Background: Cardiology divisions reshaped their activities during the coronavirus disease 2019 (C... more Background: Cardiology divisions reshaped their activities during the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to analyze the organization of echocardiographic laboratories and echocardiography practice during the second wave of the COVID-19 pandemic in Italy, and the expectations for the post-COVID era. Methods: We analyzed two different time periods: the month of November during the second wave of the COVID-19 pandemic (2020) and the identical month during 2019 (November 2019). Results: During the second wave of the COVID-19 pandemic, the hospital activity was partially reduced in 42 (60%) and wholly interrupted in 3 (4%) echocardiographic laboratories, whereas outpatient echocardiographic activity was partially reduced in 41 (59%) and completely interrupted in 7 (10%) laboratories. We observed an important change in the organization of activities in the echocardiography laboratory which reduced the operator-risk and improved self-protection of operators by u...
Chronic myeloid leukemia (CML) is a myeloproliferative disorder characterized by neoplastic trans... more Chronic myeloid leukemia (CML) is a myeloproliferative disorder characterized by neoplastic transformation of pluripotent cells due to a typical cytogenetic and molecular mutation known as Philadelphia (Ph) chromosome. In 2001, the introduction of the tyrosine kinasis inhibitor (TKI) imatinib as a therapeutic strategy for CML with PH chromosome mutation represented an important step towards treatment of these patients, and nowadays, this drug represents the gold therapeutic standard in this clinical setting. A second generation of TKIs (dasatinib, nilotinib, and bosutinib) showed an effective action in all patients with mutations resistant to imatinib. Ponatinib is a third-generation TKI and is the only inhibitor with activity against T3151 mutation. The impact of ponatinib on cardiovascular events was first evaluated in the PACE trial. We therefore report and discuss most relevant evidence currently available on cardiovascular events associated with the use of ponatinib. Though many exams can be used for diagnosis and follow-up of this kind of cardiotoxicity, echocardiography seems to have a pivotal role thanks to its feasibility, availability, and low cost.
The effectiveness trial "Stress echo (SE) 2020" evaluates novel applications of SE in a... more The effectiveness trial "Stress echo (SE) 2020" evaluates novel applications of SE in and beyond coronary artery disease. The core protocol also includes 4-site simplified scan of B-lines by lung ultrasound, useful to assess pulmonary congestion. To provide web-based upstream quality control and harmonization of B-lines reading criteria. 60 readers (all previously accredited for regional wall motion, 53 B-lines naive) from 52 centers of 16 countries of SE 2020 network read a set of 20 lung ultrasound video-clips selected by the Pisa lab serving as reference standard, after taking an obligatory web-based learning 2-h module ( http://se2020.altervista.org ). Each test clip was scored for B-lines from 0 (black lung, A-lines, no B-lines) to 10 (white lung, coalescing B-lines). The diagnostic gold standard was the concordant assessment of two experienced readers of the Pisa lab. The answer of the reader was considered correct if concordant with reference standard reading ±1 (fo...
IntroductIon Along with the growth of patients at cardiovascular risk, a new wave is hitting the ... more IntroductIon Along with the growth of patients at cardiovascular risk, a new wave is hitting the world of health care. Over the recent decade, noninvasive and invasive imaging technologies have been protagonists of a dramatic evolution. This process, as a Tsunami, may overwhelm the way the physicians were used to work until now [Figure 1]. The greater availability and reliability of current imaging modalities to reveal the details of various cardiac structures and pathophysiology has made the evaluation of cardiovascular disease multimodal. Hence, along with traditional imaging modalities, such as single photon computed emission tomography (SPECT) or tissue Doppler imaging and two-dimensional echocardiography (2DE), new technologies emerge in the scene such as deformation/ speckle tracking imaging (strain and strain rate) and three-dimensional echocardiography (3DE); miniaturized or handheld cardiovascular ultrasound machine; positron emission tomography (PET) and computed tomography (CT), and cardiac magnetic resonance (CMR) as well as the combination of them, resulting in the so-called “fusion imaging.”
