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115. Coronary Microcirculation in Essential Hypertension: A Quantitative Myocardial Contrast Echocardiographic Approach.

Author

Di Bello, V., Pedrinelli, R., Giorgi, D., Bertini, A., Talini, E., Mengozzi, G., Palagi, C., Nardi, C., Dell'Omo, G., Paterni, M., and Mariani, M.

Subjects
MICROCIRCULATION disorders, ESSENTIAL hypertension, ECHOCARDIOGRAPHY, MICROBUBBLES, DIPYRIDAMOLE, VASODILATION, HYPERTROPHY
Abstract

Aims: The aims of the present study were: (a) to demonstrate whether quantitative myocardial contrast echocardiography can detect the increase in coronary flow induced by dipyridamole infusion vasodilation through the myocardial opacification due to the transit of microbubbles, both at rest and after dipyridamole induced vasodilation; (b) to explore the coronary microcirculatory function before and after dipyridamole in two different models: asymptomatic and relatively young hypertensive patients with a mild degree of left ventricular hypertrophy, and healthy controls.Methods and Results: Two groups of strictly age-matched males were studied (case-control study): 10, relatively young and asymptomatic essential hypertensive patients with a mild degree of left ventricular hypertrophy with a normal left ventricular function, and 10 healthy controls. The main findings were: the microbubbles' appearance area was significantly lower in hypertensive patients than in controls (P<0·05) because of a significantly lower time to peak. The peak intensity at rest was higher in hypertensives than in controls (P<0·05); but the per cent increase after vasodilatory stimulus was significantly higher in controls (+71% in controls vs +31% in hypertensives; P<0·05). The microbubbles' disappearance area was comparable in both groups at rest; the per cent increase of this parameter after dipyridamole was significantly higher in controls (+124%) than in hypertensives (+90%) (P<0·05). The results achieved in this study documented that the coronary microcirculation in hypertensive patients presenting a mild degree of left ventricular hypertrophy, explored with quantitative myocardial contrast echocardiography, showed a different behaviour in comparison with controls, in the vasodilatory response to dipyridamole.Conclusion: The coronary microcirculation in hypertensives showed a reduced vasodilation capacity of the resistance arterioles under dipyridamole induced vasodilatation, and a possible impairment of the endothelium dependent vasodilation. This happened despite an increase in the left ventricular mass, where the relation between capillary bed distribution and hypertrophied myocardium (rarefaction phenomenon) is not completely respected. Copyright 2002 The European Society of Cardiology. Published by Elsevier Science Ltd. All rights reserved. [ABSTRACT FROM AUTHOR]

Published
2002
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122. Ultrasonic videodensitometric analysis of myocardium in end-stage renal disease treated with haemodialysis.

Author

Di Bello, V, Panichi, V, Pedrinelli, R, Giorgi, D, Bianchi, M, Bertini, A, Taccola, D, De Pietro, S, Talini, E, Paterni, M, and Giusti, C

Abstract

The aim of this study was to investigate videodensitometric parameters of the myocardium, in dialysis patients, who represent a complex pathophysiological model of pressure volume overload, and in essential hypertensive patients with the same level of left ventricular mass.

Published
1999
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124. Increased myocardial echo density in left ventricular pressure and volume overload in human aortic valvular disease: an ultrasonic tissue characterization study

Author

Di Bello, V., Talarico, L., Picano, E., Giorgi, D., Bertini, A., Paterni, M., and Giusti, C.

Abstract

Quantitatively assessed ultrasonic backscatter is an index of ultrasonic tissue characterization directly related to morphometrically evaluated collagen content in human beings. Our objective was to assess myocardial reflectivity pattern in patients with severe left ventricular hypertrophy caused by either aortic stenosis (AS) or aortic regurgitation (AR). Ten patients with AS, 10 patients with AR, and 10 closely age- and gender-matched healthy controls were studied by two-dimensional Doppler echocardiography. By using an echocardiographic prototype, we performed a radiofrequency analysis to obtain quantitative operator-independent measurements of the integrated backscatter signal of the ventricular septum and the posterior wall (integrated backscatter index: IBI, expressed in percentage). All patients with stenosis or aortic insufficiency showed a normal regional and global resting systolic function (fractional shortening: AS = 36.0 +/- 6.6 versus AR = 40.3 +/- 6.2 versus control = 40.2 +/- 8.7; p = not significant [NS]). Left ventricular mass index (Devereux's formula) was markedly increased in patients with stenosis or aortic insufficiency (AS = 199.3 +/- 18 versus AR = 208.8 +/- 60 versus control = 97.3 +/- 11 g/m^2; p < 0.0001). Myocardial echo density was increased in patients with stenosis or aortic insufficiency in comparison with controls, both in the septum (IBI%: AR = 40.7 +/- 7.9 versus AS = 33.4 +/- 4.2 versus control = 23.0 +/- 6.2; p < 0.0001) and in the posterior wall (IBI%: AR = 27.1 +/- 4.3 versus AS = 23.0 +/- 2.6 versus control = 15.0 +/- 4.2; p < 0.0001). No significant correlations were found between septal and posterior wall IBI and their thickness. Abnormally increased myocardial echo density-possibly related to disproportionate collagen deposition-can be detected in patients with pressure or volume overload caused by aortic valve disease and without overt systolic dysfunction. (J Am Soc Echocardiogr 1997;10:320-9.)

