76 results on '"Magatelli, M."'
Search Results
2. Plaque assessment by coronary CT angiography may predict cardiac events in high risk and very high risk diabetic patients: A long-term follow-up study.
- Author
-
Andreini D, Conte E, Mushtaq S, Magatelli M, Traversari F, Gigante C, Belmonte M, Gaudenzi-Asinelli M, Annoni A, Formenti A, Mancini ME, Guglielmo M, Baggiano A, Melotti E, Muscogiuri G, Rondinelli M, Pontone G, Bartorelli AL, Pepi M, and Genovese S
- Subjects
- Computed Tomography Angiography, Coronary Angiography methods, Follow-Up Studies, Humans, Predictive Value of Tests, Prognosis, Risk Assessment, Risk Factors, Coronary Artery Disease diagnostic imaging, Coronary Artery Disease therapy, Diabetes Mellitus diagnosis, Plaque, Atherosclerotic diagnostic imaging, Plaque, Atherosclerotic therapy
- Abstract
Background and Aims: The aim of the present study is to evaluate whether advanced coronary atherosclerosis analysis by CCTA may improve prognostic stratification among diabetic patients at high cardiovascular risk (CV risk)., Methods and Results: The study population consisted of 265 consecutive diabetic patients at high CV risk who underwent CCTA for suspected CAD between January 2011 and December 2016. For every patients both traditional and advanced, qualitative and quantitative coronary plaque analysis were performed. The occurrence of cardiac death, ACS, and non-urgent revascularization were recorded at follow-up. Among the 265 patients enrolled, 21 were lost to follow-up, whereas 244 (92%) had a complete follow-up (mean 45 ± 22 months) and were classified at high (n = 67) or very high cardiovascular risk (n = 177), according to ESC Guidelines. A total of 63 events were recorded (3 Cardiac Death, 3 NSTEMI, 8 unstable angina, 36 late non-urgent revascularization and 13 non-cardiac death) in 57 different patients. Elevated fibro-fatty plaque volume was the only predictor of events over age, gender and traditional risk factor when ACS and MACE were considered as end-points [HR (95% CI) 6.01 (1.65-21.87), p = 0.006 and 3.46 (2.00-5.97); p < 0.001]., Conclusion: The present study confirms the prognostic role of advance coronary atherosclerosis evaluation beyond risk factors and stenosis severity, even in diabetics. Despite the very high cardiovascular risk of study population, a not negligible portion (23%) of patients exhibited totally normal coronaries., Competing Interests: Declaration of competing interest None declared., (Copyright © 2021 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.)
- Published
- 2022
- Full Text
- View/download PDF
3. Cardiopoietic cell therapy for advanced ischemic heart failure : results at 39 weeks of the prospective, randomized, double blind, sham-controlled CHART-1 clinical trial
- Author
-
Bartunek, Jozef, Terzic, Andre, Davison, Beth A, Filippatos, Gerasimos S, Radovanovic, Slavica, Beleslin, Branko, Merkely, Bela, Musialek, Piotr, Wojakowski, Wojciech, Andreka, Peter, Horvath, Ivan G, Katz, Amos, Dolatabadi, Dariouch, El Nakadi, Badih, Arandjelovic, Aleksandra, Edes, Istvan, Seferovic, Petar M, Obradovic, Slobodan, Vanderheyden, Marc, Jagic, Nikola, Petrov, Ivo, Atar, Shaul, Halabi, Majdi, Gelev, Valeri L, Shochat, Michael K, Kasprzak, Jaroslaw D, Sanz Ruiz, Ricardo, Heyndrickx, Guy R, Nyolczas, Noémi, Legrand, Victor, Guédès, Antoine, Heyse, Alex, Moccetti, Tiziano, Fernandez Aviles, Francisco, Jimenez Quevedo, Pilar, Bayes Genis, Antoni, Hernandez Garcia, Jose Maria, Ribichini, Flavio, Gruchala, Marcin, Waldman, Scott A, Teerlink, John R, Gersh, Bernard J, Povsic, Thomas J, Henry, Timothy D, Metra, Marco, Hajjar, Roger J, Tendera, Michal, Behfar, Atta, Alexandre, Bertrand, Seron, Aymeric, Stough, Wendy Gattis, Sherman, Warren, Cotter, Gad, Wijns, W. i. l. l. i. a. m. Collaborators Clinical investigators, Dens, sites Belgium: Ziekenhuis Oost Limburg: J., Dupont, M., Mullens, W., Janssens, M., Dolatabadi, Hoˆpital Civil de Charleroi: D., De Bruyne, Y., Lalmand, J., Dubois, P., El Nakadi, B., Aminian, A., De Vuyst, E., Gurnet, P., Gujic, M., Blankoff, I., Guedes, CHU Mont Godinne UCL: A., Gabriel, L., Seldrum, S., Doyen, C., Andre´, M., Heyse, AZ Glorieux: A., Van Durme, F., Verschuere, J., Legrand, Domaine Universitaire du Sart Tilman: V., Gach, O., D’Orio, V., Davin, L., Lancellotti, P., Baudoux, E., Ancion, A., Dulgheru, R., Vanderheyden, OLV Ziekenhuis Aalst – Cardiologie: M., Bartunek, J., Wijns, W., Verstreken, S., Penicka, . M., Gelev, P. Meeus Bulgaria: Tokuda Hospital Sofia: V., Zheleva Kichukova, I., Parapunova, R., Melamed, R., Sardovski, S., Radev, O., Yordanov, A., Radinov, A., Nenov, D., Amine, I., Petrov, City Hospital Clinic Cardiology Center: I., Kichukov, K., Nikitasov, L., Stankov, Z., Stoyanov, H., Tasheva Dimitrova, I., Angelova, M., Dimitrov, E., Minchev, M., Garvanski, I., Botev, C., Polomski, P., Alexandrovska University Hospital, Vassilev, Sofia: D., Karamfiloff, K., Tarnovska Kadreva, R., Vladimirova, L., Dimitrov, G., Hadzhiev, E., Tzvetkova, G., Andreka, . M. Atanasova Hungary: Gottsegen Gyo¨ rgy Orszagos Kardiologiai Inte´zet: P., Fontos, G., Fabian, J., Csepregi, A., Uzonyi, G., Gelei, A., Edes, Debreceni Egyetem Orvos e´s Ege´szse´gtudomanyi Centrum Altalanos Orvostudomanyi Kar Kardiologia Inte´zet: I., Balogh, L., Vajda, G., Darago, A., Gergely, S., Fulop, T., Jenei, C., Horvath, Pe´csi Tudomanyegyetem Klinikai Ko¨zpont Szıvgyogyaszati Klinika: I., Magyari, B., Nagy, A., Cziraki, A., Faludi, R., Kittka, B., Alizadeh, H., Merkely, Semmelweis Egyetem Varosmajori Szıv e´s Ergyogyaszati Klinika: B., Geller, L., Farkas, P., Szombath, G., Foldes, G., Skopal, J., Kovacs, A., Kosztin, A., Gara, E., Sydo, N., Nyolczas, MH Ege´szse´gu¨gyi Ko¨zpont Kardiologiai Osztaly: N., Kerecsen, G., Korda, A., Kiss, . M., Borsanyi, T., Polgar, B., Muk, B., Sharif, Z. Bari Ireland: HRB Clinical Research Facility: F., Atar, Y. M. Smyth Israel:Western Galilee Hospital: S., Shturman, A., Akria, L., Kilimnik, M., Brezins, M., Halabi, Ziv Medical Center: M., Dally, N., Goldberg, A., Aehab, K., Rosenfeld, I., Levinas, T., Saleem, D., Katz, Barzilai Medical Center: A., Plaev, T., Drogenikov, T., Nemetz, A., Barshay, Y., Jafari, J., Orlov, I., Nazareth Hospital EMMS: M. Omory, N. Kogan Nielsen, Shochat, Hillel Yaffe Medical Center: M., Shotan, A., Frimerman, A., Meisel, S., Asif, A., Sofer, O., Blondheim, D. S., Vazan, A., Metra, L. Arobov Italy: A. O. Spedali Civili di Brescia: M., Bonadei, I., Inama, L., Chiari, E., Lombardi, C., Magatelli, M., Russo, D., Lazzarini, V., Carubelli, V., Vassanelli, AOUI Verona – Borgo Trento Hospital: C., Ribichini, Flavio Luciano, Bergamini, C., Krampera, Mauro, Cicoria, M. A., Zanolla, L., Dalla Mura, D., Gambaro, A., Rossi, A., Pesarini Poland: Jagiellonian University Department of Cardiac, G., Musialek, Vascular Diseases at John Paul II Hospital in Krakow: P., Mazurek, A., Drabik, L., Ka˛dzielski, A., Walter, Z., Dzieciuch Rojek, M., Rubis, P., Plazak, . W., Tekieli, L., Podolec, J., Orczyk, W., Sutor, U., Zmudka, K., Olszowska, M., Podolec, P., Gruchala, Uniwersyteckie Centrum Kliniczne: M., Ciecwierz, D., Mielczarek, M., Burakowski, S., Chmielecki, M., Zielinska, M., Frankiewicz, A., Wdowczyk, J., Stopczynska, I., Bellwon, J., Mosakowska, K., Nadolna, R., Wroblewska, J., Rozmyslowska, M., Rynkiewicz, M., Marciniak, I., Raczak, G., Tarnawska, M., Taszner, M., Kasprzak, Bieganski Hospital: J., Plewka, M., Fiutowska, D., Rechcinski, T., Lipiec, P., Sobczak, M., Weijner Mik, P., Wraga, M., Krecki, R., Markiewicz, M., Haval Qawoq, D., Wojakowski, Gornosla˛skie Centrum Medyczne Sla˛skie j. Akademii Medycznej: W., Ciosek, J., Dworowy, S., Gaszewska Zurek, E., Ochala, A., Cybulski, W., Jadczyk, T., Wanha, W., Parma, Z., Kozlowski, M., Dzierzak, M., Markiewicz Serbia: Clinical Hospital Center Zvezdara, M., Arandjelovic, Cardiology Clinic: A., Sekularac, N., Boljevic, D., Bogdanovic, A., Zivkovic, S., Cvetinovic, N., Loncar, G., Clinical Centre of Serbia, Beleslin, Cardiology Clinic: B., Nedeljkovic, M., Trifunovic, D., Giga, V., Banovic, M., Nedeljkovic, I., Stepanovic, J., Vukcevic, V., Djordjevic Dikic, A., Dobric, M., Obrenovic Kircanski, B., Seferovic, Cardiology Clinic: P., Orlic, D., Tesic, M., Petrovic, O., Milinkovic, I., Simeunovic, D., Jagic, Clinical Center of Kragujevac: N., Tasic, M., Nikolic, D., Miloradovic, V., Djurdjevic, P., Sreckovic, M., Zornic, N., Clinical Hospital Center Bezanijska Kosa, Radovanovic, Cardiology Department: S., Saric, J., Hinic, S., Djokovic, A., Ðordevic, S., Bisenic, V., Markovic, O., Stamenkovic, S., Malenkovic, V., Tresnjak, J., Misic, G., Cotra, D., Tomovic, L., Vuckovic, V., Clinic of Emergency Internal Medicine, Obradovic, Military Medical Academy: S., Jovic, Z., Vukotic, S., Markovic, D., Djenic, N., Ristic Andjelkov, A., Bayes Genis, D. Ljubinka Spain: Hospital Universitario Germans Trias I. Pujol: A., Rodriguez Leor, O., Labata, C., Vallejo, N., Ferrer, E., Batlle, M., Fernandez Aviles, Hospital General Universitario Gregorio Mara~non: F., Sanz Ruiz, R., Casado, A., Loughlin, G., Zatarain, E., Anguita, J., Ferna ndez Santos, M. E., Pascual, C., Bermejo, J., Hernandez Garcia, Hospital Clinico Universitario Virgen de la Victoria: J. M., Jimenez Navarro, M., Dominguez, A., Carrasco, F., Mu~noz, A., Garcia Pinilla, J. M., Ruiz, J., Queipo de Llano, M. P., Hernandez, A., Fernandez, A., Jimenez Quevedo, Hospital Clinico San Carlos: P., Guerra, R., Biagioni, C., Gonzalez, R. A., Gomez deDiego, J. J., Mansson Broberg, L. Perez de Isla Sweden: Karolinska University Hospital: A., Sylve´n, C., Leblanc, K., Winter, R., Blomberg, P., Gunyeli, E., Ruck, A., Silva, C., Fo¨rstedt Switzerland: CardioCentro Ticino, J., Moccetti, Switzerland: T., Rossi, M., Pasotti, E., Petrova, I., Crljenica, C., Monti, C., Murzilli, R., Su¨rder, D., Moccetti, M., Turchetto, L., Locicero, V., Chiumiento, L., Maspoli, S., Mombelli, M., Anesini, A., Biggiogero, M., Ponti, G., Camporini, C., Polledri, S., Hill, G. Dolci United Kingdom: Kings College Hospital: J., Plymen, C., Amin Youssef, G., Mcdonagh, T., Drasar, E., Mijovic, A., Jouhra, F., Mcloman, D., Dworakowski, R., Webb, I., Byrne, J., and Potter, V.
