27 results on '"Giacomo, Ingallina"'
Search Results
2. Right ventricular systolic function in severe tricuspid regurgitation: prognostic relevance of longitudinal strain
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Eustachio Agricola, Antonia Pascaretta, Azeem Latib, Michele De Bonis, Ottavio Alfieri, Alessandro Castiglioni, Francesco Ancona, Cristina Capogrosso, Stefano Stella, Marco Ancona, Matteo Montorfano, Elvin Tafciu, Nadia Attalla El Halabieh, Giacomo Ingallina, Antonio Colombo, Paolo Denti, Francesco Calvo, Francesco Melillo, Ancona, Francesco, Melillo, Francesco, Calvo, Francesco, Attalla El Halabieh, Nadia, Stella, Stefano, Capogrosso, Cristina, Ingallina, Giacomo, Tafciu, Elvin, Pascaretta, Antonia, Ancona, Marco Bruno, De Bonis, Michele, Castiglioni, Alessandro, Denti, Paolo, Montorfano, Matteo, Latib, Azeem, Colombo, Antonio, Alfieri, Ottavio, and Agricola, Eustachio
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medicine.medical_specialty ,New York Heart Association Class ,Longitudinal strain ,Regurgitation (circulation) ,030204 cardiovascular system & hematology ,right ventricular systolic function ,03 medical and health sciences ,0302 clinical medicine ,Tricuspid Valve Insufficiency ,Internal medicine ,Medicine ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Systole ,tricuspid regurgitation ,business.industry ,Atrial fibrillation ,General Medicine ,Odds ratio ,medicine.disease ,Heart failure ,Cardiology ,right ventricular free wall longitudinal strain ,strain analysis ,Cardiology and Cardiovascular Medicine ,business - Abstract
Aims The aim of this study is to analyse the prognostic implications of right ventricular (RV) dysfunction as detected by strain analysis in patients with severe tricuspid regurgitation (TR). The evaluation of RV systolic function in presence of severe TR is of paramount importance for operative risk stratification; however, it remains challenging, as conventional echocardiographic indexes usually lead to overestimation. Methods and results We enrolled 250 consecutive patients with severe TR referred to our centre. Baseline clinical and echocardiographic data and follow-up outcomes were collected. Patients were predominantly female, with multiple cardiovascular risk factors and comorbidities, history of heart failure, and atrial fibrillation. Most of them had presented with clinical signs of RV heart failure (RVHF) and advanced New York Heart Association class. The RV strain analysis [both RV free wall longitudinal strain (RVFWLS) and RV global longitudinal strain (RVGLS)] reclassified ∼42–56% of patients with normal RV systolic function according to conventional parameters in patients with impaired RV systolic function. RVFWLS ≤17% (absolute values, AUC: 0.66, P = 0.002) predicted the presence of RVHF [odds ratio (OR) 0.93, P = 0.01]. At follow-up, patients with RVFWLS >14% (absolute values, AUC: 0.70, P = 0.001, sensitivity 72%, specificity 54%) showed a better survival (P = 0.01). Conclusion Different ranges of RVFWLS have different implications in patients with severe TR, allowing to identify a preclinical and a clinical window, with correlations to RVHF and survival.
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- 2021
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3. Pulmonary hypertension and right ventricular involvement in hospitalised patients with COVID-19
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Francesco Calvo, Fabio Ciceri, Mario Gramegna, Giacomo Ingallina, Eustachio Agricola, Alessandro Beneduce, Silvia Ajello, Giovanni Landoni, Moreno Tresoldi, Vittorio Pazzanese, Paolo Scarpellini, Renato Finazzi, Matteo Pagnesi, Annalisa Ruggeri, Paolo G. Camici, Alberto Cappelletti, Antonio Napolano, Giulio Melisurgo, Luca Baldetti, Anna Mara Scandroglio, Pagnesi, Matteo, Baldetti, Luca, Beneduce, Alessandro, Calvo, Francesco, Gramegna, Mario, Pazzanese, Vittorio, Ingallina, Giacomo, Napolano, Antonio, Finazzi, Renato, Ruggeri, Annalisa, Ajello, Silvia, Melisurgo, Giulio, Camici, Paolo Guido, Scarpellini, Paolo, Tresoldi, Moreno, Landoni, Giovanni, Ciceri, Fabio, Scandroglio, Anna Mara, Agricola, Eustachio, and Cappelletti, Alberto Maria
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Male ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Hypertension, Pulmonary ,Ventricular Dysfunction, Right ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Pneumonia, Viral ,Comorbidity ,030204 cardiovascular system & hematology ,Severity of Illness Index ,Betacoronavirus ,03 medical and health sciences ,0302 clinical medicine ,medicine.artery ,Internal medicine ,Outcome Assessment, Health Care ,Severity of illness ,Prevalence ,medicine ,echocardiography ,Humans ,030212 general & internal medicine ,Correlation of Data ,Pandemics ,SARS-CoV-2 ,business.industry ,COVID-19 ,Oxygenation ,Middle Aged ,medicine.disease ,Pulmonary hypertension ,Icu admission ,Hospitalization ,Italy ,Echocardiography ,pulmonary vascular disease ,Pulmonary artery ,Cardiology ,Female ,Coronavirus Infections ,Cardiology and Cardiovascular Medicine ,business - Abstract
ObjectiveTo assess the prevalence, characteristics and prognostic value of pulmonary hypertension (PH) and right ventricular dysfunction (RVD) in hospitalised, non-intensive care unit (ICU) patients with coronavirus disease 2019 (COVID-19).MethodsThis single-centre, observational, cross-sectional study included 211 patients with COVID-19 admitted to non-ICU departments who underwent a single transthoracic echocardiography (TTE). Patients with poor acoustic window (n=11) were excluded. Clinical, imaging, laboratory and TTE findings were compared in patients with versus without PH (estimated systolic pulmonary artery pressure >35 mm Hg) and with versus without RVD (tricuspid annular plane systolic excursion ResultsA total of 200 patients were included in the final analysis (median age 62 (IQR 52–74) years, 65.5% men). The prevalence of PH and RVD was 12.0% (24/200) and 14.5% (29/200), respectively. Patients with PH were older and had a higher burden of pre-existing cardiac comorbidities and signs of more severe severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (radiological lung involvement, laboratory findings and oxygenation status) compared with those without PH. Conversely, patients with RVD had a higher burden of pre-existing cardiac comorbidities but no evidence of more severe SARS-CoV-2 infection compared with those without RVD. The presence of PH was associated with a higher rate of in-hospital death or ICU admission (41.7 vs 8.5%, pConclusionsAmong hospitalised non-ICU patients with COVID-19, PH (and not RVD) was associated with signs of more severe COVID-19 and with worse in-hospital clinical outcome.Trial registration numberNCT04318366
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- 2020
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4. Myocardial injury in patients with SARS-CoV-2 pneumonia: Pivotal role of inflammation in COVID-19
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Alberto Zangrillo, Gian Battista Danzi, Alberto Cappelletti, Francesco Melillo, Francesco Ancona, Patrizia Rovere-Querini, Paolo Scarpellini, Antonio Napolano, Fabio Ciceri, Lorenzo Dagna, Giacomo Ingallina, Marco Ripa, Marco Loffi, Antonio Boccellino, Antonella Castagna, Valentina Regazzoni, Moreno Tresoldi, Stefano Stella, Eustachio Agricola, Giovanni Landoni, Melillo, Francesco, Napolano, Antonio, Loffi, Marco, Regazzoni, Valentina, Boccellino, Antonio, Danzi, Gian Battista, Cappelletti, Alberto Maria, Rovere-Querini, Patrizia, Landoni, Giovanni, Ingallina, Giacomo, Stella, Stefano, Ancona, Francesco, Dagna, Lorenzo, Scarpellini, Paolo, Ripa, Marco, Castagna, Antonella, Tresoldi, Moreno, Zangrillo, Alberto, Ciceri, Fabio, and Agricola, Eustachio
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Male ,medicine.medical_specialty ,Systemic disease ,Heart Diseases ,Clinical Biochemistry ,Systemic inflammation ,Biochemistry ,COVID‐19 ,Internal medicine ,medicine ,Humans ,myocardial injury ,Aged ,Retrospective Studies ,Inflammation ,biology ,business.industry ,troponin ,Cancer ,COVID-19 ,Retrospective cohort study ,General Medicine ,Original Articles ,Middle Aged ,medicine.disease ,Prognosis ,Troponin ,Hospitalization ,Pneumonia ,Italy ,SARS‐coronavirus‐2 ,SARS-coronavirus-2 ,biology.protein ,cardiac complications ,Observational study ,Female ,Original Article ,medicine.symptom ,business ,Kidney disease - Abstract
Aims Infection by SARS‐CoV‐2 may result in a systemic disease and a proportion of patients ranging 15%–44% experienced cardiac injury (CI) diagnosed by abnormal troponin levels. The aim of the present study was to analyse the clinical characteristics of a large series of hospitalized patients for COVID‐19 in order to identify predisposing and/or protective factors of CI and the outcome. Methods and results This is an observational, retrospective study on patients hospitalized in two Italian centres (San Raffaele Hospital and Cremona Hospital) for COVID‐19 and at least one high‐sensitivity cardiac troponin (hs‐cTnt) measurement during hospitalization. CI was defined if at least one hs‐cTnt value was above the 99th percentile. The primary end‐point was the occurrence of CI during hospitalization. We included 750 patients (median age 67, IQR 56–77 years; 69% males), of whom 46.9% had history of hypertension, 14.7% of chronic coronary disease and 22.3% of chronic kidney disease (CKD). Abnormal troponin levels (median troponin 74, IQR 34–147 ng/l) were detected in 390 patients (52%) during the hospitalization. At multivariable analysis age, CKD, cancer, C‐reactive protein (CRP) levels were independently associated with CI. Independent predictors of very high troponin levels were chronic kidney disease and CRP levels. Patients with CI showed higher rate of all‐cause mortality (40.0% vs. 9.1%, p = 0.001) compared to those without CI. Conclusion This large, multicentre Italian study confirmed the high prevalence of CI and its prognostic role in hospitalized patients with COVID‐19, highlighting the leading role of systemic inflammation for the occurrence of CI.