Published
1997
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125. Cardiac cycle-dependent gray-level variation is not distorted by abnormal septal motion after cardiac surgery: A transesophageal videodensitometric study in humans

Author

Gigli, G., Maffei, S., Picano, E., Paterni, M., Baroni, M., Terrazzi, M., Rovai, D., and Biagini, A.

Abstract

Variation in cyclic (systolic-to-diastolic) echodensity has been demonstrated to be areliable index of preserved myocardial function. Paradoxic septal motion can be observed frequently after cardiac surgery in the absence of any functional impairment. The aim of the study was to evaluate whether regional cycle-dependent gray-level variation in the septum is affected by abnormal septal motion after cardiac surgery. Ten patients undergoing cardiac surgery for coronary artery bypass grafting were evaluated by continuous transesophageal echocardiographic monitoring from the transgastric approach, both before and after surgery. In each patient septal motion was assessed qualitatively as normal or paradoxic. Images were digitized off-line and cyclic gray-level variation was measured in each patient by means of dedicated software. By selection, all patients exhibited normal septal motion and thickening at baseline. After surgery, five patients showed a paradoxic septal motion (group I), whereas in the remaining five patients (group II) septal motion remained normal. Percent area change, measured with the floating center-of-mass reference system, was similar in the two groups both before (I=42%+/-7% versus II=44%+/-13%; difference not significant) and after surgery (I=39%+/-8% versus II=40%+/-1%; difference not significant). Cyclic gray-level variation was also similar in the two groups, both at baseline (group I=61%+/-16% versus group II=68%+/-18%; difference not significant) and after surgery (50%+/-13% versus 57%+/-16%; difference not significant). In conclusion, cardiac cycle-dependent gray-level variation provides an objective method, independent of cardiac motion, to assess regional function in paradoxic septal motion after cardiac surgery. Cyclic gray-level variation is not distorted by altered regional wall motion, consistent with the evidence that it reflects intrinsic contractile function.

Published
1995
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127. [Ultrasonic tissue characterization analysis in type 1 diabetes: a very early index of diabetic cardiomyopathy?]

Author

Di Bello V, Giampietro O, Matteucci E, Giorgi D, Alessio Bertini, Piazza F, Talini E, Paterni M, and Giusti C

Subjects
Adult, Male, Diabetes Mellitus, Type 1, Myocardium, Humans, Female, Cardiomyopathies, Diabetic Angiopathies, Echocardiography, Doppler
Abstract

Based on various epidemiological observations, it has been hypothesized that there is a "diabetic cardiomyopathy" strictly related to diabetes per se and probably due to an increase in the collagen content at the myocardial level, to microangiopathy or to complex alteration of myocardial metabolic pattern. Ultrasonic tissue characterization has recently been applied with different methodological approaches in order to identify early structural alterations of the myocardium.We used two different methods of myocardial tissue characterization, i.e. integrated backscatter and videodensitometry, to analyze 26 type I diabetics without clinical symptoms, without hypertension or coronary artery disease, which were excluded on the basis of a negative exercise ECG, and in whom conventional echocardiographic parameters were normal. Seventeen healthy age- and sex-matched subjects were evaluated as the control group.Of the common left ventricular functional indexes, only E/A ratio (expression of global diastolic function) was lower in diabetics compared with controls (p0.01). The integrated backscatter index (IBI%) at the septum and posterior wall was significantly higher in diabetics as compared to controls, expressing an increased collagen content on a myocardial level. The cyclic variation index (%) of the mean gray level (videodensitometry) was significantly lower in diabetics in comparison with controls, both for the septum (p0.0001) and posterior wall (p0.002). This probably expresses an altered intrinsic myocardial contractility, due to an increase in myocardial collagen content and/or impairment of micro-circulatory function.In agreement with previous studies, we found an altered behavior in myocardial tissue reflectivity in type I diabetics. The real significance of this finding in the "normal" heart is the subject of intense debate. One hypothesis is that these findings could be considered a very early index of a "diabetic cardiomyopathy".

