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38 results on '"Guglielmo, M."'

1. Cardiac Magnetic Resonance for Prophylactic Implantable-Cardioverter Defibrillator Therapy in Ischemic Cardiomyopathy: The DERIVATE–ICM International Registry

Author: Pontone, G, Guaricci, A, Fusini, L, Baggiano, A, Guglielmo, M, Muscogiuri, G, Volpe, A, Abete, R, Aquaro, G, Barison, A, Bogaert, J, Camastra, G, Carigi, S, Carrabba, N, Casavecchia, G, Censi, S, Cicala, G, De Cecco, C, De Lazzari, M, Di Giovine, G, Di Roma, M, Dobrovie, M, Focardi, M, Gaibazzi, N, Gismondi, A, Gravina, M, Lanzillo, C, Lombardi, M, Lorenzoni, V, Lozano-Torres, J, Martini, C, Marzo, F, Masi, A, Memeo, R, Moro, C, Nese, A, Palumbo, A, Pavon, A, Pedrotti, P, Marra, M, Pica, S, Pradella, S, Presicci, C, Rabbat, M, Raineri, C, Rodriguez-Palomares, J, Sbarbati, S, Schoepf, U, Squeri, A, Sverzellati, N, Symons, R, Tat, E, Timpani, M, Todiere, G, Valentini, A, Varga-Szemes, A, Masci, P, Schwitter, J, Pontone G., Guaricci A. I., Fusini L., Baggiano A., Guglielmo M., Muscogiuri G., Volpe A., Abete R., Aquaro G., Barison A., Bogaert J., Camastra G., Carigi S., Carrabba N., Casavecchia G., Censi S., Cicala G., De Cecco C. N., De Lazzari M., Di Giovine G., Di Roma M., Dobrovie M., Focardi M., Gaibazzi N., Gismondi A., Gravina M., Lanzillo C., Lombardi M., Lorenzoni V., Lozano-Torres J., Martini C., Marzo F., Masi A., Memeo R., Moro C., Nese A., Palumbo A., Pavon A. G., Pedrotti P., Marra M. P., Pica S., Pradella S., Presicci C., Rabbat M. G., Raineri C., Rodriguez-Palomares J. F., Sbarbati S., Schoepf U. J., Squeri A., Sverzellati N., Symons R., Tat E., Timpani M., Todiere G., Valentini A., Varga-Szemes A., Masci P. -G., Schwitter J., Pontone, G, Guaricci, A, Fusini, L, Baggiano, A, Guglielmo, M, Muscogiuri, G, Volpe, A, Abete, R, Aquaro, G, Barison, A, Bogaert, J, Camastra, G, Carigi, S, Carrabba, N, Casavecchia, G, Censi, S, Cicala, G, De Cecco, C, De Lazzari, M, Di Giovine, G, Di Roma, M, Dobrovie, M, Focardi, M, Gaibazzi, N, Gismondi, A, Gravina, M, Lanzillo, C, Lombardi, M, Lorenzoni, V, Lozano-Torres, J, Martini, C, Marzo, F, Masi, A, Memeo, R, Moro, C, Nese, A, Palumbo, A, Pavon, A, Pedrotti, P, Marra, M, Pica, S, Pradella, S, Presicci, C, Rabbat, M, Raineri, C, Rodriguez-Palomares, J, Sbarbati, S, Schoepf, U, Squeri, A, Sverzellati, N, Symons, R, Tat, E, Timpani, M, Todiere, G, Valentini, A, Varga-Szemes, A, Masci, P, Schwitter, J, Pontone G., Guaricci A. I., Fusini L., Baggiano A., Guglielmo M., Muscogiuri G., Volpe A., Abete R., Aquaro G., Barison A., Bogaert J., Camastra G., Carigi S., Carrabba N., Casavecchia G., Censi S., Cicala G., De Cecco C. N., De Lazzari M., Di Giovine G., Di Roma M., Dobrovie M., Focardi M., Gaibazzi N., Gismondi A., Gravina M., Lanzillo C., Lombardi M., Lorenzoni V., Lozano-Torres J., Martini C., Marzo F., Masi A., Memeo R., Moro C., Nese A., Palumbo A., Pavon A. G., Pedrotti P., Marra M. P., Pica S., Pradella S., Presicci C., Rabbat M. G., Raineri C., Rodriguez-Palomares J. F., Sbarbati S., Schoepf U. J., Squeri A., Sverzellati N., Symons R., Tat E., Timpani M., Todiere G., Valentini A., Varga-Szemes A., Masci P. -G., and Schwitter J.
Abstract: Background: Implantable cardioverter-defibrillator (ICD) therapy is the most effective prophylactic strategy against sudden cardiac death (SCD) in patients with ischemic cardiomyopathy (ICM) and left ventricle ejection fraction (LVEF) ≤35% as detected by transthoracic echocardiograpgy (TTE). This approach has been recently questioned because of the low rate of ICD interventions in patients who received implantation and the not-negligible percentage of patients who experienced SCD despite not fulfilling criteria for implantation. Objectives: The DERIVATE-ICM registry (CarDiac MagnEtic Resonance for Primary Prevention Implantable CardioVerter DebrillAtor ThErapy; NCT03352648) is an international, multicenter, and multivendor study to assess the net reclassification improvement (NRI) for the indication of ICD implantation by the use of cardiac magnetic resonance (CMR) as compared to TTE in patients with ICM. Methods: A total of 861 patients with ICM (mean age 65 ± 11 years, 86% male) with chronic heart failure and TTE-LVEF <50% participated. Major adverse arrhythmic cardiac events (MAACE) were the primary endpoints. Results: During a median follow-up of 1,054 days, MAACE occurred in 88 (10.2%). Left ventricular end-diastolic volume index (HR: 1.007 [95% CI: 1.000-1.011]; P = 0.05), CMR-LVEF (HR: 0.972 [95% CI: 0.945-0.999]; P = 0.045) and late gadolinium enhancement (LGE) mass (HR: 1.010 [95% CI: 1.002-1.018]; P = 0.015) were independent predictors of MAACE. A multiparametric CMR weighted predictive derived score identifies subjects at high risk for MAACE compared with TTE-LVEF cutoff of 35% with a NRI of 31.7% (P = 0.007). Conclusions: The DERIVATE-ICM registry is a large multicenter registry showing the additional value of CMR to stratify the risk for MAACE in a large cohort of patients with ICM compared with standard of care.
Published: 2023

2. Exploring the EVolution in PrognOstic CapabiLity of MUltisequence Cardiac MagneTIc ResOnance in PatieNts Affected by Takotsubo Cardiomyopathy Based on Machine Learning Analysis: Design and Rationale of the EVOLUTION Study

Author: Cau, R, Muscogiuri, G, Pisu, F, Gatti, M, Velthuis, B, Loewe, C, Cademartiri, F, Pontone, G, Montisci, R, Guglielmo, M, Sironi, S, Esposito, A, Francone, M, Dacher, N, Peebles, C, Bastarrika, G, Salgado, R, Saba, L, Cau R., Muscogiuri G., Pisu F., Gatti M., Velthuis B., Loewe C., Cademartiri F., Pontone G., Montisci R., Guglielmo M., Sironi S., Esposito A., Francone M., Dacher N., Peebles C., Bastarrika G., Salgado R., Saba L., Cau, R, Muscogiuri, G, Pisu, F, Gatti, M, Velthuis, B, Loewe, C, Cademartiri, F, Pontone, G, Montisci, R, Guglielmo, M, Sironi, S, Esposito, A, Francone, M, Dacher, N, Peebles, C, Bastarrika, G, Salgado, R, Saba, L, Cau R., Muscogiuri G., Pisu F., Gatti M., Velthuis B., Loewe C., Cademartiri F., Pontone G., Montisci R., Guglielmo M., Sironi S., Esposito A., Francone M., Dacher N., Peebles C., Bastarrika G., Salgado R., and Saba L.
Abstract: Purpose: Takotsubo cardiomyopathy (TTC) is a transient but severe acute myocardial dysfunction with a wide range of outcomes from favorable to life-threatening. The current risk stratification scores of TTC patients do not include cardiac magnetic resonance (CMR) parameters. To date, it is still unknown whether and how clinical, trans-thoracic echocardiography (TTE), and CMR data can be integrated to improve risk stratification. Methods: EVOLUTION (Exploring the eVolution in prognOstic capabiLity of mUlti-sequence cardiac magneTIc resOnance in patieNts affected by Takotsubo cardiomyopathy) is a multicenter, international registry of TTC patients who will undergo a clinical, TTE, and CMR evaluation. Clinical data including demographics, risk factors, comorbidities, laboratory values, ECG, and results from TTE and CMR analysis will be collected, and each patient will be followed-up for in-hospital and long-term outcomes. Clinical outcome measures during hospitalization will include cardiovascular death, pulmonary edema, arrhythmias, stroke, or transient ischemic attack. Clinical long-term outcome measures will include cardiovascular death, pulmonary edema, heart failure, arrhythmias, sudden cardiac death, and major adverse cardiac and cerebrovascular events defined as a composite endpoint of death from any cause, myocardial infarction, recurrence of TTC, transient ischemic attack, and stroke. We will develop a comprehensive clinical and imaging score that predicts TTC outcomes and test the value of machine learning models, incorporating clinical and imaging parameters to predict prognosis. Conclusions: The main goal of the study is to develop a comprehensive clinical and imaging score, that includes TTE and CMR data, in a large cohort of TTC patients for risk stratification and outcome prediction as a basis for possible changes in patient management.
Published: 2023

