Showing papers by "Maurizio Galderisi published in 2006"
TL;DR: A comprehensive transthoracic Doppler evaluation of diabetic patients should include the assessment of diastolic function and estimation of LVFP by tissue Dopplers, and coronary microvascular function by CFR test.
269 citations
TL;DR: In a large cohort of patients with HC from a nationwide registry, a marked increase in LA dimension were predictive of long-term outcome, independent of co-existent atrial fibrillation or outflow obstruction.
Abstract: This study assessed left atrial (LA) dimension as a potential predictor of outcome in hypertrophic cardiomyopathy (HC). From the Italian Registry for Hypertrophic Cardiomyopathy, 1,491 patients (mean age 47 ± 17 years; 61% men; 19% obstructive), followed for 9.4 ± 7.4 years after the initial echocardiographic evaluation, constituted the study group. The mean LA transverse dimension was 43 ± 9 mm and was larger in patients with severe symptoms (48 ± 9 mm for New York Heart Association classes III and IV vs 42 ± 9 mm for classes I and II, p 48 mm (the 75th percentile) had a HR of 1.9 for all-cause mortality (p = 0.008), 2.0 for cardiovascular death (p = 0.014), and 3.1 for death related to heart failure (p = 0.008) but was unassociated with sudden death (p = 0.81). Similar results were obtained after the exclusion of patients with atrial fibrillation (HR 1.7, p = 0.008) or outflow obstruction (HR 1.8, p = 0.003). The predictive power of LA dimension >48 mm was also validated in an independent HC cohort from the United States, with similar HRs (1.8 for all-cause mortality, p = 0.019). In conclusion, in a large cohort of patients with HC from a nationwide registry, a marked increase in LA dimension were predictive of long-term outcome, independent of co-existent atrial fibrillation or outflow obstruction. LA dimension is a novel and independent marker of prognosis in HC, particularly relevant to the identification of patients at risk for death related to heart failure.
198 citations
TL;DR: In DCM patients, CFR is often impaired, and a reduced CFR during vasodilator stress is an independent prognostic marker of bad prognosis.
Abstract: Aims Coronary flow-reserve (CFR) can be impaired in non-ischaemic dilated cardiomyopathy (DCM), unmasking a coronary microcirculatory dysfunction of potential prognostic impact. The aim of the present study is to evaluate the prognostic value of Doppler echocardiographic-derived CFR in patients with DCM.
Methods and results We evaluated 129 DCM patients (85 male; age 62±11) by transthoracic dipyridamole (0.84 mg/kg in 10 min) stress echocardiography. All patients had an ejection fraction 2.0) and 83 had abnormal CFR. During follow-up, 18 patients died and 33 showed worsening of NYHA class. The worse event-free survival was observed in those patients with an abnormal CFR when compared with those having a normal CFR at high dose of dipyridamole (70 vs. 22%, at 75 months of follow-up, P <0.0001). In the multivariable analysis, severity of mitral insufficiency (HR=1.9, 95% CI=1.06–2.87), abnormal CFR (HR=4.0, 95% CI=1.1–15.6), resting wall motion score index (HR=6.9, 95% CI=1.5–30.7) were independent predictors of survival.
Conclusion In DCM patients, CFR is often impaired. A reduced CFR during vasodilator stress is an independent prognostic marker of bad prognosis.
146 citations
TL;DR: Standard M-mode imaging of the mitral annulus may be considered a reliable method for the assessment of LV longitudinal function and showed good correlation with systolic annular velocity.
Abstract: Background M-mode determination of left ventricular (LV) atrioventricular plane displacement (AVPD) allows a simple assessment of LV longitudinal systolic function. Color tissue Doppler (TD) M-mode–derived AVPD and pulsed TD-derived systolic annular velocity are more sophisticated tools. Objective We sought to compare these 3 techniques for the analysis of LV longitudinal systolic function. Methods Standard M-mode AVPD, color TD M-mode AVPD, and systolic annular velocity were measured at 4 annular levels in 56 healthy individuals. The time to onset and the electromechanical interval were also determined using each technique. Results Standard M-mode AVPD ( r = 0.56, P r = .65, P Conclusions Standard M-mode imaging of the mitral annulus may be considered a reliable method for the assessment of LV longitudinal function.
78 citations
TL;DR: The degree of FMR is associated mainly with mitral deformation indices, and the regional dyssynchrony also has an independent association with ERO but with a minor influence; however, it is not a determinant of F MR in patients with ischaemic LV dysfunction.
