17 results on '"Francesco Formisano"'
Search Results
2. Usefulness of Delayed Enhancement by Magnetic Resonance Imaging in Hypertrophic Cardiomyopathy as a Marker of Disease and Its Severity
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Alessandro Pingitore, Elisabetta Strata, Francesco Formisano, Pier Giorgio Masci, Giovanni Donato Aquaro, Massimo Lombardi, Andrea Barison, Paolo Spirito, and Vincenzo Positano
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Adult ,Male ,medicine.medical_specialty ,New York Heart Association Class ,Heart disease ,Population ,Contrast Media ,Gadolinium ,Ventricular tachycardia ,Sensitivity and Specificity ,Severity of Illness Index ,Text mining ,Internal medicine ,Image Interpretation, Computer-Assisted ,Humans ,Medicine ,cardiovascular diseases ,education ,education.field_of_study ,medicine.diagnostic_test ,business.industry ,Hypertrophic cardiomyopathy ,Magnetic resonance imaging ,Cardiomyopathy, Hypertrophic ,Middle Aged ,Image Enhancement ,Prognosis ,medicine.disease ,Magnetic Resonance Imaging ,Case-Control Studies ,Circulatory system ,cardiovascular system ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
The aim of the present study was to evaluate, in patients with hypertrophic cardiomyopathy (HC), the association between late gadolinium enhancement and clinical end points, such as nonsustained ventricular tachycardia, arrhythmic risk factors, New York Heart Association class, symptoms, and left ventricular functional parameters. A total of 20 normal subjects (mean age 38 years, 16 men) and 100 patients with HC (mean age 46 years, 70 men) were enrolled in the present study. In the late gadolinium enhancement images, the extent of unenhanced, mildly enhanced, and higher enhanced myocardium was measured. Higher enhancement was present in 80% of the HC population and was significantly greater in patients with a New York Heart Association class >1. Mild enhancement was present in all the patients with HC. Receiver operating characteristic analysis revealed that a cutoff of >4.9% of mild enhancement had 100% sensitivity and 86% specificity to predict the occurrence of nonsustained ventricular tachycardia, and a cutoff of >2.4% of hyperenhancement had 77% sensitivity and 96% specificity. In conclusion, late gadolinium enhancement was associated with nonsustained ventricular tachycardia, arrhythmic risk factors, and worse New York Heart Association class.
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- 2010
3. Electrocardiographic evolution in patients with hypertrophic cardiomyopathy who develop a left ventricular apical aneurysm
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Ermelinda Pennacchini, Claudia Stöllberger, Sergio Bongioanni, Pietro Francia, Maria Rosa Conte, Francesco Formisano, Maria Beatrice Musumeci, Camillo Autore, and Massimo Volpe
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Adult ,Male ,medicine.medical_specialty ,electrocardiography ,Sensitivity and Specificity ,Ventricular Dysfunction, Left ,Internal medicine ,T wave ,medicine ,apical aneurysm ,hypertrophic cardiomyopathy ,cardiology and cardiovascular medicine ,Humans ,In patient ,Longitudinal Studies ,cardiovascular diseases ,Heart Aneurysm ,Aged ,Aged, 80 and over ,Apical aneurysm ,medicine.diagnostic_test ,business.industry ,Clinical course ,Hypertrophic cardiomyopathy ,Reproducibility of Results ,Cardiomyopathy, Hypertrophic ,Middle Aged ,medicine.disease ,Apex (geometry) ,Disease Progression ,cardiovascular system ,Cardiology ,Female ,business ,Electrocardiography ,Follow-Up Studies - Abstract
Introduction Hypertrophic cardiomyopathy (HCM) patients with apical aneurysm have a largely unfavourable clinical course, and are often unrecognised because echocardiography is limited in the assessment of the left ventricular (LV) apex. The aim of this study is the identification of electrocardiographic (ECG) abnormalities associated with the development of apical aneurysm in HCM patients. Materials and methods Electrocardiographic features were assessed in 14 HCM patients who had a good-quality baseline ECG recorded before and after the diagnosis of apical aneurysm. Results During follow-up (8.8±7.5years), the following ECG changes were observed: increase in QRS-complex duration (87±12ms to 118±34ms, p=0.006), QRS-complex fragmentation, decrease in QRS-complex amplitude (SV 1 +RV 5-6 , from 41±18mm to 26±11mm, p=0.015), ST-segment elevation in V 4 –V 6 (J-point in V 5 , from −0.9±1.3mm to +0.7±1.3, p=0.003), positivisation of negative T waves in V 3 -V 6 (T-wave depth in V 5 , from −3.4±6.6 to +3.1±4.1, p=0.005). Conclusions HCM patients who develop LV apical aneurysm exhibit distinctive ECG changes along with apical remodelling. Suggestive ECGs should lead the physician to study LV apex by nonstandard echocardiographic views, and perform MRI.
