Aspetti patogenetici comuni tra stenosi aortica calcifica e aterosclerosi: ruolo del recettore dei prodotti di glicosilazione avanzata

Clinical and experimental studies identified several similarities between calcific aortic stenosis and atherosclerosis, suggesting the involvement of similar pathogenic pathways in both conditions.There are severalmolecules involved in regulating the development, progression and calcification of the valve sclerosis and in growth and complications of atherosclerotic plaque. Among these molecules, the receptor of advanced glycation end-products , a multi-ligand receptor involved in the pathogenesis of several degenerative, inflammatory and immune diseases, could have an important regulatory role in both diseases and therefore worthy of study as a potential target therapeutic for both conditions.Studi sperimentali e clinici hanno individuato molte analogie fra la stenosi aortica calcifica e l\u27aterosclerosi,suggerendo una via patogenetica comune. Esistono diverse molecole coinvolte nella regolazione dello sviluppo, progressione della sclerosi e calcificazione della valvola,cos? come nella crescita e complicanze della placca aterosclerotica. Tra queste molecole, il recettore per i prodotti di glicosilazione avanzata, un recettoremulti-ligando che ? coinvolto nella patogenesi di diversemalattie degenerative infiammatorie e immunitarie, potrebbe avere un ruolo regolatore importante in entrambe le malattie, rappresentando un potenziale bersaglio terapeutico in ambedue le condizioni

Cardiac calcification by transthoracic echocardiography in patients with known or suspected coronary artery disease

OBJECTIVES: To estimate the correlation between the total heart calcification score index (CSI), assessed by echocardiography, left ventricle mass index (LVMI), Framingham risk score (FRS), and angiographically assessed coronary artery disease (CAD). BACKGROUND: Aortic valve and root sclerosis (AVS, ARS) and mitral annular calcium (MAC) detected by echocardiography have been associated with atherosclerosis. FRS is recommended for estimation of total coronary heart disease risk over the course of 10 years. The anatomic extent of CAD can be assessed with coronary angiography. Total and cardiovascular mortality risk increases with increasing LVMI. METHODS: 167 consecutive in-hospital patients (mean age 66.6+/-9.7 yrs, 119 men) underwent: 1) complete transthoracic echocardiography (TTE), with CSI assessment (from 0=normal to 10=diffuse calcification of aortic valve, mitral annulus and aortic root), 2) the FRS evaluation (FRS</=10=low, FRS>/=11 and </=20=average risk, and a FRS>/=21=high risk), and 3) coronary angiography (with Duke score evaluation, from 0=normal to 100=severe left main disease). RESULTS: The mean CSI of the entire population was 3.94+/-2.1, with a mean of 2.75+/-2 in patients at low risk, with a progressive increase in patients at average risk (4.11+/-2.2), at high risk (4.7+/-1.7), respectively. CSI was associated with the presence of CAD (p=0.003) and the presence of abnormal LVMI (p=0.002). CONCLUSIONS: Echocardiographically assessed CSI is correlated to FRS, Duke score and LVMI and can provide a simple, radiation-free index of cardiovascular risk

Identification of responders to CRT by stress echo: no contractile reserve, no party

Background: Cardiac resynchronization therapy (CRT) is increasingly used, but the identification of "responders" remains challenging. Aim: to assess the value of inotropic reserve during pharmacological echo stress to identify responders. Materials and methods: We enrolled 32 patients (age 69?9 years; 9 females) referred to CRT, all with LV ejection fraction (LVEF) &#8804;35n %, NYHA &#8805;IIb and QRS duration &#8805;130 milliseconds. Twenty-two patients showed echocardiographic criteria for dyssynchrony (at least one of M-mode, Tissue Doppler, or live 3D echo criteria). All patients underwent pharmacological stress echo (dobutamine, up to 40 mcg/Kg/min in 29, dipyridamole 0.84 mg/kg 10 min, in 3). Patients were considered with contractile response if variation of WMSI (from 1=normal, to 4=dyskinetic, 17 segment model of left ventricle) stress-rest (delta WMSI) was &#8805;0.20. "Responders" to CRT were defined at 6 months follow-up as survivors with NYHA class improvement &#8805;1 grade and without new hospital admission for acute heart failure. Results: In the follow-up (median=20 months), 16 patients were responders to CRT (Group I) and 16 non-responders (Group II). Responders showed a wider QRS (I=162?25 vs. II=142 ?27 msec; p .044) and a greater delta WMSI (I=0.34?0.25 vs. II= 0.15?0.18; p=.021). At individual patient analysis, inotropic reserve was more often associated with a favourable clinical outcome (see figure) whereas dyssynchrony criteria by echocardiography were equally present in the two groups (I=12/16 vs. II=10/16, p=ns). In the follow-up there were 5 deaths, all in group II. Conclusion: Patients with contractile reserve during stress echo show a favourable clinical response to CRT. This parameter shifts the focus from electrical (dyssynchrony) to the myocardial substrate of functional response: no muscle, no party

Maternal and Sex Dependency of Insulin Resistance: Longitudinal PET and Echocardiography Study from the Healthy Fetus to the Adult Minipig

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Feasibility of real-time three-dimensional stress echocardiography: pharmacological and semi-supine exercise

