Dott.ssa Antonella Moreo

Pubblicazioni su PubMed

• Corrigendum: Cardio-oncology in the COVID Era (Co & Co): The never-ending story.
  Front Cardiovasc Med

  2023 ;10():1169176. doi: 1169176.
  
  Bisceglia Irma, Canale Maria Laura, Gallucci Giuseppina, Turazza Fabio Maria, Lestuzzi Chiara, Parrini Iris, Russo Giulia, Maurea Nicola, Quagliariello Vincenzo, Oliva Stefano, Angela Di Fusco Stefania, Lucà Fabiana, Tarantini Luigi, Trambaiolo Paolo, Moreo Antonella, Geraci Giovanna, Gabrielli Domenico, Gulizia Michele Massimo, Oliva Fabrizio, Colivicchi Furio
  
  Abstract
  
  [This corrects the article DOI: 10.3389/fcvm.2022.821193.].
  
  © 2023 Bisceglia, Canale, Gallucci, Turazza, Lestuzzi, Parrini, Russo, Maurea, Quagliariello, Oliva, Angela Di Fusco, Lucà, Tarantini, Trambaiolo, Moreo, Geraci, Gabrielli, Gulizia, Oliva and Colivicchi.
  
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• Differential diagnosis of cardiac tumors: General consideration and echocardiographic approach.
  J Clin Ultrasound

  2022 Oct;50(8):1177-1193. doi: 10.1002/jcu.23309.
  
  Pino Paolo G, Moreo Antonella, Lestuzzi Chiara
  
  Abstract
  
  Cardiac tumors may be primary (either benign or malignant) or secondary (malignant) and are first detected by echocardiography in most cases. The cardiologist often challenges their identification, the differential diagnosis and the best therapeutic approach. Malignant tumors have usually a poor prognosis, which may be significantly improved by appropriate and timely therapies. The echocardiographic aspects of benign and malignant cardiac tumors described in this article, along with a clinical evaluation may orient the differential diagnosis and aid in choosing the further steps useful to define the nature of the mass.
  
  © 2022 The Authors. Journal of Clinical Ultrasound published by Wiley Periodicals LLC.
  
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• The impact of transcatheter edge-to-edge repair on right ventricle-pulmonary artery coupling in patients with functional mitral regurgitation.
  Eur J Clin Invest

  2023 Jan;53(1):e13869. doi: 10.1111/eci.13869.
  
  Tua Lorenzo, Mandurino-Mirizzi Alessandro, Colombo Claudia, Morici Nuccia, Magrini Giulia, Nava Stefano, Frassica Romina, Montalto Claudio, Ferlini Marco, Sacco Alice, Musca Francesco, Moreo Antonella, Ghio Stefano, Oreglia Jacopo, Oltrona-Visconti Luigi, Oliva Fabrizio, Crimi Gabriele
  
  
  
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• Imaging in transcatheter native mitral valve replacement with Tendyne mitral valve system: Echocardiographic pathway for the interventional imager.
  Monaldi Arch Chest Dis

  2022 Sep;():. doi: 10.4081/monaldi.2022.2404.
  
  Al Sergani Hani, Moreo Antonella, Bossone Eduardo, Vriz Olga, Alenazy Ali, Alshehri Ahmed, Al Amri Mohammed, Alhamshari Ahmad, Alamro Bandar, Galzerano Domenico
  
