Showing papers by "Maurizio Galderisi published in 2010"
TL;DR: The current 'recommendations for the practice of echocardiography in infective endocarditis' aims to provide both an updated summary concerning the value and limitations of e chocardiographic in IE, and clear and simple recommendations for the optimal use of both transthoracic and transoesophageal echocentrics in IE.
Abstract: Echocardiography plays a key role in the assessment of infective endocarditis (IE). It is useful for the diagnosis of endocarditis, the assessment of the severity of the disease, the prediction of short- and long-term prognosis, the prediction of embolic events, and the follow-up of patients under specific antibiotic therapy. Echocardiography is also useful for the diagnosis and management of the complications of IE, helping the physician in decision-making, particularly when a surgical therapy is considered. Finally, intraoperative echocardiography must be performed in IE to help the surgeon in the assessment and management of patients with IE during surgery. The current ‘recommendations for the practice of echocardiography in infective endocarditis’ aims to provide both an updated summary concerning the value and limitations of echocardiography in
440 citations
TL;DR: The hearts of young patients with hypertension are characterized by reduced GLS, whereas global circumferential strain, global radial strain, and torsion are similar to those of athletes' hearts.
Abstract: Background The aim of this study was to compare speckle-tracking echocardiography–derived left ventricular (LV) systolic mechanics and their relationships with LV diastolic properties in young patients with hypertension and in young competitive athletes in relation to their respective alterations of LV structure. Methods Nineteen sedentary controls, 22 top-level rowers, and 18 young newly diagnosed, never-treated patients with hypertension, all male, underwent Doppler echocardiography including pulsed tissue Doppler of the mitral annulus and speckle-tracking echocardiography. Peak longitudinal strain was calculated in apical long-axis, four-chamber, and two-chamber views, and values of the three views were averaged (global longitudinal strain [GLS]). Regional circumferential and radial strain were calculated at the LV basal, middle, and apical levels, and values were averaged (global circumferential strain and global radial strain). LV torsion was determined as the net difference in the mean rotation between the apical and basal levels. Results The three groups were comparable for age, whereas body mass index and blood pressure were higher in patients with hypertension, and heart rate was lower in rowers. LV mass index was higher in rowers and in patients with hypertension than in controls, without differences in relative wall thickness, ejection fraction, and midwall shortening. Left atrial volume index was greater in rowers than in controls and patients with hypertension. Annular systolic velocity (s′) ( P P P P P Conclusions The hearts of young patients with hypertension are characterized by reduced GLS, whereas global circumferential strain, global radial strain, and torsion are similar to those of athletes' hearts. The extent of GLS is strongly associated with LV diastolic function, independently of afterload changes and the degree of LV hypertrophy.
198 citations
TL;DR: In conclusion, pocket size device showed a relevant additional diagnostic value in comparison with physical examination and its appropriateness of use in compared with standard echo machine in a non-cardiologic population.
Abstract: Miniaturization has evolved in the creation of a pocket-size imaging device which can be utilized as an ultrasound stethoscope. This study assessed the additional diagnostic power of pocket size device by both experts operators and trainees in comparison with physical examination and its appropriateness of use in comparison with standard echo machine in a non-cardiologic population. Three hundred four consecutive non cardiologic outpatients underwent a sequential assessment including physical examination, pocket size imaging device and standard Doppler-echo exam. Pocket size device was used by both expert operators and trainees (who received specific training before the beginning of the study). All the operators were requested to give only visual, qualitative insights on specific issues. All standard Doppler-echo exams were performed by expert operators. One hundred two pocket size device exams were performed by experts and two hundred two by trainees. The time duration of the pocket size device exam was 304 ± 117 sec. Diagnosis of cardiac abnormalities was made in 38.2% of cases by physical examination and in 69.7% of cases by physical examination + pocket size device (additional diagnostic power = 31.5%, p < 0.0001). The overall K between pocket size device and standard Doppler-echo was 0.67 in the pooled population (0.84 by experts and 0.58 by trainees). K was suboptimal for trainees in the eyeball evaluation of ejection fraction, left atrial dilation and right ventricular dilation. Overall sensitivity was 91% and specificity 76%. Sensitivity and specificity were lower in trainees than in experts. In conclusion, pocket size device showed a relevant additional diagnostic value in comparison with physical examination. Sensitivity and specificity were good in experts and suboptimal in trainees. Specificity was particularly influenced by the level of experience. Training programs are needed for pocket size device users.
