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3. Preliminary associations among relational victimization, targeted rejection, and suicidality in adolescents: A prospective study

Author

Massing-Schaffer, M, Helms, S, Rudolph, Karen, Slavich, G, Hastings, P, Giletta, M., Nock, M, Prinstein, Mitch, Massing-Schaffer, M, Helms, S, Rudolph, Karen, Slavich, G, Hastings, P, Giletta, M., Nock, M, and Prinstein, Mitch

Abstract

This study examined associations between multiple types of interpersonal and noninterpersonal stressors and the subsequent occurrence of suicide ideation and attempts among female adolescents. Adolescents ages 12 to 18 years old (n = 160) at elevated risk for suicidal thoughts and behaviors were followed for 18 months, divided into two 9-month epochs for data analysis (Periods 1 and 2). Exposure to acute relational victimization, targeted rejection, nonspecified interpersonal, and noninterpersonal life stressors over the first 9-month epoch (Period 1) was assessed using semistructured interviews and an independent life stress rating team. Participants also completed phone-based semistructured interviews of suicidal thoughts and behaviors. Preliminary analyses showed significant prospective associations between acute targeted rejection and nonspecified interpersonal stress during Period 1 and suicide ideation during Period 2, as well as relational victimization and noninterpersonal stress during Period 1 and suicide attempts during Period 2. However, in logistic regression analyses that adjusted for prior suicidality and depressive symptoms, relational victimization during Period 1 (but not targeted rejection, nonspecified interpersonal or noninterpersonal events) was associated with increased odds of suicide attempt during Period 2. Therefore, acute relational victimization exposure is associated with heightened risk for suicidal behaviors in female adolescents. Future studies should examine potential mediators and moderators of this association, and these stressors should be considered for inclusion in clinical screening tools.

Published
2019

5. [Unusual echocardiographic images of aortic dissection]

Author

Slavich G, Luigi Badano, Mirolo R, Finato N, and Pm, Fioretti

Subjects
Aged, 80 and over, Male, Aortic Dissection, Fatal Outcome, Aortic Aneurysm, Thoracic, Humans, Aorta, Echocardiography, Transesophageal, Aged
Published
2000