  Abstract
  
  The interaction between the implanter team and the imager team is critical to the success of transcatheter native mitral valve replacement (TMVR), a novel interventional procedure in the therapeutic arsenal for mitral regurgitation. This imaging scenario necessitates the addition of a new dedicated professional figure, dubbed "the interventional imager," with specific expertise in structural heart disease procedures. As its clinical application grows, knowledge of the various imaging modalities used in the TMVR procedure is required for the interventional imager and beneficial for the interventional implanter team. The purpose of this review is to describe the key steps of the procedural imaging pathway in TMVR using the Tendyne mitral valve system, with an emphasis on echocardiography. Pre-procedure cardiac multimodality imaging screening and planning for TMVR can determine patient eligibility based on anatomic features and measurements, provide measurements for appropriate valve sizing, plan/simulate the access site, catheter/sheath trajectory, and prosthesis positioning/orientation for correct deployment, and predict the risks of potential procedural complications and their likelihood of success. Step-by-step echocardiographic TMVR intraoperative guidance includes: apical access assessment; support for catheter/sheath localization, trajectory and positioning, valve positioning and clocking; post deployment: correct clocking; hemodynamic assessment; detection of perivalvular leakage; obstruction of the left ventricular outlet tract; complications. Knowledge of the multimodality imaging pathway is essential for interventional imagers and critical to the procedure's success.
  
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• Infective Endocarditis in People Who Inject Drugs: Report from the Italian Registry of Infective Endocarditis.
  J Clin Med

  2022 Jul;11(14):. doi: 4082.
  
  Cecchi Enrico, Corcione Silvia, Lupia Tommaso, De Benedetto Ilaria, Shbaklo Nour, Chirillo Fabio, Moreo Antonella, Rinaldi Mauro, Faggiano Pompilio, Cecconi Moreno, Bargiacchi Olivia, Cialfi Alessandro, Del Ponte Stefano, Squeri Angelo, Gaddi Oscar, Carmina Maria Gabriella, Lazzaro Alessandro, Ciccone Giovannino, Castiglione Anna, De Rosa Francesco Giuseppe
  
  Abstract
  
  Intravenous drug use is a predisposing condition for infective endocarditis (IE). We report the clinical features of IE, taken from the Italian Registry of IE, in people who inject drugs (PWIDs). The registry prospectively collected epidemiological, clinical, in-hospital, and follow-up data on patients with IE from 17 Italian centers. A total of 677 patients were enrolled, and 61 (9%) were intravenous drug users (IDUs). Most PWIDs were male (78.6%), and aged between 41 and 50 years old (50%). The most frequent comorbidities were HIV (34.4%) and chronic liver disease (32%). Predisposing factors for IE were present in 6.5% of the patients, and 10% had minor valvular abnormalities. IE had occurred previously in 16.4% of the patients, and 50% of them had undergone heart surgery. Overall mortality was 9.8% in IDUs and 20% in patients with recurrent IE. IE in PWIDs mostly affected the native valves (90%). The echocardiographic diagnosis of IE was based on the detection of vegetation in 91.82% of cases. was the main microorganism isolated (70%) from blood cultures. Thirty patients (49%) underwent heart surgery: thirteen had aortic valves, eleven had mitral valves, and six had tricuspid valve interventions. IE in PWIDs was relatively common, and patients with native valve right-sided IE had a better prognosis, with a low rate of surgical interventions.
  
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• Human versus Artificial Intelligence-Based Echocardiographic Analysis as a Predictor of Outcomes: An Analysis from the World Alliance Societies of Echocardiography COVID Study.
  J Am Soc Echocardiogr

  2022 Dec;35(12):1226-1237.e7. doi: 10.1016/j.echo.2022.07.004.
  
  Asch Federico M, Descamps Tine, Sarwar Rizwan, Karagodin Ilya, Singulane Cristiane Carvalho, Xie Mingxing, Tucay Edwin S, Tude Rodrigues Ana C, Vasquez-Ortiz Zuilma Y, Monaghan Mark J, Ordonez Salazar Bayardo A, Soulat-Dufour Laurie, Alizadehasl Azin, Mostafavi Atoosa, Moreo Antonella, Citro Rodolfo, Narang Akhil, Wu Chun, Addetia Karima, Upton Ross, Woodward Gary M, Lang Roberto M,
  
  Abstract
  
  BACKGROUND:
  Transthoracic echocardiography is the leading cardiac imaging modality for patients admitted with COVID-19, a condition of high short-term mortality. The aim of this study was to test the hypothesis that artificial intelligence (AI)-based analysis of echocardiographic images could predict mortality more accurately than conventional analysis by a human expert.
  
