27 research outputs found
Use of social media by cardiovascular health care professionals: is patient privacy respected?
No full textNo abstract available
Sex differences in natural history of cardiovascular magnetic resonance‐ and biopsy‐proven lymphocytic myocarditis
No full textAIMS: The role of sex in determining the profile and the outcomes of patients with myocarditis is largely unexplored. We evaluated the impact of sex as a modifier factor in the clinical characterization and natural history of patients with definite diagnosis of myocarditis. METHODS AND RESULTS: We retrospectively analysed a single‐centre cohort of consecutive patients with definite diagnosis of myocarditis (i.e. endomyocardial biopsy or cardiac magnetic resonance proven). Specific sub‐analyses were performed in cohorts of patients with chest pain, ventricular arrhythmias, and heart failure as different main symptoms at presentation. The primary outcome measure was a composite of all‐cause mortality or heart transplantation (HTx). We included 312 patients, of which 211, 68% of the whole population, were males. Despite no clinically relevant differences found at baseline presentation, males had a higher indexed left ventricular end‐diastolic volume (62 ± 23 mL/m2 vs. 52 ± 20 mL/m2, P = 0.011 in males vs. females, respectively) at follow‐up evaluation. At a median follow‐up of 72 months, 36 (17%) males vs. 8 (8%) females experienced death or HTx (P = 0.033). Male sex emerged as predictors of all‐cause mortality or HTx in every combination of covariates (HR 2.600; 1.163–5.809; P = 0.020). Results were agreeable regardless of the main symptom of presentation. CONCLUSIONS: In a large cohort of patients with definite diagnosis of myocarditis, females experienced a more favourable long‐term prognosis than males, despite a similar clinical profile at presentation
Clinical impact of myocardial fibrosis in severe aortic stenosis
No full textThe pressure overload due to the progressive narrowing of the valve area determines the development of the left ventricular hypertrophy which characterizes aortic stenosis (AS). The onset of myocardial fibrosis marks the inexorable decline of an initially compensatory response towards heart failure. However, myocardial fibrosis does not yet represent a key element in the prognostic and therapeutic framework of AS. In this context, cardiac magnetic resonance imaging plays a major role by highlighting both the focal irreversible fibrotic replacement, using the late gadolinium enhancement (LGE) technique, and the earlier diffuse reversible interstitial fibrosis, using the T1 mapping techniques. For this reason, the presence of myocardial fibrosis would be useful to identify a subgroup of patients at greater risk of events among the subjects with severe AS. Actually, more and more evidences seem to identify the presence of LGE as a powerful prognostic factor to be used to optimize the timing of prosthetic valve replacement. Randomized clinical trials, such as the EVoLVeD trial currently underway, will be needed to better define the importance of myocardial fibrosis assessment in the management of patients with AS
Acute inflammatory cardiomyopathy: apparent neutral prognostic impact of immunosuppressive therapy
No full textN/
Autonomic function in Takotsubo syndrome long after the acute phase
No full textObjectives Although it is well documented that an exaggerated sympathetic stimulation plays a role in the development of Takotsubo Syndrome (TS) during the acute phase, only few studies have focused on autonomic adaptations in stress-induced cardiomyopathy long after the acute phase. Aim of the study was to investigate whether an impairment of the autonomic function is still present long after a TS event. This was done by comparing the response to a maximal exercise test in TS patients after apparent recovery (> 1-year after the acute event) with that obtained in healthy subjects and in post-myocardial infarction (post-MI) patients. Methods To assess heart rate recovery (HRR) and chronotropic response (CR), 24 TS patients, 25 healthy subjects and 22 post-MI patients underwent maximal exercise test, after at least 3 days of β-blockers wash-out. Results HRR in TS patients (19.2 ± 9.7 bpm) was lower than in healthy subjects (27.7 ± 8.3, p = 0.003), and similar to post-MI patients (19.3 ± 8.4; p = 0.99). A decreasing CR trend (p=0.06), higher in healthy subjects (72±13%) than in TS (65±22%) and post-MI (57±21%) patients, was also found. Conclusion Compared to healthy subjects, TS patients showed a blunted parasympathetic reactivation after exercise, similar to that observed in post-MI patients, thereby suggesting that vagal control of heart rate after exercise is abnormal long after the acute presentation of TS
The Detection Rate of Late Gadolinium Enhancement in Takotsubo Syndrome: A Systematic Review and Meta-Analysis
No full textAbsence of late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) is commonly used to distinguish takotsubo syndrome (TTS) from other myocardial diseases. However, case series have reported the presence of LGE in TTS. The present study aimed to summarize the evidence on the frequency of LGE in TTS and identify potential variables that may influence the detection of LGE. Electronic databases were systematically searched for studies reporting LGE frequency in TTS patients. The overall frequency was estimated using the inverse variance method and a random-effect model for single proportion. Factors influencing LGE detection were analyzed. Among 490 studies screened, 21 were included (703 patients, 90% female). The estimated overall frequency of LGE was 22.4% (95% CI 8.7-39.6%). Among TTS patients who underwent CMR within three days of symptom occurrence, the frequency of LGE was 40.7% (95% CI 18.8-64.5%), significantly higher than among those who performed CMR after three days (3.9%, p<0.010). The sensitivity threshold used in the imaging protocols had a statistically significant impact on the frequency of LGE detection (p=0.030). Ten studies performed a follow-up CMR after at least three months, reporting a frequency of LGE of 1.7 % (95% CI 0.0-8.9%). In conclusion, published studies report the presence of LGE in TTS at presentation among a significant proportion of patients. However, its detection is strongly influenced by the duration between symptom onset and CMR acquisition, and by the sensitivity threshold used for the imaging protocol. LGE is rarely present at follow-up