The trial "Stress Echo (SE) 2020" evaluates novel applications of SE beyond coronary ar... more The trial "Stress Echo (SE) 2020" evaluates novel applications of SE beyond coronary artery disease. The aim of the study was control quality and harmonize reading criteria. One reader from 78 centers of the SE 2020 network asked for credentials to read a set of 20 SE video-clips selected by the core lab. All aspiring centers met the pre-requisite of high-volume and the years of experience in SE ranged from 5 to 31years (mean value 18years). The diagnostic gold standard was a reading by the core lab. The a priori determined pass threshold was 18/20 (≥90%). Of the initial 78 who started, 57 completed the first attempt: individual readers' score on first attempt ranged from 07/20 to 20/20 (accuracy from 35% to 100%, mean 78.7±13%) and 44 readers passed it. There was a very poor correlation between years of experience and the reader's score on first attempt (r=-0.161, p=0.231). Of the 13 readers who failed the first attempt, 12 took it again after the web-based sessio...
Fabry disease (FD) is an inherited metabolic disorder caused by partial or full inactivation of t... more Fabry disease (FD) is an inherited metabolic disorder caused by partial or full inactivation of the lysosomal hydrolaseα-galactosidase A (α-GAL). The impairment ofα-GAL results in the accumulation of undegraded glycosphingolipids in lysosomes and subsequent cell and microvascular dysfunctions. This study reports the clinical, biochemical, and molecular characterization of 15 members of the same family. Eight members showed the exonic mutation M51I in the GLA gene, a disease-causing mutation associated with the atypical phenotype. The clinical history of this family highlights a wide phenotypic variability, in terms of involved organs and severity. The phenotypic variability of two male patients is not related to differences inα-GAL enzymatic activity: though both have no enzymatic activity, the youngest shows severe symptoms, while the eldest is asymptomatic. It is noticeable that for two female patients with the M51I mutation the initial clinical diagnosis was different from FD. On...
The preoperative cardiac evaluation of a patient who undergoes noncardiac surgery is a very impor... more The preoperative cardiac evaluation of a patient who undergoes noncardiac surgery is a very important problem, particularly for diagnostic tools used. Aim of this study is to test the usefulness of 4 most used clinical indexes for the evaluation of cardiovascular risk in the management of patients who undergo noncardiac surgery. The study is based on a retrospective analysis of a group of 45 patients, who underwent extracardiac surgery in biennium 2002-2004. The cardiovascular risk scores of Goldman, Detsky, Lee and Eagle were used; a comparison among the different scores was done. Six out of our 45 patients had perioperative cardiovascular complications, and 4 of them died. The Eagle and Lee scores were more predictive than Goldman and Detsky ones. About the 13 echocardiographic tests recorded, no one of them modified the patient preoperative risk. In the preoperative assessment of risk, the Eagle score was more useful than the others ones and improved the negative predictive value...
Inflammatory abdominal aortic aneurysm (IAAA) is defined as an unusually thickened aneurysmatic w... more Inflammatory abdominal aortic aneurysm (IAAA) is defined as an unusually thickened aneurysmatic wall, encircled by a wide dense perianeurysmal and/or retroperitoneal fibrosis with adjacent tissues adhesion, and is now considered as an extreme shape of the common phlogistic process involved in atherosclerotic plaque formation. Latest studies demonstrated that inflammation plays an important role in coronary disease and in other atherosclerosis manifestations. We introduce the clinical case of a patient with IAAA who developed an acute myocardial infarction 6 months after the surgical procedure on the aorta. Through a literature review about IAAA we stress the clinical usefulness of the inflammatory markers as independent predictors in management of patients with coronary disease and we present the hypothesis, related to the introduced case, of an advanced coronary disease, aggravated or clinically revealed after the cytokine storm related to important localized inflammatory engagemen...