9. Abstracts

Author

Dunet, V., primary, Dabiri, A., additional, Allenbach, G., additional, Goyeneche Achigar, A., additional, Waeber, B., additional, Feihl, F., additional, Heinzer, R., additional, Prior, J. O., additional, Van Velzen, J. E., additional, Schuijf, J. D., additional, De Graaf, F. R., additional, De Graaf, M. A., additional, Schalij, M. J., additional, Kroft, L. J., additional, De Roos, A., additional, Jukema, J. W., additional, Van Der Wall, E. E., additional, Bax, J. J., additional, Lankinen, E., additional, Saraste, A., additional, Noponen, T., additional, Klen, R., additional, Teras, M., additional, Kokki, T., additional, Kajander, S., additional, Pietila, M., additional, Ukkonen, H., additional, Knuuti, J., additional, Pazhenkottil, A. P., additional, Nkoulou, R. N., additional, Ghadri, J. R., additional, Herzog, B. A., additional, Buechel, R. R., additional, Kuest, S. M., additional, Wolfrum, M., additional, Gaemperli, O., additional, Husmann, L., additional, Kaufmann, P. A., additional, Andreini, D., additional, Pontone, G., additional, Mushtaq, S., additional, Antonioli, L., additional, Bertella, E., additional, Formenti, A., additional, Cortinovis, S., additional, Ballerini, G., additional, Fiorentini, C., additional, Pepi, M., additional, Koh, A. S., additional, Flores, J. S., additional, Keng, F. Y. J., additional, Tan, R. S., additional, Chua, T. S. J., additional, Annoni, A. D., additional, Tamborini, G., additional, Fusari, M., additional, Bartorelli, A. L., additional, Ewe, S. H., additional, Ng, A. C. T., additional, Delgado, V., additional, Schuijf, J., additional, Van Der Kley, F., additional, Colli, A., additional, De Weger, A., additional, Marsan, N. A., additional, Yiu, K. H., additional, Ng, A. C., additional, Timmer, S. A. J., additional, Knaapen, P., additional, Germans, T., additional, Dijkmans, P. A., additional, Lubberink, M., additional, Ten Berg, J. M., additional, Ten Cate, F. J., additional, Russel, I. K., additional, Lammertsma, A. A., additional, Van Rossum, A. C., additional, Wong, Y. Y., additional, Ruiter, G., additional, Raijmakers, P., additional, Van Der Laarse, W. J., additional, Westerhof, N., additional, Vonk-Noordegraaf, A., additional, Youssef, G., additional, Leung, E., additional, Wisenberg, G., additional, Marriot, C., additional, Williams, K., additional, Etele, J., additional, Dekemp, R. A., additional, Dasilva, J., additional, Birnie, D., additional, Beanlands, R. S. B., additional, Thompson, R. C., additional, Allam, A. H., additional, Wann, L. S., additional, Nureldin, A. H., additional, Adelmaksoub, G., additional, Badr, I., additional, Sutherland, M. L., additional, Sutherland, J. D., additional, Miyamoto, M. I., additional, Thomas, G. S., additional, Harms, H. J., additional, De Haan, S., additional, Huisman, M. C., additional, Schuit, R. C., additional, Windhorst, A. D., additional, Allaart, C., additional, Einstein, A. J., additional, Khawaja, T., additional, Greer, C., additional, Chokshi, A., additional, Jones, M., additional, Schaefle, K., additional, Bhatia, K., additional, Shimbo, D., additional, Schulze, P. C., additional, Srivastava, A., additional, Chettiar, R., additional, Moody, J., additional, Weyman, C., additional, Natale, D., additional, Bruni, W., additional, Liu, Y., additional, Ficaro, E., additional, Sinusas, A. J., additional, Peix, A., additional, Batista, E., additional, Cabrera, L. O., additional, Padron, K., additional, Rodriguez, L., additional, Sainz, B., additional, Mendoza, V., additional, Carrillo, R., additional, Fernandez, Y., additional, Mena, E., additional, Naum, A., additional, Bach-Gansmo, T., additional, Kleven-Madsen, N., additional, Biermann, M., additional, Johnsen, B., additional, Aase Husby, J., additional, Rotevatn, S., additional, Nordrehaug, J. E., additional, Schaap, J., additional, Kauling, R. M., additional, Post, M. C., additional, Rensing, B. J. W. M., additional, Verzijlbergen, J. F., additional, Sanchez, J., additional, Giamouzis, G., additional, Tziolas, N., additional, Georgoulias, P., additional, Karayannis, G., additional, Chamaidi, A., additional, Zavos, N., additional, Koutrakis, K., additional, Sitafidis, G., additional, Skoularigis, J., additional, Triposkiadis, F., additional, Radovanovic, S., additional, Djokovic, A., additional, Simic, D. V., additional, Krotin, M., additional, Savic-Radojevic, A., additional, Pljesa-Ercegovac, M., additional, Zdravkovic, M., additional, Saponjski, J., additional, Jelic, S., additional, Simic, T., additional, Eckardt, R., additional, Kjeldsen, B. J., additional, Andersen, L. I., additional, Haghfelt, T., additional, Grupe, P., additional, Johansen, A., additional, Hesse, B., additional, Pena, H., additional, Cantinho, G., additional, Wilk, M., additional, Srour, Y., additional, Godinho, F., additional, Zafrir, N., additional, Gutstein, A., additional, Mats, I., additional, Battler, A., additional, Solodky, A., additional, Sari, E., additional, Singh, N., additional, Vara, A., additional, Peters, A. M., additional, De Belder, A., additional, Nair, S., additional, Ryan, N., additional, James, R., additional, Dizdarevic, S., additional, Depuey, G., additional, Friedman, M., additional, Wray, R., additional, Old, R., additional, Babla, H., additional, Chuanyong, B., additional, Maddahi, J., additional, Tragardh Johansson, E., additional, Sjostrand, K., additional, Edenbrandt, L., additional, Aguade-Bruix, S., additional, Cuberas-Borros, G., additional, Pizzi, M. N., additional, Sabate-Fernandez, M., additional, De Leon, G., additional, Garcia-Dorado, D., additional, Castell-Conesa, J., additional, Candell-Riera, J., additional, Casset-Senon, D., additional, Edjlali-Goujon, M., additional, Alison, D., additional, Delhommais, A., additional, Cosnay, P., additional, Low, C. S., additional, Notghi, A., additional, O'brien, J., additional, Tweddel, A. C., additional, Bingham, N., additional, O Neil, P., additional, Harbinson, M., additional, Lindner, O., additional, Burchert, W., additional, Schaefers, M., additional, Marcassa, C., additional, Campini, R., additional, Calza, P., additional, Zoccarato, O., additional, Kisko, A., additional, Kmec, J., additional, Babcak, M., additional, Vereb, M., additional, Vytykacova, M., additional, Cencarik, J., additional, Gazdic, P., additional, Stasko, J., additional, Abreu, A., additional, Pereira, E., additional, Oliveira, L., additional, Colarinha, P., additional, Veloso, V., additional, Enriksson, I., additional, Proenca, G., additional, Delgado, P., additional, Rosario, L., additional, Sequeira, J., additional, Kosa, I., additional, Vassanyi, I., additional, Egyed, C. S., additional, Kozmann, G. Y., additional, Morita, S., additional, Nanasato, M., additional, Nanbu, I., additional, Yoshida, Y., additional, Hirayama, H., additional, Allam, A., additional, Sharef, A., additional, Shawky, I., additional, Farid, M., additional, Mouden, M., additional, Ottervanger, J. P., additional, Timmer, J. R., additional, De Boer, M. J., additional, Reiffers, S., additional, Jager, P. L., additional, Knollema, S., additional, Nasr, G. M., additional, Mohy Eldin, M., additional, Ragheb, M., additional, Casans-Tormo, I., additional, Diaz-Exposito, R., additional, Hurtado-Mauricio, F. J., additional, Ruano, R., additional, Diego, M., additional, Gomez-Caminero, F., additional, Albarran, C., additional, Martin De Arriba, A., additional, Rosero, A., additional, Lopez, R., additional, Martin Luengo, C., additional, Garcia-Talavera, J. R., additional, Laitinen, I. E. K., additional, Rudelius, M., additional, Weidl, E., additional, Henriksen, G., additional, Wester, H. J., additional, Schwaiger, M., additional, Pan, X. B., additional, Schindler, T., additional, Quercioli, A., additional, Zaidi, H., additional, Ratib, O., additional, Declerck, J. M., additional, Alexanderson Rosas, E., additional, Jacome, R., additional, Jimenez-Santos, M., additional, Romero, E., additional, Pena-Cabral, M. A., additional, Meave, A., additional, Gonzalez, J., additional, Rouzet, F., additional, Bachelet, L., additional, Alsac, J. M., additional, Suzuki, M., additional, Louedec, L., additional, Petiet, A., additional, Chaubet, F., additional, Letourneur, D., additional, Michel, J. B., additional, Le Guludec, D., additional, Aktas, A., additional, Cinar, A., additional, Yaman, G., additional, Bahceci, T., additional, Kavak, K., additional, Gencoglu, A., additional, Jimenez-Heffernan, A., additional, Sanchez De Mora, E., additional, Lopez-Martin, J., additional, Lopez-Aguilar, R., additional, Ramos, C., additional, Salgado, C., additional, Ortega, A., additional, Sanchez-Gonzalez, C., additional, Roa, J., additional, Tobaruela, A., additional, Nesterov, S. V., additional, Turta, O., additional, Maki, M., additional, Han, C., additional, Daou, D., additional, Tawileh, M., additional, Chamouine, S. O., additional, Coaguila, C., additional, Mariscal-Labrador, E., additional, Kisiel-Gonzalez, N., additional, De Araujo Goncalves, P., additional, Sousa, P. J., additional, Marques, H., additional, O'neill, J., additional, Pisco, J., additional, Cale, R., additional, Brito, J., additional, Gaspar, A., additional, Machado, F. P., additional, Roquette, J., additional, Martinez, M., additional, Melendez, G., additional, Kimura, E., additional, Ochoa, J. M., additional, Alessio, A. M., additional, Patel, A., additional, Lautamaki, R., additional, Bengel, F. M., additional, Bassingthwaighte, J. B., additional, Caldwell, J. H., additional, Rahbar, K., additional, Seifarth, H., additional, Schafers, M., additional, Stegger, L., additional, Spieker, T., additional, Hoffmeier, A., additional, Maintz, D., additional, Scheld, H., additional, Schober, O., additional, Weckesser, M., additional, Aoki, H., additional, Matsunari, I., additional, Kajinami, K., additional, Martin Fernandez, M., additional, Barreiro Perez, M., additional, Fernandez Cimadevilla, O. V., additional, Leon Duran, D., additional, Velasco Alonso, E., additional, Florez Munoz, J. P., additional, Luyando, L. H., additional, Templin, C., additional, Veltman, C. E., additional, Reiber, J. H. C., additional, Venuraju, S., additional, Yerramasu, A., additional, Atwal, S., additional, Lahiri, A., additional, Kunimasa, T., additional, Shiba, M., additional, Ishii, K., additional, Aikawa, J., additional, Kroner, E. S. J., additional, Ho, K. T., additional, Yong, Q. W., additional, Chua, K. C., additional, Panknin, C., additional, Roos, C. J., additional, Van Werkhoven, J. M., additional, Witkowska-Grzeslo, A. J., additional, Boogers, M. J., additional, Anand, D. V., additional, Dey, D., additional, Berman, D., additional, Mut, F., additional, Giubbini, R., additional, Lusa, L., additional, Massardo, T., additional, Iskandrian, A., additional, Dondi, M., additional, Sato, A., additional, Kakefuda, Y., additional, Ojima, E., additional, Adachi, T., additional, Atsumi, A., additional, Ishizu, T., additional, Seo, Y., additional, Hiroe, M., additional, Aonuma, K., additional, Kruk, M., additional, Pracon, R., additional, Kepka, C., additional, Pregowski, J., additional, Kowalewska, A., additional, Pilka, M., additional, Opolski, M., additional, Michalowska, I., additional, Dzielinska, Z., additional, Demkow, M., additional, Stoll, V., additional, Sabharwal, N., additional, Chakera, A., additional, Ormerod, O., additional, Fernandes, H., additional, Bernardes, M., additional, Martins, E., additional, Oliveira, P., additional, Vieira, T., additional, Terroso, G., additional, Oliveira, A., additional, Faria, T., additional, Ventura, F., additional, Pereira, J., additional, Fukuzawa, S., additional, Inagaki, M., additional, Sugioka, J., additional, Ikeda, A., additional, Okino, S., additional, Maekawa, J., additional, Uchiyama, T., additional, Kamioka, N., additional, Ichikawa, S., additional, Afshar, M., additional, Alvi, R., additional, Aguilar, N., additional, Ippili, R., additional, Shaqra, H., additional, Bella, J., additional, Bhalodkar, N., additional, Dos