The right ventricular involvement in dilated cardiomyopathy: prevalence and prognostic implications of the often-neglected child
No full textDilated cardiomyopathy (DCM) is a primary heart muscle disease characterized by left or biventricular systolic impairment. Historically, most of the clinical attention has been devoted to the evaluation of left ventricular function and morphology, while right ventricle (RV) has been for many years the forgotten chamber. Recently, progresses in cardiac imaging gave clinicians precious tools for the evaluation of RV, raising the awareness of the importance of biventricular assessment in DCM. Indeed, RV involvement is far from being uncommon in DCM, and the presence of right ventricular dysfunction (RVD) is one of the major negative prognostic determinants in DCM patients. However, some aspects such as the possible role of specific genetic mutations in determining the biventricular phenotype in DCM, or the lack of specific treatments able to primarily counteract RVD, still need research. In this review, we summarized the current knowledge on RV involvement in DCM, giving an overview on the epidemiology and pathogenetic mechanisms implicated in determining RVD. Furthermore, we discussed the imaging techniques to evaluate RV function and the role of RV failure in advanced heart failure
Impaired Right Ventricular Longitudinal Strain Without Pulmonary Hypertension in Patients Who Have Recovered From COVID-19
No full textRight ventricular (RV) dysfunction (RVD) is associated with worse outcome in coronavirus disease 2019 (COVID-19). Pulmonary hypertension (PH) is a cause of RVD in COVID-19 respiratory failure and is associated with negative prognosis. Major pulmonary embolism, alveolar and endothelial injury, and thrombotic
microangiopathy are potential triggers for new-onset PH in the acute phase. Persistent RV involvement has been reported in patients recovered from COVID-19. However, the association between persistent RV impairment and new-onset PH remains unexplored. We evaluated the prevalence of PH and RVD in patients
recovered from COVID-19
Radiologia cardiovascolare. 70 anni di immagini dall’“Archivio Camerini” ai giorni nostri
No full textDa oltre un secolo le immagini radiologiche sono entrate nella pratica medica. Nel corso del tempo la radiologia ha visto fiorire numerose tecniche divenendo un indispensabile ausilio diagnostico. Questo atlante si propone di ripercorrere brevemente la storia della diagnostica per immagini in ambito cardiovascolare, utilizzando materiale attinto dall’archivio personale del Professor Fulvio Camerini, il fondatore e direttore della Cardiologia di Trieste dalla fine degli anni ’60 al 1995, e privilegiando la metodica più semplice e diffusa, la radiografia del torace. Infatti, sebbene siano entrate nell’uso comune numerose e più “raffinate” metodiche di diagnostica per immagini, la radiografia del torace rimane uno degli esami maggiormente eseguiti, grazie alla sua facile accessibilità, immediatezza dei risultati e ridotta esposizione a radiazioni ionizzanti. Nella seconda parte dell’atlante vengono analizzati alcuni casi clinici attraverso la chiave di lettura dell’imaging multimodale avanzato, a sottolineare gli enormi progressi della radiologia clinica, nelle sue varie articolazioni e complessità. Questo testo ha una sua valenza storica ed educativa e vogliamo esprimere gratitudine per tutti coloro che hanno contribuito a raccogliere le immagini e per coloro che vi si sono dedicati negli anni
Sacubitril/Valsartan Induces Global Cardiac Reverse Remodeling in Long-Lasting Heart Failure with Reduced Ejection Fraction: Standard and Advanced Echocardiographic Evidences
No full textSacubitril/valsartan reduces mortality in heart failure with reduced ejection fraction (HFrEF) patients, partially due to cardiac reverse remodeling (RR). Little is known about the RR rate in long-lasting HFrEF and the evolution of advanced echocardiographic parameters, despite their known prognostic impact in this setting. We sought to evaluate the rates of left ventricle (LV) and left atrial (LA) RR through standard and advanced echocardiographic imaging in a cohort of HFrEF patients, after the introduction of sacubitril/valsartan. A multi-parametric standard and advanced echocardiographic evaluation was performed at the moment of introduction of sacubitril/valsartan and at 3 to 18 months subsequent follow-up. LVRR was defined as an increase in the LV ejection fraction ≥10 points associated with a decrease ≥10% in indexed LV end-diastolic diameter; LARR was defined as a decrease >15% in the left atrium end-systolic volume. We analyzed 77 patients (65 ± 11 years old, 78% males, 40% ischemic etiology) with 76 (28-165) months since HFrEF diagnosis. After a median follow-up of 9 (interquartile range 6-14) months from the beginning of sacubitril/valsartan, LVRR occurred in 20 patients (26%) and LARR in 33 patients (43%). Moreover, left ventricular global longitudinal strain (LVGLS) improved from -8.3 ± 4% to -12 ± 4.7% (p 25% of cases, both at standard and advanced echocardiographic evaluations