- Subjects
0301 basic medicine ,Male ,Cardiopoiesis ,Cardiovascular disease ,Disease severity ,Marker ,Precision medicine ,Regenerative medicine ,Stem cell ,Target population ,Adult ,Aged ,Double-Blind Method ,Female ,Heart Failure ,Humans ,Mesenchymal Stem Cell Transplantation ,Middle Aged ,Myocardial Ischemia ,Prospective Studies ,Treatment Outcome ,Young Adult ,Cardiology and Cardiovascular Medicine ,Cell- and Tissue-Based Therapy ,mesenchymal stem-cells ,030204 cardiovascular system & hematology ,Cardiorespiratory Medicine and Haematology ,outcomes ,Fast-Track Clinical Research ,Sudden cardiac death ,0302 clinical medicine ,Ischemia ,cardiovascular disease ,Clinical endpoint ,target population ,CHART Program ,Ejection fraction ,bone-marrow ,Heart Failure/Cardiomyopathy ,3. Good health ,Cohort ,Cardiology ,Fast Track ,disease severity ,delivery ,medicine.medical_specialty ,precision medicine ,Clinical Sciences ,regenerative medicine ,03 medical and health sciences ,cardiopoiesis ,Internal medicine ,medicine ,Adverse effect ,marker ,disease ,business.industry ,medicine.disease ,mortality ,Confidence interval ,Clinical trial ,stem cell ,Editor's Choice ,030104 developmental biology ,predictors ,Cardiovascular System & Hematology ,Heart failure ,business - Abstract
Altres ajuts: This work was supported by Celyad, SA (Mont-Saint-Guibert, Belgium). Celyad has received research grants from the Walloon Region (Belgium, DG06 funding). Cardiopoietic cells, produced through cardiogenic conditioning of patients' mesenchymal stem cells, have shown preliminary efficacy. The Congestive Heart Failure Cardiopoietic Regenerative Therapy (CHART-1) trial aimed to validate cardiopoiesis-based biotherapy in a larger heart failure cohort. This multinational, randomized, double-blind, sham-controlled study was conducted in 39 hospitals. Patients with symptomatic ischaemic heart failure on guideline-directed therapy (n = 484) were screened; n = 348 underwent bone marrow harvest and mesenchymal stem cell expansion. Those achieving > 24 million mesenchymal stem cells (n = 315) were randomized to cardiopoietic cells delivered endomyocardially with a retention-enhanced catheter (n = 157) or sham procedure (n = 158). Procedures were performed as randomized in 271 patients (n = 120 cardiopoietic cells, n = 151 sham). The primary efficacy endpoint was a Finkelstein–Schoenfeld hierarchical composite (all-cause mortality, worsening heart failure, Minnesota Living with Heart Failure Questionnaire score, 6-min walk distance, left ventricular end-systolic volume, and ejection fraction) at 39 weeks. The primary outcome was neutral (Mann–Whitney estimator 0.54, 95% confidence interval [CI] 0.47–0.61 [value > 0.5 favours cell treatment], P = 0.27). Exploratory analyses suggested a benefit of cell treatment on the primary composite in patients with baseline left ventricular end-diastolic volume 200–370 mL (60% of patients) (Mann–Whitney estimator 0.61, 95% CI 0.52–0.70, P = 0.015). No difference was observed in serious adverse events. One (0.9%) cardiopoietic cell patient and 9 (5.4%) sham patients experienced aborted or sudden cardiac death. The primary endpoint was neutral, with safety demonstrated across the cohort. Further evaluation of cardiopoietic cell therapy in patients with elevated end-diastolic volume is warranted.
- Published
- 2017
4. 3287Additional diagnostic value of CT perfusion over coronary CT angiography in stented patients with suspected in-stent restenosis or coronary artery disease progression: ADVANTAGE study. Preliminary results
- Author
-
Andreini, D, primary, Mushtaq, S, additional, Conte, E, additional, Mancini, E, additional, Magatelli, M, additional, Guglielmo, M, additional, Baggiano, A, additional, Sonck, J, additional, Ramada Oliveira, A M, additional, Trabattoni, D, additional, Fabbiocchi, F, additional, Pontone, G, additional, Fiorentini, C, additional, Bartorelli, A L, additional, and Pepi, M, additional
- Published
- 2018
- Full Text
- View/download PDF
5. Interpretability of coronary CT angiography performed with a novel whole-heart coverage high-definition CT scanner in 300 consecutive patients with coronary artery bypass grafts.
- Author
-
Mushtaq S, Conte E, Pontone G, Pompilio G, Guglielmo M, Annoni A, Baggiano A, Formenti A, Mancini ME, Muscogiuri G, Nicoli F, Giannitto C, Magatelli M, Tanzilli A, Consiglio E, Fiorentini C, Bartorelli AL, Pirillo SP, Pepi M, and Andreini D
- Subjects
- Aged, Coronary Vessels diagnostic imaging, Equipment Design, Female, Heart Rate, Humans, Male, Middle Aged, Predictive Value of Tests, Prospective Studies, Radiation Dosage, Radiation Exposure, Reproducibility of Results, Treatment Outcome, Computed Tomography Angiography instrumentation, Coronary Angiography instrumentation, Coronary Artery Bypass adverse effects, Coronary Vessels surgery, Multidetector Computed Tomography instrumentation, Tomography Scanners, X-Ray Computed
- Abstract
Aims: Coronary CT angiography (CCTA) is an accurate non-invasive tool for the evaluation of coronary artery bypass graft (CABG). However, inability to sustain a long breath-hold, high heart rate (HR) and atrial fibrillation may affect image quality. Moreover, radiation exposure is still a matter of some concern. A scanner combining 0.23-mm spatial resolution, new iterative reconstruction and fast gantry rotation time has been recently introduced in the clinical field. The aims of our study were to evaluate interpretability, radiation exposure and diagnostic accuracy of CCTA performed with the latest generation of cardiac-CT scanners compared to invasive coronary angiography (ICA) in the assessment of bypass grafts, and non-grafted and post-anastomotic native coronary arteries., Methods and Results: We prospectively enrolled 300 patients undergoing clinically indicated CCTA with a 16-cm z-axis coverage, 256-detector rows, and 0.28-sec gantry rotation time scanner. Coronary artery and graft interpretability, image quality and effective dose (ED) were assessed in all patients and diagnostic accuracy was evaluated in a subgroup of 100 patients who underwent ICA. Mean HR during the scan was 69.6 ± 10.8. Sinus rhythm was present in 118 patients with HR < 75 bpm and in 112 patients with HR ≥ 75 bpm, while 70 patients had atrial fibrillation. CABG interpretability was 100%. Compared to ICA, CCTA was able to correctly detecting occlusions or significant stenoses of all CABG segments. Overall interpretability of native coronary segments was 95.6%. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of coronary arteries were 98.3%, 97.4%, 93.1%, 99.3% and 96.5%, respectively. The diagnostic accuracy in a patient based analysis was 95.2%. Mean ED was 3.14 ± 1.7 mSv., Conclusions: The novel whole-heart coverage CT scanner allows to evaluating CABG and native coronary arteries with excellent interpretability and low radiation exposure even in the presence of unfavorable heart rhythm., (Copyright © 2020 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.)
- Published
- 2020
- Full Text
- View/download PDF
6. CT Perfusion Versus Coronary CT Angiography in Patients With Suspected In-Stent Restenosis or CAD Progression.
- Author
-
Andreini D, Mushtaq S, Pontone G, Conte E, Collet C, Sonck J, D'Errico A, Di Odoardo L, Guglielmo M, Baggiano A, Trabattoni D, Ravagnani P, Montorsi P, Teruzzi G, Olivares P, Fabbiocchi F, De Martini S, Calligaris G, Annoni A, Mancini ME, Formenti A, Magatelli M, Consiglio E, Muscogiuri G, Lombardi F, Fiorentini C, Bartorelli AL, and Pepi M
- Subjects
- Adenosine administration & dosage, Aged, Coronary Artery Disease physiopathology, Coronary Restenosis physiopathology, Disease Progression, Female, Fractional Flow Reserve, Myocardial, Humans, Male, Middle Aged, Percutaneous Coronary Intervention adverse effects, Predictive Value of Tests, Prospective Studies, Treatment Outcome, Vasodilator Agents administration & dosage, Computed Tomography Angiography, Coronary Angiography, Coronary Artery Disease diagnostic imaging, Coronary Artery Disease therapy, Coronary Restenosis diagnostic imaging, Multidetector Computed Tomography, Myocardial Perfusion Imaging, Percutaneous Coronary Intervention instrumentation, Stents
- Abstract
Objectives: The goal of this study was to assess the diagnostic performance of coronary computed tomography angiography (CTA) alone, adenosine-stress myocardial perfusion assessed by computed tomography (CTP) alone, and coronary CTA + CTP by using a 16-cm Z-axis coverage scanner versus invasive coronary angiography (ICA) and fractional flow reserve (FFR) as the clinical standard., Background: Diagnostic performance of coronary CTA for in-stent restenosis detection is still challenging. Recently, CTP showed additional diagnostic power over coronary CTA in patients with suspected coronary artery disease. However, few data are available on CTP performance in patients with previous stent implantation., Methods: Consecutive stable patients with previous coronary stenting referred for ICA were enrolled. All patients underwent stress myocardial CTP and rest CTP + coronary CTA. Invasive FFR was performed during ICA when clinically indicated. The diagnostic rate and diagnostic accuracy of coronary CTA, CTP, and coronary CTA + CTP were evaluated in stent-, territory-, and patient-based analyses., Results: In the 150 enrolled patients (132 men; mean age 65.1 ± 9.1 years), the CTP diagnostic rate was significantly higher than that of coronary CTA in all analyses (territory based [96.7% vs. 91.1%; p < 0.0001] and patient based [96% vs. 68%; p < 0.0001]). When ICA was used as gold standard, CTP diagnostic accuracy was significantly higher than that of coronary CTA in all analyses (territory based [92.1% vs. 85.5%, p < 0.03] and patient based [86.7% vs. 76.7%, p < 0.03]). The concordant coronary CTA + CTP assessment exhibited the highest diagnostic accuracy values versus ICA (95.8% in the territory-based analysis). The diagnostic accuracy of CTP was significantly higher than that of coronary CTA (75% vs. 30.5%; p < 0.001). The radiation exposure of coronary CTA + CTP was 4.15 ± 1.5 mSv., Conclusions: In patients with coronary stents, CTP significantly improved the diagnostic rate and accuracy of coronary CTA alone compared with both ICA and invasive FFR as gold standard., (Copyright © 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2020
- Full Text
- View/download PDF
7. Plaque quantification by coronary computed tomography angiography using intravascular ultrasound as a reference standard: a comparison between standard and last generation computed tomography scanners.
