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Showing papers by "Maurizio Galderisi published in 2003"


Journal ArticleDOI
TL;DR: In this article, the authors used multivariable Cox regression models (stratified by gender and prevalent cardiovascular disease) to examine the relations of Doppler transmitral flow indexes (ratio of the velocity-time integrals of the early [E] and late [A] diastolic filling waves [VTI E/A] to the incidence of atrial fibrillation.
Abstract: Atrial fibrillation (AF) is characterized by structural remodeling and atrial systolic failure. It is unclear if atrial filling abnormalities precede the onset of AF. We evaluated 942 Framingham Study subjects (587 women; mean age 75 years) who underwent Doppler echocardiographic evaluation at a routine examination and who did not have a history of AF. We used multivariable Cox regression models (stratified by gender and prevalent cardiovascular disease) to examine the relations of Doppler transmitral flow indexes (ratio of the velocity-time integrals of the early [E] and late [A] diastolic filling waves [VTI E/A], a correlate of atrial conduit function; E-wave deceleration time; the atrial filling fraction, an index of atrial systolic function; and peak A wave velocity) to the incidence of AF. At follow-up (mean 7 years), 85 subjects (41 women) developed AF. In models adjusting for established risk factors for AF (including left atrial size) at baseline, and for heart failure and myocardial infarction on follow-up, a 1 SD increment in VTI E/A was associated with a 28% increase in risk of AF (hazards ratio 1.28, 95% confidence interval 1.02 to 1.59). A 1 SD decrease in the atrial filling fraction was associated with a 28% higher risk of AF (hazards ratio 1.28, 95% confidence interval 0.98 to 1.67). There was a U-shaped relation between peak A-wave velocity and risk of AF. Thus, in our elderly community-based sample, increased VTI E/A and a low atrial filling fraction were markers of increased risk of AF, suggesting that altered atrial filling may antedate AF.

87 citations


Journal ArticleDOI
TL;DR: In hypertensive patients free of coronary artery disease, the degree of reduction in CFR is associated with the excess of LVM beyond the values compensatory for individual haemodynamic load, also independent of the presence of LV hypertrophy.
Abstract: Objective To assess the association between coronary flow reserve (CFR) and levels of left ventricular mass (LVM) exceeding the compensatory needs in arterial hypertension. Design, settings and patients The association between the excess of LV mass and CFR was assessed in a population of 40 consecutive hypertensive outpatients free of coronary heart disease, 22 with appropriate and 17 with inappropriately high LVM (i.e. LVM exceeding 128% of the value predicted by sex, stroke work and height in m 2.7 ). The CFR (the ratio between dipyridamole and basal diastolic peak velocity) of the distal left anterior descending artery was measured by transthoracic Doppler echocardiography. Results Patients with inappropriate LVM had similar age, body mass index (BMI), baseline blood pressure (BP) and coronary velocities, but lower LV systolic function, post-dipyridamole diastolic peak velocities (P < 0.05) and lower CFR (P < 0.002) than patients with appropriate LVM. CFR was negatively related to the extent of the excess of LVM (β = -0.44, P < 0.005), independently of potential combined effect of age, BMI and post-dipyridamole diastolic BP. Impairment of CFR (i.e. < 2) was better discriminated by identification of clear-cut inappropriate LVM (P< 0.004) than by the presence of LV hypertrophy (i.e. LV mass index ≥ 51 g/m 2.7 ; P= 0.057). Conclusions In hypertensive patients free of coronary artery disease, the degree of reduction in CFR is associated with the excess of LVM beyond the values compensatory for individual haemodynamic load. This relation is also independent of the presence of LV hypertrophy.