Abstract: Objective: To assess regional mechanical dyssynchrony as a determinant of the degree of functional mitral regurgitation (FMR). Setting: Tertiary cardiology clinic. Patients: 74 consecutive patients with left ventricular (LV) dysfunction (ejection fraction Methods: Effective regurgitant orifice (ERO) area, indices of mitral deformation (systolic valvular tenting, mitral annular contraction) and of global LV function and remodelling (ejection fraction, end systolic volume, sphericity index) and local remodelling (papillary-fibrosa distance, regional wall motion score index), and tissue Doppler-derived dyssynchrony index (DI) (regional DI, defined as the standard deviation of time to peak myocardial systolic contraction of eight LV segments supporting the papillary muscles attachment) were measured. Results: All the assessed variables correlated significantly with ERO. By multivariate analysis, systolic valvular tenting was the strongest independent predictor of ERO (R 2 = 0.77, p = 0.0001), with a minor influence of papillary-fibrosa distance (R 2 = 0.77, p = 0.01) and regional DI (R 2 = 0.77, p = 0.03). Local LV remodelling (regional wall motion score index: R 2 = 0.58, p = 0.001; papillary-fibrosa distance: R 2 = 0.58, p = 0.002) and global remodelling indices (sphericity index: R 2 = 0.58, p = 0.003) were the main determinants of systolic valvular tenting, whereas regional DI did not enter into the model. Regional DI was an independent predictor of ERO (R 2 = 0.56, p = 0.005) in patients with non-ischaemic LV dysfunction but not in patients with ischaemic LV dysfunction when these groups were analysed separately. Conclusions: The degree of FMR is associated mainly with mitral deformation indices. The regional dyssynchrony also has an independent association with ERO but with a minor influence; however, it is not a determinant of FMR in patients with ischaemic LV dysfunction.
66 citations
TL;DR: Preliminary experiences show the possibility to improve and anticipate diagnosis of several cardiovascular diseases but also the need to plan specific ultrasound training to avoid incorrect use of HHE.
36 citations
TL;DR: Coronary flow reserve evaluation adds quantitative support to the exquisitely qualitative assessment of wall motion analysis, thereby facilitating the communication of stress echo results to the cardiological world outside the echo laboratory.
Abstract: The assessment of coronary flow reserve by transthoracic echocardiography has recently been introduced into clinical practice with good results for the diagnosis of left anterior descending artery disease and fairly promising results for posterior descending coronary artery disease. By looking at what is behind wall motion, we may realize a sonographer's dream and, in particular, the addition of coronary flow reserve to regional wall motion analysis allows us to have - in the same sitting - high specificity (regional wall motion) and a highly sensitive (coronary flow reserve) diagnostic marker, with an improvement in overall diagnostic accuracy. Coronary flow reserve evaluation may shift the balance of stress choice in favor of vasodilators, which are easier to perform with dual imaging than dobutamine or exercise coronary flow reserve evaluation and may shift the choice in favor of dipyridamole or adenosine stress tests, which are also easier to perform with dual imaging than those using dobutamine or exercise. Lastly, it adds quantitative support to the exquisitely qualitative assessment of wall motion analysis, thereby facilitating the communication of stress echo results to the cardiological world outside the echo laboratory.
22 citations
TL;DR: The role of pulsed tissue Doppler (TD) is assessed to identify left (LV) and right ventricular (RV) myocardial regional involvement in acromegaly.
Abstract: OBJECTIVE The aim of this study was to assess the role of pulsed tissue Doppler (TD) to identify left (LV) and right ventricular (RV) myocardial regional involvement in acromegaly. PATIENTS AND MEASUREMENTS Thirty active acromegaly patients, free of diabetes mellitus, thyroid dysfunction, valvular and coronary heart disease, clinically overt heart failure, and 30 sex- and age-matched healthy controls underwent standard Doppler echocardiography and pulsed TD, by placing the sample volume at the level of basal posterior septum, LV lateral mitral annulus and RV lateral tricuspid annulus. Myocardial systolic (S(m)) and diastolic velocities (E(m)/A(m) ratio) and time-intervals of relaxation (RT(m)), precontraction (PCT(m)) and contraction (CT(m)) and the PCT(m)/CT(m) ratio were measured at each level. RESULTS The two groups had similar heart rate, whereas acromegaly patients had higher body mass index, systolic and diastolic blood pressure, LV mass and impaired Doppler indexes of LV and RV diastolic function, without any difference in the global systolic function. At TD, acromegaly patients showed significantly delayed RT(m) and PCT(m,) reduced E(m)/A(m), S(m) and increased PCT(m)/CT(m) of posterior septum, mitral annulus and tricuspid annulus in comparison with controls. By separate multilinear regression analyses, after adjusting for body mass index, heart rate, diastolic blood pressure and LV mass index, age was the main independent determinant of tissue Doppler diastolic but not of systolic indexes. CONCLUSIONS In active acromegaly, pulsed TD confirms LV and RV diastolic abnormalities detectable by standard Doppler, additionally identifying subclinical biventricular impairment of systolic function.
18 citations
TL;DR: A case of a 70-year-old woman with Tako-tsubo syndrome admitted to the hospital with typical chest pain and electrocardiogram changes in anterior precordial leads suggesting acute coronary syndrome supports the hypothesis that coronary microvascular dysfunction might be a determinant of Tako.
Abstract: We report a case of a 70-year-old woman with Tako-tsubo syndrome admitted to the hospital with typical chest pain and electrocardiogram changes in anterior precordial leads suggesting acute coronary syndrome. Coronary angiography demonstrated normal coronary artery and left ventriculography the typical apical ballooning of Tako-tsubo syndrome. Transthoracic echocardiographically derived coronary flow velocity reserve by adenosine was lower than normal (1.54) in the acute phase and improved after 1 month (2.68). At this time, electrocardiogram normalization also occurred. Our report supports the hypothesis that coronary microvascular dysfunction might be a determinant of Tako-tsubo syndrome.