  METHODS:
  Patients admitted to 13 hospitals for acute COVID-19 who underwent transthoracic echocardiography were included. Left ventricular ejection fraction (LVEF) and left ventricular longitudinal strain (LVLS) were obtained manually by multiple expert readers and by automated AI software. The ability of the manual and AI analyses to predict all-cause mortality was compared.
  
  RESULTS:
  In total, 870 patients were enrolled. The mortality rate was 27.4% after a mean follow-up period of 230 ± 115 days. AI analysis had lower variability than manual analysis for both LVEF (P = .003) and LVLS (P = .005). AI-derived LVEF and LVLS were predictors of mortality in univariable and multivariable regression analysis (odds ratio, 0.974 [95% CI, 0.956-0.991; P = .003] for LVEF; odds ratio, 1.060 [95% CI, 1.019-1.105; P = .004] for LVLS), but LVEF and LVLS obtained by manual analysis were not. Direct comparison of the predictive value of AI versus manual measurements of LVEF and LVLS showed that AI was significantly better (P = .005 and P = .003, respectively). In addition, AI-derived LVEF and LVLS had more significant and stronger correlations to other objective biomarkers of acute disease than manual reads.
  
  CONCLUSIONS:
  AI-based analysis of LVEF and LVLS had similar feasibility as manual analysis, minimized variability, and consequently increased the statistical power to predict mortality. AI-based, but not manual, analyses were a significant predictor of in-hospital and follow-up mortality.
  
  Copyright © 2022 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.
  
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• Outcomes of culture-negative vs. culture-positive infective endocarditis: the ESC-EORP EURO-ENDO registry.
  Eur Heart J

  2022 Aug;43(29):2770-2780. doi: 10.1093/eurheartj/ehac307.
  
  Kong William K F, Salsano Antonio, Giacobbe Daniele Roberto, Popescu Bogdan A, Laroche Cécile, Duval Xavier, Schueler Robert, Moreo Antonella, Colonna Paolo, Piper Cornelia, Calvo-Iglesias Francisco, Badano Luigi P, Srdanovic Ilija, Boutoille David, Huttin Olivier, Stöhr Elisabeth, Timóteo Ana Teresa, Vaskelyte Jolanta Justina, Sadeghpour Anita, Tornos Pilar, Abid Leila, Poh Kian Keong, Habib Gilbert, Lancellotti Patrizio
  
  Abstract
  
  AIM:
  Fatality of infective endocarditis (IE) is high worldwide, and its diagnosis remains a challenge. The objective of the present study was to compare the clinical characteristics and outcomes of patients with culture-positive (CPIE) vs. culture-negative IE (CNIE).
  
  METHODS AND RESULTS:
  This was an ancillary analysis of the ESC-EORP EURO-ENDO registry. Overall, 3113 patients who were diagnosed with IE during the study period were included in the present study. Of these, 2590 (83.2%) had CPIE, whereas 523 (16.8%) had CNIE. As many as 1488 (48.1%) patients underwent cardiac surgery during the index hospitalization, 1259 (48.8%) with CPIE and 229 (44.5%) with CNIE. The CNIE was a predictor of 1-year mortality [hazard ratio (HR) 1.28, 95% confidence interval (CI) 1.04-1.56], whereas surgery was significantly associated with survival (HR 0.49, 95% CI 0.41-0.58). The 1-year mortality was significantly higher in CNIE than CPIE patients in the medical subgroup, but it was not significantly different in CNIE vs. CPIE patients who underwent surgery.
  
  CONCLUSION:
  The present analysis of the EURO-ENDO registry confirms a higher long-term mortality in patients with CNIE compared with patients with CPIE. This difference was present in patients receiving medical therapy alone and not in those who underwent surgery, with surgery being associated with reduced mortality. Additional efforts are required both to improve the aetiological diagnosis of IE and identify CNIE cases early before progressive disease potentially contraindicates surgery.
  
  © The Author(s) 2022. Published by Oxford University Press on behalf of European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
  
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• Corrigendum: Cardio-Oncology in the COVID Era (Co & Co): The Never Ending Story.
  Front Cardiovasc Med

  2022 ;9():903766. doi: 903766.
  