129 citations
TL;DR: The current and emerging echocardiographic methodology that can help physicians in the correct diagnostic and pathophysiological assessment of patients with HCM are discussed.
Abstract: Hypertrophic cardiomyopathy (HCM) is one of the most common inherited cardiomyopathy. The identification of patients with HCM is sometimes still a challenge. Moreover, the pathophysiology of the disease is complex because of left ventricular hyper-contractile state, diastolic dysfunction, ischemia and obstruction which can be coexistent in the same patient. In this review, we discuss the current and emerging echocardiographic methodology that can help physicians in the correct diagnostic and pathophysiological assessment of patients with HCM.
60 citations
TL;DR: Investigating the prognostic effect of coronary flow reserve (CFR) on left anterior descending artery (LAD) in women and men with chest pain of unknown origin and normal stress echocardiogram found decreased CFR is associated with markedly increased risk and preserved CFR predicts excellent survival, particularly in women.
Abstract: The aim of this study was to investigate the prognostic effect of coronary flow reserve (CFR) on left anterior descending artery (LAD) in women and men with chest pain of unknown origin and normal stress echocardiogram. The study population consisted of 1,660 patients (906 women, 754 men) with chest pain syndrome, no wall motion abnormality on echocardiogram at rest, and dipyridamole (up to 0.84 mg/kg over 6 minutes) stress echocardiogram negative for wall motion criteria. All had undergone stress echocardiography with combined evaluation of CFR on LAD by Doppler. A CFR value ≤2.0 was considered abnormal. Median duration of follow-up was 19 months (interquartile range 10 to 34). Abnormal CFR was assessed in 171 women (19%) and 147 men (19%, p = 0.80). During follow-up, 80 events (20 deaths, 13 ST-elevation myocardial infarctions, and 47 non-ST-elevation myocardial infarctions) occurred. In addition, 128 patients underwent revascularization and were censored. CFR ≤2.0 on LAD was independently associated with prognosis in women (hazard ratio [HR] 16.48, 95% confidence interval [CI] 7.17 to 37.85, p 2.0 were, respectively, 27% and 2% in women (p <0.0001) and 42% and 8% in men (p <0.0001). In conclusion, decreased CFR on LAD is associated with markedly increased risk in women and men with chest pain syndrome and a normal result of dipyridamole stress echocardiography. Conversely, preserved CFR on LAD predicts excellent survival, particularly in women.
50 citations
TL;DR: This sequential testing is useful to non-invasively predict LVFP in patients with LV dysfunction, especially in those with preserved EF.
Abstract: Aims To test a decision model for non-invasive estimation of left ventricular filling pressure (LVFP) in patients with left ventricular (LV) dysfunction and a wide range of ejection fractions (EF).
Methods and results In patients with LV dysfunction ( n = 270; EF = 42 ± 16%), classification and regression tree (CART) analysis was used to generate a model for the prediction of elevated LVFP, defined as pulmonary capillary wedge pressure (PCWP) >15 mmHg, in a derivation cohort ( n = 178). At each step of the decision tree, nodes including single or multiple criteria connected by Boolean operators were tested to achieve the best information entropy gain. Averaged mitral-to-myocardial early velocities ratio ( E / e ′) ≥13 OR E-wave deceleration time 15 mmHg needed the following criteria to be satisfied: (i) intermediate E / e ′ (13 > E / e ′ > 8); (ii) left atrial volume index >40 mL/m2 OR ratio of mitral E-wave and colour M-mode propagation velocity >2 OR difference in duration of pulmonary vein and mitral flow at atrial contraction >30 ms; (iii) estimated pulmonary artery systolic pressure >35 mmHg. Patients were correctly allocated according to PCWP with an 87% sensitivity and a 90% specificity. Compared with the best single parameter estimating LVFP, a 17% relative increase in accuracy was achieved in patients with EF >50%. The model was prospectively validated in a testing group ( n = 92): 80% sensitivity, 78% specificity.
