Showing papers by "Maurizio Galderisi published in 2008"

Increased prevalence of tricuspid regurgitation in patients with prolactinomas chronically treated with cabergoline.

Abstract: Background: Cabergoline, a dopamine receptor-2 agonist used to treat prolactinomas, was associated with increased risk of cardiac valve disease in Parkinson’s disease. Objective: Our objective was to evaluate prevalence of cardiac valve regurgitation in cabergoline-treated patients with prolactinomas. Design and Setting: An observational, case-control study was conducted at a university hospital. Patients: Fifty treated patients (44 women and six men) and 50 sex- and age-matched control subjects participated; 20 de novo patients were also studied. Intervention: In the treated patients, the last cabergoline dose was 1.3 ± 1.3 mg/wk ( 3 mg/wk in 10%). Treatment duration was 12–60 months in 32% and more than 60 months in 68%. The cumulative (milligrams × months of treatment) dose of cabergoline ranged from 32–1938 mg (median 280 mg). Measurements: Valve regurgitation was assessed according to the recommendations of the American Society of Echocardiography. Results: In d...

Impact of treating acromegaly first with surgery or somatostatin analogs on cardiomyopathy.

Abstract: Objective: The objective of the study was to investigate whether first-line surgery or somatostatin analogs (SSA) have a different outcome on cardiomyopathy after 12 months. Design: This was a retrospective, comparative, nonrandomized study. Patients: Fifty-six patients treated with SSA and 33 operated on by transsphenoidal approach participated in the study. For the purposes of this study, only controlled patients were included. Measurements: Primary outcome measures were changes in left ventricular mass index, diastolic (early to atrial mitral flow velocity), and systolic performance (left ventricular ejection fraction). Secondary outcome measures were reduction of total to high-density lipoprotein-cholesterol ratio as a cardiovascular risk parameter, and improvement of glucose profile and pituitary function as indirect causes of cardiovascular improvement. Results: SSA and surgery groups were similar for gender, age, estimated disease duration, GH and IGF-I levels, and severity of cardiomyopathy lipid ...

Prognostic implications of coronary flow reserve on left anterior descending coronary artery in hypertrophic cardiomyopathy.

Abstract: The aim of the study was to prospectively evaluate a cohort of patients with hypertrophic cardiomyopathy (HC) after coronary flow reserve (CFR) assessment of the left anterior descending coronary artery. Sixty-eight patients with HC (40 men, mean ± SD 58 ± 12 years of age) underwent dipyridamole (up to 0.84 mg/kg over 6 minutes) echocardiography with CFR evaluation of the left anterior descending coronary artery by Doppler. Seventy-four age- and gender-matched, apparently healthy subjects served as controls. A CFR value

β-Blockers and Coronary Flow Reserve

Abstract: Coronary flow reserve (CFR) is the maximal increase in coronary blood flow (CBF) above its resting level for a given perfusion pressure when coronary vasculature is maximally dilated. Normally, hyperaemic CBF reaches values at least 2- to 3-fold greater than resting CBF. Reduction of CFR is mainly due to epicardial coronary artery stenosis or to coronary microvascular dysfunction. CFR can be determined by several techniques that measure CBF itself (e.g. positron emission tomography) or CBF velocities (Doppler methods) from which coronary flow velocity reserve is calculated. Hyperaemic coronary vasodilation can be obtained by pharmacological agents (e.g. adenosine and dipyridamole), but also by the cold pressure test. Long-term antihypertensive treatment induces significant improvement of CFR, which is parallel to the regression of left ventricular (LV) hypertrophy.

Risk factor-induced cardiovascular remodeling and the effects of angiotensin-converting enzyme inhibitors.