Santos, A., additional, Daicz, M., additional, Cendoya, L. O., additional, Marrero, H. G., additional, Casuscelli, J., additional, Embon, M., additional, Vera Janavel, G., additional, Duronto, E., additional, Gurfinkel, E. P., additional, Cortes, C. M., additional, Takeishi, Y., additional, Nakajima, K., additional, Yamasaki, Y., additional, Nishimura, T., additional, Hayes Brown, K., additional, Collado, F., additional, Alhaji, M., additional, Green, J., additional, Alexander, S., additional, Vashistha, R., additional, Jain, S., additional, Aldaas, F., additional, Shanes, J., additional, Doukky, R., additional, Ashikaga, K., additional, Akashi, Y. J., additional, Uemarsu, M., additional, Kamijima, R., additional, Yoneyama, K., additional, Omiya, K., additional, Miyake, Y., additional, Brodov, Y., additional, Raval, U., additional, Berezin, A., additional, Seden, V., additional, Koretskaya, E., additional, Panasenko, T. A., additional, Matsuo, S., additional, Kinuya, S., additional, Chen, J., additional, Van Bommel, R. J., additional, Van Der Hiel, B., additional, Dibbets-Schneider, P., additional, Garcia, E. V., additional, Rutten-Vermeltfoort, I., additional, Gevers, M. M. J., additional, Verhoeven, B., additional, Dijk Van, A. B., additional, Raaijmakers, E., additional, Raijmakers, P. G. H. M., additional, Engvall, J. E., additional, Gjerde, M., additional, De Geer, J., additional, Olsson, E., additional, Quick, P., additional, Persson, A., additional, Mazzanti, M., additional, Marini, M., additional, Pimpini, L., additional, Perna, G. P., additional, Marciano, C., additional, Gargiulo, P., additional, Galderisi, M., additional, D'amore, C., additional, Savarese, G., additional, Casaretti, L., additional, Paolillo, S., additional, Cuocolo, A., additional, Perrone Filardi, P., additional, Al-Amoodi, M., additional, Thompson, E. C., additional, Kennedy, K., additional, Bybee, K. A., additional, Mcghie, A. I., additional, O'keefe, J. H., additional, Bateman, T. M., additional, Van Der Palen, R. L. F., additional, Mavinkurve-Groothuis, A. M., additional, Bulten, B., additional, Bellersen, L., additional, Van Laarhoven, H. W. M., additional, Kapusta, L., additional, De Geus-Oei, L. F., additional, Pollice, P. P., additional, Bonifazi, M. B., additional, Pollice, F. P., additional, Clements, I. P., additional, Hodge, D. O., additional, Scott, C. G., additional, De Ville De Goyet, M., additional, Brichard, B., additional, Pirotte, T., additional, Moniotte, S., additional, Tio, R. A., additional, Elvan, A., additional, Dierckx, R. A. I. O., additional, Slart, R. H. J. A., additional, Furuhashi, T., additional, Moroi, M., additional, Hase, H., additional, Joki, N., additional, Masai, H., additional, Nakazato, R., additional, Fukuda, H., additional, Sugi, K., additional, Kryczka, K., additional, Kaczmarska, E., additional, Petryka, J., additional, Mazurkiewicz, L., additional, Ruzyllo, W., additional, Smanio, P., additional, Vieira Segundo, E., additional, Siqueira, M., additional, Kelendjian, J., additional, Ribeiro, J., additional, Alaca, J., additional, Oliveira, M., additional, Alves, F., additional, Peovska, I., additional, Maksimovic, J., additional, Vavlukis, M., additional, Kostova, N., additional, Pop Gorceva, D., additional, Majstorov, V., additional, Zdraveska, M., additional, Hussain, S., additional, Djearaman, M., additional, Hoey, E., additional, Morus, L., additional, Erinfolami, O., additional, Macnamara, A., additional, Opolski, M. P., additional, Witkowski, A., additional, Berti, V., additional, Ricci, F., additional, Gallicchio, R., additional, Acampa, W., additional, Cerisano, G., additional, Vigorito, C., additional, Sciagra', R., additional, Pupi, A., additional, Sliem, H., additional, Collado, F. M., additional, Schmidt, S., additional, Maheshwari, A., additional, Kiriakos, R., additional, Mwansa, V., additional, Ljubojevic, S., additional, Sedej, S., additional, Holzer, M., additional, Marsche, G., additional, Marijanski, V., additional, Kockskaemper, J., additional, Pieske, B., additional, Ricalde, A., additional, Alexanderson, G., additional, Mohani, A., additional, Khanna, P., additional, Sinusas, A., additional, Lee, F., additional, Pinas, V. A., additional, Van Eck-Smit, B. L. F., additional, Verberne, H. J., additional, De Bruin, C. M., additional, Guilhermina, G., additional, Jimenez-Angeles, L., additional, Ruiz De Jesus, O., additional, Yanez-Suarez, O., additional, Vallejo, E., additional, Reyes, E., additional, Chan, M., additional, Hossen, M. L., additional, Underwood, S. R., additional, Karu, A., additional, Bokhari, S., additional, Pineda, V., additional, Gracia-Sanchez, L. M., additional, Garcia-Burillo, A., additional, Zavadovskiy, K., additional, Lishmanov, Y. U., additional, Saushkin, W., additional, Kovalev, I., additional, Chernishov, A., additional, Annoni, A., additional, Tarkia, M., additional, Saanijoki, T., additional, Oikonen, V., additional, Savunen, T., additional, Green, M. A., additional, Strandberg, M., additional, Roivainen, A., additional, Gaeta, M. C., additional, Artigas, C., additional, Deportos, J., additional, Geraldo, L., additional, Flotats, A., additional, La Delfa, V., additional, Carrio, I., additional, Laarse, W. J., additional, Izquierdo Gomez, M. M., additional, Lacalzada Almeida, J., additional, Barragan Acea, A., additional, De La Rosa Hernandez, A., additional, Juarez Prera, R., additional, Blanco Palacios, G., additional, Bonilla Arjona, J. A., additional, Jimenez Rivera, J. J., additional, Iribarren Sarrias, J. L., additional, Laynez Cerdena, I., additional, Dedic, A., additional, Rossi, A., additional, Ten Kate, G. J. R., additional, Dharampal, A., additional, Moelker, A., additional, Galema, T. W., additional, Mollet, N., additional, De Feyter, P. J., additional, Nieman, K., additional, Trabattoni, D., additional, Broersen, A., additional, Frenay, M., additional, Boogers, M. M., additional, Kitslaar, P. H., additional, Dijkstra, J., additional, Annoni, D. A., additional, Muratori, M., additional, Johki, N., additional, Tokue, M., additional, Dharampal, A. S., additional, Weustink, A. C., additional, Neefjes, L. A. E., additional, Papadopoulou, S. L., additional, Chen, C., additional, Mollet, N. R. A., additional, Boersma, E. H., additional, Krestin, G. P., additional, Purvis, J. A., additional, Sharma, D., additional, Hughes, S. M., additional, Berman, D. S., additional, Taillefer, R., additional, Udelson, J., additional, Devine, M., additional, Lazewatsky, J., additional, Bhat, G., additional, Washburn, D., additional, Patel, D., additional, Mazurek, T., additional, Tandon, S., additional, Bansal, S., additional, Inzucchi, S., additional, Staib, L., additional, Davey, J., additional, Chyun, D., additional, Young, L., additional, Wackers, F., additional, Harbinson, M. T., additional, Wells, G., additional, Dougan, J., additional, Borges-Neto, S., additional, Phillips, H., additional, Farzaneh-Far, A., additional, Starr, Z., additional, Shaw, L. K., additional, Fiuzat, M., additional, O'connor, C., additional, Henzlova, M., additional, Duvall, W. L., additional, Levine, A., additional, Baber, U., additional, Croft, L., additional, Sahni, S., additional, Sethi, S., additional, Hermann, L., additional, Nureldin, A., additional, Gomaa, A., additional, Soliman, M. A. T., additional, Hany, H. A. R., additional, De Graaf, F., additional, Pazhenkottil, A., additional, Siebelink, H. M. J., additional, Reiber, J. H., additional, Ayub, M., additional, Naveed, T., additional, Azhar, M., additional, Van Tosh, A., additional, Faber, T. L., additional, Votaw, J. R., additional, Reichek, N., additional, Pulipati, B., additional, Palestro, C., additional, Nichols, K. J., additional, Okuda, K., additional, Kirihara, Y., additional, Ishikawa, T., additional, Taki, J., additional, Yoshita, M., additional, Yamada, M., additional, Salacata, A., additional, Keavey, S., additional, Chavarri, V., additional, Mills, J., additional, Nagaraj, H., additional, Bhambhani, P., additional, Kliner, D. E., additional, Soman, P., additional, Heo, J., additional, Iskandrian, A. E., additional, Jain, M., additional, Lin, B., additional, Walker, A., additional, Nkonde, C., additional, Bond, S., additional, Baskin, A., additional, Declerck, J., additional, Soto, M. E., additional, Mendoza, G., additional, Aguilar, M., additional, Williams, S. P., additional, Colice, G., additional, Mcardle, J. R., additional, Lankford, A., additional, Kajdasz, D. K., additional, Reed, C. R., additional, Angelini, L., additional, Angelozzi, F., additional, Ascoli, G., additional, Jacobson, A., additional, Lessig, H. J., additional, Gerson, M. C., additional, Cerqueira, M. D., additional, Narula, J., additional, Uematsu, M., additional, Kida, K., additional, Suzuki, K., additional, Bravo, P. E., additional, Fukushima, K., additional, Chaudhry, M., additional, Merrill, J., additional, Alonso Tello, A., additional, Rodriguez Palomares, J. F., additional, Marti Aguasca, G., additional, Aguade Bruix, S., additional, Aliaga, V., additional, Mahia, P., additional, Gonzalez-Alujas, T., additional, Candell, J., additional, Evangelista, A., additional, Mlynarski, R., additional, Mlynarska, A., additional, Sosnowski, M., additional, Zerahn, B., additional, Hasbak, P., additional, Mortensen, C. E., additional, Mathiesen, H. F., additional, Andersson, M., additional, Nielsen, D., additional, Ferreira Santos, L., additional, Ferreira, M. J., additional, Ramos, D., additional, Moreira, D., additional, Cunha, M. J., additional, Albuquerque, A., additional, Moreira, A., additional, Oliveira Santos, J., additional, Costa, G., additional, Providencia, L. A., additional, Arita, Y., additional, Kihara, S., additional, Mitsusada, N., additional, Miyawaki, M., additional, Ueda, H., additional, Hiraoka, H., additional, Matsuzawa, Y., additional, Askew, J., additional, O'connor, M., additional, Jordan, L., additional, Ruter, R., additional, Gibbons, R., additional, Miller, T., additional, Emmett, L., additional, Ng, A., additional, Sorensen, N., additional, Mansberg, R., additional, Kritharides, L., additional, Gonzalez, T., additional, Majmundar, H., additional, Coats, N. P., additional, Vernotico, S., additional, Doan, J. H., additional, Hernandez, T. M., additional, Evini, M., additional, Hepner, A. D., additional, Ip, T. K., additional, Chalela, W. A., additional, Falcao, A. M., additional, Azouri, L. O., additional, Ramires, J. A. F., additional, Meneghetti, J. C., additional, Manganelli, F., additional, Spadafora, M., additional, Varrella, P., additional, Peluso, G., additional, Sauro, R., additional, Di Lorenzo, E., additional, Rotondi, F., additional, Daniele, S., additional, Miletto, P., additional, Rijnders, A. J. M., additional, Hendrickx, B. W., additional, Van Der Bruggen, W., additional, America, Y. G. C. J., additional, Thorley, P. J., additional, Chowdhury, F. U., additional, Dickinson, C. J., additional, Sazonova, S. I., additional, Proskokova, I. Y. U., additional, Gusakova, A. M., additional, Minin, S. M., additional, Lishmanov, Y. U. B., additional, Saushkin, V. V., additional, Rodriguez, G., additional, Roffe, F., additional, Ilarraza, H., additional, Bialostozky, D., additional, Kitsiou, A. N., additional, Arsenos, P., additional, Tsiantis, I., additional, Charizopoulos, S., additional, Karas, S., additional, Vidal Perez, R. 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2011
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13. MEDICAL SCIENCE. GISSI-2: A factorial randomised trial of alteplase versus streptokinase and heparin versus no heparin among 12 490 patients with acute myocardial infarction