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- 2015
4. Significance of Late Gadolinium Enhancement at Right Ventricular Attachment to Ventricular Septum in Patients with Hypertrophic Cardiomyopathy
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Benedetta Tomberli, Paolo Spirito, Raymond H. Chan, Gabriele Egidy Assenza, James E. Udelson, Martin S. Maron, Massimo Lombardi, Iacopo Olivotto, Barry J. Maron, Christiane Gruner, Ethan J. Rowin, Harry Rakowski, Camillo Autore, Cristina Basso, Francesco Formisano, Andrew M. Crean, Elena Biagini, Warren J. Manning, Tammy S. Haas, Evan Appelbaum, Martina Perazzolo Marra, John R. Lesser, and William C. Roberts
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Adult ,Male ,medicine.medical_specialty ,Time Factors ,Adolescent ,Cardiomyopathy ,Heart Ventricles ,Magnetic Resonance Imaging, Cine ,Gadolinium ,Ventricular Septum ,Sudden death ,Young Adult ,Fibrosis ,Internal medicine ,Medicine ,Humans ,cardiovascular diseases ,Aged ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Medicine (all) ,Hazard ratio ,Hypertrophic cardiomyopathy ,Reproducibility of Results ,Magnetic resonance imaging ,Cardiomyopathy, Hypertrophic ,Middle Aged ,medicine.disease ,Image Enhancement ,Prognosis ,Magnetic Resonance Imaging ,Female ,Follow-Up Studies ,medicine.anatomical_structure ,Ventricle ,Hypertrophic ,Cine ,Cardiology ,Histopathology ,business ,Cardiology and Cardiovascular Medicine - Abstract
Cardiovascular magnetic resonance (CMR) with extensive late gadolinium enhancement (LGE) is a novel marker for increased risk for sudden death (SD) in patients with hypertrophic cardiomyopathy (HC). Small focal areas of LGE confined to the region of right ventricular (RV) insertion to ventricular septum (VS) have emerged as a frequent and highly visible CMR imaging pattern of uncertain significance. The aim of this study was to evaluate the prognostic significance of LGE confined to the RV insertion area in patients with HC. CMR was performed in 1,293 consecutive patients with HC from 7 HC centers, followed for 3.4 ± 1.7 years. Of 1,293 patients (47 ± 14 years), 134 (10%) had LGE present only in the anterior and/or inferior areas of the RV insertion to VS, occupying 3.7 ± 2.9% of left ventricular myocardium. Neither the presence nor extent of LGE in these isolated areas was a predictor of adverse HC-related risk, including SD (adjusted hazard ratio 0.82, 95% confidence interval 0.45 to 1.50, p = 0.53; adjusted hazard ratio 1.16/10% increase in LGE, 95% confidence interval 0.29 to 4.65, p = 0.83, respectively). Histopathology in 20 HC hearts show the insertion areas of RV attachment to be composed of a greatly expanded extracellular space characterized predominantly by interstitial-type fibrosis and interspersed disorganized myocyte patterns and architecture. In conclusion, LGE confined to the insertion areas of RV to VS was associated with low risk of adverse events (including SD). Gadolinium pooling in this region of the left ventricle does not reflect myocyte death and repair with replacement fibrosis or scarring.
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- 2015
5. Prognostic value of quantitative contrast-enhanced cardiovascular magnetic resonance for the evaluation of sudden death risk in patients with hypertrophic cardiomyopathy
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Barry J. Maron, Christiane Gruner, Franco Cecchi, Michael J. Pencina, James E. Udelson, Elena Biagini, Evan Appelbaum, Tammy S. Haas, Massimo Lombardi, Raymond H. Chan, Iacopo Olivotto, Francesco Formisano, Gabriele Egidy Assenza, Benedetta Tomberli, Andrew M. Crean, Warren J. Manning, Ethan J. Rowin, E. Francis Cook, Camillo Autore, C. Michael Gibson, Carlo N. De Cecco, Claudio Rapezzi, John R. Lesser, Paolo Spirito, Susie N. Hong, Harry Rakowski, Martin S. Maron, Chan, R.H., Maron, B.J., Olivotto, I., Pencina, M.J., Assenza, G.E., Haas, T., Lesser, J.R., Gruner, C., Crean, A.M., Rakowski, H., Udelson, J.E., Rowin, E., Lombardi, M., Cecchi, F., Tomberli, B., Spirito, P., Formisano, F., Biagini, E., Rapezzi, C., De Cecco, C.N., Autore, C., Cook, E.F., Hong, S.N., Gibson, C.M., Manning, W.J., Appelbaum, E., and Maron, M.S.
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Male ,Cardiomyopathy ,Contrast Media ,Gadolinium ,Sudden cardiac death ,Cohort Studies ,Risk Factors ,80 and over ,Single-Blind Method ,Child ,cardiomyopathies ,heart arrest ,magnetic resonance imaging Comment in ,Aged, 80 and over ,cardiomyopathie ,medicine.diagnostic_test ,Hazard ratio ,Hypertrophic cardiomyopathy ,Middle Aged ,Prognosis ,Death ,Cine ,embryonic structures ,Cardiology ,Female ,Cardiomyopathies ,Heart arrest ,Magnetic resonance imaging ,Adolescent ,Adult ,Aged ,Cardiomyopathy, Hypertrophic ,Death, Sudden, Cardiac ,Humans ,Magnetic Resonance Imaging, Cine ,Young Adult ,Physiology (medical) ,Cardiology and Cardiovascular Medicine ,Cardiac ,medicine.medical_specialty ,Sudden death ,NO ,Internal medicine ,medicine ,In patient ,cardiovascular diseases ,business.industry ,medicine.disease ,Sudden ,Hypertrophic ,Myocardial fibrosis ,business - Abstract
Background— Hypertrophic cardiomyopathy (HCM) is the most common cause of sudden death in the young, although not all patients eligible for sudden death prevention with an implantable cardioverter-defibrillator are identified. Contrast-enhanced cardiovascular magnetic resonance with late gadolinium enhancement (LGE) has emerged as an in vivo marker of myocardial fibrosis, although its role in stratifying sudden death risk in subgroups of HCM patients remains incompletely understood. Methods and Results— We assessed the relation between LGE and cardiovascular outcomes in 1293 HCM patients referred for cardiovascular magnetic resonance and followed up for a median of 3.3 years. Sudden cardiac death (SCD) events (including appropriate defibrillator interventions) occurred in 37 patients (3%). A continuous relationship was evident between LGE by percent left ventricular mass and SCD event risk in HCM patients ( P =0.001). Extent of LGE was associated with an increased risk of SCD events (adjusted hazard ratio, 1.46/10% increase in LGE; P =0.002), even after adjustment for other relevant disease variables. LGE of ≥15% of LV mass demonstrated a 2-fold increase in SCD event risk in those patients otherwise considered to be at lower risk, with an estimated likelihood for SCD events of 6% at 5 years. Performance of the SCD event risk model was enhanced by LGE (net reclassification index, 12.9%; 95% confidence interval, 0.3–38.3). Absence of LGE was associated with lower risk for SCD events (adjusted hazard ratio, 0.39; P =0.02). Extent of LGE also predicted the development of end-stage HCM with systolic dysfunction (adjusted hazard ratio, 1.80/10% increase in LGE; P Conclusions— Extensive LGE measured by quantitative contrast enhanced CMR provides additional information for assessing SCD event risk among HCM patients, particularly patients otherwise judged to be at low risk.