Abstract: Cardiovascular (CV) risk factors, primarily arterial hypertension, modify the structural and functional features of the myocardium and the blood vessels, a process known as CV remodeling. Cardiac remodeling refers to changes in left ventricular (LV) geometry, such as concentric LV geometry and LV hypertrophy (LVH), an independent hallmark of CV risk. Vascular remodeling consists of structural changes of the arterial walls, such as increased intima-media thickness, arterial stiffening, and deteriorating endothelial function. CV remodeling is to a large extent a result of compensatory mechanisms, and its pathophysiology is partially mediated by the activation of the renin-angiotensin-aldosterone system and its primary effector peptide angiotensin II, which together play a key role in the progression of CV disease. Angiotensin-converting enzyme (ACE) inhibitors, a class of drugs used in the treatment of arterial hypertension, appear to be effective in controlling or even reversing CV remodeling, independently of simple blood pressure reduction. Evidence shows that ACE inhibitors counteract CV remodeling by reducing LV mass and regressing LVH, attenuating vascular atherosclerosis and improving vascular compliance. ACE inhibitors possessing a sulfhydryl moiety appear to have additional benefits in increasing nitric-oxide release and improving vascular endothelial function.

Usefulness and limitations of transthoracic echocardiography in heart transplantation recipients

Abstract: Transthoracic echocardiography is a primary non-invasive modality for investigation of heart transplant recipients. It is a versatile tool which provides comprehensive information about cardiac structure and function. Echocardiographic examinations can be easily performed at the bedside and serially repeated without any patient's discomfort. This review highlights the usefulness of Doppler echocardiography in the assessment of left ventricular and right ventricular systolic and diastolic function, of left ventricular mass, valvular heart disease, pulmonary arterial hypertension and pericardial effusion in heart transplant recipients. The main experiences performed by either standard Doppler echocardiography and new high-tech ultrasound technologies are summarised, pointing out advantages and limitations of the described techniques in diagnosing acute allograft rejection and cardiac graft vasculopathy. Despite the sustained efforts of echocardiographic technique in predicting the biopsy state, endocardial myocardial biopsies are still regarded as the gold standard for detection of acute allograft rejection. Conversely, stress echocardiography is able to identify accurately cardiac graft vasculopathy and has a recognised prognostic in this clinical setting. A normal stress-echo justifies postponement of invasive studies. Another use of transthoracic echocardiography is the monitorisation and the visualisation of the catheter during the performance of endomyocardial biopsy. Bedside stress echocardiography is even useful to select appropriately heart donors with brain death. The ultrasound monitoring is simple and effective for monitoring a safe performance of biopsy procedures.

GH and IGF-I excess control contributes to blood pressure control: results of an observational, retrospective, multicentre study in 105 hypertensive acromegalic patients on hypertensive treatment.

Abstract: Summary Context Approximately one-third of patients with acromegaly have concomitant hypertension. The outcome of hypertension after treatment of acromegaly is unknown. Objective To evaluate the role of GH and IGF-I control on systolic (SBP) and diastolic blood pressure (DBP) levels. Patients One hundred and five hypertensive patients (60 women, 45 men) with active disease receiving treatment for hypertension at their diagnosis of acromegaly. Design Observational, retrospective, multicentre. Measurements At diagnosis and after 24 months (median) of treatment we measured serum GH and IGF-I levels, blood pressure levels, left ventricular (LV) mass index (LVMi), early-to-late mitral flow velocity (E/A, as a measure of diastolic function) and LV ejection fraction (LVEF, as a measure of systolic function). Results At the diagnosis of acromegaly, hypertension was mild in 41·1% and severe in 58·9%. Serum GH and IGF-I levels did not differ in patients with mild or severe hypertension. After 24 months of treatment, all patients had a notable decrease in both GH and IGF-I levels, and achieved significantly lower levels of DBP, heart rate and LVMi; 76 patients (71%) had achieved control of GH and IGF-I levels. Only the patients with controlled acromegaly achieved significantly lower SBP levels and significantly improved cardiac systolic and diastolic function. A higher dose of antihypertensive drugs and/or an increased number of drugs to control hypertension were significantly greater in patients with uncontrolled (32·3%) than in those with controlled acromegaly (7·8%; P = 0·004). Conclusion Hypertensive patients with controlled acromegaly achieved improved control of hypertension and of cardiac diastolic and systolic function. The use of antihypertensive drugs was significantly less in patients achieving control of acromegaly.

