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Firenze, Italy

Cameli M.,University of Siena | Ballo P.,Cardiology Operative Unit | Righini F.M.,University of Siena | Caputo M.,University of Siena | And 2 more authors.
Echocardiography | Year: 2011

Background: The associations of left ventricular (LV) systolic torsion with clinical and echocardiographic variables in physiological conditions have not been fully investigated. We explored the independent determinants of LV systolic torsion in a population of normal subjects. Methods: In 119 healthy subjects, peak twist angle (LVtw) and torsion (LVtor) during ejection, and the QRS-LVtw interval (time-to-peak LVtw) were measured by speckle tracking. LV twisting rate and rotational deformation delay were also determined. Results: Stepwise multiple regression showed that LVtw was independently associated with indexed end-systolic volume (β=-0.200, P < 0.0001), peak early diastolic mitral annulus velocity (β=-0.186, P = 0.0001), heart rate (β= 0.178, P = 0.0003), and male gender (β=-0.174, P = 0.0004). Similar results were found for LVtor. Age was the only parameter, which has demonstrated an independent correlation with time-to-peak LVtw (β= 0.329, P < 0.0001). Despite significance of these associations, the proportions of variability explained by regression models were relatively low (range 11-26%), and no accurate predictive models were identifiable for LV twisting rate and rotational deformation delay. Conclusion: In normal individuals, indexed end-systolic LV volume, LV relaxation, heart rate, gender, and age correlate independently with LV torsion mechanics. However, conventional echocardiographic and clinical variables are not able to predict LV torsion mechanics. © 2011, Wiley Periodicals, Inc. Source


Cameli M.,University of Siena | Lisi M.,University of Siena | Righini F.M.,University of Siena | Tsioulpas C.,University of Siena | And 6 more authors.
Journal of Cardiac Failure | Year: 2012

Background: Right ventricular (RV) systolic function has a critical role in determining the clinical outcome and success of using left ventricular assist devices (LVADs) in patients with refractory heart failure. Tissue Doppler and M-mode measurements of tricuspid systolic motion (tricuspid S′ and tricuspid annular plane systolic excursion [TAPSE]) are the most currently used methods for the quantification of RV longitudinal function; RV deformation analysis by speckle-tracking echocardiography (STE) has recently allowed the analysis of global RV longitudinal function. Using cardiac catheterization as the reference standard, this study aimed at exploring the correlation between RV longitudinal function by STE and RV stroke work index (RVSWI) in patients referred for cardiac transplantation. Methods and Results: Right-side heart catheterization and transthoracic echo Doppler were simultaneously performed in 41 patients referred for cardiac transplantation evaluation for advanced systolic heart failure. Thermodilution RV stroke volume and invasive pulmonary pressures were used to obtain RVSWI. RV longitudinal strain (RVLS) by STE was assessed averaging all segments in apical 4-chamber view (global RVLS) and by averaging RV free-wall segments (free-wall RVLS). Tricuspid S′ and TAPSE were also calculated. No significant correlations were found for TAPSE or tricuspid S′ with RVSWI (r = 0.14; r = 0.06; respectively). Close negative correlations between global RVLS and free-wall RVLS with the RVSWI were found (r = -0.75; r = -0.82; respectively; both P <.0001). Furthermore, free-wall RVLS demonstrated the highest diagnostic accuracy (area under the receiver operating characteristic (ROC) curve 0.90) and good sensitivity and specificity of 92% and 86%, respectively, to predict depressed RVSWI using a cutoff value of less than -11.8%. Conclusions: In a group of patients referred for heart transplantation, TAPSE and tricuspid S′ did not correlate with invasively obtained RVSWI. RV longitudinal deformation analysis by STE correlated well with RVSWI, providing a better estimation of RV systolic performance. © 2012 Elsevier Inc. All rights reserved. Source


Ballo P.,Cardiology Operative Unit | Guarini G.,University of Pisa | Simioniuc A.,University of Pisa | Gistri T.,University of Pisa | And 4 more authors.
Echocardiography | Year: 2012