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- 2021
5. Tricuspid Regurgitation in Left Ventricular Systolic Dysfunction: Marker or Target?
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Davide Margonato, Francesco Ancona, Giacomo Ingallina, Francesco Melillo, Stefano Stella, Federico Biondi, Antonio Boccellino, Cosmo Godino, Alberto Margonato, Eustachio Agricola, Margonato, Davide, Ancona, Francesco, Ingallina, Giacomo, Melillo, Francesco, Stella, Stefano, Biondi, Federico, Boccellino, Antonio, Godino, Cosmo, Margonato, Alberto, and Agricola, Eustachio
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medicine.medical_specialty ,heart failure ,Context (language use) ,Regurgitation (circulation) ,Disease ,Review ,030204 cardiovascular system & hematology ,Cardiovascular Medicine ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Diseases of the circulatory (Cardiovascular) system ,Medicine ,echocardiography ,030212 general & internal medicine ,tricuspid regurgitation ,left ventricular dysfunction ,Ejection fraction ,business.industry ,right heart failure ,Atrial fibrillation ,medicine.disease ,Pulmonary hypertension ,RC666-701 ,Heart failure ,Cardiology ,Etiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
Far from being historically considered a primary healthcare problem, tricuspid regurgitation (TR) has recently gained much attention from the scientific community. In fact, in the last years, robust evidence has emerged regarding the epidemiological impact of TR, whose prevalence seems to be similar to that of other valvulopathies, such as aortic stenosis, with an estimated up to 4% of people >75 years affected by at least moderate TR in the United States, and up to 23% among patients suffering from heart failure with reduced ejection fraction. This recurrent coexistence of left ventricular systolic dysfunction (LVSD) and TR is not surprising, considered the multiple etiologies of tricuspid valve disease. TR can complicate heart failure mostly as a functional disease, because of pulmonary hypertension (PH), subsequent to elevated left ventricular end-diastolic pressure, leading to right ventricular dilatation, and valve tethering. Moreover, the so-called “functional isolated” TR can occur, in the absence of PH, as a result of right atrial dilatation associated with atrial fibrillation, a common finding in patients with LVSD. Finally, TR can result as a iatrogenic consequence of transvalvular lead insertion, another frequent scenario in this cohort of patients. Nonetheless, despite the significant coincidence of these two conditions, their mutual relation, and the independent prognostic role of TR is still a matter of debate. Whether significant TR is just a marker for advanced left-heart disease, or a crucial potential therapeutical target, remains unclear. Aim of the authors in this review is to present an update concerning the epidemiological features and the clinical burden of TR in the context of LVSD, its prognostic value, and the potential benefit for early tricuspid intervention in patients affected by contemporary TR and LVSD.
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- 2021
6. Use of edge-to-edge percutaneous mitral valve repair for severe mitral regurgitation in cardiogenic shock: A multicenter observational experience (MITRA-SHOCK study)
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Michele De Bonis, Francesco Ancona, Mara Scandroglio, Giacomo Ingallina, Antonio Colombo, Federico Ronco, Renato Valenti, Laura Lupi, Giulio Falasconi, Alessandro Castiglioni, Stefano Stella, Kusha Rahgozar, Luca Branca, Rodolfo Citro, Matteo Montorfano, Cristina Capogrosso, Luigi Pannone, Marianna Adamo, Francesco Melillo, Eustachio Agricola, Cosmo Godino, Nazario Carrabba, Paolo Denti, Azeem Latib, Falasconi, Giulio, Melillo, Francesco, Pannone, Luigi, Adamo, Marianna, Ronco, Federico, Latib, Azeem, Rahgozar, Kusha, Carrabba, Nazario, Valenti, Renato, Citro, Rodolfo, Stella, Stefano, Ingallina, Giacomo, Capogrosso, Cristina, Scandroglio, Mara, Ancona, Francesco, Godino, Cosmo, Denti, Paolo, Castiglioni, Alessandro, De Bonis, Michele, Colombo, Antonio, Lupi, Laura, Branca, Luca, Montorfano, Matteo, and Agricola, Eustachio
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Male ,medicine.medical_specialty ,MitraClip® ,cardiogenic shock ,mechanical circulatory support ,percutaneous mitral valve repair ,Aged ,Female ,Humans ,Mitral Valve ,Retrospective Studies ,Shock, Cardiogenic ,Treatment Outcome ,Heart Valve Prosthesis Implantation ,Mitral Valve Insufficiency ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Interquartile range ,Internal medicine ,Mitral valve ,medicine ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Mitral regurgitation ,business.industry ,Cardiogenic shock ,MitraClip ,Shock ,General Medicine ,medicine.disease ,Cardiogenic ,medicine.anatomical_structure ,Shock (circulatory) ,Concomitant ,Cardiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Percutaneous Mitral Valve Repair - Abstract
Objectives The aim of this study was to evaluate the impact of edge-to-edge PMVR on short and mid-term clinical outcomes in patients with CS and severe MR.Background Severe mitral regurgitation (MR) in the setting of cardiogenic shock (CS) is associated with three times higher risk of 1-year mortality. In refractory CS, edge-to-edge percutaneous mitral valve repair (PMVR) can be a potential therapeutic option.Methods We retrospectively included consecutive patients with refractory CS and concomitant severe MR treated with MitraClip (R) system. CS was defined according to the criteria used in the SHOCK trial and procedural success according to Mitral Valve Academic Research Consortium (MVARC) criteria. The 30-day and 6-month mortality were the primary and secondary endpoints respectively.Results Thirty-one patients (median age 73 years [interquartile range, IQR 66-78], 25.8% female), STS mortality score 37.9 [IQR 30.4-42.4]), with CS and concomitant severe MR treated with edge-to-edge PMVR were retrospectively enrolled. Procedural success was 87.1%. Thirty-day and 6-month survival rates were 78.4 and 45.2% respectively. Univariate Cox Regression Model analysis showed that procedural success was a predictor of both 30-day (HR = 0.12, 95% CI 0.03-0.55, p < .01) and 6-month survival (HR = 0.22, 95% CI 0.06-0.84, p = .027).Conclusions Edge-to-edge PMVR in patients with CS and concomitant severe MR was associated with good procedural safety and success with acceptable short and mid-term survival rates. It could be considered a bailout option in this setting of patients.