137. Poster session 3: Thursday 4 December 2014, 14:00-18:00 * Location: Poster area

Author

Shahgaldi, K, Hegner, T, Da Silva, C, Fukuyama, A, Takeuchi, M, Uema, A, Kado, Y, Nagata, Y, Hayashi, A, Otani, K, Fukuda, S, Yoshitani, H, Otsuji, Y, Morhy, S, Lianza, AC, Afonso, TR, Oliveira, WA, Tavares, GP, Rodrigues, AC, Vieira, MC, Warth, AN, Deutsch, AD, Fischer, CH, Tezynska-Oniszk, I, Turska-Kmiec, A, Kawalec, W, Dangel, J, Maruszewski, B, Bokiniec, R, Burczynski, P, Borszewska-Kornacka, K, Ziolkowska, L, Zuk, M, Mazowsza, eSUM Dzieciaki, Troshina, A, Dzhalilova, DA, Poteshkina, NG, Hamitov, FF, Warita, S, Kawasaki, M, Tanaka, R, Yagasaki, H, Minatoguchi, S, Wanatabe, T, Ono, K, Noda, T, Wanatabe, S, Minatoguchi, S, Angelis, A, Ageli, K, Vlachopoulos, C, Felekos, I, Ioakimidis, N, Aznaouridis, K, Vaina, S, Abdelrasoul, M, Tsiamis, E, Stefanadis, C, Cameli, M, Sparla, S, D'ascenzi, F, Fineschi, M, Favilli, R, Pierli, C, Henein, M, Mondillo, S, Lindqvist, P, Tossavainen, E, Gonzalez, M, Soderberg, S, Henein, M, Holmgren, A, Strachinaru, M, Catez, E, Jousten, I, Pavel, O, Janssen, C, Morissens, M, Chatzistamatiou, E, Moustakas, G, Memo, G, Konstantinidis, D, Mpampatzeva Vagena, I, Manakos, K, Traxanas, K, Vergi, N, Feretou, A, Kallikazaros, I, Tsai, W-C, Sun, Y-T, Lee, W-H, Yang, L-T, Liu, Y-W, Lee, C-H, Li, W-T, Mizariene, V, Bieseviciene, M, Karaliute, R, Verseckaite, R, Vaskelyte, J, Lesauskaite, V, Chatzistamatiou, E, Mpampatseva Vagena, I, Manakos, K, Moustakas, G, Konstantinidis, D, Memo, G, Mitsakis, O, Kasakogias, A, Syros, P, Kallikazaros, I, Hristova, K, Cornelissen, G, Singh, RB, Shiue, I, Coisne, D, Madjalian, A-M, Tchepkou, C, Raud Raynier, P, Degand, B, Christiaens, L, Baldenhofer, G, Spethmann, S, Dreger, H, Sanad, W, Baumann, G, Stangl, K, Stangl, V, Knebel, F, Azzaz, S, Kacem, S, Ouali, S, Risos, L, Dedobbeleer, C, Unger, P, Sinem Cakal, SC, Elif Eroglu, EE, Baydar, O, Beytullah Cakal, BC, Mehmet Vefik Yazicioglu, MVY, Mustafa Bulut, MB, Cihan Dundar, CD, Kursat Tigen, KT, Birol Ozkan, BO, Ali Metin Esen, AME, Tournoux, F, Chequer, R, Sroussi, M, Hyafil, F, Rouzet, F, Leguludec, D, Baum, P, Stoebe, S, Pfeiffer, D, Hagendorff, A, Fang, F, Lau, M, Zhang, Q, Luo, XX, Wang, XY, Chen, L, Yu, CM, -CRT, Predict, Zaborska, B, Smarz, K, Makowska, E, Kulakowski, P, Budaj, A, Bengrid, T M, Zhao, Y, Henein, M Y, Caminiti, G, D'antoni, V, Cardaci, V, Conti, V, Volterrani, M, Warita, S, Kawasaki, M, Yagasaki, H, Minatoguchi, S, Nagaya, M, Ono, K, Noda, T, Watanabe, S, Houle, H, Minatoguchi, S, Gillebert, T C, Chirinos, J A, Claessens, T C, Raja, M W, De Buyzere, M L, Segers, P, Rietzschel, E R, Investigators, The Asklepios, Kim, KH, Cha, JJ, Chung, HM, Kim, JY, Yoon, YW, Lee, BK, Hong, BK, Rim, SJ, Kwon, HM, Choi, EY, Pyankov, V, Aljaroudi, W, Matta, S, Al-Shaar, L, Habib, R, Gharzuddin, W, Arnaout, S, Skouri, H, Jaber, W, Abchee, A, Bouzas Mosquera, A, Peteiro, J, Broullon, FJ, Constanso Conde, IP, Bescos Galego, H, Martinez Ruiz, D, Yanez Wonenburger, JC, Vazquez Rodriguez, JM, Alvarez Garcia, N, Castro Beiras, A, Gunyeli, E, Oliveira Da Silva, C, Shahgaldi, K, Manouras, A, Winter, R, Meimoun, P, Abouth, S, Martis, S, Boulanger, J, Elmkies, F, Zemir, H, Detienne, JP, Luycx-Bore, A, Clerc, J, Rodriguez Palomares, J F, Gutierrez, LG, Maldonado, GM, Garcia, GG, Galuppo, VG, Gruosso, DG, Teixido, GT, Gonzalez