scispace - formally typeset
Search or ask a question

Showing papers by "Maurizio Galderisi published in 2016"


Journal ArticleDOI
TL;DR: This document describes the development and use of angiotensin-converting enzyme, a non-volatile substance that acts as a “spatially aggregating substance” to reduce the chances of heart attack in women.
Abstract: 2-D : two-dimensional 3-D : three-dimensional 5-FU : 5-fluorouracil ACE : angiotensin-converting enzyme ARB : angiotensin II receptor blocker ASE : American Society of Echocardiography BNP : B-type natriuretic peptide CABG : coronary artery bypass graft CAD : coronary artery

1,875 citations


Journal ArticleDOI
TL;DR: No abstract available Keywords: European Society of Cardiology; arrhythmias; cancer therapy; cardio-oncology; cardiotoxicity; chemotherapy; early detection; ischaemia; myocardial dysfunction; surveillance.
Abstract: No abstract available Keywords: European Society of Cardiology; arrhythmias; cancer therapy; cardio-oncology; cardiotoxicity; chemotherapy; early detection; ischaemia; myocardial dysfunction; surveillance.

1,421 citations


Journal ArticleDOI
TL;DR: The present document is an expert consensus from the European Association of Cardiovascular Imaging (EACVI) and the European Heart Rhythm Association and may serve as a guide for both imagers and electrophysiologists for best selecting the imaging technique and for best interpreting its results in AF patients.
Abstract: Atrial fibrillation (AF) is the commonest cardiac rhythm disorder. Evaluation of patients with AF requires an electrocardiogram, but imaging techniques should be considered for defining management and driving treatment. The present document is an expert consensus from the European Association of Cardiovascular Imaging (EACVI) and the European Heart Rhythm Association. The clinical value of echocardiography, cardiac magnetic resonance (CMR), computed tomography (CT), and nuclear imaging in AF patients are challenged. Left atrial (LA) volume and strain in echocardiography as well as assessment of LA fibrosis in CMR are discussed. The value of CT, especially in planning interventions, is highlighted. Fourteen consensus statements have been reached. These may serve as a guide for both imagers and electrophysiologists for best selecting the imaging technique and for best interpreting its results in AF patients.

219 citations


Journal Article
TL;DR: A multimodality imaging approach (including echocardiography, cardiac magnetic resonance, cardiac computed tomography, and cardiac nuclear imaging) is encouraged in the assessment of patients with hypertrophic cardiomyopathy.
Abstract: Taking into account the complexity and limitations of clinical assessment in hypertrophic cardiomyopathy (HCM), imaging techniques play an essential role in the evaluation of patients with this disease. Thus, in HCM patients, imaging provides solutions for most clinical needs, from diagnosis to prognosis and risk stratification, from anatomical and functional assessment to ischaemia detection, from metabolic evaluation to monitoring of treatment modalities, from staging and clinical profiles to follow-up, and from family screening and preclinical diagnosis to differential diagnosis. Accordingly, a multimodality imaging (MMI) approach (including echocardiography, cardiac magnetic resonance, cardiac computed tomography, and cardiac nuclear imaging) is encouraged in the assessment of these patients. The choice of which technique to use should be based on a broad perspective and expert knowledge of what each technique has to offer, including its specific advantages and disadvantages. Experts in different imaging techniques should collaborate and the different methods should be seen as complementary, not as competitors. Each test must be selected in an integrated and rational way in order to provide clear answers to specific clinical questions and problems, trying to avoid redundant and duplicated information, taking into account its availability, benefits, risks, and cost.

175 citations


Journal Article
TL;DR: In this paper, a multi-modality imaging approach to the athlete's heart aims to differentiate physiological changes due to intensive training in the athletes' heart from serious cardiac diseases with similar morphological features.
Abstract: The term 'athlete's heart' refers to a clinical picture characterized by a slow heart rate and enlargement of the heart. A multi-modality imaging approach to the athlete's heart aims to differentiate physiological changes due to intensive training in the athlete's heart from serious cardiac diseases with similar morphological features. Imaging assessment of the athlete's heart should begin with a thorough echocardiographic examination.Left ventricular (LV) wall thickness by echocardiography can contribute to the distinction between athlete's LV hypertrophy and hypertrophic cardiomyopathy (HCM). LV end-diastolic diameter becomes larger (>55 mm) than the normal limits only in end-stage HCM patients when the LV ejection fraction is <50%. Patients with HCM also show early impairment of LV diastolic function, whereas athletes have normal diastolic function.When echocardiography cannot provide a clear differential diagnosis, cardiac magnetic resonance (CMR) imaging should be performed.With CMR, accurate morphological and functional assessment can be made. Tissue characterization by late gadolinium enhancement may show a distinctive, non-ischaemic pattern in HCM and a variety of other myocardial conditions such as idiopathic dilated cardiomyopathy or myocarditis. The work-up of athletes with suspected coronary artery disease should start with an exercise ECG. In athletes with inconclusive exercise ECG results, exercise stress echocardiography should be considered. Nuclear cardiology techniques, coronary cardiac tomography (CCT) and/or CMR may be performed in selected cases. Owing to radiation exposure and the young age of most athletes, the use of CCT and nuclear cardiology techniques should be restricted to athletes with unclear stress echocardiography or CMR.