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- 2021
7. Impact on outcome of different etiologies, baseline degree and improvement of mitral regurgitation in patients with aortic stenosis who underwent transcatheter aortic valve replacement
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Francesco Ancona, Giacomo Ingallina, Antonio Colombo, Francesco Melillo, Cristina Capogrosso, Stefano Stella, Eustachio Agricola, Matteo Montorfano, and F Putorti
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Mitral regurgitation ,medicine.medical_specialty ,Transcatheter aortic ,business.industry ,medicine.medical_treatment ,General Medicine ,medicine.disease ,Stenosis ,Valve replacement ,Aortic valve stenosis ,Internal medicine ,Etiology ,Cardiology ,Medicine ,Radiology, Nuclear Medicine and imaging ,In patient ,Cardiology and Cardiovascular Medicine ,business ,Functional mitral regurgitation - Abstract
Funding Acknowledgements Type of funding sources: None. Background - Mitral regurgitation (MR) is a frequent finding in patients with aortic stenosis (AS). Moderate or severe MR is present in up to one-third of pts undergoing TAVR and it is a negative prognostic factor as well as the presence of residual MR after TAVR. However, whether different etiologies/mechanisms of MR have different effects on outcome and MR degree changes after TAVR is yet unknown. Aim – The aim of the study is to evaluate the prognostic impact of baseline MR degree and its changes after TAVR procedures according to different etiologies of MR in patients who underwent TAVR. Methods - We performed a retrospective observational study on a cohort of patients who underwent TAVR between January 2015 and December 2019. During the index period 947 pts underwent TAVR. To better characterize the mechanism of MR only pts with pre-procedural 3D transesophageal echocardiographic and at least one follow-up available study were included. The final study population consisted of 224 pts. MR severity was evaluated by multiparametric approach and classified in 4 degrees. The study population was further divided in 4 groups: Group I: fibro-calcific degeneration of the leaflets (78.6% pts); 2. Group II: prolapse or flail (4.4% pts); Group III: functional MR (FMR) due to leaflets tethering (5.6% pts); Group IV: FMR due to annular dysfunction or dilatation (11.3% pts). Primary outcome was all-cause of death. Results and Discussion – MR was absent in 15 pts (6.7%), mild in 79 pts (35.7%), mild-to-moderate in 109 in pts (49.3%), moderate-to-severe in 7 pts (3.1%) and severe in 11 pts (4.9%). Patients with > moderate MR degree at baseline had a worse outcome than patients with < moderate MR degree (p log rank = 0.029). FMR (groups III and IV) was associated with better outcome than organic MR (groups I and II) (p log rank = 0.035). Moreover, group IV showed a better outcome compared groups I (p log rank = 0.047) and II (p log rank = 0.038). Patients who showed improvement of MR of at least 1 degree post TAVR showed better outcome compared to patients without improvement (p log rank = 0.04). At multivariate analysis, including pre procedural MR > 2+, pre procedural TR > 2+, organic vs functional etiology and MR improvement after TAVR as covariates, only baseline MR > moderate was an independent predictor of mortality (HR 6.3; 95% CI 1.4 -27.0; p Conclusion - This study confirms the prognostic role of the baseline degree of MR in patients with AS undergoing TAVR. Moreover, this is the first study demonstrating that FMR due to annular dilatation but not due to leaflet tethering is associated with better outcome compared to organic etiologies.
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- 2021
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8. Subclinical myocardial dysfunction in patients recovered from COVID-19
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Paolo Scarpellini, Francesco Ancona, Stefano Stella, Eustachio Agricola, Giacomo Ingallina, Marco Rolando, Fabio Ciceri, Moreno Tresoldi, Francesco Cannata, Gabriele Fragasso, Francesco Melillo, Francesco De Cobelli, Antonio Esposito, Marco Ripa, Alessandro Ortalda, Antonio Boccellino, Antonio Napolano, Patrizia Rovere, Martina Belli, Antonella Castagna, Leonardo Italia, Beatrice Righetti, Italia, L., Ingallina, G., Napolano, A., Boccellino, A., Belli, M., Cannata, F., Rolando, M., Ancona, F., Melillo, F., Stella, S., Ripa, M., Scarpellini, P., Tresoldi, M., Ortalda, A., Righetti, B., De Cobelli, F., Esposito, A., Ciceri, F., Castagna, A., Rovere, P. Q., Fragasso, G., and Agricola, E.
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medicine.medical_specialty ,Myocarditis ,heart failure ,Ventricular Function, Left ,Group B ,strain ,COVID‐19 ,Internal medicine ,Natriuretic Peptide, Brain ,medicine ,Humans ,echocardiography ,Radiology, Nuclear Medicine and imaging ,Subclinical infection ,Ejection fraction ,business.industry ,Myocardium ,COVID-19 ,Heart ,Stroke Volume ,Original Articles ,medicine.disease ,Brain natriuretic peptide ,Peptide Fragments ,Cross-Sectional Studies ,medicine.anatomical_structure ,Echocardiography ,Ventricle ,Heart failure ,Cohort ,Cardiology ,Original Article ,myocarditis ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background: Myocardial injury (MI) can be detected during the acute phase of Coronavirus disease 19 (COVID-19) and is associated with a dismal prognosis. Recent imaging studies described the persistence of cardiac abnormalities after the recovery. The aim of the study was to investigate the spectrum of cardiac abnormalities at mid-term follow-up in patients recovered from COVID-19 using clinical assessment, laboratory tests, and imaging evaluation with comprehensive echocardiography. Methods: This is an observational, cross-sectional study assessing an unselected cohort of consecutive patients recovered from COVID-19. MI was defined by elevated plasma levels of high sensitive troponin T (hsTnT). At the follow-up, a complete examination including echocardiography was performed. Results: The 123 patients included were divided into two groups according to the presence of MI during hospitalization: group A (without MI) and group B (with MI). After a median of 85 days, group B patients were more frequently symptomatic for dyspnea and had significantly higher values of hsTnT and N-Terminal prohormone of Brain Natriuretic Peptide (NT-proBNP), compared to Group A. No differences between the two groups in left nor right ventricle dimension and ejection fraction were found. However, in group B a significant reduction of mean left ventricle global longitudinal strain was observed (-15.7±.7vs -18.1±.3 in group A, p 
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- 2021
9. Transcatheter mitral valve interventions: pre-procedural planning and intra-procedural guidance
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Paolo Denti, Giacomo Ingallina, Francesco Faletra, Eustachio Agricola, Francesco Melillo, Stefano Stella, Antonio Napolano, Antonio Boccellino, Francesco Ancona, Cristina Capogrosso, Boccellino, Antonio, Melillo, Francesco, Ancona, Francesco, Napolano, Antonio, Ingallina, Giacomo, Capogrosso, Cristina, Stella, Stefano, Denti, Paolo, Faletra, Francesco F, and Agricola, Eustachio
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medicine.medical_specialty ,Percutaneous ,Mitral Valve Annuloplasty ,medicine.medical_treatment ,Conventional surgery ,Psychological intervention ,Mitral valve ,medicine ,Fluoroscopy ,Humans ,cardiovascular diseases ,Heart Valve Prosthesis Implantation ,Mitral regurgitation ,medicine.diagnostic_test ,business.industry ,Mitral valve replacement ,Mitral Valve Insufficiency ,medicine.disease ,medicine.anatomical_structure ,cardiovascular system ,Mitral Valve ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Mitral valve regurgitation ,Echocardiography, Transesophageal - Abstract
Mitral regurgitation is the most prevalent valve disease worldwide. Percutaneous mitral valve interventions are emerging as alternative options for high-risk patients with severe mitral regurgitation not eligible for conventional surgery. Accurate patient selection is based on a detailed pre-procedural multimodality imaging evaluation. Morphology and functional anatomy of the mitral valve should be evaluated to determine the feasibility of treatments and to identify the best therapeutic approach. The procedures are guided by fluoroscopy, transoesophageal echocardiography and fusion imaging, ensuring a continuous communication between the interventionalist and the imaging specialist. The present review will cover the pre-procedural planning and the intra-procedural guidance of the most used transcatheter approaches in the setting of native mitral valve regurgitation: edge to edge repair, percutaneous direct and indirect annuloplasty, transapical beating-heart chordal implantation and transcatheter mitral valve replacement.