Author

Feruglio, G. A., Lotto, A., Rovelli, F., Solinas, P., Tavazzi, L., Tognoni, G., De Vita, C., Franzosi, M. G., Maggiom, A. P., Mauri, F., Volpi, A., Selvini, A., Donato, L., Garattmi, S., Loi, U., Sirchia, G., Ambrosioni, E., Camerini, F., Campolo, L., Donati, M. B., Ferrari, M., Farchi, G., Geraci, E., Mannucci, P. M., Marubini, E., Neri Semeri, G. G., Peto, R., Prati, P. L., Specchia, G., Vecchio, C., Visani, L., Yusuf, S., Mezzanotte, G., Santoro, E., Bruno, M., Cappello, T., Coppini, A., Fincati, F., Mantovani, G., Pangrazzi, J., Pogna, M., Turazza, F. M., Ansehni, M., Barbonaglia, L., Bigi, R., Cavalli, A., Frigerio, M., Giordano, A., Gualtierotti, C., Torta, D., Vinci, P., Bossi, M., Furlanello, F., Braito, E., Giulia, V., Palmieri, M., Majoimo, P., Pinelli, G., Papi, L., Nardelli, A., Capestro, F., Rossi, A., Ricci, D., Mininni, N., Bianco, G., Barbuzzi, S., Plastina, F., Di Giovanna, F., Mereu, D., Giordano, F., Barlotti, R., Loparco, G., Boscarino, S., Ruggeri, G., Anastasi, R., Paciaroni, E., Tomassini, P. F., Purcaro, A., Francesconi, M., Figliolia, S., Tesse, S., Devoti, G., Giometti, R., Teoni, P., Burali, A., Zucconelli, V., Iervoglini, A., Amabili, S., Caratti, C. A., Zola, G., Ferraguto, P., Sagci, G., Rotiroti, D., Genovese, M., Da€™amato, N., Taurino, L., Colonna, L., Bovenzi, F., Messina, D., Sarcina, G., Compostella, L., Cucchini, F., Malacrida, R., Gradel, C., Bridda, A., Pellegrini, P., Acone, L., Bruno, A., Tespili, M., Guaghurrii, G., Casari, A., Bobba, F., Scaramuzzino, G., Berardi, C., De Castro, U., Fulvi, M., Lintner, W., Erlicher, A., Pitscheider, W., Scola Gagliardi, R., Bonizzato, G., Roggero, C., Perrini, A., Tsialtas, D., Straneo, U., Storelli, A., Verrienti, A., Albonico, B., Corradi, L., De Petra, V., Villani, C., Maxia, P., Bianco, A., Crabu, E., Centamore, G., Di Stefano, G., Vancheri, F., Amico, C., Baldini, F., Santopuoli, G., Pantaleoni, A., Contessotto, F., Terlizzi, R., Turchi, E., Teglio, V., Pignatti, F., Aletto, C., Gozzelino, G., Pettinati, G., De Santis, F., Correale, E., Romano, S., Perrotta, R., Tritto, C., May, L., Achilli, G., Suzzi, G., Cemetti, C., Longobardi, R., Somma, G., Palumbo, C., Gallone, P., Sorrentino, F., Dato, A., Della Monica, R., Pagano, L., Alberti, A., Orselli, L., Negrini, M., De Ponti, C., Acito, P., Capelletti, D., Bortolini, F., Coppola, V., Ciglia, C., De Cesare, M., De Lio, U., Maiolino, P., Giannini, R., Niccolini, A., Marinoni, C., Guasconi, C., Sonnino, S., Pagliei, M., Ferrari, G., Politi, A., Galli, M., De Rinaldis, G., Calcagnile, A., Bendinelli, S., Lusetti, L., Mollaioli, M., Cosmi, F., Venneri, N., Feraco, E., Lauro, A., Catelli, P., Poluzzi, C., Distante, S., Pedroni, P., Zampaglione, G., Lumare, R., Bruna, C., De Benedictis, N., Ziacchi, V., Lomanto, B., Riva, D., Bertocchi, P., Tirella, G., Tessitori, M., Bini, A., Peruzzi, F., Maresta, A., Pirazzini, L., Gaggi, S., Frausini, G., Malacame, C., Codeca, L., Cappato, R., Andreoli, L., Bastoni, L. A., Pucci, P., Sarro, F., Vergassola, R., Barchielli, M., De Matteis, D., Carrone, M., Liberati, R., Meniconi, L., Radogna, M., Tallone, M., Ieri, A., Ferreri, A., Guidali, P., Canziani, R., Mariello, F., Minelli, C., Muzio, L., Rota Baldini, M., Lupi, G., Cecchi, A., Giuliano, G., Bellotti, S., Livi, S., Corti, E., Rossi, P., Delfino, R., Iannetti, M., Pastorini, C., Pennesi, A., Di Giacinto, N., Bertolo, L., Slomp, L., Cresti, A., Svetoni, N., Distefano, S., Veneri, L., Moretti, S., Palermo, R., Giovanelli, N., Parchi, C., Dethomads, M., Paparella, N., Carrino, C., Aquaro, G., Idone, P., Marsili, P., Sideri, F., Valerio, A., Tullio, D., Ragazzini, G., Gramenzi, S., De Pasquale, B., Gelfo, P. G., Rosselli, P., De Marchi, E., Greco, M. R., Fazio, A. M., Savoia, M. T., Gerosa, C., Barbiero, M., Barbaresi, F., Volta, G., Da€™urbano, M., Passoni, F., Parola, G., Lanzini, A., Baldini, U., Del Bene, P., Orlandi, M., Oddone, A., Lazzari, M., Ballerini, B., Bozzi, L., Moccetti, T., Bemasconi, E., Sanguinetti, M., Tognoli, T., Bardelli, G., Maggi, A., Turato, R., Piva, M., Izzo, A., Tantalo, L., Rizzi, A., Scilabra, G., Varvaro, F., Colombo, G., Grieco, A., Dovico, E., Belluzzi, F., Casellato, F., Lecchi, G., Maugeri Sacci, C., Consolo, A., Piccolo, E., Zuin, G., Zappa, C., Sanna, G. P., Dossena, M. G., Corsini, C., Lettino, M., Marconi, M., Mafrici, A., Leonardi, G., Moreo, A., Seregni, R., Pastine, I., Casazza, F., Regalia, F., Maggiolini, S., Benenati, P. M., Rigo, R., Pascotto, P., Zanocco, A., Artusi, L., Cappelli, C., Bernardi, C., Pahnieri, M., Zilio, G., Sandri, R., Neri, G., Valagussa, F., Osculati, G., Cira, A., Da€™aniello, L., Piantadosi, F. R., Improta, M., Severino, S., Bisconti, C., Mostacci, M., Randon, L., Boschello, M., Allegri, M., Freggiaro, V., Mureddu, V., Soro, F., Marras, E., Marchi, S. M., De Luca, C., Manetta, M., Dalla Volta, S., Maddalena, F., Donzelli, M., Vitrano, M. G., Canonico, A., Ledda, A., Bellomare, D., Carrubba, A., Da€™antonio, E., Scardulla, C., Raineri, A., Traina, M., La Calce, C., Cirincione, V., Montanar, F., Strizzolo, L., Di Gregorio, D., Mantini, L., Chiriatti, G., Gazzola, U., Rosi, A., Mellini, M., Piazza, R., Micheli, G., Bechi, S., Martines, C., Marchese, D., Bigalli, A., Davini, P., Boem, A., Del Citerna, F., Giomi, A., Codeluppi, P., Negrelli, M., Brieda, M., Charmet, P. A., Petrella, A., Bardazzi, L., Bianco, G. A., Marco, A., Licitra, R., Lettica, G. V., Tumiotto, G., Bosi, S., Spitali, G., Casali, G., Bottoni, N., Parenti, G. F., Triulzi, E., Brighi, F., Benati, A., De Sanctis, A., Mene, A., Pesaresi, A., Bologna, F., Lumia, F., Barbato, G., Milazzotto, F., Proietti, F., Angrisani, G., Azzolini, P., Coppola, E., Trani, Carlo, Masini, V., Rocchi, M., Borgia, M. C., Luciani, C., Vitucci, N. C., Giuliani, P., Tugnoli, F., Vetta, C., Altieri, T., Gimigliano, F., Striano, U., Salituri, S., Zanazzi, G., Zonzin, P., Bugatti, U., Ravera, B., Allemano, P., Reynaud, S., Sanson, A., Milani, L., De Simone, M. V., Villella, A., Grazzini, M., Amidei, S., Ansehni, L., Benza, G., Tagliamonte, A., Messina, V., Etro, M. D., Vivaldi, F., Cortese, R., Ibba, G. V., Sannia, L., Pedrazzini, F., Gazzotti, G. L., Pizzuti, A., Antonielli, E., Becchi, G., Filice, A., Salmoiraghi, A., Caramanno, G., Caporicci, D., Brun, M., Ferrario, G., Giani, P., Ronconi, G., Douglas, S., Bianchi, C., Cucchi, G., Marieni, M., Marcellini, G., Speca, G., Beato, E., Serabni, N., Bazzucchi, M., Coronelli, R., Rossi, L., Basso, G., Presbitero, P., Bevilacqua, R., Pallisco, O., Di Leo, M., Golzio, P. G., Parigi, A., Belli, R., Trinchero, R., Gaschino, G., Barenghi, M., Poggio, G. L., Braschi, G. B., Sciacca, R., Sammartano, A., Braito, G., Cuzzato, V., Frigo, G., Perissinono, F., Galati, A., Accogli, M., Morgera, T., Barbieri, L., Slavich, G. A., Fresco, C., Cuda, A., Liguori, A., Cozzi, A., Caico, S., Alberio, M., Di Marco, G., De Vito, G., Valente, S., Zagatti, G., Zardini, P., Nidasio, G. P., Girardi, P., Mazzini, C., Nava, S., Achilli, A., Bisogno, A., Pasotti, C., Ballestra, A. M., and Giustarini, C.