The heart in the city

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Increased prevalence of tricuspid regurgitation in patients with prolactinomas chronically treated with cabergoline: dose and treatment duration effect

Abstract: BACKGROUND Cabergoline, a dopamine receptor-2 agonist used to treat prolactinomas, was associated with increased risk of cardiac valve disease in Parkinson's disease. OBJECTIVE Our objective was to evaluate prevalence of cardiac valve regurgitation in cabergoline-treated patients with prolactinomas. DESIGN AND SETTING An observational, case-control study was conducted at a university hospital. PATIENTS Fifty treated patients (44 women and six men) and 50 sex- and age-matched control subjects participated; 20 de novo patients were also studied. INTERVENTION In the treated patients, the last cabergoline dose was 1.3 +/- 1.3 mg/wk (<1 mg/wk in 44%, 1-3 mg/wk in 46%, and >3 mg/wk in 10%). Treatment duration was 12-60 months in 32% and more than 60 months in 68%. The cumulative (milligrams x months of treatment) dose of cabergoline ranged from 32-1938 mg (median 280 mg). MEASUREMENTS Valve regurgitation was assessed according to the recommendations of the American Society of Echocardiography. RESULTS In de novo patients, treated patients, and controls, the prevalence of mild regurgitation of mitral (35, 22, and 12%, P = 0.085), aortic (0, 4, and 2%, P = 0.59), tricuspid (55, 30, and 42%, P = 0.13) or pulmonic (20, 12, and 6%, P = 0.22) valves was similar. Conversely, the prevalence of moderate tricuspid regurgitation was higher in the treated patients (54%) than in de novo patients (0%) and controls (18%, P < 0.0001). Moderate tricuspid regurgitation was more frequent in patients receiving a cumulative dose above the median (72%) than in those receiving a lower dose (36%, P = 0.023). A higher systolic (P = 0.03) and diastolic blood pressure (P < 0.0001) was found in patients with than in those without moderate tricuspid regurgitation. CONCLUSION Moderate tricuspid regurgitation is more frequent in patients taking cabergoline (at higher cumulative doses) than in de novo patients and control subjects, but the clinical significance of this finding has not been established. A complete echocardiographic assessment is indicated in patients treated long term with cabergoline, particularly in those requiring elevated doses.

Transthoracic Echo-Doppler Assessment of Coronary Microvascular Function Late after Kawasaki Disease

Abstract: The goal of this study was to demonstrate that Doppler transthoracic echocardiography (TTE) may represent a valuable tool for the noninvasive demonstration of coronary microvascular dysfunction in children with previous Kawasaki disease (KD) by the measurement of coronary flow reserve (CFR) during cold pressor test (CPT) Twenty-five children with previous KD (mean follow-up, 46 ± 26 years) were included in the study—16 with no evidence of coronary artery lesions (CALs−) by TTE and 9 with coronary aneurysms (CALs+) Seventeen age-matched healthy subjects were also recruited Diastolic peak velocity was measured by pulsed Doppler both at rest (DPVRest) and during CPT (DPVCPT) in the anterior descending artery CFR was calculated as DPVCPT/DPVRest KD patients demonstrated significantly higher values of DPVRest (021 ± 005 vs 013 ± 001 cm/sec, p < 00001) and DPVCPT (033 ± 007 vs 027 ± 003 cm/sec, p < 0005) CFR was reduced in KD compared to control subjects (15 ± 04 vs 21 ± 02, p < 00001) CFR was decreased in a similar manner in both CALs+ patients (14 ± 04, p = 0002 vs controls) and CALs− patients (16 ± 04, p < 00001 vs controls) Doppler TTE at rest and during CPT may represent a valuable modality for CFR evaluation in children with a history of KD CFR is significantly reduced in KD patients independently of the presence of CALs

Mechanical dyssynchrony and functional mitral regurgitation: pathophysiology and clinical implications.