3. Worldwide Disparities in Recovery of Cardiac Testing 1 Year Into COVID-19

Author: Einstein, A, Hirschfeld, C, Williams, M, Vitola, J, Better, N, Villines, T, Cerci, R, Shaw, L, Choi, A, Dorbala, S, Karthikeyan, G, Lu, B, Sinitsyn, V, Ansheles, A, Kudo, T, Bucciarelli-Ducci, C, Norgaard, B, Maurovich-Horvat, P, Campisi, R, Milan, E, Louw, L, Allam, A, Bhatia, M, Sewanan, L, Malkovskiy, E, Cohen, Y, Randazzo, M, Narula, J, Morozova, O, Pascual, T, Pynda, Y, Dondi, M, Paez, D, Hinterleitner, G, Lu, Y, Xu, Z, Erinne, I, Shetty, M, Lopez-Mattei, J, Parwani, P, Goda, A, Shirka, E, Bouyoucef, S, Chelghoum, L, Mansouri, F, Medjahedi, A, Naili, Q, Ridouh, M, Alasia, D, Alberghina, L, Aramayo, N, Buchara, D, Busso, F, Bustos Rivadero, J, Camilletti, J, Campanelli, H, Castro, R, Daicz, M, del Riego, H, Dragonetti, L, Echazarreta, D, Erriest, J, Faccio, F, Facello, A, Gallegos, H, Geronazzo, R, Glait, H, Hasbani, V, Jager, V, Lewkowicz, J, Lotti, J, Maciel, N, Masoli, O, Mastrovito, E, Medus, M, Merani, M, Molteni, S, Montecinos, M, Parisi, G, Sueldo, C, Perez de Arenaza, D, Quintana, L, Radzinschi, A, Redruello, M, Rodriguez, M, Rojas, H, Acuna, A, Schere, D, Traverso, S, Vazquez, G, Zeffiro, S, Sakanyan, M, Beuzeville, S, Boktor, R, Crowley, M, Downie, D, Dwivedi, G, Elison, B, Farouque, O, Jasper, K, Joshi, S, Lee, J, Lee, K, Lui, E, Mcconachie, P, Meaker, J, Nandurkar, D, Neill, J, O'Rourke, E, O'Sullivan, P, Pandos, G, Premaratne, M, Prior, D, Rutherford, N, Saunders, C, Taubman, K, Tauro, A, Taylor, A, Theuerle, J, Thomas, P, Tow, J, Upton, A, Vamadevan, S, Wayne, V, Wegner, E, Wong, D, Younger, J, Beitzke, D, Feuchtner, G, Sommer, O, Weiss, K, Maroz-Vadalazhskaya, N, Tserakhau, U, Homans, F, Van De Heyning, C, Araujo, R, Soldat-Stankovic, V, Stankovic, S, Almeida, A, Anselmi, C, Azevedo, G, Bittencourt, M, Pianta, D, Cabeda, E, Carreira, L, Coelho, I, de Amorim Fernandes, F, de Lorenzo, A, Delgado, R, Erthal, F, Fernandes, F, Fernandes, J, Ferreira de Souza, T, Foppa, M, Matos Alves, W, Gontijo, C, Gottlieb, I, Grossman, G, Albernaz Siqueira, M, Nomura, C, Koga, K, Lima, R, Lopes, R, Marcal Filho, H, Masiero, P, Mastrocola, L, Menezes de Siqueira, M, Mesquita, C, Naves, D, Penna, F, Pinto, I, Rocha, T, Rocha, J, Rodrigues, A, Salioni, L, Sanches, A, Santos, M, Da Silva, L, Schvartzman, P, Matushita, C, Senra, T, Silva, M, Soares, C, Spiro, B, Suaide Silva, C, Torres, R, Monte, G, Vilela, A, Villa, A, Voss, T, Waltrick, R, Zapparoli, M, Naseer, H, Garcheva-Tsacheva, M, Ouattara, T, Thou, S, Varoeun, S, Abikhzer, G, Beanlands, R, Chetrit, M, Dabreo, D, Dennie, C, Friedrich, M, Hafez, M, Hanneman, K, Miller, R, Oikonomou, A, Roifman, I, Small, G, Tandon, V, Trivedi, A, White, J, Zukotynski, K, Alay, R, Concha, C, Massardo, T, Abad, P, Anzola, K, Arturo, H, Benitez, L, Cadena, A, Zamudio, C, Calderon, A, Gutierrez Villamil, C, Jaimes, C, Londono, J, Lopez, N, Merlano-Gaitan, S, Murgieitio-Cabrera, R, Valencia, M, Vergel, D, Santamaria, A, Solis, F, Batinic, T, Franceschi, M, Paar, M, Prpic, M, Felipe Batista, C, Cabrera, L, Peix, A, Pena, Y, Rochela Vazquez, L, Ntalas, I, Kaminek, M, Kincl, V, Lang, O, Abdulla, J, Bottcher, M, Busk, M, Geisler, U, Gormsen, L, Hansson, N, Hess, S, Hove, J, Jensen, L, Jensen, M, Kragholm, K, Ovrehus, K, Rasmussen, J, Ronnow Sand, N, Sondergaard, H, Zaremba, T, Speckter, H, Amores, N, Velez, M, Alrahman, T, Elsamad, S, Abdelfattah, A, Elkaffas, S, Hassan, M, Hussein, E, Ibrahim, A, Kandeel, A, Ali, M, Shaaban, M, Flores, C, Gomez Leiva, V, Liiver, A, Larikka, M, Uusitalo, V, Agostini, D, Berger, C, Dietz, M, Hyafil, F, Ohana, M, Prigent, K, Regaieg, H, Sarda-Mantel, L, H-Ici, D, Ayetey, H, Angelidis, G, Fragkaki, C, Fragkiadaki, C, Georgoulias, P, Koutelou, M, Kyrozi, E, Lama, N, Prassopoulos, V, Spartalis, M, Zaglavara, T, Gonzalez, C, Gutierrez, G, Maldonado, A, Martinez, Y, Kovacs, A, Szilveszter, B, Banthia, N, Bhat, V, Choudhury, P, Chowdekar, V, Christopher, J, Garg, T, Goyal, N, Gupta, R, Gupta, A, Hephzibah, J, Jain, S, Krupa, J, Kumar, P, Kumar, S, Lalchandani, A, Mishra, A, Mishra, V, Mohan, P, Ozair, A, Pandey, S, Parameswaran, R, Patel, C, Patel, T, Patel, S, Vimala, L, Kumar Sarangi, D, Sengupta, S, Sethi, A, Sharma, A, Sharma, P, Shrigiriwar, A, Singh, S, Singh, H, Sood, A, Verma, A, Vyas, A, Soeriadi, E, Bun, E, Hutomo, F, Syawaluddin, H, Yudistiro, R, Albadr, A, Assadi, M, Emami, F, Emami-Ardekani, A, Farzanehfar, S, Jafari, R, Manafi-Farid, R, Tajik, M, Arnson, Y, Fuchs, S, Goldkorn, R, Kennedy, J, Leitman, M, Shalev, A, Acampa, W, Albano, D, Alongi, P, Arnone, G, Assante, R, Baritussio, A, Bauckneht, M, Bianco, F, Bonfiglioli, R, Bovenzi, F, Bruno, I, Bruno, A, Busnardo, E, Califaretti, E, Casoni, R, Censullo, V, Chierichetti, F, Chiocchi, M, Cittanti, C, Clemente, A, Cuocolo, A, De Rimini, M, De Vincentis, G, Della Tommasina, V, Dellegrottaglie, S, Erba, P, Evangelista, L, Faggi, L, Faragasso, E, Florimonte, L, Frantellizzi, V, Gatti, M, Gaudiano, A, Gelardi, F, Gerali, A, Gimelli, A, Guglielmo, M, Leccisotti, L, Liga, R, Liguori, C, Longo, G, Maffione, M, Marcassa, C, Matassa, G, Mele, D, Mircoli, L, Paccagnella, A, Pacella, S, Padovano, F, Pellegrini, D, Pergola, V, Pugliese, L, Quartuccio, N, Rampin, L, Ricci, F, Rubini, G, Russo, V, Sambuceti, G, Scatteia, A, Sciagra, R, Spidalieri, G, Stefanelli, A, Tedeschi, C, Ventroni, G, Baugh, D, Madu, E, Aikawa, T, Asano, H, Fujimoto, S, Fujise, K, Fukushima, Y, Fukuyama, K, Ichikawa, Y, Ideguchi, R, Iguchi, N, Imai, M, Ishimura, H, Isobe, S, Ito, K, Izawa, Y, Kadokami, T, Kasai, T, Kato, T, Kawamoto, T, Kiryu, S, Kumita, S, Manabe, O, Maruno, H, Matsumoto, N, Miyagawa, M, Moroi, M, Nagamachi, S, Nakajima, K, Nakazato, R, Nanasato, M, Naya, M, Norikane, T, Ohta, Y, Otomi, Y, Otsuka, H, Oyama-Manabe, N, Saito, M, Sarai, M, Sato, J, Sato, D, Shiraishi, S, Takanami, K, Takehana, K, Taniguchi, Y, Teragawa, H, Tomizawa, N, Umeji, K, Wakabayashi, Y, Yamada, S, Yamazaki, S, Yoneyama, T, Rawashdeh, M, Dautov, T, Makhdomi, K, Abass, M, Garashi, M, Siraj, Q, Kalnina, M, Haidar, M, Komiagiene, R, Kviecinskiene, G, Vajauskas, D, Karim, N, Doucoure, M, Reichmuth, L, Samuel, A, Dieng, M, Naojee, A, Hernandez, E, Alducin Tellez, C, Alexanderson-Rosas, E, Barragan, E, Cabada, M, Calderon, D, Carvajal-Juarez, I, Esparza, J, Gama-Moreno, M, Quinto, V, Gonzalez, N, Herrera-Zarza, M, Meave, A, Medina Verdugo, J, Melendez, G, Morales Murguia, R, Navarro Quiroz, C, Ornelas, M, Preciado-Anaya, A, Preciado-Gutierrez, O, Puente, A, Salazar, A, Rosales Uvera, S, Rosales-Uvera, S, Serna Macias, J, Sierra-Galan, L, Tirado Alderete, J, Vallejo, E, Faraggi, M, Sereegotov, E, Ben Rais, N, Alaoui, N, Kyiphyu, T, Oo, S, Win, S, Zar, H, Ghimire, R, Neupane, M, Glaudemans, A, Slart, R, Verschure, D, Allen, B, Edmond, J, Mckenzie, C, Tie, S, Van Pelt, N, Worthington, K, Young, C, Soli, I, Kana, S, Onubogu, U, Sani, M, Braten, A, Jorgensen, A, Vassbotn, H, Al Dhuhli, H, Jawa, Z, Tag, N, Fatima, S, Imran, M, Younis, M, Saadullah, M, Malo, Y, Lenturut-Katal, D, Castillo, M, Ortellado, J, Akhter, A, Cader, F, Hussain, R, Khan, S, Mandal, T, Nasreen, F, An, Y, Cao, D, Gong, L, Hou, Y, Jia, C, Li, T, Li, C, Liu, H, Liu, W, Liu, J, Ng, M, Shi, H, Tang, C, Wang, X, Wang, Z, Wang, Y, Wu, J, Yi, Y, Yuan, L, Zhang, T, Zhang, L, Chavez, E, Cruz, C, Llontop, C, Morales, R, Abrihan, P, Bustos-Barroso, A, Duldulao-Ogbac, M, Eduarte, C, Obaldo, J, Quinon, A, San Juan, B, San Juan, C, Sauler-Gomez, M, Uy, M, Kostkiewicz, M, Kunikowska, J, Teresinska, A, Urbanik, T, Bettencourt, N, Fontes-Carvalho, R, Gavina, C, Goncalves, L, Macedo, F, Moreno, N, Sousa, C, Timoteo, A, Vidigal, M, Al Heidous, M, Ramanathan, S, Arnous, S, Aytani, S, Byrne, A, Gleeson, T, Kerins, D, O'Brien, J, Bang, J, Bom, H, Cheon, M, Cheon, G, Cho, S, Hong, C, Jeong, Y, Kang, W, Kang, Y, Kim, J, Oh, S, So, Y, Song, H, Won, K, Yoo, S, Mitevska, I, Vavlukis, M, Salobir, B, Stalc, M, Benedek, T, Pop, M, Stan, C, Dariy, O, Gagarina, N, Itskovich, I, Karalkin, A, Kokov, A, Marina, G, Migunova, E, Pospelov, V, Ryzhkova, D, Sayfullina, G, Sergienko, V, Shurupova, I, Vakhromeeva, M, Valiullina, N, Zavadovsky, K, Zhuravlev, K, Abazid, R, Al Garni, T, Alasnag, M, Aljizeeri, A, Amer, H, Amro, A, Hamdy, H, Smettei, O, Saranovic, D, Vlajkovic, M, Keng, F, See, J, Berecova, Z, Mistinova, J, Evbuomwan, O, Govender, N, Hack, J, Hadebe, B, Hlongwa, K, Kaplan, M, Lakhi, H, Milos, K, Modiselle, M, More, S, Muambadzi, N, Scholtz, L, Barreiro-Perez, M, Blanco, I, Broncano, J, Camarero, A, Casans-Tormo, I, De Haro, J, Flotats, A, Garcia, E, Mendiguchia, C, Jimenez-Heffernan, A, Leta, R, Diaz, J, Vega, L, Manovel-Sanchez, A, Monzonis, A, Patrut, B, Pubul, V, Perez, R, Zeidan, N, Nanayakkara, D, Suliman, A, Engblom, H, Murtadha, M, Ostenfeld, E, Simonsson, M, Alkadhi, H, Buechel, R, Burger, P, Grani, C, Kamani, C, Kawel-Bohm, N, Klaeser, B, Manka, R, Prior, J, Kaewchur, T, Khiewvan, B, Kositwattanarerk, A, Namwongprom, S, Thientunyakit, T, Sayman, H, Yuksel, M, Sebikali, M, Okello, E, Korol, P, Noverko, I, Satyr, M, Ahmad, T, Alfakih, K, Andrade, I, Buckingham, S, Bularga, A, Carpenter, J, Cole, G, Cusack, D, David, S, Davis, P, Fairbairn, T, Ghosh, A, Ramkumar, P, Hamilton, M, Haque, F, Hudson, B, Johnstone, A, Karthikeyan, V, Kay, M, Khan, M, Kitt, J, Low, C, Mcalindon, E, Mccreavy, D, Morrissey, B, Motwani, M, Na, D, Nicol, E, Patel, D, Rodrigues, J, Rofe, C, Schofield, R, Semple, T, Sheikh, A, Sinha, A, Subedi, D, Topping, W, Tweed, K, Underwood, S, Weir-Mccall, J, Zuhairy, H, Abbasi, T, Abohashem, S, Abramson, S, Al-Mallah, M, Kumar, M, Balmer-Swain, M, Berman, D, Bernheim, A, Bhatti, S, Biederman, R, Bieging, E, Bingham, S, Bloom, S, Blue, S, Borges, A, Branch, K, Bravo, P, Buddhe, S, Budoff, M, Bullock-Palmer, R, Cahill, M, Candela, C, Cao, J, Chatterjee, S, Chatzizisis, Y, Chaudhuri, N, Cheezum, M, Chelliah, A, Chen, T, Chen, M, Chen, L, Chokshi, A, Chung, J, Danciu, S, Desisto, W, Dilorenzo, M, Doukky, R, Duvall, W, Ferencik, M, Foster, C, Fuisz, A, Gannon, M, German, D, Gerson, M, Geske, J, Hage, F, Haider, A, Haider, S, Hamirani, Y, Hassen, K, Hendel, R, Henkel, J, Horgan, S, Hyun, M, Janardhanan, R, Jerome, S, Kalra, D, Kassop, D, Kinkhabwala, M, Kinzfogl, G, Koch, B, Koweek, L, Krepp, J, Kwon, Y, Layer, J, Lesser, J, Leung, S, Lisske, B, Magurany, K, Markowitz, J, Mccullough, B, Moalemi, A, Moffitt, C, Montanez, J, Moore, W, Morayati, S, Mossa-Basha, M, Mrsic, Z, Murthy, V, Nagpal, P, Nelson, K, Nijjar, P, O'Quinn, R, Passen, E, Patil, P, Pursnani, A, Quachang, N, Rabbat, M, Ranjan, P, Lozano, P, Schemmer, M, Seifried, R, Shah, N, Shah, A, Shanbhag, S, Sharma, G, Skotnicki, R, Sobczak, M, Soman, P, Sorrell, V, Srichai, M, Streeter, J, Strickland, L, Suliman, S, Tebyanian, N, Thomas, D, Thompson, R, Uretsky, S, Vallurupalli, S, Vandyck-Acquah, M, Verma, V, Weinstein, J, Wolinsky, D, Zareba, K, Zgaljardic, M, Beretta, M, Ferrando, R, Kapitan, M, Mut, F, Djuraev, O, Rozikhodjaeva, G, Vera, L, Duc, B, Nguyen, X, Hiep Nguyen, P, Einstein A. 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R., Burger P., Grani C., Kamani C., Kawel-Bohm N., Klaeser B., Manka R., Prior J., Kaewchur T., Khiewvan B., Kositwattanarerk A., Namwongprom S., Thientunyakit T., Sayman H. B., Yuksel M., Sebikali M. J., Okello E., Korol P., Noverko I., Satyr M., Ahmad T., Alfakih K., Andrade I., Buckingham S., Bularga A., Carpenter J. -P., Cole G., Cusack D., David S., Davis P., Fairbairn T., Ghosh A., Ramkumar P. G., Hamilton M., Haque F., Hudson B., Johnstone A., Karthikeyan V. J., Kay M., Khan M. A., Kitt J., Low C. S., Mcalindon E., Mccreavy D., Morrissey B., Motwani M., Na D., Nicol E., Patel D., Rodrigues J., Rofe C., Schofield R., Semple T., Sheikh A., Sinha A., Subedi D., Topping W., Tweed K., Underwood S. R., Weir-Mccall J., Zuhairy H., Abbasi T., Abohashem S., Abramson S., Al-Mallah M., Kumar M. A., Balmer-Swain M., Berman D., Bernheim A., Bhatti S., Biederman R., Bieging E., Bingham S., Bloom S., Blue S., Borges A., Branch K., Bravo P., Buddhe S., Budoff M., Bullock-Palmer R., Cahill M., Candela C., Cao J., Chatterjee S., Chatzizisis Y., Chaudhuri N. R., Cheezum M., Chelliah A., Chen T., Chen M., Chen L., Chokshi A., Chung J., Danciu S., DeSisto W., Dilorenzo M., Doukky R., Duvall W., Ferencik M., Foster C., Fuisz A., Gannon M., German D., Gerson M., Geske J., Hage F., Haider A., Haider S., Hamirani Y., Hassen K., Hendel R., Henkel J., Horgan S., Hyun M., Janardhanan R., Jerome S., Kalra D., Kassop D., Kinkhabwala M., Kinzfogl G., Koch B., Koweek L., Krepp J., Kwon Y., Layer J., Lesser J., Leung S., Lisske B., Magurany K., Markowitz J., Mccullough B., Moalemi A., Moffitt C., Montanez J., Moore W., Morayati S., Mossa-Basha M., Mrsic Z., Murthy V., Nagpal P., Nelson K., Nijjar P., O'Quinn R., Passen E., Patil P., Pursnani A., Quachang N., Rabbat M., Ranjan P., Lozano P. R., Schemmer M., Seifried R., Shah N., Shah A., Shanbhag S., Sharma G., Skotnicki R., Sobczak M., Soman P., Sorrell V., Srichai M., Streeter J., Strickland L., Suliman S., Tebyanian N., Thomas D., Thompson R., Uretsky S., Vallurupalli S., Vandyck-Acquah M., Verma V., Villines T., Weinstein J., Wolinsky D., Zareba K., Zgaljardic M., Beretta M., Ferrando R., Kapitan M., Mut F., Djuraev O., Rozikhodjaeva G., Vera L., Duc B. D., Nguyen X. C., and Hiep Nguyen P. M.
Abstract: Background: The extent to which health care systems have adapted to the COVID-19 pandemic to provide necessary cardiac diagnostic services is unknown. Objectives: The aim of this study was to determine the impact of the pandemic on cardiac testing practices, volumes and types of diagnostic services, and perceived psychological stress to health care providers worldwide. Methods: The International Atomic Energy Agency conducted a worldwide survey assessing alterations from baseline in cardiovascular diagnostic care at the pandemic's onset and 1 year later. Multivariable regression was used to determine factors associated with procedure volume recovery. Results: Surveys were submitted from 669 centers in 107 countries. Worldwide reduction in cardiac procedure volumes of 64% from March 2019 to April 2020 recovered by April 2021 in high- and upper middle-income countries (recovery rates of 108% and 99%) but remained depressed in lower middle- and low-income countries (46% and 30% recovery). Although stress testing was used 12% less frequently in 2021 than in 2019, coronary computed tomographic angiography was used 14% more, a trend also seen for other advanced cardiac imaging modalities (positron emission tomography and magnetic resonance; 22%-25% increases). Pandemic-related psychological stress was estimated to have affected nearly 40% of staff, impacting patient care at 78% of sites. In multivariable regression, only lower-income status and physicians’ psychological stress were significant in predicting recovery of cardiac testing. Conclusions: Cardiac diagnostic testing has yet to recover to prepandemic levels in lower-income countries. Worldwide, the decrease in standard stress testing is offset by greater use of advanced cardiac imaging modalities. Pandemic-related psychological stress among providers is widespread and associated with poor recovery of cardiac testing.
Published: 2022

4. Preoperative Ozaki technique measures on tridimensional engineered root

Author: Pirola, S, Mastroiacovo, G, Mostardini, G, Bonomi, A, Guglielmo, M, Muscogiuri, G, Baggiano, A, Montisci, A, Pontone, G, Polvani, G, Pirola S, Mastroiacovo G, Mostardini G, Bonomi A, Guglielmo M, Muscogiuri G, Baggiano A, Montisci A, Pontone G, Polvani G., Pirola, S, Mastroiacovo, G, Mostardini, G, Bonomi, A, Guglielmo, M, Muscogiuri, G, Baggiano, A, Montisci, A, Pontone, G, Polvani, G, Pirola S, Mastroiacovo G, Mostardini G, Bonomi A, Guglielmo M, Muscogiuri G, Baggiano A, Montisci A, Pontone G, and Polvani G.
Abstract: Background: The aortic valve neocuspidalization (AVNeo) is an innovative surgical technique aiming at the reconstruction of the aortic valve using autologous pericardium. One of the main criticisms to AVNeo is the longer duration of the aortic clamping time (ACT) as compared to standard aortic valve replacement due to the sizing of the valve neocusps. Methods: We retrospectively enrolled 30 consecutives patients underwent AVNeo. For each patient we developed a 3D aortic root model (ARM) based on CT-scan datasets. We retrospectively compared the leaflets measurements performed during surgery with those obtained on the corresponding ARMs. Results: In 100% of cases no difference between the in vitro and in vivo measurements exceeded the acceptable error limit of 2 mm. The correlation of each single in vitro versus in vivo measurements demonstrates a strong coincidence between the two different methods of sizing (r > 0,9, p < .0001). By analyzing the data considering the annulus perimeter and not the single cusp size, the perfect coincidence was to be found in 89.9% with a slight acceptable discrepancy (2 mm on total) in the remaining 10.1%. Conclusions: 3D-ARMs, printed from CT-scan, represent a reproducible process to obtain overlapping cusp sizes compared to those measured in-vivo, possibly reducing the ACT.
Published: 2022