Subjects
Aspirin, medicine.medical_specialty, business.industry, Streptokinase, acute myocardial infarction, General Medicine, Heparin, medicine.disease, Atenolol, Surgery, Anistreplase, Anesthesia, Settore MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLARE, medicine, Myocardial infarction, business, Stroke, medicine.drug, Killip class
Abstract

A multicentre, randomised, open trial with a 2 x 2 factorial design was conducted to compare the benefits and risks of two thrombolytic agents, streptokinase (SK, 1·5 MU infused intravenously over 30-60 min) and alteplase (tPA, 100 mg infused intravenously over 3 h) in patients with acute myocardial infarction admitted to coronary care units within 6 h from onset of symptoms. The patients were also randomised to receive heparin (12 500 U subcutaneously twice daily until discharge from hospital, starting 12 h after beginning the tPA or SK infusion) or usual therapy. All patients without specific contraindications were given atenolol (5-10 mg iv) and aspirin (300-325 mg a day). The end-point of the study was the combined estimate of death plus severe left ventricular damage. 12 490 patients were randomised to four treatment groups (SK alone, SK plus heparin, tPA alone, tPA plus heparin). No specific differences between the two thrombolytic agents were detected as regards the combined end-point (tPA 23·1%; SK 22·5%; relative risk 1·04, 95% Cl 0·95-1·13), nor after the addition of heparin to the aspirin treatment (hep 22·7%, no hep 22·9%; RR 0·99, 95% Cl 0·91-1·08). The outcome of patients allocated to the four treatment groups was similar with respect to baseline risk factors such as age, Killip class, hours from onset of symptoms, and site and type of infarct. The rates of major in-hospital cardiac complications (reinfarction, post-infarction angina) were also similar. The incidence of major bleeds was significantly higher in SK and heparin treated patients (respectively, tPA 0·5%, SK 1·0%, RR 0·57, 95% Cl 0·38-0·85; hep 1·0%, no hep 0·6%, RR 1·64, 95% Cl 1·09-2·45), whereas the overall incidence of stroke was similar in all groups. SK and tPA appear equally effective and safe for use in routine conditions of care, in all infarct patients who have no contraindications, with or without post-thrombolytic heparin treatment. The 8·8% hospital mortality of the study population (compared with approximately 13% in the control cohort of the GISSI-1 trial) indicates the beneficial impact of the proven acute treatments for AMI.

Published
1990

17. ASSENCE (assessment of cost-effectiveness of several strategies of early diagnosis in patients with acute chest pain and non-conclusive electrocardiogram)

Author

Luigi Badano, Gregori D, Slavich G, Gremese E, Ghidina M, and Pm, Fioretti

Subjects
Chest Pain, Cardiotonic Agents, Time Factors, Cost-Benefit Analysis, Clinical Enzyme Tests, Diagnosis, Differential, Electrocardiography, Echocardiography, Research Design, Dobutamine, Acute Disease, Exercise Test, Quality of Life, Humans
Abstract

Clinical, economical, organizative, and medico-legal issues raised by management of citizens who come to Emergency Department with acute chest pain and non diagnostic electrocardiogram are well known. Data from the Italian Health Ministry show that, in 1996, 37,444 patients had been discharged from Italian hospitals with the main diagnosis of chest pain. To obtain this "non-diagnosis", it was needed a mean hospital stay of 4.2 days with estimated costs close to $57,000,000. The ASSENCE study is a randomized, multicenter, international trial aimed at comparing three strategies of handling citizens presenting to emergency department for unexplained chest pain in terms of cost/effectiveness ratio and quality of patients' life. The three strategies that will be compared are: 1. current clinical protocols, prescribing an in-hospital observation period and discharge after several hours/days; 2. performing a dobutamine-atropine stress echocardiography between 0 and 18 hours after randomization (at 6 hours after index chest pain onset) and discharging the patients (if negative) immediately thereafter; 3. performing an electrocardiographic exercise stress test between 0 and 18 hours after randomization and discharging the patients (if negative) immediately thereafter. The main ASSENCE study end-point will be assessment of cost/effectiveness of the 3 strategies tested. Costs will be assessed taking into account: hospital stay length, performed diagnostic procedures and treatments during index admission, in-hospital and 2-month follow-up events (cardiac death, myocardial infarction, definite unstable angina, coronary angioplasty, by-pass surgery, re-admission to hospital for chest-pain). A secondary ASSENCE study end-point will be to assess the effect on patient quality of life of the use of the 3 strategies tested. Sample size estimation calculated in order to detect an absolute difference of at least 10% and based on a 30% expected rate of events, was of 186 patients for each strategy tested.

18. [Images in cardiovascular medicine. Appearance is deceptive]

Author

Slavich G, Popiel M, Pavoni D, and Luigi Badano

Subjects
Adult, Diagnosis, Differential, Male, Electrocardiography, Echocardiography, Electrocardiography, Ambulatory, Myocardial Ischemia, Humans, Female, Heart, Middle Aged, Coronary Angiography, Radionuclide Imaging

21. Echocardiographic and Doppler Findings in Primary Sarcoma of the Pulmonary Artery

Author

Gianni Slavich, Fulvio Calucci, Furio Silvestri, Rossana Bussani, Gianfranco Sinagra, Vincenzo De Pangher Manzini, Bruno Pinamonti, Pinamonti, B, Sinagra, Gianfranco, Slavich, G, Calucci, F, DE PANGHER MANZINI, V, Bussani, Rossana, and Silvestri, Furio

Subjects
Pressure overload, medicine.medical_specialty, medicine.diagnostic_test, business.industry, Hemodynamics, Autopsy, Doppler echocardiography, medicine.disease, Right pulmonary artery, Embolus, Internal medicine, medicine.artery, Pulmonary artery, cardiovascular system, medicine, Cardiology, Radiology, Nuclear Medicine and imaging, Sarcoma, Radiology, Cardiology and Cardiovascular Medicine, business
Abstract

Primary sarcoma of the pulmonary artery is a rare heart tumor. In the reported case, the clinical findings were nonspecific, and were characterized by progressive dyspnea, fever, and a systolic murmur in the pulmonary area. Echocardiographic examination showed an echogenic mass partially obstructing the pulmonary artery trunk, dilation of the right cardiac chambers, and a pressure overload pattern. Doppler and color Doppler demonstrated a high-velocity systolic flow jet in the pulmonary artery due to obstruction of the vessel by the tumor, as well as severe high-velocity tricuspid regurgitation. The patient died suddenly soon thereafter. The autopsy confirmed almost total occlusion of the pulmonary artery by a neoplastic mass. Histopathological diagnosis was primary vascular leiomyosarcoma of the pulmonary artery. In addition, a large tumor embolus had occluded the right pulmonary artery. Doppler echocardiography proved useful in noninvasively recognizing the sarcoma of the pulmonary artery, and explaining the clinical picture and hemodynamic derangements produced by this tumor. This could, in other patients, allow an early diagnosis and timely surgical intervention.

Published
1992

22. Quantitative texture analysis in echocardiography: application to the diagnosis of myocarditis

Author

Eugenio Picano, Antonio Benassi, Fulvio Camerini, E.M. Ferdeghini, Bruno Pinamonti, Fabio Lattanzi, Antonio L'Abbate, Gianni Slavich, Rossana Bussani, Luigi Landini, Federghini, Em, Pinamonti, B, Picano, E, Lattanzi, F, Bussani, Rossana, Slavich, G, Benassi, A, Camerini, F, Landini, L, and L'Abbate, A.

Subjects
Adult, Male, medicine.medical_specialty, Pathology, Myocarditis, Biopsy, Cardiomyopathy, Endomyocardial biopsy, Image texture, Fibrosis, Internal medicine, medicine, Image Processing, Computer-Assisted, Humans, Radiology, Nuclear Medicine and imaging, Retrospective Studies, Analysis of Variance, Wound Healing, business.industry, Myocardium, Ultrasound, Signal Processing, Computer-Assisted, Middle Aged, medicine.disease, Endomyocardial Fibrosis, Gray level, Echocardiography, Cardiology, Myocardial fibrosis, Female, business, Follow-Up Studies
Abstract

Altered myocardial texture associated with inflammatory infiltration or fibrosis of the myocardium has already been described using qualitative and subjective analysis of two-dimensional echocardiograms. The aim of this work is to test whether quantitative analysis of regional image texture in two-dimensional echocardiograms would be an accurate method to identify myocarditis and myocardial fibrosis. A set of 20 two-dimensional studies with endomyocardial biopsy evaluation was examined in 13 patients. Biopsy-proven myocarditis was present in 8 studies; myocarditis and fibrosis in 4; fibrosis in 3; healing/healed myocarditis in 5. A control group of 8 normal subjects was also studied by echocardiography. After quantitative texture analysis of the first order, entropy appeared to consistently differentiate myocarditis from controls. Among second-order parameters, patients affected by myocarditis or fibrosis showed a decreased entropy and higher angular second moment versus controls. We conclude that myocarditis and fibrosis induce similar image texture alterations in ultrasonic images, with increased spatial heterogeneity of the gray level distribution, which can be differentiated from normal structures with digital image analysis techniques.

Published
1991

23. Don't Look at ST Segment Only.

Author

Slavich M and Slavich G

Subjects
Chest Pain etiology, Diagnosis, Differential, Electrocardiography, Exercise Test, Female, Heart Atria, Humans, Middle Aged, Myocardial Ischemia complications, Myocardial Ischemia diagnosis, Myocardial Ischemia diagnostic imaging, Single Photon Emission Computed Tomography Computed Tomography, Atrial Function, Myocardial Ischemia physiopathology
Published
2016
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24. Biventricular non-compaction demonstrated on multi-slice computed tomography with echocardiographic correlation.

Author

Grillone S, Nucifora G, Piccoli G, Gianfagna P, Hysko F, Pavoni D, Slavich G, Proclemer A, and Gasparini D

Subjects
Echocardiography, Humans, Male, Middle Aged, Multidetector Computed Tomography, Heart Defects, Congenital diagnostic imaging
Abstract

Left ventricular non-compaction (LVNC) is a myocardial disorder characterized by prominent trabeculations and deep intertrabecular recesses within the left ventricular wall. Multi-slice computed tomography (CT) might represent a valid non-invasive imaging technique for the diagnostic work-up of these patients, being able to visualize the compacted and non-compacted layers and to simultaneously rule out the presence of associated coronary artery disease and congenital heart disease. In the present report, the CT features of LVNC are described.

Published
2013
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25. Infarct-like acute myocarditis: relation between electrocardiographic findings and myocardial damage as assessed by cardiac magnetic resonance imaging.