<p>Abstract</p> <p>Background</p> <p>Real time three dimensional (RT3D) echocardiography is an accurate and reproducible method for assessing left ventricular shape and function.</p> <p>Aim</p> <p>assess the feasibility and reproducibility of RT3D stress echocardiography (SE) (exercise and pharmacological) in the evaluation of left ventricular function compared to 2D.</p> <p>Methods and results</p> <p>One hundred eleven patients with known or suspected coronary artery disease underwent 2D and RT3DSE. The agreement in WMSI, EDV, ESV measurements was made off-line.</p> <p>The feasibility of RT-3DSE was 67%. The inter-observer variability for WMSI by RT3D echo was higher during exercise and with suboptimal quality images (good: k = 0.88; bad: k = 0.69); and with high heart rate both for pharmacological (HR < 100 bpm, k = 0.83; HR ≥ 100 bpm, k = 0.49) and exercise SE (HR < 120 bpm, k = 0.88; HR ≥ 120 bpm, k = 0.78). The RT3D reproducibility was high for ESV volumes (0.3 ± 14 ml; CI 95%: -27 to 27 ml; p = n.s.).</p> <p>Conclusions</p> <p>RT3DSE is more vulnerable than 2D due to tachycardia, signal quality, patient decubitus and suboptimal resting image quality, making exercise RT3DSE less attractive than pharmacological stress.</p

Quality control of B-lines analysis in stress Echo 2020

Background 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. Purpose To provide web-based upstream quality control and harmonization of B-lines reading criteria. Methods 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 (for instance, reference standard reading of 5 B-lines; correct answer 4, 5, or 6). The a priori determined pass threshold was 18/20 (≥ 90%) with R value (intra-class correlation coefficient) between reference standard and recruiting center) > 0.90. Inter-observer agreement was assessed with intra-class correlation coefficient statistics. Results All 60 readers were successfully accredited: 26 (43%) on first, 24 (40%) on second, and 10 (17%) on third attempt. The average diagnostic accuracy of the 60 accredited readers was 95%, with R value of 0.95 compared to reference standard reading. The 53 B-lines naive scored similarly to the 7 B-lines expert on first attempt (90 versus 95%, p = NS). Compared to the step-1 of quality control for regional wall motion abnormalities, the mean reading time per attempt was shorter (17 ± 3 vs 29 ± 12 min, p < .01), the first attempt success rate was higher (43 vs 28%, p < 0.01), and the drop-out of readers smaller (0 vs 28%, p < .01). Conclusions Web-based learning is highly effective for teaching and harmonizing B-lines reading. Echocardiographers without previous experience with B-lines learn quickly.info:eu-repo/semantics/publishedVersio

Therapy and futility in interventional cardiology: an alternative way to reduce the complexity of the percutaneous closure of interatrial shunts

Background. The interatrial communications that could be treated by percutaneous approach are represented by the patent foramen ovale (PFO) and secundum type of atrial septum defect (ASD). The indications to ASD closure are well defined by the international guidelines for the management of the congenital heart diseases. The management of PFO related to thromboembolic events is still controversial, despite an increase in interventional closure procedures with newer devices. Aim. The aim of this study was to identify an alternative approach to the standard percutaneous closure procedure of the interatrial shunts, in order to reduce the intraprocedural risk. Methods: Between 2005 and 2015, a total of 176 patients underwent percutaneous PFO and ASDs closure in our institution. A contemporary and retrospective of the interventional reports identified 3 groups of patients: Group A, represented by the patients treated under general anaesthesia with transesophageal echocardiographic (TEE) guidance; Group B, represented by the patients treated with intracardiac echocardiography (ICE); Group C, represented by the patients who were treated without general anaesthesia, and under TEE guidance. Data on the pre-procedural evaluation (clinic, imaging), on percutaneous procedure and the ultrasound controls during the first 6 months after the procedure were collected. Results: A total of 176 pts were enrolled (mean age 49±12.2 yrs, 68 females) and distributed in 3 groups: Group A: 53 pts, Group B: 55 pts, and Group C 68 pts. The main indications to perform the interatrial shunt closure was represented by TIA in 91 pts (51.7%), stroke in 64 pts (36.3%), migraine in 15 (8.5%), increased right heart chambers in 11 pts (6.2%). Successful device deployment was obtained in 172 pts (97.7%). There was a statistically significant difference of total procedure time between the groups: 82.5±16.6 min for Group A, 65.8±22.7 min for Group B, and 59.9±25.4 min for Group C (p= .06 Group B vs. Group A; p< .001 Group C vs. Group A; p= n.s. Group B vs. Group C). The total radiation exposure was higher in Group A (3995.6±4486 cGy/cm2) compared to Group B (2223.4±2540 cGy/cm2, p= .02) and Group C (1452.6±1158 cGy/cm2, p< .0001). The dose of contrast agent was significantly lower in Group C (15.8±18 ml) than in the other groups (Group A: 39.6±35 ml, p< .0001, Group B: 25.4±18.4, p= .01). No major intraprocedural complications were observed. At the 6 months follow-up assessed by transcranial Doppler, a minimal shunt with the appearance of late micromebolic signals was observed in 5 cases (1 in Group A and 2 in each of the other groups), with no clinical impact. Conclusion: To our knowledge this is the first study that demonstrates that the percutaneous closure of interatrial shunts is feasible and safe in conscious patients under transesophageal echocardiographic guidance. This “alternative approach” helps to reduce the intraprocedural risk of complications and the complexity of the procedure, reducing the total procedure time, the contrast agent dose and total radiation exposure