- Author
-
Conte E, Mushtaq S, Pontone G, Li Piani L, Ravagnani P, Galli S, Collet C, Sonck J, Di Odoardo L, Guglielmo M, Baggiano A, Trabattoni D, Annoni A, Mancini ME, Formenti A, Muscogiuri G, Magatelli M, Nicoli F, Poggi C, Fiorentini C, Bartorelli AL, Pepi M, Montorsi P, and Andreini D
- Subjects
- Computed Tomography Angiography, Coronary Angiography, Humans, Reference Standards, Tomography, X-Ray Computed, Ultrasonography, Interventional, Coronary Artery Disease diagnostic imaging, Plaque, Atherosclerotic diagnostic imaging
- Abstract
Aims: The emerging role of coronary computed tomography angiography (CCTA) as a non-invasive tool for atherosclerosis evaluation is supported by data reporting a good correlation between CCTA and intravascular ultrasound (IVUS) for plaque volume quantification. Aim of the present study was to evaluate whether a last generation CT-scanner may improve coronary plaque volume assessment using IVUS as standard-of-reference., Methods and Results: From a registry of 1915 consecutive, all-comers, patients who underwent a clinically indicated IVUS evaluation we enrolled 59 patients who underwent CCTA with a 64-slice CT (Group 1) and 59 patients who underwent CCTA with whole-heart coverage CT scanner (Group 2). Patients who underwent CCTA with unfavourable heart rhythm were not excluded from the analysis. Image quality (4-point Likert scale) focused on plaque analysis was evaluated. Plaque volume quantification by CCTA was compared to IVUS. No difference in clinical characteristics was found between Group 1 and Group 2. Plaque volume quantification by CCTA was considered not feasible in 11 plaques of Group 1 and in 4 plaques of Group 2 (P = 0.09). Higher correlation for plaque volume quantification by CCTA vs. IVUS was demonstrated in Group 2 when compared with Group 1 (r = 0.9888 vs. 0.9499; P < 0.0001). The Bland-Altman analysis showed plaque volume overestimation by CCTA of 11.9 mm3 in Group 1 and 4 mm2 in Group 2 (P < 0.001). Effective radiation dose of CCTA was significantly lower in Group 2 vs. Group 1 (2.7 ± 0.9 vs. 8.1 ± 3.6 mSv, respectively; P < 0.001)., Conclusions: CCTA using a new scanner generation showed to be an accurate non-invasive tool to assess and quantify coronary plaque volume., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.)
- Published
- 2020
- Full Text
- View/download PDF
8. CMR for Identifying the Substrate of Ventricular Arrhythmia in Patients With Normal Echocardiography.
- Author
-
Andreini D, Dello Russo A, Pontone G, Mushtaq S, Conte E, Perchinunno M, Guglielmo M, Coutinho Santos A, Magatelli M, Baggiano A, Zanchi S, Melotti E, Fusini L, Gripari P, Casella M, Carbucicchio C, Riva S, Fassini G, Li Piani L, Fiorentini C, Bartorelli AL, Tondo C, and Pepi M
- Subjects
- Adult, Female, Heart Diseases complications, Heart Diseases physiopathology, Humans, Male, Middle Aged, Predictive Value of Tests, Prospective Studies, Reproducibility of Results, Risk Assessment, Risk Factors, Tachycardia, Ventricular diagnosis, Tachycardia, Ventricular physiopathology, Ventricular Premature Complexes diagnosis, Ventricular Premature Complexes physiopathology, Echocardiography, Heart Diseases diagnostic imaging, Heart Rate, Magnetic Resonance Imaging, Cine, Tachycardia, Ventricular etiology, Ventricular Premature Complexes etiology
- Abstract
Objectives: This study sought to determine whether cardiac magnetic resonance (CMR) may identify structural heart disease (SHD) in patients with ventricular arrhythmia who had echocardiography ruled out pathological findings., Background: Approximately one-half of sudden cardiac deaths are attributable to malignant VA. Echocardiography is commonly used to identify SHD that is the most frequent substrate of VA., Methods: A single-center prospective study was conducted in consecutive patients with significant VA, categorized as >1,000 but <10,000 ventricular ectopic beats [VEBs]/24 h; ≥10,000 VEBs/24 h; nonsustained ventricular tachycardia, sustained ventricular tachycardia, or a history of resuscitated cardiac arrest, and no pathological findings at echocardiography, requiring a clinically indicated CMR. Primary endpoint was CMR detection of SHD. Secondary endpoints were a composite of CMR detection of SHD and abnormal findings not specific for a definite SHD diagnosis., Results: A total of 946 patients were enrolled (mean 41 ± 16 years of age; 64% men). CMR studies were used to diagnose SHD in 241 patients (25.5%) and abnormal findings not specific for a definite SHD diagnosis in 187 patients (19.7%). Myocarditis (n = 91) was the more frequent disease, followed by arrhythmogenic cardiomyopathy (n = 55), dilated cardiomyopathy (n = 39), ischemic heart disease (n = 22), hypertrophic cardiomyopathy (n = 13), congenital cardiac disease (n = 10), left ventricle noncompaction (n = 5), and pericarditis (n = 5). The strongest univariate and multivariate predictors of SHD on CMR images were chest pain (odds ratios [OR]: 2.52 and 2.38, respectively) and sustained ventricular tachycardia (ORs: 2.67 and 2.23, respectively)., Conclusions: SHD was able to be identified on CMR imaging in a sizable number of patients with significant VA and completely normal echocardiography. Chest pain and sustained ventricular tachycardia were the strongest predictors of positive CMR imaging results., (Copyright © 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2020
- Full Text
- View/download PDF
9. Role of echocardiography on the diagnosis is ventricular dyssynchrony in patients selected for cardiac resynchronization
- Author
-
Bonadei, Ivano, Vizzardi, Enrico, D'Aloia, A, Quinzani, F, Magatelli, M, Salghetti, F, Curnis, Antonio, and Metra, Marco
- Published
- 2013
10. La sindrome di 'Tako-Tsubo': un inusuale caso clinico
- Author
-
Vizzardi, Enrico, D’Aloia, A, Rovetta, R, Bonadei, Ivano, Quinzani, F, Magatelli, M, Piovanelli, B, Tanghetti, E, and DEI CAS, Livio
- Published
- 2012
11. Home montoring in Cardiologia oggi
- Author
-
Lombardi, Carlo Mario, Volpato, V, Danesi, R, Guidetti, F, Rovetta, R, Quinzani, F, Castrini, An, Magatelli, M, Metra, Marco, and DEI CAS, Livio
- Published
- 2012
12. I nuovi sartani nella terapia cardiovascolare: un reale vantaggio?
- Author
-
Lombardi, Carlo Mario, Castrini, An, Metra, Marco, Guidetti, F, Genovese, D, Quinzani, F, Pezzotti E, Magatelli M., and DEI CAS, Livio
- Published
- 2012
13. La tachicardia: un fattore di rischio cardiovascolare
- Author
-
Metra, Marco, Lombardi, Carlo Mario, Carubelli, V, Volpato, V, Magatelli, M, Guidetti, F, Aloisi, G, Rovetta, R, Armato, A, Nodari, Savina, and DEI CAS, Livio
- Published
- 2012
14. Low-Dose Coronary CT Angiography in Patients with Atrial Fibrillation: Comparison of Image Quality and Radiation Exposure with Two Different Approaches.
- Author
-
Mushtaq S, Pontone G, Conte E, Guglielmo M, Consiglio E, Magatelli M, Oliveira M, Muscogiuri G, Annoni A, Baggiano A, Formenti A, Mancini ME, Di Odoardo L, Melotti E, Fiorentini C, Bartorelli AL, Pepi M, and Andreini D
- Subjects
- Aged, Female, Humans, Male, Middle Aged, Prospective Studies, Radiation Dosage, Atrial Fibrillation complications, Computed Tomography Angiography methods, Coronary Angiography methods, Coronary Disease complications, Coronary Disease diagnosis, Image Enhancement methods, Radiation Exposure prevention & control
- Abstract
Rationale and Objectives: To evaluate image quality, coronary interpretability and radiation exposure of coronary CT angiography (CCTA) performed in patients with atrial fibrillation (AF) with the latest scanner generation, comparing two different technical approaches. A new scanner that combines a 0.23 mm spatial resolution, a new generation of iterative reconstruction, fast gantry rotation time and the intracycle motion-correction algorithm to improve the temporal resolution was recently introduced in the clinical field., Materials and Methods: We enrolled 105 consecutive patients with chronic AF who performed CCTA with a whole-heart coverage high-definition CT scanner (16-cm z-axis coverage with 256 detector rows, 0.28 s gantry rotation time). Five of them were excluded for impaired renal function. Patients were randomized between a double acquisition protocol (50 patients, group 1) or a single acquisition protocol (50 patients, group 2). The image quality, coronary segment interpretability and effective dose (ED) of CCTA were assessed., Results: The mean HR during the scan was 85.6±21 bpm in group 1 vs. 83.7±23 bpm in Group 2, respectively (p < ns). In group 2, overall image quality was high and comparable with that of group 1 (Likert scale =3.2 ± 1.4 vs. 3.3 ± 1.2, p = ns, in group 1 and 2, respectively). Coronary interpretability was high and similar between the two groups (97.5% and 97.1% in group 1 and 2, p = ns, respectively). Mean ED was significantly higher in group 1 than in group 2 (5.3 ± 1.8 mSv vs. 2.7 ± 0.7 mSv, p < 0.001)., Conclusion: The novel whole-heart coverage CT scanner allows to perform CCTA with a single-acquisition protocol with high image quality and low radiation exposure in AF patients., (Copyright © 2018 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.)
- Published
- 2019
- Full Text
- View/download PDF
15. Diagnostic accuracy of coronary CT angiography performed in 100 consecutive patients with coronary stents using a whole-organ high-definition CT scanner.
- Author
-
Andreini D, Pontone G, Mushtaq S, Conte E, Guglielmo M, Mancini ME, Annoni A, Baggiano A, Formenti A, Montorsi P, Magatelli M, Di Odoardo L, Melotti E, Resta M, Muscogiuri G, Fiorentini C, Bartorelli AL, and Pepi M
- Subjects
- Aged, Coronary Artery Disease diagnosis, Coronary Artery Disease surgery, Coronary Restenosis physiopathology, Coronary Vessels surgery, Female, Follow-Up Studies, Heart Rate physiology, Humans, Male, Middle Aged, Prospective Studies, Reproducibility of Results, Algorithms, Computed Tomography Angiography methods, Coronary Angiography methods, Coronary Restenosis diagnosis, Coronary Vessels diagnostic imaging, Stents
- Abstract
Aims: To evaluate image quality, interpretability, diagnostic accuracy and radiation exposure of coronary CT angiography (CCTA) performed with a new scanner equipped with 0.23-mm spatial resolution, new generation iterative reconstruction, 0.28-second gantry rotation time and intra-cycle motion-correction algorithm in consecutive patients with coronary stents, including those with high heart rate (HR) and atrial fibrillation (AF)., Materials and Methods: We enrolled 100 consecutive patients (85 males, mean age 65 ± 10 years) with previous coronary stent implantation scheduled for clinically indicated non-emergent invasive coronary angiography (ICA). Image quality, coronary interpretability and diagnostic accuracy vs. ICA were evaluated and the effective dose (ED) was recorded., Results: Mean HR during the scan was 67 ± 13 bpm. Twenty-six patients had >65 bpm HR during scanning and 13 patients had AF. Overall, image quality was high (Likert = 3.2 ± 0.9). Stent interpretability was 95.8% (184/192 stents). Among 192 stented segments, CCTA correctly identified 22 out of 24 with >50% in-stent restenosis (ISR) (sensitivity 92%). In a stent-based analysis, specificity, positive and negative predictive values and diagnostic accuracy for ISR detection were 91%, 99%, 60% and 91%, respectively. In a patient-based analysis, CCTA diagnostic accuracy was 85%. Overall, mean ED of CCTA was 2.4 ± 1.2 mSv., Conclusions: A whole-organ CT scanner was able to evaluate coronary stents with good diagnostic performance and low radiation exposure, also in presence of unfavorable HR and heart rhythm., Translational Aspect: The present study is the first to evaluate the CCTA capability of detecting in-stent restenosis in consecutive patients, including those with high HR and AF, using a recent scanner generation that combines improved spatial and temporal resolution with wide coverage. Using the whole-organ high-definition CT scanner we obtained high quality images of coronary stents with good interpretability and diagnostic accuracy combined with low radiation exposure, even in patients with unfavorable HR or heart rhythm for CCTA evaluation., (Copyright © 2018. Published by Elsevier B.V.)