Author

Nucifora G, Miani D, Di Chiara A, Piccoli G, Artico J, Puppato M, Slavich G, De Biasio M, Gasparini D, and Proclemer A

Subjects
Acute Disease, Adult, Chi-Square Distribution, Contrast Media, Diagnosis, Differential, Female, Gadolinium DTPA, Humans, Linear Models, Male, Middle Aged, Multivariate Analysis, Myocardial Infarction pathology, Myocardial Infarction physiopathology, Myocarditis pathology, Myocarditis physiopathology, Predictive Value of Tests, Stroke Volume, Ventricular Function, Left, Young Adult, Electrocardiography, Magnetic Resonance Imaging, Cine, Myocardial Infarction diagnosis, Myocarditis diagnosis, Myocardium pathology
Abstract

Background: Acute myocarditis (AM) may occasionally have an infarct-like presentation. The aim of the present study was to investigate the relation between electrocardiographic (ECG) findings in this group of patients and myocardial damage assessed by cardiac magnetic resonance imaging (MRI) with the late gadolinium enhancement (LGE) technique., Hypothesis: Myocardial damage may be associated with ECG changes in infarct-like AM., Methods: Forty-one consecutive patients (36 males; mean age, 36 ± 12 years) with diagnosis of AM according to cardiac MRI Lake Louise criteria and infarct-like presentation were included. The relation between site of ST-segment elevation (STE), sum of STE (sumSTE), time to normalization of STE, and development of negative T wave with the extent of LGE (expressed as % of left ventricular mass [%LV LGE]), was evaluated., Results: Most (80%) patients presented with inferolateral STE; mean sumSTE was 5 ± 3 mm. Normalization of STE occurred within 24 hours in 20 (49%) patients. Development of negative T wave occurred in 28 (68%) patients. Cardiac MRI showed LGE in all patients; mean %LV LGE was 9.6 ± 7.2%. Topographic agreement between site of STE and LGE was 68%. At multivariate analysis, sumSTE (β = 0.42, P < 0.001), normalization of STE >24 hours (β = 0.39, P < 0.001), and development of negative T wave (β = 0.49, P < 0.001) were independently related to %LV LGE., Conclusions: Analysis of the site of STE underestimates the extent of myocardial injury among patients with infarct-like myocarditis. However, some ECG features (ie, sumSTE, normalization of STE >24 hours, and development of negative T wave) may help to identify patients with larger areas of myocardial damage., (© 2012 Wiley Periodicals, Inc.)

Published
2013
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26. [Electrocardiographic identification of the culprit artery and occlusion site in ST-elevation myocardial infarction].

Author

Slavich G, Poli S, Spedicato L, Sappa R, and Trianni A

Subjects
Aged, Algorithms, Female, Humans, Male, Myocardial Infarction pathology, Electrocardiography, Myocardial Infarction diagnosis
Abstract

Background: In clinical practice, the identification of the culprit vessel and the localization of the occlusion site in ST-elevation myocardial infarction (STEMI) are provided by coronary angiography. Over the last few years, however, an increasing body of literature focused upon the reassessment of the ECG as a reliable technique to obtain this useful information. The aim of this study was to evaluate the accuracy of electrocardiographic criteria compared to coronary angiography., Methods: On the basis of the available literature, we developed an electrocardiographic algorithm based on the analysis of ST-segment elevation and reciprocal depression, whose accuracy was verified through its use in our cohort of 343 consecutive patients during calendar years 2008-2010. All patients underwent emergent percutaneous coronary intervention in the setting of acute STEMI. Patients with left bundle branch block, pacemaker rhythm and/or with a history of previous reperfusion were excluded. The admission electrocardiograms were reviewed by experienced cardiologists blinded to the angiographic findings., Results: The criteria adopted allowed a correct identification of the culprit vessel in 87.5% of cases. The sensitivity for left anterior descending, right coronary artery, left circumflex and diagonal branch/double anterior descending/ramus intermediate was 98.8%, 93.7%, 31.7% and 44.4%, respectively; the specificity was 94.3%, 87.6%, 99.0% and 99.1%, respectively. The proximal/distal location was correctly identified in 62.4% of cases., Conclusions: Our results confirm that careful interpretation of the ECG, which is a versatile and widely available tool, appears useful for the detection of the culprit vessel and the coronary occlusion site in STEMI patients, with relevant implications for clinical management and selection of appropriate therapeutic strategies.

Published
2012
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27. Prolonged nocturnal asystole and cerebral neurogliosis in a marathon runner.

Author

Slavich G, Poser S, Antonutto G, Fregolent R, Piccoli G, and di Prampero PE

Subjects
Adult, Bradycardia diagnosis, Bradycardia therapy, Electrocardiography, Ambulatory, Female, Heart Arrest diagnosis, Heart Arrest therapy, Humans, Pacemaker, Artificial, Running, Sleep Wake Disorders, Athletes, Bradycardia complications, Heart Arrest complications, Neuroglia pathology
Published
2011
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28. [ECG and ST-elevation myocardial infarction in multivessel coronary disease].

Author

Slavich G, Spedicato L, Poli S, Sappa R, and Piccoli G

Subjects
Aged, Coronary Angiography, Female, Humans, Male, Middle Aged, Myocardial Infarction diagnosis, Angioplasty, Balloon, Coronary methods, Electrocardiography, Myocardial Infarction therapy
Abstract

Percutaneous coronary intervention is the first-line treatment for ST-elevation myocardial infarction. In the setting of multivessel disease, concomitant reperfusion of all obstructed vessels is controversial, notably when the culprit vessel cannot be easily identified. We describe two cases with acute inferior-posterior myocardial infarction (ST-segment elevation in the inferior leads and ST-segment depression in the precordial leads). In the first case, angiography revealed severe three-vessel disease and the culprit vessel could not be identified. Following standard pharmacological therapy, the clinical picture and the ECG pattern improved, so that coronary revascularization was postponed. In the second case, angiography showed two-vessel disease with total occlusion of the right coronary and left circumflex arteries, which was treated with coronary angioplasty and drug-eluting stent implantation on the right coronary artery. In patients who undergo coronary angioplasty immediately, careful reading of the ECG can be a reliable tool for the identification of the culprit vessel in ST-elevation myocardial infarction associated with multivessel disease, allowing to choose the appropriate reperfusion strategy.

Published
2010

30. [Non ST ergometric variables in the diabetic patient and their prognostic significance].

Author

Slavich G, Mapelli P, Fregolent R, Slavich M, and Tuniz D

Subjects
Aged, Blood Pressure, Case-Control Studies, Female, Follow-Up Studies, Heart Failure diagnosis, Heart Rate, Humans, Male, Middle Aged, Myocardial Infarction diagnosis, Predictive Value of Tests, Prognosis, Risk Factors, Arrhythmias, Cardiac complications, Arrhythmias, Cardiac diagnosis, Diabetes Complications, Electrocardiography, Exercise Test
Abstract

Background: Recent research based on large number of patients has demonstrated that there are strong exercise predictors of cardiovascular events other than ST-segment behaviour. Studies focused on non-ST segment variables in exercise testing (exercise capacity, chronotropic and pressure response, heart rate recovery) in diabetics are lacking. The aim of our study is to find out differences in the exercise-testing variables between diabetics and non and to evaluate their prognostic role., Methods: We analyzed non ST-variables in 1172 patients undergoing exercise testing with Bruce protocol: diabetics vs. non diabetics: n=83 (7%) vs n=1089 (93%); mean age: 64.37 +/- 8.44 vs 60.44 +/- 11.44; males: n=56 (67.47%) vs n=665 (61.06%). Mean follow-up was 13.5 +/- 4 months., Results: Follow-up data were available in 74 diabetics (89%), 14 (18,9%) presented cardiac events (death, infarction, coronaric revascularization, heart failure). Diabetics with events showed significantly worse 1st min Heart Rate (HR) and 3rd min Systolic Blood Pressure (SBP) recovery., Conclusions: Preliminary results highlight that non-ST variables (exercise time, chronotropic response, heart rate and blood pressure recovery) are significantly different in diabetics. Abnormal HR and SBP recovery identify a subgroup of diabetics at higher risk of cardiac events in the follow-up.

Published
2010
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32. [ST-segment elevation in leads aVR and V1 during exercise test: a case report].

Author

Slavich G, Piccoli G, Piccoli G, and Slavich M

Subjects
Aged, Coronary Artery Disease physiopathology, Female, Humans, Predictive Value of Tests, Sensitivity and Specificity, Coronary Artery Disease diagnosis, Electrocardiography, Exercise Test, Heart Conduction System physiopathology
Abstract

Exercise test is the first-line tool for the diagnosis of ischemic heart disease. Presently, high technology tests would appear to have lessened the value of this test. We report a case in which ST-segment abnormalities during exercise (ST-segment elevation in leads aVR and V1) allowed us to define the presence and severity of coronary artery disease.

Published
2009

33. Radionuclide evidence for reversible ischemia after percutaneous treatment of anomalous right coronary artery with dynamic compression by great vessels.

Author

Morucutti G, Pecoraro R, Zanuttini D, Spedicato L, Slavich G, and Bernardi G

Subjects
Aged, Coronary Angiography, Coronary Vessel Anomalies complications, Coronary Vessel Anomalies therapy, Female, Humans, Myocardial Ischemia etiology, Myocardial Ischemia therapy, Treatment Outcome, Angioplasty, Balloon, Coronary instrumentation, Coronary Vessel Anomalies diagnostic imaging, Myocardial Ischemia diagnostic imaging, Myocardial Perfusion Imaging, Stents
Abstract

Anomalous origin of the right coronary artery from the left sinus is a rare congenital anomaly, possibly related to myocardial ischemia by dynamic compression. We present a case of percutaneous treatment of this coronary anomaly resulting in regression of inducible ischemia, as demonstrated by radionuclide scintigraphy.

