ines monte - Academia.edu (original) (raw)
Papers by ines monte
European Heart Journal, 2018
Results: There was little difference in mean (±SD) lysis time comparing hospital discharge with 1... more Results: There was little difference in mean (±SD) lysis time comparing hospital discharge with 1-month results (803±426 vs. 817±388 secs, respectively; P<0.001), the slight increase after hospital discharge being explained by inhospital low-molecular-weight heparin treatment. Conversely, mean maximum turbidity reduced from 0.51±0.19 AU at discharge to 0.42±0.14 AU at 1 month (P<0.001). While the relationship between change in lysis time and change in CRP levels was weak, the relationship between change in clot maximum turbidity and CRP appeared linear (Figure). The prevalence of diabetes mellitus, chronic kidney disease and peripheral artery disease was highest in the highest quartile groups of both lysis time (>882 secs) and maximum turbidity (>0.49 AU) at 1 month. Conclusion: Resolution of systemic inflammation at 1-month post-ACS is associated with a drop in fibrin clot density but little effect on lysis potential. This indicates that clot density has little effect on lysis time and the derangement in fibrinolysis is not related to an enhanced inflammatory environment in ACS patients. The impact of contemporary therapy on lysis efficiency is limited, which may therefore constitute a suitable target for secondary prevention therapy, particularly in individuals with multiple risk factors.
The International Journal of Cardiovascular Imaging, 2020
An enlarged left atrial volume index (LAVI) at rest mirrors increased LA pressure and/or impairme... more An enlarged left atrial volume index (LAVI) at rest mirrors increased LA pressure and/or impairment of LA function. A cardiovascular stress may acutely modify left atrial volume (LAV) within minutes. Aim of this study was to assess the feasibility and functional correlates of LAV-stress echocardiography (SE) Out of 514 subjects referred to 10 quality-controlled labs, LAV-SE was completed in 490 (359 male, age 67 ± 12 years) with suspected or known chronic coronary syndromes (n = 462) or asymptomatic controls (n = 28). The utilized stress was exercise in 177, vasodilator in 167, dobutamine in 146. LAV was measured with the biplane disk summation method. SE was performed with the ABCDE protocol. The intra-observer and inter-observer LAV variability were 5% and 8%, respectively. ∆-LAVI changes (stress-rest) were negatively correlated with resting LAVI (r = − 0.271, p < 0.001) and heart rate reserve (r =-.239, p < 0.001). LAV-dilators were defined as those with stress-rest increase ≥ 6.8 ml/m 2 , a cutoff derived from a calculated reference change value above the biological, analytical and observer variability of LAVI. LAV dilation occurred in 56 patients (11%), more frequently with exercise (16%) and dipyridamole (13%) compared to dobutamine (4%, p < 0.01). At multivariable logistic regression analysis, B-lines ≥ 2 (OR: 2.586, 95% CI = 1.1293-5.169, p = 0.007) and abnormal contractile reserve (OR: 2.207, 95% CI = 1.111-4.386, p = 0.024) were associated with LAV dilation. In conclusion, LAV-SE is feasible with high success rate and low variability in patients with chronic coronary syndromes. LAV dilation is more likely with reduced left ventricular contractile reserve and pulmonary congestion.
Journal of Clinical Medicine, 2021
Background: Cardiology divisions reshaped their activities during the coronavirus disease 2019 (C... more Background: Cardiology divisions reshaped their activities during the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to analyze the organization of echocardiographic laboratories and echocardiography practice during the second wave of the COVID-19 pandemic in Italy, and the expectations for the post-COVID era. Methods: We analyzed two different time periods: the month of November during the second wave of the COVID-19 pandemic (2020) and the identical month during 2019 (November 2019). Results: During the second wave of the COVID-19 pandemic, the hospital activity was partially reduced in 42 (60%) and wholly interrupted in 3 (4%) echocardiographic laboratories, whereas outpatient echocardiographic activity was partially reduced in 41 (59%) and completely interrupted in 7 (10%) laboratories. We observed an important change in the organization of activities in the echocardiography laboratory which reduced the operator-risk and improved self-protection of operators by u...
Heart Failure Reviews, 2020
Chronic myeloid leukemia (CML) is a myeloproliferative disorder characterized by neoplastic trans... more Chronic myeloid leukemia (CML) is a myeloproliferative disorder characterized by neoplastic transformation of pluripotent cells due to a typical cytogenetic and molecular mutation known as Philadelphia (Ph) chromosome. In 2001, the introduction of the tyrosine kinasis inhibitor (TKI) imatinib as a therapeutic strategy for CML with PH chromosome mutation represented an important step towards treatment of these patients, and nowadays, this drug represents the gold therapeutic standard in this clinical setting. A second generation of TKIs (dasatinib, nilotinib, and bosutinib) showed an effective action in all patients with mutations resistant to imatinib. Ponatinib is a third-generation TKI and is the only inhibitor with activity against T3151 mutation. The impact of ponatinib on cardiovascular events was first evaluated in the PACE trial. We therefore report and discuss most relevant evidence currently available on cardiovascular events associated with the use of ponatinib. Though many exams can be used for diagnosis and follow-up of this kind of cardiotoxicity, echocardiography seems to have a pivotal role thanks to its feasibility, availability, and low cost.