- Published
- 2019
- Full Text
- View/download PDF
16. Rationale and design of advantage (additional diagnostic value of CT perfusion over coronary CT angiography in stented patients with suspected in-stent restenosis or coronary artery disease progression) prospective study.
- Author
-
Andreini D, Mushtaq S, Pontone G, Conte E, Sonck J, Collet C, Guglielmo M, Baggiano A, Trabattoni D, Galli S, Montorsi P, Ferrari C, Fabbiocchi F, De Martini S, Annoni A, Mancini ME, Formenti A, Magatelli M, Resta M, Consiglio E, Muscogiuri G, Fiorentini C, Bartorelli AL, and Pepi M
- Subjects
- Clinical Protocols, Coronary Restenosis etiology, Coronary Restenosis physiopathology, Humans, Percutaneous Coronary Intervention adverse effects, Predictive Value of Tests, Prospective Studies, Reproducibility of Results, Research Design, Computed Tomography Angiography, Coronary Angiography methods, Coronary Restenosis diagnostic imaging, Fractional Flow Reserve, Myocardial, Multidetector Computed Tomography, Myocardial Perfusion Imaging methods, Percutaneous Coronary Intervention instrumentation, Stents
- Abstract
Background: Recent studies demonstrated a significant improvement in the diagnostic performance of coronary CT angiography (CCTA) for the evaluation of in-stent restenosis (ISR). However, coronary stent assessment is still challenging, especially because of beam-hardening artifacts due to metallic stent struts and high atherosclerotic burden of non-stented segments. Adenosine-stress myocardial perfusion assessed by CT (CTP) recently demonstrated to be a feasible and accurate tool for evaluating the functional significance of coronary stenoses in patients with suspected coronary artery disease (CAD). Yet, scarce data are available on the performance of CTP in patients with previous stent implantation., Aim of the Study: We aim to assess the diagnostic performance of CCTA alone, CTP alone and CCTA plus CTP performed with a new scanner generation using quantitative invasive coronary angiography (ICA) and invasive fractional flow reserve (FFR) as standard of reference., Methods: We will enroll 300 consecutive patients with previous stent implantation, referred for non-emergent and clinically indicated invasive coronary angiography (ICA) due to suspected ISR or progression of CAD in native coronary segments. All patients will be subjected to stress myocardial CTP and a rest CCTA. The first 150 subjects will undergo static CTP scan, while the following 150 patients will undergo dynamic CTP scan. Measurement of invasive FFR will be performed during ICA when clinically indicated., Results: The primary study end points will be: 1) assessment of the diagnostic performance (diagnostic rate, sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy) of CCTA, CTP, combined CCTA-CTP and concordant CCTA-CTP vs. ICA as standard of reference in a territory-based and patient-based analysis; 2) assessment of sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of CCTA, CTP, combined CCTA-CTP and concordant CCTA-CTP vs. invasive FFR as standard of reference in a territory-based analysis., Conclusions: The ADVANTAGE study aims to provide an answer to the intriguing question whether the combined anatomical and functional assessment with CCTA plus CTP may have higher diagnostic performance as compared to CCTA alone in identifying stented patients with significant ISR or CAD progression., (Copyright © 2018. Published by Elsevier Inc.)
- Published
- 2018
- Full Text
- View/download PDF
17. Percutaneous edge-to-edge mitral valve repair for the treatment of acute mitral regurgitation complicating myocardial infarction: A single centre experience.
- Author
-
Adamo M, Curello S, Chiari E, Fiorina C, Chizzola G, Magatelli M, Locantore E, Cuminetti G, Lombardi C, Manzato A, Metra M, and Ettori F
- Subjects
- Acute Disease, Aged, Aged, 80 and over, Female, Follow-Up Studies, Hemodynamics, Humans, Italy, Male, Middle Aged, Myocardial Infarction diagnosis, Pulmonary Edema etiology, Pulmonary Edema therapy, Risk Assessment, Severity of Illness Index, Shock, Cardiogenic etiology, Shock, Cardiogenic therapy, Treatment Outcome, Cardiac Surgical Procedures methods, Mitral Valve diagnostic imaging, Mitral Valve physiopathology, Mitral Valve surgery, Mitral Valve Insufficiency diagnosis, Mitral Valve Insufficiency etiology, Mitral Valve Insufficiency physiopathology, Mitral Valve Insufficiency surgery, Myocardial Infarction complications
- Abstract
Background: Limited evidence is available about MitraClip therapy in patients with acute mitral regurgitation (MR) complicating myocardial infarction (MI)., Methods and Results: Among 80 consecutive patients undergoing MitraClip treatment, 5 (6.3%) had been admitted for acute MI complicated by severe MR. Mean age was 73±6years and 3 were males. At the time of admission they were in cardiogenic shock (80%) or pulmonary oedema (20%), with severe MR, left ventricular dysfunction and pulmonary hypertension. The indication to MitraClip treatment was based on severe hemodynamic instability with dependence on intravenous therapy and mechanical supports despite percutaneous coronary revascularization and on high surgical risk of 27.1±13% and 10.2±6% using Euroscore II and STS score respectively. MitraClip procedure was performed at 53±33days from admission. One or two clips were employed in 2 and 3 patients respectively. Procedural success (MR≤2+) was achieved in all patients without complications and with successful weaning from mechanical supports and intravenous drugs in all but one patient who underwent left ventricular assist device implantation at 60days from MitraClip procedure. MR recurrence occurred at 30-day follow-up in one patient who had concomitant aortic regurgitation. One patient died during follow-up for non-cardiovascular cause. However, recovery of hemodynamic balance with significant and persistent pulmonary pressure reduction and functional status improvement up to 2-year follow-up was observed in most of the patients., Conclusions: Critical patients with acute ischemic MR post-MI with persistence of hemodynamic instability after coronary revascularization may benefit from MitraClip therapy acutely with favourable long-term follow-up results., (Copyright © 2017 Elsevier B.V. All rights reserved.)
- Published
- 2017
- Full Text
- View/download PDF
18. Beta-blockers can improve survival in medically-treated patients with severe symptomatic aortic stenosis.
- Author
-
Rossi A, Temporelli PL, Cicoira M, Gaibazzi N, Cioffi G, Nistri S, Magatelli M, Tavazzi L, and Faggiano P
- Subjects
- Aged, Aged, 80 and over, Aortic Valve Stenosis diagnosis, Female, Follow-Up Studies, Humans, Male, Retrospective Studies, Survival Rate trends, Treatment Outcome, Adrenergic beta-Antagonists therapeutic use, Aortic Valve Stenosis drug therapy, Aortic Valve Stenosis mortality, Severity of Illness Index
- Published
- 2015
- Full Text
- View/download PDF
19. Combined Use of MITRACLIP and Ventricular ASSIST Devices in Cardiogenic Shock: MITRA-ASSIST Registry.
- Author
-
Rivero-Santana, Borja, Jurado-Roman, Alfonso, Pascual, Isaac, Li, Chi Hion, Jimenez, Pilar, Estevez-Loureiro, Rodrigo, Cepas-Guillén, Pedro, Benito-González, Tomás, Serrador, Ana, De La Torre-Hernandez, Jose Maria, Avanzas, Pablo, Fernandez-Peregrina, Estefania, Nombela, Luis, Caneiro-Queija, Berenice, Freixas, Xavier, Fernandez-Vazquez, Felipe, Amat-Santos, Ignacio, Lee, Dae-Hyun, Leon, Victor, and Arzamendi, Dabit
- Subjects
HEART assist devices ,MECHANICAL hearts ,ST elevation myocardial infarction ,ARTIFICIAL blood circulation ,MYOCARDIAL infarction ,INTRA-aortic balloon counterpulsation - Abstract
Background: Patients with cardiogenic shock (CS) and mitral regurgitation (MI) have a prohibitive risk that contraindicates surgical treatment. Although the feasibility of transcatheter edge-to-edge therapy (TEER) has been demonstrated in this setting, the benefit of the combined use of TEER with mechanical circulatory support devices (MCS) has not been studied. The aim of this study was to evaluate the clinical outcomes of TEER in patients with MCS. Methods: The MITRA-ASSIST study is a retrospective multicentre Spanish registry that included patients with MR and CS who underwent TEER in combination with MCS. The primary endpoint was death from any cause at 12 months. The secondary endpoint was a composite of death from any cause or hospitalisation for heart failure at 12 months. Results: A total of twenty-four patients in nine high-volume Spanish centres (66.2 (51–82) years, 70.8% female, EuroSCORE II 20.4 ± 17.8) were included. Acute ST-elevation myocardial infarction was the main CS aetiology (56%), and the most implanted MCS was the intra-aortic balloon pump (82.6%), followed by ECMO (8.7%), IMPELLACP
® (4.3%), or a combination of both (4.3%). Procedural success was 95.8%, with 87.5% in-hospital survival. At 12-month follow-up, 25.0% of patients died, and 33.3% had a composite event of death from any cause or hospitalisation for heart failure. Conclusions: TEER in patients with concomitant CS and MR who require MCS appears to be a promising therapeutic alternative with a high device procedural success rate and acceptable mortality and heart failure readmission rates at follow-up. [ABSTRACT FROM AUTHOR]- Published
- 2024
- Full Text
- View/download PDF
20. Plaque assessment by coronary CT angiography may predict cardiac events in high risk and very high risk diabetic patients: A long-term follow-up study
- Abstract
Background and aims: The aim of the present study is to evaluate whether advanced coronary atherosclerosis analysis by CCTA may improve prognostic stratification among diabetic patients at high cardiovascular risk (CV risk). Methods and results: The study population consisted of 265 consecutive diabetic patients at high CV risk who underwent CCTA for suspected CAD between January 2011 and December 2016. For every patients both traditional and advanced, qualitative and quantitative coronary plaque analysis were performed. The occurrence of cardiac death, ACS, and non-urgent revascularization were recorded at follow-up. Among the 265 patients enrolled, 21 were lost to follow-up, whereas 244 (92%) had a complete follow-up (mean 45 ± 22 months) and were classified at high (n = 67) or very high cardiovascular risk (n = 177), according to ESC Guidelines. A total of 63 events were recorded (3 Cardiac Death, 3 NSTEMI, 8 unstable angina, 36 late non-urgent revascularization and 13 non-cardiac death) in 57 different patients. Elevated fibro-fatty plaque volume was the only predictor of events over age, gender and traditional risk factor when ACS and MACE were considered as end-points [HR (95% CI) 6.01 (1.65–21.87), p = 0.006 and 3.46 (2.00–5.97); p < 0.001]. Conclusion: The present study confirms the prognostic role of advance coronary atherosclerosis evaluation beyond risk factors and stenosis severity, even in diabetics. Despite the very high cardiovascular risk of study population, a not negligible portion (23%) of patients exhibited totally normal coronaries.
- Published
- 2022
21. [Role of echocardiography on the diagnosis is ventricular dyssynchrony in patients selected for cardiac resynchronization].