16 citations
TL;DR: Pulsed tissue Doppler is able to detect early myocardial diastolic impairment in CA and is very useful in diagnosing increased LV filling pressure, regardless of the transmitral pattern, and may, therefore, be helpful in the clinical management of these patients.
Abstract: OBJECTIVE The aim of this study was to evaluate the incremental diagnostic role of tissue Doppler in primary cardiac amyloidosis (CA). METHODS Eleven patients with CA at diagnosis and 11 healthy controls, matched for sex and age, underwent standard Doppler echocardiography and pulsed tissue Doppler of the left ventricular (LV) lateral annulus, in the apical four-chamber view. The ratio of early transmitral flow velocity to early diastolic mitral annular velocity (E/E(m) ratio) was derived as an index of LV filling pressure. RESULTS The two groups were comparable for body mass index, blood pressure, heart rate and standard Doppler diastolic measurements. Patients with CA had a significantly higher sum of wall thickness (SWT) and LV mass, a lower E(m) peak velocity (P 1 (likely pseudonormal/restrictive pattern) (n = 6) did not show any difference in the E/E(m) ratio (14.5 + or - 7.1 vs. 15.1 + or - 6.4, P = NS). In the overall population, the E/E(m) ratio was related to SWT (r = 0.84, P < 0.0001) and LV mass index (r = 0.72, P < 0.0001). After adjusting for age and heart rate by separate multivariate models, SWT (beta = 0.78, P < 0.0001; cumulative r(2) = 0.63, SE = 3.38, P < 0.0001) and LV mass index (beta = 0.71, P < 0.0001; cumulative r(2) = 0.53, SE = 3.80, P < 0.002) were both independently associated with the E/E(m) ratio. CONCLUSIONS Pulsed tissue Doppler is able to detect early myocardial diastolic impairment in CA. The E/E(m) ratio is very useful in diagnosing increased LV filling pressure, regardless of the transmitral pattern, and may, therefore, be helpful in the clinical management of these patients.
10 citations
TL;DR: Strain rate imaging (SRI) is an implementation of color TD, which is not angle dependent, and therefore potentially more feasible and reliable, and a novel technique is the implemention of 2D SRI, which was derived from regional Doppler velocity gradients.
Abstract: New ultrasound technology is mainly represented by tissue Doppler (TD), which allows the quantitative analysis of myocardial function and includes two modalies: pulsed-wave TD and color TD. Strain rate imaging (SRI) is an implementation of color TD. Pulsed-wave TD, performed and analyzed in real time, instantaneously measures myocardial velocities. Color TD, performed offline on digitally stored images, allows the quantification of mean myocardial velocities. The advantage of color TD compared with pulsed TD is the ability to simultaneously analyze multiple myocardial segments. The limit of both these methodologies consists of the myocardial velocity dependence by the base-apex myocardial gradient. SRI measures the rate and percentage of myocardial wall deformation. From digitally recorded color TD cine loops containing velocity data from the entire myocardium, SRI can be derived from regional Doppler velocity gradients. Strain rate is relatively load dependent, and, therefore, can be considered a strong index of myocardial contractility. Due to these favorable characteristics, SRI may potentially overcome the limitations of color TD, discriminating between active and merely passive wall motion. A novel technique is the implementation of 2D SRI, which is not angle dependent, and therefore potentially more feasible and reliable.
TL;DR: Determinants of discrepancy between left ventricular chamber systolic performance and effective myocardial contractility in subjects with hypertension are determined.
Abstract: Determinants of discrepancy between left ventricular chamber systolic performance and effective myocardial contractility in subjects with hypertension
TL;DR: The present letter concerns the State-of-the-Art Paper by Marwick ([1][1]) published in the April 4, 2006, issue of the Journal.
TL;DR: Pulsed Doppler at the level of LV and RV outflow tract is used to evaluate the interventricular mechanical delay and an important improvement appears due to both shortening of LV timing and lengthening of RV timing.
Abstract: Figure 1. Pulsed Doppler at the level of LV (on the left) and RV (on the right) outflow tract, pre-CRT (upper panel) and post-CRT (lower panel) to evaluate the interventricular mechanical delay (IVMD = difference between the time from the onset of ECG QRS complex to the beginning of outflow) of LV and RV inflow. Upper panel (pre-CRT): IVMD is 77.6 ms suggesting an evident interventricular dyssynchrony. Lower panel (post-CRT): IVMD is 39.2 ms suggesting an important improvement of interventricular dissynchrony. This improvement appears due to both shortening of LV timing and lengthening of RV timing. The patient had successfully undergone coronary angioplasty for 80% left anterior descending artery stenosis. ECG showed 1st degree AV block and complete left bundle branch block (QRS = 220 ms). Doppler-echo (Vivid Seven, GE) showed severe left ventricular (LV) dilation, apex akinesis, septal dyskinesis, and hypokinesis of the other walls, ejection fraction (EF) = 20%, restrictive LV filling pattern