Journal of the American College of Cardiology, 2019
BACKGROUND The assessment of coronary flow velocity reserve (CFVR) in left anterior descending co... more BACKGROUND The assessment of coronary flow velocity reserve (CFVR) in left anterior descending coronary artery (LAD) expands the risk stratification potential of stress echocardiography (SE) based on stress-induced regional wall motion abnormalities (RWMA). OBJECTIVES The purpose of this study was to assess the feasibility and functional correlates of CFVR. METHODS This prospective, observational, multicenter study initially screened 3,410 patients (2,061 [60%] male; age 63 AE 11 years; ejection fraction 61 AE 9%) with known or suspected coronary artery disease and/or heart failure. All patients underwent SE (exercise, n ¼ 1,288; vasodilator, n ¼ 1,860; dobutamine, n ¼ 262) based on new or worsening RWMA in 20 accredited laboratories of 8 countries. CFVR was calculated as the stress/rest ratio of diastolic peak flow velocity pulsed-Doppler assessment of LAD flow. A subset of 1,867 patients was followed up. RESULTS The success rate for CFVR on LAD was 3,002 of 3,410 (feasibility ¼ 88%). Reduced (#2.0) CFVR was found in 896 of 3,002 (30%) patients. At multivariable logistic regression analysis, inducible RWMA (odds ratio [OR]: 6.5; 95% confidence interval [CI]: 4.9 to 8.5; p < 0.01), abnormal left ventricular contractile reserve (OR: 3.4; 95% CI: 2.7 to 4.2; p < 0.01), and B-lines (OR: 1.5; 95% CI: 1.1 to 1.9; p ¼ 0.01) were associated with reduced CFVR. During a median followup time of 16 months, 218 events occurred. RWMA (hazard ratio: 3.8; 95% CI: 2.3 to 6.3; p < 0.001) and reduced CFVR (hazard ratio: 1.5; 95% CI: 1.1 to 2.2; p ¼ 0.009) were independently associated with adverse outcome. CONCLUSIONS CFVR is feasible with all SE protocols. Reduced CFVR is often accompanied by RWMA, abnormal LVCR, and pulmonary congestion during stress, and shows independent value over RWMA in predicting an adverse outcome.
Cardiovascular ultrasound, Jan 25, 2018
The effectiveness trial "Stress echo (SE) 2020" evaluates novel applications of SE in a... more The effectiveness trial "Stress echo (SE) 2020" evaluates novel applications of SE in and beyond coronary artery disease. The core protocol also includes 4-site simplified scan of B-lines by lung ultrasound, useful to assess pulmonary congestion. To provide web-based upstream quality control and harmonization of B-lines reading criteria. 60 readers (all previously accredited for regional wall motion, 53 B-lines naive) from 52 centers of 16 countries of SE 2020 network read a set of 20 lung ultrasound video-clips selected by the Pisa lab serving as reference standard, after taking an obligatory web-based learning 2-h module ( http://se2020.altervista.org ). Each test clip was scored for B-lines from 0 (black lung, A-lines, no B-lines) to 10 (white lung, coalescing B-lines). The diagnostic gold standard was the concordant assessment of two experienced readers of the Pisa lab. The answer of the reader was considered correct if concordant with reference standard reading ±1 (fo...
Journal of cardiovascular echography
IntroductIon Along with the growth of patients at cardiovascular risk, a new wave is hitting the ... more IntroductIon Along with the growth of patients at cardiovascular risk, a new wave is hitting the world of health care. Over the recent decade, noninvasive and invasive imaging technologies have been protagonists of a dramatic evolution. This process, as a Tsunami, may overwhelm the way the physicians were used to work until now [Figure 1]. The greater availability and reliability of current imaging modalities to reveal the details of various cardiac structures and pathophysiology has made the evaluation of cardiovascular disease multimodal. Hence, along with traditional imaging modalities, such as single photon computed emission tomography (SPECT) or tissue Doppler imaging and two-dimensional echocardiography (2DE), new technologies emerge in the scene such as deformation/ speckle tracking imaging (strain and strain rate) and three-dimensional echocardiography (3DE); miniaturized or handheld cardiovascular ultrasound machine; positron emission tomography (PET) and computed tomography (CT), and cardiac magnetic resonance (CMR) as well as the combination of them, resulting in the so-called “fusion imaging.”
International journal of cardiology, 2017
The trial "Stress Echo (SE) 2020" evaluates novel applications of SE beyond coronary ar... more The trial "Stress Echo (SE) 2020" evaluates novel applications of SE beyond coronary artery disease. The aim of the study was control quality and harmonize reading criteria. One reader from 78 centers of the SE 2020 network asked for credentials to read a set of 20 SE video-clips selected by the core lab. All aspiring centers met the pre-requisite of high-volume and the years of experience in SE ranged from 5 to 31years (mean value 18years). The diagnostic gold standard was a reading by the core lab. The a priori determined pass threshold was 18/20 (≥90%). Of the initial 78 who started, 57 completed the first attempt: individual readers' score on first attempt ranged from 07/20 to 20/20 (accuracy from 35% to 100%, mean 78.7±13%) and 44 readers passed it. There was a very poor correlation between years of experience and the reader's score on first attempt (r=-0.161, p=0.231). Of the 13 readers who failed the first attempt, 12 took it again after the web-based sessio...