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- 2014
6. Significance of sarcomere gene mutations analysis in the end-stage phase of hypertrophic cardiomyopathy
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Francesca Girolami, Attilio Iacovoni, Elena Biagini, Giuseppe Limongelli, Maria Isola Parodi, Camillo Autore, Franco Cecchi, Giulia Frisso, Martin S. Maron, Massimiliano Cecconi, Claudio Rapezzi, Paolo Spirito, Stefania Rosmini, Maria Letizia Bacchi Reggiani, Beatrice Musumeci, Barry J. Maron, Maria Iascone, Iacopo Olivotto, Francesco Formisano, Tammy S. Haas, Paolo Ferrazzi, Francesco Salvatore, Biagini, E, Olivotto, I, Iascone, M, Parodi, Mi, Girolami, F, Frisso, G, Autore, C, Limongelli, Giuseppe, Cecconi, M, Maron, Bj, Maron, M, Rosmini, S, Formisano, F, Musumeci, B, Cecchi, F, Iacovoni, A, Haas, T, Bacchi reggiani, Ml, Ferrazzi, P, Salavtore, F, Spirito, P, Rapezzi, C., Biagini, Elena, Olivotto, Iacopo, Iascone, Maria, Parodi, Maria I, Girolami, Francesca, Frisso, Giulia, Autore, Camillo, Cecconi, Massimiliano, Maron, Barry J, Maron, Martin S, Rosmini, Stefania, Formisano, Francesco, Musumeci, Beatrice, Cecchi, Franco, Iacovoni, Attilio, Haas, Tammy S, Bacchi Reggiani, Maria L, Ferrazzi, Paolo, Salvatore, Francesco, Spirito, Paolo, Rapezzi, Claudio, Parodi, Maria I., Maron, Barry J., Maron, Martin S., Haas, Tammy S., and Bacchi Reggiani, Maria L.
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Male ,Pathology ,TNNT2 ,DNA Mutational Analysis ,TPM1 ,Gene mutation ,Severity of Illness Index ,Adult ,Aged ,Cardiomyopathy ,Hypertrophic ,Familial ,Carrier Proteins ,Cross-Sectional Studies ,DNA ,Echocardiography ,Female ,Follow-Up Studies ,Genotype ,Humans ,Magnetic Resonance Imaging ,Cine ,Middle Aged ,Myosin Heavy Chains ,Pedigree ,Prevalence ,Retrospective Studies ,Sarcomeres ,Mutation ,Cardiology and Cardiovascular Medicine ,Retrospective Studie ,Cardiomyopathy, Hypertrophic, Familial ,Magnetic Resonance Imaging, Cine ,Hypertrophic cardiomyopathy ,Sarcomere ,Cardiology ,Human ,medicine.medical_specialty ,Follow-Up Studie ,NO ,DNA Mutational Analysi ,Internal medicine ,medicine ,Cross-Sectional Studie ,business.industry ,ACTC1 ,Myosin Heavy Chain ,medicine.disease ,MYL3 ,MYL2 ,MYH7 ,Carrier Protein ,business - Abstract
End-stage hypertrophic cardiomyopathy (ES-HC) has an ominous prognosis. Whether genotype can influence ES-HC occurrence is unresolved. We assessed the spectrum and clinical correlates of HC-associated mutations in a large multicenter cohort with end-stage ES-HC. Sequencing analysis of 8 sarcomere genes (MYH7, MYBPC3, TNNI3, TNNT2, TPM1, MYL2, MYL3, and ACTC1) and 2 metabolic genes (PRKAG2 and LAMP2) was performed in 156 ES-HC patients with left ventricular (LV) ejection fraction (EF)
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- 2014
7. Risk of sudden death and outcome in patients with hypertrophic cardiomyopathy with benign presentation and without risk factors
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Sergio Bongioanni, Francesco Lai, Beatrice Musumeci, Barry J. Maron, Emmanuela Devoto, Elena Biagini, Laura Yeates, Christopher Semsarian, Maria Rosa Conte, Camillo Autore, Tammy S. Haas, Gabriele Egidy Assenza, Francesco Formisano, Luca Boni, Claudio Rapezzi, Paolo Spirito, Spirito, P., Autore, C., Formisano, F., Assenza, G.E., Biagini, E., Haas, T.S., Bongioanni, S., Semsarian, C., Devoto, E., Musumeci, B., Lai, F., Yeates, L., Conte, M.R., Rapezzi, C., Boni, L., and Maron, B.J.