Alujas, MTGA, Evangelista, AE, Garcia Dorado, DGD, Rechcinski, T, Wierzbowska-Drabik, K, Wejner-Mik, P, Szymanska, B, Jerczynska, H, Lipiec, P, Kasprzak, JD, El-Touny, K, El-Fawal, S, Loutfi, M, El-Sharkawy, E, Ashour, S, Boniotti, C, Carminati, MC, Fusini, L, Andreini, D, Pontone, G, Pepi, M, Caiani, EG, Oryshchyn, N, Kramer, B, Hermann, S, Liu, D, Hu, K, Ertl, G, Weidemann, F, Ancona, F, Miyazaki, S, Slavich, M, Figini, F, Latib, A, Chieffo, A, Montorfano, M, Alfieri, O, Colombo, A, Agricola, E, Nogueira, MA, Branco, LM, Rosa, SA, Portugal, G, Galrinho, A, Abreu, J, Cacela, D, Patricio, L, Fragata, J, Cruz Ferreira, R, Igual Munoz, B, Erdociain Perales, MEP, Maceira Gonzalez, AMG, Estornell Erill Jordi, JEE, Donate Bertolin, LDB, Vazquez Sanchez Alejandro, AVS, Miro Palau Vicente, VMP, Cervera Zamora, ACZ, Piquer Gil, MPG, Montero Argudo, AMA, Girgis, H Y A, Illatopa, V, Cordova, F, Espinoza, D, Ortega, J, Khan, US, Islam, AKMM, Majumder, AAS, Girgis, H Y A, Bayat, F, Naghshbandi, E, Naghshbandi, E, Samiei, N, Samiei, N, Malev, E, Omelchenko, M, Vasina, L, Zemtsovsky, E, Piatkowski, R, Kochanowski, J, Budnik, M, Scislo, P, Opolski, G, Kochanowski, J, Piatkowski, R, Scislo, P, Budnik, M, Marchel, M, Opolski, G, Abid, L, Ben Kahla, S, Abid, D, Charfeddine, S, Maaloul, I, Ben Jmaa, M, Kammoun, S, Hashimoto, G, Suzuki, M, Yoshikawa, H, Otsuka, T, Isekame, Y, Yamashita, H, Kawase, I, Ozaki, S, Nakamura, M, Sugi, K, Benvenuto, E, Leggio, S, Buccheri, S, Bonura, S, Deste, W, Tamburino, C, Monte, I P, Gripari, P, Fusini, L, Muratori, M, Tamborini, G, Ghulam Ali, S, Bottari, V, Cefalu', C, Bartorelli, A, Agrifoglio, M, Pepi, M, Zambon, E, Iorio, A, Di Nora, C, Abate, E, Lo Giudice, F, Di Lenarda, A, Agostoni, P, Sinagra, G, Timoteo, A T, Galrinho, A, Moura Branco, L, Rio, P, Aguiar Rosa, S, Oliveira, M, Silva Cunha, P, Leal, A, Cruz Ferreira, R, Zemanek, D, Tomasov, P, Belehrad, M, Kostalova, J, Kara, T, Veselka, J, Hassanein, M, El Tahan, S, El Sharkawy, E, Shehata, H, Yoon, YE, Choi, HM, Seo, HY, Lee, SP, Kim, HK, Youn, TJ, Kim, YJ, Sohn, DW, Choi, GY, Mielczarek, M, Huttin, O, Voilliot, D, Sellal, JM, Manenti, V, Carillo, S, Olivier, A, Venner, C, Juilliere, Y, Selton-Suty, C, Butz, T, Faber, L, Brand, M, Piper, C, Wiemer, M, Noelke, J, Sasko, B, Langer, C, Horstkotte, D, Trappe, HJ, Maysou, LA, Tessonnier, L, Jacquier, A, Serratrice, J, Copel, C, Stoppa, AM, Seguier, J, Saby, L, Verschueren, A, Habib, G, Petroni, R, Bencivenga, S, Di Mauro, M, Acitelli, A, Cicconetti, M, Romano, S, Petroni, A, Penco, M, Maceira Gonzalez, A M, Cosin-Sales, J, Igual, B, Sancho-Tello, R, Ruvira, J, Mayans, J, Choi, JH, Kim, SWK, Almeida, A, Azevedo, O, Amado, J, Picarra, B, Lima, R, Cruz, I, Pereira, V, Marques, N, Biering-Sorensen, T, Mogelvang, R, Schnohr, P, Jensen, JS, Chatzistamatiou, E, Konstantinidis, D, Manakos, K, Mpampatseva Vagena, I, Moustakas, G, Memo, G, Mitsakis, O, Kasakogias, A, Syros, P, Kallikazaros, I, Cho, EJ, Kim, JJ, Hwang, BH, Kim, DB, Jang, SW, Jeon, HK, Cho, JS, Chatzistamatiou, E, Konstantinidis, D, Memo, G, Mpapatzeva Vagena, I, Moustakas, G, Manakos, K, Traxanas, K, Vergi, N, Feretou, A, Kallikazaros, I, Jedrzejewska, I, Konopka, M, Krol, W, Swiatowiec, A, Dluzniewski, M, Braksator, W, Sefri Noventi, S, Sugiri, S, Uddin, I, Herminingsih, S, Arif Nugroho, M, Boedijitno, S, Caro Codon, J, Blazquez