Journal of Cardiovascular Medicine, 2016
The evaluation by cardiovascular imaging of chemotherapy patients became a central topic in the l... more The evaluation by cardiovascular imaging of chemotherapy patients became a central topic in the last several years. The use of drugs for the treatment of cancers increased, and new molecules and protocols were developed to improve outcomes in these patients. Although, these novel approaches also produced a progressive increase in side effects, particularly myocardial dysfunction. Imaging of the heart was highly accurate in the early diagnosis of cancer therapeutics related-cardiac dysfunction. Echocardiography is the first-line method to assess ventricular function alterations, and it is required to satisfy the need for an early, easy and accurate diagnosis to stratify the risk of heart failure and manage treatments. A careful monitoring of cardiac function during the course of therapy should prevent the onset of severe heart impairment. This review provides an overview of the most important findings of the role of echocardiography in the management of chemotherapy-treated patients to create a clear and complete description of the efficacy of conventional measurements, the importance of comprehensive heart evaluations, the additional role of new echocardiographic techniques, the utility of integrated studies using other imaging tools and the positions of the most important international societies on this topic.
Echocardiography, 2015
Introduction: Current guidelines recommend three-dimensional echocardiography (3DE) as the refere... more Introduction: Current guidelines recommend three-dimensional echocardiography (3DE) as the reference technique to assess left ventricular (LV) volumes and ejection fraction (EF). We performed a metaanalysis to identify normative reference values by real time 3DE in healthy subjects. Methods: We searched MEDLINE and the Cochrane Library databases using the key search terms three-dimensional echocardiography, volumes, and healthy. Data were pooled using random-effects meta-analysis, and source of variation was investigated using meta-regression. After selection, 13 articles were included (2806 subjects). Four studies were conducted in children and young adolescents; one study provided data in an independent pediatric subgroup. Results: In adults, pooled mean value for LV EDV was 98.4 mL (95%CI, 87-110 mL), while LV ESV mean value was 37.0 mL (95%CI, 32-42 mL). LV EF mean value was 62.9% (95%CI 61.7-64.2%). Male subjects showed a significant increase in both LV EDV index (mean difference 5.3 mL/m 2 ; P < 0.001) and LV ESV index (mean difference 3.3 mL/m 2 ; P < 0.001). LV EF was significantly higher in female subjects (P = 0.003). In pediatric studies, LV EDV pooled mean value was 53.1 mL (95%CI, 38.1-68 mL), while for LV ESV, it was 19.8 mL (95%CI, 14.8-24.8 mL); LV EF mean value was 63.3% (95%CI, 61.6-65%). Significant heterogeneity and inconsistency were noted among studies. Age, systolic blood pressure, and heart rate were identified as a source of between-studies variation for LV volumes. Body surface area was a predictor of nonindexed LV volumes. Conclusions: Data from available studies of normative values for 3DE were summarized. Our findings may increase the generalizability of LV normative data by 3DE.
BioMed Research International, 2015
Fabry disease (FD) is an inherited metabolic disorder caused by partial or full inactivation of t... more Fabry disease (FD) is an inherited metabolic disorder caused by partial or full inactivation of the lysosomal hydrolaseα-galactosidase A (α-GAL). The impairment ofα-GAL results in the accumulation of undegraded glycosphingolipids in lysosomes and subsequent cell and microvascular dysfunctions. This study reports the clinical, biochemical, and molecular characterization of 15 members of the same family. Eight members showed the exonic mutation M51I in the GLA gene, a disease-causing mutation associated with the atypical phenotype. The clinical history of this family highlights a wide phenotypic variability, in terms of involved organs and severity. The phenotypic variability of two male patients is not related to differences inα-GAL enzymatic activity: though both have no enzymatic activity, the youngest shows severe symptoms, while the eldest is asymptomatic. It is noticeable that for two female patients with the M51I mutation the initial clinical diagnosis was different from FD. On...
Minerva cardioangiologica, 2006
The preoperative cardiac evaluation of a patient who undergoes noncardiac surgery is a very impor... more The preoperative cardiac evaluation of a patient who undergoes noncardiac surgery is a very important problem, particularly for diagnostic tools used. Aim of this study is to test the usefulness of 4 most used clinical indexes for the evaluation of cardiovascular risk in the management of patients who undergo noncardiac surgery. The study is based on a retrospective analysis of a group of 45 patients, who underwent extracardiac surgery in biennium 2002-2004. The cardiovascular risk scores of Goldman, Detsky, Lee and Eagle were used; a comparison among the different scores was done. Six out of our 45 patients had perioperative cardiovascular complications, and 4 of them died. The Eagle and Lee scores were more predictive than Goldman and Detsky ones. About the 13 echocardiographic tests recorded, no one of them modified the patient preoperative risk. In the preoperative assessment of risk, the Eagle score was more useful than the others ones and improved the negative predictive value...
Minerva cardioangiologica, 2006
Inflammatory abdominal aortic aneurysm (IAAA) is defined as an unusually thickened aneurysmatic w... more Inflammatory abdominal aortic aneurysm (IAAA) is defined as an unusually thickened aneurysmatic wall, encircled by a wide dense perianeurysmal and/or retroperitoneal fibrosis with adjacent tissues adhesion, and is now considered as an extreme shape of the common phlogistic process involved in atherosclerotic plaque formation. Latest studies demonstrated that inflammation plays an important role in coronary disease and in other atherosclerosis manifestations. We introduce the clinical case of a patient with IAAA who developed an acute myocardial infarction 6 months after the surgical procedure on the aorta. Through a literature review about IAAA we stress the clinical usefulness of the inflammatory markers as independent predictors in management of patients with coronary disease and we present the hypothesis, related to the introduced case, of an advanced coronary disease, aggravated or clinically revealed after the cytokine storm related to important localized inflammatory engagemen...
