Showing papers by "Maurizio Galderisi published in 2009"

Feasibility and reference values of left atrial longitudinal strain imaging by two-dimensional speckle tracking.

Abstract: Background The role of speckle tracking in the assessment of left atrial (LA) deformation dynamics is not established. We sought to determine the feasibility and reference ranges of LA longitudinal strain indices measured by speckle tracking in a population of normal subjects.

Additive Prognostic Value of Coronary Flow Reserve in Patients With Chest Pain Syndrome and Normal or Near-Normal Coronary Arteries

Abstract: In patients with angiographically normal coronary arteries and chest pain, pharmacologic stress echocardiography can identify a subgroup of patients with a less benign prognosis. Coronary flow reserve (CFR) in the left anterior descending artery (LAD) can currently be combined with wall motion analysis during vasodilator stress echocardiography. The aim of this study was to assess the prognostic value of CFR response in patients with normal coronary arteries and normal wall motion during stress. We selected 394 patients (171 men, 61 +/- 11 years of age) who underwent dipyridamole stress echocardiography (0.84 mg/kg over 6 minutes) with 2-dimensional echocardiography and CFR evaluation of the LAD by Doppler. All had angiographically nonsignificant (<50% quantitatively assessed) stenosis in any major vessel, normal left ventricular function (wall motion score index 1), and test negativity for conventional wall motion criteria. Images were independently read by a core laboratory for wall motion and a core laboratory for CFR. Mean CFR was 2.5 +/- 0.6 and 87 patients (22%) had an abnormal CFR <2. During a median follow-up of 51 months, 31 events occurred, namely 4 deaths and 27 nonfatal myocardial infarctions (3 ST-elevated myocardial infarctions and 24 non-ST-elevated myocardial infarctions). Kaplan-Meier survival estimates for hard events showed a better outcome for those patients with a normal CFR compared with those with an abnormal CFR (96% vs 55%, p = 0.001, at 48 months of follow-up). In conclusion, in patients with angiographically normal or near-normal coronary arteries and preserved at-rest regional and global left ventricular function at baseline and during stress, CFR adds incremental value to the prognostic stratification achieved with clinical and angiographic data.

Echocardiographic myocardial scar burden predicts response to cardiac resynchronization therapy in ischemic heart failure.

Abstract: Background Because echocardiography is routinely applied for left ventricle (LV) evaluation before cardiac resynchronization therapy (CRT), it is important to know whether echocardiographic assessment of myocardial scar burden may also help to predict CRT response in patients with drug-refractory systolic heart failure of ischemic origin. Methods Seventy-one patients with ischemic heart failure who underwent CRT were retrospectively analyzed. The number of LV scar segments was evaluated in each patient, defining transmural scar as an end-diastolic wall thickness ≤ 5 mm associated with increased acoustic reflectance. CRT response was defined by LV end-systolic volume decrease by at least 10% after 6 months of treatment. The role of pacing site with respect to scar location was also assessed. Results Thirty-nine patients (55%) were responders and 32 patients (45%) were nonresponders to CRT. At baseline, responders had a lower number of scar segments (1.7 ± 1.6 vs 3.5 ± 2.5, P = .001). The number of scar segments was significantly associated with CRT response and correlated significantly with end-systolic volume variation ( r = 0.57, P = .0001). The presence of 3 or more scar segments allowed the identification of nonresponders with a sensitivity of 62% and specificity of 71%. In responders, the pacing stimulus was more frequently delivered remote from scar segments, whereas in nonresponders it was more often delivered over the scar segments. Conclusion Echocardiographic evaluation of transmural scar burden predicts CRT response after 6 months of treatment and should be performed in all candidates for CRT with ischemic heart failure before biventricular pacemaker implantation.

Endothelial-mediated coronary flow reserve in patients with mild thyroid hormone deficiency.

