic disease. The patient was managed adequately with thrombolytic and inotropic therapy; oral anticoagulation was started with improvement of his clinical status and was screened for pulmonary thrombo endarterectomy, but he refused. The case presented despite ...
IJC Metabolic & Endocrine, 2014
ABSTRACT An increased risk of restrictive valvular heart disease (VHD) has been widely reported i... more ABSTRACT An increased risk of restrictive valvular heart disease (VHD) has been widely reported in patients with Parkinson's disease (PD), as a possible consequence of the chronic use of ergot-derived dopamine agonists (EDA), such as pergolide and cabergoline. An aspect that remains poorly investigated is the extent of reversibility of the valvular dysfunction after drug discontinuation.
Cardiogenetics, 2014
ABSTRACT 600799) is frequently associated with concomitant diseases, including congenital heart d... more ABSTRACT 600799) is frequently associated with concomitant diseases, including congenital heart disease. 6% of patients with PAH show a family history of the disease [hereditary PAH (HPAH)], with the major genetic determinants of HPAH being heterozygous germline mutations in the bone morphogenetic protein type II receptor (BMPR2). We present the case of a 38-year-old woman of Indian descent; initially admitted with progressive dyspnea [New York Heart Association (NYHA) class III]. The results of the proband’s clinical assessments are presented here. Cardiac catheterization confirmed idiopathic PAH with severe right ventricular hypertrophy associated with pulmonary arteriopathy. Initial treatment comprised the dual endothelin receptor antagonist, bosentan, furosemide, warfarin and intravenous infusion of prostaglandin I2 (PGI2) for 3 days. Despite this, the patient died of pulmonary hemorrhagic edema and cardiogenic shock after 6 days of intensive care. After relatives’ consent, post mortem assessments confirmed a diagnosis of PAH; the heart displayed significant right ventricular hypertrophy and it was particularly noted that the right atrial appendage had undergone extreme dilation. Pulmonary arteriopathy was characterized by medial hypertrophy, arterialization of muscular arteries and muscularization of non-muscularized muscularized distal arteries. Molecular genetic analyses revealed the presence of cis-mutations in the BMPR2 gene (p.Cys123Arg and p.Arg332X). Cosegregation studies were not available. Our findings suggest that mutations of the BMPR2 gene gave rise to the onset of PAH in this patient and that the severity of the onset and progression could be attributed to the presence of multiple mutations in a genedosage manner.
Journal of Clinical & Experimental Cardiology, 2010
Journals »». A Accounting & Marketing Addiction Research & Therapy Advances in Automobile... more Journals »». A Accounting & Marketing Addiction Research & Therapy Advances in Automobile Engineering Advances in Pharmacoepidemiology & Drug Safety Advances in Robotics & Automation Aeronautics & Aerospace ...
Respiratory Care, 2013
BACKGROUND: Patients with congestive heart failure or COPD may share an increased response in min... more BACKGROUND: Patients with congestive heart failure or COPD may share an increased response in minute ventilation (V E ) to carbon dioxide output (V CO 2 ) during exercise. The goal of this study was to ascertain whether the V E /V CO 2 slope and V E /V CO 2 intercept can discriminate between subjects with congestive heart failure and those with COPD at equal peak oxygen uptake (V O 2 ). METHODS: We studied 46 subjects with congestive heart failure (mean age 61 ؎ 9 y) and 46 subjects with COPD (mean age 64 ؎ 8 y) who performed a cardiopulmonary exercise test. RESULTS: The V E /V CO 2 slope was significantly higher in subjects with congestive heart failure compared with those with COPD (39.5 ؎ 9.5 vs 31.8 ؎ 7.4, P < .01) at peak V O 2 < 16 mL/kg/min, but not > 16 mL/kg/min (28.3 ؎ 5.3 vs 28.9 ؎ 6.6). The V E /V CO 2 intercept was significantly higher in both subgroups of subjects with COPD compared with the corresponding values in the subjects with congestive heart failure (3.60 ؎ 1.7 vs ؊0.16 ؎ 1.7 L/min, P < .01; 3.63 ؎ 2.7 vs 0.87 ؎ 1.5 L/min, P < .01). According to receiver operating characteristic curve analysis, when all subjects with peak V O 2 < 16 mL/kg/min were considered, subjects with COPD had a higher likelihood to have the V E /V CO 2 intercept > 2.14 L/min (0.92 sensitivity, 0.96 specificity). Regardless of peak V O 2 , the end-tidal pressure of CO 2 (P ETCO 2 ) at peak exercise was not different in subjects with congestive heart failure (P ؍ .42) and was significantly higher in subjects with COPD (P < .01) compared with the corresponding unloaded P ETCO 2 . CONCLUSIONS: The ventilatory response to V CO 2 during exercise was significantly different between subjects with congestive heart failure and those with COPD in terms of the V E /V CO 2 slope with moderate-to-severe reduction in exercise capacity and in terms of the V E /V CO 2 intercept regardless of exercise capacity.
Journal of the American Society of Echocardiography, 2011
Background: Because of the shortage of donor hearts, the criteria for acceptance have been consid... more Background: Because of the shortage of donor hearts, the criteria for acceptance have been considerably expanded. Abnormal results on pharmacologic stress echocardiography are associated with significant coronary artery disease and/or occult cardiomyopathy on verification by cardiac autopsy. The aim of this study was to establish the feasibility of an approach based on pharmacologic stress echocardiography as a gatekeeper for extended heart donor criteria. donors (mean age, 56 6 6 years; 21 men) were initially enrolled. After legal declaration of brain death, marginal donors underwent rest echocardiography, and if the results were normal, dipyridamole (0.84 mg/kg over 6 min, n = 25) or dobutamine (up to 40 mg/ kg/min, n = 3) stress echocardiography.
International Journal of Cardiology, 2011
Background: Prostaglandin E1 (PGE1) is a potent vasodilating drug, which has been used in treatme... more Background: Prostaglandin E1 (PGE1) is a potent vasodilating drug, which has been used in treatment of primary pulmonary hypertension. However intravenous PGE1 infusion may be of benefit and also has been proposed as a therapeutic tool in patients with end-stage heart failure.