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Male ,medicine.medical_specialty ,hypertrophic cardiomyopathy, sudden death ,Cardiomyopathy ,sudden death ,Sudden death ,NO ,Death, Sudden ,Risk Factors ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,In patient ,Stroke ,Aged ,Analysis of Variance ,business.industry ,Mortality rate ,Hypertrophic cardiomyopathy ,Cardiomyopathy, Hypertrophic ,Middle Aged ,hypertrophic cardiomyopathy ,medicine.disease ,Death, Sudden, Cardiac ,Heart failure ,Cardiology ,Female ,Presentation (obstetrics) ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Patients with hypertrophic cardiomyopathy (HC) are reported to have a mortality rate of about 1.0% per year, and those patients without sudden death risk factors and with no or mild symptoms are generally considered to have a benign clinical presentation. However, the risk of sudden death and the outcome in this latter subgroup have not been investigated systematically and remain unresolved. We assessed the risk of sudden death and outcome in 653 consecutive patients with HC without risk factors and with no or mild symptoms. Over a median follow-up of 5.3 years, 35 patients (5.4%) died of HC-related causes. Mean age at death was 46 ± 20 years in patients who died suddenly and 66 ± 15 and 72 ± 9 years, respectively, in patients who died of heart failure or stroke. Event rate was 0.6% per year for sudden death, 0.2% per year for heart failure death, and 0.1% per year for stroke-related death. Sudden death risk was independently and inversely related to age, and risk of heart failure or stroke death was directly related to age (p = 0.020). At 10 years after the initial evaluation, sudden death risk was 5.9%, with sudden death rate being the lowest (0.3% per year) in patients with normal left atrial dimension (≤40 mm). In conclusion, in patients with HC without conventional risk factors and with no or mild symptoms, the risk of sudden death was not negligible, with an event rate of 0.6% per year. Heart failure and stroke-related death were less common and largely confined to older patients. These results underscore the need for a more accurate assessment of the sudden death risk in patients with HC. © 2014 Elsevier Inc. All rights reserved.
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- 2014
8. Ventricular tachycardia/fibrillation early after defibrillator implantation in patients with hypertrophic cardiomyopathy is explained by a high risk subgroup of patients
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Win Kuang Shen, N.A. Mark Estes, Alawi A. Alsheikh-Ali, Martin S. Maron, Tammy S. Haas, Francesco Formisano, Giuseppe Boriani, Mark S. Link, Paolo Spirito, Christopher Semsarian, Barry J. Maron, Alsheikh-Ali AA, Link MS, Semsarian C, Shen WK, Mark Estes NA 3rd, Maron MS, Haas TS, Formisano F, Boriani G, Spirito P, and Maron BJ.
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Male ,Tachycardia ,Databases, Factual ,medicine.medical_treatment ,Kaplan-Meier Estimate ,Ventricular tachycardia ,Sudden cardiac death ,Registries ,IMPLANTABLE CARDIOVERTER DEFIBRILLATOR ,Ejection fraction ,HYPERTROPHIC CARDIOMYOPATHY ,Age Factors ,Hypertrophic cardiomyopathy ,Middle Aged ,Prognosis ,Implantable cardioverter-defibrillator ,Defibrillators, Implantable ,Europe ,Treatment Outcome ,Anesthesia ,Ventricular Fibrillation ,Cardiology ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,Adult ,medicine.medical_specialty ,VENTRICULAR TACHYCARDIA ,Electric Countershock ,Risk Assessment ,Statistics, Nonparametric ,Sex Factors ,Physiology (medical) ,Internal medicine ,Confidence Intervals ,medicine ,Humans ,Aged ,Proportional Hazards Models ,Retrospective Studies ,Fibrillation ,business.industry ,Australia ,Cardiomyopathy, Hypertrophic ,medicine.disease ,Survival Analysis ,United States ,Death, Sudden, Cardiac ,Ventricular fibrillation ,Tachycardia, Ventricular ,business - Abstract
BACKGROUND: Implantable cardioverter-defibrillator (ICD) studies in patients with coronary artery disease report higher risk of ventricular tachycardia/fibrillation (VT/VF) early post-implant, potentially related to local proarrhythmic effects of ICD leads. OBJECTIVE: To characterize early and long-term risk of ICD discharge for VT/VF in a large hypertrophic cardiomyopathy (HCM) cohort. METHODS: By using HCM multicenter registry data, we compared long-term risk of VT/VF subsequent to an early post-implant period (a priori defined as within 3 months of implant) between patients with or without VT/VF within 3 months after ICD implantation. RESULTS: Over a median follow-up of 4.3 years, 109 of 506 (22%) patients with HCM who received ICDs received at least 1 ICD discharge for VT/VF. Risk of first ICD discharge for VT/VF was highest in the first year post-implant (10.8% per person-year; 95% confidence interval 7.9-13.8) and particularly in the first 3 months (17.0% per person-year; 95% confidence interval 9.8-24.3). Patients with early VT/VF (≤3 months post-implant) were older, and more commonly had secondary prevention ICDs following cardiac arrest or systolic dysfunction (end-stage HCM with ejection fraction
