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4. Determinants of myocardial mechanics in top-level endurance athletes: three-dimensional speckle tracking evaluation.

Author

Lo Iudice, Francesco, Petitto, Marta, Ferrone, Marco, Esposito, Roberta, Vaccaro, Andrea, Buonauro, Agostino, D'Andrea, Antonello, Trimarco, Bruno, and Galderisi, Maurizio

Abstract

Aims The determinants of systolic function in the performing heart are not completely understood. Aim of the study was to assess the contributors of left ventricular (LV) strain components, using 3D speckle tracking echocardiography (STE) in endurance athletes. Methods and results A total of 36 top-level male endurance athletes (AT) and 36 age-matched sedentary normal controls (NC) underwent standard and real-time 3D echocardiography. Global longitudinal strain (GLS), global circumferential strain (GCS), glo bal area strain (GAS), and global radial strain (GRS) were assessed using 3D STE. AT had significantly higher GLS (-22.1 ± 4.4 vs. -18.4 ± 3.5%; P < 0.0001), GCS (-17.9 ± 2.4 vs. -16.0 ± 3.2; P = 0.006), and GAS ( -35.5 ± 6.7 vs. -30.2 ± 4.9; P < 0.0001), while GRS did not differ significantly with NC. At separate multiple linear regression analyses, heart rate emerged as independent predictor of GLS (β = -0.37, P < 0.002), GCS (β = -0.32, P = 0.007), GAS (β = -0.37, P < 0.001), and GRS (β = -0.29, P = 0.019); LV mass was independently associated with GLS (β = 0.34, P = 0.009) and GAS (β = 0.41, P < 0.001) but not with GCS and GRS, while diastolic blood pressure predicted GCS (β = -0.46, P < 0.0001), GAS (β = -0.28; P = 0.006), and GRS (β = -0.42, P < 0.001). No independent correlation emerged for body surface area and stroke volume. By replacing LV mass with end-diastolic volume, the latter showed independent association with GCS (β = -0.65, P = 0.028) and with GRS (β = -0.60, P < 0.05). Conclusion AT have an increased myocardial function at rest when compared with NC, this being elicited mainly by subendocardial and mid-wall fibres. Sinus bradycardia, LV mass, and afterload are independent determinants of supernormal myocardial deformation at rest. [ABSTRACT FROM AUTHOR]

Published
2017
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6. Prognostic Value of Combined Target-Organ Damage in Patients With Essential Hypertension.

Author

Carpinella, Gerardo, Pagano, Gennaro, Buono, Francesco, Petitto, Marta, Guarino, Giovanna, Orefice, Giuseppe, Rengo, Giuseppe, Trimarco, Bruno, and Morisco, Carmine

Subjects
KIDNEY diseases, LEFT ventricular hypertrophy, CARDIOVASCULAR diseases, ANTHROPOMETRY, PATIENT participation
Abstract

BACKGROUND Whether the combination of chronic kidney disease (CKD) and left ventricular hypertrophy (LVH) affects the cardiovascular (CV) risk in patients with uncomplicated hypertension is poorly investigated. The aim of this study was to assess the effects of LVH, CKD, and their combination on CV events in hypertension. METHODS This study analyzed 1,078 patients with essential hypertension. RESULTS LVH was present in 104 (9.6%) patients, CKD was present in 556 (51.5%) patients, and the combination of LVH and CKD was found in 174 (16.1%) patients. During the follow-up (median = 84 months), 52 CV events were observed (0.64 events/100 patient-years): 6 (2.4%) in patients without target-organ damage (TOD), 6 (5.7%) in patients with LVH, 20 (3.6%) in patients with CKD, and 20 (11.4%) in patients with combined LVH+CKD. Adjusted hazard ratio (HR) for CV events was 1.62 (P = 0.34) for LVH, 0.951 (P = 0.94) for CKD, and 2.45 (P = 0.03) for LVH+CKD. After multivariable Cox proportional hazard analysis, the combination of LVH+CKD was significantly associated with risk of CV events, when the model was adjusted for sex and age (HR = 2.447; P = 0.03) and for the presence of 1 CV risk factor (HR = 3.226; P = 0.02). In contrast, the association of LVH+CKD was no longer significant when the model was adjusted for sex, age, and the presence of ≥2 CV risk factors. CONCLUSIONS The results of this study highlight the relevance of the interactions between TODs and hemodynamic, anthropometric, and metabolic abnormalities in the CV risk stratification of patients with essential hypertension. [ABSTRACT FROM PUBLISHER]