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- 2021
10. Systematic Fluoroscopic-Echocardiographic Fusion Imaging Protocol for Transcatheter Edge-to-Edge Mitral Valve Repair Intraprocedural Monitoring
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Matteo Montorfano, Francesco Ancona, Stefano Stella, Eustachio Agricola, Cosmo Godino, Davide Maccagni, Giacomo Ingallina, Antonio Colombo, Azeem Latib, Vittorio Romano, Francesco Melillo, Andrea Fisicaro, Stefania Ruggeri, Cristina Capogrosso, Melillo, F., Fisicaro, A., Stella, S., Ancona, F., Capogrosso, C., Ingallina, G., Maccagni, D., Romano, V., Ruggeri, S., Godino, C., Latib, A., Montorfano, M., Colombo, A., and Agricola, E.
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medicine.medical_specialty ,Percutaneous mitral valve repair ,medicine.medical_treatment ,Population ,030204 cardiovascular system & hematology ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Fluoroscopy ,Humans ,Radiology, Nuclear Medicine and imaging ,education ,Heart Valve Prosthesis Implantation ,Mitral valve repair ,Mitral regurgitation ,Percutaneous repair ,education.field_of_study ,3D echocardiography ,medicine.diagnostic_test ,business.industry ,MitraClip ,Mitral Valve Insufficiency ,Odds ratio ,Fusion imaging ,Echocardiography ,Mitral Valve ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Percutaneous Mitral Valve Repair - Abstract
Background Whether fluoroscopic-echocardiographic fusion imaging (FI) might offer added value for intraprocedural guidance during transcatheter edge-to-edge mitral valve repair is yet unknown, and few data exist regarding the safety and feasibility of this novel technology. Methods The aim of this single-center study was to test and validate a FI protocol for intraprocedural monitoring of transcatheter edge-to-edge mitral valve repair and assess its clinical usefulness. Eighty patients underwent MitraClip implantation using FI guidance (FI+) for either degenerative (35%) or functional (65%) mitral regurgitation and were compared with the last 80 patients before FI introduction, treated using conventional echocardiography and fluoroscopic monitoring (FI−). Results The number of patients treated for functional and degenerative mitral regurgitation was similar between the FI+ and FI− groups, as well as the number of devices implanted (1.51 ± 0.5 vs 1.58 ± 0.6, P = .46). The prevalence of complex mitral anatomy for percutaneous repair was high (32.5%, up to 39.2% in the hybrid arm). Fluoroscopy time was significantly lower in FI+ patients (37.3 ± 14.6 vs 48.3 ± 28.3 min, P = .003), but not kerma area product (91.5 ± 74.1 vs 108.8 ± 105.0 Gy · cm2, P = .23) or procedural time (92.2 ± 36.1 vs 103.1 ± 42.7 min, P = .086). After adjusting for confounding factors (MitraClip XT device and complex anatomy), FI reduced fluoroscopy time (coefficient = −10.4 min; 95% CI, −18.03 to −2.82; P = .007) and improved procedural success at the end of the procedure (odds ratio, 2.87; 95% CI, 1.00 to 8.24; P = .049) and discharge (odds ratio, 2.24; 95% CI, 1.04 to 4.80; P = .039). Rates of periprocedural complications were similar in both groups (8.9% vs 13.0%, P = .40). Conclusions The authors describe the systematic use of an FI protocol for intraprocedural guidance during transcatheter edge-to-edge mitral valve repair, demonstrating a reduction in fluoroscopy time and an improvement in procedural success in a population with a high prevalence of challenging mitral anatomy for percutaneous repair.
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- 2021
11. Multimodality imaging for preprocedural planning of percutaneous mitral valve repair: a comprehensive review
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Eustachio Agricola, Francesco Melillo, Cristina Capogrosso, Antonio Boccellino, Antonio Napolano, Giacomo Ingallina, Stefano Stella, and Francesco Ancona
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medicine.medical_specialty ,business.industry ,Medicine ,Radiology ,business ,3d echocardiography ,Percutaneous Mitral Valve Repair - Published
- 2020
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12. Intraprocedural guidance in percutaneous mitral valve repair
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Antonio Boccellino, Francesco Ancona, Giacomo Ingallina, Stefano Stella, Antonio Napolano, Francesco Melillo, Cristina Capogrosso, and Eustachio Agricola
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medicine.medical_specialty ,Mitral regurgitation ,business.industry ,Internal medicine ,Cardiology ,Medicine ,business ,Percutaneous Mitral Valve Repair - Published
- 2020
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13. Use of MitraClip system for severe mitral regurgitation in cardiogenic shock: results from a multicentre observational Italian experience (the MITRA-SHOCK study)
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Luigi Pannone, N Carrabba, Eustachio Agricola, Giulio Falasconi, F Ronco, Francesco Melillo, Mara Scandroglio, Rodolfo Citro, Stefano Stella, Paolo Denti, Giacomo Ingallina, Matteo Montorfano, Francesco Ancona, Cristina Capogrosso, and Marianna Adamo
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medicine.medical_specialty ,Mitral regurgitation ,business.industry ,Cardiogenic shock ,MitraClip ,medicine.disease ,Intensive care unit ,law.invention ,medicine.anatomical_structure ,law ,Internal medicine ,Mitral valve ,Shock (circulatory) ,Cardiology ,Medicine ,Observational study ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Percutaneous Mitral Valve Repair - Abstract
Background/Introduction Cardiogenic shock (CS) is a medical emergency and a frequent cause of death. CS can be complicated by mitral regurgitation (MR). The presence of at least moderate MR in the setting of shock was associated with about three-times higher odds of 1-year mortality. In the setting of refractory CS, percutaneous mitral valve repair (PMVR) can be a potential therapeutic option. Purpose The aim of the study was to evaluate the efficacy of percutaneous approach of severe MR in patients with CS assessing short-term clinical outcomes. Methods In this study we retrospectively included patients with CS and concomitant severe MR treated with Mitraclip system. We enrolled 28 patients from 5 Italian centers between 2012 and 2019. MitraClip implantation was performed according to each hospital standard care. CS was defined utilizing the Diagnostic Criteria of Cardiogenic Shock used in the SHOCK trial. Procedural success was defined as the presence of moderate or less MR after MitraClip implantation. Results All patients presented at least severe MR. All treated patients were at high surgical risk (STS mortality score 36.4±11.7%). Procedural success was obtained in 24 patients (86%). A mean of 1.71±0.76 clips per patients were implanted. In-hospital complications occurred in 13 patients (46%): 7 minor bleedings (25% of patients), 7 major bleedings (25%), 8 acute kidney injuries (28%). In-hospital mortality was 25% and the reported causes of death were cardiovascular in all patients. At Cox multivariate analysis procedural success was a strong predictor of in-hospital survival (HR 0.11, CI 95% 0.02–0.67, p=0.017). Conclusions PMVR with Mitraclip system in patients with CS and concomitant MR demonstrated high procedural success and acceptable safety. It can be considered a bailout option in this setting of patients with high short-term mortality. Larger prospective studies are needed. In-hospital mortality predictors Funding Acknowledgement Type of funding source: None
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- 2020
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14. Persistent pulmonary vein thrombosis
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Francesco Ancona, R Mellone, Giacomo Ingallina, Francesco Melillo, Cristina Capogrosso, Eustachio Agricola, Stefano Stella, Marco Rolando, Rolando, M., Ingallina, G., Stella, S., Mellone, R., Ancona, F., Capogrosso, C., Melillo, F., and Agricola, E.
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Venous Thrombosis ,medicine.medical_specialty ,Pulmonary Circulation ,business.industry ,MEDLINE ,Pulmonary vein thrombosis ,Text mining ,Predictive Value of Tests ,Pulmonary Veins ,Internal medicine ,medicine ,Cardiology ,Humans ,Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine ,business ,Pulmonary Embolism ,Cardiac imaging - Published
- 2020
15. Giant right pulmonary vein thrombus
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Cristina Capogrosso, Stefano Stella, Francesco Ancona, Giacomo Ingallina, Francesco Melillo, Marco Rolando, Eustachio Agricola, and Mellone Renata
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medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Hemodynamics ,Computed tomography ,Pulmonary vessels ,medicine.disease ,Right pulmonary vein ,Compliance (physiology) ,Stenosis ,Pulmonary vein thrombosis ,cardiovascular system ,Medicine ,Radiology ,Thrombus ,business ,human activities - Abstract
Pulmonary Vein Thrombosis (PVT) is a rare and insidious condition with only few case series and case reports described in literature. PVT effects on pulmonary circulation is similar to mitral stenosis and its haemodynamic consequences depend on the number of veins involved, the obstruction severity and the pulmonary vessels compliance. Here we present a case in which a multimodality approach with Transesophageal Echocardiography (TEE) and Computed Tomography (CT) imaging helped to guide therapeutic decisions. Specifically, a post-processing reconstruction of TEE projection directly from CT imaging was performed.
