11 results on '"Leonardo Italia"'
Search Results
2. Characteristics and outcomes of patients hospitalized for COVID-19 and cardiac disease in Northern Italy
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Elio Gorga, Leonardo Italia, Marco Metra, Claudia Specchia, Pompilio Faggiano, Roberto Maroldi, Antonio Curnis, Savina Nodari, Marianna Adamo, Chiara Tedino, Davide Fabbricatore, Riccardo M. Inciardi, Carlo Lombardi, Daniela Tomasoni, M. Volpini, Mattia Di Pasquale, G Milesi, Michela Bezzi, Dario Cani, Laura Lupi, Gregorio Zaccone, and Enrico Vizzardi
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Male ,030204 cardiovascular system & hematology ,Coronary artery disease ,0302 clinical medicine ,Risk Factors ,Atrial Fibrillation ,Natriuretic Peptide, Brain ,80 and over ,Viral ,030212 general & internal medicine ,Cardiovascular disease ,COVID-19 ,Mortality ,Pneumonia ,Aged ,Aged, 80 and over ,Betacoronavirus ,Coronavirus Infections ,Creatinine ,Female ,Heart Diseases ,Heart Failure ,Humans ,Italy ,Middle Aged ,Pandemics ,Peptide Fragments ,Pneumonia, Viral ,Prognosis ,Respiratory Distress Syndrome, Adult ,Shock, Septic ,Thromboembolism ,Troponin T ,Hospitalization ,Respiratory Distress Syndrome ,Brain ,Shock ,Atrial fibrillation ,Cardiology and Cardiovascular Medicine ,Adult ,medicine.medical_specialty ,03 medical and health sciences ,Natriuretic Peptide ,Internal medicine ,medicine ,Septic ,SARS-CoV-2 ,Septic shock ,business.industry ,medicine.disease ,Embolism ,Heart failure ,Relative risk ,Concomitant ,business - Abstract
Aims To compare demographic characteristics, clinical presentation, and outcomes of patients with and without concomitant cardiac disease, hospitalized for COVID-19 in Brescia, Lombardy, Italy. Methods and results The study population includes 99 consecutive patients with COVID-19 pneumonia admitted to our hospital between 4 March and 25 March 2020. Fifty-three patients with a history of cardiac disease were compared with 46 without cardiac disease. Among cardiac patients, 40% had a history of heart failure, 36% had atrial fibrillation, and 30% had coronary artery disease. Mean age was 67 ± 12 years, and 80 (81%) patients were males. No differences were found between cardiac and non-cardiac patients except for higher values of serum creatinine, N-terminal probrain natriuretic peptide, and high sensitivity troponin T in cardiac patients. During hospitalization, 26% patients died, 15% developed thrombo-embolic events, 19% had acute respiratory distress syndrome, and 6% had septic shock. Mortality was higher in patients with cardiac disease compared with the others (36% vs. 15%, log-rank P = 0.019; relative risk 2.35; 95% confidence interval 1.08–5.09). The rate of thrombo-embolic events and septic shock during the hospitalization was also higher in cardiac patients (23% vs. 6% and 11% vs. 0%, respectively). Conclusions Hospitalized patients with concomitant cardiac disease and COVID-19 have an extremely poor prognosis compared with subjects without a history of cardiac disease, with higher mortality, thrombo-embolic events, and septic shock rates.