151 citations


Journal ArticleDOI
TL;DR: The aim of this paper was to review the main echocardiographic parameters of LV systolic function and to describe its pros and cons.
Abstract: Assessment of left ventricular (LV) systolic function is the cornerstone of the echocardiographic examination. There are many echocardiographic parameters that can be used for clinical and research purposes, each one with its pros and cons. The LV ejection fraction is the most used one due to its feasibility and predictability, but it also has many limits, related to both the imaging technique used for calculation and to the definition itself. LV longitudinal function is expression of subendocardial fibers contraction. Because the subendocardium is often involved early in many pathological processes, its analysis has been a fertile field for the development of sensitive parameters. Longitudinal function can be evaluated in many ways, such as M-mode echocardiography, tissue Doppler imaging, and speckle tracking echocardiography. This latter is a relatively new tool to assess LV function through measurement of myocardial strain, with a high temporal and spatial resolution and a better inter- and intra-observer reproducibility compared to Doppler strain. It is angle independent, not affected by translation cardiac movements, and can assess simultaneously the entire myocardium along all the three-dimensional geometrical (longitudinal, circumferential, and radial) axes. Speckle tracking echocardiography also allows the analysis of LV torsion. The aim of this paper was to review the main echocardiographic parameters of LV systolic function and to describe its pros and cons.

78 citations


Journal ArticleDOI
TL;DR: Pre-existing AF is a predictor of all-cause mortality in patients undergoing TAVI and NOAF is related to the occurrence of CVE at short-term follow-up; the optimal management and risk stratification of these patients should be further investigated.
Abstract: AIMS Little is known about the prognostic role of pre-existing atrial fibrillation (AF) and new-onset AF (NOAF) in transcatheter aortic valve implantation (TAVI). Therefore, the aim of this meta-analysis was to compare the short- and long-term clinical outcomes of patients undergoing TAVI with and without pre-existing and new-onset AF. METHODS AND RESULTS Twenty-six studies, enrolling 14,078 patients undergoing TAVI, of whom 33.4% had pre-existing AF and 17.5% had NOAF, were analysed for early and long-term all-cause mortality, cardiovascular mortality and cerebrovascular events (CVE). In patients with pre-existing AF, 30-day all-cause mortality was similar to patients in sinus rhythm (SR). Conversely, long-term all-cause and cardiovascular mortality were significantly greater in pre-existing AF patients than in patients with SR (20 studies; 8,743 patients; HR: 1.68; p<0.00001, and three studies; 1,138 patients; HR: 2.07; p=0.01, respectively). Pre-existing AF was not a predictor of CVE at long-term follow-up. NOAF patients showed similar short- and long-term all-cause mortality when compared to patients in SR, whereas they experienced a significantly higher incidence of CVE at short-term follow-up (six studies; 2,025 patients; HR: 2.86; p<0.00001). A non-significant increase in the incidence of CVE was observed at long-term follow-up. CONCLUSIONS Pre-existing AF is a predictor of all-cause mortality in patients undergoing TAVI. NOAF is related to the occurrence of CVE at short-term follow-up. Similarly to surgical aortic valve replacement (SAVR), the optimal management and risk stratification of these patients should be further investigated.