60 citations


Journal Article
TL;DR: Tissue Doppler may be useful to distinguish septal myocardial asynchrony in LBBB with and without LAD stenosis and in the overall population, PSM was positively associated with ejection fraction and negatively with age and sePTal thickness.
Abstract: BACKGROUND An asynchronous contraction occurring during a prolonged relaxation period, defined as post-systolic motion (PSM), has been described as being a consequence of coronary occlusion but also in other conditions including isolated left bundle branch block (LBBB). The aim of this study was to characterize PSM of the interventricular septum at pulsed tissue Doppler in LBBB with or without stenosis of the left anterior descending coronary artery (LAD). METHODS Forty-two patients with chronic, complete LBBB and tissue Doppler-derived septal PSM were divided into two groups on the basis of their coronary angiography: 27 without LAD stenosis and 15 with LAD stenosis (> or = 50%). Standard Doppler echocardiography and tissue Doppler of both the middle posterior septum and lateral mitral annulus were performed in the apical 4-chamber view. RESULTS Standard Doppler diastolic indexes were comparable between the two groups. Septal tissue Doppler showed lower myocardial systolic (Sm) and atrial peak velocities (both p < 0.05), a higher PSM (p < 0.005), and a longer relaxation time (p < 0.02) and pre-contraction time (p < 0.05) in patients with LAD stenosis. A Sm/PSM ratio < 1 was detected in 86% of patients with LAD stenosis and in 22% without LAD stenosis (sensitivity 73%, specificity 77%, positive predictive value 64%, negative predictive value 84%). Tissue Doppler of the mitral annulus showed a significantly longer relaxation time and pre-contraction time and a lower atrial velocity in the presence of LAD stenosis. In the overall population, PSM was positively associated with ejection fraction and negatively with age and septal thickness. In a multiple linear regression analysis, only LAD stenosis (beta = 0.42, p < 0.005) and ejection fraction (beta = 032, p = 0.03) were independent predictors of PSM (cumulative r2 = 0.27, p < 0.002). CONCLUSIONS Tissue Doppler may be useful to distinguish septal myocardial asynchrony in LBBB with and without LAD stenosis.

15 citations


Journal ArticleDOI
TL;DR: Depth and its relation with gain should be taken into account and might be almost fully predicted and allow analysis in optimal imaging conditions, tolerating between-patient comparisons even in limited diastolic frames.
Abstract: Integrated backscatter signal (IBS) has been proposed as a tool to measure cardiac fibrosis. To overcome problems associated with machine settings and attenuation of the chest wall, IBS has been expressed in relation to posterior pericardium, as a variation across cardiac cycle, or both. Depth of the reflecting structure has never been considered as a source of variability. Accordingly, we studied the effect of structure depth on IBS and examined its interaction with gain setting. Backscatter signals were recorded from plastic phantoms containing identical structures set at increasing depth and in 1 healthy volunteer using silicone spacers to modify depth, on a wide range of gain settings. In the phantom, IBS signal linearly decreased with increasing depth and nonlinearly increased with increasing gain (all r(2) > 0.97). In the healthy volunteer, results from septum were very similar to the phantom experiment. Values of septal IBS were adjusted using multiple regression coefficients for gain and depth from the phantom experiment and resulted in a near-complete offset of effect of depth and gain on septal IBS (P = not significant for both gain and depth). These assumptions were also used to compare IBS analysis between hypertensive patients and patients with hypertrophic cardiomyopathy. Thus, depth and its relation with gain should be taken into account and might be almost fully predicted. Using appropriate regression modeling may allow analysis in optimal imaging conditions, tolerating between-patient comparisons even in limited diastolic frames.