- Author
-
Bonadei I, Vizzardi E, D'Aloia A, Quinzani F, Magatelli M, Salghetti F, Curnis A, and Metra M
- Subjects
- Clinical Trials as Topic statistics & numerical data, Echocardiography trends, Echocardiography, Doppler methods, Echocardiography, Three-Dimensional, Heart Failure physiopathology, Heart Failure therapy, Humans, Multicenter Studies as Topic statistics & numerical data, Myocardial Contraction, Observer Variation, Predictive Value of Tests, Sensitivity and Specificity, Cardiac Resynchronization Therapy, Echocardiography methods, Heart Failure diagnostic imaging, Heart Ventricles diagnostic imaging, Patient Selection
- Abstract
Currently, cardiac resynchronization therapy (CRT) is a treatment for heart failure refractory to optimized medical therapy. However, approximately 30% -45% of patients selected according to the guidelines, are "non responders" to CRT. Since the CRT is an invasive treatment, the candidates for such therapy should be carefully selected to ensure an optimal clinical benefit and instrumental. Despite its demonstrated effectiveness in reducing mortality and hospitalizations in patients with chronic heart failure on optimal medical therapy, the diagnosis of dyssynchrony is not easy. On the one hand, some echocardiographic indices have proved unreliable, other, more complex parameters still need to be validated before being implemented in clinical routine. The purpose of our paper is to evaluate echocardiographic techniques and not consolidated in patient response to CRT.
- Published
- 2013
- Full Text
- View/download PDF
22. A Type A Aortic Dissection Mimicking an Acute Myocardial Infarction.
- Author
-
D'Aloia A, Vizzardi E, Bugatti S, Magatelli M, Bonadei I, Rovetta R, Quinzani F, Curnis A, and Cas LD
- Abstract
We describe a case of a 54 years old man in whom an initial diagnosis of acute coronary syndrome (ACS) revealed to be finally an acute aortic dissection. This case report stresses the importance to maintain a high grade of suspicion of aortic dissection as a possible alternative in presence of eletrocardiographic myocardial ischemic signs. In many medical centers where thrombolitic therapy, antiplatelets receptor blockers, heparin or percutaneous coronary angioplasty is the first line therapy for ACS the outcome may be catastrophic in situation such as aortic dissection.
- Published
- 2012
- Full Text
- View/download PDF
23. Transcatheter Structural Heart Interventions in the Acute Setting: An Emerging Indication.
- Author
-
Pyrpyris, Nikolaos, Dimitriadis, Kyriakos, Theofilis, Panagiotis, Iliakis, Panagiotis, Beneki, Eirini, Pitsiori, Daphne, Tsioufis, Panagiotis, Shuvy, Mony, Aznaouridis, Konstantinos, and Tsioufis, Konstantinos
- Subjects
MITRAL valve insufficiency ,HEART valve prosthesis implantation ,HEART valve diseases ,HEART diseases ,HEART ,MITRAL valve - Abstract
Structural heart disease is increasingly prevalent in the general population, especially in patients of increased age. Recent advances in transcatheter structural heart interventions have gained a significant following and are now considered a mainstay option for managing stable valvular disease. However, the concept of transcatheter interventions has also been tested in acute settings by several investigators, especially in cases where valvular disease comes as a result of acute ischemia or in the context of acute decompensated heart failure. Tested interventions include both the mitral and aortic valve, mostly evaluating mitral transcatheter edge-to-edge repair and transcatheter aortic valve implantation, respectively. This review is going to focus on the use of acute structural heart interventions in the emergent setting, and it will delineate the available data and provide a meaningful discussion on the optimal patient phenotype and future directions of the field. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
24. Prevalence and prognosis of structural heart disease among athletes with negative T waves and normal transthoracic echocardiography.
- Author
-
Conte, Edoardo, Pizzamiglio, Francesca, Dessanai, Maria Antonietta, Guarnieri, Gianluca, Ardizzone, Valentina, Schillaci, Matteo, Dello Russo, Antonio, Casella, Michela, Mushtaq, Saima, Melotti, Eleonora, Marchetti, Davide, Volpato, Valentina, Drago, Gabrile, Gigante, Carlo, Sforza, Chiarella, Bartorelli, Antonio L., Pepi, Mauro, Pontone, Gianluca, Tondo, Claudio, and Andreini, Daniele
- Abstract
Introduction: The aim of the present study was to evaluate the prevalence and prognosis of structural heart disease (SHD) among competitive athletes with negative T waves without pathological findings at transthoracic echocardiogram. Methods: From a prospective register of 450 athletes consecutively evaluated during a second-level cardiological examination, we retrospectively identified all subjects with the following inclusion criteria: (1) not previously known cardiovascular disease; (2) negative T waves in leads other than V1–V2; (3) normal transthoracic echocardiogram. Patients underwent cardiac MRI and CT. The primary endpoint was the diagnosis of definite SHD after multimodality imaging evaluation. A follow-up was collected for a combined end-point of sudden death, resuscitated sudden cardiac death and hospitalization for any cardiovascular causes. Results: A total of 55 competitive athletes were finally enrolled (50 males, 90%) with a mean age of 27.5 ± 14.1 years. Among the population enrolled 16 (29.1%) athletes had a final diagnosis of SHD. At multivariate analysis, only deep negative T waves remained statistically significant [OR (95% CI) 7.81 (1.24–49.08), p = 0.0285]. Contemporary identification of deep negative T waves and complex arrhythmias in the same patients appeared to have an incremental diagnostic value. No events were collected at 49.3 ± 12.3 months of follow-up. Conclusions: In a cohort of athletes with negative T waves at ECG, cardiac MRI (and selected use of cardiac CT) enabled the identification of 16 (29.1%) subjects with SHD despite normal transthoracic echocardiography. Deep negative T waves and complex ventricular arrhythmias were the only clinical characteristic associated with SHD diagnosis. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
25. Plaque quantification by coronary computed tomography angiography using intravascular ultrasound as a reference standard: A comparison between standard and last generation computed tomography scanners
- Abstract
Aims: The emerging role of coronary computed tomography angiography (CCTA) as a non-invasive tool for atherosclerosis evaluation is supported by data reporting a good correlation between CCTA and intravascular ultrasound (IVUS) for plaque volume quantification. Aim of the present study was to evaluate whether a last generation CT-scanner may improve coronary plaque volume assessment using IVUS as standard-of-reference. Methods and results: From a registry of 1915 consecutive, all-comers, patients who underwent a clinically indicated IVUS evaluation we enrolled 59 patients who underwent CCTA with a 64-slice CT (Group 1) and 59 patients who underwent CCTA with whole-heart coverage CT scanner (Group 2). Patients who underwent CCTA with unfavourable heart rhythm were not excluded from the analysis. Image quality (4-point Likert scale) focused on plaque analysis was evaluated. Plaque volume quantification by CCTA was compared to IVUS. No difference in clinical characteristics was found between Group 1 and Group 2. Plaque volume quantification by CCTA was considered not feasible in 11 plaques of Group 1 and in 4 plaques of Group 2 (P = 0.09). Higher correlation for plaque volume quantification by CCTA vs. IVUS was demonstrated in Group 2 when compared with Group 1 (r = 0.9888 vs. 0.9499; P < 0.0001). The Bland-Altman analysis showed plaque volume overestimation by CCTA of 11.9 mm3 in Group 1 and 4 mm2 in Group 2 (P < 0.001). Effective radiation dose of CCTA was significantly lower in Group 2 vs. Group 1 (2.7 ± 0.9 vs. 8.1 ± 3.6 mSv, respectively; P < 0.001). Conclusions: CCTA using a new scanner generation showed to be an accurate non-invasive tool to assess and quantify coronary plaque volume.
- Published
- 2020
26. Interpretability of Coronary CT Angiography Performed With a Novel Whole-Heart Coverage High-Definition CT Scanner in 300 Consecutive Patients With Coronary Artery Bypass Grafts
- Abstract
Aims: Coronary CT angiography (CCTA) is an accurate non-invasive tool for the evaluation of coronary artery bypass graft (CABG). However, inability to sustain a long breath-hold, high heart rate (HR) and atrial fibrillation may affect image quality. Moreover, radiation exposure is still a matter of some concern. A scanner combining 0.23-mm spatial resolution, new iterative reconstruction and fast gantry rotation time has been recently introduced in the clinical field. The aims of our study were to evaluate interpretability, radiation exposure and diagnostic accuracy of CCTA performed with the latest generation of cardiac-CT scanners compared to invasive coronary angiography (ICA) in the assessment of bypass grafts, and non-grafted and post-anastomotic native coronary arteries. Methods and results: We prospectively enrolled 300 patients undergoing clinically indicated CCTA with a 16-cm z-axis coverage, 256-detector rows, and 0.28-sec gantry rotation time scanner. Coronary artery and graft interpretability, image quality and effective dose (ED) were assessed in all patients and diagnostic accuracy was evaluated in a subgroup of 100 patients who underwent ICA. Mean HR during the scan was 69.6 ± 10.8. Sinus rhythm was present in 118 patients with HR < 75 bpm and in 112 patients with HR ≥ 75 bpm, while 70 patients had atrial fibrillation. CABG interpretability was 100%. Compared to ICA, CCTA was able to correctly detecting occlusions or significant stenoses of all CABG segments. Overall interpretability of native coronary segments was 95.6%. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of coronary arteries were 98.3%, 97.4%, 93.1%, 99.3% and 96.5%, respectively. The diagnostic accuracy in a patient based analysis was 95.2%. Mean ED was 3.14 ± 1.7 mSv. Conclusions: The novel whole-heart coverage CT scanner allows to evaluating CABG and native coronary arteries with excellent interpretability and low radiation exposure even
- Published
- 2020
27. CT Perfusion Versus Coronary CT Angiography in Patients With Suspected In-Stent Restenosis or CAD Progression
- Abstract
Objectives: The goal of this study was to assess the diagnostic performance of coronary computed tomography angiography (CTA) alone, adenosine-stress myocardial perfusion assessed by computed tomography (CTP) alone, and coronary CTA + CTP by using a 16-cm Z-axis coverage scanner versus invasive coronary angiography (ICA) and fractional flow reserve (FFR) as the clinical standard. Background: Diagnostic performance of coronary CTA for in-stent restenosis detection is still challenging. Recently, CTP showed additional diagnostic power over coronary CTA in patients with suspected coronary artery disease. However, few data are available on CTP performance in patients with previous stent implantation. Methods: Consecutive stable patients with previous coronary stenting referred for ICA were enrolled. All patients underwent stress myocardial CTP and rest CTP + coronary CTA. Invasive FFR was performed during ICA when clinically indicated. The diagnostic rate and diagnostic accuracy of coronary CTA, CTP, and coronary CTA + CTP were evaluated in stent-, territory-, and patient-based analyses. Results: In the 150 enrolled patients (132 men; mean age 65.1 ± 9.1 years), the CTP diagnostic rate was significantly higher than that of coronary CTA in all analyses (territory based [96.7% vs. 91.1%; p < 0.0001] and patient based [96% vs. 68%; p < 0.0001]). When ICA was used as gold standard, CTP diagnostic accuracy was significantly higher than that of coronary CTA in all analyses (territory based [92.1% vs. 85.5%, p < 0.03] and patient based [86.7% vs. 76.7%, p < 0.03]). The concordant coronary CTA + CTP assessment exhibited the highest diagnostic accuracy values versus ICA (95.8% in the territory-based analysis). The diagnostic accuracy of CTP was significantly higher than that of coronary CTA (75% vs. 30.5%; p < 0.001). The radiation exposure of coronary CTA + CTP was 4.15 ± 1.5 mSv. Conclusions: In patients with coronary stents, CTP significantly improved the diagn