Conclusion This sequential testing is useful to non-invasively predict LVFP in patients with LV dysfunction, especially in those with preserved EF.
44 citations
TL;DR: For most of the techniques currently used to explore LV longitudinal function, the clinical usefulness in both research and daily practice has been validated by consistent evidence and their use is rapidly increasing.
Abstract: Quantification of left ventricular (LV) systolic function represents a major aspect of echocardiographic assessment in the spectrum of cardiac diseases. However, because of the high complexity of LV contraction mechanics, the classical approach with assessment of a single measure of systolic function, such as ejection fraction or fractional shortening, has been largely superseded. During the last years, through the considerable technical advances in the field of ultrasonography, a number of different echocardiographic methodologies have become available to perform a detailed assessment of different aspects of LV contraction. In particular, evaluation of LV longitudinal systolic dynamics has progressively gained importance as a key aspect in the assessment of LV systolic function. For most of the techniques currently used to explore LV longitudinal function, the clinical usefulness in both research and daily practice has been validated by consistent evidence and their use is rapidly increasing. Technical considerations and potential clinical applications of the assessment of LV longitudinal systolic function are reviewed.
36 citations
TL;DR: Normotensive diabetics and nondiabetic hypertensives show comparable depression inLV longitudinal systolic indices when compared with age- and gender-matched healthy controls; the co-existence of diabetes and hypertension leads to further impairment in LV longitudinal syStolic function in an additive manner.
28 citations
TL;DR: An independent negative association between body mass index (BMI) and myocardial contractility was confirmed and the impact of BMI category on circumferential function did not differ between the study population and age- and gender-matched controls, suggesting additive interaction, rather than synergistic, between overweight-obesity and hypertension.
12 citations
TL;DR: The possibility to visualize guidewires and catheters in cardiac chambers and their relationship with cardiac structures during percutaneous transcatheter procedures reduces the time of radiation exposure and simplifies the approach becoming the reference method for monitoring.
Abstract: Real-time three-dimensional transesophageal echocardiography (RT3DTEE) is now commonly used in daily clinical practice. The transesophageal, compared to the transthoracic approach, allows the visualization of the whole spectrum of the mitral valve apparatus and the posterior cardiac structures. Moreover, images obtained by RT 3D TEE provide a unique and complete visualization of the mitral valve prosthetic elements. Indeed, the possibility to visualize guidewires and catheters in cardiac chambers and their relationship with cardiac structures during percutaneous transcatheter procedures reduces the time of radiation exposure and simplifies the approach becoming the reference method for monitoring. This review aims to underline the potential clinical applications and the advantages of RT3DTEE compared to other methods.
11 citations
TL;DR: Diastolic LV components of motion, amplitude and velocities are not independent, neither from each other nor from filling pressures, and an integrated approach towards using them all in assessing diastolic function, particularly in patients with raised filling pressure should be of great clinical value.
TL;DR: Assessment of longitudinal strain in the coronary care unit using speckle tracking echocardiography can help to quantify myocardial damage in the context of acute coronary syndromes and detect changes otherwise not visible with semi-quantitative evaluation of wall motion.
Abstract: The present clinical case shows that assessment of longitudinal strain in the coronary care unit using speckle tracking echocardiography can help to quantify myocardial damage in the context of acute coronary syndromes and detect changes otherwise not visible with semi-quantitative evaluation of wall motion.