  Bisceglia Irma, Canale Maria Laura, Gallucci Giuseppina, Turazza Fabio Maria, Lestuzzi Chiara, Parrini Iris, Russo Giulia, Maurea Nicola, Quagliariello Vincenzo, Oliva Stefano, Di Fusco Stefania Angela, Lucà Fabiana, Tarantini Luigi, Trambaiolo Paolo, Moreo Antonella, Geraci Giovanna, Gabrielli Domenico, Gulizia Michele Massimo, Oliva Fabrizio, Colivicchi Furio
  
  Abstract
  
  [This corrects the article DOI: 10.3389/fcvm.2022.821193.].
  
  Copyright © 2022 Bisceglia, Canale, Gallucci, Turazza, Lestuzzi, Parrini, Russo, Maurea, Quagliariello, Oliva, Di Fusco, Lucà, Tarantini, Trambaiolo, Moreo, Geraci, Gabrielli, Gulizia, Oliva and Colivicchi.
  
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• [ANMCO Position paper: Care pathway for advanced heart failure patients candidate for heart transplantation/ventricular assist device].
  G Ital Cardiol (Rome)

  2022 May;23(5):340-378. doi: 10.1714/3796.37817.
  
  Iacoviello Massimo, Cipriani Manlio, Valente Serafina, Marini Marco, Ammirati Enrico, Benvenuto Manuela, Cassaniti Leonarda Rosaria, De Maria Renata, Gori Mauro, Municinò Annamaria, Navazio Alessandro, Amodeo Vincenzo, Aspromonte Nadia, Barili Fabio, Casolo Giancarlo, Clemenza Francesco, Di Eusanio Marco, Di Lenarda Andrea, Di Tano Giuseppe, Domenicucci Stefano, Faggian Giuseppe, Francese Giuseppina Maura, Frongillo Doriana, Gilardi Rossella, Iacovoni Attilio, Imazio Massimo, Livi Ugolino, Maiello Ciro, Milano Aldo, Mondino Michele, Moreo Antonella Maurizia, Mortara Andrea, Murrone Adriano, Palmieri Vittorio, Pelenghi Stefano, Pini Daniela, Pistono Massimo, Porcu Maurizio, Potena Luciano, Rinaldi Mauro, Romanò Massimo, Roncon Loris, Rossini Roberta, Russo Claudio Francesco, Scotto di Uccio Fortunato, Urbinati Stefano, Zecchin Massimo, Caldarola Pasquale, Oliveti Alessandra, Frigerio Maria, Musumeci Francesco, Gulizia Michele Massimo, Oliva Fabrizio, Gabrielli Domenico, Colivicchi Furio
  
  Abstract
  
  Heart failure is a complex clinical syndrome with a severe prognosis, despite therapeutic progress. The management of the advanced stages of the syndrome is particularly complex in patients who are referred to palliative care as well as in those who are candidates for cardiac replacement therapy. For the latter group, a prompt recognition of the transition to the advanced stage as well as an early referral to the centers for cardiac replacement therapy are essential elements to ensure that patients follow the most appropriate diagnostic-therapeutic pathway. The aim of this document is to focus on the main diagnostic and therapeutic aspects related to the advanced stages of heart failure and, in particular, on the management of patients who are candidates for cardiac replacement therapy.
  
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• Biochemical but not imaging parameters are predictive of outcome in septic shock: a pilot study.
  Cardiovasc Ultrasound

  2022 Mar;20(1):6. doi: 6.
  
  Belli Oriana E, Campolo Jonica, Vallerio Paola, Musca Francesco, Moreo Antonella, Maloberti Alessandro, Parolini Marina, Bonacchini Luca, Monti Gianpaola, De Gasperi Andrea, Fumagalli Roberto, Giannattasio Cristina
  
  Abstract
  
  BACKGROUND:
  Septic shock is a severe form of sepsis marked by hypotension with an ominous outcome despite the introduction of modern intensive care. The aim of the present study is to obtain a panel with biomarkers, echocardiographic and vascular parameters to better risk stratify patients and identify those at higher risk of ominous outcome.
  