8 citations


Journal Article
TL;DR: The echocardiographic evaluation of the mammary grafts is a simple, noninvasive method for the assessment of the graft patency and of the functional status of the vessel.
Abstract: BACKGROUND The aim of this study was to evaluate the patency of left and right internal mammary artery grafts respectively on the left anterior descending and right coronary artery by noninvasive transthoracic color Doppler echocardiography. METHODS Thirty eight patients (34 males, 4 females, mean age 59 +/- 2 years), with a history of coronary artery bypass grafting for a total of 42 mammary artery grafts, were studied by means of color Doppler echocardiography at baseline and after vasodilation with dipyridamole infusion (0.56 mg/kg i.v. over 4 min). The evaluated echocardiographic parameters included: systolic (SPV) and diastolic peak velocities (DPV), systolic (SVI) and diastolic velocity-time integrals (DVI), and the DPV/SPV and DVI/SVI ratios. We also calculated the dipyridamole infusion to baseline ratio of the diastolic peak velocities (DPVdip/DPVbaseline), the index of internal mammary artery graft blood flow reserve and the percent DPV increment as an index of graft stenosis. RESULTS On the basis of coronary angiography, two groups were selected: group A (36 mammary grafts) with patent grafts and group B (6 mammary grafts) with moderate or severe stenosis of the grafts. Group A had a predominant diastolic pattern with a DPV of 0.24 +/- 0.13 m/s, whereas group B had a predominant systolic pattern with a reduced DPV of 0.12 +/- 0.03 m/s (p < 0.01). Dipyridamole induced an increase in the DPV respectively of 86.8 +/- 64.4% in group A and 13.8 +/- 15.9% in group B (p < 0.001). Statistical analysis (Mann-Whitney test) revealed a significant difference between the two groups for the baseline DPV (p < 0.01), DVI (p < 0.05), DPV/SPV ratio (p < 0.005), DVI/SVI ratio (p < 0.05), and for the after dipyridamole infusion values: DPV (p < 0.0001), DVI (p < 0.005), DPV/SPV ratio (p < 0.001), and DVI/SVI ratio (p < 0.05). Multivariate analysis showed that the percent DPV increment, the DPVdip/DPVbaseline ratio and the baseline DPV were independent determinants of the stenosis as evaluated at angiography (beta = -0.38, p < 0.01; beta = -0.37, p < 0.01, and beta = -0.33, p < 0.05, respectively; cumulative r2 = 0.25, standard error 0.30 m/s, p < 0.005). CONCLUSIONS The echocardiographic evaluation of the mammary grafts is a simple, noninvasive method for the assessment of the graft patency and of the functional status of the vessel. The percent DPV increment and baseline DPV were independent determinants of mammary graft stenosis.

4 citations


Journal Article
TL;DR: The assessment of coronary flow reserve with transthoracic Doppler echocardiography, measured as the ratio between hyperemic and baseline coronary flow velocities, is a new tool for the evaluation of coronary artery disease and coronary microcirculation.
Abstract: The assessment of coronary flow reserve with transthoracic Doppler echocardiography, measured as the ratio between hyperemic and baseline coronary flow velocities, is a new tool for the evaluation of coronary artery disease and coronary microcirculation. Color-guided pulsed Doppler allows almost optimal identification of flow velocities at the middle and distal left anterior descending artery and good visualization of the right coronary artery. The development of ultrasound technology (second harmonic, contrast agents, dedicated softwares) is responsible for great feasibility (until 98% for the left anterior descending artery and 40-50% for the right coronary artery) and very good reproducibility of this tool. Doppler-derived coronary flow reserve has excellent concordance with that obtainable with intravascular Doppler flow wire. Diagnosis of stenosis and restenosis after stent implantation in the middle and/or proximal left anterior descending artery and of stenosis of the right coronary artery is very accurate. In the absence of stenosis of epicardial coronary arteries, the reduction in coronary flow reserve implies a damage of coronary microcirculation, which can be a determinant of angina pectoris and signs of myocardial ischemia in arterial hypertension, diabetes mellitus and coronary X syndrome. Further progress may be expected by using myocardial contrast agents for quantitation of regional myocardial coronary flow reserve.

2 citations


Journal Article
TL;DR: The use of the myocardial contrast agent SonoVue may be, therefore, useful to distinguish the origin of "in plus" images often evident at echocardiography in the hypereosinophilic syndrome.
Abstract: We describe the case of a 37-year-old male referred because of hypereosinophilia associated with dyspnea. Transthoracic harmonic echocardiography showed an extensive myocardial infiltration and highlighted an intraventricular "in plus" image, whose characteristics were compatible with a diagnosis of intracardiac thrombus. The use of the myocardial contrast agent SonoVue (1 ml in bolus i.v. and 4 ml at an infusion velocity of 2 ml/min) allowed us to immediately identify, during left ventricular chamber opacification, the exact endocardial border of the left ventricular cavity and, later (when the residual SonoVue was evident only at the level of the myocardial walls), the true characteristics of the "in plus" image. This approach revealed the infiltration of the myocardial tissue and of both papillary muscles and chordae tendinae. The use of the myocardial contrast agent SonoVue may be, therefore, useful to distinguish the origin of "in plus" images often evident at echocardiography in the hypereosinophilic syndrome.

1 citations