- Published
- 2020
28. Complications in Acute Myocardial Infarction: Navigating Challenges in Diagnosis and Management.
- Author
-
Moras, Errol, Yakkali, Shreyas, Gandhi, Kruti D., Virk, Hafeez Ul Hassan, Alam, Mahboob, Zaid, Syed, Barman, Nitin, Jneid, Hani, Vallabhajosyula, Saraschandra, Sharma, Samin K., and Krittanawong, Chayakrit
- Subjects
MYOCARDIAL infarction ,CARDIOGENIC shock ,DIAGNOSIS ,HOSPITAL utilization ,SURGICAL technology ,PATIENTS' attitudes - Abstract
In recent decades, significant advancements in pharmacological, catheter-based, and surgical reperfusion technologies have markedly improved outcomes for individuals undergoing acute myocardial infarction. Despite these remarkable progressions, a segment of patients, particularly those with extensive infarctions or delays in revascularization, remains vulnerable to the onset of mechanical complications associated with myocardial infarction. These complications, spanning mechanical, electrical, ischemic, inflammatory, and thromboembolic events, pose substantial risks of morbidity, mortality, and increased utilization of hospital resources. The management of patients experiencing these complications is intricate, necessitating collaborative efforts among various specialties. Timely identification, accurate diagnosis, hemodynamic stabilization, and decision-making support are crucial for guiding patients and their families in choosing between definitive treatments or palliative care. This review underscores the critical importance of promptly identifying and initiating therapy to reduce prolonged periods of cardiogenic shock and the potential for fatality. By presenting key clinical and diagnostic insights, this review aims to further improve early diagnosis and offer an updated perspective on current management strategies for the diverse range of complications associated with acute myocardial infarction. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
29. Diagnostic accuracy of coronary CT angiography performed in 100 consecutive patients with coronary stents using a whole-organ high-definition CT scanner
- Abstract
Aims: To evaluate image quality, interpretability, diagnostic accuracy and radiation exposure of coronary CT angiography (CCTA) performed with a new scanner equipped with 0.23-mm spatial resolution, new generation iterative reconstruction, 0.28-second gantry rotation time and intra-cycle motion-correction algorithm in consecutive patients with coronary stents, including those with high heart rate (HR) and atrial fibrillation (AF). Materials and methods: We enrolled 100 consecutive patients (85 males, mean age 65 ± 10 years) with previous coronary stent implantation scheduled for clinically indicated non-emergent invasive coronary angiography (ICA). Image quality, coronary interpretability and diagnostic accuracy vs. ICA were evaluated and the effective dose (ED) was recorded. Results: Mean HR during the scan was 67 ± 13 bpm. Twenty-six patients had >65 bpm HR during scanning and 13 patients had AF. Overall, image quality was high (Likert = 3.2 ± 0.9). Stent interpretability was 95.8% (184/192 stents). Among 192 stented segments, CCTA correctly identified 22 out of 24 with >50% in-stent restenosis (ISR) (sensitivity 92%). In a stent-based analysis, specificity, positive and negative predictive values and diagnostic accuracy for ISR detection were 91%, 99%, 60% and 91%, respectively. In a patient-based analysis, CCTA diagnostic accuracy was 85%. Overall, mean ED of CCTA was 2.4 ± 1.2 mSv. Conclusions: A whole-organ CT scanner was able to evaluate coronary stents with good diagnostic performance and low radiation exposure, also in presence of unfavorable HR and heart rhythm. Translational aspect: The present study is the first to evaluate the CCTA capability of detecting in-stent restenosis in consecutive patients, including those with high HR and AF, using a recent scanner generation that combines improved spatial and temporal resolution with wide coverage. Using the whole-organ high-definition CT scanner we obtained high quality images of coronary stents with g
- Published
- 2019
30. Low-Dose Coronary CT Angiography in Patients with Atrial Fibrillation: Comparison of Image Quality and Radiation Exposure with Two Different Approaches
- Abstract
Rationale and Objectives: To evaluate image quality, coronary interpretability and radiation exposure of coronary CT angiography (CCTA)performed in patients with atrial fibrillation (AF)with the latest scanner generation, comparing two different technical approaches. A new scanner that combines a 0.23 mm spatial resolution, a new generation of iterative reconstruction, fast gantry rotation time and the intracycle motion-correction algorithm to improve the temporal resolution was recently introduced in the clinical field. Materials and Methods: We enrolled 105 consecutive patients with chronic AF who performed CCTA with a whole-heart coverage high-definition CT scanner (16-cm z-axis coverage with 256 detector rows, 0.28 s gantry rotation time). Five of them were excluded for impaired renal function. Patients were randomized between a double acquisition protocol (50 patients, group 1)or a single acquisition protocol (50 patients, group 2). The image quality, coronary segment interpretability and effective dose (ED)of CCTA were assessed. Results: The mean HR during the scan was 85.6±21 bpm in group 1 vs. 83.7±23 bpm in Group 2, respectively (p < ns). In group 2, overall image quality was high and comparable with that of group 1 (Likert scale =3.2 ± 1.4 vs. 3.3 ± 1.2, p = ns, in group 1 and 2, respectively). Coronary interpretability was high and similar between the two groups (97.5% and 97.1% in group 1 and 2, p = ns, respectively). Mean ED was significantly higher in group 1 than in group 2 (5.3 ± 1.8 mSv vs. 2.7 ± 0.7 mSv, p < 0.001). Conclusion: The novel whole-heart coverage CT scanner allows to perform CCTA with a single-acquisition protocol with high image quality and low radiation exposure in AF patients.
- Published
- 2019
31. Electrocardiographic Characteristics, Identification, and Management of Frequent Premature Ventricular Contractions.
- Author
-
Tsiachris, Dimitris, Botis, Michail, Doundoulakis, Ioannis, Bartsioka, Lamprini Iro, Tsioufis, Panagiotis, Kordalis, Athanasios, Antoniou, Christos-Konstantinos, Tsioufis, Konstantinos, and Gatzoulis, Konstantinos A.
- Subjects
ARRHYTHMIA ,CARDIAC magnetic resonance imaging ,CATHETER ablation ,HEART diseases ,MYOCARDIAL depressants - Abstract
Premature ventricular complexes (PVCs) are frequently encountered in clinical practice. The association of PVCs with adverse cardiovascular outcomes is well established in the context of structural heart disease, yet not so much in the absence of structural heart disease. However, cardiac magnetic resonance (CMR) seems to contribute prognostically in the latter subgroup. PVC-induced myocardial dysfunction refers to the impairment of ventricular function due to PVCs and is mostly associated with a PVC burden > 10%. Surface 12-lead ECG has long been used to localize the anatomic site of origin and multiple algorithms have been developed to differentiate between right ventricular and left ventricular outflow tract (RVOT and LVOT, respectively) origin. Novel algorithms include alternative ECG lead configurations and, lately, sophisticated artificial intelligence methods have been utilized to determine the origins of outflow tract arrhythmias. The decision to therapeutically address PVCs should be made upon the presence of symptoms or the development of PVC-induced myocardial dysfunction. Therapeutic modalities include pharmacological therapy (I-C antiarrhythmic drugs and beta blockers), as well as catheter ablation, which has demonstrated superior efficacy and safety. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
32. Rationale and design of advantage (additional diagnostic value of CT perfusion over coronary CT angiography in stented patients with suspected in-stent restenosis or coronary artery disease progression) prospective study
- Abstract
Background: Recent studies demonstrated a significant improvement in the diagnostic performance of coronary CT angiography (CCTA) for the evaluation of in-stent restenosis (ISR). However, coronary stent assessment is still challenging, especially because of beam-hardening artifacts due to metallic stent struts and high atherosclerotic burden of non-stented segments. Adenosine-stress myocardial perfusion assessed by CT (CTP) recently demonstrated to be a feasible and accurate tool for evaluating the functional significance of coronary stenoses in patients with suspected coronary artery disease (CAD). Yet, scarce data are available on the performance of CTP in patients with previous stent implantation. Aim of the study: We aim to assess the diagnostic performance of CCTA alone, CTP alone and CCTA plus CTP performed with a new scanner generation using quantitative invasive coronary angiography (ICA) and invasive fractional flow reserve (FFR) as standard of reference. Methods: We will enroll 300 consecutive patients with previous stent implantation, referred for non-emergent and clinically indicated invasive coronary angiography (ICA) due to suspected ISR or progression of CAD in native coronary segments. All patients will be subjected to stress myocardial CTP and a rest CCTA. The first 150 subjects will undergo static CTP scan, while the following 150 patients will undergo dynamic CTP scan. Measurement of invasive FFR will be performed during ICA when clinically indicated. Results: The primary study end points will be: 1) assessment of the diagnostic performance (diagnostic rate, sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy) of CCTA, CTP, combined CCTA-CTP and concordant CCTA-CTP vs. ICA as standard of reference in a territory-based and patient-based analysis; 2) assessment of sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of CCTA, CTP, combined CCTA-CTP an
- Published
- 2018
33. Rationale and design of advantage (additional diagnostic value of CT perfusion over coronary CT angiography in stented patients with suspected in-stent restenosis or coronary artery disease progression) prospective study
- Abstract
Background: Recent studies demonstrated a significant improvement in the diagnostic performance of coronary CT angiography (CCTA) for the evaluation of in-stent restenosis (ISR). However, coronary stent assessment is still challenging, especially because of beam-hardening artifacts due to metallic stent struts and high atherosclerotic burden of non-stented segments. Adenosine-stress myocardial perfusion assessed by CT (CTP) recently demonstrated to be a feasible and accurate tool for evaluating the functional significance of coronary stenoses in patients with suspected coronary artery disease (CAD). Yet, scarce data are available on the performance of CTP in patients with previous stent implantation. Aim of the study: We aim to assess the diagnostic performance of CCTA alone, CTP alone and CCTA plus CTP performed with a new scanner generation using quantitative invasive coronary angiography (ICA) and invasive fractional flow reserve (FFR) as standard of reference. Methods: We will enroll 300 consecutive patients with previous stent implantation, referred for non-emergent and clinically indicated invasive coronary angiography (ICA) due to suspected ISR or progression of CAD in native coronary segments. All patients will be subjected to stress myocardial CTP and a rest CCTA. The first 150 subjects will undergo static CTP scan, while the following 150 patients will undergo dynamic CTP scan. Measurement of invasive FFR will be performed during ICA when clinically indicated. Results: The primary study end points will be: 1) assessment of the diagnostic performance (diagnostic rate, sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy) of CCTA, CTP, combined CCTA-CTP and concordant CCTA-CTP vs. ICA as standard of reference in a territory-based and patient-based analysis; 2) assessment of sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of CCTA, CTP, combined CCTA-CTP an
- Published
- 2018
34. Diagnostic Approach for Suspected Acute Myocarditis: Considerations for Standardization and Broadening Clinical Spectrum.
- Author
-
Martens, Pieter, Cooper, Leslie T., and Wilson Tang, W. H.
