Aortic valve sclerosis is associatedwith systemic endothelial dysfunction

AbstractObjectivesWe sought to examine the association between aortic valve sclerosis (AVS) and systemic endothelial manifestations of the atherosclerotic process.BackgroundClinical and experimental studies suggest that AVS is a manifestation of the atherosclerotic process. Systemic endothelial dysfunction is an early sign of the atherosclerotic process and can be assessed by ultrasonography of the brachial artery.MethodsA total of 102 in-hospital patients (76 men; mean age 63.5 ± 9.7 years) referred to the stress echocardiography laboratory underwent: 1) transthoracic echocardiography, with specific assessment of AVS (thickened valve leaflets with a transaortic flow velocity <2.5 m/s); 2) stress echocardiography; 3) coronary angiography, with evaluation of the Duke score (from 0 [normal] to 100 [most severe disease]); and 4) an endothelial function study, with assessment of endothelium-dependent, post-ischemic, flow-mediated dilation (FMD).ResultsAortic valve sclerosis was present in 35 patients (group I) and absent in 67 (group II). Groups I and II were similar in terms of the frequency of stress-induced wall motion abnormalities (35.3% vs. 19.4%, p = NS) and the angiographic Duke score (33.8 ± 28.6 vs. 35.2 ± 29.1, p = NS). Patients with AVS showed a markedly lower FMD than those without AVS (2.2 ± 3.5% vs. 5.3 ± 5.3%, p < 0.01). On multivariate analysis, only FMD was highly predictive of AVS, with an odds ratio of 1.18 for each percent decrease in FMD (95% confidence interval 1.05 to 1.32; p = 0.01).ConclusionsAortic valve stenosis is associated with systemic endothelial dysfunction. This observation may provide a mechanistic insight into the emerging association between AVS and cardiovascular events

The prognostic value of ultrasound lung comets in patients with pulmonary hypertension

Background: Ultrasound Lung Comets (ULCs) consist of multiple comet tails originating from thickened interlobular septa, due to water or connective tissue accumulation. Therefore they are detectable in patients with several lung diseases. Aim: To assess the prognostic value of ULCs in patients with pulmonary hypertension. Materials and methods: 33 in-hospital patients (age 67?13 years, 16 females) admitted to the Pneumology Division of Clinical Physiology in Pisa with diagnosis of idiopathic or secondary pulmonary hypertension were evaluated upon admission with a comprehensive 2D and Doppler echocardiography, and chest sonography with ULCs assessment. A patient ULC score was obtained by summing the number of comets from each of the scanning spaces in the anterior right and left hemithorax, from second to fifth intercostal spaces. By echocardiography, we measured Tricuspid Annular Plane Systolic Excursion (TAPSE) as an index of right ventricular function, and Pulmonary Artery Systolic Pressure (PASP) from tricuspid regurgitant jet velocity. Results: During the follow-up, 16 events occurred: 4 deaths, 12 new admission for the worsening of symptoms or respiratory function. A ROC analysis identified 14 ULCs as the best diagnostic cut-off to predict events with 94 % sensitivity and 71 % specificity. The 9-months event-free survival was higher in patients with no ULCs and lower in patients with ULCs (see Figure). There was a weak significant correlation between ULCs and PAPs (r=.541, p<.001) and no correlation between ULCs and TAPSE (r=.088, p=ns). Conclusion: ULCs are a simple, user-friendly, radiation-free bedside sign of thickened lung interlobular septa, adding a useful information for straightforward prognostic stratification of patients with pulmonary hypertension