Bermejo, Z, Valbuena Lopez, S C, Lopez Fernandez, T, Rodriguez Fraga, O, Torrente Regidor, M, Pena Conde, L, Moreno Yanguela, M, Buno Soto, A, Lopez-Sendon, J L, Stevanovic, A, Dekleva, M, Kim, MN, Kim, SA, Kim, YH, Shim, JM, Park, SM, Park, SW, Kim, YH, Shim, WJ, Kozakova, M, Muscelli, E, Morizzo, C, Casolaro, A, Paterni, M, Palombo, C, Bayat, F, Nazmdeh, M, Naghshbandi, E, Nateghi, S, Tomaszewski, A, Kutarski, A, Brzozowski, W, Tomaszewski, M, Nakano, E, Harada, T, Takagi, Y, Yamada, M, Takano, M, Furukawa, T, Akashi, Y, Lindqvist, G, Henein, MY, Backman, C, Gustafsson, S, Morner, S, Marinov, R, Hristova, K, Geirgiev, S, Pechilkov, D, Kaneva, A, Katova, TZ, Pilosoff, V, Pena Pena, ML, Mesa Rubio, D, Ruiz Ortin, M, Delgado Ortega, M, Romo Penas, E, Pardo Gonzalez, L, Rodriguez Diego, S, Hidalgo Lesmes, F, Pan Alvarez-Ossorio, M, Suarez De Lezo Cruz-Conde, J, Gospodinova, M, Sarafov, S, Guergelcheva, V, Vladimirova, L, Tournev, I, Denchev, S, Mozenska, O, Segiet, A, Rabczenko, D, Kosior, DA, Gao, SA, Eliasson, M, Polte, CL, Lagerstrand, K, Bech-Hanssen, O, Morosin, M, Piazza, R, Leonelli, V, Leiballi, E, Pecoraro, R, Cinello, M, Dell' Angela, L, Cassin, M, Sinagra, G, Nicolosi, GL, Savu, O, Carstea, N, Stoica, E, Macarie, C, Moldovan, H, Iliescu, V, Chioncel, O, Moral, S, Gruosso, D, Galuppo, V, Teixido, G, Rodriguez-Palomares, JF, Gutierrez, L, Evangelista, A, Jansen Klomp, W W, Peelen, LM, Spanjersberg, AJ, Brandon Bravo Bruinsma, GJ, Van 'T Hof, AWJ, Laveau, F, Hammoudi, N, Helft, G, Barthelemy, O, Michel, PL, Petroni, T, Djebbar, M, Boubrit, L, Le Feuvre, C, Isnard, R, Cho, EJ, Park, S-J, Kim, CH, Song, JE, Kim, SH, Chang, S-A, Lee, S-C, Park, SW, Bandera, F, Generati, G, Pellegrino, M, Alfonzetti, E, Labate, V, Villani, S, Gaeta, M, Guazzi, M, Gabriels, C, Lancellotti, P, Van De Bruaene, A, Voilliot, D, De Meester, P, Buys, R, Delcroix, M, Budts, W, Cruz, I, Stuart, B, Caldeira, D, Morgado, G, Almeida, AR, Lopes, LR, Fazendas, P, Joao, I, Cotrim, C, Pereira, H, Weissler Snir, A, Greenberg, G, Shapira, Y, Weisenberg, D, Monakier, D, Nevzorov, R, Sagie, A, Vaturi, M, Bando, M, Yamada, H, Saijo, Y, Takagawa, Y, Sawada, N, Hotchi, J, Hayashi, S, Hirata, Y, Nishio, S, Sata, M, Jackson, TA, Sammut, E, Siarkos, M, Lee, L, Carr-White, G, Rajani, R, Kapetanakis, S, Ciobotaru, V, Yagasaki, H, Kawasaki, M, Tanaka, R, Minatoguchi, S, Sato, N, Amano, K, Warita, S, Ono, K, Noda, T, Minatoguchi, S, Breithardt, O-A, Razavi, H, Nabutovsky, Y, Ryu, K, Gaspar, T, Kosiuk, J, John, S, Prinzen, F, Hindricks, G, Piorkowski, C, Nemchyna, O, Tovstukha, V, Chikovani, A, Golikova, I, Lutai, M, Nemes, A, Kalapos, A, Domsik, P, Lengyel, C, Orosz, A, Forster, T, Nordenfur, T, Babic, A, Giesecke, A, Bulatovic, I, Ripsweden, J, Samset, E, Winter, R, Larsson, M, Blazquez Bermejo, Z, Lopez Fernandez, T, Caro Codon, J, Valbuena, SC, Caro Codon, J, Mori Junco, R, Moreno Yanguela, M, Lopez-Sendon, JL, MEdicamentos, Grupo de Estudio de CArdiotoxicidad por, Pinto-Teixeira, P, Branco, L, Galrinho, A, Oliveira, M, Cunha, P, Silva, T, Rio, P, Feliciano, J, Nogueira-Silva, M, Ferreira, R, Shkolnik, E, Vasyuk, Y, Nesvetov, V, Shkolnik, L, Varlan, G, Bajraktari, G, Ronn, F, Ibrahimi, P, Jashari, F, Jensen, SM, Henein, MY, Kang, M-K, Mun, H-S, Choi, S, Cho, J-R, Han, SW, Lee, N, Cho, I J, Heo, R, Chang, HJ, Shin, S, Shim, CY, Hong, GR, and Chung, N