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- 2013
9. FEMALE GENDER IS ASSOCIATED WITH MAJOR ADVERSE CARDIOVASCULAR EVENTS IN PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY
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Elena Biagini, I Olivotto, Susie N. Hong-Zohlman, Christiane Gruner, James E. Udelson, Tammy S. Haas, Gabriele Egidy Assenza, Harry Rakowski, Raymond H. Chan, Martin S. Maron, Thomas H. Hauser, Barry Maron, Camillo Autore, John Lesser, Carlo Nicola De Cecco, Francesco Formisano, Andrew M. Crean, Paolo Spirito, Warren J. Manning, Benedetta Tomberli, Evan Appelbaum, Ethan Rowin, C. Michael Gibson, Claudio Rapezzi, and E. Francis Cook
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medicine.medical_specialty ,business.industry ,Hypertrophic cardiomyopathy ,macromolecular substances ,medicine.disease ,Sudden cardiac death ,Internal medicine ,Cardiovascular Disorder ,cardiovascular system ,Cardiology ,medicine ,In patient ,cardiovascular diseases ,Young adult ,business ,Cardiology and Cardiovascular Medicine - Abstract
Hypertrophic cardiomyopathy (HCM) is the most common, heritable cardiovascular disorder and the most frequent cause of sudden cardiac death (SCD) in young adults. Gender disparities with regards to clinical outcomes among HCM patients are not well-defined. We investigated the relationship between
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- 2012
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10. Progression of myocardial fibrosis assessed with cardiac magnetic resonance in hypertrophic cardiomyopathy
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Mario Marzilli, Giovanni Donato Aquaro, Massimo Lombardi, Andrea Barison, Pier Giorgio Masci, Giancarlo Todiere, Paolo Piaggi, Lorenzo Bacigalupo, Alessandro Pingitore, Elisabetta Strata, and Francesco Formisano
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Adult ,Male ,medicine.medical_specialty ,Clinical variables ,Magnetic Resonance Spectroscopy ,Time Factors ,Adolescent ,Cardiomyopathy ,Gadolinium ,cardiac magnetic resonance ,Article ,Muscle hypertrophy ,hypertrophic cardiomyopathy ,late gadolinium enhancement ,myocardial fibrosis ,Aged ,Aged, 80 and over ,Cardiomyopathy, Hypertrophic ,Disease Progression ,Female ,Fibrosis ,Humans ,Middle Aged ,Myocardium ,Prognosis ,Radiopharmaceuticals ,Sample Size ,Ventricular Dysfunction ,Cardiology and Cardiovascular Medicine ,Internal medicine ,medicine ,80 and over ,Late gadolinium enhancement ,cardiovascular diseases ,business.industry ,Hypertrophic cardiomyopathy ,Mean age ,medicine.disease ,Hypertrophic ,embryonic structures ,cardiovascular system ,Cardiology ,Myocardial fibrosis ,Cardiac magnetic resonance ,business - Abstract
ObjectivesThis study sought to assess the rate of progression of fibrosis by 2 consecutive cardiac magnetic resonance (CMR) examinations and its relation with clinical variables.BackgroundIn hypertrophic cardiomyopathy (HCM) myocardial fibrosis, detected by late gadolinium enhancement (LGE), is associated to a progressive ventricular dysfunction and worse prognosis.MethodsA total of 55 HCM patients (37 males; mean age 43 ± 18 years) underwent 2 CMR examinations (CMR-1 and CMR-2) separated by an interval of 719 ± 410 days. Extent of LGE was measured, and the rate of progression of LGE (LGE-rate) was calculated as the ratio between the increment of LGE (in grams) and the time (months) between the CMR examinations.ResultsAt CMR-1, LGE was detected in 45 subjects, with an extent of 13.3 ± 15.2 g. At CMR-2, 53 (96.4%) patients had LGE, with an extent of 24.6 ± 27.5 g. In 44 patients, LGE extent increased significantly (≥1 g). Patients with apical HCM had higher increments of LGE (p = 0.004) and LGE-rate (p < 0.001) than those with other patterns of hypertrophy. The extent of LGE at CMR-1 and the apical pattern of hypertrophy were independent predictors of the increment of LGE. Patients with worsened New York Heart Association functional class presented higher increase of LGE (p = 0.031) and LGE-rate (p < 0.05) than those with preserved functional status.ConclusionsMyocardial fibrosis in HCM is a progressive and fast phenomenon. LGE increment, related to a worse clinical status, is more extensive in apical hypertrophy than in other patterns.