73 citations


Journal ArticleDOI
TL;DR: The mechanisms through which cardiac dyssynchrony is involved in FMR pathophysiologic cascade and how cardiac resynchronization therapy (CRT) can have therapeutic effects on FMR by reverting specific dyss synchrony pathways are discussed.
Abstract: Functional mitral regurgitation (FMR) is a common complication of left ventricle (LV) dysfunction and remodelling. Recently, it has been recognized as an independent prognostic factor in both ischaemic and non-ischaemic LV dysfunctions. In this review article, we discuss the mechanisms through which cardiac dyssynchrony is involved in FMR pathophysiologic cascade and how cardiac resynchronization therapy (CRT) can have therapeutic effects on FMR by reverting specific dyssynchrony pathways. We analyse recent clinical trials focusing on CRT impact on FMR in 'real-world' patients, the limits and future perspectives that could eventually generate new predictors of CRT response in terms of FMR reduction. Finally, we propose a practical diagnostic and therapeutic strategy for the management of symptomatic patients with severe LV dysfunction and concomitant 'prognostic' FMR.

51 citations



Journal ArticleDOI
TL;DR: Los miembros del Comite de la ESC para la Elaboracion de GPC y los revisores del documento representantes de las sociedades nacionales de cardiologia aparecen listados en el apendice.
Abstract: Los miembros del Comite de la ESC para la Elaboracion de GPC y los revisores del documento representantes de las sociedades nacionales de cardiologia aparecen listados en el apendice. Se puede consultar las declaraciones de conflicto de intereses de los expertos participantes en el desarrollo de esta guia en la pagina web de la ESC: www.escardio.org/guidelines

39 citations


Journal ArticleDOI
TL;DR: Elevated pulse pressure negatively influences left ventricular longitudinal mechanics in a mixed population of normotensive and untreated hypertensive individuals.
Abstract: Objectives:Little is known about the impact of pulse pressure on left ventricular systolic function. The aim of our study was to evaluate whether high pulse pressure is associated with subclinical left ventricular systolic dysfunction.Methods:The study population included 143 participants (68 newly

Journal ArticleDOI
TL;DR: The aim was to differentiate cardiac amyloidosis (CA) at diagnosis from hypertensive LV hypertrophy (LVH) by analysis of longitudinal myocardial deformation by identifying the markers of longitudinal strain.
Abstract: Background Longitudinal strain is an early marker of left ventricular (LV) dysfunction in several cardiac diseases. Our aim was to differentiate cardiac amyloidosis (CA) at diagnosis from hypertensive LV hypertrophy (LVH) by analysis of longitudinal myocardial deformation. Methods Thirty healthy controls (C), 30 newly diagnosed, never treated hypertensives with LVH (H-LVH), and 33 patients with CA at diagnosis underwent echo Doppler including speckle tracking–based automated function imaging (AFI). Averaged peak systolic global longitudinal strain (GLS, 18 segments) and basal, middle, and apical longitudinal strain (BLS, MLS, and ALS, respectively, six segments each) were calculated. Results Left ventricular mass index, relative wall thickness, and ejection fraction did not differ between H-LVH and CA. E/e′ ratio was higher in CA than in H-LVH (P<.001) and C (P<.0001). GLS was lower in CA than in C (P<.0001), without difference with H-LVH. ALS did not differ among the three groups, MLS was significantly lower in both CA and H-LVH than in C but BLS was lower in CA compared to both H-LVH and C (both P<.0001). In the pooled population, E/e′ was independently associated with BLS (β=−0.54, P<.0001). At receiver operating curve analysis, CA was predicted by BLS≤−11.3% (sensitivity=63.3%, specificity=100%) and E/e′≥12.3 (sensitivity=69.7%, specificity=83.3%). The best AUC (=0.819) was obtained by the combination E/e′+BLS. Conclusions Our findings highlight a real difference of E/e′ ratio and longitudinal strain of LV basal segments between hypertensive LVH and CA, which could be used to differentiate the two diseases.


Journal ArticleDOI
TL;DR: The findings suggest that ISH is a sign of aggravation of the atherosclerotic disease already evident by the target organDamage and prompt aggressive therapy for arterial hypertension should be issued before the onset of target organ damage, to reduce global CV risk.
Abstract: Little is known about the potential progression of hypertensive patients towards isolated systolic hypertension (ISH) and about the phenotypes associated with the development of this condition. Aim of this study was to detect predictors of evolution towards ISH in patients with initial systolic-diastolic hypertension. We selected 7801 hypertensive patients free of prevalent cardiovascular (CV) diseases or severe chronic kidney disease and with at least 6-month follow-up from the Campania Salute Network. During 55±44 months of follow-up, incidence of ISH was 21%. Patients with ISH at the follow-up were significantly older (P 0.05). Our findings suggest that ISH is a sign of aggravation of the atherosclerotic disease already evident by the target organ damage. Great efforts should be paid to prevent this evolution and prompt aggressive therapy for arterial hypertension should be issued before the onset of target organ damage, to reduce global CV risk.