5. Cardiac Magnetic Resonance Tissue Characterization in Ischemic Cardiomyopathy

Author: Muscogiuri, G, Ricci, F, Scafuri, S, Guglielmo, M, Baggiano, A, De Stasio, V, Di Donna, C, Spiritigliozzi, L, Chiocchi, M, Lee, S, De Cecco, C, van Assen, M, Rabbat, M, Pontone, G, Muscogiuri G, Ricci F, Scafuri S, Guglielmo M, Baggiano A, De Stasio V, Di Donna C, Spiritigliozzi L, Chiocchi M, Lee SJ, De Cecco CN, van Assen M, Rabbat MG, Pontone G, Muscogiuri, G, Ricci, F, Scafuri, S, Guglielmo, M, Baggiano, A, De Stasio, V, Di Donna, C, Spiritigliozzi, L, Chiocchi, M, Lee, S, De Cecco, C, van Assen, M, Rabbat, M, Pontone, G, Muscogiuri G, Ricci F, Scafuri S, Guglielmo M, Baggiano A, De Stasio V, Di Donna C, Spiritigliozzi L, Chiocchi M, Lee SJ, De Cecco CN, van Assen M, Rabbat MG, and Pontone G
Abstract: Ischemic cardiomyopathy (ICM) is one of the most common causes of congestive heart failure. In patients with ICM, tissue characterization with cardiac magnetic resonance imaging (CMR) allows for evaluation of myocardial abnormalities in acute and chronic settings. Myocardial edema, microvascular obstruction (MVO), intracardiac thrombus, intramyocardial hemorrhage, and late gadolinium enhancement of the myocardium are easily depicted using standard CMR sequences. In the acute setting, tissue characterization is mainly focused on assessment of ventricular thrombus and MVO, which are associated with poor prognosis. Conversely, in chronic ICM, it is important to depict late gadolinium enhancement and myocardial ischemia using stress perfusion sequences. Overall, with CMR's ability to accurately characterize myocardial tissue in acute and chronic ICM, it represents a valuable diagnostic and prognostic imaging method for treatment planning. In particular, tissue characterization abnormalities in the acute setting can provide information regarding the patients that may develop major adverse cardiac event and show the presence of ventricular thrombus; in the chronic setting, evaluation of viable myocardium can be fundamental for planning myocardial revascularization. In this review, the main findings on tissue characterization are illustrated in acute and chronic settings using qualitative and quantitative tissue characterization.
Published: 2022

6. Aortic regurgitation: A multimodality approach

Author: Siani, A, Perone, F, Costantini, P, Rodolfi, S, Muscogiuri, G, Sironi, S, Carriero, S, Pavon, A, van der Bilt, I, van Rosendael, P, Broekhuizen, L, Teske, A, Cramer, M, Guglielmo, M, Siani A., Perone F., Costantini P., Rodolfi S., Muscogiuri G., Sironi S., Carriero S., Pavon A. G., van der Bilt I., van Rosendael P., Broekhuizen L., Teske A., Cramer M. J., Guglielmo M., Siani, A, Perone, F, Costantini, P, Rodolfi, S, Muscogiuri, G, Sironi, S, Carriero, S, Pavon, A, van der Bilt, I, van Rosendael, P, Broekhuizen, L, Teske, A, Cramer, M, Guglielmo, M, Siani A., Perone F., Costantini P., Rodolfi S., Muscogiuri G., Sironi S., Carriero S., Pavon A. G., van der Bilt I., van Rosendael P., Broekhuizen L., Teske A., Cramer M. J., and Guglielmo M.
Abstract: Aortic regurgitation (AR) is a common valvular pathology. Multimodality noninvasive cardiovascular imaging is routinely used to assess the mechanism of AR, degree, and its hemodynamic impact on the cardiovascular system. Collecting this information is crucial in establishing the prognosis and in guiding patient management and follow-up. While echocardiography remains the primary test to assess AR, a comprehensive assessment of this valvulopathy can be obtained by combining the information from different techniques. This state-of-the-art review is intended to provide an update ed overview of the applications, strengths, and limits of transthoracic echocardiography, cardiac magnetic resonance, and cardiac computed tomography in patients with AR.
Published: 2022

7. State of the art paper: Cardiovascular CT for planning ventricular tachycardia ablation procedures

Author: Conte, E, Mushtaq, S, Carbucicchio, C, Piperno, G, Catto, V, Mancini, M, Formenti, A, Annoni, A, Guglielmo, M, Baggiano, A, Muscogiuri, G, Belmonte, M, Cattani, F, Pontone, G, Jereczek-Fossa, B, Orecchia, R, Tondo, C, Andreini, D, Conte E, Mushtaq S, Carbucicchio C, Piperno G, Catto V, Mancini ME, Formenti A, Annoni A, Guglielmo M, Baggiano A, Muscogiuri G, Belmonte M, Cattani F, Pontone G, Jereczek-Fossa BA, Orecchia R, Tondo C, Andreini D., Conte, E, Mushtaq, S, Carbucicchio, C, Piperno, G, Catto, V, Mancini, M, Formenti, A, Annoni, A, Guglielmo, M, Baggiano, A, Muscogiuri, G, Belmonte, M, Cattani, F, Pontone, G, Jereczek-Fossa, B, Orecchia, R, Tondo, C, Andreini, D, Conte E, Mushtaq S, Carbucicchio C, Piperno G, Catto V, Mancini ME, Formenti A, Annoni A, Guglielmo M, Baggiano A, Muscogiuri G, Belmonte M, Cattani F, Pontone G, Jereczek-Fossa BA, Orecchia R, Tondo C, and Andreini D.
Abstract: In the last 20 years coronary computed tomography angiography (CCTA) gained a pivotal role in the evaluation of patients with suspected coronary artery disease (CAD) as finally recognized by the ESC guidelines on stable CAD. Technological advances have progressively improved the temporal resolution of CT scanners, contemporary reducing acquisition time, radiation dose and contrast volume needed for the whole heart volume acquisition, further expanding the role of cardiac CT beyond coronary anatomy evaluation. Aim of the present review is to discuss use and benefit of cardiac CT for the planning and preparation of VT ablation.
Published: 2021

8. Role of computed tomography in COVID-19

Author: Pontone, G, Scafuri, S, Mancini, M, Agalbato, C, Guglielmo, M, Baggiano, A, Muscogiuri, G, Fusini, L, Andreini, D, Mushtaq, S, Conte, E, Annoni, A, Formenti, A, Gennari, A, Guaricci, A, Rabbat, M, Pompilio, G, Pepi, M, Rossi, A, Pontone G, Scafuri S, Mancini ME, Agalbato C, Guglielmo M, Baggiano A, Muscogiuri G, Fusini L, Andreini D, Mushtaq S, Conte E, Annoni A, Formenti A, Gennari AG, Guaricci AI, Rabbat MR, Pompilio G, Pepi M, Rossi A, Pontone, G, Scafuri, S, Mancini, M, Agalbato, C, Guglielmo, M, Baggiano, A, Muscogiuri, G, Fusini, L, Andreini, D, Mushtaq, S, Conte, E, Annoni, A, Formenti, A, Gennari, A, Guaricci, A, Rabbat, M, Pompilio, G, Pepi, M, Rossi, A, Pontone G, Scafuri S, Mancini ME, Agalbato C, Guglielmo M, Baggiano A, Muscogiuri G, Fusini L, Andreini D, Mushtaq S, Conte E, Annoni A, Formenti A, Gennari AG, Guaricci AI, Rabbat MR, Pompilio G, Pepi M, and Rossi A
Abstract: Coronavirus disease 2019 (COVID-19) has become a rapid worldwide pandemic. While COVID-19 primarily manifests as an interstitial pneumonia and severe acute respiratory distress syndrome, severe involvement of other organs has been documented. In this article, we will review the role of non-contrast chest computed tomography in the diagnosis, follow-up and prognosis of patients affected by COVID-19 pneumonia with a detailed description of the imaging findings that may be encountered. Given that patients with COVID-19 may also suffer from coagulopathy, we will discuss the role of CT pulmonary angiography in the detection of acute pulmonary embolism. Finally, we will describe more advanced applications of CT in the differential diagnosis of myocardial injury with an emphasis on ruling out acute coronary syndrome and myocarditis.
Published: 2021

9. Current evidence on the diagnostic and prognostic role of native T1 mapping in heart diseases

Author: Tonet, E, Baggiano, A, Pavasini, R, Guglielmo, M, Censi, S, Cossu, A, Rapezzi, C, Muscogiuri, G, Squeri, A, Campo, G, Pontone, G, Tonet E, Baggiano A, Pavasini R, Guglielmo M, Censi S, Cossu A, Rapezzi C, Muscogiuri G, Squeri A, Campo G, Pontone G., Tonet, E, Baggiano, A, Pavasini, R, Guglielmo, M, Censi, S, Cossu, A, Rapezzi, C, Muscogiuri, G, Squeri, A, Campo, G, Pontone, G, Tonet E, Baggiano A, Pavasini R, Guglielmo M, Censi S, Cossu A, Rapezzi C, Muscogiuri G, Squeri A, Campo G, and Pontone G.
Abstract: Tissue characterization represents a prerogative of cardiac magnetic resonance. Beside late gadolinium enhancement, native T1 mapping (nT1m) reveals tissue composition. It could represent a useful tool for example when contrast medium can't be administrated. The present review summarises current evidence about nT1m in main heart diseases.
Published: 2021

10. Diagnostic Accuracy of Single-shot 2-Dimensional Multisegment Late Gadolinium Enhancement in Ischemic and Nonischemic Cardiomyopathy

Author: Muscogiuri, G, Gatti, M, Dell'Aversana, S, Andreini, D, Guaricci, A, Guglielmo, M, Baggiano, A, Mushtaq, S, Conte, E, Annoni, A, Formenti, A, Mancini, M, Gripari, P, Rabbat, M, Pepi, M, Pontone, G, Muscogiuri G, Gatti M, Dell'Aversana S, Andreini D, Guaricci AI, Guglielmo M, Baggiano A, Mushtaq S, Conte E, Annoni A, Formenti A, Mancini ME, Gripari P, Rabbat MG, Pepi M, Pontone G., Muscogiuri, G, Gatti, M, Dell'Aversana, S, Andreini, D, Guaricci, A, Guglielmo, M, Baggiano, A, Mushtaq, S, Conte, E, Annoni, A, Formenti, A, Mancini, M, Gripari, P, Rabbat, M, Pepi, M, Pontone, G, Muscogiuri G, Gatti M, Dell'Aversana S, Andreini D, Guaricci AI, Guglielmo M, Baggiano A, Mushtaq S, Conte E, Annoni A, Formenti A, Mancini ME, Gripari P, Rabbat MG, Pepi M, and Pontone G.
Abstract: Purpose:The aim of this study was to assess the reliability of single-shot 2-dimensional multislice late gadolinium enhancement (2D-MSLGE) compared with gold standard single-slice 2D inversion recovery segmented gradient echo (2D-SSLGE).Materials and Methods:Sixty-seven patients prospectively underwent clinically indicated cardiac magnetic resonance (CMR) imaging and were enrolled. The image quality was assessed using a 4-point scale. Segments positive for LGE were classified as ischemic or nonischemic for 2D-MSLGE and 2D-SSLGE. Interobserver and intraobserver variability was assessed for both sequences by 2 readers. The endpoints were as follows: (a) detection of myocardial segments involved by LGE and (b) classification of LGE as ischemic and nonischemic pattern. Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy value were calculated for the 2 endpoints.Results:2D-MSLGE and 2D-SSLGE were successfully performed in all patients with comparable image quality (1.56±0.59 vs. 1.54±0.58, P=0.84). For the overall population, 2D-MSLGE correctly identified 1093 of 1139 myocardial segments positive for LGE (96%; 95% confidence interval [CI]: 95%-97%), as compared with 2D-SSLGE. Similarly, 2D-MSLGE correctly identified 1128 of 1139 (99%; 95% CI: 98%-99%) and 1108 of 1139 (97%; 95% CI: 96%-98%) of nonischemic and ischemic LGE patterns.Interobserver and intraobserver variability for quantification of LGE using 2D-MSLGE was 0.98 and 0.99, respectively. The acquisition time was shorter for 2D-MSLGE as compared with 2D-SSLGE (2.0±0.5 vs. 6.0±2.0 min, P: 0.01).Conclusions:As compared with 2D-SSLGE, 2D-MSLGE is a reliable tool in both ischemic and nonischemic cardiac disease; it is associated with shorter scan times without the need for prolonged breath holding and may be beneficial for those with dysrhythmia.
Published: 2020

11. Interpretability of Coronary CT Angiography Performed With a Novel Whole-Heart Coverage High-Definition CT Scanner in 300 Consecutive Patients With Coronary Artery Bypass Grafts

Author: Mushtaq, S, Conte, E, Pontone, G, Pompilio, G, Guglielmo, M, Annoni, A, Baggiano, A, Formenti, A, Mancini, M, Muscogiuri, G, Nicoli, F, Giannitto, C, Magatelli, M, Tanzilli, A, Consiglio, E, Fiorentini, C, Bartorelli, A, Pirillo, S, Pepi, M, Andreini, D, Mushtaq S, Conte E, Pontone G, Pompilio G, Guglielmo M, Annoni A, Baggiano A, Formenti A, Mancini ME, Muscogiuri G, Nicoli F, Giannitto C, Magatelli M, Tanzilli A, Consiglio E, Fiorentini C, Bartorelli AL, Pirillo SP, Pepi M, Andreini D, Mushtaq, S, Conte, E, Pontone, G, Pompilio, G, Guglielmo, M, Annoni, A, Baggiano, A, Formenti, A, Mancini, M, Muscogiuri, G, Nicoli, F, Giannitto, C, Magatelli, M, Tanzilli, A, Consiglio, E, Fiorentini, C, Bartorelli, A, Pirillo, S, Pepi, M, Andreini, D, Mushtaq S, Conte E, Pontone G, Pompilio G, Guglielmo M, Annoni A, Baggiano A, Formenti A, Mancini ME, Muscogiuri G, Nicoli F, Giannitto C, Magatelli M, Tanzilli A, Consiglio E, Fiorentini C, Bartorelli AL, Pirillo SP, Pepi M, and Andreini D
Abstract: Aims: Coronary CT angiography (CCTA) is an accurate non-invasive tool for the evaluation of coronary artery bypass graft (CABG). However, inability to sustain a long breath-hold, high heart rate (HR) and atrial fibrillation may affect image quality. Moreover, radiation exposure is still a matter of some concern. A scanner combining 0.23-mm spatial resolution, new iterative reconstruction and fast gantry rotation time has been recently introduced in the clinical field. The aims of our study were to evaluate interpretability, radiation exposure and diagnostic accuracy of CCTA performed with the latest generation of cardiac-CT scanners compared to invasive coronary angiography (ICA) in the assessment of bypass grafts, and non-grafted and post-anastomotic native coronary arteries. Methods and results: We prospectively enrolled 300 patients undergoing clinically indicated CCTA with a 16-cm z-axis coverage, 256-detector rows, and 0.28-sec gantry rotation time scanner. Coronary artery and graft interpretability, image quality and effective dose (ED) were assessed in all patients and diagnostic accuracy was evaluated in a subgroup of 100 patients who underwent ICA. Mean HR during the scan was 69.6 ± 10.8. Sinus rhythm was present in 118 patients with HR < 75 bpm and in 112 patients with HR ≥ 75 bpm, while 70 patients had atrial fibrillation. CABG interpretability was 100%. Compared to ICA, CCTA was able to correctly detecting occlusions or significant stenoses of all CABG segments. Overall interpretability of native coronary segments was 95.6%. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of coronary arteries were 98.3%, 97.4%, 93.1%, 99.3% and 96.5%, respectively. The diagnostic accuracy in a patient based analysis was 95.2%. Mean ED was 3.14 ± 1.7 mSv. Conclusions: The novel whole-heart coverage CT scanner allows to evaluating CABG and native coronary arteries with excellent interpretability and low radiation exposure even
Published: 2020

12. State-of-the-art-myocardial perfusion stress testing: Static CT perfusion

Author: Mushtaq, S, Conte, E, Pontone, G, Baggiano, A, Annoni, A, Formenti, A, Mancini, M, Guglielmo, M, Muscogiuri, G, Tanzilli, A, Nicoli, F, Bartorelli, A, Pepi, M, Andreini, D, Mushtaq S., Conte E., Pontone G., Baggiano A., Annoni A., Formenti A., Mancini M. E., Guglielmo M., Muscogiuri G., Tanzilli A., Nicoli F., Bartorelli A. L., Pepi M., Andreini D., Mushtaq, S, Conte, E, Pontone, G, Baggiano, A, Annoni, A, Formenti, A, Mancini, M, Guglielmo, M, Muscogiuri, G, Tanzilli, A, Nicoli, F, Bartorelli, A, Pepi, M, Andreini, D, Mushtaq S., Conte E., Pontone G., Baggiano A., Annoni A., Formenti A., Mancini M. E., Guglielmo M., Muscogiuri G., Tanzilli A., Nicoli F., Bartorelli A. L., Pepi M., and Andreini D.
Abstract: Large multicenter studies and meta-analysis have documented the diagnostic accuracy and the prognostic implications of stress echocardiography, cardiac magnetic resonance and, mainly, nuclear stress tests. However, none of them provides a comprehensive anatomical and functional evaluation within the same study as stress CT perfusion. Myocardial CT perfusion is the only non-invasive modality that allows to quantifying coronary stenosis and determining its functional relevance, constituting a potential “one-stop-shop” method for the diagnosis and global management of patients with known or suspected coronary artery disease. In comparison with the dynamic modality, that requires increased radiation, precise acquisition protocols and dedicated post-processing softwares, static CT perfusion was associated with less radiation exposure, non-inferior diagnostic accuracy, easier interpretation of images and is nowadays more widely available.
Published: 2020

13. Rationale and design of the EPLURIBUS Study (Evidence for a comPrehensive evaLUation of left ventRicle dysfnctIon By a whole-heart coverage cardiac compUted tomography Scanner)