Italian heart journal. Supplement : official journal of the Italian Federation of Cardiology, 2005
Strain rate (SR) is considered as an accurate index of myocardial contractility, capable of diffe... more Strain rate (SR) is considered as an accurate index of myocardial contractility, capable of differentiating regional myocardial contractions from hypokinetic ones. It is not dependent on adjacent myocardial motion or heart translation. Clinical studies proved this method to be useful in case of heart disease but detailed analyses, homogeneous normal reference parameters, and studies about atrial myocardium are still scanty. The aim of this study was to evaluate longitudinal SR of the left myocardial ventricle and atrium in normal subjects. Nineteen normal subjects were examined with tissue Doppler imaging; SR values were obtained off-line on images stored by internal software using the curved M-mode of the left ventricle and atrium. Mean SR values were obtained at the distal, mid, and basal left ventricular segments of the septum and lateral wall, and at the basal and distal left atrial segments of the septum and lateral wall. Ventricular SR values showed a negative systolic peak, t...
Cardiologia (Rome, Italy), 1982
Journal of Cardiovascular Echography, 2012
Introduction: In the last 50 years the utilization of ultrasound has greatly developed into echoc... more Introduction: In the last 50 years the utilization of ultrasound has greatly developed into echocardiography, generating a confused picture of the echocardiographic technique, with patients who do not receive the right echocardiogram. Objectives: The present proposal for reclassification of Echocardiography based on function, competence, applications, proper machines and purposes is intended to give a coherent and adequate definition of requirements, in order to have: One tool for a given place, One technique for a given clinical situation, One application for a given function, One modality for a given information, One exam for a given purpose and One educational pathway for a given operator. Materials and methods: According to these points, the new classification will be oriented towards an application-and competence-based Echocardiography, introducing an innovative way to look at Echocardiography that overcomes the traditional technical-based or pathology-based classification. Results: Therefore, the following function-and competence-echocardiography application and profiles have been identified: 1
Journal of Cardiovascular Medicine, 2014
In continuation of a previous publication, the present study will take into account for each appl... more In continuation of a previous publication, the present study will take into account for each application and profile the clinical use, the minimal data settings, the echo data findings, the indications, the quality process, the accreditation requirements, educational tailored pathway contents and modalities. The aim of the present document was to define the main applications of echocardiography and to tailor for each application-derived profile, according with the previous definitions, requirements that clearly identify the indication, objective, clinical situation in which echocardiography is used, educational pathway and training, quality process and accreditation.
Journal of the American Society of Echocardiography, 2012
Iron-mediated cardiomyopathy is the leading cause of death in patients with thalassemia major (TM... more Iron-mediated cardiomyopathy is the leading cause of death in patients with thalassemia major (TM). The identification of subclinical cardiac involvement in the early phases of the disease is important to optimize therapeutic strategies. The aim of this study was to identify early markers of cardiac dysfunction through new parameters of cardiac rotational dynamics and to look for a relationship with parameters of iron overload. Methods: Twenty-seven asymptomatic patients with TM and 27 healthy control subjects were prospectively enrolled. All subjects underwent standard echocardiography and subsequent offline analysis to assess left ventricular (LV) rotation and longitudinal mechanics using speckle-tracking echocardiography. In all patients with TM, ferritin levels were measured, and a subgroup underwent cardiac magnetic resonance imaging. Results: All subjects had normal parameters of cardiac function, although patients with TM showed significantly lower S 0 values (P = .030) and E 0 values (P = .025), with increased E/E 0 ratio (P = .003) and indexed left atrial volumes (P = .022). Compared with controls, patients with TM had significantly reduced systolic apical rotation (P = .006), LV twist (P = .002), and LV torsion (P = .001). Systolic and diastolic rotational peak velocities at the apical level were also significantly decreased in the TM group (P = .003 and P = .011, respectively) with reductions of twisting and untwisting rates (P = .003 and P = .001, respectively). Patients with TM also showed a significant reduction of longitudinal displacement from the two-chamber apical view (P = .042) but preserved longitudinal strain and strain rate. Patients with T2* values > 20 msec had preserved rotational function, while those with T2* values < 20 msec showed significantly lower mean values of LV peak basal systolic rotation (À3.
Journal of Inherited Metabolic Disease, 2013
AimsFabry disease (FD) is a rare X‐linked genetic disorder caused by the deficiency or absent act... more AimsFabry disease (FD) is a rare X‐linked genetic disorder caused by the deficiency or absent activity of lysosomal α‐galactosidase A. Cardiovascular remodelling is a hallmark of FD. The present study aimed to comprehensively evaluate the cardiac, vascular and microvascular status in a population of patients with genetic mutations for FD without left ventricular hypertrophy (LVH).Methods and resultsThis study includes subjects carrying genetic mutations for FD (Fabry disease mutation‐carrier, FDMC) without LVH (n = 19). A group of control subjects (n = 19) matched for age, sex, body mass index and cardiovascular risk factors were also included. All subjects underwent echocardiography, carotid ultrasound scan, endothelial flow‐mediated dilatation (FMD) and nailfold capillaroscopy (NFC) assessment. When compared to the subjects in the control group, FDMC patients showed significantly lower mean values of systolic myocardial velocity (7.33 ± 1.28 vs. 10.08 ± 1.63 cm/s, p < 0.0001), ...
Journal of Hypertension, 2011
Conclusions: Polymorphism of analyzed genes influenced IMT in patients with EAH and associates wi... more Conclusions: Polymorphism of analyzed genes influenced IMT in patients with EAH and associates with number of severe grades of intestinal dysbiosis.