Published
2015
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7. Sex-specific echocardiographic reference values: the women's point of view

Author

Regina Sorrentino, Roberta Esposito, Lucia La Mura, Patrizio Lancellotti, F Luciano, Anna Maria De Roberto, Maurizio Galderisi, Silvia Maffei, Maria Lembo, Marta Petitto, Enrica Pezzullo, Petitto, Marta, Esposito, Roberta, Sorrentino, Regina, Lembo, Maria, Luciano, Federica, De Roberto, Anna Maria, LA MURA, Lucia, Pezzullo, Enrica, Maffei, Silvia, Galderisi, Maurizio, and Lancellotti, Patrizio

Subjects
Adult, Male, medicine.medical_specialty, Heart Ventricles, Diastole, Echocardiography, Three-Dimensional, Predictive Value of Test, Disease, Sex Factor, 030204 cardiovascular system & hematology, Affect (psychology), Ventricular Function, Left, Heart Ventricle, 03 medical and health sciences, Young Adult, Sex Factors, 0302 clinical medicine, Predictive Value of Tests, Reference Values, Internal medicine, Cardiovascular Disease, medicine, Humans, Age Factor, Reference Value, 030212 general & internal medicine, Ejection fraction, business.industry, Age Factors, Stroke Volume, General Medicine, Stroke volume, Middle Aged, medicine.disease, Sex specific, Myocardial Contraction, Echocardiography, Doppler, Cardiovascular Diseases, Reference values, Heart failure, Cardiology, Women's Health, Female, Cardiology and Cardiovascular Medicine, business, Human
Abstract

Clinical presentation, diagnosis and outcomes of cardiac diseases are influenced by the activity of sex steroid hormones. These hormonal differences explain the later development of heart diseases in women in comparison with men and the different clinical picture, management and prognosis. Echocardiography is a noninvasive and easily available technique for the analysis of cardiac structure and function. The aim of the present review is to underline the most important echocardiographic differences between sexes. Several echocardiographic studies have found differences in healthy populations between women and men. Sex-specific difference of some of these parameters, such as left ventricular (LV) linear dimensions and left atrial volume, can be explained on the grounds of smaller body size of women, but other parameters (LV volumes, stroke volume and ejection fraction, right ventricular size and systolic function) are specifically lower in women, even after adjusting for body size and age. Sex-specific differences of standard Doppler and Tissue Doppler diastolic indices remain controversial, but it is likely for aging to affect LV diastolic function more in women than in men. Global longitudinal strain appears to be higher in women during the childbearing age - a finding that also highlights a possible hormonal influence in women. All these findings have practical implications, and sex-specific reference values are necessary for the majority of echocardiographic parameters in order to distinguish normalcy from disease. Careful attention on specific cut-off points in women could avoid misinterpretation, inappropriate management and delayed treatment of cardiac diseases such as valvular disease and heart failure.

Published
2018

8. Determinants of myocardial mechanics in top-level endurance athletes: three-dimensional speckle tracking evaluation

Author

Marco Ferrone, Roberta Esposito, Antonello D'Andrea, Agostino Buonauro, Marta Petitto, Francesco Lo Iudice, Bruno Trimarco, Maurizio Galderisi, Andrea Vaccaro, LO IUDICE, Francesco, Petitto, Marta, Ferrone, Marco, Esposito, Roberta, Vaccaro, Andrea, Buonauro, Agostino, D'Andrea, Antonello, Trimarco, Bruno, and Galderisi, Maurizio