Valve disease in cardiac amyloidosis: an echocardiographic score

Cardiac amyloidosis (CA) may affect all cardiac structures, including the valves. From 423 patients undergoing a diagnostic workup for CA we selected 2 samples of 20 patients with amyloid transthyretin (ATTR-) or light-chain (AL-) CA, and age- and sex-matched controls. We chose 31 echocardiographic items related to the mitral, aortic and tricuspid valves, giving a value of 1 to each abnormal item. Patients with ATTR-CA displayed more often a shortened/hidden and restricted posterior mitral valve leaflet (PMVL), thickened mitral chordae tendineae and aortic stenosis than those with AL-CA, and less frequent PMVL calcification than matched controls. Score values were 15.8 (13.6-17.4) in ATTR-CA, 11.0 (9.3-14.9) in AL-CA, 12.8 (11.1-14.4) in ATTR-CA controls, and 11.0 (9.1-13.0) in AL-CA controls (p = 0.004 for ATTR- vs. AL-CA, 0.009 for ATTR-CA vs. their controls, and 0.461 for AL-CA vs. controls). Area under the curve values to diagnose ATTR-CA were 0.782 in patients with ATTR-CA or matched controls, and 0.773 in patients with LV hypertrophy. Patients with ATTR-CA have a prominent impairment of mitral valve structure and function, and higher score values. The valve score may help identify patients with ATTR-CA among patients with CA or unexplained hypertrophy

Spectroscopic characterization of the protocluster of galaxies around 7C 1756+6520 at z - 1.4

The aim of this paper is the spectroscopic study of 13 galaxies belonging to the field of the protocluster associated with the radio galaxy (RG) 7C 1756+6520 at z = 1.4156. In particular, we focus on the characterization of the nuclear activity. This analysis has been performed on rest-frame optical spectra taken with LBT-LUCI. The spectral coverage allowed us to observe emission lines such as Halpha, Hbeta, [Oiii]5007 A, and [Nii]6583 A at the z of the central RG. We observed the central part of the protocluster, which is suitable to include the radio galaxy, several spectroscopically confirmed AGN belonging to the protocluster, and other objects that might be members of the protocluster. For four previously identified protocluster members, we derived the redshift by detecting emission lines that have never detected before for these galaxies. The stacked spectrum of the galaxies in which we detected the [Oiii]5007 A emission line revealed the presence of the second line of the [Oiii] doublet at 4959 A and of Hbeta, which confirms that they belong to the protocluster. By collecting all members identified so far in this work and other members from the literature, we defined 31 galaxies, including the central RG, around z = 1.4152 +/- 0.056, corresponding to peculiar velocities <~5000 km/s with respect to the RG. The PV phase-space diagram suggests that 3 protocluster AGN and the central RG might be a virialized population that has been coexisting for a long time in the densest core region of this forming structure. This protocluster is characterized by a high fraction of AGN (23%). For one of them, AGN1317, we produced 2 BPT diagrams. The high fraction of AGN and their distribution within the protocluster seem to be consistent with predictions of some theoretical models on AGN growth and feedback.Comment: Accepted for publication in A&A, 17 pages, 8 Figures, 2 Tables. Revised versio

Left ventricular outflow tract velocity-time integral improves outcome prediction in patients with secondary mitral regurgitation.

peer reviewedAIMS: Left ventricular outflow velocity-time integral (LVOT-VTI) has been shown to improve outcome prediction in different patients' subsets, with or without heart failure (HF). Nevertheless, the prognostic value of LVOT-VTI in patients with HF and secondary mitral regurgitation (MR) has never been investigated so far. Therefore, in the present study, we aimed to assess the prognostic value different metrics of LV forward output, including LVOT-VTI, in HF patients with secondary MR. METHODS AND RESULTS: Consecutive patients with HF and moderate-to-severe/severe secondary MR and systolic dysfunction (i.e., left ventricular ejection fraction [LVEF] <50%) were retrospectively selected and followed-up for the primary endpoint of cardiac death. Out of the 287 patients analyzed (aged 74 ± 11 years, 70% men, 46% ischemic etiology, mean LVEF 30 ± 9%, mean LVOT-VTI 20 ± 5 cm), 71 met the primary endpoint over a 33-month median follow-up (16-47 months). Patients with an LVOT-VTI ≤17 cm (n = 96, 32%) showed the greatest risk of cardiac death (Log Rank 44.3, p < 0.001) and all-cause mortality (Log rank 8.6, p = 0.003). At multivariable regression analysis, all the measures of LV forward volume (namely LVOT-VTI, stroke volume index, cardiac output, and cardiac index) were predictors of poor outcomes. Among these, LVOT-VTI was the most accurate in risk prediction (univariable C-statistics 0.70 [95%CI 0.64-0.77]). CONCLUSION: Left ventricular forward output, noninvasively estimated through LVOT-VTI, improves outcome prediction in HF patients with low LVEF and secondary MR