Italian heart journal. Supplement : official journal of the Italian Federation of Cardiology, 2005
Strain rate (SR) is considered as an accurate index of myocardial contractility, capable of diffe... more Strain rate (SR) is considered as an accurate index of myocardial contractility, capable of differentiating regional myocardial contractions from hypokinetic ones. It is not dependent on adjacent myocardial motion or heart translation. Clinical studies proved this method to be useful in case of heart disease but detailed analyses, homogeneous normal reference parameters, and studies about atrial myocardium are still scanty. The aim of this study was to evaluate longitudinal SR of the left myocardial ventricle and atrium in normal subjects. Nineteen normal subjects were examined with tissue Doppler imaging; SR values were obtained off-line on images stored by internal software using the curved M-mode of the left ventricle and atrium. Mean SR values were obtained at the distal, mid, and basal left ventricular segments of the septum and lateral wall, and at the basal and distal left atrial segments of the septum and lateral wall. Ventricular SR values showed a negative systolic peak, t...
AimsFabry disease (FD) is a rare X‐linked genetic disorder caused by the deficiency or absent act... more AimsFabry disease (FD) is a rare X‐linked genetic disorder caused by the deficiency or absent activity of lysosomal α‐galactosidase A. Cardiovascular remodelling is a hallmark of FD. The present study aimed to comprehensively evaluate the cardiac, vascular and microvascular status in a population of patients with genetic mutations for FD without left ventricular hypertrophy (LVH).Methods and resultsThis study includes subjects carrying genetic mutations for FD (Fabry disease mutation‐carrier, FDMC) without LVH (n = 19). A group of control subjects (n = 19) matched for age, sex, body mass index and cardiovascular risk factors were also included. All subjects underwent echocardiography, carotid ultrasound scan, endothelial flow‐mediated dilatation (FMD) and nailfold capillaroscopy (NFC) assessment. When compared to the subjects in the control group, FDMC patients showed significantly lower mean values of systolic myocardial velocity (7.33 ± 1.28 vs. 10.08 ± 1.63 cm/s, p < 0.0001), ...
Background: Cardiology divisions reshaped their activities during the coronavirus disease 2019 (C... more Background: Cardiology divisions reshaped their activities during the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to analyze the organization of echocardiographic laboratories and echocardiography practice during the second wave of the COVID-19 pandemic in Italy, and the expectations for the post-COVID era. Methods: We analyzed two different time periods: the month of November during the second wave of the COVID-19 pandemic (2020) and the identical month during 2019 (November 2019). Results: During the second wave of the COVID-19 pandemic, the hospital activity was partially reduced in 42 (60%) and wholly interrupted in 3 (4%) echocardiographic laboratories, whereas outpatient echocardiographic activity was partially reduced in 41 (59%) and completely interrupted in 7 (10%) laboratories. We observed an important change in the organization of activities in the echocardiography laboratory which reduced the operator-risk and improved self-protection of operators by u...
Chronic myeloid leukemia (CML) is a myeloproliferative disorder characterized by neoplastic trans... more Chronic myeloid leukemia (CML) is a myeloproliferative disorder characterized by neoplastic transformation of pluripotent cells due to a typical cytogenetic and molecular mutation known as Philadelphia (Ph) chromosome. In 2001, the introduction of the tyrosine kinasis inhibitor (TKI) imatinib as a therapeutic strategy for CML with PH chromosome mutation represented an important step towards treatment of these patients, and nowadays, this drug represents the gold therapeutic standard in this clinical setting. A second generation of TKIs (dasatinib, nilotinib, and bosutinib) showed an effective action in all patients with mutations resistant to imatinib. Ponatinib is a third-generation TKI and is the only inhibitor with activity against T3151 mutation. The impact of ponatinib on cardiovascular events was first evaluated in the PACE trial. We therefore report and discuss most relevant evidence currently available on cardiovascular events associated with the use of ponatinib. Though many exams can be used for diagnosis and follow-up of this kind of cardiotoxicity, echocardiography seems to have a pivotal role thanks to its feasibility, availability, and low cost.