European Heart Journal, 2018
Results: There was little difference in mean (±SD) lysis time comparing hospital discharge with 1... more Results: There was little difference in mean (±SD) lysis time comparing hospital discharge with 1-month results (803±426 vs. 817±388 secs, respectively; P<0.001), the slight increase after hospital discharge being explained by inhospital low-molecular-weight heparin treatment. Conversely, mean maximum turbidity reduced from 0.51±0.19 AU at discharge to 0.42±0.14 AU at 1 month (P<0.001). While the relationship between change in lysis time and change in CRP levels was weak, the relationship between change in clot maximum turbidity and CRP appeared linear (Figure). The prevalence of diabetes mellitus, chronic kidney disease and peripheral artery disease was highest in the highest quartile groups of both lysis time (>882 secs) and maximum turbidity (>0.49 AU) at 1 month. Conclusion: Resolution of systemic inflammation at 1-month post-ACS is associated with a drop in fibrin clot density but little effect on lysis potential. This indicates that clot density has little effect on lysis time and the derangement in fibrinolysis is not related to an enhanced inflammatory environment in ACS patients. The impact of contemporary therapy on lysis efficiency is limited, which may therefore constitute a suitable target for secondary prevention therapy, particularly in individuals with multiple risk factors.
The International Journal of Cardiovascular Imaging, 2020
An enlarged left atrial volume index (LAVI) at rest mirrors increased LA pressure and/or impairme... more An enlarged left atrial volume index (LAVI) at rest mirrors increased LA pressure and/or impairment of LA function. A cardiovascular stress may acutely modify left atrial volume (LAV) within minutes. Aim of this study was to assess the feasibility and functional correlates of LAV-stress echocardiography (SE) Out of 514 subjects referred to 10 quality-controlled labs, LAV-SE was completed in 490 (359 male, age 67 ± 12 years) with suspected or known chronic coronary syndromes (n = 462) or asymptomatic controls (n = 28). The utilized stress was exercise in 177, vasodilator in 167, dobutamine in 146. LAV was measured with the biplane disk summation method. SE was performed with the ABCDE protocol. The intra-observer and inter-observer LAV variability were 5% and 8%, respectively. ∆-LAVI changes (stress-rest) were negatively correlated with resting LAVI (r = − 0.271, p < 0.001) and heart rate reserve (r =-.239, p < 0.001). LAV-dilators were defined as those with stress-rest increase ≥ 6.8 ml/m 2 , a cutoff derived from a calculated reference change value above the biological, analytical and observer variability of LAVI. LAV dilation occurred in 56 patients (11%), more frequently with exercise (16%) and dipyridamole (13%) compared to dobutamine (4%, p < 0.01). At multivariable logistic regression analysis, B-lines ≥ 2 (OR: 2.586, 95% CI = 1.1293-5.169, p = 0.007) and abnormal contractile reserve (OR: 2.207, 95% CI = 1.111-4.386, p = 0.024) were associated with LAV dilation. In conclusion, LAV-SE is feasible with high success rate and low variability in patients with chronic coronary syndromes. LAV dilation is more likely with reduced left ventricular contractile reserve and pulmonary congestion.
Journal of Clinical Medicine, 2021
Background: Cardiology divisions reshaped their activities during the coronavirus disease 2019 (C... more Background: Cardiology divisions reshaped their activities during the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to analyze the organization of echocardiographic laboratories and echocardiography practice during the second wave of the COVID-19 pandemic in Italy, and the expectations for the post-COVID era. Methods: We analyzed two different time periods: the month of November during the second wave of the COVID-19 pandemic (2020) and the identical month during 2019 (November 2019). Results: During the second wave of the COVID-19 pandemic, the hospital activity was partially reduced in 42 (60%) and wholly interrupted in 3 (4%) echocardiographic laboratories, whereas outpatient echocardiographic activity was partially reduced in 41 (59%) and completely interrupted in 7 (10%) laboratories. We observed an important change in the organization of activities in the echocardiography laboratory which reduced the operator-risk and improved self-protection of operators by u...
Heart Failure Reviews, 2020
Chronic myeloid leukemia (CML) is a myeloproliferative disorder characterized by neoplastic trans... more Chronic myeloid leukemia (CML) is a myeloproliferative disorder characterized by neoplastic transformation of pluripotent cells due to a typical cytogenetic and molecular mutation known as Philadelphia (Ph) chromosome. In 2001, the introduction of the tyrosine kinasis inhibitor (TKI) imatinib as a therapeutic strategy for CML with PH chromosome mutation represented an important step towards treatment of these patients, and nowadays, this drug represents the gold therapeutic standard in this clinical setting. A second generation of TKIs (dasatinib, nilotinib, and bosutinib) showed an effective action in all patients with mutations resistant to imatinib. Ponatinib is a third-generation TKI and is the only inhibitor with activity against T3151 mutation. The impact of ponatinib on cardiovascular events was first evaluated in the PACE trial. We therefore report and discuss most relevant evidence currently available on cardiovascular events associated with the use of ponatinib. Though many exams can be used for diagnosis and follow-up of this kind of cardiotoxicity, echocardiography seems to have a pivotal role thanks to its feasibility, availability, and low cost.