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- 2020
3. Effect of Chronic Kidney Disease on 5-Year Outcome in Patients With Heart Failure and Secondary Mitral Regurgitation Undergoing Percutaneous MitraClip Insertion
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Antonio Sisinni, Andrea Munafò, Carlo Andrea Pivato, Marianna Adamo, Maurizio Taramasso, Andrea Scotti, Antonio L.M. Parlati, Leonardo Italia, Davide Voci, Nicola Buzzatti, Paolo Denti, Francesco Ancona, Alessandra Marengo, Alessandra Sala, Francesca Bodega, Martina Maria Ruffo, Salvatore Curello, Alessandro Castiglioni, Matteo Montorfano, Michele de Bonis, Ottavio Alfieri, Eustachio Agricola, Antonio Colombo, Francesco Maisano, Marco Metra, Alberto Margonato, Cosmo Godino, Sisinni, Antonio, Munafò, Andrea, Pivato, Carlo Andrea, Adamo, Marianna, Taramasso, Maurizio, Scotti, Andrea, Parlati, Antonio L M, Italia, Leonardo, Voci, Davide, Buzzatti, Nicola, Denti, Paolo, Ancona, Francesco, Marengo, Alessandra, Sala, Alessandra, Bodega, Francesca, Ruffo, Martina Maria, Curello, Salvatore, Castiglioni, Alessandro, Montorfano, Matteo, de Bonis, Michele, Alfieri, Ottavio, Agricola, Eustachio, Colombo, Antonio, Maisano, Francesco, Metra, Marco, Margonato, Alberto, and Godino, Cosmo
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Heart Failure ,Heart Valve Prosthesis Implantation ,Treatment Outcome ,Humans ,Mitral Valve ,Mitral Valve Insufficiency ,Renal Insufficiency ,Renal Insufficiency, Chronic ,Chronic ,Cardiology and Cardiovascular Medicine - Abstract
Chronic kidney disease (CKD) is strongly related to outcomes in cardiovascular diseases. Limited data are available regarding the independent prognostic role of CKD after transcatheter mitral valve repair with MitraClip. We sought to evaluate the real impact of CKD in a large series of patients with heart failure (HF) and secondary mitral regurgitation (SMR) who underwent MitraClip treatment. The study included 565 patients with severe SMR from a multicenter international registry. Patients were stratified into 3 groups according to estimated glomerular filtration rate (eGFR) assessment before MitraClip implantation: normal eGFR (≥60ml/min/1.73m2) (n=196), mild-to-moderate CKD (30 to 59ml/min/1.73m2) (n=267), and severe CKD (
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- 2022
4. Myocardial Involvement in COVID-19: an Interaction Between Comorbidities and Heart Failure with Preserved Ejection Fraction. A Further Indication of the Role of Inflammation
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Gregorio Zaccone, Marco Metra, Carlo Lombardi, Daniela Tomasoni, and Leonardo Italia
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medicine.medical_specialty ,Diastole ,Cardiomyopathy ,Comorbidity ,Physiology (medical) ,Internal medicine ,COVID-19 ,HFpEF ,Heart failure ,Heart failure with preserved ejection fraction ,SARS-CoV-2 infection ,Disease Progression ,Humans ,SARS-CoV-2 ,Stroke Volume ,Heart Failure ,medicine ,Decompensation ,Risk factor ,Ejection fraction ,business.industry ,medicine.disease ,Comorbidities of Heart Failure (J. Tromp, Section Editor) ,Emergency Medicine ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,Kidney disease - Abstract
Purpose of the review Coronavirus Disease 2019 (COVID-19) and cardiovascular (CV) disease have a close relationship that emerged from the earliest reports. The aim of this review is to show the possible associations between COVID-19 and heart failure (HF) with preserved ejection fraction (HFpEF). Recent findings In hospitalized patients with COVID-19, the prevalence of HFpEF is high, ranging from 4 to 16%, probably due to the shared cardio-metabolic risk profile. Indeed, comorbidities including hypertension, diabetes, obesity and chronic kidney disease — known predictors of a severe course of COVID-19 — are major causes of HFpEF, too. COVID-19 may represent a precipitating factor leading to acute decompensation of HF in patients with known HFpEF and in those with subclinical diastolic dysfunction, which becomes overt. COVID-19 may also directly or indirectly affect the heart. In otherwise healthy patients, echocardiographic studies showed that the majority of COVID-19 patients present diastolic (rather than systolic) impairment, pulmonary hypertension and right ventricular dysfunction. Such abnormalities are observed both in the acute or subacute phase of COVID-19. Cardiac magnetic resonance reveals myocardial inflammation and fibrosis in up to the 78% of patients in the chronic phase of the disease. Summary These findings suggest that COVID-19 might be a novel independent risk factor for the development of HFpEF, through the activation of a systemic pro-inflammatory state. Follow-up studies are urgently needed to better understand long-term sequelae of COVID-19 inflammatory cardiomyopathy.