- Published
- 2023
- Full Text
- View/download PDF
35. Acute heart failure and valvular heart disease: A scientific statement of the Heart Failure Association, the Association for Acute CardioVascular Care and the European Association of Percutaneous Cardiovascular Interventions of the European Society of Cardiology
- Author
-
Chioncel, Ovidiu, Adamo, Marianna, Nikolaou, Maria, Parissis, John, Mebazaa, Alexandre, Yilmaz, Mehmet Birhan, Hassager, Christian, Moura, Brenda, Bauersachs, Johann, Harjola, Veli‐Pekka, Antohi, Elena‐Laura, Ben‐Gal, Tuvia, Collins, Sean P., Iliescu, Vlad Anton, Abdelhamid, Magdy, Čelutkienė, Jelena, Adamopoulos, Stamatis, Lund, Lars H., Cicoira, Mariantonietta, and Masip, Josep
- Subjects
HEART valve diseases ,HEART failure ,CARDIOGENIC shock ,CARDIOLOGY ,SYMPTOMS ,RANDOMIZED controlled trials - Abstract
Acute heart failure (AHF) represents a broad spectrum of disease states, resulting from the interaction between an acute precipitant and a patient's underlying cardiac substrate and comorbidities. Valvular heart disease (VHD) is frequently associated with AHF. AHF may result from several precipitants that add an acute haemodynamic stress superimposed on a chronic valvular lesion or may occur as a consequence of a new significant valvular lesion. Regardless of the mechanism, clinical presentation may vary from acute decompensated heart failure to cardiogenic shock. Assessing the severity of VHD as well as the correlation between VHD severity and symptoms may be difficult in patients with AHF because of the rapid variation in loading conditions, concomitant destabilization of the associated comorbidities and the presence of combined valvular lesions. Evidence‐based interventions targeting VHD in settings of AHF have yet to be identified, as patients with severe VHD are often excluded from randomized trials in AHF, so results from these trials do not generalize to those with VHD. Furthermore, there are not rigorously conducted randomized controlled trials in the setting of VHD and AHF, most of the data coming from observational studies. Thus, distinct to chronic settings, current guidelines are very elusive when patients with severe VHD present with AHF, and a clear‐cut strategy could not be yet defined. Given the paucity of evidence in this subset of AHF patients, the aim of this scientific statement is to describe the epidemiology, pathophysiology, and overall treatment approach for patients with VHD who present with AHF. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
36. The Role of Non-Invasive Multimodality Imaging in Chronic Coronary Syndrome: Anatomical and Functional Pathways.
- Author
-
Bergamaschi, Luca, Pavon, Anna Giulia, Angeli, Francesco, Tuttolomondo, Domenico, Belmonte, Marta, Armillotta, Matteo, Sansonetti, Angelo, Foà, Alberto, Paolisso, Pasquale, Baggiano, Andrea, Mushtaq, Saima, De Zan, Giulia, Carriero, Serena, Cramer, Maarten-Jan, Teske, Arco J., Broekhuizen, Lysette, van der Bilt, Ivo, Muscogiuri, Giuseppe, Sironi, Sandro, and Leo, Laura Anna
- Subjects
SINGLE-photon emission computed tomography ,POSITRON emission tomography ,CARDIAC magnetic resonance imaging ,CORONARY arteries ,STRESS echocardiography ,MYOCARDIAL ischemia - Abstract
Coronary artery disease (CAD) is one of the major causes of mortality and morbidity worldwide, with a high socioeconomic impact. Currently, various guidelines and recommendations have been published about chronic coronary syndromes (CCS). According to the recent European Society of Cardiology guidelines on chronic coronary syndrome, a multimodal imaging approach is strongly recommended in the evaluation of patients with suspected CAD. Today, in the current practice, non-invasive imaging methods can assess coronary anatomy through coronary computed tomography angiography (CCTA) and/or inducible myocardial ischemia through functional stress testing (stress echocardiography, cardiac magnetic resonance imaging, single photon emission computed tomography—SPECT, or positron emission tomography—PET). However, recent trials (ISCHEMIA and REVIVED) have cast doubt on the previous conception of the management of patients with CCS, and nowadays it is essential to understand the limitations and strengths of each imaging method and, specifically, when to choose a functional approach focused on the ischemia versus a coronary anatomy-based one. Finally, the concept of a pathophysiology-driven treatment of these patients emerged as an important goal of multimodal imaging, integrating 'anatomical' and 'functional' information. The present review aims to provide an overview of non-invasive imaging modalities for the comprehensive management of CCS patients. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
37. State-of-the-Art Multimodality Imaging in Sudden Cardiac Arrest with Focus on Idiopathic Ventricular Fibrillation: A Review.
- Author
-
Verheul, Lisa M., Groeneveld, Sanne A., Kirkels, Feddo P., Volders, Paul G. A., Teske, Arco J., Cramer, Maarten J., Guglielmo, Marco, and Hassink, Rutger J.
- Subjects
CARDIAC arrest ,CARDIAC magnetic resonance imaging ,CARDIAC imaging ,VENTRICULAR fibrillation ,DIAGNOSTIC imaging ,BRUGADA syndrome - Abstract
Idiopathic ventricular fibrillation is a rare cause of sudden cardiac arrest and a diagnosis by exclusion. Unraveling the mechanism of ventricular fibrillation is important for targeted management, and potentially for initiating family screening. Sudden cardiac arrest survivors undergo extensive clinical testing, with a growing role for multimodality imaging, before diagnosing "idiopathic" ventricular fibrillation. Multimodality imaging, considered as using multiple imaging modalities as diagnostics, is important for revealing structural myocardial abnormalities in patients with cardiac arrest. This review focuses on combining imaging modalities (echocardiography, cardiac magnetic resonance and computed tomography) and the electrocardiographic characterization of sudden cardiac arrest survivors and discusses the surplus value of multimodality imaging in the diagnostic routing of these patients. We focus on novel insights obtained through electrostructural and/or electromechanical imaging in apparently idiopathic ventricular fibrillation patients, with special attention to non-invasive electrocardiographic imaging. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
38. Complementary role of computed tomography angiography with fixed perfusion defects on SPECT myocardial perfusion imaging.
- Author
-
Abazid, Rami M., Sallam, Yasmine T., Romsa, Jonathan G., Warrington, James C., Akincioglu, Cigdem, De, Sabe, Tzemos, Nikolaos, and Vezina, William C.
- Subjects
MYOCARDIAL perfusion imaging ,COMPUTED tomography ,CARDIAC radionuclide imaging ,ST elevation myocardial infarction ,SINGLE-photon emission computed tomography ,ANGIOGRAPHY ,CARDIOGRAPHIC tomography - Abstract
Purpose: We present this case series exploring the complementary role of coronary computed tomography angiography (CCTA) to SPECT myocardial perfusion imaging (MPI) in the detection of myocardial necrosis. Methods: A cardiac hybrid imaging database search identified 144 patients with a previous history of ST-segment elevation myocardial infarction treated with coronary revascularization. CCTA and MPI scans were evaluated to determine whether CCTA had an added value to MPI in detecting myocardial necrosis. Results: Five patients with patent stents and/or bypass grafts and both fixed perfusion defects on MPI and sub-endocardial hypo-perfusion on CCTA were identified. The extent and location of the perfusion defects were closely correlated between the CCTA and SPECT MPI images. Conclusion: In this series, CCTA and SPECT MPI were found to play a complementary role in the assessment of fixed perfusion defect, with CCTA adding specificity to the diagnosis of myocardial necrosis. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
39. A case report of transcatheter mitral valve repair in patient with severe acute mitral regurgitation, cardiogenic shock, and left atrial appendage thrombus as a rescue therapy: facing all enemies at once!
- Author
-
Alachkar, Mhd Nawar, Schröder, Jörg, Autschbach, Rüdiger, and Almalla, Mohammad
- Subjects
MITRAL valve diseases ,MITRAL valve insufficiency ,CARDIOGENIC shock ,MYOCARDIAL infarction ,DISEASES in women - Abstract
Background Transcatheter mitral valve repair (TMVR) in patients with severe acute mitral regurgitation (MR) and high surgical risk has been described. Moreover, the use of cerebral protection device (CPD) during TMVR in patients without evidence of intracardiac thrombus has been investigated. To the best of our knowledge, TMVR as a rescue therapy in a patient with acute ischaemic MR, cardiogenic shock, and left atrial appendage (LAA) thrombus with concurrent use of CPD has not been reported. Case summary A 59-year-old female with subacute lateral myocardial infarction caused by subacute stent thrombosis after stent implantation in the left circumflex artery 3 weeks previously presented with acute heart failure due to acute severe MR at a peripheral hospital. The patient was transferred to our tertiary centre for operative mitral valve repair. Transoesophageal echocardiogram revealed the presence of LAA thrombus. During the admission, the patient developed an electrical storm and cardiogenic shock. Because of the extremely high surgical risk and the lack of other therapeutic options, the patient was treated with TMVR (MitraClip™, Abbott Structural Heart Devices, Santa Clara, CA, USA) with the use of CPD (Sentinel™; Boston scientific) as a rescue therapy. After the procedure, the clinical and haemodynamic conditions of the patient improved significantly, and she could be discharged home without any neurological sequelae. Conclusion TMVR with concurrent use of CPD as a rescue therapy may be considered in non-operable patients with cardiogenic shock caused by acute severe MR and evidence of LAA thrombus when no other therapy options are possible. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
40. Imaging in CABG Patients.
- Author
-
Small, Gary R. and Chow, Benjamin J. W.
- Abstract
Purpose of the review: Coronary artery bypass grafting (CABG) is one of the most common major surgical procedures performed. Atherosclerosis however is a progressive condition; it is probably therefore that patients with CABG will represent with ischemic symptoms. The purpose of this review is to provide familiarity with testing in CABG patients to assist clinicians in their decision-making. Recent findings: CT angiography of coronary arteries and grafts (CCTA) has evolved into an alternative approach to diagnose graft disease or occlusion. As such, CCTA may help risk stratify patients post-CABG. CCTA thus joins the armamentarium of traditional functional tests that can be used. The consequences of which type of test is chosen are discussed. Summary: Through discussion of the contemporary literature for imaging in CABG patients, this review will focus on the strengths and weaknesses of both anatomical and functional approaches. It appears that the impact of which index test is chosen is as important post-CABG as it is in patients with suspected CAD. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
41. Reversible Cause of Cardiac Arrest and Secondary Prevention Implantable Cardioverter Defibrillators in Patients With Coronary Artery Disease: Value of Complete Revascularization and LGE-CMR.
- Author
-
van der Lingen, Anne-Lotte C. J., Becker, Marthe A. J., Kemme, Michiel J. B., Rijnierse, Mischa T., Spoormans, Eva M., Timmer, Stefan A. J., van Rossum, Albert C., van Halm, Vokko P., Germans, Tjeerd, and Allaart, Cornelis P.
- Published
- 2021
- Full Text
- View/download PDF
42. Comprehensive plaque assessment with serial coronary CT angiography: translation to bedside.
- Author
-
Lakshmanan, Suvasini, Rezvanizadeh, Vahid, and Budoff, Matthew J.
- Abstract
The purpose of this review is to highlight the utility of comprehensive plaque assessment by serial coronary computed tomography angiography (CCTA) to understand atherosclerosis and its effect on cardiovascular risk stratification and management. CCTA is a validated, noninvasive imaging modality for coronary atherosclerotic plaque characterization. Numerous clinical trials have used approach of serial CCTA to demonstrate the potential benefits of multiple treatment strategies to reduce coronary plaque progression and its translation to benefits with cardiovascular outcomes. Serial CCTA trials for cardiovascular therapies combined with clinical outcome studies are providing mechanistic correlations of coronary atherogenesis and cardiovascular risk reduction, thereby establishing a new standard of care in addressing cardiac disease. Advancements in CCTA imaging and plaque analysis continue to expand the potential for CCTA in the evaluation of cardiovascular risk and targeted treatment of CAD. [ABSTRACT FROM AUTHOR]
- Published
- 2020
- Full Text
- View/download PDF
43. XXV Congresso Nazionale della Società Scientifica FADOI.
- Subjects
ANTIPHOSPHOLIPID syndrome ,MEDICAL personnel ,HEALTH facilities ,PHYSICIANS ,PLASMA cell diseases ,HISTORY of medicine - Published
- 2020
44. The MAGGIC risk score predicts mortality in patients undergoing transcatheter aortic valve replacement: sub-analysis of the OCEAN-TAVI registry.