Journal of the American College of Cardiology, 2019
BACKGROUND The assessment of coronary flow velocity reserve (CFVR) in left anterior descending co... more BACKGROUND The assessment of coronary flow velocity reserve (CFVR) in left anterior descending coronary artery (LAD) expands the risk stratification potential of stress echocardiography (SE) based on stress-induced regional wall motion abnormalities (RWMA). OBJECTIVES The purpose of this study was to assess the feasibility and functional correlates of CFVR. METHODS This prospective, observational, multicenter study initially screened 3,410 patients (2,061 [60%] male; age 63 AE 11 years; ejection fraction 61 AE 9%) with known or suspected coronary artery disease and/or heart failure. All patients underwent SE (exercise, n ¼ 1,288; vasodilator, n ¼ 1,860; dobutamine, n ¼ 262) based on new or worsening RWMA in 20 accredited laboratories of 8 countries. CFVR was calculated as the stress/rest ratio of diastolic peak flow velocity pulsed-Doppler assessment of LAD flow. A subset of 1,867 patients was followed up. RESULTS The success rate for CFVR on LAD was 3,002 of 3,410 (feasibility ¼ 88%). Reduced (#2.0) CFVR was found in 896 of 3,002 (30%) patients. At multivariable logistic regression analysis, inducible RWMA (odds ratio [OR]: 6.5; 95% confidence interval [CI]: 4.9 to 8.5; p < 0.01), abnormal left ventricular contractile reserve (OR: 3.4; 95% CI: 2.7 to 4.2; p < 0.01), and B-lines (OR: 1.5; 95% CI: 1.1 to 1.9; p ¼ 0.01) were associated with reduced CFVR. During a median followup time of 16 months, 218 events occurred. RWMA (hazard ratio: 3.8; 95% CI: 2.3 to 6.3; p < 0.001) and reduced CFVR (hazard ratio: 1.5; 95% CI: 1.1 to 2.2; p ¼ 0.009) were independently associated with adverse outcome. CONCLUSIONS CFVR is feasible with all SE protocols. Reduced CFVR is often accompanied by RWMA, abnormal LVCR, and pulmonary congestion during stress, and shows independent value over RWMA in predicting an adverse outcome.
Cardiovascular ultrasound, Jan 25, 2018
The effectiveness trial "Stress echo (SE) 2020" evaluates novel applications of SE in a... more The effectiveness trial "Stress echo (SE) 2020" evaluates novel applications of SE in and beyond coronary artery disease. The core protocol also includes 4-site simplified scan of B-lines by lung ultrasound, useful to assess pulmonary congestion. To provide web-based upstream quality control and harmonization of B-lines reading criteria. 60 readers (all previously accredited for regional wall motion, 53 B-lines naive) from 52 centers of 16 countries of SE 2020 network read a set of 20 lung ultrasound video-clips selected by the Pisa lab serving as reference standard, after taking an obligatory web-based learning 2-h module ( http://se2020.altervista.org ). Each test clip was scored for B-lines from 0 (black lung, A-lines, no B-lines) to 10 (white lung, coalescing B-lines). The diagnostic gold standard was the concordant assessment of two experienced readers of the Pisa lab. The answer of the reader was considered correct if concordant with reference standard reading ±1 (fo...
Journal of cardiovascular echography
IntroductIon Along with the growth of patients at cardiovascular risk, a new wave is hitting the ... more IntroductIon Along with the growth of patients at cardiovascular risk, a new wave is hitting the world of health care. Over the recent decade, noninvasive and invasive imaging technologies have been protagonists of a dramatic evolution. This process, as a Tsunami, may overwhelm the way the physicians were used to work until now [Figure 1]. The greater availability and reliability of current imaging modalities to reveal the details of various cardiac structures and pathophysiology has made the evaluation of cardiovascular disease multimodal. Hence, along with traditional imaging modalities, such as single photon computed emission tomography (SPECT) or tissue Doppler imaging and two-dimensional echocardiography (2DE), new technologies emerge in the scene such as deformation/ speckle tracking imaging (strain and strain rate) and three-dimensional echocardiography (3DE); miniaturized or handheld cardiovascular ultrasound machine; positron emission tomography (PET) and computed tomography (CT), and cardiac magnetic resonance (CMR) as well as the combination of them, resulting in the so-called “fusion imaging.”
International journal of cardiology, 2017
The trial "Stress Echo (SE) 2020" evaluates novel applications of SE beyond coronary ar... more The trial "Stress Echo (SE) 2020" evaluates novel applications of SE beyond coronary artery disease. The aim of the study was control quality and harmonize reading criteria. One reader from 78 centers of the SE 2020 network asked for credentials to read a set of 20 SE video-clips selected by the core lab. All aspiring centers met the pre-requisite of high-volume and the years of experience in SE ranged from 5 to 31years (mean value 18years). The diagnostic gold standard was a reading by the core lab. The a priori determined pass threshold was 18/20 (≥90%). Of the initial 78 who started, 57 completed the first attempt: individual readers' score on first attempt ranged from 07/20 to 20/20 (accuracy from 35% to 100%, mean 78.7±13%) and 44 readers passed it. There was a very poor correlation between years of experience and the reader's score on first attempt (r=-0.161, p=0.231). Of the 13 readers who failed the first attempt, 12 took it again after the web-based sessio...