Journal Article•
TL;DR: The present review focuses on the state-of-the-art of real-time three-dimensional transthoracic echocardiography in TV morphology and function evaluation with its clinical applications and limits and may suggest new surgical techniques in order to improve surgical outcomes.
Abstract: Tricuspid valve (TV) morphology and function evaluation plays a key role in several cardiac diseases, including left-sided valvular diseases and heart failure. However, TV is structurally complex and, differently from aortic and mitral valves, cannot be visualized in a single two-dimensional echocardiographic view, neither transthoracic nor transesophageal (i.e., simultaneous imaging of the three TV leaflets and their attachment to the annulus is not feasible). Conversely, real-time three-dimensional transthoracic echocardiography allows complete visualization of the TV apparatus from multiple views. This can lead to an improvement of our understanding about the pathophysiological mechanisms underlying TV diseases and functional tricuspid regurgitation, and may suggest new surgical techniques in order to improve surgical outcomes. The present review focuses on the state-of-the-art of real-time three-dimensional transthoracic echocardiography in TV morphology and function evaluation with its clinical applications and limits.
Journal Article•
TL;DR: This review evaluates the state of the art of multiplane echocardiography and discusses possible clinical applications, advantages and limitations of this technique.
Abstract: Echocardiography is the most commonly used imaging technique in current clinical cardiology practice and is usually performed using a monoplane approach. In recent years new matrix-array transducers have become available that allow the real-time simultaneous display of two or more echocardiographic scanning planes from the same acoustic window. This multiplane approach is particularly interesting as it may reduce, during the examination, the number of probe movements and consequently facilitate image acquisition. In some clinical applications, moreover, the multiplane approach improves both accuracy and reproducibility of echocardiography. This review evaluates the state of the art of multiplane echocardiography and discusses possible clinical applications, advantages and limitations of this technique.
Journal Article•
TL;DR: The advantages of real-time three-dimensional echocardiography in assessing heart valves are reviewed and also technological limitations are shown in order to provide the scientific basis for its clinical use.
Abstract: The introduction of three-dimensional echocardiography and its evolution from time-consuming and cumbersome off-line reconstruction to real-time volumetric technique (real-time three-dimensional echocardiography) are one of the most significant advances in ultrasound imaging of the heart of the past decade. This imaging modality currently provides realistic views of cardiac valves capable of demonstrating the anatomy of various heart valve diseases in a unique, noninvasive manner. In addition, real-time three-dimensional echocardiography offers completely new views of the valves and surrounding structures, and allows accurate quantification of severity of valve disease. This article reviews the advantages of real-time three-dimensional echocardiography in assessing heart valves and shows also technological limitations in order to provide the scientific basis for its clinical use.
01 Jan 2010
TL;DR: Echocardiography parameters are not established end-points of pivotal trials designed in order to approve new drugs in conditions like heart failure, post-myocardial infarction dysfunction and arterial hypertension.
Abstract: There are two main typologies of clinical trials in whom echocardiography may be used. The first one is represented by studies in which echocardiography is used as part of the assessment, but does not contribute substantially to the end-points. This is the case of trials using echo parameters to define a given study population, a use accepted and supported also by the regulatory authorities. The second one, more ambitious for echocardiography, corresponds to studies involving echocardiographic measurements (e.g., chamber volume and/or shape and LV mass) as primary or secondary efficacy and safety end-points. This second use of echocardiography is debated, at least when the effect of a therapy is concerned. In fact, for phase II trials echo parameters are considered acceptable to prove a concept of a treatment, while the use of echo measures as primary end-points in phase III (purpose of registering a drug) remains controversial. In this case it is necessary to demonstrate that a given echo measure is a real surrogate of clinical events. In this view, the prognostic value alone is not sufficient and should be combined with the demonstration that modifications of the echo measures correspond (better if proportionally) to changes in outcome events. By analyzing the existing notes for guidance of regulatory authorities, echo parameters are not established end-points of pivotal trials designed in order to approve new drugs in conditions like heart failure, post-myocardial infarction dysfunction and arterial hypertension.