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- 2021
5. Subclinical myocardial dysfunction in patients recovered from COVID-19
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Paolo Scarpellini, Francesco Ancona, Stefano Stella, Eustachio Agricola, Giacomo Ingallina, Marco Rolando, Fabio Ciceri, Moreno Tresoldi, Francesco Cannata, Gabriele Fragasso, Francesco Melillo, Francesco De Cobelli, Antonio Esposito, Marco Ripa, Alessandro Ortalda, Antonio Boccellino, Antonio Napolano, Patrizia Rovere, Martina Belli, Antonella Castagna, Leonardo Italia, Beatrice Righetti, Italia, L., Ingallina, G., Napolano, A., Boccellino, A., Belli, M., Cannata, F., Rolando, M., Ancona, F., Melillo, F., Stella, S., Ripa, M., Scarpellini, P., Tresoldi, M., Ortalda, A., Righetti, B., De Cobelli, F., Esposito, A., Ciceri, F., Castagna, A., Rovere, P. Q., Fragasso, G., and Agricola, E.
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medicine.medical_specialty ,Myocarditis ,heart failure ,Ventricular Function, Left ,Group B ,strain ,COVID‐19 ,Internal medicine ,Natriuretic Peptide, Brain ,medicine ,Humans ,echocardiography ,Radiology, Nuclear Medicine and imaging ,Subclinical infection ,Ejection fraction ,business.industry ,Myocardium ,COVID-19 ,Heart ,Stroke Volume ,Original Articles ,medicine.disease ,Brain natriuretic peptide ,Peptide Fragments ,Cross-Sectional Studies ,medicine.anatomical_structure ,Echocardiography ,Ventricle ,Heart failure ,Cohort ,Cardiology ,Original Article ,myocarditis ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background: Myocardial injury (MI) can be detected during the acute phase of Coronavirus disease 19 (COVID-19) and is associated with a dismal prognosis. Recent imaging studies described the persistence of cardiac abnormalities after the recovery. The aim of the study was to investigate the spectrum of cardiac abnormalities at mid-term follow-up in patients recovered from COVID-19 using clinical assessment, laboratory tests, and imaging evaluation with comprehensive echocardiography. Methods: This is an observational, cross-sectional study assessing an unselected cohort of consecutive patients recovered from COVID-19. MI was defined by elevated plasma levels of high sensitive troponin T (hsTnT). At the follow-up, a complete examination including echocardiography was performed. Results: The 123 patients included were divided into two groups according to the presence of MI during hospitalization: group A (without MI) and group B (with MI). After a median of 85 days, group B patients were more frequently symptomatic for dyspnea and had significantly higher values of hsTnT and N-Terminal prohormone of Brain Natriuretic Peptide (NT-proBNP), compared to Group A. No differences between the two groups in left nor right ventricle dimension and ejection fraction were found. However, in group B a significant reduction of mean left ventricle global longitudinal strain was observed (-15.7±.7vs -18.1±.3 in group A, p 
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- 2021
6. Percutaneous Edge-to-Edge Mitral Valve Repair: Beyond the Left Heart
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Marianna Adamo, Marta Scodro, Marco Metra, Salvatore Curello, Leonardo Italia, and Laura Lupi
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Right ventricular reverse remodeling ,medicine.medical_specialty ,Percutaneous ,medicine.medical_treatment ,Ventricular Dysfunction, Right ,Regurgitation (circulation) ,Percutaneous edge-to-edge mitral valve repair ,Right ventricular function ,Tricuspid regurgitation ,Humans ,Mitral Valve ,Treatment Outcome ,Cardiac Surgical Procedures ,Mitral Valve Insufficiency ,Tricuspid Valve Insufficiency ,030204 cardiovascular system & hematology ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Ventricular Dysfunction ,Medicine ,Radiology, Nuclear Medicine and imaging ,In patient ,cardiovascular diseases ,Mitral valve repair ,business.industry ,Right ,medicine.anatomical_structure ,Ventricle ,Right heart ,Rv function ,cardiovascular system ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,Percutaneous Mitral Valve Repair - Abstract