There is still some debate regarding the prognostic significance of left ventricular longitudinal systolic dysfunction as assessed by tissue Doppler (TD) imaging in patients with chronic heart failure (HF), since previous studies have included patients with postischemic wall motion abnormalities. Thus, this study was designed to ascertain whether TD-derived longitudinal systolic dysfunction may influence the outcome of patients with nonischemic chronic HF. In 200 consecutive patients with chronic HF secondary to dilated cardiomyopathy and no history of ischemic heart disease, peak systolic mitral annular velocity (S m) was measured by pulsed TD at the septal and lateral annular sites. The end points were cardiac death or hospitalization for worsening HF. Mean follow-up duration was 30 months. In a time independent analysis, averaged S m calculated as the average of septal and lateral S m, resulted to be a significant predictor of outcome in the study population (area under receiver-operator characteristic curve: cardiovascular death, 0.69, P < 0.0001; cardiovascular events, 0.64, P = 0.0005). In a time-dependent analysis, average S m was associated with both cardiovascular death (hazard ratio 0.832, P = 0.0019) and cardiovascular events (hazard ratio 0.904, P = 0.039), independently of other clinical risk factors and echocardiographic parameters of systolic function. Septal S m but not lateral S m was independently associated with the outcome measures. In conclusion, the assessment of systolic mitral annular velocity by pulsed TD is a useful indicator for prognostic stratification of patients with nonischemic dilated cardiomyopathy and chronic HF. © 2011, Wiley Periodicals, Inc. Source


Ballo P.,Cardiology Operative Unit | Zaca V.,University of Siena | Giacomin E.,University of Siena | Galderisi M.,University of Naples Federico II | Mondillo S.,University of Siena
International Journal of Cardiology | Year: 2010

We sought to investigate the potential impact of obesity on left ventricular (LV) systolic function in patients with hypertension and normal ejection fraction (EF). In 112 hypertensive subjects with echocardiographic evidence of normal EF, M-mode left atrio-ventricular plane displacement, and Tissue Doppler-derived peak systolic velocity of the mitral annulus were measured and used as sensitive indices of longitudinal LV systolic dysfunction. The midwall stress-shortening relation was considered as a sensitive load-independent measure of circumferential LV myocardial contractility. There were no differences in either atrio-ventricular plane displacement or peak systolic velocity between normal weight, overweight, and obese subjects. In contrast, circumferential myocardial contractility tended to be reduced in overweight (90.3 ± 14.4%) and was significantly depressed in obese (85.9 ± 14.3%) as compared to normal weight individuals (95.3 ± 14.8%; P = 0.042). Multivariate analysis confirmed an independent negative association between body mass index (BMI) and myocardial contractility. The impact of BMI category on circumferential function did not differ between the study population and age- and gender-matched controls, suggesting additive interaction, rather than synergistic, between overweight-obesity and hypertension. © 2008 Elsevier Ireland Ltd. All rights reserved. Source


Mondillo S.,University of Siena | Ballo P.,Cardiology Operative Unit | Galderisi M.,University of Naples Federico II | Focardi M.,University of Siena | And 3 more authors.
International Journal of Cardiology | Year: 2010

Background: Left ventricular (LV) diastolic function represents a complex performance that involves long axis displacement, myocardial lengthening velocities as well as cavity filling. The aim of this study was to assess the various diastolic event interrelations in a group of patients with different degrees of diastolic dysfunction. Methods: 128 consecutive subjects with various degrees of diastolic impairment were studied by Doppler echocardiography. The amplitude of early diastolic (El) and late diastolic (Al) long axis lengthening was measured by M-mode and corresponding myocardial velocities (Ea and Aa) by Tissue Doppler. LV filling velocities were also acquired by spectral pulsed wave Doppler. Results: Early diastolic long axis amplitudes and velocities correlated (r = 0.73, P < 0.0001) as did late diastolic ones (r = 0.67, P < 0.0001). El of ≤ 5.6 mm was 80.6% sensitive and 70.5% specific in predicting Ea of < 8.0 cm/s, a feature of LV impaired relaxation. El/A l correlated with Ea/Aa (r = 0.78, P < 0.0001), as did E/El with E/Ea ratios (r = 0.74, P < 0.0001). An E/El ratio > 17.3 cm/s/mm had 94.1% sensitivity and 87.4% specificity for predicting an E/Ea ratio > 15, a marker for raised LV filling pressures. El ≤ 6.8 mm, total amplitude of diastolic motion (El + Al) ≤ 11.5 mm, and E/E l > 14.2 cm/s/mm were the best criteria to discriminate between normal diastolic function and pseudonormal/restrictive LV filling. Conclusion: Diastolic LV components of motion, amplitude and velocities are not independent, neither from each other nor from filling pressures. An integrated approach towards using them all in assessing diastolic function, particularly in patients with raised filling pressure should be of great clinical value. © 2009 Elsevier Ireland Ltd. Source

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