Published
2008
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34. [Exercise training parameters and pre- and post-test scores in the light of the most recent studies: review of the literature].

Author

Slavich G, Fregolent R, Tuniz D, and Slavich M

Subjects
Coronary Artery Disease physiopathology, Hemodynamics, Humans, Prognosis, Coronary Artery Disease diagnosis, Exercise Test
Abstract

Exercise test is the simplest, most thorough and cost-effective tool capable of providing diagnostic and prognostic evaluation of patients with known or suspected coronary heart disease. Imaging tests have been lately utilized with increasing frequency: while quite useful to define the presence and extent of ischemia, these tests do not have the prognostic insight offered by data derived from exercise parameters like effort duration, behavior of heart rate, blood pressure and occurrence of arrhythmias. The diagnostic and prognostic value of exercise test-derived data may be further enhanced by the utilization of scores. The authors have carried out a comprehensive review of the current literature on this topic.

Published
2008

35. Precordial murmur originating from pulmonary artero-venous malformation with and without pulmonary sequestration.

Author

Slavich G, Piccoli G, Gianfagna P, Slavich M, and Gasparini D

Subjects
Adult, Arteriovenous Malformations diagnosis, Bronchopulmonary Sequestration diagnosis, Humans, Male, Pulmonary Artery abnormalities, Pulmonary Veins abnormalities, Arteriovenous Malformations complications, Bronchopulmonary Sequestration complications, Heart Murmurs etiology, Lung blood supply
Abstract

We report two cases of young patients in whom a continuous murmur was the only abnormal physical finding. The diagnosis was artero-venous malformation (AVM) in the context of pulmonary sequestration in the first patient and AVM alone in the second. The aim is to stress the perennial role of physical examination, the role of Doppler echocardiography and the importance of a multidisciplinary approach in the study of a pathological process involving the pulmonary vascular system.

Published
2007
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36. Successful treatment of polymicrobial multivalve infective endocarditis. Multivalve infective endocarditis.

Author

Allocca G, Slavich G, Nucifora G, Slavich M, Frassani R, Crapis M, and Badano L

Subjects
Anemia microbiology, Anemia surgery, Anti-Infective Agents therapeutic use, Aortic Valve microbiology, Aortic Valve pathology, Blood Transfusion, Cardiotonic Agents therapeutic use, Echocardiography, Endocarditis, Bacterial complications, Endocarditis, Bacterial microbiology, Endocarditis, Bacterial pathology, Endocarditis, Bacterial therapy, Enterococcus faecalis isolation & purification, Heart Failure microbiology, Heart Failure surgery, Humans, Lung Abscess microbiology, Lung Abscess surgery, Male, Middle Aged, Mitral Valve microbiology, Mitral Valve pathology, Respiration, Artificial, Severity of Illness Index, Streptococcus bovis isolation & purification, Tomography, X-Ray Computed, Treatment Outcome, Tricuspid Valve microbiology, Tricuspid Valve pathology, Aortic Valve surgery, Endocarditis, Bacterial surgery, Heart Valve Prosthesis Implantation, Mitral Valve surgery, Tricuspid Valve surgery
Abstract

A 57-year-old man presented with triple valve infective endocarditis. There were vegetations on the tricuspid, mitral, and aortic valve. He had multiple complications such as pulmonary abscess, severe anaemia, and congestive heart failure. His general condition was extremely poor. Intensive medical therapy, such as blood transfusion, mechanical ventilation, and inotropic support, allowed him to tolerate surgery. Triple valve replacement was successfully performed without major complication. Vegetation cultures grew Streptococcus bovis and Enterecoccus faecalis. At 1 year follow-up, the patient is alive in NYHA functional class I.

Published
2007
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37. [Pseudoischemic ST-segment due to atrial repolarization during exercise test. Review of the literature, diagnostic criteria and personal experience].

Author

Slavich G, Tuniz D, Fregolent R, and Slavich M

Subjects
False Positive Reactions, Female, Humans, Male, Middle Aged, Myocardial Ischemia diagnosis, Electrocardiography, Exercise Test, Myocardial Ischemia physiopathology
Abstract

Atrial repolarization wave has been known since many years: it is opposite in direction to P wave, may have a magnitude of 100 to 200 microV and may extent into the ST segment (usually it is hidden in the QRS complex). It was hypothesized that this wave could cause ST-segment depression mimicking myocardial ischemia. The false positive response is characterized by marked downsloping of the PR segment at peak exercise, longer exercise time (> 6 min), peak exercise heart rate > 125 bpm, absence of chest pain and ST-segment normalization in the first minute of recovery. In our experience a role of atrial repolarization in ST-segment depression was found in 5.5% of 144 consecutive and non-selected individuals evaluated with exercise testing.

Published
2006

38. Electrocardiography during hypothermia.

Author

Slavich G and Badano LP

Subjects
Adult, Bradycardia physiopathology, Female, Heart Conduction System physiopathology, Humans, Bradycardia diagnosis, Electrocardiography, Hypothermia physiopathology
Published
2004

40. Significance of ST-segment depression during supraventricular tachycardia. Clues offered by its return to normal at the end of the episode.

Author

Slavich G, Pavoni D, Badano L, and Popiel M

Subjects
Female, Humans, Male, Middle Aged, Electrocardiography, Tachycardia, Supraventricular physiopathology
Abstract

The finding of transient ST-segment depression during episodes of supraventricular tachycardia is common but its ischemic significance is usually uncertain. Several authors came to the conclusion that in the absence of positive myocardial scintigraphy these alterations are not associated with a coronary flow-limiting stenosis. Our report tends to confirm this view but we suggest to observe the evolution of ST-segment changes at the very end of the episodes; these mechanisms have not been adequately addressed in previous studies and could provide useful clues to the ischemic or non-ischemic origin of ST-segment abnormalities.

Published
2002

41. [Atrial fibrillation: always cardioversion? Yes].

Author

Slavich G

Subjects
Humans, Atrial Fibrillation therapy, Electric Countershock
Abstract

It is obvious that sinus rhythm is preferable to atrial fibrillation for the improvement of the clinical conditions of patients and to avoid the risks of anticoagulation. This clinical reality associated with recent scientific evidence, i.e. atrial fibrillation can be treated with focal ablation, a fibrillating atrium undergoes an unfavorable remodeling that can negatively influence attempts of electrical cardioversion, results of clinical studies have demonstrated that a large atrial size and long-standing atrial fibrillation do not represent a contraindication to electrical cardioversion, explain why at present cardiologists try to maintain normal sinus rhythm more than in the past. Results of current studies that compare rate control versus sinus rhythm maintenance could solve the controversy.

Published
2002

42. [Forensic medicine aspects in patients with chest pain in the emergency room].

Author

Slavich G and Buonocore G

Subjects
Chest Pain etiology, Emergency Service, Hospital, Forensic Medicine, Humans, Malpractice, Chest Pain diagnosis, Chest Pain therapy
Abstract

The correct management of patients presenting with chest pain in the emergency room is, at the moment, a very peculiar and controversial issue. A rapid confirmation or exclusion is imperative for the respect of the health of citizens and the reduction of public expenditure. The concept of professional fault is defined and the previous and present behavior of the magistrature are debated as regards the faults of physicians. Some practical suggestions conclude this review.

Published
2001

43. [Images in cardiovascular medicine. Appearance is deceptive].

Author

Slavich G, Popiel M, Pavoni D, and Badano LP

Subjects
Adult, Coronary Angiography, Diagnosis, Differential, Echocardiography, Electrocardiography, Ambulatory, Female, Heart diagnostic imaging, Humans, Male, Middle Aged, Myocardial Ischemia diagnostic imaging, Radionuclide Imaging, Electrocardiography, Myocardial Ischemia diagnosis
Published
2000

44. Gated Tc-99m sestamibi SPECT versus stress-rest SPECT in detecting coronary artery disease: correlation with coronary angiography in patients without myocardial infarction.

Author

Guerra UP, Giacomuzzi F, Di Gregorio F, Bax JJ, Slavich GA, and Fioretti PM

Subjects
Adult, Aged, Blood Pressure physiology, Coronary Circulation physiology, Coronary Vessels diagnostic imaging, Dipyridamole, Electrocardiography, Exercise Test, Female, Heart Rate physiology, Heart Ventricles diagnostic imaging, Humans, Image Processing, Computer-Assisted, Male, Middle Aged, Myocardial Infarction, Sensitivity and Specificity, Vasodilator Agents, Coronary Angiography, Coronary Disease diagnostic imaging, Radiopharmaceuticals, Technetium Tc 99m Sestamibi, Tomography, Emission-Computed, Single-Photon methods
Abstract

Purpose: It is possible to simultaneously evaluate wall thickening and perfusion abnormalities with radionuclide techniques that use tracers such as Tc-99m MIBI. We presumed that detection of wall thickening by gated MIBI SPECT imaging in the presence of a stress-induced perfusion defect correlates with reversibility of that defect on resting images. Therefore, the aim of our study was to analyze, in patients without myocardial infarction, resting wall thickening and stress perfusion imaging as an alternative to conventional stress-rest imaging., Methods and Results: The patients (n = 44) underwent an exercise (n = 37) or pharmacologic (n = 7) stress protocol. All patients had previous coronary angiography within 3 months. Stress-rest MIBI SPECT and gated MIBI SPECT studies were analyzed by visual scoring. The sensitivity and specificity of segmental analysis of both stress-rest MIBI SPECT perfusion and gated MIBI SPECT studies for the overall detection of coronary artery disease were, respectively, 71% and 96%. For patient evaluation for detection of coronary artery disease, stress-rest MIBI SPECT perfusion and gated MIBI SPECT studies showed a sensitivity rate of 96% for both and specificity rates of 84% and 79%, respectively., Conclusions: Our data revealed close agreement between reversible perfusion defects on stress-rest MIBI SPECT scans and significant wall thickening on gated MIBI SPECT stress images in patients without previous myocardial infarction (95%). Gated MIBI SPECT stress, without resting studies, which provide an assessment of wall motion and wall thickening, potentially allows stress defect reversibility to be evaluated in patients without previous myocardial infarction.