Journal of Cardiovascular Medicine, 2016
The evaluation by cardiovascular imaging of chemotherapy patients became a central topic in the l... more The evaluation by cardiovascular imaging of chemotherapy patients became a central topic in the last several years. The use of drugs for the treatment of cancers increased, and new molecules and protocols were developed to improve outcomes in these patients. Although, these novel approaches also produced a progressive increase in side effects, particularly myocardial dysfunction. Imaging of the heart was highly accurate in the early diagnosis of cancer therapeutics related-cardiac dysfunction. Echocardiography is the first-line method to assess ventricular function alterations, and it is required to satisfy the need for an early, easy and accurate diagnosis to stratify the risk of heart failure and manage treatments. A careful monitoring of cardiac function during the course of therapy should prevent the onset of severe heart impairment. This review provides an overview of the most important findings of the role of echocardiography in the management of chemotherapy-treated patients to create a clear and complete description of the efficacy of conventional measurements, the importance of comprehensive heart evaluations, the additional role of new echocardiographic techniques, the utility of integrated studies using other imaging tools and the positions of the most important international societies on this topic.
Echocardiography, 2015
Introduction: Current guidelines recommend three-dimensional echocardiography (3DE) as the refere... more Introduction: Current guidelines recommend three-dimensional echocardiography (3DE) as the reference technique to assess left ventricular (LV) volumes and ejection fraction (EF). We performed a metaanalysis to identify normative reference values by real time 3DE in healthy subjects. Methods: We searched MEDLINE and the Cochrane Library databases using the key search terms three-dimensional echocardiography, volumes, and healthy. Data were pooled using random-effects meta-analysis, and source of variation was investigated using meta-regression. After selection, 13 articles were included (2806 subjects). Four studies were conducted in children and young adolescents; one study provided data in an independent pediatric subgroup. Results: In adults, pooled mean value for LV EDV was 98.4 mL (95%CI, 87-110 mL), while LV ESV mean value was 37.0 mL (95%CI, 32-42 mL). LV EF mean value was 62.9% (95%CI 61.7-64.2%). Male subjects showed a significant increase in both LV EDV index (mean difference 5.3 mL/m 2 ; P < 0.001) and LV ESV index (mean difference 3.3 mL/m 2 ; P < 0.001). LV EF was significantly higher in female subjects (P = 0.003). In pediatric studies, LV EDV pooled mean value was 53.1 mL (95%CI, 38.1-68 mL), while for LV ESV, it was 19.8 mL (95%CI, 14.8-24.8 mL); LV EF mean value was 63.3% (95%CI, 61.6-65%). Significant heterogeneity and inconsistency were noted among studies. Age, systolic blood pressure, and heart rate were identified as a source of between-studies variation for LV volumes. Body surface area was a predictor of nonindexed LV volumes. Conclusions: Data from available studies of normative values for 3DE were summarized. Our findings may increase the generalizability of LV normative data by 3DE.
BioMed Research International, 2015
Fabry disease (FD) is an inherited metabolic disorder caused by partial or full inactivation of t... more Fabry disease (FD) is an inherited metabolic disorder caused by partial or full inactivation of the lysosomal hydrolaseα-galactosidase A (α-GAL). The impairment ofα-GAL results in the accumulation of undegraded glycosphingolipids in lysosomes and subsequent cell and microvascular dysfunctions. This study reports the clinical, biochemical, and molecular characterization of 15 members of the same family. Eight members showed the exonic mutation M51I in the GLA gene, a disease-causing mutation associated with the atypical phenotype. The clinical history of this family highlights a wide phenotypic variability, in terms of involved organs and severity. The phenotypic variability of two male patients is not related to differences inα-GAL enzymatic activity: though both have no enzymatic activity, the youngest shows severe symptoms, while the eldest is asymptomatic. It is noticeable that for two female patients with the M51I mutation the initial clinical diagnosis was different from FD. On...
Minerva cardioangiologica, 2006
The preoperative cardiac evaluation of a patient who undergoes noncardiac surgery is a very impor... more The preoperative cardiac evaluation of a patient who undergoes noncardiac surgery is a very important problem, particularly for diagnostic tools used. Aim of this study is to test the usefulness of 4 most used clinical indexes for the evaluation of cardiovascular risk in the management of patients who undergo noncardiac surgery. The study is based on a retrospective analysis of a group of 45 patients, who underwent extracardiac surgery in biennium 2002-2004. The cardiovascular risk scores of Goldman, Detsky, Lee and Eagle were used; a comparison among the different scores was done. Six out of our 45 patients had perioperative cardiovascular complications, and 4 of them died. The Eagle and Lee scores were more predictive than Goldman and Detsky ones. About the 13 echocardiographic tests recorded, no one of them modified the patient preoperative risk. In the preoperative assessment of risk, the Eagle score was more useful than the others ones and improved the negative predictive value...
Minerva cardioangiologica, 2006
Inflammatory abdominal aortic aneurysm (IAAA) is defined as an unusually thickened aneurysmatic w... more Inflammatory abdominal aortic aneurysm (IAAA) is defined as an unusually thickened aneurysmatic wall, encircled by a wide dense perianeurysmal and/or retroperitoneal fibrosis with adjacent tissues adhesion, and is now considered as an extreme shape of the common phlogistic process involved in atherosclerotic plaque formation. Latest studies demonstrated that inflammation plays an important role in coronary disease and in other atherosclerosis manifestations. We introduce the clinical case of a patient with IAAA who developed an acute myocardial infarction 6 months after the surgical procedure on the aorta. Through a literature review about IAAA we stress the clinical usefulness of the inflammatory markers as independent predictors in management of patients with coronary disease and we present the hypothesis, related to the introduced case, of an advanced coronary disease, aggravated or clinically revealed after the cytokine storm related to important localized inflammatory engagemen...