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- 2012
11. PROGNOSTIC UTILITY OF CONTRAST-ENHANCED CARDIOVASCULAR MAGNETIC RESONANCE IN HYPERTROPHIC CARDIOMYOPATHY: AN INTERNATIONAL MULTICENTER STUDY
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M. Susie Hong, Elena Biagini, Harry Rakowski, Martin S. Maron, Benedetta Tomberli, Warren J. Manning, Tammy S. Haas, Raymond H. Chan, Paolo Spirito, C. Michael Gibson, Claudio Rapezzi, Camillo Autore, John Lesser, Barry Maron, Andrew M. Crean, I Olivotto, James E. Udelson, Francesco Formisano, Carlo Nicola De Cecco, Ethan Rowin, Earl Francis Cook, Gabriele Egidy Assenza, Thomas H. Hauser, Evan Appelbaum, and Christiane Gruner
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medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,media_common.quotation_subject ,Hypertrophic cardiomyopathy ,Magnetic resonance imaging ,medicine.disease ,Multicenter study ,Internal medicine ,medicine ,Cardiology ,Contrast (vision) ,business ,Cardiology and Cardiovascular Medicine ,media_common - Published
- 2012
12. Quantitative analysis of late gadolinium enhancement in hypertrophic cardiomyopathy
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Elisabetta Strata, Gianluca Di Bella, Giovanni Donato Aquaro, Massimo Lombardi, Paolo Spirito, Alessandro Pingitore, Vincenzo Positano, and Francesco Formisano
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Adult ,Gadolinium DTPA ,Male ,lcsh:Diseases of the circulatory (Cardiovascular) system ,medicine.medical_specialty ,Contrast Media ,Magnetic Resonance Imaging, Cine ,Sensitivity and Specificity ,Predictive Value of Tests ,Region of interest ,Image Interpretation, Computer-Assisted ,medicine ,Humans ,Late gadolinium enhancement ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,Angiology ,Medicine(all) ,Observer Variation ,Radiological and Ultrasound Technology ,medicine.diagnostic_test ,business.industry ,Myocardium ,Research ,Hypertrophic cardiomyopathy ,Reproducibility of Results ,Magnetic resonance imaging ,Mean age ,Cardiomyopathy, Hypertrophic ,Middle Aged ,medicine.disease ,Fibrosis ,lcsh:RC666-701 ,Case-Control Studies ,Predictive value of tests ,cardiovascular system ,Female ,Cardiology and Cardiovascular Medicine ,business ,Nuclear medicine ,Quantitative analysis (chemistry) ,Algorithms - Abstract
Background Cardiovascular Magnetic resonance (CMR) with the late gadolinium enhancement (LGE) technique allows the detection of myocardial fibrosis in Hypertrophic cardiomyopathy (HCM). The aim of this study was to compare different methods of automatic quantification of LGE in HCM patients. Methods: Forty HCM patients (mean age 48 y, 30 males) and 20 normal subjects (mean age 38 y, 16 males) underwent CMR, and we compared 3 methods of quantification of LGE: 1) in the SD2 method a region of interest (ROI) was placed within the normal myocardium and enhanced myocardium was considered as having signal intensity >2 SD above the mean of ROI; 2) in the SD6 method enhanced myocardium was defined with a cut-off of 6 SD above mean of ROI; 3) in the RC method a ROI was placed in the background of image, a Rayleigh curve was created using the SD of that ROI and used as ideal curve of distribution of signal intensity of a perfectly nulled myocardium. The maximal signal intensity found in the Rayleigh curve was used as cut-off for enhanced myocardium. Parametric images depicting non enhanced and enhanced myocardium was created using each method. Three investigators assigned a score to each method by the comparison of the original LGE image to the respective parametric map generated. Results Patients with HCM had lower concordance between the measured curve of distribution of signal intensity and the Rayleigh curve than controls (63.7 ± 12.3% vs 92.2 ± 2.3%, p < 0.0001). A cut off of concordance < 82.9% had a 97.1% sensitivity and 92.3% specificity to distinguish HCM from controls. The RC method had higher score than the other methods. The average extent of enhanced myocardium measured by SD6 and Rayleigh curve method was not significant different but SD6 method showed underestimation of enhancement in 12% and overestimation in 5% of patients with HCM. Conclusions Quantification of fibrosis in LGE images with a cut-off derived from the Rayleigh curve is more accurate than using a fixed cut-off.
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- 2010
13. Standardized T2* Map of a Normal Human Heart to Correct T2* Segmental Artefacts; Myocardial Iron Overload and Fibrosis in Thalassemia Intermedia Versus Thalassemia Major Patients and Electrocardiogram Changes in Thalassemia Major Patients
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Daniele De Marchi, Marcello Capra, Luciano Prossomariti, Gian Luca Forni, Luigi Landini, Marcello Pili, Aurelio Maggio, Francesco Formisano, Barbara Scattini, Massimo Lombardi, Petra Keilberg, Aldo Filosa, Paolo Cianciulli, Anna Ramazzotti, Maria E. Lai, Alessia Pepe, Lorella Pitrolo, Caterina Borgna-Pignatti, Vincenzo Positano, Giorgio Derchi, and Maria Filomena Santarelli
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Adult ,Male ,medicine.medical_specialty ,Thalassemia ,T2 mapping ,Clinical Biochemistry ,Thalassemia major (TM) ,T2 ,Myocardial iron ,Magnetic resonance imaging (MRI) ,Iron overload ,Thalassemia intermedia (TI) ,Fibrosis ,Electrocardiogram (ECG) change ,Electrocardiography ,Internal medicine ,medicine ,Humans ,Genetics (clinical) ,medicine.diagnostic_test ,business.industry ,Myocardium ,Biochemistry (medical) ,Human heart ,Magnetic resonance imaging ,Hematology ,medicine.disease ,Magnetic Resonance Imaging ,Cardiology ,Female ,Thalassemia intermedia ,business - Abstract
Studies of the standardized, 3D, 16-segments map of the circumferential distribution of T2* values, of cardiovascular magnetic resonance (CMR) in thalassemia major (TM) and thalassemia intermedia (TI) patients and of electrocardiogram (ECG) changes associated with TM, have been carried out. Similarly, the segment-dependent correction map of the T2* values and the artifactual variations in normal subjects and the T2* correction map to correct segmental measurements in patients with different levels of myocardial iron burden have been evaluated. Cardiovascular magnetic resonance can be a suitable guide to cardiac management in TI, as well as in TM; TI patients show lower myocardial iron burden and more pronounced high cardiac output findings than TM patients. Moreover, it is proposed that, due to its good positive predictive value (PPV) and low cost, ECG can be a suitable guide to orient towards CMR examination in TM cases.