Abstract: Context: Although coronary flow reserve (CFR) is reduced in patients with subclinical hypothyroidism (SHypo), the endothelial response of coronary vasomotion has never been explored in this clinical setting. Objective: To investigate the endothelial response of coronary flow in young and middle-aged patients with SHypo, without associated cardiovascular risk factors compared with healthy control subjects. Patients and methods: The study population consisted of 20 women (mean age 38.4C12.1 years) with newly diagnosed, untreated and persistent SHypo due to Hashimoto’s thyroiditis. A total of 15 volunteers served as controls. Age, gender, body surface area, glucose, insulin levels, heart rate, systolic, diastolic, and mean blood pressure were similar in patients and controls. Body mass index was significantly higher in SHypo patients. Total cholesterol and low-density lipoprotein cholesterol, despite not significant, tended to be higher, and high-density lipoprotein cholesterol to be lower in SHypo. Coronary blood flow velocities were recorded in patients at rest and after the cold pressor test (CPT), a stimulus that can be considered totally endothelium-dependent. CFR was calculated as the ratio of hyperemic-to-resting diastolic peak velocities. Results: Coronary diastolic peak velocities at rest did not differ between the two groups but were significantly lower after CPT in patients with SHypo, thereby resulting in a lower CFR. The difference remained significant after adjusting resting and CPT velocities for the respective mean blood pressures. TSH was inversely correlated with CFR in the pooled population. Conclusion: Patients with SHypo without associated cardiovascular risk factors have a coronary endothelial dysfunction that appears in response to a physiological stimulus (the CPT).

Myocardial mechano-energetic efficiency in hypertensive adults.

Abstract: BACKGROUND Myocardial mechanical efficiency can be measured as the ratio between systolic work and energy consumption. We evaluated the relation between myocardial mechanical efficiency and left ventricular (LV) mass in untreated hypertensive patients. METHODS Myocardial work was estimated in 256 normotensive (35 +/- 12 years) and 306 hypertensive patients (47 +/- 10 years) with normal ejection fraction, as stroke work in gram-meters (stroke work = BPs x SV x 0.0144, where BPs is systolic blood pressure, SV is echocardiographic stroke volume). Myocardial O2 consumption was estimated as the product of heart rate (HR) x BPs (eMVO2). Myocardial mechanical efficiency was estimated as the ratio of stroke work/eMVO2, which can be simplified and expressed as ml/s. RESULTS LV mass was greater in hypertensive than in normotensive patients (46 +/- 13 vs. 38 +/- 11 g/m2.7, P < 0.0001), but myocardial mechanical efficiency was identical (85 +/- 23 vs. 86 +/- 26 ml/s). Relations between myocardial mechanical efficiency and LV mass were close (both P < 0.0001), but more scattered among hypertensive patients because of 56 patients exhibiting low myocardial mechanical efficiency relative to the magnitude of LV mass. At comparable age and body size, these patients had higher HR, BPs, and pulse pressure than those with normal myocardial mechanical efficiency (all P < 0.001). After adjusting for age and sex, hypertensive patients with low myocardial mechanical efficiency showed greater relative wall thickness and lower ejection fraction and midwall shortening than those with normal myocardial mechanical efficiency (all P < 0.001). Low myocardial mechanical efficiency was also associated with inappropriately high LV mass (P < 0.0001). CONCLUSION In some hypertensive patients the left ventricle works inefficiently with a high energy wasting, at the same level of LV mass as hypertensive patients with normal myocardial mechanical efficiency. Those patients feature a high cardiovascular risk phenotype, with concentric LV geometry, systolic dysfunction, and indirect signs of more severe vascular impairment.

Nebivolol induces parallel improvement of left ventricular filling pressure and coronary flow reserve in uncomplicated arterial hypertension.

Abstract: PurposeOur aim was to analyze the effects of 3-month antihypertensive therapy by nebivolol, a β-blocking agent with nitric oxide-mediated vasodilatory properties, on coronary flow reserve (CFR) and left ventricular filling pressure (LVFP) in uncomplicated arterial hypertension.MethodsTwenty newly di

[Echocardiographic evaluation of the athlete's heart: from morphological adaptations to myocardial function].

Abstract: The definition of the athlete's heart includes the mechanisms of cardiac adaptation to training, characterized by the increase of internal chamber dimensions, ventricular wall thickness, and atrial chambers. The morphology of the athlete's heart is intermediate between concentric and eccentric left ventricular hypertrophy (LVH), in relation to the large prevalence of mixed sports activities and training protocols (including both aerobic and anaerobic exercise). Echocardiography is the tool of choice for the assessment of the athlete's heart and also for the differentiation of physiologic and pathologic LVH (hypertrophic cardiomyopathy and LVH due to arterial hypertension). The initial echocardiographic approach includes the quantitative analysis of the left ventricle, in order to calculate left ventricular mass, left ventricular mass index and relative wall thickness for diagnosing concentric or eccentric LVH. Tissue Doppler (pulsed or color modality) and strain rate imaging (Doppler or two-dimensional modality) may give additional information to the standard indices of systolic function. Diastolic function can be evaluated not only by standard Doppler transmitral inflow measurements but also using pulsed tissue Doppler, which may allow to distinguish the athlete's LVH from diastolic impairment of hypertensive patients or hypertrophic cardiomyopathy by the simple determination of myocardial early diastolic velocity. Also the morphological and functional features of the left atrium and of the right ventricle can be assessed in the athlete's heart by combining standard echocardiography with new echocardiographic technologies.