  METHODS:
  Between May 2013 and April 2016, 35 consecutive patients admitted at the Intensive Care Unit (ICU) of ASST Great Metropolitan Hospital Niguarda with the diagnosis of severe sepsis or septic shock were enrolled. All patients underwent rest echocardiography and several circulating biomarkers of myocardial damage or oxidative stress.
  
  RESULTS:
  The multivariate Cox's proportional hazard model showed that the only independent prognostic predictor for 30-day mortality was the angiopoietin-2, (HR 1.017, 95% CI 1.000-1.034; P?=?0.049). An angiopoietin-2 concentrations ? of 33,418?pg/mL was identified as the optimal threshold for the discrimination between survivors and non survivors at the time of admission in ICU, with a sensitivity of 80% and a specificity of 68%.
  
  CONCLUSIONS:
  Septic shock has a poor in-hospital outcome even when the best of care is implemented. Among the biochemical parameters angiopoietin was able to identify patients at risk of death. The lowest the value at admission, the highest the risk of in-hospital death. No echocardiographic nor vascular parameter was able to predict outcome in this setting.
  
  © 2022. The Author(s).
  
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• Prevalence and Rate of Resolution of Left Atrial Thrombus in Patients with Non-Valvular Atrial Fibrillation: A Two-Center Retrospective Real-World Study.
  J Clin Med

  2022 Mar;11(6):. doi: 1520.
  
  Faggiano Pompilio, Dinatolo Elisabetta, Moreo Antonella, De Chiara Benedetta, Sbolli Marco, Musca Francesco, Curnis Antonio, Belli Oriana, Giannattasio Cristina, Tomasi Cesare, Metra Marco, Santangelo Gloria
  
  Abstract
  
  BACKGROUND AND AIM:
  Thromboembolic events due to left atrial appendage (LAA) thrombosis are the main complication of non-valvular atrial fibrillation (NVAF). Although anticoagulants are effective in patients with NVAF, a minimal residual thromboembolic risk persists. Little is known about the prevalence of LAA thrombus and the rate of resolution after the recommended period of anticoagulation therapy, including vitamin K antagonists (VKA), heparin, and non-vitamin K antagonist oral anticoagulants (NOACs).
  
  METHODS AND RESULTS:
  We aimed to study the prevalence of LAA thrombus in an unselected cohort of patients undergoing transesophageal echocardiogram (TEE), and the determinants of LAA thrombus resolution. We retrospectively analyzed 8888 consecutive TEEs performed over five years in two high-volume centers and included all patients with LAA thrombus. A total of 265 patients (3%) had an LAA thrombus. Among these, 97% presented with AF. Fifty-eight percent of patients were on anticoagulants at least three weeks before the diagnosis. After the LAA thrombus diagnosis, VKAs were prescribed in 52%, heparin in 18.5%, and NOAC in 27% of patients. Among the 183 patients with repeat TEE, performed at (25-75th) 39 days (21-84), 67% showed resolution of the LAA thrombus. Although the rate of thrombus resolution was higher in patients treated with NOACs (NOACs 71%, VKA 66%, Heparin 60%) the difference between anticoagulants was statistically non-significant (VKA, OR 0.9, = 0.83; NOAC, OR 1.23, = 0.42; heparin, OR 0.69, = 0.35). Thus, NOACs were demonstrated to be at least as effective as other anticoagulants in the rate of LAA thrombus resolution. Upon multivariate-adjusted analysis, higher LAA emptying velocities were the only predictor of thrombus resolution. In conclusion, the majority of patients were already on anticoagulants. NOACs could be at least as effective as other anticoagulants, yielding an LAA thrombus resolution in two-thirds of patients. This may have clinical relevance, especially in patients undergoing cardioversion or catheter ablation.
  