Abstract: Functional mitral regurgitation (FMR) is a common finding in patients with ischemic or nonischemic dilated cardiomyopathy as a complication of left ventricular (LV) dysfunction and remodeling associated with a fibrotic remodeling response of mitral leaflets to abnormal valvular loading. Although mitral valve tenting is the main determinant of FMR, clinical and experimental observations suggest that intraventricular delay could be a potential co-determinant of FMR. LV dyssynchrony can potentially contribute to FMR by several mechanisms, such as creating an uncoordinated regional LV mechanical activation in segments supporting the papillary muscles, determining diastolic mitral regurgitation, reducing the sphincteric function of the mitral annulus, and decreasing the efficiency of LV contraction and closing forces. Cardiac resynchronization therapy has been demonstrated to reduce FMR with correction of some of the underlying pathophysiological mechanisms. The present review article focuses on the role of mechanical dyssynchrony as a pathophysiological determinant of FMR, and on the potential role of cardiac resynchronization therapy as a therapeutic option for treatment of FMR in patients with severe heart failure and advanced LV dysfunction.

Circulating IGF-I levels are associated with increased biventricular contractility in top-level rowers.

Abstract: Summary Background The intensive physical activity is often associated with cardiac changes. Objectives (i) To evaluate the IGF-I system and myocardial structure and function by standard Doppler echocardiography and Tissue Doppler in athletes and sedentary controls; and (ii) to determine any relationship between IGF-I system and echocardiographic parameters. Methods Nineteen male top-level rowers and 19 age-matched healthy sedentary male controls underwent blood determination of fasting serum IGF-I, IGFBP-3 and acid-labile subunit levels and standard Doppler echocardiography combined with pulsed Tissue Doppler of posterior septal wall, left ventricular (LV) lateral mitral annulus and right ventricular (RV) tricuspid annulus. Myocardial presystolic (PSm), systolic (Sm), the ratio of early diastolic (Em) to atrial (Am) velocities as well as myocardial time intervals were calculated. Results Rowers had higher serum IGF-I levels (P = 0·04), higher biventricular cavity dimensions and wall thicknesses compared to controls. They also had better LV and RV myocardial function than controls. In the rowers, IGF-I was associated with LV ejection fraction (r = 0·50, P = 0·03), RV PSm velocity (r = 0·55, P = 0·01) and with RV myocardial precontraction time (r = −0·57, P = 0·01). These associations remained significant after adjusting for age and heart rate. Conclusions Top-level athletes showed higher IGF-I levels and a better myocardial performance than controls, particularly for the RV systolic activity. The independent correlations between IGF-I and systolic parameters of the left (ejection fraction) and right (PSm velocity and precontraction time) ventricles may possibly indicate a role of IGF-I system in the modulation of myocardial inotropism in athletes. Further studies are needed to confirm this hypothesis.

Practical echocardiography in aortic valve stenosis.

Abstract: Aortic valve stenosis is a common disease. Despite this, the diagnosis may often be missed; a significant proportion of patients are still identified at post-mortem examination, and 5% of operations are performed at end stage. Unrecognized aortic valve stenosis is an important cause of anesthetic mortality. One reason for failing to make a diagnosis is that the clinical signs can be difficult to interpret due to the confounding association with arterial hypertension, coronary artery disease and systemic arteriosclerosis, potentially blunting the effects of aortic valve stenosis on the circulation. Moreover, most patients with aortic valve stenosis have a long asymptomatic period and may not seek medical attention. In patients with severe, symptomatic, calcific aortic valve stenosis, aortic valve replacement is the only effective treatment; much evidence suggests that it should be offered to patients regardless of age, after appropriate clinical evaluation. Doppler echocardiography plays a pivotal role in confirming the diagnosis of aortic valve stenosis in assessing the severity of the disease and, ultimately, in giving prognostically relevant information. Moreover, echocardiography is suitable for monitoring of disease progression and left ventricular function in these patients, and is of fundamental support for clinical follow-up. Accurate noninvasive quantification of aortic valve stenosis is, however, a technically demanding and time-consuming procedure, with several potential pitfalls. Considering the frequency and importance of aortic valve stenosis, a comprehensive echocardiographic study should be offered and carefully performed in all patients with noteworthy murmurs and repeated regularly (at appropriate time intervals), together with clinical review, in patients in whom aortic valve stenosis has been diagnosed.