Abstract

Objective:  We aimed to investigate the reproducibility of vena contracta (VC) in mitral regurgitation (MR) of different etiology between an inexperienced and an experienced echocardiographer. Background: MR is the second most common valvular heart disease in Europe that requires surgery.  Echocardiography is the principal modality of investigation when MR is suspected. In European and American guidelines VC is described as one of the most feasible echocardiographic measurements in the assessment of MR. There is a lack of publications regarding intra-observer variability and studies comparing inexperienced and experienced echocardiographers for the assessment of VC. Method/Material: VC of 55 recorded 2D echocardiograms with known MR of different degree and etiology were analyzed from parasternal long axis view, 4- and 3 chamber view. The mean value of the different plane measurements of each exam was used for statistical analysis. Analyses were made by an inexperienced (A) fellow echocardiographer (<100 studies) and a level 3 experienced (B) echocardiographer. Measurements of VC by the 2 echocardiographers were performed blinded to clinical data. Measurements were performed with at least 2 weeks apart, blinded to the first measurement. Results: Three exams were excluded (feasibility 95%) from statistical analysis because adequate color Doppler images from all tree planes was not available. The inter class correlation (ICC) between the first and second analysis was (r=0.75; 95% CI -1.1 to 1.7mm) for A and (r=0.94; 95% CI -0.76 to 0.84mm) for B. There was good ICC between the 2 echocardiographers (r=0.78; 95% CI -1.5 to 1.3mm). The intra observer variability was 11.1% for A and 6.1% for B. The inter observer variability was 11.7% (p>0.05 for all). Conclusion: Measurement of vena contracta in mitral regurgitation is a feasible semi-quantitative parameter. Good correlation and narrow limits of agreement between a novice and an experienced echocardiographer was demonstrated in our study.

Published
2014
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139. 429 Early impairment of coronary reserve in men with essential hypertension: a quantitative myocardial contrast echocardiographic study.

Author

Di Bello, V., Giorgi, D., Pedrinelli, R., Palagi, C., Delle Donne, M. G., Talini, E., Paterni, M., and Mariani, M.

Subjects
HYPERTENSION, ECHOCARDIOGRAPHY
Abstract

An abstract of the article "Early impairment of coronary reserve in men with essential hypertension: a quantitative myocardial contrast echocardiographic study" by V. Di Bello, D. Giorgi, R. Pedrinelli, C. Palagi, M.G. Delle Donne, E. Talini, M. Paterni and M. Mariani is presented.

Published
2003

148. Functional, Anatomical, and Prognostic Correlates of Coronary Flow Velocity Reserve During Stress Echocardiography

Author

Fausto Rigo, Iana Simova, Antonello D'Andrea, Pablo Merlo, Clarissa Borguezan Daros, Eugenio Picano, Alla A. Boshchenko, Eduardo Bossone, Suzana Gligorova, Fabio Marco Costantino, Nadezhda Zhuravskaya, Ana Djordjevic-Dikic, Albert Varga, Michele De Nes, Rodolfo Citro, Marco Antonio Rodrigues Torres, Marco Paterni, Dario Gregori, Milica Dekleva, Maria Chiara Scali, Angela Zagatina, Sergio Severino, Alessandro Salustri, Clara Carpeggiani, Lauro Cortigiani, Alexander V. Vrublevsky, Fabio Lattanzi, Paolo Colonna, Ines Monte, Quirino Ciampi, Hugo Rodríguez-Zanella, Jorge Lowenstein, Jarosław D. Kasprzak, Nicola Gaibazzi, Claudio Dodi, José Luis de Castro e Silva Pretto, Karina Wierzbowska-Drabik, Miguel Amor, Ciampi, Q., Zagatina, A., Cortigiani, L., Gaibazzi, N., Borguezan Daros, C., Zhuravskaya, N., Wierzbowska-Drabik, K., Kasprzak, J. D., de Castro e Silva Pretto, J. L., D'Andrea, A., Djordjevic-Dikic, A., Monte, I., Simova, I., Boshchenko, A., Citro, R., Amor, M., Merlo, P. M., Dodi, C., Rigo, F., Gligorova, S., Dekleva, M., Severino, S., Lattanzi, F., Scali, M. C., Vrublevsky, A., Torres, M. A. R., Salustri, A., Rodriguez-Zanella, H., Costantino, F. M., Varga, A., Bossone, E., Colonna, P., De Nes, M., Paterni, M., Carpeggiani, C., Lowenstein, J., Gregori, D., and Picano, E.

Subjects
Male, coronary artery disease, coronary flow velocity reserve, heart failure, lung ultrasound, stress echocardiography, medicine.medical_specialty, Diastole, 030204 cardiovascular system & hematology, Anterior Descending Coronary Artery, Coronary artery disease, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Stress Echocardiography, Humans, Prospective Studies, 030212 general & internal medicine, Aged, Ejection fraction, business.industry, Odds ratio, Middle Aged, Prognosis, medicine.disease, 3. Good health, Fractional Flow Reserve, Myocardial, Heart failure, Cardiology, Female, Dobutamine, Cardiology and Cardiovascular Medicine, business, Blood Flow Velocity, Echocardiography, Stress, medicine.drug
Abstract