Right ventricular (RV) dysfunction and tricuspid regurgitation (TR) are known to be associated with adverse outcomes in patients undergoing percutaneous mitral valve repair (PMVR). Although the effect of PMVR on left ventricular function is well known, data on the response of the right ventricle to PMVR, and its impact on prognosis, are limited. In this review the authors summarize available data regarding the prognostic role of RV function and TR in PMVR recipients and the possible effects of PMVR on the right heart. Preprocedural tricuspid annular plane systolic excursion15 mm, tricuspid annular tissue Doppler S' velocity9.5 cm/sec, and moderate or severe TR are reported as predictors of adverse outcome after PMVR. Therefore, they should be carefully evaluated for patient selection. Moreover, emerging data show that the benefit of PMVR may go beyond the left heart, leading to an improvement in RV function and a reduction in TR severity. Among PMVR recipients, improvement in RV function and reduction of TR degree are observed mainly in patients with RV dysfunction at baseline. On the other hand, high postprocedural transmitral pressure gradients seem to be associated with lack of RV reverse remodeling. Timing of mitral intervention with respect to RV impairment and predictors of RV reverse remodeling after PMVR are unknown. Further studies are needed to fill these gaps in evidence.
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- 2021
7. Impact of COVID-2019 outbreak on prevalence, clinical presentation and outcomes of ST-elevation myocardial infarction
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Marco Metra, Salvatore Curello, Laura Lupi, Marianna Adamo, Daniela Tomasoni, Claudia Fiorina, Leonardo Italia, Dario Cani, Luca Branca, Giuliano Chizzola, Carlo Lombardi, and Riccardo M. Inciardi
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Male ,medicine.medical_treatment ,Heart Rupture ,030204 cardiovascular system & hematology ,Pericardial effusion ,0302 clinical medicine ,Prevalence ,030212 general & internal medicine ,Myocardial infarction ,Viral ,Hospital Mortality ,Heart Aneurysm ,Troponin T ,Incidence (epidemiology) ,General Medicine ,Middle Aged ,Coronavirus outbreak ,outcome ,reperfusion time ,ST-elevation myocardial infarction ,Betacoronavirus ,COVID-19 ,Diagnostic Tests, Routine ,Female ,Heart Rupture, Post-Infarction ,Hospitalization ,Humans ,Italy ,Outcome and Process Assessment, Health Care ,SARS-CoV-2 ,Time-to-Treatment ,Coronavirus Infections ,Pandemics ,Percutaneous Coronary Intervention ,Pericardial Effusion ,Pneumonia, Viral ,ST Elevation Myocardial Infarction ,Post-Infarction ,Cardiology and Cardiovascular Medicine ,medicine.medical_specialty ,Revascularization ,Outcome and Process Assessment ,03 medical and health sciences ,Diagnostic Tests ,Internal medicine ,medicine ,Routine ,business.industry ,Percutaneous coronary intervention ,Pneumonia ,medicine.disease ,Confidence interval ,Health Care ,business - Abstract
AIMS: The aim of this study was to report the prevalence, clinical features and outcomes of patients with ST-elevation myocardial infarction (STEMI) hospitalized during the Corona-Virus Disease 2019 (COVID-19) outbreak compared with those admitted in a previous equivalent period. METHODS AND RESULTS: Eighty-five patients admitted for STEMI at a high-volume Italian centre were included. Patients hospitalized during the COVID-19 outbreak (21 February-10 April 2020) (40%) were compared with those admitted in pre-COVID-19 period (3 January-20 February 2020) (60%). A 43% reduction in STEMI admissions was observed during the COVID-19 outbreak compared with the previous period. Time from symptom onset to first medical contact (FMC) and time from FMC to primary percutaneous coronary intervention (PPCI) were longer in patients admitted during the COVID-19 period compared with before [148 (79-781) versus 130 (30-185) min; Pâ=â0.018, and 75 (59-148)] versus 45 (30-70) min; Pâ
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- 2020
8. Coronavirus disease 2019 and cardiovascular implications
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Marco Metra, Silvia Frattini, Leonardo Italia, Gian Battista Danzi, and Gloria Maccagni