The effectiveness trial "Stress echo (SE) 2020" evaluates novel applications of SE in a... more The effectiveness trial "Stress echo (SE) 2020" evaluates novel applications of SE in and beyond coronary artery disease. The core protocol also includes 4-site simplified scan of B-lines by lung ultrasound, useful to assess pulmonary congestion. To provide web-based upstream quality control and harmonization of B-lines reading criteria. 60 readers (all previously accredited for regional wall motion, 53 B-lines naive) from 52 centers of 16 countries of SE 2020 network read a set of 20 lung ultrasound video-clips selected by the Pisa lab serving as reference standard, after taking an obligatory web-based learning 2-h module ( http://se2020.altervista.org ). Each test clip was scored for B-lines from 0 (black lung, A-lines, no B-lines) to 10 (white lung, coalescing B-lines). The diagnostic gold standard was the concordant assessment of two experienced readers of the Pisa lab. The answer of the reader was considered correct if concordant with reference standard reading ±1 (fo...
IntroductIon Along with the growth of patients at cardiovascular risk, a new wave is hitting the ... more IntroductIon Along with the growth of patients at cardiovascular risk, a new wave is hitting the world of health care. Over the recent decade, noninvasive and invasive imaging technologies have been protagonists of a dramatic evolution. This process, as a Tsunami, may overwhelm the way the physicians were used to work until now [Figure 1]. The greater availability and reliability of current imaging modalities to reveal the details of various cardiac structures and pathophysiology has made the evaluation of cardiovascular disease multimodal. Hence, along with traditional imaging modalities, such as single photon computed emission tomography (SPECT) or tissue Doppler imaging and two-dimensional echocardiography (2DE), new technologies emerge in the scene such as deformation/ speckle tracking imaging (strain and strain rate) and three-dimensional echocardiography (3DE); miniaturized or handheld cardiovascular ultrasound machine; positron emission tomography (PET) and computed tomography (CT), and cardiac magnetic resonance (CMR) as well as the combination of them, resulting in the so-called “fusion imaging.”
The trial "Stress Echo (SE) 2020" evaluates novel applications of SE beyond coronary ar... more The trial "Stress Echo (SE) 2020" evaluates novel applications of SE beyond coronary artery disease. The aim of the study was control quality and harmonize reading criteria. One reader from 78 centers of the SE 2020 network asked for credentials to read a set of 20 SE video-clips selected by the core lab. All aspiring centers met the pre-requisite of high-volume and the years of experience in SE ranged from 5 to 31years (mean value 18years). The diagnostic gold standard was a reading by the core lab. The a priori determined pass threshold was 18/20 (≥90%). Of the initial 78 who started, 57 completed the first attempt: individual readers' score on first attempt ranged from 07/20 to 20/20 (accuracy from 35% to 100%, mean 78.7±13%) and 44 readers passed it. There was a very poor correlation between years of experience and the reader's score on first attempt (r=-0.161, p=0.231). Of the 13 readers who failed the first attempt, 12 took it again after the web-based sessio...
Fabry disease (FD) is an inherited metabolic disorder caused by partial or full inactivation of t... more Fabry disease (FD) is an inherited metabolic disorder caused by partial or full inactivation of the lysosomal hydrolaseα-galactosidase A (α-GAL). The impairment ofα-GAL results in the accumulation of undegraded glycosphingolipids in lysosomes and subsequent cell and microvascular dysfunctions. This study reports the clinical, biochemical, and molecular characterization of 15 members of the same family. Eight members showed the exonic mutation M51I in the GLA gene, a disease-causing mutation associated with the atypical phenotype. The clinical history of this family highlights a wide phenotypic variability, in terms of involved organs and severity. The phenotypic variability of two male patients is not related to differences inα-GAL enzymatic activity: though both have no enzymatic activity, the youngest shows severe symptoms, while the eldest is asymptomatic. It is noticeable that for two female patients with the M51I mutation the initial clinical diagnosis was different from FD. On...