Background: The assessment of coronary flow velocity reserve (CFVR) in left anterior descending coronary artery (LAD) expands the risk stratification potential of stress echocardiography (SE) based on stress-induced regional wall motion abnormalities (RWMA). Objectives: The purpose of this study was to assess the feasibility and functional correlates of CFVR. Methods: This prospective, observational, multicenter study initially screened 3,410 patients (2,061 [60%] male; age 63 ± 11 years; ejection fraction 61 ± 9%) with known or suspected coronary artery disease and/or heart failure. All patients underwent SE (exercise, n = 1,288; vasodilator, n = 1,860; dobutamine, n = 262) based on new or worsening RWMA in 20 accredited laboratories of 8 countries. CFVR was calculated as the stress/rest ratio of diastolic peak flow velocity pulsed-Doppler assessment of LAD flow. A subset of 1,867 patients was followed up. Results: The success rate for CFVR on LAD was 3,002 of 3,410 (feasibility = 88%). Reduced (≤2.0) CFVR was found in 896 of 3,002 (30%) patients. At multivariable logistic regression analysis, inducible RWMA (odds ratio [OR]: 6.5; 95% confidence interval [CI]: 4.9 to 8.5; p < 0.01), abnormal left ventricular contractile reserve (OR: 3.4; 95% CI: 2.7 to 4.2; p < 0.01), and B-lines (OR: 1.5; 95% CI: 1.1 to 1.9; p = 0.01) were associated with reduced CFVR. During a median follow-up time of 16 months, 218 events occurred. RWMA (hazard ratio: 3.8; 95% CI: 2.3 to 6.3; p < 0.001) and reduced CFVR (hazard ratio: 1.5; 95% CI: 1.1 to 2.2; p = 0.009) were independently associated with adverse outcome. Conclusions: CFVR is feasible with all SE protocols. Reduced CFVR is often accompanied by RWMA, abnormal LVCR, and pulmonary congestion during stress, and shows independent value over RWMA in predicting an adverse outcome.

Published
2019

149. Normal basic 2D echocardiographic values to screen and follow up the athlete's heart from juniors to adults: What is known and what is missing. A critical review

Author

Giorgio Iervasi, Raffaele Giordano, Flavio D'Ascenzi, Maurizio Galderisi, Antonello D'Andrea, Massimiliano Cantinotti, Marco Paterni, Nadia Assanta, Martin Koestenberger, Eliana Franchi, Giuseppe Santoro, Cantinotti, M, Koestenberger, M, Santoro, G, Assanta, N, Eliana Franchi, E, Paterni, M, Iervasi, G, D’Andrea, A, D’Ascenzi, F, Giordano, R, and Galderisi, M

Subjects
medicine.medical_specialty, Epidemiology, Heart Ventricles, Athlete's heart, Population, heart, Normal values, 030204 cardiovascular system & hematology, Ventricular Function, Left, 03 medical and health sciences, 0302 clinical medicine, Humans, Medicine, Cardiomegaly, Exercise-Induced, Heart Atria, 030212 general & internal medicine, education, education.field_of_study, biology, business.industry, Athletes, Nomogram, biology.organism_classification, athletes, Echocardiography, Reference values, Physical therapy, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies
Abstract

In the last few years, multiple echocardiographic nomograms have been published. However, normal values calculated in the general population are not applicable to athletes, whose hearts may be enlarged and hypercontractile. Accordingly, athletes require specific nomograms. Our aim is to provide a critical review of echocardiographic nomograms on two-dimensional (2D) measures for athletes. We performed a systematic search in the National Library of Medicine for Medical Subject Headings and free text terms including echocardiography, athletes, normal values and nomograms. The search was refined by adding the keywords heart, sport, elite, master, children and young. Twenty-eight studies were selected for the final analysis. Our research revealed that currently available ranges of normality for athletes reported by different authors are quite consistent, with limited exceptions (e.g. atria, aorta). Numerical and methodological limitations, however, emerged. Numerical limitations included a limited sample size (e.g.