Author: Andreini, D, Conte, E, Mushtaq, S, Pontone, G, Guglielmo, M, Baggiano, A, Annoni, A, Mancini, M, Formenti, A, Nicoli, F, Tanzilli, A, Muscogiuri, G, Magini, A, Agostoni, P, Bartorelli, A, Fiorentini, C, Pepi, M, Andreini D., Conte E., Mushtaq S., Pontone G., Guglielmo M., Baggiano A., Annoni A., Mancini M. E., Formenti A., Nicoli F., Tanzilli A., Muscogiuri G., Magini A., Agostoni P., Bartorelli A. L., Fiorentini C., Pepi M., Andreini, D, Conte, E, Mushtaq, S, Pontone, G, Guglielmo, M, Baggiano, A, Annoni, A, Mancini, M, Formenti, A, Nicoli, F, Tanzilli, A, Muscogiuri, G, Magini, A, Agostoni, P, Bartorelli, A, Fiorentini, C, Pepi, M, Andreini D., Conte E., Mushtaq S., Pontone G., Guglielmo M., Baggiano A., Annoni A., Mancini M. E., Formenti A., Nicoli F., Tanzilli A., Muscogiuri G., Magini A., Agostoni P., Bartorelli A. L., Fiorentini C., and Pepi M.
Abstract: BACKGROUND: Cardiac magnetic resonance (CMR) is the standard of reference for myocardial fibrosis detection by late gadolinium enhancement. Cardiac computed tomography (CCT) is emerging as a promising alternative. The Evidence for a comPrehensive evaLUation of left ventRicle dysfnctIon By a whole-heart coverage cardiac compUted tomography Scanner study will assess the feasibility and diagnostic accuracy of a comprehensive functional and anatomical cardiac evaluation with CCT as compared with CMR and invasive coronary angiography as standard of reference. METHODS: Consecutive patients with a newly diagnosed left ventricle (LV) dysfunction (left ventricular ejection fraction <50%) and a clinical indication to CMR will be screened. Exclusion criteria will be contraindications to contrast agents and impaired renal function. CCT will be performed per protocol within 10 days from CMR. A total of 100 patients will be enrolled within 24 months. We will evaluate with CCT volume and ejection fraction of the LV and right ventricle, presence, extent and pattern of delayed enhancement and cardiac venous system. Moreover, presence and degree of coronary stenoses will be evaluated among patients undergoing invasive coronary angiography in the 6 months following CCT. RESULTS: The primary study endpoints will be: first, to assess the diagnostic performance of CCT vs. CMR to detect the delayed enhancement in a territory-based and patient-based analysis; second, to assess the agreement between CCT and CMR in the discrimination between ischemic vs. nonischemic delayed enhancement patters in a territory-based analysis; third, to assess the correlation between CCT and CMR for LV and right ventricle end-diastolic and end-systolic volumes and ejection fraction measurements. CONCLUSION: The Evidence for a comPrehensive evaLUation of left ventRicle dysfnctIon By a whole-heart coverage cardiac compUted tomography Scanner study will assess the diagnostic performance of CCT using the latest
Published: 2020

14. Anomalous origin of the left circumflex artery from the right coronary sinus with retro-aortic course: A potential malign variant

Author: Del Torto, A, Baggiano, A, Guglielmo, M, Muscogiuri, G, Pontone, G, Del Torto A, Baggiano A, Guglielmo M, Muscogiuri G, Pontone G, Del Torto, A, Baggiano, A, Guglielmo, M, Muscogiuri, G, Pontone, G, Del Torto A, Baggiano A, Guglielmo M, Muscogiuri G, and Pontone G
Published: 2020

15. Stress Computed Tomography Perfusion Versus Fractional Flow Reserve CT Derived in Suspected Coronary Artery Disease: The PERFECTION Study

Author: Pontone, G, Baggiano, A, Andreini, D, Guaricci, A, Guglielmo, M, Muscogiuri, G, Fusini, L, Fazzari, F, Mushtaq, S, Conte, E, Calligaris, G, De Martini, S, Ferrari, C, Galli, S, Grancini, L, Ravagnani, P, Teruzzi, G, Trabattoni, D, Fabbiocchi, F, Lualdi, A, Montorsi, P, Rabbat, M, Bartorelli, A, Pepi, M, Pontone G, Baggiano A, Andreini D, Guaricci AI, Guglielmo M, Muscogiuri G, Fusini L, Fazzari F, Mushtaq S, Conte E, Calligaris G, De Martini S, Ferrari C, Galli S, Grancini L, Ravagnani P, Teruzzi G, Trabattoni D, Fabbiocchi F, Lualdi A, Montorsi P, Rabbat MG, Bartorelli AL, Pepi M, Pontone, G, Baggiano, A, Andreini, D, Guaricci, A, Guglielmo, M, Muscogiuri, G, Fusini, L, Fazzari, F, Mushtaq, S, Conte, E, Calligaris, G, De Martini, S, Ferrari, C, Galli, S, Grancini, L, Ravagnani, P, Teruzzi, G, Trabattoni, D, Fabbiocchi, F, Lualdi, A, Montorsi, P, Rabbat, M, Bartorelli, A, Pepi, M, Pontone G, Baggiano A, Andreini D, Guaricci AI, Guglielmo M, Muscogiuri G, Fusini L, Fazzari F, Mushtaq S, Conte E, Calligaris G, De Martini S, Ferrari C, Galli S, Grancini L, Ravagnani P, Teruzzi G, Trabattoni D, Fabbiocchi F, Lualdi A, Montorsi P, Rabbat MG, Bartorelli AL, and Pepi M
Abstract: Objectives: This study sought to compare the diagnostic accuracy of coronary computed tomography angiography (cCTA) with that of cCTA+fractional flow reserve derived from cCTA datasets (FFRCT) and that of cCTA+static stress-computed tomography perfusion (stress-CTP) in detecting functionally significant coronary artery lesions using invasive coronary angiography (ICA) plus invasive FFR as the reference standard. Background: FFRCT and static stress-CTP are new techniques that combine anatomy and functional evaluation to improve assessment of coronary artery disease (CAD) using cCTA. Methods: A total of 147 consecutive symptomatic patients scheduled for clinically indicated ICA+invasive FFR were evaluated with cCTA, FFRCT, and stress-CTP. Results: Vessel-based and patient-based sensitivity, specificity, and negative predictive values, and positive predictive values, and accuracy rates of cCTA were 99%, 76%, 100%, 61%, 82%, and 95%, 54%, 94%, 63%, 73%, respectively. cCTA+FFRCT showed vessel-based and patient-based sensitivity, specificity, and negative predictive values, and positive predictive values and accuracy rates of 88%, 94%, 95%, 84%, 92%, and 90%, 85%, 92%, 83%, 87%, respectively. Finally, cCTA+stress-CTP showed vessel-based and patient-based sensitivity, specificity, and negative predictive values, and positive predictive values and accuracy rates of 92%, 95%, 97%, 87%, 94% and 98%, 87%, 99%, 86%, 92%, respectively. Both FFRCT and stress-CTP significantly improved specificity and positive predictive values compared to those of cCTA alone. The area under the curve to detect flow-limiting stenoses of cCTA, cCTA+FFRCT, and cCTA+CTP were 0.89, 0.93, 0.92, and 0.90, 0.94, and 0.93 in a vessel-based and patient-based model, respectively, with significant additional values for both cCTA+FFRCT and cCTA+CTP versus cCTA alone (p < 0.001) but no differences between cCTA+FFRCT versus cCTA+CTP. Conclusions: FFRCT and stress-CTP in addition to cCTA are valid and compara
Published: 2019

16. Incremental Diagnostic Value of Stress Computed Tomography Myocardial Perfusion With Whole-Heart Coverage CT Scanner in Intermediate- to High-Risk Symptomatic Patients Suspected of Coronary Artery Disease

Author: Pontone, G, Andreini, D, Guaricci, A, Baggiano, A, Fazzari, F, Guglielmo, M, Muscogiuri, G, Berzovini, C, Pasquini, A, Mushtaq, S, Conte, E, Calligaris, G, De Martini, S, Ferrari, C, Galli, S, Grancini, L, Ravagnani, P, Teruzzi, G, Trabattoni, D, Fabbiocchi, F, Lualdi, A, Montorsi, P, Rabbat, M, Bartorelli, A, Pepi, M, Pontone G., Andreini D., Guaricci A. I., Baggiano A., Fazzari F., Guglielmo M., Muscogiuri G., Berzovini C. M., Pasquini A., Mushtaq S., Conte E., Calligaris G., De Martini S., Ferrari C., Galli S., Grancini L., Ravagnani P., Teruzzi G., Trabattoni D., Fabbiocchi F., Lualdi A., Montorsi P., Rabbat M. G., Bartorelli A. L., Pepi M., Pontone, G, Andreini, D, Guaricci, A, Baggiano, A, Fazzari, F, Guglielmo, M, Muscogiuri, G, Berzovini, C, Pasquini, A, Mushtaq, S, Conte, E, Calligaris, G, De Martini, S, Ferrari, C, Galli, S, Grancini, L, Ravagnani, P, Teruzzi, G, Trabattoni, D, Fabbiocchi, F, Lualdi, A, Montorsi, P, Rabbat, M, Bartorelli, A, Pepi, M, Pontone G., Andreini D., Guaricci A. I., Baggiano A., Fazzari F., Guglielmo M., Muscogiuri G., Berzovini C. M., Pasquini A., Mushtaq S., Conte E., Calligaris G., De Martini S., Ferrari C., Galli S., Grancini L., Ravagnani P., Teruzzi G., Trabattoni D., Fabbiocchi F., Lualdi A., Montorsi P., Rabbat M. G., Bartorelli A. L., and Pepi M.
Abstract: Objectives: The goal of this study was to evaluate the diagnostic accuracy of stress computed tomography myocardial perfusion (CTP) for the detection of functionally significant coronary artery disease (CAD) by using invasive coronary angiography (ICA) plus invasive fractional flow reserve (FFR) as the reference standard in consecutive intermediate- to high-risk symptomatic patients. Background: Stress CTP recently emerged as a potential strategy to combine the anatomic and functional evaluation of CAD in a single scan. Methods: A total of 100 consecutive symptomatic patients scheduled for ICA were prospectively enrolled. All patients underwent rest coronary computed tomography angiography (CTA) followed by stress static CTP with a whole-heart coverage CT scanner (Revolution CT, GE Healthcare, Milwaukee, Wisconsin). Diagnostic accuracy and overall effective dose were assessed and compared versus those of ICA and invasive FFR. Results: The prevalence of obstructive CAD and functionally significant CAD were 69% and 44%, respectively. Coronary CTA alone demonstrated a per-vessel and per-patient sensitivity, specificity, negative predictive value, positive predictive value, and accuracy of 98%, 76%, 99%, 63%, and 83% and of 98%, 54%, 96%, 68%, and 76%, respectively. Combining coronary CTA with stress CTP, per-vessel and per-patient sensitivity, specificity, negative predictive value, positive predictive value, and accuracy were 91%, 94%, 96%, 86%, and 93% and 98%, 83%, 98%, 86%, and 91%, with a significant improvement in specificity, positive predictive value, and accuracy in both models. The mean effective dose for coronary CTA and stress CTP were 2.8 ± 1.4 mSv and 2.5 ± 1.1 mSv. Conclusions: The inclusion of stress CTP for the evaluation of patients with an intermediate to high risk for CAD is feasible and improved the diagnostic performance of coronary CTA for detecting functionally significant CAD.
Published: 2019

17. Association Between Haptoglobin Phenotype and Microvascular Obstruction in Patients With ST-Segment Elevation Myocardial Infarction

Author: Pontone, G, Andreini, D, Guaricci, A, Guglielmo, M, Baggiano, A, Muscogiuri, G, Fusini, L, Fazzari, F, Berzovini, C, Pasquini, A, Mushtaq, S, Conte, E, Cosentino, N, Rabbat, M, Marenzi, G, Bartorelli, A, Pepi, M, Tremoli, E, Banfi, C, Pontone G, Andreini D, Guaricci AI, Guglielmo M, Baggiano A, Muscogiuri G, Fusini L, Fazzari F, Berzovini C, Pasquini A, Mushtaq S, Conte E, Cosentino N, Rabbat MG, Marenzi G, Bartorelli AL, Pepi M, Tremoli E, Banfi C., Pontone, G, Andreini, D, Guaricci, A, Guglielmo, M, Baggiano, A, Muscogiuri, G, Fusini, L, Fazzari, F, Berzovini, C, Pasquini, A, Mushtaq, S, Conte, E, Cosentino, N, Rabbat, M, Marenzi, G, Bartorelli, A, Pepi, M, Tremoli, E, Banfi, C, Pontone G, Andreini D, Guaricci AI, Guglielmo M, Baggiano A, Muscogiuri G, Fusini L, Fazzari F, Berzovini C, Pasquini A, Mushtaq S, Conte E, Cosentino N, Rabbat MG, Marenzi G, Bartorelli AL, Pepi M, Tremoli E, and Banfi C.
Abstract: Objectives: This study aimed to evaluate the correlation between different haptoglobin (Hp)phenotypes and myocardial infarction characteristics as detected by cardiac magnetic resonance (CMR)in consecutive patients after ST-segment elevation myocardial infarction (STEMI). Background: Hp is a plasma protein that prevents iron-mediated oxidative tissue damage. CMR has emerged as the gold standard technique to detect left ventricular ejection fraction (LVEF), extent of scar with late gadolinium enhancement (LGE)technique, microvascular obstruction (MVO), and myocardial hemorrhage (MH)in patients with STEMI treated by primary percutaneous coronary intervention (pPCI). Methods: A total of 145 consecutive STEMI patients (mean age 62.2 ± 10.3 years; 78% men)were prospectively enrolled and underwent Hp phenotyping and CMR assessment within 1 week after STEMI. Results: CMR showed an area at risk (AAR)involving 26.6 ± 19.1% of left ventricular (LV)mass with a late LGE extent of 15.2 ± 13.1% of LV mass. MVO and MH occurred in 38 (26%)and 12 (8%)patients, respectively. Hp phenotypes 1-1, 2-1, 2-2 were observed in 15 (10%), 62 (43%), and 68 (47%), respectively. Multivariable analysis demonstrated that body mass index, Hp2-2, diabetes, and peak troponin I were independent predictors of MVO with Hp2-2 associated with the highest odds ratio (OR)(OR: 5.5 [95% confidence interval [CI]: 2.1 to 14.3; p < 0.001]). Hp2-2 significantly predicted both the presence (area under the curve [AUC]: 0.63 [95% CI: 0.53 to 0.72; p = 0.008])and extent of MVO (AUC: 0.63 [95% CI: 0.54 to 0.72; p = 0.007]). Conclusions: Hp phenotype is an independent predictor of MVO. Therefore, Hp phenotyping could be used for risk stratification and may be useful in assessing new therapies to reduce myocardial reperfusion injury in patients with STEMI.
Published: 2019

18. Incremental Diagnostic Value of Stress Computed Tomography Myocardial Perfusion With Whole-Heart Coverage CT Scanner in Intermediate- to High-Risk Symptomatic Patients Suspected of Coronary Artery Disease

Author: Pontone, G, Andreini, D, Guaricci, A, Baggiano, A, Fazzari, F, Guglielmo, M, Muscogiuri, G, Berzovini, C, Pasquini, A, Mushtaq, S, Conte, E, Calligaris, G, De Martini, S, Ferrari, C, Galli, S, Grancini, L, Ravagnani, P, Teruzzi, G, Trabattoni, D, Fabbiocchi, F, Lualdi, A, Montorsi, P, Rabbat, M, Bartorelli, A, Pepi, M, Pontone G., Andreini D., Guaricci A. I., Baggiano A., Fazzari F., Guglielmo M., Muscogiuri G., Berzovini C. M., Pasquini A., Mushtaq S., Conte E., Calligaris G., De Martini S., Ferrari C., Galli S., Grancini L., Ravagnani P., Teruzzi G., Trabattoni D., Fabbiocchi F., Lualdi A., Montorsi P., Rabbat M. G., Bartorelli A. L., Pepi M., Pontone, G, Andreini, D, Guaricci, A, Baggiano, A, Fazzari, F, Guglielmo, M, Muscogiuri, G, Berzovini, C, Pasquini, A, Mushtaq, S, Conte, E, Calligaris, G, De Martini, S, Ferrari, C, Galli, S, Grancini, L, Ravagnani, P, Teruzzi, G, Trabattoni, D, Fabbiocchi, F, Lualdi, A, Montorsi, P, Rabbat, M, Bartorelli, A, Pepi, M, Pontone G., Andreini D., Guaricci A. I., Baggiano A., Fazzari F., Guglielmo M., Muscogiuri G., Berzovini C. M., Pasquini A., Mushtaq S., Conte E., Calligaris G., De Martini S., Ferrari C., Galli S., Grancini L., Ravagnani P., Teruzzi G., Trabattoni D., Fabbiocchi F., Lualdi A., Montorsi P., Rabbat M. G., Bartorelli A. L., and Pepi M.
Abstract: Objectives: The goal of this study was to evaluate the diagnostic accuracy of stress computed tomography myocardial perfusion (CTP) for the detection of functionally significant coronary artery disease (CAD) by using invasive coronary angiography (ICA) plus invasive fractional flow reserve (FFR) as the reference standard in consecutive intermediate- to high-risk symptomatic patients. Background: Stress CTP recently emerged as a potential strategy to combine the anatomic and functional evaluation of CAD in a single scan. Methods: A total of 100 consecutive symptomatic patients scheduled for ICA were prospectively enrolled. All patients underwent rest coronary computed tomography angiography (CTA) followed by stress static CTP with a whole-heart coverage CT scanner (Revolution CT, GE Healthcare, Milwaukee, Wisconsin). Diagnostic accuracy and overall effective dose were assessed and compared versus those of ICA and invasive FFR. Results: The prevalence of obstructive CAD and functionally significant CAD were 69% and 44%, respectively. Coronary CTA alone demonstrated a per-vessel and per-patient sensitivity, specificity, negative predictive value, positive predictive value, and accuracy of 98%, 76%, 99%, 63%, and 83% and of 98%, 54%, 96%, 68%, and 76%, respectively. Combining coronary CTA with stress CTP, per-vessel and per-patient sensitivity, specificity, negative predictive value, positive predictive value, and accuracy were 91%, 94%, 96%, 86%, and 93% and 98%, 83%, 98%, 86%, and 91%, with a significant improvement in specificity, positive predictive value, and accuracy in both models. The mean effective dose for coronary CTA and stress CTP were 2.8 ± 1.4 mSv and 2.5 ± 1.1 mSv. Conclusions: The inclusion of stress CTP for the evaluation of patients with an intermediate to high risk for CAD is feasible and improved the diagnostic performance of coronary CTA for detecting functionally significant CAD.
Published: 2019