Italian heart journal. Supplement : official journal of the Italian Federation of Cardiology, 2005
Strain rate (SR) is considered as an accurate index of myocardial contractility, capable of diffe... more Strain rate (SR) is considered as an accurate index of myocardial contractility, capable of differentiating regional myocardial contractions from hypokinetic ones. It is not dependent on adjacent myocardial motion or heart translation. Clinical studies proved this method to be useful in case of heart disease but detailed analyses, homogeneous normal reference parameters, and studies about atrial myocardium are still scanty. The aim of this study was to evaluate longitudinal SR of the left myocardial ventricle and atrium in normal subjects. Nineteen normal subjects were examined with tissue Doppler imaging; SR values were obtained off-line on images stored by internal software using the curved M-mode of the left ventricle and atrium. Mean SR values were obtained at the distal, mid, and basal left ventricular segments of the septum and lateral wall, and at the basal and distal left atrial segments of the septum and lateral wall. Ventricular SR values showed a negative systolic peak, t...
Cardiologia (Rome, Italy), 1982
Journal of Cardiovascular Echography, 2012
Introduction: In the last 50 years the utilization of ultrasound has greatly developed into echoc... more Introduction: In the last 50 years the utilization of ultrasound has greatly developed into echocardiography, generating a confused picture of the echocardiographic technique, with patients who do not receive the right echocardiogram. Objectives: The present proposal for reclassification of Echocardiography based on function, competence, applications, proper machines and purposes is intended to give a coherent and adequate definition of requirements, in order to have: One tool for a given place, One technique for a given clinical situation, One application for a given function, One modality for a given information, One exam for a given purpose and One educational pathway for a given operator. Materials and methods: According to these points, the new classification will be oriented towards an application-and competence-based Echocardiography, introducing an innovative way to look at Echocardiography that overcomes the traditional technical-based or pathology-based classification. Results: Therefore, the following function-and competence-echocardiography application and profiles have been identified: 1
Journal of Cardiovascular Medicine, 2014
In continuation of a previous publication, the present study will take into account for each appl... more In continuation of a previous publication, the present study will take into account for each application and profile the clinical use, the minimal data settings, the echo data findings, the indications, the quality process, the accreditation requirements, educational tailored pathway contents and modalities. The aim of the present document was to define the main applications of echocardiography and to tailor for each application-derived profile, according with the previous definitions, requirements that clearly identify the indication, objective, clinical situation in which echocardiography is used, educational pathway and training, quality process and accreditation.
Journal of the American Society of Echocardiography, 2012
Iron-mediated cardiomyopathy is the leading cause of death in patients with thalassemia major (TM... more Iron-mediated cardiomyopathy is the leading cause of death in patients with thalassemia major (TM). The identification of subclinical cardiac involvement in the early phases of the disease is important to optimize therapeutic strategies. The aim of this study was to identify early markers of cardiac dysfunction through new parameters of cardiac rotational dynamics and to look for a relationship with parameters of iron overload. Methods: Twenty-seven asymptomatic patients with TM and 27 healthy control subjects were prospectively enrolled. All subjects underwent standard echocardiography and subsequent offline analysis to assess left ventricular (LV) rotation and longitudinal mechanics using speckle-tracking echocardiography. In all patients with TM, ferritin levels were measured, and a subgroup underwent cardiac magnetic resonance imaging. Results: All subjects had normal parameters of cardiac function, although patients with TM showed significantly lower S 0 values (P = .030) and E 0 values (P = .025), with increased E/E 0 ratio (P = .003) and indexed left atrial volumes (P = .022). Compared with controls, patients with TM had significantly reduced systolic apical rotation (P = .006), LV twist (P = .002), and LV torsion (P = .001). Systolic and diastolic rotational peak velocities at the apical level were also significantly decreased in the TM group (P = .003 and P = .011, respectively) with reductions of twisting and untwisting rates (P = .003 and P = .001, respectively). Patients with TM also showed a significant reduction of longitudinal displacement from the two-chamber apical view (P = .042) but preserved longitudinal strain and strain rate. Patients with T2* values > 20 msec had preserved rotational function, while those with T2* values < 20 msec showed significantly lower mean values of LV peak basal systolic rotation (À3.
Journal of Inherited Metabolic Disease, 2013
AimsFabry disease (FD) is a rare X‐linked genetic disorder caused by the deficiency or absent act... more AimsFabry disease (FD) is a rare X‐linked genetic disorder caused by the deficiency or absent activity of lysosomal α‐galactosidase A. Cardiovascular remodelling is a hallmark of FD. The present study aimed to comprehensively evaluate the cardiac, vascular and microvascular status in a population of patients with genetic mutations for FD without left ventricular hypertrophy (LVH).Methods and resultsThis study includes subjects carrying genetic mutations for FD (Fabry disease mutation‐carrier, FDMC) without LVH (n = 19). A group of control subjects (n = 19) matched for age, sex, body mass index and cardiovascular risk factors were also included. All subjects underwent echocardiography, carotid ultrasound scan, endothelial flow‐mediated dilatation (FMD) and nailfold capillaroscopy (NFC) assessment. When compared to the subjects in the control group, FDMC patients showed significantly lower mean values of systolic myocardial velocity (7.33 ± 1.28 vs. 10.08 ± 1.63 cm/s, p < 0.0001), ...
Journal of Hypertension, 2011
Conclusions: Polymorphism of analyzed genes influenced IMT in patients with EAH and associates wi... more Conclusions: Polymorphism of analyzed genes influenced IMT in patients with EAH and associates with number of severe grades of intestinal dysbiosis.