Ecocardiografia tridimensionale in tempo reale. Attuali applicazioni, vantaggi e limiti per lo studio del ventricolo sinistro

Abstract: Left ventricle; Myocardial dyssynchrony; Three-dimensional echocardiography. In the last decades the introduction and development of echocardiography allowed a significant improvement in the diagnosis as well as in the morphological and functional evaluation of several heart diseases, and to- day many therapeutic decisions are taken based on the results of the echocardiographic examination. One of the most important development in the field of echocardiography is three-dimensional imaging, which has evolved from the slow and labor-intense off-line reconstruction techniques to the faster and simpler real-time volumetric imaging, which has the potential to be integrated in routine clinical practice. One of the major proven advantages of real-time three-dimensional echocardiography is the evaluation of left ventricular vol- ume, mass and function, which is achieved by eliminating the need for geometric modeling and the errors caused by foreshortened views. In this review we discuss the state-of-the-art and anticipate future develop- ments of real-time three-dimensional echocardiography that are relevant to its application to the left ventricle.

Letter by Galderisi and Esposito regarding article, "Tissue Doppler imaging in the estimation of intracardiac filling pressure in decompensated patients with advanced systolic heart failure".

Abstract: To the Editor: We read with worry the article by Mullens et al1 with regard to the inaccuracy of tissue Doppler in estimating left ventricular (LV) filling pressure in advanced heart failure. Is the dream of noninvasive cardiologists truly disappearing? In our opinion, a critical analysis of this article is needed. The first criticism corresponds to the selected population, which included heterogeneous subsets of patients with advanced heart failure. In particular, cardiac resynchronization therapy represents an important confounding factor by influencing both LV filling and pulsed tissue Doppler in an unpredictable manner. The ratio of early transmitral velocity to tissue Doppler mitral annular early …

Reduction of coronary flow reserve in a patient with type 2 diabetes mellitus without epicardial coronary stenosis

Abstract: We present a clinical case that demonstrates the usefulness of transthoracic Doppler-derived coronary flow reserve in distinguishing coronary microvascular dysfunction from epicardial coronary artery stenosis in type 2 diabetes mellitus. Our patient had signs of inducible ischemia on effort electrocardiogram and single photon emission computed tomography, but no angiographic evidence of epicardial coronary artery stenosis. On these grounds, coronary microvascular impairment was identified because the coronary flow reserve was reduced, whereas regional wall motion was completely normal, after administration of high-dose dipyridamole. These abnormalities of the coronary microcirculation were combined with concentric left ventricular hypertrophy, whereas the metabolic status (fasting blood glucose 149mg/dL, HbA1c 7.7%) was near normal. Heart Metab. 2009;45:30‐33.

[B-type natriuretic peptide and Doppler echocardiography in the diagnosis of heart failure: alternative or complementary tools?].

Abstract: Several studies have demonstrated the usefulness of B-type natriuretic peptide (BNP) dosage in patients referring for acute dyspnea in the emergency department. BNP is strongly associated not only with the evidence but even with the degree of heart failure, and BNP values are particularly increased in the advanced NYHA classes and in patients with poor prognosis. High BNP levels correlate with echocardiographic indexes of left ventricular and right ventricular systolic dysfunction but even better with diastolic dysfunction and degree of left ventricular filling pressure. However, in presence of some clinical confounders, such as obesity, renal insufficiency and anemia, BNP dosage itself cannot be interpretable. Under these circumstances, Doppler echocardiography is able to identify with better accuracy patients affected by heart failure. Algorithms built taking into account clinical and echocardiographic parameters as well as BNP measurements are already available in the guidelines of the European Society of Cardiology on heart failure with normal ejection fraction. They will lead to a better and earlier identification, better risk stratification and management of patients referring for heart failure.