Valve disease in cardiac amyloidosis: an echocardiographic score

: Cardiac amyloidosis (CA) may affect all cardiac structures, including the valves. From 423 patients undergoing a diagnostic workup for CA we selected 2 samples of 20 patients with amyloid transthyretin (ATTR-) or light-chain (AL-) CA, and age- and sex-matched controls. We chose 31 echocardiographic items related to the mitral, aortic and tricuspid valves, giving a value of 1 to each abnormal item. Patients with ATTR-CA displayed more often a shortened/hidden and restricted posterior mitral valve leaflet (PMVL), thickened mitral chordae tendineae and aortic stenosis than those with AL-CA, and less frequent PMVL calcification than matched controls. Score values were 15.8 (13.6-17.4) in ATTR-CA, 11.0 (9.3-14.9) in AL-CA, 12.8 (11.1-14.4) in ATTR-CA controls, and 11.0 (9.1-13.0) in AL-CA controls (p = 0.004 for ATTR- vs. AL-CA, 0.009 for ATTR-CA vs. their controls, and 0.461 for AL-CA vs. controls). Area under the curve values to diagnose ATTR-CA were 0.782 in patients with ATTR-CA or matched controls, and 0.773 in patients with LV hypertrophy. Patients with ATTR-CA have a prominent impairment of mitral valve structure and function, and higher score values. The valve score may help identify patients with ATTR-CA among patients with CA or unexplained hypertrophy

Multi-chamber speckle tracking imaging and diagnostic value of left atrial strain in cardiac amyloidosis

Aims: Cardiac amyloidosis (CA) affects the four heart chambers, which can all be evaluated through speckle-tracking echocardiography (STE). Methods and results: We evaluated 423 consecutive patients screened for CA over 5 years at two referral centres. CA was diagnosed in 261 patients (62%) with either amyloid transthyretin (ATTR; n = 144, 34%) or amyloid light-chain (AL; n = 117, 28%) CA. Strain parameters of all chambers were altered in CA patients, particularly those with ATTR-CA. Nonetheless, only peak left atrial longitudinal strain (LA-PALS) displayed an independent association with the diagnosis of CA or ATTR-CA beyond standard echocardiographic variables and cardiac biomarkers (Model 1), or with the diagnosis of ATTR-CA beyond the validated IWT score in patients with unexplained left ventricular (LV) hypertrophy. Patients with the most severe impairment of LA strain were those most likely to have CA or ATTR-CA. Specifically, LA-PALS and/or LA-peak atrial contraction strain (PACS) in the first quartile (i.e. LA-PALS &lt;6.65% and/or LA-PACS &lt;3.62%) had a 3.60-fold higher risk of CA, and a 3.68-fold higher risk of ATTR-CA beyond Model 1. Among patients with unexplained LV hypertrophy, those with LA-PALS or LA-PACS in the first quartile had an 8.76-fold higher risk for CA beyond Model 1, and a 2.04-fold higher risk of ATTR-CA beyond the IWT score. Conclusions: Among STE measures of the four chambers, PALS and PACS are the most informative ones to diagnose CA and ATTR-CA. Patients screened for CA and having LA-PALS and/or LA-PACS in the first quartile have a high likelihood of CA and ATTR-CA