Journal ArticleDOI
TL;DR: AT have an increased myocardial function at rest when compared with NC, this being elicited mainly by subendocardial and mid-wall fibres, and Sinus bradycardia, LV mass, and afterload are independent determinants of supernormal mycardial deformation at rest.
Abstract: Aims The determinants of systolic function in the performing heart are not completely understood. Aim of the study was to assess the contributors of left ventricular (LV) strain components, using 3D speckle tracking echocardiography (STE) in endurance athletes. Methods and results A total of 36 top-level male endurance athletes (AT) and 36 age-matched sedentary normal controls (NC) underwent standard and real-time 3D echocardiography. Global longitudinal strain (GLS), global circumferential strain (GCS), global area strain (GAS), and global radial strain (GRS) were assessed using 3D STE. AT had significantly higher GLS (−22.1 ± 4.4 vs. −18.4 ± 3.5%; P < 0.0001), GCS (−17.9 ± 2.4 vs. −16.0 ± 3.2; P = 0.006), and GAS (−35.5 ± 6.7 vs. −30.2 ± 4.9; P < 0.0001), while GRS did not differ significantly with NC. At separate multiple linear regression analyses, heart rate emerged as independent predictor of GLS ( β = −0.37, P < 0.002), GCS ( β = −0.32, P = 0.007), GAS ( β = −0.37, P < 0.001), and GRS ( β = −0.29, P = 0.019); LV mass was independently associated with GLS ( β = 0.34, P = 0.009) and GAS ( β = 0.41, P < 0.001) but not with GCS and GRS, while diastolic blood pressure predicted GCS ( β = −0.46, P < 0.0001), GAS ( β = −0.28; P = 0.006), and GRS ( β = −0.42, P < 0.001). No independent correlation emerged for body surface area and stroke volume. By replacing LV mass with end-diastolic volume, the latter showed independent association with GCS ( β = −0.65, P = 0.028) and with GRS ( β = −0.60, P < 0.05). Conclusion AT have an increased myocardial function at rest when compared with NC, this being elicited mainly by subendocardial and mid-wall fibres. Sinus bradycardia, LV mass, and afterload are independent determinants of supernormal myocardial deformation at rest.


Journal ArticleDOI
TL;DR: GLS appeared to overcome the information provided by LV hypertrophy (LVH), allowing to identify a subclinical target organ damage, which could make possible a more targeted patient’s management.
Abstract: T he observational study of Lee et al. [1] investigated the prognostic value of global longitudinal strain (GLS), subendocardial and subepicardial longitudinal strain (EndLS and EpiLS, respectively) in regularly treated hypertensive patients after a mean follow-up of 7.3 years. Using multivariate Cox regression analysis, EpiLS was the only independent predictor of events and a cut-off point value of 17.57% distinguished the worse cardiovascular outcome in the population assessed. This is an important study, which confirms the prognostic value of GLS in the clinical setting and, particularly in the hypertensive population. Of interest, in the Coronary Artery Risk Development In young Adults study [2], among 2479 patients (average entry age1⁄4 25 years), high cumulative exposure (over 25 years) to SBP and DBP was not associated with the reduction of left ventricular (LV) ejection fraction but with lower longitudinal systolic and early diastolic strain rate derived by Speckle Tracking Echocardiography. Accordingly, GLS appeared to overcome the information provided by LV hypertrophy (LVH), allowing to identify a subclinical target organ damage, which could make possible a more targeted patient’s management. The prognostic power of GLS in arterial hypertension is largely supported by the physiopathologic meaning of this parameter. GLS refers mainly to LV longitudinal function of subendocardial fibers which are early involved in cardiac damage of several cardiac diseases including hypertension. Young, never treated hypertensives had lower GLS than both young sedentary controls and athletes and GLS extent was associated with the degree of E/e0 ratio, an estimate of LV filling pressure, independent of afterload and LV mass [3]. An early GLS reduction was also found in borderline prehypertension detected by ambulatory blood pressure [4].

Journal ArticleDOI
TL;DR: Echocardiographic techniques in delineating the athlete's morphology and functional properties of the left atrium are reviewed, which can recognize early atrial dysfunction and assess left atrial myocardial function in patients with either physiologic or pathologic left ventricular hypertrophy.