The preoperative cardiac evaluation of a patient who undergoes noncardiac surgery is a very impor... more The preoperative cardiac evaluation of a patient who undergoes noncardiac surgery is a very important problem, particularly for diagnostic tools used. Aim of this study is to test the usefulness of 4 most used clinical indexes for the evaluation of cardiovascular risk in the management of patients who undergo noncardiac surgery. The study is based on a retrospective analysis of a group of 45 patients, who underwent extracardiac surgery in biennium 2002-2004. The cardiovascular risk scores of Goldman, Detsky, Lee and Eagle were used; a comparison among the different scores was done. Six out of our 45 patients had perioperative cardiovascular complications, and 4 of them died. The Eagle and Lee scores were more predictive than Goldman and Detsky ones. About the 13 echocardiographic tests recorded, no one of them modified the patient preoperative risk. In the preoperative assessment of risk, the Eagle score was more useful than the others ones and improved the negative predictive value...
Inflammatory abdominal aortic aneurysm (IAAA) is defined as an unusually thickened aneurysmatic w... more Inflammatory abdominal aortic aneurysm (IAAA) is defined as an unusually thickened aneurysmatic wall, encircled by a wide dense perianeurysmal and/or retroperitoneal fibrosis with adjacent tissues adhesion, and is now considered as an extreme shape of the common phlogistic process involved in atherosclerotic plaque formation. Latest studies demonstrated that inflammation plays an important role in coronary disease and in other atherosclerosis manifestations. We introduce the clinical case of a patient with IAAA who developed an acute myocardial infarction 6 months after the surgical procedure on the aorta. Through a literature review about IAAA we stress the clinical usefulness of the inflammatory markers as independent predictors in management of patients with coronary disease and we present the hypothesis, related to the introduced case, of an advanced coronary disease, aggravated or clinically revealed after the cytokine storm related to important localized inflammatory engagemen...
Italian heart journal. Supplement : official journal of the Italian Federation of Cardiology, 2005
Strain rate (SR) is considered as an accurate index of myocardial contractility, capable of diffe... more Strain rate (SR) is considered as an accurate index of myocardial contractility, capable of differentiating regional myocardial contractions from hypokinetic ones. It is not dependent on adjacent myocardial motion or heart translation. Clinical studies proved this method to be useful in case of heart disease but detailed analyses, homogeneous normal reference parameters, and studies about atrial myocardium are still scanty. The aim of this study was to evaluate longitudinal SR of the left myocardial ventricle and atrium in normal subjects. Nineteen normal subjects were examined with tissue Doppler imaging; SR values were obtained off-line on images stored by internal software using the curved M-mode of the left ventricle and atrium. Mean SR values were obtained at the distal, mid, and basal left ventricular segments of the septum and lateral wall, and at the basal and distal left atrial segments of the septum and lateral wall. Ventricular SR values showed a negative systolic peak, t...
AimsFabry disease (FD) is a rare X‐linked genetic disorder caused by the deficiency or absent act... more AimsFabry disease (FD) is a rare X‐linked genetic disorder caused by the deficiency or absent activity of lysosomal α‐galactosidase A. Cardiovascular remodelling is a hallmark of FD. The present study aimed to comprehensively evaluate the cardiac, vascular and microvascular status in a population of patients with genetic mutations for FD without left ventricular hypertrophy (LVH).Methods and resultsThis study includes subjects carrying genetic mutations for FD (Fabry disease mutation‐carrier, FDMC) without LVH (n = 19). A group of control subjects (n = 19) matched for age, sex, body mass index and cardiovascular risk factors were also included. All subjects underwent echocardiography, carotid ultrasound scan, endothelial flow‐mediated dilatation (FMD) and nailfold capillaroscopy (NFC) assessment. When compared to the subjects in the control group, FDMC patients showed significantly lower mean values of systolic myocardial velocity (7.33 ± 1.28 vs. 10.08 ± 1.63 cm/s, p < 0.0001), ...
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