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• Primary mediastinal large B-cell lymphoma and pregnancy: a challenging clinical scenario.
  Monaldi Arch Chest Dis

  2022 Feb;92(4):. doi: 10.4081/monaldi.2022.2198.
  
  Intravaia Rita, De Chiara Benedetta, Musca Francesco, Casadei Francesca, Santambrogio Gloria, Spanò Francesca, Belli Oriana, Quattrocchi Giuseppina, Giannattasio Cristina, Moreo Antonella
  
  Abstract
  
  A 26-weeks pregnant woman presented with progressively worsening dyspnoea and poor general conditions. Using low-dose radiation multi-imaging techniques and thoracic biopsy a primary mediastinal large B cell was diagnosed. A multidisciplinary approach identified the correct hemodynamic management, the best therapeutic strategy and the timing for delivery.
  
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• Cardio-Oncology in the COVID Era (Co & Co): The Never Ending Story.
  Front Cardiovasc Med

  2022 ;9():821193. doi: 821193.
  
  Bisceglia Irma, Canale Maria Laura, Gallucci Giuseppina, Turazza Fabio Maria, Lestuzzi Chiara, Parrini Iris, Russo Giulia, Maurea Nicola, Quagliariello Vincenzo, Oliva Stefano, Di Fusco Stefania Angela, Lucà Fabiana, Tarantini Luigi, Trambaiolo Paolo, Moreo Antonella, Geraci Giovanna, Gabrielli Domenico, Gulizia Michele Massimo, Oliva Fabrizio, Colivicchi Furio
  
  Abstract
  
  The pathophysiology of some non-communicable diseases (NCDs) such as hypertension, cardiovascular disease (CVD), diabetes, and cancer includes an alteration of the endothelial function. COVID-19 is a pulmonary and vascular disease with a negative impact on patients whose damaged endothelium is particularly vulnerable. The peculiar SARS-CoV-2-induced "endothelitis" triggers an intriguing immune-thrombosis that affects both the venous and arterial vascular beds. An increased liability for infection and an increased likelihood of a worse outcome have been observed during the pandemic in patients with active cancer and in cancer survivors. "Overlapping commonalities" between COVID-19 and Cardio-Oncology have been described that include shared phenotypes of cardiovascular toxicities such as left ventricular dysfunction, ischemic syndromes, conduction disturbances, myocarditis, pericarditis and right ventricular failure; shared pathophysiologic mechanisms such as inflammation, release of cytokines, the renin-angiotensin-aldosterone-pathway, coagulation abnormalities, microthrombosis and endothelial dysfunction. For these features and for the catalyst role of NCDs (mainly CVD and cancer), we should refer to COVID-19 as a "syndemic." Another challenging issue is the persistence of the symptoms, the so-called "long COVID" whose pathogenesis is still uncertain: it may be due to persistent multi-organ viral attacks or to an abnormal immune response. An intensive vaccination campaign is the most successful pharmacological weapon against SARS-CoV-2, but the increasing number of variants has reduced the efficacy of the vaccines in controlling SARS-CoV-2 infections. After a year of vaccinations we have also learned more about efficacy and side-effects of COVID-19 vaccines. An important byproduct of the COVID-19 pandemic has been the rapid expansion of telemedicine platforms across different care settings; this new modality of monitoring cancer patients may be useful even in a post pandemic era. In this paper we analyze the problems that the cardio-oncologists are facing in a pandemic scenario modified by the extensive vaccination campaign and add actionable recommendations derived from the ongoing studies and from the syndemic nature of the infection.
  
  Copyright © 2022 Bisceglia, Canale, Gallucci, Turazza, Lestuzzi, Parrini, Russo, Maurea, Quagliariello, Oliva, Di Fusco, Lucà, Tarantini, Trambaiolo, Moreo, Geraci, Gabrielli, Gulizia, Oliva and Colivicchi.
  
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• Cancer and Infective Endocarditis: Characteristics and Prognostic Impact.
  Front Cardiovasc Med

  2021 ;8():766996. doi: 766996.
  