Subjects
Adult, Male, medicine.medical_specialty, Diastole, Echocardiography, Three-Dimensional, Speckle tracking echocardiography, 030204 cardiovascular system & hematology, Ventricular Function, Left, 03 medical and health sciences, Young Adult, strain, 0302 clinical medicine, Afterload, Reference Values, Internal medicine, Heart rate, athlete's heart, heart rate, Image Processing, Computer-Assisted, Medicine, Humans, Radiology, Nuclear Medicine and imaging, 030212 general & internal medicine, Systole, Body surface area, business.industry, Stroke Volume, three-dimensional speckle tracking echocardiography, General Medicine, Stroke volume, Myocardial Contraction, Blood pressure, Athletes, left ventricular ma, Case-Control Studies, Multivariate Analysis, Cardiology, Linear Models, Physical Endurance, Sedentary Behavior, Cardiology and Cardiovascular Medicine, business
Abstract

Aims The determinants of systolic function in the performing heart are not completely understood. Aim of the study was to assess the contributors of left ventricular (LV) strain components, using 3D speckle tracking echocardiography (STE) in endurance athletes. Methods and results A total of 36 top-level male endurance athletes (AT) and 36 age-matched sedentary normal controls (NC) underwent standard and real-time 3D echocardiography. Global longitudinal strain (GLS), global circumferential strain (GCS), global area strain (GAS), and global radial strain (GRS) were assessed using 3D STE. AT had significantly higher GLS (−22.1 ± 4.4 vs. −18.4 ± 3.5%; P < 0.0001), GCS (−17.9 ± 2.4 vs. −16.0 ± 3.2; P = 0.006), and GAS (−35.5 ± 6.7 vs. −30.2 ± 4.9; P < 0.0001), while GRS did not differ significantly with NC. At separate multiple linear regression analyses, heart rate emerged as independent predictor of GLS ( β = −0.37, P < 0.002), GCS ( β = −0.32, P = 0.007), GAS ( β = −0.37, P < 0.001), and GRS ( β = −0.29, P = 0.019); LV mass was independently associated with GLS ( β = 0.34, P = 0.009) and GAS ( β = 0.41, P < 0.001) but not with GCS and GRS, while diastolic blood pressure predicted GCS ( β = −0.46, P < 0.0001), GAS ( β = −0.28; P = 0.006), and GRS ( β = −0.42, P < 0.001). No independent correlation emerged for body surface area and stroke volume. By replacing LV mass with end-diastolic volume, the latter showed independent association with GCS ( β = −0.65, P = 0.028) and with GRS ( β = −0.60, P < 0.05). Conclusion AT have an increased myocardial function at rest when compared with NC, this being elicited mainly by subendocardial and mid-wall fibres. Sinus bradycardia, LV mass, and afterload are independent determinants of supernormal myocardial deformation at rest.

Published
2016

9. Prognostic value of combined target-organ damage in patients with essential hypertension

Author

Giuseppe Rengo, Giovanna Guarino, Marta Petitto, Bruno Trimarco, Gerardo Carpinella, Giuseppe Orefice, Carmine Morisco, Gennaro Pagano, Francesco Buono, Carpinella, Gerardo, Pagano, Gennaro, Buono, Francesco, Petitto, Marta, Guarino, Giovanna, Orefice, Giuseppe, Rengo, Giuseppe, Trimarco, Bruno, and Morisco, Carmine

Subjects
Male, Time Factors, Blood Pressure, Sex Factor, Left ventricular hypertrophy, Essential hypertension, Heart Rate, Risk Factors, Chronic kidney disease, Prevalence, Medicine, Age Factor, Prospective Studies, Prospective cohort study, Multivariate Analysi, Medicine (all), Hazard ratio, Age Factors, Middle Aged, Stroke, Antihypertensive Agent, Italy, Hypertension, Cardiology, Female, Hypertrophy, Left Ventricular, Human, Glomerular Filtration Rate, Adult, medicine.medical_specialty, Time Factor, Risk Assessment, Disease-Free Survival, Sex Factors, Internal medicine, Internal Medicine, Humans, cardiovascular diseases, Risk factor, Renal Insufficiency, Chronic, Antihypertensive Agents, Proportional Hazards Models, Chi-Square Distribution, business.industry, Proportional hazards model, Risk Factor, medicine.disease, Cardiovascular risk, Myocardial infarction, Prospective Studie, Blood pressure, Multivariate Analysis, Proportional Hazards Model, business, Kidney disease
Abstract