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- 2020
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16. Aortic valve area calculation using 3D transesophageal echocardiography: Implications for aortic stenosis severity grading
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Marco Ancona, Antonio Esposito, Stefano Stella, Anna Palmisano, Giacomo Ingallina, Matteo Montorfano, Antonio Colombo, Giulio Falasconi, Francesco Moroni, Luigi Pannone, Azeem Latib, Francesco Melillo, Eustachio Agricola, Vittorio Romano Rt, Alessandro Beneduce, Francesco Ancona, Cristina Capogrosso, Beneduce, A., Capogrosso, C., Moroni, F., Ancona, F., Falasconi, G., Pannone, L., Stella, S., Ingallina, G., Melillo, F., Ancona, M. B., Romano RT, V., Palmisano, A., Latib, A., Colombo, A., Montorfano, M., Esposito, A., and Agricola, E.
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Male ,Echocardiography, Three-Dimensional ,multidetector computed tomography ,Severity grading ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Multidetector computed tomography ,medicine ,Cutoff ,Ventricular outflow tract ,Humans ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Grading (tumors) ,Reproducibility ,business.industry ,aortic stenosis ,Reproducibility of Results ,Stroke volume ,Aortic Valve Stenosis ,medicine.disease ,Stenosis ,Aortic Valve ,3D transesophageal echocardiography ,cardiovascular system ,Female ,Cardiology and Cardiovascular Medicine ,Nuclear medicine ,business ,human activities ,Echocardiography, Transesophageal - Abstract
Aims: Aortic stenosis (AS) grading by 2D-transthoracic echocardiography (2D-TTE) aortic valve area (AVA) calculation is limited by left ventricular outflow tract (LVOT) area underestimation. The combination of Doppler parameters with 3D LVOT area obtained by multidetector computed tomography (MDCT) can improve AS grading, reconciling discordant 2D-TTE findings. This study aimed to systematically evaluate the role of 3D-transesophageal echocardiography (3D-TEE) in AS grading using MDCT as reference standard. Methods and results: 288 patients (81±6.3years, 52.4% female) with symptomatic AS underwent 2D-TTE, 3D-TEE, and MDCT for transcatheter aortic valve implantation. Doppler parameters were combined with 3D LVOT areas measured by manual and semi-automated software 3D-TEE and by MDCT to calculate AVA, reassessing AS severity. Both 3D-TEE modalities demonstrated good correlation with MDCT, with excellent intra-observer and inter-observer variability. Compared to MDCT, 3D-TEE measurements significantly underestimated AVA (PANOVA 
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- 2020
17. Heart and Lung Multimodality Imaging in COVID-19
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Alberto Zangrillo, Giacomo Ingallina, Francesco De Cobelli, Antonio Esposito, Matteo Pagnesi, Alessandro Beneduce, Luca Baldetti, Anna Palmisano, Giulio Melisurgo, Diego Palumbo, Eustachio Agricola, Francesco Ancona, Agricola, Eustachio, Beneduce, Alessandro, Esposito, Antonio, Ingallina, Giacomo, Palumbo, Diego, Palmisano, Anna, Ancona, Francesco, Baldetti, Luca, Pagnesi, Matteo, Melisurgo, Giulio, Zangrillo, Alberto, and De Cobelli, Francesco
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CMR, Cardiac Magnetic Resonance ,Chest X-Ray ,Disease ,030204 cardiovascular system & hematology ,Global Health ,Multimodal Imaging ,030218 nuclear medicine & medical imaging ,0302 clinical medicine ,Myocardial infarction ,LUS, Lung Ultrasound ,Lung ,Subclinical infection ,Lung ultrasound ,Incidence (epidemiology) ,Incidence ,ARDS, Acute Respiratory Distress Syndrome ,Multimodality Imaging ,Heart ,CT, Computed Tomography ,Pulmonary embolism ,FoCUS, Focused Cardiac Ultrasound ,medicine.anatomical_structure ,ICA, Invasive Coronary Angiography ,Radiology Nuclear Medicine and imaging ,Echocardiography ,PPE, Personal Protection Equipment ,COVID-19, Coronavirus Disease 2019 ,Cardiac Magnetic Resonance ,Cardiology and Cardiovascular Medicine ,Coronavirus Infections ,medicine.medical_specialty ,Myocarditis ,RT-PCR, Real-Time Polymerase Chain Reaction ,Heart Diseases ,Pneumonia, Viral ,Magnetic Resonance Imaging, Cine ,Article ,03 medical and health sciences ,Betacoronavirus ,Computed Tomography ,ICU, Intensive Care Unit ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Intensive care medicine ,Pandemics ,business.industry ,SARS-CoV-2 ,COVID-19 ,CXR, Chest X-Ray ,medicine.disease ,Coronavirus ,SARS-CoV-2, Severe Acute Respiratory Syndrome Coronavirus 2 ,Heart failure ,business ,Tomography, X-Ray Computed - Abstract
SARS-CoV-2 outbreak has rapidly reached a pandemic proportion and has become a major threaten to global health. Although the predominant clinical feature of COVID-19 is an acute respiratory syndrome of varying severity, ranging from mild symptomatic interstitial pneumonia to acute respiratory distress syndrome, the cardiovascular system can be involved with several facets. As many as 40% hospitalized patients presenting with COVID-19 have pre-existing history of cardiovascular disease and current estimates report a proportion of myocardial injury in COVID-19 patients ranging up to 12%. Multiple pathways have been advocated to explain this finding and the related clinical scenarios, encompassing local and systemic inflammatory response and oxygen supply-demand imbalance. From a clinical point of view, cardiac involvement during COVID-19 may present a wide spectrum of severity ranging from subclinical myocardial injury to well-defined clinical entities (myocarditis, myocardial infarction, pulmonary embolism and heart failure), whose incidence and prognostic implications are currently largely unknown due to a significant lack of imaging data. The use of integrated heart and lung multimodality imaging plays a central role in different clinical settings and is essential in diagnosis, risk stratification and management of COVID-19 patients. Aim of this review is to summarize imaging-oriented pathophysiological mechanisms of lung and cardiac involvement in COVID-19 and to provide a guide for an integrated imaging assessment in these patients., Graphical abstract, Highlights • Although lung injury is predominant, cardiac involvement is present in up to 12% of COVID-19 patients. • Heart and lung multimodality imaging plays an essential role in different clinical settings in COVID-19 patients. • Multimodality imaging findings are useful in diagnosis, risk stratification and management of COVID-19 patients. • Strategies for preventing SARS-CoV-2 transmission during examinations in Imaging Departments must be adopted.
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- 2020
18. Lung ultrasound-guided therapy reduces acute decompensation events in chronic heart failure
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Eustachio Agricola, Vincenzo Tufaro, Alberto Margonato, Sirvard Gabrielyan, Ferdinando Loiacono, Stefano Stella, Laura Sahakyan, Leonardo Italia, Hamayak Sisakian, Claudia Marini, Gabriele Fragasso, Mariam Avetisyan, Giacomo Ingallina, Marco Fabio Costantino, Francesco Ancona, Pasquale Innelli, Marini, Claudia, Fragasso, Gabriele, Italia, Leonardo, Sisakian, Hamayak, Tufaro, Vincenzo, Ingallina, Giacomo, Stella, Stefano, Ancona, Francesco, Loiacono, Ferdinando, Innelli, Pasquale, Costantino, Marco Fabio, Sahakyan, Laura, Gabrielyan, Sirvard, Avetisyan, Mariam, Margonato, Alberto, and Agricola, Eustachio
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Male ,medicine.medical_specialty ,Acute decompensated heart failure ,heart failure ,Physical examination ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,Internal medicine ,medicine ,Clinical endpoint ,Humans ,Decompensation ,heart failure with reduced ejection fraction ,030212 general & internal medicine ,Lung ,Ultrasonography, Interventional ,Subclinical infection ,Aged ,Heart Failure ,medicine.diagnostic_test ,business.industry ,medicine.disease ,Heart failure ,Relative risk ,Therapy, Computer-Assisted ,Acute Disease ,Chronic Disease ,Number needed to treat ,Female ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
ObjectivePulmonary congestion is the main cause of hospital admission in patients with heart failure (HF). Lung ultrasound (LUS) is a useful tool to identify subclinical pulmonary congestion. We evaluated the usefulness of LUS in addition to physical examination (PE) in the management of outpatients with HF.MethodsIn this randomised multicentre unblinded study, patients with chronic HF and optimised medical therapy were randomised in two groups: ‘PE+LUS’ group undergoing PE and LUS and ‘PE only’ group. Diuretic therapy was modified according to LUS findings and PE, respectively. The primary endpoint was the reduction in hospitalisation rate for acute decompensated heart failure (ADHF) at 90-day follow-up. Secondary endpoints were reduction in NT-proBNP, quality-of-life test (QLT) and cardiac mortality at 90-day follow-up.ResultsA total of 244 patients with chronic HF and optimised medical therapy were enrolled and randomised in ‘PE+LUS’ group undergoing PE and LUS, and in ‘PE only’ group. Thirty-seven primary outcome events occurred. The hospitalisation for ADHF at 90 day was significantly reduced in ‘PE+LUS’ group (9.4% vs 21.4% in ‘PE only’ group; relative risk=0.44; 95% CI 0.23 to 0.84; p=0.01), with a reduction of risk for hospitalisation for ADHF by 56% (p=0.01) and a number needed to treat of 8.4 patients (95% CI 4.8 to 34.3). At day 90, NT-proBNP and QLT score were significantly reduced in ‘PE+LUS’ group, whereas in ‘PE only’ group both were increased. There were no differences in mortality between the two groups.ConclusionsLUS-guided management reduces hospitalisation for ADHF at mid-term follow-up in outpatients with chronic HF.