19. Association Between Haptoglobin Phenotype and Microvascular Obstruction in Patients With ST-Segment Elevation Myocardial Infarction

Author: Pontone, G, Andreini, D, Guaricci, A, Guglielmo, M, Baggiano, A, Muscogiuri, G, Fusini, L, Fazzari, F, Berzovini, C, Pasquini, A, Mushtaq, S, Conte, E, Cosentino, N, Rabbat, M, Marenzi, G, Bartorelli, A, Pepi, M, Tremoli, E, Banfi, C, Pontone G, Andreini D, Guaricci AI, Guglielmo M, Baggiano A, Muscogiuri G, Fusini L, Fazzari F, Berzovini C, Pasquini A, Mushtaq S, Conte E, Cosentino N, Rabbat MG, Marenzi G, Bartorelli AL, Pepi M, Tremoli E, Banfi C., Pontone, G, Andreini, D, Guaricci, A, Guglielmo, M, Baggiano, A, Muscogiuri, G, Fusini, L, Fazzari, F, Berzovini, C, Pasquini, A, Mushtaq, S, Conte, E, Cosentino, N, Rabbat, M, Marenzi, G, Bartorelli, A, Pepi, M, Tremoli, E, Banfi, C, Pontone G, Andreini D, Guaricci AI, Guglielmo M, Baggiano A, Muscogiuri G, Fusini L, Fazzari F, Berzovini C, Pasquini A, Mushtaq S, Conte E, Cosentino N, Rabbat MG, Marenzi G, Bartorelli AL, Pepi M, Tremoli E, and Banfi C.
Abstract: Objectives: This study aimed to evaluate the correlation between different haptoglobin (Hp)phenotypes and myocardial infarction characteristics as detected by cardiac magnetic resonance (CMR)in consecutive patients after ST-segment elevation myocardial infarction (STEMI). Background: Hp is a plasma protein that prevents iron-mediated oxidative tissue damage. CMR has emerged as the gold standard technique to detect left ventricular ejection fraction (LVEF), extent of scar with late gadolinium enhancement (LGE)technique, microvascular obstruction (MVO), and myocardial hemorrhage (MH)in patients with STEMI treated by primary percutaneous coronary intervention (pPCI). Methods: A total of 145 consecutive STEMI patients (mean age 62.2 ± 10.3 years; 78% men)were prospectively enrolled and underwent Hp phenotyping and CMR assessment within 1 week after STEMI. Results: CMR showed an area at risk (AAR)involving 26.6 ± 19.1% of left ventricular (LV)mass with a late LGE extent of 15.2 ± 13.1% of LV mass. MVO and MH occurred in 38 (26%)and 12 (8%)patients, respectively. Hp phenotypes 1-1, 2-1, 2-2 were observed in 15 (10%), 62 (43%), and 68 (47%), respectively. Multivariable analysis demonstrated that body mass index, Hp2-2, diabetes, and peak troponin I were independent predictors of MVO with Hp2-2 associated with the highest odds ratio (OR)(OR: 5.5 [95% confidence interval [CI]: 2.1 to 14.3; p < 0.001]). Hp2-2 significantly predicted both the presence (area under the curve [AUC]: 0.63 [95% CI: 0.53 to 0.72; p = 0.008])and extent of MVO (AUC: 0.63 [95% CI: 0.54 to 0.72; p = 0.007]). Conclusions: Hp phenotype is an independent predictor of MVO. Therefore, Hp phenotyping could be used for risk stratification and may be useful in assessing new therapies to reduce myocardial reperfusion injury in patients with STEMI.
Published: 2019

20. Stress Computed Tomography Perfusion Versus Fractional Flow Reserve CT Derived in Suspected Coronary Artery Disease: The PERFECTION Study

Author: Pontone, G, Baggiano, A, Andreini, D, Guaricci, A, Guglielmo, M, Muscogiuri, G, Fusini, L, Fazzari, F, Mushtaq, S, Conte, E, Calligaris, G, De Martini, S, Ferrari, C, Galli, S, Grancini, L, Ravagnani, P, Teruzzi, G, Trabattoni, D, Fabbiocchi, F, Lualdi, A, Montorsi, P, Rabbat, M, Bartorelli, A, Pepi, M, Pontone G, Baggiano A, Andreini D, Guaricci AI, Guglielmo M, Muscogiuri G, Fusini L, Fazzari F, Mushtaq S, Conte E, Calligaris G, De Martini S, Ferrari C, Galli S, Grancini L, Ravagnani P, Teruzzi G, Trabattoni D, Fabbiocchi F, Lualdi A, Montorsi P, Rabbat MG, Bartorelli AL, Pepi M, Pontone, G, Baggiano, A, Andreini, D, Guaricci, A, Guglielmo, M, Muscogiuri, G, Fusini, L, Fazzari, F, Mushtaq, S, Conte, E, Calligaris, G, De Martini, S, Ferrari, C, Galli, S, Grancini, L, Ravagnani, P, Teruzzi, G, Trabattoni, D, Fabbiocchi, F, Lualdi, A, Montorsi, P, Rabbat, M, Bartorelli, A, Pepi, M, Pontone G, Baggiano A, Andreini D, Guaricci AI, Guglielmo M, Muscogiuri G, Fusini L, Fazzari F, Mushtaq S, Conte E, Calligaris G, De Martini S, Ferrari C, Galli S, Grancini L, Ravagnani P, Teruzzi G, Trabattoni D, Fabbiocchi F, Lualdi A, Montorsi P, Rabbat MG, Bartorelli AL, and Pepi M
Abstract: Objectives: This study sought to compare the diagnostic accuracy of coronary computed tomography angiography (cCTA) with that of cCTA+fractional flow reserve derived from cCTA datasets (FFRCT) and that of cCTA+static stress-computed tomography perfusion (stress-CTP) in detecting functionally significant coronary artery lesions using invasive coronary angiography (ICA) plus invasive FFR as the reference standard. Background: FFRCT and static stress-CTP are new techniques that combine anatomy and functional evaluation to improve assessment of coronary artery disease (CAD) using cCTA. Methods: A total of 147 consecutive symptomatic patients scheduled for clinically indicated ICA+invasive FFR were evaluated with cCTA, FFRCT, and stress-CTP. Results: Vessel-based and patient-based sensitivity, specificity, and negative predictive values, and positive predictive values, and accuracy rates of cCTA were 99%, 76%, 100%, 61%, 82%, and 95%, 54%, 94%, 63%, 73%, respectively. cCTA+FFRCT showed vessel-based and patient-based sensitivity, specificity, and negative predictive values, and positive predictive values and accuracy rates of 88%, 94%, 95%, 84%, 92%, and 90%, 85%, 92%, 83%, 87%, respectively. Finally, cCTA+stress-CTP showed vessel-based and patient-based sensitivity, specificity, and negative predictive values, and positive predictive values and accuracy rates of 92%, 95%, 97%, 87%, 94% and 98%, 87%, 99%, 86%, 92%, respectively. Both FFRCT and stress-CTP significantly improved specificity and positive predictive values compared to those of cCTA alone. The area under the curve to detect flow-limiting stenoses of cCTA, cCTA+FFRCT, and cCTA+CTP were 0.89, 0.93, 0.92, and 0.90, 0.94, and 0.93 in a vessel-based and patient-based model, respectively, with significant additional values for both cCTA+FFRCT and cCTA+CTP versus cCTA alone (p < 0.001) but no differences between cCTA+FFRCT versus cCTA+CTP. Conclusions: FFRCT and stress-CTP in addition to cCTA are valid and compara
Published: 2019

21. Left atrial appendage closure guided by 3D computed tomography printing technology: A case control study

Author: Conti, M, Marconi, S, Muscogiuri, G, Guglielmo, M, Baggiano, A, Italiano, G, Mancini, M, Auricchio, F, Andreini, D, Rabbat, M, Guaricci, A, Fassini, G, Gasperetti, A, Costa, F, Tondo, C, Maltagliati, A, Pepi, M, Pontone, G, Conti M, Marconi S, Muscogiuri G, Guglielmo M, Baggiano A, Italiano G, Mancini ME, Auricchio F, Andreini D, Rabbat MG, Guaricci AI, Fassini G, Gasperetti A, Costa F, Tondo C, Maltagliati A, Pepi M, Pontone G, Conti, M, Marconi, S, Muscogiuri, G, Guglielmo, M, Baggiano, A, Italiano, G, Mancini, M, Auricchio, F, Andreini, D, Rabbat, M, Guaricci, A, Fassini, G, Gasperetti, A, Costa, F, Tondo, C, Maltagliati, A, Pepi, M, Pontone, G, Conti M, Marconi S, Muscogiuri G, Guglielmo M, Baggiano A, Italiano G, Mancini ME, Auricchio F, Andreini D, Rabbat MG, Guaricci AI, Fassini G, Gasperetti A, Costa F, Tondo C, Maltagliati A, Pepi M, and Pontone G
Abstract: Background: We sought to evaluate the additional value of left atrial appendage (LAA) 3D printing derived from computed tomography (CCT) in determining the size for LAA occlusion (LAAO) devices as compared to standard measurement by using occurrence of LAA leak as endpoint. Methods: We evaluated 6 patients with LAA leak (cases) and 14 matched patients without LAA leak (controls) after LAAO. For each group, a patient-specific 3D printed model of LAA was manufactured using CT pre-operative images. The size recommended by the 3D printed model was compared with the size of the implanted device. Results: Compared to the 3D printed model, 55% of the devices were underestimated, the two sizing approaches agreed in 35% of the patients, while the 3D printed model overestimated the size in 10% of patients. The prevalence of LAA leak was significantly higher in the subset of patients with underestimation of prosthesis implanted with the standard approach as compared to the other patients (p = 0.019). Conclusion: 3D printing of the LAA may provide additional value to standard practice for LAAO device prosthesis sizing with the potential impact to reduce LAA leak.
Published: 2019

22. Determinants of Rejection Rate for Coronary CT Angiography Fractional Flow Reserve Analysis

Author: Pontone, G, Weir-McCall, J, Baggiano, A, Del Torto, A, Fusini, L, Guglielmo, M, Muscogiuri, G, Guaricci, A, Andreini, D, Patel, M, Nieman, K, Akasaka, T, Rogers, C, Nørgaard, B, Bax, J, Raff, G, Chinnaiyan, K, Berman, D, Fairbairn, T, Koweek, L, Leipsic, J, Pontone G, Weir-McCall JR, Baggiano A, Del Torto A, Fusini L, Guglielmo M, Muscogiuri G, Guaricci AI, Andreini D, Patel M, Nieman K, Akasaka T, Rogers C, Nørgaard BL, Bax J, Raff GL, Chinnaiyan K, Berman D, Fairbairn T, Koweek LH, Leipsic J, Pontone, G, Weir-McCall, J, Baggiano, A, Del Torto, A, Fusini, L, Guglielmo, M, Muscogiuri, G, Guaricci, A, Andreini, D, Patel, M, Nieman, K, Akasaka, T, Rogers, C, Nørgaard, B, Bax, J, Raff, G, Chinnaiyan, K, Berman, D, Fairbairn, T, Koweek, L, Leipsic, J, Pontone G, Weir-McCall JR, Baggiano A, Del Torto A, Fusini L, Guglielmo M, Muscogiuri G, Guaricci AI, Andreini D, Patel M, Nieman K, Akasaka T, Rogers C, Nørgaard BL, Bax J, Raff GL, Chinnaiyan K, Berman D, Fairbairn T, Koweek LH, and Leipsic J
Abstract: Background: Coronary artery fractional flow reserve (FFR) derived from CT angiography (FFTCT) enables functional assessment of coronary stenosis. Prior clinical trials showed 13%-33% of coronary CT angiography studies had insufficient quality for quantitative analysis with FFRCT. Purpose: To determine the rejection rate of FFRCT analysis and to determine factors associated with technically unsuccessful calculation of FFRCT. Materials and Methods: Prospectively acquired coronary CT angiography scans submitted as part of the Assessing Diagnostic Value of Noninvasive FFRCT in Coronary Care (ADVANCE) registry (https://ClinicalTrials.gov: NCT02499679) and coronary CT angiography series submitted for clinical analysis were included. The primary outcome was the FFRCT rejection rate (defined as an inability to perform quantitative analysis with FFRCT). Factors that were associated with FFRCT rejection rate were assessed with multiple linear regression. Results: In the ADVANCE registry, FFRCT rejection rate due to inadequate image quality was 2.9% (80 of 2778 patients; 95% confidence interval [CI]: 2.1%, 3.2%). In the 10 621 consecutive patients who underwent clinical analysis, the FFRCT rejection rate was 8.4% (n = 892; 95% CI: 6.2%, 7.2%; P , .001 vs the ADVANCE cohort). The main reason for the inability to perform FFRCT analysis was the presence of motion artifacts (63 of 80 [78%] and 729 of 892 [64%] in the ADVANCE and clinical cohorts, respectively). At multivariable analysis, section thickness in the ADVANCE (odds ratio [OR], 1.04; 95% CI: 1.001, 1.09; P = .045) and clinical (OR, 1.03; 95% CI: 1.02, 1.04; P , .001) cohorts and heart rate in the ADVANCE (OR, 1.05; 95% CI: 1.02, 1.08; P , .001) and clinical (OR, 1.06; 95% CI: 1.05, 1.07; P , .001) cohorts were independent predictors of rejection. Conclusion: The rates for technically unsuccessful CT-derived fractional flow reserve in the ADVANCE registry and in a large clinical cohort were 2.9% and 8.4%, respectively. Th
Published: 2019