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2019-20 coronavirus outbreak ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Cardiovascular health ,Pneumonia, Viral ,Cardiovascular care ,Comorbidity ,030204 cardiovascular system & hematology ,Antiviral Agents ,Virus ,03 medical and health sciences ,Betacoronavirus ,0302 clinical medicine ,Pandemic ,medicine ,Humans ,In patient ,030212 general & internal medicine ,Intensive care medicine ,Pandemics ,Host Microbial Interactions ,business.industry ,SARS-CoV-2 ,COVID-19 ,General Medicine ,medicine.disease ,Cardiovascular Diseases ,Cardiology and Cardiovascular Medicine ,business ,Coronavirus Infections - Abstract
The coronavirus disease 2019 (COVID-19) has important implications for the cardiovascular care of patients. COVID-19 interacts with the cardiovascular system on multiple levels, increasing morbidity in patients with underlying cardiovascular conditions and favoring acute myocardial injury and dysfunction. COVID-19 infection may also have long-term implications for overall cardiovascular health. Many issues regarding the involvement of the cardiovascular system remain controversial. Despite angiotensin-converting enzyme 2 serving as the site of entry of the virus into the cells, the role of angiotensin-converting enzyme inhibitors or AT1 blockers requires further investigation. Therapies under investigation for COVID-19 may have cardiovascular side effects. Treatment of COVID-19, especially the use of antivirals, must be closely monitored. This article is a review of the most updated literature.
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- 2020
9. Lung ultrasound-guided therapy reduces acute decompensation events in chronic heart failure
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Eustachio Agricola, Vincenzo Tufaro, Alberto Margonato, Sirvard Gabrielyan, Ferdinando Loiacono, Stefano Stella, Laura Sahakyan, Leonardo Italia, Hamayak Sisakian, Claudia Marini, Gabriele Fragasso, Mariam Avetisyan, Giacomo Ingallina, Marco Fabio Costantino, Francesco Ancona, Pasquale Innelli, Marini, Claudia, Fragasso, Gabriele, Italia, Leonardo, Sisakian, Hamayak, Tufaro, Vincenzo, Ingallina, Giacomo, Stella, Stefano, Ancona, Francesco, Loiacono, Ferdinando, Innelli, Pasquale, Costantino, Marco Fabio, Sahakyan, Laura, Gabrielyan, Sirvard, Avetisyan, Mariam, Margonato, Alberto, and Agricola, Eustachio
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Male ,medicine.medical_specialty ,Acute decompensated heart failure ,heart failure ,Physical examination ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,Internal medicine ,medicine ,Clinical endpoint ,Humans ,Decompensation ,heart failure with reduced ejection fraction ,030212 general & internal medicine ,Lung ,Ultrasonography, Interventional ,Subclinical infection ,Aged ,Heart Failure ,medicine.diagnostic_test ,business.industry ,medicine.disease ,Heart failure ,Relative risk ,Therapy, Computer-Assisted ,Acute Disease ,Chronic Disease ,Number needed to treat ,Female ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
ObjectivePulmonary congestion is the main cause of hospital admission in patients with heart failure (HF). Lung ultrasound (LUS) is a useful tool to identify subclinical pulmonary congestion. We evaluated the usefulness of LUS in addition to physical examination (PE) in the management of outpatients with HF.MethodsIn this randomised multicentre unblinded study, patients with chronic HF and optimised medical therapy were randomised in two groups: ‘PE+LUS’ group undergoing PE and LUS and ‘PE only’ group. Diuretic therapy was modified according to LUS findings and PE, respectively. The primary endpoint was the reduction in hospitalisation rate for acute decompensated heart failure (ADHF) at 90-day follow-up. Secondary endpoints were reduction in NT-proBNP, quality-of-life test (QLT) and cardiac mortality at 90-day follow-up.ResultsA total of 244 patients with chronic HF and optimised medical therapy were enrolled and randomised in ‘PE+LUS’ group undergoing PE and LUS, and in ‘PE only’ group. Thirty-seven