Abstract 6096: Long-Term Survival of Patients with Chest Pain Syndrome and Angiographically Normal or Near Normal Coronary Arteries: The Additional Prognostic Value of Coronary Flow Reserve

Abstract: It has been demonstrated that in the low risk subset of patients with angiographically normal coronary arteries, 1 out of 10 shows wall motion abnormalities during dipyridamole echocardiography tes...

Three-dimensional echocardiography for optimization of cardiac resynchronization therapy.

Abstract: We read with great interest the nice review by Stanton et al. 1 concerning techniques for optimization of cardiac resynchronization therapy (CRT). In addition to the methods discussed by the authors, a promising technique in this context is represented by three-dimensional echocardiography (3D-echo). Although there are still no definite data regarding the effective clinical value of 3D-echo for optimization of …

The new European definition of cardiomyopathies: which space for muscle dystrophies?

Abstract: I read with interest the new classification of the cardiomyopathies of the European Society of Cardiology1 and the Editorial of Thiene et al. 2 In relation with new knowledge of genetic alterations and with terrific progress in imaging techniques of the recent years, this issue is very controversial and the European classification differs deeply from similar classification formulated from the American Heart Association in 2006.3 The effort of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases shall be acknowledged with enthusiasm since cardiomyopathy subtypes are characterized and …

Principles of cardiovascular dynamics in the perspective of echocardiography

Abstract: The possibilities of applying the laws of dynamics to the study of myocardial mechanics are remarkable and to some extent neglected to characterize ventricular performance by the imaging techniques. There are potentially useful applications derived from the analyses of Doppler flow velocity profiles of left ventricular outflow to be applied to the study of cardiovascular dynamics. They include ejection force, pressure-volume work and ventricular power. All these variables require measurements that are easy to obtain even during a standard examination, like stroke volume, ventricular outflow velocity, and the velocity-time integral.

Coronary vasoreactivity is not altered in young people with type 1 diabetes.

Abstract: Background and aim: Abnormal coronary microvascular circulation has been demonstrated in diabetes and is associated with increased rate of cardiovascular events. Our objective was to evaluate coronary vasoreactivity in young people with type 1 diabetes with and without microvascular complications. Methods and results: Twenty-five type 1 diabetic patients without microvascular complica- tions (DCe), 23 with microvascular complications (DCþ), and 18 control subjects (C) were studied. Coronary vasoreactivity was assessed by means of coronary flow reserve (CFR). Blood flow velocity in the left anterior descending coronary artery was measured at rest and after high-dose dipyridamole using transthoracic color-guided pulsed Doppler echocardiography. CFR was defined as the ratio of hyperaemic to resting diastolic peak flow velocities. The three groups had similar cardiac function parameters, and also systolic and diastolic blood pressure at rest, which remained unchanged during dipyridamole infusion. Resting coro- nary flow velocity was comparable in C, DCe ,a nd DC þ (p Zns). Dipyridamole infusion produced a threefold increase in coronary diastolic peak velocity, which reached similar values in C (0.69 � 0.16 m/s), DCe (0.69 � 0.18 m/s), and DCþ (0.66 � 0.11 m/s). Mean CFR ratio was similar in C (3.33 � 0.66), DCe (3.30 � 0.51), and DCþ (3.24 � 0.60). At multiple linear regres- sion analysis, no association was found between CFR and age, sex, HbA1c, duration of diabetes, and complications. Conclusion: Coronary vasodilatory function is preserved in young D patients, even those with early microvascular complications, suggesting that coronary vasoreactivity deteriorates at more advanced stages of microvascular complications and/or in the presence of other cardio- vascular risk factors.