23. G-CSF for Extensive STEMI: Results from the STEM-AMI OUTCOME CMR Substudy

Author: Achilli, F, Pontone, G, Bassetti, B, Squadroni, L, Campodonico, J, Corrada, E, Facchini, C, Mircoli, L, Esposito, G, Scarpa, D, Pidello, S, Righetti, S, Di Gennaro, F, Guglielmo, M, Muscogiuri, G, Baggiano, A, Limido, A, Lenatti, L, Di Tano, G, Malafronte, C, Soffici, F, Ceseri, M, Maggiolini, S, Colombo, G, Pompilio, G, Achilli F., Pontone G., Bassetti B., Squadroni L., Campodonico J., Corrada E., Facchini C., Mircoli L., Esposito G., Scarpa D., Pidello S., Righetti S., Di Gennaro F., Guglielmo M., Muscogiuri G., Baggiano A., Limido A., Lenatti L., Di Tano G., Malafronte C., Soffici F., Ceseri M., Maggiolini S., Colombo G. I., Pompilio G., Achilli, F, Pontone, G, Bassetti, B, Squadroni, L, Campodonico, J, Corrada, E, Facchini, C, Mircoli, L, Esposito, G, Scarpa, D, Pidello, S, Righetti, S, Di Gennaro, F, Guglielmo, M, Muscogiuri, G, Baggiano, A, Limido, A, Lenatti, L, Di Tano, G, Malafronte, C, Soffici, F, Ceseri, M, Maggiolini, S, Colombo, G, Pompilio, G, Achilli F., Pontone G., Bassetti B., Squadroni L., Campodonico J., Corrada E., Facchini C., Mircoli L., Esposito G., Scarpa D., Pidello S., Righetti S., Di Gennaro F., Guglielmo M., Muscogiuri G., Baggiano A., Limido A., Lenatti L., Di Tano G., Malafronte C., Soffici F., Ceseri M., Maggiolini S., Colombo G. I., and Pompilio G.
Abstract: Rationale: In the exploratory Phase II STEM-AMI (Stem Cells Mobilization in Acute Myocardial Infarction) trial, we reported that early administration of G-CSF (granulocyte colony-stimulating factor), in patients with anterior ST-segment-elevation myocardial infarction and left ventricular (LV) dysfunction after successful percutaneous coronary intervention, had the potential to significantly attenuate LV adverse remodeling in the long-Term. Objective: The STEM-AMI OUTCOME CMR (Stem Cells Mobilization in Acute Myocardial Infarction Outcome Cardiac Magnetic Resonance) Substudy was adequately powered to evaluate, in a population showing LV ejection fraction ≤45% after percutaneous coronary intervention for extensive ST-segment-elevation myocardial infarction, the effects of early administration of G-CSF in terms of LV remodeling and function, infarct size assessed by late gadolinium enhancement, and myocardial strain. Methods and Results: Within the Italian, multicenter, prospective, randomized, Phase III STEM-AMI OUTCOME trial, 161 ST-segment-elevation myocardial infarction patients were enrolled in the CMR Substudy and assigned to standard of care (SOC) plus G-CSF or SOC alone. In 119 patients (61 G-CSF and 58 SOC, respectively), CMR was available at baseline and 6-month follow-up. Paired imaging data were independently analyzed by 2 blinded experts in a core CMR lab. The 2 groups were similar for clinical characteristics, cardiovascular risk factors, and pharmacological treatment, except for a trend towards a larger infarct size and longer symptom-To-balloon time in G-CSF patients. ANCOVA showed that the improvement of LV ejection fraction from baseline to 6 months was 5.1% higher in G-CSF patients versus SOC (P=0.01); concurrently, there was a significant between-group difference of 6.7 mL/m2 in the change of indexed LV end-systolic volume in favor of G-CSF group (P=0.02). Indexed late gadolinium enhancement significantly decreased in G-CSF group only (P=0.04). Mor
Published: 2019

24. Dynamic Stress Computed Tomography Perfusion With a Whole-Heart Coverage Scanner in Addition to Coronary Computed Tomography Angiography and Fractional Flow Reserve Computed Tomography Derived

Author: Pontone, G, Baggiano, A, Andreini, D, Guaricci, A, Guglielmo, M, Muscogiuri, G, Fusini, L, Soldi, M, Del Torto, A, Mushtaq, S, Conte, E, Calligaris, G, De Martini, S, Ferrari, C, Galli, S, Grancini, L, Olivares, P, Ravagnani, P, Teruzzi, G, Trabattoni, D, Fabbiocchi, F, Montorsi, P, Rabbat, M, Bartorelli, A, Pepi, M, Pontone G., Baggiano A., Andreini D., Guaricci A. I., Guglielmo M., Muscogiuri G., Fusini L., Soldi M., Del Torto A., Mushtaq S., Conte E., Calligaris G., De Martini S., Ferrari C., Galli S., Grancini L., Olivares P., Ravagnani P., Teruzzi G., Trabattoni D., Fabbiocchi F., Montorsi P., Rabbat M. G., Bartorelli A. L., Pepi M., Pontone, G, Baggiano, A, Andreini, D, Guaricci, A, Guglielmo, M, Muscogiuri, G, Fusini, L, Soldi, M, Del Torto, A, Mushtaq, S, Conte, E, Calligaris, G, De Martini, S, Ferrari, C, Galli, S, Grancini, L, Olivares, P, Ravagnani, P, Teruzzi, G, Trabattoni, D, Fabbiocchi, F, Montorsi, P, Rabbat, M, Bartorelli, A, Pepi, M, Pontone G., Baggiano A., Andreini D., Guaricci A. I., Guglielmo M., Muscogiuri G., Fusini L., Soldi M., Del Torto A., Mushtaq S., Conte E., Calligaris G., De Martini S., Ferrari C., Galli S., Grancini L., Olivares P., Ravagnani P., Teruzzi G., Trabattoni D., Fabbiocchi F., Montorsi P., Rabbat M. G., Bartorelli A. L., and Pepi M.
Abstract: Objectives: The aims of the study were to test the diagnostic accuracy of integrated evaluation of dynamic myocardial computed tomography perfusion (CTP) on top of coronary computed tomography angiography (cCTA) plus fractional flow reserve computed tomography derived (FFRCT) by using a whole-heart coverage computed tomography (CT) scanner as compared with clinically indicated invasive coronary angiography (ICA) and invasive fractional flow reserve (FFR). Background: Recently, new techniques such as dynamic stress computed tomography perfusion (stress-CTP) emerged as potential strategies to combine anatomical and functional evaluation in a one-shot scan. However, previous experiences with this technique were associated with high radiation exposure. Methods: Eighty-five consecutive symptomatic patients scheduled for ICA were prospectively enrolled. All patients underwent rest cCTA followed by stress dynamic CTP with a whole-heart coverage CT scanner (Revolution CT, GE Healthcare, Milwaukee, Wisconsin). FFRCT was also measured by using the rest cCTA dataset. The diagnostic accuracy to detect functionally significant coronary artery disease (CAD) in a vessel-based model of cCTA alone, cCTA+FFRCT, cCTA+CTP, or cCTA+FFRCT+CTP were assessed and compared by using ICA and invasive FFR as reference. The overall effective dose of dynamic CTP was also measured. Results: The prevalence of obstructive CAD and functionally significant CAD was 77% and 57%, respectively. The sensitivity and specificity of cCTA alone, cCTA+FFRCT, and cCTA+CTP were 83% and 66%, 86% and 75%, and 73% and 86%, respectively. Both the addition of FFRCT and CTP improves the area under the curve (AUC: 0.876 and 0.878, respectively) as compared with cCTA alone (0.826; p < 0.05). The sequential strategy of cCTA+FFRCT+CTP showed the highest AUC (0.919; p < 0.05) as compared with all other strategies. The mean effective radiation dose (ED) for cCTA and stress CTP was 2.8 ± 1.2 mSv and 5.3 ± 0.7 mSv, respe
Published: 2019

25. Prognostic relevance of subclinical coronary and carotid atherosclerosis in a diabetic and non-diabetic asymptomatic population

Author: Guaricci, A, Lorenzoni, V, Guglielmo, M, Mushtaq, S, Muscogiuri, G, Cademartiri, F, Rabbat, M, Andreini, D, Serviddio, G, Gaibazzi, N, Pepi, M, Pontone, G, Guaricci AI, Lorenzoni V, Guglielmo M, Mushtaq S, Muscogiuri G, Cademartiri F, Rabbat M, Andreini D, Serviddio G, Gaibazzi N, Pepi M, Pontone G., Guaricci, A, Lorenzoni, V, Guglielmo, M, Mushtaq, S, Muscogiuri, G, Cademartiri, F, Rabbat, M, Andreini, D, Serviddio, G, Gaibazzi, N, Pepi, M, Pontone, G, Guaricci AI, Lorenzoni V, Guglielmo M, Mushtaq S, Muscogiuri G, Cademartiri F, Rabbat M, Andreini D, Serviddio G, Gaibazzi N, Pepi M, and Pontone G.
Abstract: Background: We sought to evaluate the incremental prognostic benefit of carotid artery disease and subclinical coronary artery disease (CAD) features in addition to clinical evaluation in an asymptomatic population. Methods: Over a 6-year period, 10-year Framingham risk score together with carotid ultrasound and coronary computed tomography angiography were evaluated for prediction of major adverse cardiac events (MACE). Results: We enrolled 517 consecutive asymptomatic patients (63% male, mean age 64 ±10 years; 17.6% with diabetes). Median (interquartile range) coronary artery calcium score (CACS) was 34 (0–100). Over a median follow-up of 4.4 (3.4–5.1) years, there were 53 MACE (10%). Patients experiencing MACE had higher CACS, incidence of carotid disease, presence of CAD ≥50%, and remodeled plaque as compared with patients without MACE. At multivariable analyses, presence of CAD ≥50% (HR: 5.14, 95% CI: 2.1–12.4) and percentage of segments with remodeled plaque (HR: 1.04, 95% CI: 1.03–1.06) independently predicted MACE (P < 0.001). Models adding CAD ≥50% or percentage of segments with remodeled plaque resulted in higher discrimination and reclassification ability compared with a model based on 10-year FRS, carotid disease, and CACS. Specifically, the C-statistic improved to 0.75 with addition of CAD and 0.84 when adding percentage of segments with remodeled plaque, whereas net reclassification improvement indices were 0.86 and 0.92, respectively. Conclusions: In an asymptomatic population, CAD and plaque positive remodeling increase MACE prediction compared with a model based on 10-year FRS, carotid disease, and CACS estimation. In the diabetes subgroup, percentage of segments with remodeled plaque was the only predictor of MACE.
Published: 2018

26. Rationale and design of advantage (additional diagnostic value of CT perfusion over coronary CT angiography in stented patients with suspected in-stent restenosis or coronary artery disease progression) prospective study

Author: Andreini, D, Mushtaq, S, Pontone, G, Conte, E, Sonck, J, Collet, C, Guglielmo, M, Baggiano, A, Trabattoni, D, Galli, S, Montorsi, P, Ferrari, C, Fabbiocchi, F, De Martini, S, Annoni, A, Mancini, M, Formenti, A, Magatelli, M, Resta, M, Consiglio, E, Muscogiuri, G, Fiorentini, C, Bartorelli, A, Pepi, M, Andreini D, Mushtaq S, Pontone G, Conte E, Sonck J, Collet C, Guglielmo M, Baggiano A, Trabattoni D, Galli S, Montorsi P, Ferrari C, Fabbiocchi F, De Martini S, Annoni A, Mancini ME, Formenti A, Magatelli M, Resta M, Consiglio E, Muscogiuri G, Fiorentini C, Bartorelli AL, Pepi M., Andreini, D, Mushtaq, S, Pontone, G, Conte, E, Sonck, J, Collet, C, Guglielmo, M, Baggiano, A, Trabattoni, D, Galli, S, Montorsi, P, Ferrari, C, Fabbiocchi, F, De Martini, S, Annoni, A, Mancini, M, Formenti, A, Magatelli, M, Resta, M, Consiglio, E, Muscogiuri, G, Fiorentini, C, Bartorelli, A, Pepi, M, Andreini D, Mushtaq S, Pontone G, Conte E, Sonck J, Collet C, Guglielmo M, Baggiano A, Trabattoni D, Galli S, Montorsi P, Ferrari C, Fabbiocchi F, De Martini S, Annoni A, Mancini ME, Formenti A, Magatelli M, Resta M, Consiglio E, Muscogiuri G, Fiorentini C, Bartorelli AL, and Pepi M.
Abstract: Background: Recent studies demonstrated a significant improvement in the diagnostic performance of coronary CT angiography (CCTA) for the evaluation of in-stent restenosis (ISR). However, coronary stent assessment is still challenging, especially because of beam-hardening artifacts due to metallic stent struts and high atherosclerotic burden of non-stented segments. Adenosine-stress myocardial perfusion assessed by CT (CTP) recently demonstrated to be a feasible and accurate tool for evaluating the functional significance of coronary stenoses in patients with suspected coronary artery disease (CAD). Yet, scarce data are available on the performance of CTP in patients with previous stent implantation. Aim of the study: We aim to assess the diagnostic performance of CCTA alone, CTP alone and CCTA plus CTP performed with a new scanner generation using quantitative invasive coronary angiography (ICA) and invasive fractional flow reserve (FFR) as standard of reference. Methods: We will enroll 300 consecutive patients with previous stent implantation, referred for non-emergent and clinically indicated invasive coronary angiography (ICA) due to suspected ISR or progression of CAD in native coronary segments. All patients will be subjected to stress myocardial CTP and a rest CCTA. The first 150 subjects will undergo static CTP scan, while the following 150 patients will undergo dynamic CTP scan. Measurement of invasive FFR will be performed during ICA when clinically indicated. Results: The primary study end points will be: 1) assessment of the diagnostic performance (diagnostic rate, sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy) of CCTA, CTP, combined CCTA-CTP and concordant CCTA-CTP vs. ICA as standard of reference in a territory-based and patient-based analysis; 2) assessment of sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of CCTA, CTP, combined CCTA-CTP an
Published: 2018

27. Rationale and design of advantage (additional diagnostic value of CT perfusion over coronary CT angiography in stented patients with suspected in-stent restenosis or coronary artery disease progression) prospective study

Author: Andreini, D, Mushtaq, S, Pontone, G, Conte, E, Sonck, J, Collet, C, Guglielmo, M, Baggiano, A, Trabattoni, D, Galli, S, Montorsi, P, Ferrari, C, Fabbiocchi, F, De Martini, S, Annoni, A, Mancini, M, Formenti, A, Magatelli, M, Resta, M, Consiglio, E, Muscogiuri, G, Fiorentini, C, Bartorelli, A, Pepi, M, Andreini D, Mushtaq S, Pontone G, Conte E, Sonck J, Collet C, Guglielmo M, Baggiano A, Trabattoni D, Galli S, Montorsi P, Ferrari C, Fabbiocchi F, De Martini S, Annoni A, Mancini ME, Formenti A, Magatelli M, Resta M, Consiglio E, Muscogiuri G, Fiorentini C, Bartorelli AL, Pepi M., Andreini, D, Mushtaq, S, Pontone, G, Conte, E, Sonck, J, Collet, C, Guglielmo, M, Baggiano, A, Trabattoni, D, Galli, S, Montorsi, P, Ferrari, C, Fabbiocchi, F, De Martini, S, Annoni, A, Mancini, M, Formenti, A, Magatelli, M, Resta, M, Consiglio, E, Muscogiuri, G, Fiorentini, C, Bartorelli, A, Pepi, M, Andreini D, Mushtaq S, Pontone G, Conte E, Sonck J, Collet C, Guglielmo M, Baggiano A, Trabattoni D, Galli S, Montorsi P, Ferrari C, Fabbiocchi F, De Martini S, Annoni A, Mancini ME, Formenti A, Magatelli M, Resta M, Consiglio E, Muscogiuri G, Fiorentini C, Bartorelli AL, and Pepi M.
Abstract: Background: Recent studies demonstrated a significant improvement in the diagnostic performance of coronary CT angiography (CCTA) for the evaluation of in-stent restenosis (ISR). However, coronary stent assessment is still challenging, especially because of beam-hardening artifacts due to metallic stent struts and high atherosclerotic burden of non-stented segments. Adenosine-stress myocardial perfusion assessed by CT (CTP) recently demonstrated to be a feasible and accurate tool for evaluating the functional significance of coronary stenoses in patients with suspected coronary artery disease (CAD). Yet, scarce data are available on the performance of CTP in patients with previous stent implantation. Aim of the study: We aim to assess the diagnostic performance of CCTA alone, CTP alone and CCTA plus CTP performed with a new scanner generation using quantitative invasive coronary angiography (ICA) and invasive fractional flow reserve (FFR) as standard of reference. Methods: We will enroll 300 consecutive patients with previous stent implantation, referred for non-emergent and clinically indicated invasive coronary angiography (ICA) due to suspected ISR or progression of CAD in native coronary segments. All patients will be subjected to stress myocardial CTP and a rest CCTA. The first 150 subjects will undergo static CTP scan, while the following 150 patients will undergo dynamic CTP scan. Measurement of invasive FFR will be performed during ICA when clinically indicated. Results: The primary study end points will be: 1) assessment of the diagnostic performance (diagnostic rate, sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy) of CCTA, CTP, combined CCTA-CTP and concordant CCTA-CTP vs. ICA as standard of reference in a territory-based and patient-based analysis; 2) assessment of sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of CCTA, CTP, combined CCTA-CTP an
Published: 2018

28. Prognostic relevance of subclinical coronary and carotid atherosclerosis in a diabetic and non-diabetic asymptomatic population