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- 2020
19. P271 Hypoplastic posterior mitral leaflet associated with Marfan syndrome
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Eustachio Agricola, O. Alfieri, Stefano Stella, Alessandro Castiglioni, Giacomo Ingallina, Francesco Ancona, Cristina Capogrosso, M De Bonis, and Elvin Tafciu
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Marfan syndrome ,business.industry ,cardiovascular system ,medicine ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,General Medicine ,Anatomy ,Cardiology and Cardiovascular Medicine ,medicine.disease ,Posterior mitral leaflet ,business - Abstract
A sixty-two years old female presents with shortness of breath. She has Marfan syndrome (c.6448C > T mutation variant) with a previous history relevant for type A aortic dissection which was treated by Bentall procedure with a mechanical aortic prosthesis and ascending aorta prosthesis, coronary artery bypass graft on the right coronary artery and pacemaker for third degree AV block; subsequent aortic arch reconstruction and endovascular repair of the descending aorta for thoracic aorta aneurism rupture. Upon visit she is in NYHA class III, blood pressure of 145/85 mmHg and heart rate of 75 bpm. A systolic murmur with a prosthetic second tone was heard at heart auscultation and bilateral crackles were heard at pulmonary auscultation. Peripheral pulses were symmetrical. ECG showed sinus rhythm, right bundle branch block with left anterior hemiblock and left ventricular hypertrophy. Blood tests were within normal range. Chest X-ray showed bilateral pulmonary congestion. She underwent transesophageal echocardiography which showed severe mitral regurgitation (MR) with a normal bi-ventricular systolic function. Posterior mitral leaflet (PML) was severely hypoplastic especially at the level of P1 which was confirmed by CT (see picture). Diuretic therapy together with an ACE inhibitor was introduced with a decrease in MR severity. The patients was sent home with an indication for strict follow up visits. Congenital mitral valve defects are very rare and can be isolated or associated with other cardiac malformations. Limited data are available about hypoplastic posterior mitral leaflet (PML) including singular case reports or anecdotal descriptions, therefore its etiology, association with other cardiac or systemic syndromes and prognosis is not well understood. However, it is suggested that absence of PML has a high fetal or infant mortality due to severe mitral regurgitation (MR). The degree of MR varies among patients and in the same patient at different timepoints as it depends on anatomical variations of the anterior mitral leaflet, residual PML tissue, posterior ventricular wall conformation and other associated cardiac abnormalities. We showed a case of a patient with hypoplastic PML and advanced age with a concomitant history of Marfan syndrome. Picture legend (A) Mid-esophageal 4-chamber view shows severe hypoplasia of PML (red arrow) and the posterior ventricular myocardial shelf (green arrow). (B) Mid-esophageal commissural view shows a large central MR jet. (C) 3D ventricular perspective of the mitral valve: an almost complete absence of the PML can be appreciated in the central and lateral scallops (grey arrows). (D) CT 3 chamber view shows the myocardial shelf which takes the role of the posterior mitral annulus (blue arrow) and direct PML chordal insertion into the ventricular wall (yellow arrow). (E) CT reconstruction of the mitral valve shows a virtually absent P1 (< 1mm), a P2 length of 4.1 mm, and a P3 length of 5 mm. Abstract P271 Figure. Hypoplastic posterior mitral leaflet
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- 2020
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20. 1183 Three-dimensional echocardiographic paramenters for mitral valve quantification: a feasibility and validation study
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Giacomo Ingallina, Alessandro Castiglioni, Francesco Ancona, Cristina Capogrosso, G Granata, Eustachio Agricola, Stefano Stella, Elvin Tafciu, O. Alfieri, M De Bonis, and Francesco Melillo
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medicine.medical_specialty ,Validation study ,medicine.anatomical_structure ,business.industry ,Internal medicine ,Mitral valve ,medicine ,Cardiology ,Radiology, Nuclear Medicine and imaging ,General Medicine ,Cardiology and Cardiovascular Medicine ,business - Abstract
Introduction Mitral regurgitation (MR) severity affects prognosis and a correct quantification is key for surgical indication. A multiparametric approach (MPA) is recommended, as singular parameters suffer pitfalls. Recently suggested three-dimensional echocardiographic (3DE) parameters lack clear reference values. No studies have assessed the feasibility of regurgitant volume (RV) and fraction (RF) using the 3D planimetric area of the mitral annulus (MAA) and of the left ventricular outflow tract (LVOTA). Purpose To assess the feasibility and reliability of 3DE, RV and RF obtained by doppler volumetric method using MAA and LVOTA, compare results with 2DE and 3D vena contracta area (VCA) and propose cut-offs for these parameters using MPA as gold standard. Methods Patients referred to our Department for MR assessment were enrolled from September 2018 to February 2019 without more than mild aortic regurgitation or severe stenosis, mitral stenosis and previous valvular surgery. Transthoracic 2DE was used to calculate a multiparametric index of MR severity including: jet area/left atrium (LA) area, CW characteristics, 2D vena contracta, PISA, pulmonary vein flow, LA volume and systolic pulmonary artery pressure. Transoesophageal 3DE was used to assess MAA and LVOTA from a 3D dataset. RV and RF were calculated by Doppler volumetric method using the planimetric areas instead of diameters. VCA 3D was calculated from a 3D color dataset as the cross-sectional area of the regurgitant jet. We compared the results between 2DE and 3DE and between functional and organic MR. ROC curves were analyzed to assess diagnostic performance and identify cut-offs for severity prediction. Intraclass correlation coefficient was calculated to assess variability in measurements. Results Population was composed by 87 patients (56 male, 65 ± 13 years), 72% organic MR. MAA was larger in 2DE (10.4 ± 3.2 vs 9.8 ± 2.9 cm2,) as was the RV (76.6 ± 36.1 vs 66.4 ± 31.9 ml) and RF (55.4 ± 12.4 vs 50.4 vs 10.9%, all p < 0.0001), while LVOTA was smaller (3.9 ± 0.98 vs 4.1 ± 1.0 cm2, p < 0.0001). RV 2D and RF 2D were larger in the organic MR group (p < 0.0001), meanwhile VCA 3D, RV 3D and RF 3D did not show a significant difference (all p > 0.1). VCA 3D had a good correlation with RV 3D (r = 0.593, p < 0.0001) and RF 3D (r = 0.576, p < 0.0001). We proposed a cut-off value of 41.5 mm2 for VCA 3D (94% sens, 96% spec, AUC 0.978), 52 ml for RV 3D (84% sens, 78% spec, AUC 0.901) and 47.6% for RF 3D (91% sens, 90% spec, AUC 0.966) to predict MR severity as assessed by MPA. Intraclass correlation coefficient was 0.980 for MAA and 0.985 for LVOTA for intra-observer variability, while for inter-observer variability it was 0.951 for MAA and 0.962 for LVOTA. Conclusion 2DE overestimates MA dimensions and underestimates LVOT dimensions thus overestimating RV and RF. 3DE measures are relatively simple and reproducible. Proposed cut-offs for RV, RF and VCA 3D have a good diagnostic power.