Journal ArticleDOI
TL;DR: The aim of this study was to compare regional and local PWV values in healthy volunteers.
Abstract: Background Gold standard for pulse-wave velocity (PWV) measurement is determination of the carotid-femoral cfPWV, reflecting regional aortic PWV. Nevertheless, in several echocardiographic laboratories, PWV is measured locally, most commonly at the common carotid artery (CCA). The aim of this study was to compare regional and local PWV values in healthy volunteers. Methods The study population consisted of 22 prospectively enrolled healthy subjects, mean age 38.7 ± 11.1 years, 50% male. For regional PWV measurement, we evaluated cfPWV with a standard echo scanner. Regional PWV was measured at the CCA, with semiautomated dedicated software (MyLab, EsaOte, Italy). Results cfPWV and local PWV values correlated significantly with high Pearson correlation coefficient (0.62, P = 0.002). Mean regional cfPWV (9.29 ± 3.73 m/s), however, was significantly higher than mean local PWV value (5.96 ± 1.08 m/s) (P < 0.001). The difference persisted in the subgroup analysis using different cfPWV cutoff values (10, 9, 8, and 7 m/s), except for subjects with cfPWV ≤7 m/s, where regional and local PWV values were similar. Conclusion In a group of healthy volunteers, regional and local PWV values showed a good correlation. However, regional PWV was significantly higher than local PWV. These findings should be carefully taken into account when using this technique in the clinical setting.

Journal ArticleDOI
01 Nov 2016-Thyroid
TL;DR: Evaluated the endothelial response of coronary flow to TSH in patients with differentiated thyroid cancer (DTC) without cardiovascular risk factors to determine the effect of thyroid hormone action on endothelial cells.
Abstract: Background: The role of thyrotropin (TSH) on the cardiovascular system has been poorly investigated. It is unknown whether the changes in the vasculature associated with thyroid diseases result from altered thyroid hormone action or whether they are a consequence of a direct effect of TSH on endothelial cells. The present study was designed to evaluate the endothelial response of coronary flow to TSH in patients with differentiated thyroid cancer (DTC) without cardiovascular risk factors. Methods: The study population consisted of three men and seven women (Mage = 32.6 ± 8 years) who underwent total thyroidectomy for DTC. All were receiving therapy with L-thyroxine to maintain TSH within the reference range. No patient was obese, or had hypertension, diabetes, or dyslipidemia. Patients underwent standard echo-Doppler examination with evaluation of the coronary flow reserve (CFR) of the distal left anterior descending artery obtained by cold pressure test (CPT) before and 24 h after the second recombinant ...


Journal ArticleDOI
TL;DR: This comprehensive assessment of LV longitudinal function should be provided as it precedes the impairment of EF and could also be useful to differentiate heart failure with reduced and preserved EF in particular.
Abstract: Several indices are available to assess left ventricular (LV) function. Although ejection fraction (EF) is widely used, it has many limitations. An assessment of LV longitudinal function should be therefore provided as it precedes the impairment of EF. In this context, speckle tracking derived global longitudinal strain is the gold standard but S' velocity of mitral annulus (by pulsed tissue Doppler) and mitral annular plane systolic excursion (by M-mode) represent more than simple surrogates. LV diastolic assessment should be oriented not to the simple classification of transmitral patterns (E/A ratio and E velocity deceleration time) but to non-invasive estimation of LV filling pressures. This can be mainly obtained from E/e' ratio, with additional calculation of other measurements such as pulmonary flow atrial reverse velocity, systolic pulmonary arterial pressure and left atrial volume index. This comprehensive assessment could also be useful to differentiate heart failure with reduced and preserved EF in particular.


Journal ArticleDOI
TL;DR: This work is licensed to www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/ 3.0/).
Abstract: php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). Research Reports in Clinical Cardiology 2016:7 147–158 Research Reports in Clinical Cardiology Dovepress


Journal ArticleDOI
TL;DR: A new model based on a more realistic truncated ellipsoid LV shape is developed, and the concordance between models among hypertensive patients is explored, supporting the need of model-specific normative data.


Journal ArticleDOI
TL;DR: The recommendations given in this document are intended as a guide for the writing committees with the aim to harmonize the style and content of EACVI expert consensus and recommendation documents.
Abstract: The recommendations given in this document are intended as a guide for the writing committees with the aim to harmonize the style and content of EACVI expert consensus and recommendation documents.