Il rapporto Massa Ventricolare Sinistra/Volume Telediastolico mediante Ecocardiografia tridimensionale in pazienti ipertesi di nuova diagnosi: rapporto tra la geometria ventricolare sinistra e la gittata sistolica

Background: Il rapporto Massa Ventricolare Sinistra/Volume tele-diastolico (LVM/EDV) è un indice per la valutazione della geometria ventricolare sinistra, validato dalla risonanza magnetica nucleare, nell’ipertensione arteriosa. Scopo dello studio è quello di valutare il fenotipo ecocardiografico in relazione al rapporto LVM/EDV analizzato mediante ecocardiografia tridimensionale real-time ed esaminare la relazione tra il rapporto LVM/EDV e la gittata sistolica in pazienti ipertesi di nuova diagnosi. Metodi: 104 pazienti ipertesi di nuova diagnosi (M/F=68/36; 42±15 anni di età, pressione arteriosa (PA)= 143.5±16.8/89.5±9.2mmHg sottoposti ad eco tridimensionale con la valutazione dei volumi tele-diastolico (LVEDV3D) e tele-sistolico (LVESV3D) del ventricolo sinistro, della frazione di eiezione (FE), gittata (CO) e massa indicizzata (LVMi3D). La popolazione di studio è stata suddivisa in due gruppi in base al rapporto LVM/EDV: LVM/EDV≥0.90 (geometria concentrica del ventricolo sinistro, n=91) e LVM/EDV<0.90 (n=13,normale geometria del ventricolo sinistro), usando come cut-off point il limite inferiore dell’intervallo di confidenza del rapporto LVM/EDV medio in una nostra popolazione di soggetti sani normotesi. Risultati: I due gruppi erano sovrapponibili per indice di massa corporea, frequenza cardiaca e PA. Ipertrofia ventricolare sinistra derivata dall’ecocardiografia bidimensionale era presente nel 4.9% dei pazienti (n=5/104). I pazienti con LVM/EDV≥0.90 erano più anziani (p<0.0001) e mostravano valori più bassi di LVEDV3D e LVESV3D (entrambi p<0.0001 rispetto ai pazienti con LVM/EDV<0.90). Nessuna differenza significativa è stata trovata per la FEeperLVMi3D. La gittata sistolica (p<0.0001) e CO (p=0.003) sono risultati significativamente più bassi nei pazienti con LVM/EDV≥0.90. La gittata sistolica ha mostrato una correlazione inversa con LVM/EDV (r=-0.79; p<0.0001) e una correlazione positiva con LVM3D (r=0.52) e LVEDV3D (r=0.93) (entrambi p<0.0001). Mediante una analisi di regressione lineare multipla condotta sull’ intera popolazione di studio, in seguito a correzione per età, frequenza cardiaca, PA media e indice di massa corporea, il rapporto LVM/EDV e la gittata sistolica sono risultati essere indipendentemente associati (beta =-0.675; p<0.0001). Conclusioni: In pazienti ipertesi di nuova diagnosi con geometria concentrica la riduzione della gittata sistolica rappresenta un marker di disfunzione miocardica molto precoce ed è indipendentemente e negativamente associata al rapporto LVM/EDV

Improved cardiovascular diagnostic accuracy by pocket size imaging device in non-cardiologic outpatients: the NaUSiCa (Naples Ultrasound Stethoscope in Cardiology) study

Miniaturization has evolved in the creation of a pocket-size imaging device which can be utilized as an ultrasound stethoscope. This study assessed the additional diagnostic power of pocket size device by both experts operators and trainees in comparison with physical examination and its appropriateness of use in comparison with standard echo machine in a non-cardiologic population

Cancer therapy and cardiotoxicity: The need of serial Doppler echocardiography

Cancer therapy has shown terrific progress leading to important reduction of morbidity and mortality of several kinds of cancer. The therapeutic management of oncologic patients includes combinations of drugs, radiation therapy and surgery. Many of these therapies produce adverse cardiovascular complications which may negatively affect both the quality of life and the prognosis. For several years the most common noninvasive method of monitoring cardiotoxicity has been represented by radionuclide ventriculography while other tests as effort EKG and stress myocardial perfusion imaging may detect ischemic complications, and 24-hour Holter monitoring unmask suspected arrhythmias. Also biomarkers such as troponine I and T and B-type natriuretic peptide may be useful for early detection of cardiotoxicity. Today, the widely used non-invasive method of monitoring cardiotoxicity of cancer therapy is, however, represented by Doppler-echocardiography which allows to identify the main forms of cardiac complications of cancer therapy: left ventricular (systolic and diastolic) dysfunction, valve heart disease, pericarditis and pericardial effusion, carotid artery lesions. Advanced ultrasound tools, as Integrated Backscatter and Tissue Doppler, but also simple ultrasound detection of "lung comet" on the anterior and lateral chest can be helpful for early, subclinical diagnosis of cardiac involvement. Serial Doppler echocardiographic evaluation has to be encouraged in the oncologic patients, before, during and even late after therapy completion. This is crucial when using anthracyclines, which have early but, most importantly, late, cumulative cardiac toxicity. The echocardiographic monitoring appears even indispensable after radiation therapy, whose detrimental effects may appear several years after the end of irradiation

Resolution of angina pectoris and improvement of the coronary flow reserve after ranolazine treatment in a woman with isolated impaired coronary microcirculation

In a 61-year-old woman with well controlled arterial hypertension, hypercholesterolemia, and smoke and suffering from recurrent angina pectoris despite angiographically normal epicardial coronary vessels and maximal therapy, the replacement of nitrates with novel antiangina drug ranolazine, after 6-month therapy, induced a complete relief of angina and a relevant rising of the transthoracic Doppler-derived coronary flow reserve (CFR). The present clinical case underlines therefore how in patients with chronic ischemic heart disease without epicardial coronary stenosis ranolazine can induce an improvement till the complete solution of the angina symptoms and a substantial increase of CFR as expression of the enhancement of the microvascular coronary function. The improvement of both symptoms and coronary microvascular function is strictly linked to the mechanism of action of the drug. Ranolazine induces in fact a reduction of the intracellular late sodium current that leads to a reduction of the intracellular calcium concentration thus producing a better myocardial diastolic relaxation process which in its turns enhances the myocardial perfusion. The ranolazine acts therefore as a lusitropic drug that improves the diastolic dysfunction and the segmental ischemia thus affecting one of the first steps of the ischemic cascade

Early markers of right heart involvement in regular smokers by Pocket Size Imaging Device

To test the diagnostic power of Pocket Size Imaging Device (PSID) in detecting early signs of right heart (RH) involvement in regular smokers (RS) free of overt cardiac involvement

Identification of the main determinants of abdominal aorta size: a screening by Pocket Size Imaging Device

Ultrasound exam as a screening test for abdominal aorta (AA) can visualize the aorta in 99% of patients and has a sensitivity and specificity approaching 100% in screening settings for aortic aneurysm. Pocket Size Imaging Device (PSID) has a potential value as a screening tool, because of its possible use in several clinical settings. Our aim was to assess the impact of demographics and cardiovascular (CV) risk factors on AA size by using PSID in an outpatient screening

Three-dimensional echocardiographic ventricular mass/end-diastolic volume ratio in native hypertensive patients: relation between stroke volume and geometry

Elevated left ventricular (LV) mass/end-diastolic volume ratio (LVM/EDV) has been associated with higher evidence of myocardial fibrosis and dysfunction in hypertensive patients by cardiac magnetic resonance, a technique with limited availability