Author: Guaricci, A, Lorenzoni, V, Guglielmo, M, Mushtaq, S, Muscogiuri, G, Cademartiri, F, Rabbat, M, Andreini, D, Serviddio, G, Gaibazzi, N, Pepi, M, Pontone, G, Guaricci AI, Lorenzoni V, Guglielmo M, Mushtaq S, Muscogiuri G, Cademartiri F, Rabbat M, Andreini D, Serviddio G, Gaibazzi N, Pepi M, Pontone G., Guaricci, A, Lorenzoni, V, Guglielmo, M, Mushtaq, S, Muscogiuri, G, Cademartiri, F, Rabbat, M, Andreini, D, Serviddio, G, Gaibazzi, N, Pepi, M, Pontone, G, Guaricci AI, Lorenzoni V, Guglielmo M, Mushtaq S, Muscogiuri G, Cademartiri F, Rabbat M, Andreini D, Serviddio G, Gaibazzi N, Pepi M, and Pontone G.
Abstract: Background: We sought to evaluate the incremental prognostic benefit of carotid artery disease and subclinical coronary artery disease (CAD) features in addition to clinical evaluation in an asymptomatic population. Methods: Over a 6-year period, 10-year Framingham risk score together with carotid ultrasound and coronary computed tomography angiography were evaluated for prediction of major adverse cardiac events (MACE). Results: We enrolled 517 consecutive asymptomatic patients (63% male, mean age 64 ±10 years; 17.6% with diabetes). Median (interquartile range) coronary artery calcium score (CACS) was 34 (0–100). Over a median follow-up of 4.4 (3.4–5.1) years, there were 53 MACE (10%). Patients experiencing MACE had higher CACS, incidence of carotid disease, presence of CAD ≥50%, and remodeled plaque as compared with patients without MACE. At multivariable analyses, presence of CAD ≥50% (HR: 5.14, 95% CI: 2.1–12.4) and percentage of segments with remodeled plaque (HR: 1.04, 95% CI: 1.03–1.06) independently predicted MACE (P < 0.001). Models adding CAD ≥50% or percentage of segments with remodeled plaque resulted in higher discrimination and reclassification ability compared with a model based on 10-year FRS, carotid disease, and CACS. Specifically, the C-statistic improved to 0.75 with addition of CAD and 0.84 when adding percentage of segments with remodeled plaque, whereas net reclassification improvement indices were 0.86 and 0.92, respectively. Conclusions: In an asymptomatic population, CAD and plaque positive remodeling increase MACE prediction compared with a model based on 10-year FRS, carotid disease, and CACS estimation. In the diabetes subgroup, percentage of segments with remodeled plaque was the only predictor of MACE.
Published: 2018

29. CT Perfusion Versus Coronary CT Angiography in Patients With Suspected In-Stent Restenosis or CAD Progression

Author: Andreini, D, Mushtaq, S, Pontone, G, Conte, E, Collet, C, Sonck, J, D'Errico, A, Di Odoardo, L, Guglielmo, M, Baggiano, A, Trabattoni, D, Ravagnani, P, Montorsi, P, Teruzzi, G, Olivares, P, Fabbiocchi, F, De Martini, S, Calligaris, G, Annoni, A, Mancini, M, Formenti, A, Magatelli, M, Consiglio, E, Muscogiuri, G, Lombardi, F, Fiorentini, C, Bartorelli, A, Pepi, M, De Martini S, Mancini, ME, Bartorelli, AL, Andreini, D, Mushtaq, S, Pontone, G, Conte, E, Collet, C, Sonck, J, D'Errico, A, Di Odoardo, L, Guglielmo, M, Baggiano, A, Trabattoni, D, Ravagnani, P, Montorsi, P, Teruzzi, G, Olivares, P, Fabbiocchi, F, De Martini, S, Calligaris, G, Annoni, A, Mancini, M, Formenti, A, Magatelli, M, Consiglio, E, Muscogiuri, G, Lombardi, F, Fiorentini, C, Bartorelli, A, Pepi, M, De Martini S, Mancini, ME, and Bartorelli, AL
Abstract: Objectives: The goal of this study was to assess the diagnostic performance of coronary computed tomography angiography (CTA) alone, adenosine-stress myocardial perfusion assessed by computed tomography (CTP) alone, and coronary CTA + CTP by using a 16-cm Z-axis coverage scanner versus invasive coronary angiography (ICA) and fractional flow reserve (FFR) as the clinical standard. Background: Diagnostic performance of coronary CTA for in-stent restenosis detection is still challenging. Recently, CTP showed additional diagnostic power over coronary CTA in patients with suspected coronary artery disease. However, few data are available on CTP performance in patients with previous stent implantation. Methods: Consecutive stable patients with previous coronary stenting referred for ICA were enrolled. All patients underwent stress myocardial CTP and rest CTP + coronary CTA. Invasive FFR was performed during ICA when clinically indicated. The diagnostic rate and diagnostic accuracy of coronary CTA, CTP, and coronary CTA + CTP were evaluated in stent-, territory-, and patient-based analyses. Results: In the 150 enrolled patients (132 men; mean age 65.1 ± 9.1 years), the CTP diagnostic rate was significantly higher than that of coronary CTA in all analyses (territory based [96.7% vs. 91.1%; p < 0.0001] and patient based [96% vs. 68%; p < 0.0001]). When ICA was used as gold standard, CTP diagnostic accuracy was significantly higher than that of coronary CTA in all analyses (territory based [92.1% vs. 85.5%, p < 0.03] and patient based [86.7% vs. 76.7%, p < 0.03]). The concordant coronary CTA + CTP assessment exhibited the highest diagnostic accuracy values versus ICA (95.8% in the territory-based analysis). The diagnostic accuracy of CTP was significantly higher than that of coronary CTA (75% vs. 30.5%; p < 0.001). The radiation exposure of coronary CTA + CTP was 4.15 ± 1.5 mSv. Conclusions: In patients with coronary stents, CTP significantly improved the diagn
Published: 2020

30. Prognostic Stratification of Patients With ST-Segment-Elevation Myocardial Infarction (PROSPECT): A Cardiac Magnetic Resonance Study

Author: Pontone, G, Guaricci, A, Andreini, D, Ferro, G, Guglielmo, M, Baggiano, A, Fusini, L, Muscogiuri, G, Lorenzoni, V, Mushtaq, S, Conte, E, Annoni, A, Formenti, A, Mancini, M, Carità, P, Verdecchia, M, Pica, S, Fazzari, F, Cosentino, N, Marenzi, G, Rabbat, M, Agostoni, P, Bartorelli, A, Pepi, M, Masci, P, Pontone G, Guaricci AI, Andreini D, Ferro G, Guglielmo M, Baggiano A, Fusini L, Muscogiuri G, Lorenzoni V, Mushtaq S, Conte E, Annoni A, Formenti A, Mancini ME, Carità P, Verdecchia M, Pica S, Fazzari F, Cosentino N, Marenzi G, Rabbat MG, Agostoni P, Bartorelli AL, Pepi M, Masci PG., Pontone, G, Guaricci, A, Andreini, D, Ferro, G, Guglielmo, M, Baggiano, A, Fusini, L, Muscogiuri, G, Lorenzoni, V, Mushtaq, S, Conte, E, Annoni, A, Formenti, A, Mancini, M, Carità, P, Verdecchia, M, Pica, S, Fazzari, F, Cosentino, N, Marenzi, G, Rabbat, M, Agostoni, P, Bartorelli, A, Pepi, M, Masci, P, Pontone G, Guaricci AI, Andreini D, Ferro G, Guglielmo M, Baggiano A, Fusini L, Muscogiuri G, Lorenzoni V, Mushtaq S, Conte E, Annoni A, Formenti A, Mancini ME, Carità P, Verdecchia M, Pica S, Fazzari F, Cosentino N, Marenzi G, Rabbat MG, Agostoni P, Bartorelli AL, Pepi M, and Masci PG.
Abstract: Background-Cardiac magnetic resonance (CMR) is a robust tool to evaluate left ventricular ejection fraction (LVEF), myocardial salvage index, microvascular obstruction, and myocardial hemorrhage in patients with ST-segment-elevation myocardial infarction. We evaluated the additional prognostic benefit of a CMR score over standard prognostic stratification with global registry of acute coronary events (GRACE) score and transthoracic echocardiography LVEF measurement. Methods and Results-Two hundred nine consecutive patients with ST-segment-elevation myocardial infarction (age, 61.4±11.4 years; 162 men) underwent transthoracic echocardiography and CMR after succesful primary percutaneous coronary intervention. Major adverse cardiac events (MACE) were assessed at a mean follow-up of 2.5±1.2 years. MACE occurred in 24 (12%) patients who at baseline showed higher GRACE risk score (P<0.01), lower LVEF with both transthoracic echocardiography and CMR, lower myocardial salvage index, and higher per-patient myocardial hemorrhage and microvascular obstruction prevalence and amount as compared with patients without MACE (P<0.01). The best cut-off values of transthoracic echocardiography-LVEF, CMR-LVEF, myocardial salvage index, and microvascular obstruction to predict MACE were 46.7%, 37.5%, 0.4, and 2.6% of left ventricular mass, respectively. Accordingly, a weighted CMR score, including the following 4 variables (CMR-LVEF, myocardial salvage index, microvascular obstruction, and myocardial hemorrhage), with a maximum of 17 points was calculated and included in the multivariable analysis showing that only CMR score (hazard ratio, 1.867 per SD increase [1.311-2.658]; P<0.001) was independently associated with MACE with the highest net reclassification improvement as compared to GRACE score and transthoracic echocardiography-LVEF measurement. Conclusions-CMR score provides incremental prognostic stratification as compared with GRACE score and transthoracic echocardiogr
Published: 2017

31. Prognostic Stratification of Patients With ST-Segment-Elevation Myocardial Infarction (PROSPECT): A Cardiac Magnetic Resonance Study

Author: Pontone, G, Guaricci, A, Andreini, D, Ferro, G, Guglielmo, M, Baggiano, A, Fusini, L, Muscogiuri, G, Lorenzoni, V, Mushtaq, S, Conte, E, Annoni, A, Formenti, A, Mancini, M, Carità, P, Verdecchia, M, Pica, S, Fazzari, F, Cosentino, N, Marenzi, G, Rabbat, M, Agostoni, P, Bartorelli, A, Pepi, M, Masci, P, Pontone G, Guaricci AI, Andreini D, Ferro G, Guglielmo M, Baggiano A, Fusini L, Muscogiuri G, Lorenzoni V, Mushtaq S, Conte E, Annoni A, Formenti A, Mancini ME, Carità P, Verdecchia M, Pica S, Fazzari F, Cosentino N, Marenzi G, Rabbat MG, Agostoni P, Bartorelli AL, Pepi M, Masci PG., Pontone, G, Guaricci, A, Andreini, D, Ferro, G, Guglielmo, M, Baggiano, A, Fusini, L, Muscogiuri, G, Lorenzoni, V, Mushtaq, S, Conte, E, Annoni, A, Formenti, A, Mancini, M, Carità, P, Verdecchia, M, Pica, S, Fazzari, F, Cosentino, N, Marenzi, G, Rabbat, M, Agostoni, P, Bartorelli, A, Pepi, M, Masci, P, Pontone G, Guaricci AI, Andreini D, Ferro G, Guglielmo M, Baggiano A, Fusini L, Muscogiuri G, Lorenzoni V, Mushtaq S, Conte E, Annoni A, Formenti A, Mancini ME, Carità P, Verdecchia M, Pica S, Fazzari F, Cosentino N, Marenzi G, Rabbat MG, Agostoni P, Bartorelli AL, Pepi M, and Masci PG.
Abstract: Background-Cardiac magnetic resonance (CMR) is a robust tool to evaluate left ventricular ejection fraction (LVEF), myocardial salvage index, microvascular obstruction, and myocardial hemorrhage in patients with ST-segment-elevation myocardial infarction. We evaluated the additional prognostic benefit of a CMR score over standard prognostic stratification with global registry of acute coronary events (GRACE) score and transthoracic echocardiography LVEF measurement. Methods and Results-Two hundred nine consecutive patients with ST-segment-elevation myocardial infarction (age, 61.4±11.4 years; 162 men) underwent transthoracic echocardiography and CMR after succesful primary percutaneous coronary intervention. Major adverse cardiac events (MACE) were assessed at a mean follow-up of 2.5±1.2 years. MACE occurred in 24 (12%) patients who at baseline showed higher GRACE risk score (P<0.01), lower LVEF with both transthoracic echocardiography and CMR, lower myocardial salvage index, and higher per-patient myocardial hemorrhage and microvascular obstruction prevalence and amount as compared with patients without MACE (P<0.01). The best cut-off values of transthoracic echocardiography-LVEF, CMR-LVEF, myocardial salvage index, and microvascular obstruction to predict MACE were 46.7%, 37.5%, 0.4, and 2.6% of left ventricular mass, respectively. Accordingly, a weighted CMR score, including the following 4 variables (CMR-LVEF, myocardial salvage index, microvascular obstruction, and myocardial hemorrhage), with a maximum of 17 points was calculated and included in the multivariable analysis showing that only CMR score (hazard ratio, 1.867 per SD increase [1.311-2.658]; P<0.001) was independently associated with MACE with the highest net reclassification improvement as compared to GRACE score and transthoracic echocardiography-LVEF measurement. Conclusions-CMR score provides incremental prognostic stratification as compared with GRACE score and transthoracic echocardiogr
Published: 2017

32. Role of Cardiac Magnetic Resonance Imaging in Myocardial Infarction

Author: Pontone, G, Carità, P, Rabbat, M, Guglielmo, M, Baggiano, A, Muscogiuri, G, Guaricci, A, Pontone G, Carità P, Rabbat MG, Guglielmo M, Baggiano A, Muscogiuri G, Guaricci AI., Pontone, G, Carità, P, Rabbat, M, Guglielmo, M, Baggiano, A, Muscogiuri, G, Guaricci, A, Pontone G, Carità P, Rabbat MG, Guglielmo M, Baggiano A, Muscogiuri G, and Guaricci AI.
Abstract: Purpose of Review: The purpose of the present paper is to analytically review the diagnostic and prognostic role of CMR in ST-segment elevation myocardial infarction (STEMI) survivors. Percutaneous coronary intervention (PCI) is the treatment of choice in patients STEMI. However, risk of future events remains substantial. Assessment of the extent of myocardial infarction (MI), cardiac function and ventricular remodelling has become the focus of recent studies. Electrocardiography, angiography and echocardiography parameters, as well as risk scores, lack sensitivity and reproducibility in predicting future cardiovascular events. A major advantage of cardiac magnetic resonance imaging (CMR) is that it provides myocardial tissue characterization. Recent Findings: CMR is able to quantify both reversible and irreversible myocardial injury and correlates with future events. Summary: This review will illustrate how microvascular function indices (myocardial salvage index, presence and amount of microvascular obstruction and intramyocardial haemorrhage) detectable by CMR add prognostic information and could impact on future strategies to improve outcomes in revascularized patients.
Published: 2017

33. Multimodality imaging of left atrium in patients with atrial brillation

Author: Guglielmo, M, Baggiano, A, Muscogiuri, G, Fusini, L, Andreini, D, Mushtaq, S, Conte, E, Annoni, A, Formenti, A, Maria Mancini, E, Gripari, P, Igoren Guaricci, A, Rabbat, M, Pepi, M, Pontone, G, Marco Guglielmo, Andrea Baggiano, Giuseppe Muscogiuri, Laura Fusini, Daniele Andreini, Saima Mushtaq, Edoardo Conte, Andrea Annoni, Alberto Formenti, Elisabetta Maria Mancini, Paola Gripari, Andrea Igoren Guaricci, Mark G. Rabbat, Mauro Pepi, Gianluca Pontone, Guglielmo, M, Baggiano, A, Muscogiuri, G, Fusini, L, Andreini, D, Mushtaq, S, Conte, E, Annoni, A, Formenti, A, Maria Mancini, E, Gripari, P, Igoren Guaricci, A, Rabbat, M, Pepi, M, Pontone, G, Marco Guglielmo, Andrea Baggiano, Giuseppe Muscogiuri, Laura Fusini, Daniele Andreini, Saima Mushtaq, Edoardo Conte, Andrea Annoni, Alberto Formenti, Elisabetta Maria Mancini, Paola Gripari, Andrea Igoren Guaricci, Mark G. Rabbat, Mauro Pepi, and Gianluca Pontone
Abstract: Atrial fibrillation (AF) is the most common arrhythmia worldwide associated with significant morbidity and mortality and represents a significant health care burden. Goals of AF treatment include prevention of cardioembolic stroke using anticoagulation and device therapy and restoration of sinus rhythm using antiarrhythmic drugs or catheter ablation techniques. A comprehensive assessment of cardiac chamber size and function is often started with echocardiography as a first line diagnostic imaging strategy. Recently, innovations in advanced imaging using cardiac magnetic resonance (CMR) and cardiac computed tomography (CCT) provide a detailed characterization of atrial anatomy and have been shown to accurately exclude thrombus and guide left atrial appendage (LAA) closure or catheter ablation (CA) of atrial fibrillation. Compared to echocardiography, CCT offers an uncompromised spatial resolution and a fast dataset acquisition, with the disadvantages of the need of iodine contrast agent and radiation exposure. CMR, conversely, can rely on very high temporal resolution, the unique feature of tissue characterization and the absence of radiation exposure. However, the main drawbacks of this diagnostic tool are long scan times and low availability. This review will illustrate the vital role of multimodality cardiac imaging in the accurate identification of left atrial, pulmonary vein and LAA size and function, discuss advanced imaging techniques to rule out thrombus and highlight novel CMR and CCT techniques to guide catheter ablation of AF and LAA occlusion.
Published: 2019

34. The STRATEGY Study (Stress Cardiac Magnetic Resonance Versus Computed Tomography Coronary Angiography for the Management of Symptomatic Revascularized Patients) Resources and Outcomes Impact