Published
1999
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45. ASSENCE (assessment of cost-effectiveness of several strategies of early diagnosis in patients with acute chest pain and non-conclusive electrocardiogram).

Author

Badano LP, Gregori D, Slavich G, Gremese E, Ghidina M, and Fioretti PM

Subjects
Acute Disease, Cardiotonic Agents, Clinical Enzyme Tests economics, Clinical Enzyme Tests statistics & numerical data, Cost-Benefit Analysis statistics & numerical data, Diagnosis, Differential, Dobutamine, Echocardiography economics, Echocardiography methods, Echocardiography statistics & numerical data, Electrocardiography statistics & numerical data, Exercise Test economics, Exercise Test methods, Exercise Test statistics & numerical data, Humans, Quality of Life, Research Design, Time Factors, Chest Pain diagnosis, Chest Pain economics, Electrocardiography economics
Abstract

Clinical, economical, organizative, and medico-legal issues raised by management of citizens who come to Emergency Department with acute chest pain and non diagnostic electrocardiogram are well known. Data from the Italian Health Ministry show that, in 1996, 37,444 patients had been discharged from Italian hospitals with the main diagnosis of chest pain. To obtain this "non-diagnosis", it was needed a mean hospital stay of 4.2 days with estimated costs close to $57,000,000. The ASSENCE study is a randomized, multicenter, international trial aimed at comparing three strategies of handling citizens presenting to emergency department for unexplained chest pain in terms of cost/effectiveness ratio and quality of patients' life. The three strategies that will be compared are: 1. current clinical protocols, prescribing an in-hospital observation period and discharge after several hours/days; 2. performing a dobutamine-atropine stress echocardiography between 0 and 18 hours after randomization (at 6 hours after index chest pain onset) and discharging the patients (if negative) immediately thereafter; 3. performing an electrocardiographic exercise stress test between 0 and 18 hours after randomization and discharging the patients (if negative) immediately thereafter. The main ASSENCE study end-point will be assessment of cost/effectiveness of the 3 strategies tested. Costs will be assessed taking into account: hospital stay length, performed diagnostic procedures and treatments during index admission, in-hospital and 2-month follow-up events (cardiac death, myocardial infarction, definite unstable angina, coronary angioplasty, by-pass surgery, re-admission to hospital for chest-pain). A secondary ASSENCE study end-point will be to assess the effect on patient quality of life of the use of the 3 strategies tested. Sample size estimation calculated in order to detect an absolute difference of at least 10% and based on a 30% expected rate of events, was of 186 patients for each strategy tested.

Published
1999

46. Myocardial viability: known and unknown.

Author

Bax JJ, Poldermans D, Rambaldi R, Valkema R, Slavich GA, and Fioretti PM

Subjects
Cardiomyopathies pathology, Cardiomyopathies physiopathology, Heart physiopathology, Heart Function Tests, Humans, Cardiomyopathies diagnosis, Heart physiology, Myocardium cytology
Abstract

The assessment of myocardial viability has gained a lot of attention over the past few years. Various imaging techniques, mainly nuclear and echocardiographic approaches, have been developed for this purpose. From the existing data, it has become clear that the presence of dysfunctional yet viable myocardium can predict improvement of regional and global left ventricular (LV) function after revascularization. This issue is most relevant in patients with severely depressed LV function, since in these patients revascularization carries a high (peri-)procedural risk on the one hand, but may substantially improve LV function in some patients. Besides the improvement of resting LV function after revascularization, other end-points may also be clinically relevant, including the response during stress, improvement of exercise capacity, the quality of life and the prevention of LV remodeling. These issues have not been studied extensively thusfar. Finally, several retrospective studies have shown the prognostic value of viability assessment; patients with viable but jeopardized myocardium were significantly more prone to experience cardiac events than patients with viability who underwent revascularization. The different aspects of viability assessment (including pathophysiology, available techniques, current implications and unresolved issues) will be addressed in this manuscript.

Published
1998

47. [The prognostic role of the stress test in patients discharged alive after an acute myocardial infarct. From thrombolytic studies prior to GISSI-2. Grupo Italiano per lo Studio della Streptochinasi nell'Infarto Miocardico].

Author

Cavalli A, Pizzetti F, Aletto C, Slavich G, Di Marco G, Levantesi G, Rosselli P, Bechi S, Dalle Mule J, and Di Gregorio D

Subjects
Humans, Italy epidemiology, Multicenter Studies as Topic, Myocardial Infarction mortality, Prognosis, Randomized Controlled Trials as Topic, Exercise Test, Myocardial Infarction diagnosis, Myocardial Infarction drug therapy, Patient Discharge, Streptokinase therapeutic use, Thrombolytic Therapy
Published
1995

48. Transient myocardial ischemia during daily life in rest and exertional angina pectoris and comparison of effectiveness of metoprolol versus nifedipine.

Author

Ardissino D, Savonitto S, Egstrup K, Marraccini P, Slavich G, Rosenfeld M, Feruglio GA, Roncarolo P, Giordano MP, and Wahlqvist I

Subjects
Angina Pectoris classification, Angina Pectoris drug therapy, Angina Pectoris physiopathology, Circadian Rhythm physiology, Coronary Angiography, Coronary Disease physiopathology, Double-Blind Method, Electrocardiography, Ambulatory, Female, Humans, Male, Metoprolol adverse effects, Middle Aged, Nifedipine adverse effects, Surveys and Questionnaires, Coronary Disease drug therapy, Metoprolol therapeutic use, Nifedipine therapeutic use, Physical Exertion physiology
Abstract

The clinical characteristics of 65 patients with mixed angina were classified by means of (1) a questionnaire investigating the proportion of symptoms occurring at rest and on effort, (2) an exercise stress test, (3) 24-hour ambulatory Holter monitoring, and (4) coronary arteriography. According to the questionnaire, the proportion of effort-induced anginal episodes ranged from 1 to 99%. The ischemic threshold during exercise testing ranged from 110 x 10(2) to 350 x 10(2) mm Hg x beats/min. At least 1 episode of ST-segment depression was observed in 29 of the 65 patients during Holter monitoring. Ischemic episodes during Holter monitoring were more frequent (p less than 0.05) in patients reporting greater than or equal to 50% of anginal attacks on effort, with moderate to severe limitation of exercise capacity and with multivessel coronary artery disease. The effect on ambulatory ischemia of a 6-week treatment with a beta blocker (metoprolol CR, 200 mg once daily) or a dihydropyridine calcium antagonist (nifedipine retard 20 mg twice daily) were then compared according to a double-blind, parallel group design. Metoprolol significantly reduced the number and duration of the ischemic episodes during daily life (p less than 0.05) irrespective of the patients' clinical characteristics. Nifedipine was ineffective, particularly in patients with angina predominantly on effort and with a moderate to severe reduction in exercise tolerance. It is concluded that in patients with mixed angina, ischemic episodes during daily life are more likely to occur in patients with a clinical presentation suggesting poor coronary reserve.(ABSTRACT TRUNCATED AT 250 WORDS)

Published
1991
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49. Two-dimensional echocardiography in myocardial amyloidosis.

Author

Picano E, Pinamonti B, Ferdeghini EM, Landini L, Slavich G, Orlandini A, Marini C, Lattanzi F, and Camerini F

Subjects
Humans, Ultrasonics, Amyloidosis diagnostic imaging, Cardiomyopathies diagnostic imaging, Echocardiography methods
Abstract

Two-dimensional echocardiography is the best means of identifying early cardiac amyloid infiltration and gauging its subsequent progression. The early asymptomatic phase is characterized on echocardiography by a mild-to-moderate increase in left ventricular and/or right ventricular wall thicknesses. The distinctive combination of low electrocardiography voltage and increase in left ventricular mass on the echocardiogram, both compatible with substantial amyloid infiltration, is valuable in diagnosis and appears to indicate the severity of the disease. Other ancillary but common findings are left atrial dilatation, a small pericardial effusion, thickening of cardiac valves, papillary muscles, and interatrial septum. Finally, there is a peculiar texture of myocardial walls, with highly refractile areas that are typical, although not specific, of myocardial amyloidosis and can also be quantitatively described by digital image analysis techniques. The echocardiographic appearance of amyloidosis can closely mimic several other diseases. Asymmetric hypertrophy of the septum due to amyloid deposition may occur, simulating hypertrophic cardiomyopathy. The granular sparkling of myocardial walls is also found in myocarditis with severe fibrosis, and it is quite common in hypertrophic cardiomyopathy, as well as in other infiltrative diseases of the myocardium. It is not uncommon that the echocardiographic examination represents a turning point in the work-up of the patient, briskly orienting the clinician towards the correct diagnostic pathway. However, the likelihood of the cardiologist-echocardiographer to successfully and prospectively identify myocardial amyloidosis is substantially higher if all the clinical and electrocardiographic information is reviewed at the time of the echocardiographic examination.

Published
1991
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