primary outcome events occurred. The hospitalisation for ADHF at 90 day was significantly reduced in ‘PE+LUS’ group (9.4% vs 21.4% in ‘PE only’ group; relative risk=0.44; 95% CI 0.23 to 0.84; p=0.01), with a reduction of risk for hospitalisation for ADHF by 56% (p=0.01) and a number needed to treat of 8.4 patients (95% CI 4.8 to 34.3). At day 90, NT-proBNP and QLT score were significantly reduced in ‘PE+LUS’ group, whereas in ‘PE only’ group both were increased. There were no differences in mortality between the two groups.ConclusionsLUS-guided management reduces hospitalisation for ADHF at mid-term follow-up in outpatients with chronic HF.
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- 2020
10. Accuracy and reproducibility of aortic annular measurements obtained from echocardiographic 3D manual and semi-automated software analyses in patients referred for transcatheter aortic valve implantation: implication for prosthesis size selection
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Manuela Giglio, Isabella Rosa, Antonio Colombo, Leonardo Italia, Francesco Ancona, Eustachio Agricola, Giulia Geremia, Matteo Montorfano, Stefano Stella, Claudia Marini, Cristina Capogrosso, Azeem Latib, Alberto Margonato, Stella, Stefano, Italia, Leonardo, Geremia, Giulia, Rosa, Isabella, Ancona, Francesco, Marini, Claudia, Capogrosso, Cristina, Giglio, Manuela, Montorfano, Matteo, Latib, Azeem, Margonato, Alberto, Colombo, Antonio, and Agricola, Eustachio
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Male ,medicine.medical_treatment ,Echocardiography, Three-Dimensional ,Contrast Media ,030204 cardiovascular system & hematology ,Prosthesis ,Transcatheter Aortic Valve Replacement ,Perimeter ,03 medical and health sciences ,0302 clinical medicine ,Software ,Prosthesis Fitting ,Triiodobenzoic Acids ,medicine.artery ,Image Interpretation, Computer-Assisted ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Cardiac skeleton ,Aged, 80 and over ,Heart Valve Prosthesis Implantation ,Reproducibility ,Aorta ,business.industry ,Reproducibility of Results ,Aortic Valve Stenosis ,General Medicine ,Gold standard (test) ,Treatment Outcome ,Heart Valve Prosthesis ,Female ,Tomography ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,business ,Nuclear medicine - Abstract
A 3D transoesophageal echocardiography (3D-TOE) reconstruction tool has recently been introduced. The system automatically configures a geometric model of the aortic root and performs quantitative analysis of these structures. We compared the measurements of the aortic annulus (AA) obtained by semi-automated 3D-TOE quantitative software and manual analysis vs. multislice computed tomography (MSCT) ones.One hundred and seventy-five patients (mean age 81.3 ± 6.3 years, 77 men) who underwent both MSCT and 3D-TOE for annulus assessment before transcatheter aortic valve implantation were analysed. Hypothetical prosthetic valve sizing was evaluated using the 3D manual, semi-automated measurements using manufacturer-recommended CT-based sizing algorithm as gold standard. Good correlation between 3D-TOE methods vs. MSCT measurements was found, but the semi-automated analysis demonstrated slightly better correlations for AA major diameter (r = 0.89), perimeter (r = 0.89), and area (r = 0.85) (all P 0.0001) than manual one. Both 3D methods underestimated the MSCT measurements, but semi-automated measurements showed narrower limits of agreement and lesser bias than manual measurements for most of AA parameters. On average, 3D-TOE semi-automated major diameter, area, and perimeter underestimated the respective MSCT measurements by 7.4%, 3.5%, and 4.4%, respectively, whereas minor diameter was overestimated by 0.3%. Moderate agreement for valve sizing for both 3D-TOE techniques was found: Kappa agreement 0.5 for both semi-automated and manual analysis. Interobserver and intraobserver agreements for the AA measurements were excellent for both techniques (intraclass correlation coefficients for all parameters0.80).The 3D-TOE semi-automated analysis of AA is feasible and reliable and can be used in clinical practice as an alternative to MSCT for AA assessment.