BACKGROUND Whether the combination of chronic kidney disease (CKD) and left ventricular hypertrophy (LVH) affects the cardiovascular (CV) risk in patients with uncomplicated hypertension is poorly investigated. The aim of this study was to assess the effects of LVH, CKD, and their combination on CV events in hypertension. METHODS This study analyzed 1,078 patients with essential hypertension. RESULTS LVH was present in 104 (9.6%) patients, CKD was present in 556 (51.5%) patients, and the combination of LVH and CKD was found in 174 (16.1%) patients. During the follow-up (median = 84 months), 52 CV events were observed (0.64 events/100 patient-years): 6 (2.4%) in patients without target-organ damage (TOD), 6 (5.7%) in patients with LVH, 20 (3.6%) in patients with CKD, and 20 (11.4%) in patients with combined LVH+CKD. Adjusted hazard ratio (HR) for CV events was 1.62 (P = 0.34) for LVH, 0.951 (P = 0.94) for CKD, and 2.45 (P = 0.03) for LVH+CKD. After multivariable Cox proportional hazard analysis, the combination of LVH+CKD was significantly associated with risk of CV events, when the model was adjusted for sex and age (HR = 2.447; P = 0.03) and for the presence of 1 CV risk factor (HR = 3.226; P = 0.02). In contrast, the association of LVH+CKD was no longer significant when the model was adjusted for sex, age, and the presence of ≥ 2 CV risk factors. CONCLUSIONS The results of this study highlight the relevance of the interactions between TODs and hemodynamic, anthropometric, and metabolic abnormalities in the CV risk stratification of patients with essential hypertension.

Published
2014

10. Determinants of myocardial mechanics in top-level endurance athletes: three-dimensional speckle tracking evaluation.

Author

Lo Iudice F, Petitto M, Ferrone M, Esposito R, Vaccaro A, Buonauro A, D'Andrea A, Trimarco B, and Galderisi M

Subjects
Adult, Case-Control Studies, Humans, Linear Models, Male, Multivariate Analysis, Myocardial Contraction physiology, Reference Values, Sedentary Behavior, Young Adult, Athletes, Echocardiography, Three-Dimensional methods, Image Processing, Computer-Assisted, Physical Endurance physiology, Stroke Volume physiology, Ventricular Function, Left physiology
Abstract

Aims: The determinants of systolic function in the performing heart are not completely understood. Aim of the study was to assess the contributors of left ventricular (LV) strain components, using 3D speckle tracking echocardiography (STE) in endurance athletes., Methods and Results: A total of 36 top-level male endurance athletes (AT) and 36 age-matched sedentary normal controls (NC) underwent standard and real-time 3D echocardiography. Global longitudinal strain (GLS), global circumferential strain (GCS), global area strain (GAS), and global radial strain (GRS) were assessed using 3D STE. AT had significantly higher GLS (-22.1 ± 4.4 vs. -18.4 ± 3.5%; P < 0.0001), GCS (-17.9 ± 2.4 vs. -16.0 ± 3.2; P = 0.006), and GAS (-35.5 ± 6.7 vs. -30.2 ± 4.9; P < 0.0001), while GRS did not differ significantly with NC. At separate multiple linear regression analyses, heart rate emerged as independent predictor of GLS (β = -0.37, P < 0.002), GCS (β = -0.32, P = 0.007), GAS (β = -0.37, P < 0.001), and GRS (β = -0.29, P = 0.019); LV mass was independently associated with GLS (β = 0.34, P = 0.009) and GAS (β = 0.41, P < 0.001) but not with GCS and GRS, while diastolic blood pressure predicted GCS (β = -0.46, P < 0.0001), GAS (β = -0.28; P = 0.006), and GRS (β = -0.42, P < 0.001). No independent correlation emerged for body surface area and stroke volume. By replacing LV mass with end-diastolic volume, the latter showed independent association with GCS (β = -0.65, P = 0.028) and with GRS (β = -0.60, P < 0.05)., Conclusion: AT have an increased myocardial function at rest when compared with NC, this being elicited mainly by subendocardial and mid-wall fibres. Sinus bradycardia, LV mass, and afterload are independent determinants of supernormal myocardial deformation at rest., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com)

Published
2017
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