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- 2008
14. Implantable cardioverter-defibrillators and prevention of sudden cardiac death in hypertrophic cardiomyopathy
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Stefano Favale, Giuseppe Boriani, Thorsten Lawrenz, N.A. Mark Estes, Andrew E. Epstein, Mark S. Link, Stephen L. Winters, Mark V. Sherrid, Paolo Spirito, Adrian K. Almquist, Marco Piccininno, Gianfranco Buja, Christopher Semsarian, Francesco Formisano, Massimo Santini, Fernando Arribas, Win Kuang Shen, Paolo Bruzzi, James P. Daubert, Tammy S. Haas, Sandro Betocchi, Barry J. Maron, Maron, Bj, Spirito, P, Shen, Wk, Haas, T, Formisano, F, Link, M, Epstein, Ae, Almquist, Ak, Daubert, Jp, Lawrenz, T, Boriani, G, ESTES NA, Rd, Favale, S, Piccininno, M, Winters, Sl, Santini, M, Betocchi, Sandro, Arribas, F, Sherrid, Mv, Buja, G, Semsarian, C, Bruzzi, P., Maron BJ, Spirito P, Shen WK, Haas TS, Formisano F, Link MS, Epstein AE, Almquist AK, Daubert JP, Lawrenz T, Boriani G, Estes NA 3rd, Favale S, Piccininno M, Winters SL, Santini M, Betocchi S, Arribas F, Sherrid MV, Buja G, Semsarian C, and Bruzzi P.
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Tachycardia ,Adult ,Male ,medicine.medical_specialty ,Cardiomyopathy ,morte improvvisa ,Ventricular tachycardia ,Sudden death ,Risk Assessment ,Sudden cardiac death ,Internal medicine ,Medicine ,Humans ,Registries ,Risk factor ,Aged ,business.industry ,Hypertrophic cardiomyopathy ,Cardiomyopathy, Hypertrophic ,Death, Sudden, Cardiac ,Female ,Middle Aged ,Tachycardia, Ventricular ,Ventricular Fibrillation ,Defibrillators, Implantable ,Ventricular ,General Medicine ,medicine.disease ,Sudden ,Cardiomiopatia ipertrofica ,Death ,Hypertrophic ,Ventricular fibrillation ,Cardiology ,medicine.symptom ,Implantable ,business ,Cardiac ,Defibrillators - Abstract
Context Recently, the implantable cardioverter-defibrillator (ICD) has been promoted for prevention of sudden death in hypertrophic cardiomyopathy (HCM). However, the effectiveness and appropriate selection of patients for this therapy is incompletely resolved. Objective To study the relationship between clinical risk profile and incidence and efficacy of ICD intervention in HCM. Design, Setting, and Patients Multicenter registry study of ICDs implanted between 1986 and 2003 in 506 unrelated patients with HCM. Patients were judged to be at high risk for sudden death; had received ICDs; underwent evaluation at 42 referral and nonreferral institutions in the United States, Europe, and Australia; and had a mean follow-up of 3.7 (SD, 2.8) years. Measured risk factors for sudden death included family history of sudden death, massive left ventricular hypertrophy, nonsustained ventricular tachycardia on Holter monitoring, and unexplained prior syncope. Main OutcomeMeasure Appropriate ICD intervention terminating ventricular tachycardia or fibrillation. Results The 506 patients were predominately young (mean age, 42 [SD, 17] years) at implantation, and most (439 [87%]) had no or only mildly limiting symptoms. ICD interventions appropriately terminated ventricular tachycardia/fibrillation in 103 patients (20%). Intervention rates were 10.6% per year for secondary prevention after cardiac arrest (5-year cumulative probability, 39% [SD, 5%]), and 3.6% per year for primary prevention (5-year probability, 17% [SD, 2%]). Time to first appropriate discharge was up to 10 years, with a 27% (SD, 7%) probability 5 years or more after implantation. For primary prevention, 18 of the 51 patients with appropriate ICD interventions (35%) had undergone implantation for only a single risk factor; likelihood of appropriate discharge was similar in patients with 1, 2, or 3 or more risk markers (3.83, 2.65, and 4.82 per 100 person-years, respectively; P=.77). The single sudden death due to an arrhythmia (in the absence of advanced heart failure) resulted from ICD malfunction. ICD complications included inappropriate shocks in 136 patients (27%). Conclusions In a high-risk HCM cohort, ICD interventions for life-threatening ventricular tachyarrhythmias were frequent and highly effective in restoring normal rhythm. An important proportion of ICD discharges occurred in primary prevention patients who had undergone implantation for a single risk factor. Therefore, a single marker of high risk for sudden death may be sufficient to justify consideration for prophylactic defibrillator implantation in selected patients with HCM.
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- 2007
15. Prevalence, clinical profile, and significance of left ventricular remodeling in the end-stage phase of hypertrophic cardiomyopathy
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John R. Lesser, Francesco Formisano, Warren J. Manning, Martin S. Maron, Andrey G. Zenovich, James E. Udelson, Shannon Mackey-Bojack, Paolo Spirito, Kevin M. Harris, and Barry J. Maron
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Adult ,Male ,medicine.medical_specialty ,Time Factors ,Heart disease ,Adolescent ,medicine.medical_treatment ,Cardiomyopathy ,Sudden death ,Cohort Studies ,Physiology (medical) ,Internal medicine ,medicine ,Prevalence ,Humans ,Child ,Retrospective Studies ,Heart transplantation ,Ejection fraction ,Ventricular Remodeling ,business.industry ,Hypertrophic cardiomyopathy ,Cardiomyopathy, Hypertrophic ,medicine.disease ,Magnetic Resonance Imaging ,United States ,Transplantation ,Echocardiography ,Heart failure ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Background— End stage (ES) is a recognized part of the hypertrophic cardiomyopathy (HCM) disease spectrum. Frequency, clinical profile and course, and treatment strategies in these patients remain incompletely defined. Methods and Results— Three HCM cohorts comprised 1259 patients, including 44 (3.5%) characterized as ES with systolic dysfunction (ejection fraction P =0.84). Appropriate defibrillator interventions were 10% per year in patients awaiting donor hearts. Most ES patients (n=23; 52%) showed substantial left ventricular (LV) remodeling with cavity dilatation. Less complete remodeling occurred in 21 patients (48%), including 5 with persistence of a nondilated and markedly hypertrophied LV. Pathology and magnetic resonance imaging showed extensive (transmural) fibrosis in 9 of 11 ES patients. At initial evaluation, patients who developed ES were younger with more severe symptoms, had a larger LV cavity, and more frequently had a family history of ES than other HCM patients. Conclusions— ES of nonobstructive HCM has an expanded and more diverse clinical expression than previously appreciated, including occurrence in young patients, heterogeneous patterns of remodeling, frequent association with atrial fibrillation, and impaired LV contractility that precedes cavity dilatation, wall thinning, and heart failure symptoms. ES is an unfavorable complication (mortality rate 11% per year) and a sudden death risk factor; it requires vigilance to permit timely recognition and the necessity for defibrillator implantation and heart transplantation.