Published
2019

150. Lung Ultrasound and Pulmonary Congestion During Stress Echocardiography

Author

Fausto Rigo, Katarzyna Wdowiak-Okrojek, Fabio Lattanzi, Ana Djordjevic-Dikic, Karina Wierzbowska-Drabik, Eugenio Picano, Francesco Ferrara, Paul E Vargas Mieles, Doralisa Morrone, Angela Zagatina, Claudio Dodi, Barbara Reisenhofer, Tamara Preradovic-Kovacevic, Jarosław D. Kasprzak, Hugo Rodríguez-Zanella, Miguel Amor, Aleksandra Nikolic, Alessandro Salustri, Clarissa Borguezan Daros, Nicola Gaibazzi, Maciej Haberka, Federica Re, Iana Simova, Nikola Boskovic, Gergely Ágoston, Eduardo Bossone, Marco Paterni, Antonello D'Andrea, Clara Carpeggiani, Michele De Nes, Quirino Ciampi, Ewa Szymczyk, Sergio Severino, Maria Chiara Scali, Fabio Mori, Diego M. Lowenstein Haber, Miodrag Ostojic, Lauro Cortigiani, Milica Dekleva, Ana Cristina Camarozano, Giovanni Di Salvo, Maria Grazia D'Alfonso, Maurizio Galderisi, Alla A. Boshchenko, José Luis de Castro e Silva Pretto, Milorad Tesic, Branko Beleslin, Elisa Merli, Alexander V. Vrublevsky, Paulina Wejner-Mik, T. Bombardini, Paolo Colonna, Jelena Celutkiene, Fabio Marco Costantino, Ines Monte, Valentina Lorenzoni, Jorge Lowenstein, Pablo Merlo, Martina Vladova, Suzana Gligorova, Andrea Barbieri, Nadezhda Zhuravskaya, Albert Varga, R Arbucci, Rodolfo Citro, Marco Antonio Rodrigues Torres, Marcelo Haertel Miglioranza, Marija Petrović, Scali, M. C., Zagatina, A., Ciampi, Q., Cortigiani, L., D'Andrea, A., Daros, C. B., Zhuravskaya, N., Kasprzak, J. D., Wierzbowska-Drabik, K., Luis de Castro e Silva Pretto, J., Djordjevic-Dikic, A., Beleslin, B., Petrovic, M., Boskovic, N., Tesic, M., Monte, I., Simova, I., Vladova, M., Boshchenko, A., Vrublevsky, A., Citro, R., Amor, M., Vargas Mieles, P. E., Arbucci, R., Merlo, P. M., Lowenstein Haber, D. M., Dodi, C., Rigo, F., Gligorova, S., Dekleva, M., Severino, S., Lattanzi, F., Morrone, D., Galderisi, M., Torres, M. A. R., Salustri, A., Rodriguez-Zanella, H., Costantino, F. M., Varga, A., Agoston, G., Bossone, E., Ferrara, F., Gaibazzi, N., Celutkiene, J., Haberka, M., Mori, F., D'Alfonso, M. G., Reisenhofer, B., Camarozano, A. C., Miglioranza, M. H., Szymczyk, E., Wejner-Mik, P., Wdowiak-Okrojek, K., Preradovic-Kovacevic, T., Bombardini, T., Ostojic, M., Nikolic, A., Re, F., Barbieri, A., Di Salvo, G., Merli, E., Colonna, P., Lorenzoni, V., De Nes, M., Paterni, M., Carpeggiani, C., Lowenstein, J., and Picano, E.

Subjects
medicine.medical_specialty, stress echocardiography, heart failure, 030204 cardiovascular system & hematology, 030218 nuclear medicine & medical imaging, Coronary artery disease, 03 medical and health sciences, 0302 clinical medicine, Interquartile range, Predictive Value of Tests, Internal medicine, Dobutamine, Heart rate, medicine, Stress Echocardiography, Humans, Radiology, Nuclear Medicine and imaging, Myocardial infarction, Lung, lung ultrasound, business.industry, Hazard ratio, medicine.disease, Prognosis, coronary artery disease, Coronary Vessels, 3. Good health, Heart failure, Cardiology, Cardiology and Cardiovascular Medicine, business, medicine.drug, Echocardiography, Stress
Abstract

Objectives The purpose of this study was to assess the functional and prognostic correlates of B-lines during stress echocardiography (SE). Background B-profile detected by lung ultrasound (LUS) is a sign of pulmonary congestion during SE. Methods The authors prospectively performed transthoracic echocardiography (TTE) and LUS in 2,145 patients referred for exercise (n = 1,012), vasodilator (n = 1,054), or dobutamine (n = 79) SE in 11 certified centers. B-lines were evaluated in a 4-site simplified scan (each site scored from 0: A-lines to 10: white lung for coalescing B-lines). During stress the following were also analyzed: stress-induced new regional wall motion abnormalities in 2 contiguous segments; reduced left ventricular contractile reserve (peak/rest based on force, ≤2.0 for exercise and dobutamine, ≤1.1 for vasodilators); and abnormal coronary flow velocity reserve ≤2.0, assessed by pulsed-wave Doppler sampling in left anterior descending coronary artery and abnormal heart rate reserve (peak/rest heart rate) ≤1.80 for exercise and dobutamine (≤1.22 for vasodilators). All patients completed follow-up. Results According to B-lines at peak stress patients were divided into 4 different groups: group I, absence of stress B-lines (score: 0 to 1; n = 1,389; 64.7%); group II, mild B-lines (score: 2 to 4; n = 428; 20%); group III, moderate B-lines (score: 5 to 9; n = 209; 9.7%) and group IV, severe B-lines (score: ≥10; n = 119; 5.4%). During median follow-up of 15.2 months (interquartile range: 12 to 20 months) there were 38 deaths and 28 nonfatal myocardial infarctions in 64 patients. At multivariable analysis, severe stress B-lines (hazard ratio [HR]: 3.544; 95% confidence interval [CI]: 1.466 to 8.687; p = 0.006), abnormal heart rate reserve (HR: 2.276; 95% CI: 1.215 to 4.262; p = 0.010), abnormal coronary flow velocity reserve (HR: 2.178; 95% CI: 1.059 to 4.479; p = 0.034), and age (HR: 1.031; 95% CI: 1.002 to 1.062; p = 0.037) were independent predictors of death and nonfatal myocardial infarction. Conclusions Severe stress B-lines predict death and nonfatal myocardial infarction. (Stress Echo 2020 - The International Stress Echo Study [SE2020]; NCT03049995)

Published
2020

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