- Author
-
Hioki, Hirofumi, Watanabe, Yusuke, Kozuma, Ken, Kawashima, Hideyuki, Nagura, Fukuko, Nakashima, Makoto, Kataoka, Akihisa, Yamamoto, Masanori, Naganuma, Toru, Araki, Motoharu, Tada, Norio, Shirai, Shinichi, Yamanaka, Futoshi, Higashimori, Akihiro, Mizutani, Kazuki, Tabata, Minoru, Takagi, Kensuke, Ueno, Hiroshi, and Hayashida, Kentaro
- Subjects
HEART valve prosthesis implantation ,PERCUTANEOUS balloon valvuloplasty - Abstract
This study is aimed to evaluate the performance of MAGGIC risk score for predicting mortality by external validation using multicenter transcatheter aortic valve replacement (TAVR) registry. We assessed 1383 patients who underwent TAVR from October 2013 to April 2016. Patients were divided into 2 groups according to the median of MAGGIC score and we compared the incidence of all-cause death between high and low MAGGIC score. To assess whether the MAGGIC risk score add prognostic value on STS risk score, we also compared the incidence of all-cause death between the 2 groups according to low, intermediate, and high STS score. The median of MAGGIC score was 29 (interquartile range: 13–46). Within 2 years, 147 cases of all-cause death were observed. The high MAGGIC (30–46) risk score was significantly associated with an increased risk of all-cause death as compared to low MAGGIC (11–29) risk score and this relationship was also observed in patients with high STS risk score. However, this relationship was not observed in patients with low and intermediate STS score. Multivariate analysis showed that the MAGGIC risk score was an independent predictor of all-cause death (hazard ratio, 1.07; 95% confidence interval, 1.03–1.11). Our results demonstrated that the MAGGIC score predicts all-cause death in TAVR population and provides better risk stratification, particularly in patients with high STS risk. [ABSTRACT FROM AUTHOR]
- Published
- 2019
- Full Text
- View/download PDF
45. Salvage MitraClip in severe secondary mitral regurgitation complicating acute myocardial infarction: data from a multicentre international study.
- Author
-
Haberman, Dan, Taramasso, Maurizio, Czarnecki, Andrew, Kerner, Arthur, Chrissoheris, Michael, Spargias, Konstantinos, Poles, Lion, Agmon, Yoram, Scianna, Salvatore, Beeri, Ronen, Lotan, Chaim, Maisano, Francesco, and Shuvy, Mony
- Subjects
INTRA-aortic balloon counterpulsation ,MITRAL valve insufficiency ,MYOCARDIAL infarction ,WASTE salvage ,MITRAL valve surgery ,MYOCARDIAL infarction complications ,HEART ventricle diseases ,COMPARATIVE studies ,LEFT heart ventricle ,RESEARCH methodology ,MEDICAL cooperation ,RESEARCH ,SURGICAL instruments ,EVALUATION research ,ACUTE diseases ,SALVAGE therapy ,STROKE volume (Cardiac output) - Published
- 2019
- Full Text
- View/download PDF
46. Plaque assessment by coronary CT angiography may predict cardiac events in high risk and very high risk diabetic patients: A long-term follow-up study
- Author
-
Daniele Andreini, Edoardo Conte, Saima Mushtaq, Marco Magatelli, Federica Traversari, Carlo Gigante, Marta Belmonte, Marcherita Gaudenzi-Asinelli, Andrea Annoni, Alberto Formenti, Maria E. Mancini, Marco Guglielmo, Andrea Baggiano, Eleonora Melotti, Giuseppe Muscogiuri, Maurizio Rondinelli, Gianluca Pontone, Antonio L. Bartorelli, Mauro Pepi, Stefano Genovese, Andreini, D, Conte, E, Mushtaq, S, Magatelli, M, Traversari, F, Gigante, C, Belmonte, M, Gaudenzi-Asinelli, M, Annoni, A, Formenti, A, Mancini, M, Guglielmo, M, Baggiano, A, Melotti, E, Muscogiuri, G, Rondinelli, M, Pontone, G, Bartorelli, A, Pepi, M, and Genovese, S
- Subjects
Nutrition and Dietetics ,Computed Tomography Angiography ,Prognosi ,Endocrinology, Diabetes and Metabolism ,Medicine (miscellaneous) ,Coronary Angiography ,Prognosis ,Diabete ,Risk Assessment ,Coronary artery disease ,Plaque, Atherosclerotic ,Predictive Value of Tests ,Risk Factors ,Diabetes Mellitus ,Cardiac CT ,Humans ,Vulnerable coronary plaque ,Cardiology and Cardiovascular Medicine ,Follow-Up Studies - Abstract
Background and aims: The aim of the present study is to evaluate whether advanced coronary atherosclerosis analysis by CCTA may improve prognostic stratification among diabetic patients at high cardiovascular risk (CV risk). Methods and results: The study population consisted of 265 consecutive diabetic patients at high CV risk who underwent CCTA for suspected CAD between January 2011 and December 2016. For every patients both traditional and advanced, qualitative and quantitative coronary plaque analysis were performed. The occurrence of cardiac death, ACS, and non-urgent revascularization were recorded at follow-up. Among the 265 patients enrolled, 21 were lost to follow-up, whereas 244 (92%) had a complete follow-up (mean 45 ± 22 months) and were classified at high (n = 67) or very high cardiovascular risk (n = 177), according to ESC Guidelines. A total of 63 events were recorded (3 Cardiac Death, 3 NSTEMI, 8 unstable angina, 36 late non-urgent revascularization and 13 non-cardiac death) in 57 different patients. Elevated fibro-fatty plaque volume was the only predictor of events over age, gender and traditional risk factor when ACS and MACE were considered as end-points [HR (95% CI) 6.01 (1.65–21.87), p = 0.006 and 3.46 (2.00–5.97); p < 0.001]. Conclusion: The present study confirms the prognostic role of advance coronary atherosclerosis evaluation beyond risk factors and stenosis severity, even in diabetics. Despite the very high cardiovascular risk of study population, a not negligible portion (23%) of patients exhibited totally normal coronaries.
- Published
- 2022
47. Recommendations in pre-procedural imaging assessment for TAVI intervention: SIC-SIRM position paper part 2 (CT and MR angiography, standard medical reporting, future perspectives).
- Author
-
Marano R, Pontone G, Agricola E, Alushi B, Bartorelli A, Cameli M, Carrabba N, Esposito A, Faletti R, Francone M, Galea N, Golino P, Guglielmo M, Palmisano A, Petronio S, Petullà M, Pradella S, Ribichini F, Romeo F, Russo V, Scandura S, Schicchi N, Spaccarotella C, Tomai F, Indolfi C, and Centonze M
- Subjects
- Angiography, Aortic Valve diagnostic imaging, Aortic Valve surgery, Humans, Tomography, X-Ray Computed methods, Aortic Valve Stenosis diagnostic imaging, Aortic Valve Stenosis surgery, Cardiology, Transcatheter Aortic Valve Replacement methods
- Abstract
Non-invasive cardiovascular imaging owns a pivotal role in the preoperative assessment of patient candidates for transcatheter aortic valve implantation (TAVI), providing a wide range of crucial information to select the patients who will benefit the most and have the procedure done safely. This document has been developed by a joined group of experts of the Italian Society of Cardiology and the Italian Society of Medical and Interventional Radiology and aims to produce an updated consensus statement about the pre-procedural imaging assessment in candidate patients for TAVI intervention. The writing committee consisted of members and experts of both societies who worked jointly to develop a more integrated approach in the field of cardiac and vascular radiology. Part 2 of the document will cover CT and MR angiography, standard medical reporting, and future perspectives., (© 2022. Italian Society of Medical Radiology.)
- Published
- 2022
- Full Text
- View/download PDF
48. Metoprolol Reduces Hemodynamic and Metabolic Overload in Asymptomatic Aortic Valve Stenosis Patients: A Randomized Trial.
- Author
-
Hansson, Nils Henrik, Sörensen, Jens, Harms, Hendrik Johannes, Won Yong Kim, Nielsen, Roni, Tolbod, Lars Poulsen, Frøkiær, Jørgen, Bouchelouche, Kirsten, Dodt, Karen Kaae, Sihm, Inger, Poulsen, Steen Hvitfeldt, and Wiggers, Henrik
- Published
- 2017
- Full Text
- View/download PDF
49. Percutaneous bail-out in severe acute mitral regurgitation: when surgery is not an option.
- Author
-
Nitsche, Christian and Goliasch, Georg
- Subjects
MITRAL valve insufficiency ,SURGERY - Published
- 2021
- Full Text
- View/download PDF
50. Plaque quantification by coronary computed tomography angiography using intravascular ultrasound as a reference standard: a comparison between standard and last generation computed tomography scanners
- Author
-
Gianluca Pontone, Marco Guglielmo, Andrea Annoni, Cesare Fiorentini, Giuseppe Muscogiuri, Piero Montorsi, Edoardo Conte, Paolo Ravagnani, Jeroen Sonck, Saima Mushtaq, Andrea Baggiano, Maria Elisabetta Mancini, Luca Di Odoardo, Mauro Pepi, Stefano Galli, Antonio L. Bartorelli, Carlotta Poggi, Daniele Andreini, Daniela Trabattoni, Alberto Formenti, Carlos Collet, Flavia Nicoli, Letizia Li Piani, Marco Magatelli, Graduate School, ACS - Heart failure & arrhythmias, Conte, E, Mushtaq, S, Pontone, G, Li Piani, L, Ravagnani, P, Galli, S, Collet, C, Sonck, J, Di Odoardo, L, Guglielmo, M, Baggiano, A, Trabattoni, D, Annoni, A, Mancini, M, Formenti, A, Muscogiuri, G, Magatelli, M, Nicoli, F, Poggi, C, Fiorentini, C, Bartorelli, A, Pepi, M, Montorsi, P, and Andreini, D
- Subjects
Computed Tomography Angiography ,whole-heart coverage CT ,Computed tomography ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Coronary Angiography ,intravascular ultrasound ,03 medical and health sciences ,atherosclerosi ,0302 clinical medicine ,Coronary plaque ,Plaque volume ,Intravascular ultrasound ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,coronary plaque analysi ,Reference standards ,Ultrasonography, Interventional ,medicine.diagnostic_test ,business.industry ,Radiation dose ,Coronary computed tomography angiography ,General Medicine ,Reference Standards ,coronary plaque volume ,Plaque, Atherosclerotic ,Heart Rhythm ,coronary computed tomography angiography ,atherosclerosis ,Cardiology and Cardiovascular Medicine ,Nuclear medicine ,business ,Tomography, X-Ray Computed ,coronary plaque analysis - Abstract
Aims: The emerging role of coronary computed tomography angiography (CCTA) as a non-invasive tool for atherosclerosis evaluation is supported by data reporting a good correlation between CCTA and intravascular ultrasound (IVUS) for plaque volume quantification. Aim of the present study was to evaluate whether a last generation CT-scanner may improve coronary plaque volume assessment using IVUS as standard-of-reference. Methods and results: From a registry of 1915 consecutive, all-comers, patients who underwent a clinically indicated IVUS evaluation we enrolled 59 patients who underwent CCTA with a 64-slice CT (Group 1) and 59 patients who underwent CCTA with whole-heart coverage CT scanner (Group 2). Patients who underwent CCTA with unfavourable heart rhythm were not excluded from the analysis. Image quality (4-point Likert scale) focused on plaque analysis was evaluated. Plaque volume quantification by CCTA was compared to IVUS. No difference in clinical characteristics was found between Group 1 and Group 2. Plaque volume quantification by CCTA was considered not feasible in 11 plaques of Group 1 and in 4 plaques of Group 2 (P = 0.09). Higher correlation for plaque volume quantification by CCTA vs. IVUS was demonstrated in Group 2 when compared with Group 1 (r = 0.9888 vs. 0.9499; P < 0.0001). The Bland-Altman analysis showed plaque volume overestimation by CCTA of 11.9 mm3 in Group 1 and 4 mm2 in Group 2 (P < 0.001). Effective radiation dose of CCTA was significantly lower in Group 2 vs. Group 1 (2.7 ± 0.9 vs. 8.1 ± 3.6 mSv, respectively; P < 0.001). Conclusions: CCTA using a new scanner generation showed to be an accurate non-invasive tool to assess and quantify coronary plaque volume.
- Published
- 2020
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.