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- 2018
11. Echocardiographic features of post−transcatheter aortic valve implantation thrombosis and endocarditis
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Antonio Colombo, Francesco Ancona, Alberto Margonato, Marta Barletta, Leonardo Italia, Stefano Stella, Ottavio Alfieri, Azeem Latib, Eustachio Agricola, Isabella Rosa, Matteo Montorfano, Claudia Marini, Marco Spartera, Spartera, Marco, Ancona, Francesco, Barletta, Marta, Rosa, Isabella, Stella, Stefano, Marini, Claudia, Italia, Leonardo, Montorfano, Matteo, Latib, Azeem, Alfieri, Ottavio, Margonato, Alberto, Colombo, Antonio, and Agricola, Eustachio
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Male ,medicine.medical_specialty ,Coronary Thrombosi ,Transcatheter aortic ,Regurgitation (circulation) ,030204 cardiovascular system & hematology ,Sensitivity and Specificity ,endocarditi ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,thrombosi ,Humans ,Endocarditis ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Heart valve ,Aged ,Aged, 80 and over ,transcatheter aortic valve implantation (TAVI) ,business.industry ,Coronary Thrombosis ,Mean Aortic Pressure ,medicine.disease ,Thrombosis ,Stenosis ,Heart Valve Prosthesi ,Treatment Outcome ,medicine.anatomical_structure ,Echocardiography ,Aortic Valve ,Heart Valve Prosthesis ,cardiovascular system ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Complication ,Human - Abstract
BACKGROUND Transcatheter heart valve thrombosis (THV-t) and endocarditis (THV-e) are relevant complications after transcatheter aortic valve implantation (TAVI). Transcatheter heart valve (THV) dysfunction definition is mostly based on Doppler (stenosis/regurgitation) without considering leaflets characteristics. PURPOSE To evaluate the additional diagnostic value of leaflets echocardiographic features over Doppler when prosthetic valve complication is suspected. METHODS Among 621 post-TAVI patients, 128 cases with probable valve complication were identified. THV-t was finally diagnosed in 13 patients (10%) and THV-e in 8 (6%), while the remaining 107 (84%) had no definitive diagnosis of thrombosis/endocarditis (THV-no). We analyzed at 2 time points (baseline and follow-up) both traditional Doppler parameters and leaflets morpho-functional features. RESULTS Both Doppler and leaflets parameters showed high sensitivity (sensitivity 92%) and low specificity (ranging from specificity 32% to 74%) in detecting THV-t. Interestingly, the combination of mean aortic pressure gradient ≥20 mm Hg and leaflet thickening significantly improved the specificity of echocardiography for diagnosis of THV thrombosis (specificity 94%). On the other hand, echocardiographic diagnosis of THV endocarditis remained limited by very low sensitivity despite showing high specificity. CONCLUSIONS The combination of Doppler and leaflets parameters can improve the echocardiographic diagnosis of THV thrombosis in post-TAVI patients with suspicious symptoms, via a significant increase in the overall test specificity. This would potentially allow more rational gatekeeping to more expensive/invasive diagnostic examinations (eg, CT scan) or therapeutic trials (eg, unnecessary anticoagulation).
- Published
- 2017
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