- Published
- 2006
16. DOES FOCAL LATE GADOLINIUM ENHANCEMENT AT THE RIGHT VENTRICULAR INSERTION POINTS MATTER IN RISK STRATIFICATION FOR SUDDEN DEATH IN HYPERTROPHIC CARDIOMYOPATHY?
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Earl Francis Cook, I Olivotto, James E. Udelson, Elena Biagini, Raymond H. Chan, C. Michael Gibson, Warren J. Manning, John Lesser, Susie Hong, Gabriele Egidy Assenza, Ethan Rowin, Paolo Spirito, Martin S. Maron, Claudio Rapezzi, Benedetta Tomberli, Andrew Creane, Francesco Formisano, Tammy S. Haas, Camillo Autore, Evan Appelbaum, Carlo Nicola De Cecco, Harry Rakowski, Barry Maron, and Christiane Gruner
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medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Hypertrophic cardiomyopathy ,Magnetic resonance imaging ,medicine.disease ,Sudden death ,Increased risk ,Fibrosis ,Internal medicine ,embryonic structures ,Risk stratification ,cardiovascular system ,medicine ,Cardiology ,Late gadolinium enhancement ,In patient ,cardiovascular diseases ,Cardiology and Cardiovascular Medicine ,business - Abstract
Cardiovascular magnetic resonance (CMR) with extensive late gadolinium enhancement (LGE) is a novel marker for increased risk for sudden death in patients with hypertrophic cardiomyopathy (HCM) presumably due to ventricular tachyarrhythmias emanating from areas of replacement fibrosis. Of particular
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- 2013
17. Incidence of Pulmonary Hypertension in Haemoglobinopathic Patients without Left Ventricular Disfunction
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Gian Luca Forni, Francesco Formisano, Renzo Galanello, Martina Lamagna, Antonio Piga, Disma Renda, Luciano Prossomariti, Maria Rosaria Fasulo, Giorgio Derchi, Guido Donato, Patrizia Cinque, Maria Domenica Cappellini, Aurelio Maggio, Patrizio Bina, Tiziana Cogliandro, and Paolo Cianciulli
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medicine.medical_specialty ,Ejection fraction ,business.industry ,Thalassemia ,Incidence (epidemiology) ,Immunology ,Mean age ,macromolecular substances ,Cell Biology ,Hematology ,medicine.disease ,Biochemistry ,Pulmonary hypertension ,Gastroenterology ,Surgery ,Jet velocity ,Internal medicine ,medicine ,Thalassemia intermedia ,business ,Normal range - Abstract
Incidence of Pulmonary Hypertension (PH) has been described in haemoglobinopathic patients, ranging from 10% to 50%, depending on age, therapy, coexisting left ventricular dysfunction (LVD) and classification of the disease. To determine whether PH can occurs in haemoglobinopathic patients in absence of overt LVD, we studied 1121 pts from 7 Thalassemia Centers in Italy(485 Thalassemia Major (TM), 458 thalassemia intermedia (TI), 178 Sickle Cell or Sickle Thalassemia Disease (SCD),49% males, mean age 30 yrs, range 13–56 yrs). In all pts echocardiographic (Echo) defined ejection fraction (EF%) was > 45% and clinically overt LVD was excluded. A cross-sectional Echo study was performed in order to detect PH that was prospectively defined as mild with tricuspid regurgitant jet velocity (TRV)of at least 2.5 m per second and defined as severe with a TRV> 3.5 m per second. Severe PH was observed in 9 pts, 3 with TM, in 6 with TI and in 1 patients with SCD. Mild PH occurs in 46 patients with TM, in 57 patients with TI and 11 pts with SCD. In the remaining patients, PH was in the normal range (TM 89,9%, TI 86,2% and SCD 93,2% of pts, respectively). In the whole group of hemoglobinopathic pts the incidence of PH (mild plus severe) range from 6.5 % to 13.8% of pts. PH (mild to severe) particularly affects pts with TI (13,8% of pts). | Tricuspid Regurgitant Jet Velocity | Thal Major 485 pts | Thal Int 458 pts | SCD 178 pts | % pts | |:----------------------------------:| ------------------ | ---------------- | ----------- | ----- | | TRV3.5 m/sec | 3 (0.6%) | 6 (1.3%) | 1 (0.9%) | 0.9% | Incidence of PH in TM, TI and SCD Our data support a significant presence of PH in haemoglobinopathic pts (6.2 to 13,8%) even though well treated and without LVD. Considering the pathophisiology of haemoglobinopathies a specific consideration to PH in these diseases is required in order to establish a preventive and therapeutic approach.
- Published
- 2005
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