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- 2020
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21. Lung Ultrasound to Predict COVID-19 Pneumonia: A Multicenter Descriptive Study
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Lorenzo Ghiadoni, Stefano Perlini, Francesco Salinaro, Nogué M, Francesco Corradi, Michele Covella, Robinson M Ferre, McDermott C, Caterina Zattera, Giacomo Ingallina, Luna Gargani, Luigi Vetrugno, Julia Burkert, Enrico Boero, Alessandro Lamorte, Andrea Boccatonda, Fraga Dn, Paolo Frumento, Greta Barbieri, Peiman Nazerian, Cristiano Perani, Francesco Forfori, Gianmarco Secco, Stefanone, Eustachio Agricola, Paramjeet Singh Deol, Fabrizio Giostra, Stefano Spinelli, Tomás Villén, García Cg, Aguiar Fm, Paolo Navalesi, Giovanni Volpicelli, Antonella Lanotte, Alice Grignaschi, Giampaolo Martinelli, Cristoni L, Covid IMSoLi, and Bou Rn
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Pneumonia ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Internal medicine ,medicine ,Descriptive research ,medicine.disease ,business ,Lung ultrasound - Published
- 2020
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22. P1251 Percutaneous closure of two mitral perivalvular leaks: when the imaging guides the hands during threatening complications
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Giacomo Ingallina, A Ruggio, Cristina Capogrosso, Luigi Pannone, Francesco Melillo, D Cocco, Francesco Ancona, Stefano Stella, Matteo Montorfano, and Eustachio Agricola
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medicine.medical_specialty ,Percutaneous ,business.industry ,Closure (topology) ,Medicine ,Radiology, Nuclear Medicine and imaging ,General Medicine ,Cardiology and Cardiovascular Medicine ,business ,Surgery - Abstract
With the contemporary development of structural interventional cardiology the prevalence of perivalvular leaks (PVL) is expected to grow. Advanced multimodality imaging is necessary for the guidance of transcatheter closure of PVL. We describe the case of a 57 year-old woman who underwent transcatheter mitral PVL closure. Past clinical history included a lymphoma treated with chemio and radiotherapy. Six months before she underwent a surgical replacement of the aortic and mitral valves with two mechanical prosthesis for severe aortic and mitral stenosis. Because of the calcium burden in both the annuluses, undersized mitral valve prosthesis was implanted leading to the presence of two moderate mitral PVL. The patient subsequently required hospitalization for acute HF and hemolytic anemia and received multiple blood transfusions. TEE confirmed the presence of a large antero-lateral PVL and a small medial PVL (3D VCA 0,32 cm2 and 0,2 cm2 respectively, associated with reverse flow in the pulmonary veins) with an extension of 33% of the circumference of the prosthesis. The regurgitation was considered severe and a percutaneous closure was planned with 3D-TEE and fluoroscopy image fusion guidance. Under general anesthesia a transeptal puncture was performed and the medial leak was closed with two vascular plugs (6mm each). During the deployment of the plugs an intermittent blockage of the medial disk of the prosthesis was noticed, which resolved completely after the removal of the wires previously positioned for the engagement of the leak. The lateral leak was then engaged and a second plug (10mm) was advanced causing a discontinuous interference with the two disks. The direct interference with the lateral disk caused a blockage in the closing position (leading to moderate stenosis, medium gradient 7mmHg) and in the opening position (leading to a massive regurgitation). The medial disk was intermittently blocked in the closing position due to the bulky effect of the devices provoking a traction and displacement of the prosthesis towards the medial region of the valve. To avoid this interference the plug was released with a marked atrial protrusion. Notably, after the removal of the wires no malfunctioning of the disks was noticed and the mild residual shunts appeared further decreased. The procedure was considered successful and at follow-up no residual leak was found. The percutaneous closure of PVL is a safe and effective intervention. Multimodality imaging is essential for the diagnosis, planning and procedural guidance. The knowledge of possible complications is warranted for the achievement of an optimal result. This case clearly show the possibility of interference with the prosthesis and overestimation of residual leaks. Abstract P1251 Figure. PVL closure:procedure and complications
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- 2020
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23. P755 Aortic valve area calculation by 3D transesophageal echocardiography: new insights in severity grading of aortic stenosis
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Francesco Ancona, Stefano Stella, Luigi Pannone, Eustachio Agricola, Matteo Montorfano, Marco Ancona, Giacomo Ingallina, Alessandro Beneduce, Giulio Falasconi, and Cristina Capogrosso
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medicine.medical_specialty ,Stenosis ,business.industry ,Internal medicine ,Cardiology ,Medicine ,Radiology, Nuclear Medicine and imaging ,Severity grading ,Aortic area ,General Medicine ,Cardiology and Cardiovascular Medicine ,business ,medicine.disease - Abstract
Background Aortic stenosis (AS) grading is mainly based on aortic valve area (AVA) calculation by 2D transthoracic echocardiography (2D-TTE), using continuity equation (CE). However, 2D-TTE shows several limits, mainly due to left ventricular outflow tract (LOVT) underestimation. Different 3D imaging modalities have been proposed to overcome 2D-TTE limitations, including 3D transesophageal echocardiography manual and software measurements (3D-TEEm and 3D-TEEs) and multidetector computed tomography (MDCT). The AVA cut-off value generally used to define severe AS has been established and validated by outcome studies in which AVA was measured by 2D-TTE. This cut-off value cannot be directly extrapolated to the 3D-TEE combined approach that systematically measures larger LVOT compared with 2D-TTE. Purpose.To evaluate the diagnostic accuracy of 3D transesophageal echocardiography manual and software measurements (3D-TEEm and 3D-TEEs) in AS grading, compared with multidetector computed tomography (MDCT) as gold standard, and to identify a new cut-off for AS severity assessment. Methods 218 patients (81 ± 5.4 years, 54% male) with symptomatic normal-flow AS underwent 2D-TTE, 3D-TTEm, 3D-TEEs and MDCT within the same hospitalization. 3D-TEE LVOT reconstruction was performed manually and with semi-automated software (EchoPAC version 201). 3D-TEEm, 3D-TEEs and MDCT LVOT areas were combined with 2D-TTE Doppler parameters to calculate AVA by CE. Using Doppler parameters (Vmax >4 m/s and MPG >40 mmHg) to define AS severity, a receiving-operating curve (ROC) was calculated for AVA obtained with different 3D imaging modalities. Results There was a good correlation between both 3D-TEEm and 3D-TEEs and MDCT measurements (r = 0.800 and r = 0.814, respectively) and excellent agreement between 3D-TEEm and 3D-TEEs with minimum bias. 2D-TTE significantly underestimated AVA compared to 3D-TEEm, 3D-TEEs and MDCT. On the other hand, both 3D-TEEm and 3D-TEEs underestimated AVA compared to MDCT (mean AVA difference = 0.13 and =0.06 cm2, respectively). ROC curve analysis demonstrated 91% sensibility and 34% specificity for 2D-TTE AVA using a cut-off of 1 cm2 (AUC 0.732). For 3D-TEEm and 3D-TEEs, a 1 cm2cut-off resulted in 74% sensibility and 59% specificity, while a 1.2 cm2cut-off resulted in 91% sensibility and 31% specificity (AUC 0.715). MDCT showed 59% sensibility and 70% specificity using a 1 cm2 cut-off and 83% sensibility and 45% specificity using a 1.2 cm2 cut-off (AUC 0.708). Conclusion 3D-TEE represents a valuable tool for AS grading using a combined approach incorporating 3D LVOT measurements and 2D Doppler parameters in the CE. Both 3D-TEEm and 3D-TEEs AVA measurements demonstrated good correlation with MDCT and excellent reproducibility. 3D-TEE measurements underestimate AVA compared to MDCT. Given the multiparametric assessment of AS severity, a 1.2 cm2 AVA cut-off could be considered to define AS severity with emerging 3D imaging modalities.