Author: Pontone, G, Andreini, D, Guaricci, A, Rota, C, Guglielmo, M, Mushtaq, S, Baggiano, A, Beltrama, V, Fusini, L, Solbiati, A, Segurini, C, Conte, E, Gripari, P, Annoni, A, Formenti, A, Petulla', M, Lombardi, F, Muscogiuri, G, Bartorelli, A, Pepi, M, Pontone G, Andreini D, Guaricci AI, Rota C, Guglielmo M, Mushtaq S, Baggiano A, Beltrama V, Fusini L, Solbiati A, Segurini C, Conte E, Gripari P, Annoni A, Formenti A, Petulla' M, Lombardi F, Muscogiuri G, Bartorelli AL, Pepi M., Pontone, G, Andreini, D, Guaricci, A, Rota, C, Guglielmo, M, Mushtaq, S, Baggiano, A, Beltrama, V, Fusini, L, Solbiati, A, Segurini, C, Conte, E, Gripari, P, Annoni, A, Formenti, A, Petulla', M, Lombardi, F, Muscogiuri, G, Bartorelli, A, Pepi, M, Pontone G, Andreini D, Guaricci AI, Rota C, Guglielmo M, Mushtaq S, Baggiano A, Beltrama V, Fusini L, Solbiati A, Segurini C, Conte E, Gripari P, Annoni A, Formenti A, Petulla' M, Lombardi F, Muscogiuri G, Bartorelli AL, and Pepi M.
Abstract: Background - Computed tomography coronary angiography (cTCA) and stress cardiac magnetic resonance (stress-CMR) are suitable tools for diagnosing obstructive coronary artery disease in symptomatic patients with previous history of revascularization. However, performance appraisal of noninvasive tests must take in account the consequent diagnostic testing, invasive procedures, clinical outcomes, radiation exposure, and cumulative costs rather than their diagnostic accuracy only. We aimed to compare an anatomic (cTCA) versus a functional (stress-CMR) strategy in symptomatic patients with previous myocardial revascularization procedures. Methods and Results - Six hundred patients with chest pain and previous revascularization included in a prospective observational registry and evaluated by clinically indicated cTCA (n=300, mean age 68.2±9.7 years, male 255) or stress-CMR (n=300, mean age 67.6±9.7 years, male 263) were enrolled and followed-up in terms of subsequent noninvasive tests, invasive coronary angiography, revascularization procedures, cumulative effective radiation dose, major adverse cardiac events, defined as a composite end point of nonfatal myocardial infarction and cardiac death, and medical costs. The mean follow-up for cTCA and stress-CMR groups was similar (773.6±345 versus 752.8±291 days; P=0.21). Compared with stress-CMR, cTCA was associated with a higher rate of subsequent noninvasive tests (28% versus 17%; P=0.0009), invasive coronary angiography (31% versus 20%; P=0.0009), and revascularization procedures (24% versus 16%; P=0.007). Stress-CMR strategy was associated with a significant reduction of radiation exposure and cumulative costs (59% and 24%, respectively; P<0.001). Finally, patients undergoing stress-CMR showed a lower rate of major adverse cardiac events (5% versus 10%; P<0.010) and cost-effectiveness ratio (119.98±250.92 versus 218.12±298.45 Euro/y; P<0.001). Conclusions - Compared with cTCA, stress-CMR is more cost-effective
Published: 2016

35. Prognostic Benefit of Cardiac Magnetic Resonance over Transthoracic Echocardiography for the Assessment of Ischemic and Nonischemic Dilated Cardiomyopathy Patients Referred for the Evaluation of Primary Prevention Implantable Cardioverter-Defibrillator Therapy

Author: Pontone, G, Guaricci, A, Andreini, D, Solbiati, A, Guglielmo, M, Mushtaq, S, Baggiano, A, Beltrama, V, Fusini, L, Rota, C, Segurini, C, Conte, E, Gripari, P, Dello Russo, A, Moltrasio, M, Tundo, F, Lombardi, F, Muscogiuri, G, Lorenzoni, V, Tondo, C, Agostoni, P, Bartorelli, A, Pepi, M, Pontone G, Guaricci AI, Andreini D, Solbiati A, Guglielmo M, Mushtaq S, Baggiano A, Beltrama V, Fusini L, Rota C, Segurini C, Conte E, Gripari P, Dello Russo A, Moltrasio M, Tundo F, Lombardi F, Muscogiuri G, Lorenzoni V, Tondo C, Agostoni P, Bartorelli AL, Pepi M., Pontone, G, Guaricci, A, Andreini, D, Solbiati, A, Guglielmo, M, Mushtaq, S, Baggiano, A, Beltrama, V, Fusini, L, Rota, C, Segurini, C, Conte, E, Gripari, P, Dello Russo, A, Moltrasio, M, Tundo, F, Lombardi, F, Muscogiuri, G, Lorenzoni, V, Tondo, C, Agostoni, P, Bartorelli, A, Pepi, M, Pontone G, Guaricci AI, Andreini D, Solbiati A, Guglielmo M, Mushtaq S, Baggiano A, Beltrama V, Fusini L, Rota C, Segurini C, Conte E, Gripari P, Dello Russo A, Moltrasio M, Tundo F, Lombardi F, Muscogiuri G, Lorenzoni V, Tondo C, Agostoni P, Bartorelli AL, and Pepi M.
Abstract: Background - The aim of this study was to determine the prognostic benefit of cardiac magnetic resonance (CMR) over transthoracic echocardiography (TTE) in ischemic cardiomyopathy and nonischemic dilated cardiomyopathy patients evaluated for primary prevention implantable cardioverter-defibrillator therapy. Methods and Results - We enrolled 409 consecutive ischemic and dilated cardiomyopathy patients (mean age: 64±12 years; 331 men). All patients underwent TTE and CMR, and left ventricle end-diastolic volume, left ventricle end-systolic volume, and left ventricle ejection fraction (LVEF) were evaluated. In addition, late gadolinium enhancement was also assessed. All patients were followed up for major adverse cardiac events (MACE) defined as a composite end point of long runs of nonsustained ventricular tachycardia, sustained ventricular tachycardia, aborted sudden cardiac death, or sudden cardiac death. The median follow-up was 545 days. CMR showed higher left ventricle end-diastolic volume (mean difference: 43±22.5 mL), higher left ventricle end-systolic volume (mean difference: 34±20.5 mL), and lower LVEF (mean difference: -4.9±10%) as compared to TTE (P<0.01). MACE occurred in 103 (25%) patients. Patients experiencing MACE showed higher left ventricle end-diastolic volume, higher left ventricle end-systolic volume, and lower LVEF with both imaging modalities and higher late gadolinium enhancement per-patient prevalence as compared to patients without MACE. At multivariable analysis, CMR-LVEF ≤35% (hazard ratio=2.18 [1.3-3.8]) and the presence of late gadolinium enhancement (hazard ratio=2.2 [1.4-3.6]) were independently associated with MACE (P<0.01). A model based on CMR-LVEF ≤35% or CMR-LVEF ≤35% plus late gadolinium enhancement detection showed a higher performance in the prediction of MACE as compared to TTE-LVEF resulting in net reclassification improvement of 0.468 (95% confidence interval, 0.283-0.654; P<0.001) and 0.413 (95% confidence interval
Published: 2016

36. The STRATEGY Study (Stress Cardiac Magnetic Resonance Versus Computed Tomography Coronary Angiography for the Management of Symptomatic Revascularized Patients) Resources and Outcomes Impact

Author: Pontone, G, Andreini, D, Guaricci, A, Rota, C, Guglielmo, M, Mushtaq, S, Baggiano, A, Beltrama, V, Fusini, L, Solbiati, A, Segurini, C, Conte, E, Gripari, P, Annoni, A, Formenti, A, Petulla', M, Lombardi, F, Muscogiuri, G, Bartorelli, A, Pepi, M, Pontone G, Andreini D, Guaricci AI, Rota C, Guglielmo M, Mushtaq S, Baggiano A, Beltrama V, Fusini L, Solbiati A, Segurini C, Conte E, Gripari P, Annoni A, Formenti A, Petulla' M, Lombardi F, Muscogiuri G, Bartorelli AL, Pepi M., Pontone, G, Andreini, D, Guaricci, A, Rota, C, Guglielmo, M, Mushtaq, S, Baggiano, A, Beltrama, V, Fusini, L, Solbiati, A, Segurini, C, Conte, E, Gripari, P, Annoni, A, Formenti, A, Petulla', M, Lombardi, F, Muscogiuri, G, Bartorelli, A, Pepi, M, Pontone G, Andreini D, Guaricci AI, Rota C, Guglielmo M, Mushtaq S, Baggiano A, Beltrama V, Fusini L, Solbiati A, Segurini C, Conte E, Gripari P, Annoni A, Formenti A, Petulla' M, Lombardi F, Muscogiuri G, Bartorelli AL, and Pepi M.
Abstract: Background - Computed tomography coronary angiography (cTCA) and stress cardiac magnetic resonance (stress-CMR) are suitable tools for diagnosing obstructive coronary artery disease in symptomatic patients with previous history of revascularization. However, performance appraisal of noninvasive tests must take in account the consequent diagnostic testing, invasive procedures, clinical outcomes, radiation exposure, and cumulative costs rather than their diagnostic accuracy only. We aimed to compare an anatomic (cTCA) versus a functional (stress-CMR) strategy in symptomatic patients with previous myocardial revascularization procedures. Methods and Results - Six hundred patients with chest pain and previous revascularization included in a prospective observational registry and evaluated by clinically indicated cTCA (n=300, mean age 68.2±9.7 years, male 255) or stress-CMR (n=300, mean age 67.6±9.7 years, male 263) were enrolled and followed-up in terms of subsequent noninvasive tests, invasive coronary angiography, revascularization procedures, cumulative effective radiation dose, major adverse cardiac events, defined as a composite end point of nonfatal myocardial infarction and cardiac death, and medical costs. The mean follow-up for cTCA and stress-CMR groups was similar (773.6±345 versus 752.8±291 days; P=0.21). Compared with stress-CMR, cTCA was associated with a higher rate of subsequent noninvasive tests (28% versus 17%; P=0.0009), invasive coronary angiography (31% versus 20%; P=0.0009), and revascularization procedures (24% versus 16%; P=0.007). Stress-CMR strategy was associated with a significant reduction of radiation exposure and cumulative costs (59% and 24%, respectively; P<0.001). Finally, patients undergoing stress-CMR showed a lower rate of major adverse cardiac events (5% versus 10%; P<0.010) and cost-effectiveness ratio (119.98±250.92 versus 218.12±298.45 Euro/y; P<0.001). Conclusions - Compared with cTCA, stress-CMR is more cost-effective
Published: 2016

37. Prognostic Benefit of Cardiac Magnetic Resonance over Transthoracic Echocardiography for the Assessment of Ischemic and Nonischemic Dilated Cardiomyopathy Patients Referred for the Evaluation of Primary Prevention Implantable Cardioverter-Defibrillator Therapy

Author: Pontone, G, Guaricci, A, Andreini, D, Solbiati, A, Guglielmo, M, Mushtaq, S, Baggiano, A, Beltrama, V, Fusini, L, Rota, C, Segurini, C, Conte, E, Gripari, P, Dello Russo, A, Moltrasio, M, Tundo, F, Lombardi, F, Muscogiuri, G, Lorenzoni, V, Tondo, C, Agostoni, P, Bartorelli, A, Pepi, M, Pontone G, Guaricci AI, Andreini D, Solbiati A, Guglielmo M, Mushtaq S, Baggiano A, Beltrama V, Fusini L, Rota C, Segurini C, Conte E, Gripari P, Dello Russo A, Moltrasio M, Tundo F, Lombardi F, Muscogiuri G, Lorenzoni V, Tondo C, Agostoni P, Bartorelli AL, Pepi M., Pontone, G, Guaricci, A, Andreini, D, Solbiati, A, Guglielmo, M, Mushtaq, S, Baggiano, A, Beltrama, V, Fusini, L, Rota, C, Segurini, C, Conte, E, Gripari, P, Dello Russo, A, Moltrasio, M, Tundo, F, Lombardi, F, Muscogiuri, G, Lorenzoni, V, Tondo, C, Agostoni, P, Bartorelli, A, Pepi, M, Pontone G, Guaricci AI, Andreini D, Solbiati A, Guglielmo M, Mushtaq S, Baggiano A, Beltrama V, Fusini L, Rota C, Segurini C, Conte E, Gripari P, Dello Russo A, Moltrasio M, Tundo F, Lombardi F, Muscogiuri G, Lorenzoni V, Tondo C, Agostoni P, Bartorelli AL, and Pepi M.
Abstract: Background - The aim of this study was to determine the prognostic benefit of cardiac magnetic resonance (CMR) over transthoracic echocardiography (TTE) in ischemic cardiomyopathy and nonischemic dilated cardiomyopathy patients evaluated for primary prevention implantable cardioverter-defibrillator therapy. Methods and Results - We enrolled 409 consecutive ischemic and dilated cardiomyopathy patients (mean age: 64±12 years; 331 men). All patients underwent TTE and CMR, and left ventricle end-diastolic volume, left ventricle end-systolic volume, and left ventricle ejection fraction (LVEF) were evaluated. In addition, late gadolinium enhancement was also assessed. All patients were followed up for major adverse cardiac events (MACE) defined as a composite end point of long runs of nonsustained ventricular tachycardia, sustained ventricular tachycardia, aborted sudden cardiac death, or sudden cardiac death. The median follow-up was 545 days. CMR showed higher left ventricle end-diastolic volume (mean difference: 43±22.5 mL), higher left ventricle end-systolic volume (mean difference: 34±20.5 mL), and lower LVEF (mean difference: -4.9±10%) as compared to TTE (P<0.01). MACE occurred in 103 (25%) patients. Patients experiencing MACE showed higher left ventricle end-diastolic volume, higher left ventricle end-systolic volume, and lower LVEF with both imaging modalities and higher late gadolinium enhancement per-patient prevalence as compared to patients without MACE. At multivariable analysis, CMR-LVEF ≤35% (hazard ratio=2.18 [1.3-3.8]) and the presence of late gadolinium enhancement (hazard ratio=2.2 [1.4-3.6]) were independently associated with MACE (P<0.01). A model based on CMR-LVEF ≤35% or CMR-LVEF ≤35% plus late gadolinium enhancement detection showed a higher performance in the prediction of MACE as compared to TTE-LVEF resulting in net reclassification improvement of 0.468 (95% confidence interval, 0.283-0.654; P<0.001) and 0.413 (95% confidence interval
Published: 2016

38. The New Frontier of Cardiac Computed Tomography Angiography: Fractional Flow Reserve and Stress Myocardial Perfusion

Author: Pontone, G, Muscogiuri, G, Andreini, D, Guaricci, A, Guglielmo, M, Mushtaq, S, Baggiano, A, Conte, E, Beltrama, V, Annoni, A, Formenti, A, Mancini, E, Rabbat, M, Pepi, M, Pontone G, Muscogiuri G, Andreini D, Guaricci AI, Guglielmo M, Mushtaq S, Baggiano A, Conte E, Beltrama V, Annoni A, Formenti A, Mancini E, Rabbat MG, Pepi M., Pontone, G, Muscogiuri, G, Andreini, D, Guaricci, A, Guglielmo, M, Mushtaq, S, Baggiano, A, Conte, E, Beltrama, V, Annoni, A, Formenti, A, Mancini, E, Rabbat, M, Pepi, M, Pontone G, Muscogiuri G, Andreini D, Guaricci AI, Guglielmo M, Mushtaq S, Baggiano A, Conte E, Beltrama V, Annoni A, Formenti A, Mancini E, Rabbat MG, and Pepi M.
Abstract: The increased number of patients with coronary artery disease (CAD) in developed countries is of great clinical relevance and involves a large burden of the healthcare system. The management of these patients is focused on relieving symptoms and improving clinical outcomes. Therefore the ideal test would provide the correct diagnosis and actionable information. To this aim, several non-invasive functional imaging modalities are usually used as gatekeeper to invasive coronary angiography (ICA), but their diagnostic yield remains low with limited accuracy when compared to obstructive CAD at the time of ICA or invasive fractional flow reserve (FFR). Invasive FFR is considered the gold standard for the evaluation of functionally relevant CAD. Therefore, an urgent need for non-invasive techniques that evaluate both the functional and morphological severity of CAD is growing. Coronary computed tomography angiography (CCTA) has emerged as a unique non-invasive technique providing coronary artery anatomic imaging. More recently, the evaluation of FFR with CCTA (FFRCT) has demonstrated high diagnostic performance compared to invasive FFR. Additionally, stress myocardial computed tomography perfusion (CTP) represents a novel tool for the diagnosis of ischemia with high diagnostic accuracy. Compared to nuclear imaging and cardiac magnetic resonance imaging, both FFRCT and stress-CTP, allow us to integrate the anatomical evaluation of coronary arteries with the functional relevance of coronary artery lesions having the potential to revolutionize the diagnostic paradigm of suspected CAD. FFRCT and stress-CTP could be assimilated in diagnostic pathways of patients with stable CAD and will likely result in a decrease of invasive diagnostic procedures and costs. The current review evaluates the technical aspects and clinical experience of FFRCT and stress-CTP in the evaluation of functionally relevant CAD discussing the strengths and weaknesses of each approach. ï¿1⁄2 2016, Spring
Published: 2016

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