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- 2020
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24. P300 Reappraisal of aortic stenosis severity grading inconsistencies using 3D aortic valve area
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Cristina Capogrosso, Stefano Stella, Alessandro Beneduce, Giulio Falasconi, Marco Ancona, Giacomo Ingallina, Eustachio Agricola, Matteo Montorfano, Francesco Melillo, Luigi Pannone, and Francesco Ancona
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medicine.medical_specialty ,Stenosis ,Aortic valve area ,business.industry ,Internal medicine ,Cardiology ,medicine ,Radiology, Nuclear Medicine and imaging ,Severity grading ,General Medicine ,Cardiology and Cardiovascular Medicine ,business ,medicine.disease - Abstract
Funding Acknowledgements no fundings Background Different 3D imaging modalities have been proposed to overcome the limitations in aortic stenosis (AS) grading derived from underestimation of left ventricular outflow tract (LVOT) area by 2D transthoracic echocardiography (2D-TTE). Transesophageal echocardiography manual and software measurements (3D-TEEm and 3D-TEEs) and multidetector computed tomography (MDCT) have been recently been shown as valuable tools for AS grading using a combined approach incorporating 3D LVOT measurements and 2D Doppler parameters in the continuity equation (CE). This approach results particularly useful in cases of 2D-TTE grading inconsistence. As all these 3D imaging modalities provide larger AVA compared to 2D-TTE, we have recently proposed a 1.2 cm2 AVA cut-off could to define AS severity with 3D-TEE and MDCT. Purpose To compare AVA measurements with 3D-TEEm and 3D-TEEs using MDCT as gold standard in order to assess inconsistencies and evaluate the impact of a 1.2 cm2 AVA cut-off on AS severity grading. Methods 288 patients (80 ± 11 years, 52.4% male) with symptomatic AS underwent 2D-TTE, 3D-TTEm, 3D-TEEs and MDCT within the same hospitalization. 3D-TEE LVOT reconstruction was performed manually and with semi-automated software (EchoPAC version 201). 3D-TEEm, 3D-TEEs and MDCT LVOT areas were combined with 2D-TTE Doppler parameters to calculate AVA by CE. The grading of AS was reassessed in patients with low flow-low gradient AS using a 1.2 cm2 cut-off for severity. Results Patients were classified according to flow state (stroke volume index ≥35 ml/m2 or Conclusion The use of a 1.2 cm2 AVA cut-off for 3D-TEE and MDCT significantly reduces the number of cases of inconsistently graded AS, increasing the proportion of patients with severe AS.
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- 2020
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25. Integrated clinical role of echocardiography in patients with COVID-19
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Silvia Ajello, Annalisa Ruggeri, Anna Mara Scandroglio, Francesco Calvo, Alessandro Beneduce, Eustachio Agricola, Giovanni Landoni, Fabio Ciceri, Antonio Napolano, Giacomo Ingallina, Paolo Scarpellini, Renato Finazzi, Luca Baldetti, Paolo G. Camici, Moreno Tresoldi, Vittorio Pazzanese, Giulio Melisurgo, Alberto Cappelletti, Matteo Pagnesi, Mario Gramegna, Pagnesi, Matteo, Baldetti, Luca, Beneduce, Alessandro, Calvo, Francesco, Gramegna, Mario, Pazzanese, Vittorio, Ingallina, Giacomo, Napolano, Antonio, Finazzi, Renato, Ruggeri, Annalisa, Ajello, Silvia, Melisurgo, Giulio, Camici, Paolo Guido, Scarpellini, Paolo, Tresoldi, Moreno, Landoni, Giovanni, Ciceri, Fabio, Scandroglio, Anna Mara, Agricola, Eustachio, and Cappelletti, Alberto Maria
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2019-20 coronavirus outbreak ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Hypertension, Pulmonary ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Pneumonia, Viral ,MEDLINE ,Context (language use) ,030204 cardiovascular system & hematology ,Betacoronavirus ,03 medical and health sciences ,0302 clinical medicine ,echocardiography ,Humans ,Medicine ,In patient ,030212 general & internal medicine ,Intensive care medicine ,Pandemics ,Pulmonary Vascular Disease ,SARS-CoV-2 ,business.industry ,COVID-19 ,Integrated approach ,Echocardiography ,Coronavirus Infections ,Cardiology and Cardiovascular Medicine ,business - Abstract
Objective To assess the prevalence, characteristics and prognostic value of pulmonary hypertension (PH) and right ventricular dysfunction (RVD) in hospitalised, non-intensive care unit (ICU) patients with coronavirus disease 2019 (COVID-19). Methods This single-centre, observational, cross-sectional study included 211 patients with COVID-19 admitted to non-ICU departments who underwent a single transthoracic echocardiography (TTE). Patients with poor acoustic window (n=11) were excluded. Clinical, imaging, laboratory and TTE findings were compared in patients with versus without PH (estimated systolic pulmonary artery pressure >35 mm Hg) and with versus without RVD (tricuspid annular plane systolic excursion
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- 2020
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26. Impact of functional tricuspid regurgitation on heart failure and death in patients with functional mitral regurgitation and left ventricular dysfunction
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Stefano Stella, Eustachio Agricola, Alberto Margonato, Michele Oppizzi, Marco Ancona, Rossella D'Amato, Giacomo Ingallina, Mariangela Gullace, Massimo Slavich, Agricola, E, Stella, S, Gullace, M, Ingallina, G, D'Amato, R, Slavich, M, Oppizzi, M, Ancona, Mb, and Margonato, Alberto
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Male ,medicine.medical_specialty ,Regurgitation (circulation) ,Kaplan-Meier Estimate ,Risk Assessment ,Ventricular Function, Left ,Ventricular Dysfunction, Left ,Internal medicine ,Confidence Intervals ,Medicine ,Humans ,Prospective Studies ,Prospective cohort study ,Aged ,Heart Failure ,business.industry ,Incidence (epidemiology) ,valvular heart disease ,Hazard ratio ,Mitral Valve Insufficiency ,Stroke Volume ,Ultrasonography, Doppler ,Stroke volume ,medicine.disease ,Prognosis ,Confidence interval ,Tricuspid Valve Insufficiency ,Italy ,Heart failure ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Aims The prognostic role of tricuspid regurgitation (TR) associated with organic left-sided valvular heart disease is well known. However, no data are available regarding the prognostic value of functional TR (FTR) in patients with functional mitral regurgitation (FMR) and left ventricular (LV) dysfunction. The purpose of this study was to evaluate the prognostic role of FTR for occurrence of heart failure (HF) and mortality in patients with FMR. Methods and results We enrolled 373 consecutive patients (mean age 68 ±11 years) with LV dysfunction and at least mild FMR and with or without FTR, both quantitated by echocardiography. The median follow-up was 32 months (range 1–120 months); 132 (35.4%) and 97 patients developed HF or died, respectively. The incidence of HF at 3 and 6 years was 36 ±2% and 55 ±4%, respectively. Moderate to severe FTR [hazard ratio (HR) 1.4, 95% confidence interval (CI) 1.1–2.1, P = 0.01) was an independent determinant of HF. The incidence of HF was 41 ±5, 46 ±7, 57 ±7, and 65 ±8% for patients without, and with mild, moderate, and severe FTR respectively (P = 0.03). At 3 and 6 years the survival free of all-cause mortality was 77.5 ±2% and 60 ±3%, respectively. Moderate to severe FTR (HR 1.6, 95% CI 1.2–2.1, P = 0.01) was an independent determinant of overall mortality. At 6 years, survival free of all-cause mortality was 69 ±2.5, 67 ±2.1, 51 ±2.5, and 40 ±4.8% for patients without, and with mild, moderate, and severe FTR, respectively (P = 0.004). Conclusions Moderate or more FTR is independently associated with worse survival and a high incidence of HF episodes in patients with FMR.
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- 2012
27. Usefulness of lung ultrasound in the outpatient management of chronic heart failure patients: preliminary results of multicenter prospective randomized study
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Claudia Marini, Vincenzo Tufaro, Ferdinando Loiacono, Giacomo Ingallina, Andrea Fisicaro, Alberto Margonato, Eustachio Agricola, and Gabriele Fragasso
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medicine.medical_specialty ,Ejection fraction ,Acute decompensated heart failure ,medicine.diagnostic_test ,business.industry ,Surrogate endpoint ,Physical examination ,medicine.disease ,Lung ultrasound ,Internal medicine ,Heart failure ,medicine ,Prospective randomized study ,Cardiology and Cardiovascular Medicine ,business ,Intensive care medicine ,Outpatient management - Published
- 2013
- Full Text
- View/download PDF
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