  Cosyns Bernard, Roosens Bram, Lancellotti Patrizio, Laroche Cécile, Dulgheru Raluca, Scheggi Valentina, Vilacosta Isidre, Pasquet Agnès, Piper Cornelia, Reyes Graciela, Mahfouz Essam, Kobalava Zhanna, Piroth Lionel, Kasprzak Jaros?aw D, Moreo Antonella, Faucher Jean-François, Ternacle Julien, Meshaal Marwa, Maggioni Aldo P, Iung Bernard, Habib Gilbert
  
  Abstract
  
  The interplay between cancer and IE has become of increasing interest. This study sought to assess the prevalence, baseline characteristics, management, and outcomes of IE cancer patients in the ESC EORP EURO-ENDO registry. Three thousand and eighty-five patients with IE were identified based on the ESC 2015 criteria. Three hundred and fifty-nine (11.6%) IE cancer patients were compared to 2,726 (88.4%) cancer-free IE patients. In cancer patients, IE was mostly community-acquired (74.8%). The most frequently identified microorganisms were (25.4%) and Enterococci (23.8%). The most frequent complications were acute renal failure (25.9%), embolic events (21.7%) and congestive heart failure (18.1%). Theoretical indication for cardiac surgery was not significantly different between groups (65.5 vs. 69.8%, = 0.091), but was effectively less performed when indicated in IE patients with cancer (65.5 vs. 75.0%, = 0.002). Compared to cancer-free IE patients, in-hospital and 1-year mortality occurred in 23.4 vs. 16.1%, = 0.006, and 18.0 vs. 10.2%; 2 mg/dL, congestive heart failure and unperformed cardiac surgery (when indicated). Cancer in IE patients is common and associated with a worse outcome. This large, observational cohort provides new insights concerning the contemporary profile, management, and clinical outcomes of IE cancer patients across a wide range of countries.
  
  Copyright © 2021 Cosyns, Roosens, Lancellotti, Laroche, Dulgheru, Scheggi, Vilacosta, Pasquet, Piper, Reyes, Mahfouz, Kobalava, Piroth, Kasprzak, Moreo, Faucher, Ternacle, Meshaal, Maggioni, Iung and Habib.
  
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• [Transcranial color Doppler ultrasonography: methodology and usefulness for the study of patent foramen ovale in cryptogenic stroke].
  G Ital Cardiol (Rome)

  2021 Dec;22(12):988-999. doi: 10.1714/3698.36878.
  
  D'Andrea Antonello, Radmilovic Juri, Mele Donato, Di Giannuario Giovanna, Rizzo Massimiliano, Campana Marco, Riegler Lucia, Gimelli Alessia, Khoury Georgette, Strano Stefano, Moreo Antonella,
  
  Abstract
  
  Non-invasive Doppler ultrasonographic study of cerebral arteries (transcranial Doppler, TCD) has been extensively applied on both outpatient and inpatient settings. It is performed placing a low-frequency (?2 MHz) transducer on the scalp of the patient over specific acoustic windows, in order to visualize the intracranial arterial vessels and to evaluate the cerebral blood flow velocity and its alteration in many different conditions. Nowadays a valid indication for TCD in the outpatient setting is the research of right-to-left shunting, responsible for the so-called "paradoxical embolism", most often due to patency of foramen ovale, which is responsible for the majority of cryptogenic strokes occurring in patients younger than 55 years. TCD also allows to classify the grade of severity of such shunts using the so-called "microembolic signal grading score". Therefore, TCD is an essential cardiological exam for the detection of patent foramen ovale, assuming an important role as a first-level examination to guide the subsequent diagnostic-therapeutic management. In addition, TCD has found many useful applications in neurocritical care practice. It is useful for the identification of intracranial vascular stenosis and for the assessment of critical conditions including vasospasm in subarachnoid hemorrhage, traumatic brain injury and brain stem death. It is also used to evaluate cerebral hemodynamic changes after stroke, to investigate cerebral pressure autoregulation, and for the clinical evaluation of cerebral vasomotor reactivity.
  
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• Predictors of Ascending Aorta Enlargement and Valvular Dysfunction Progression in Patients with Bicuspid Aortic Valve.
  J Clin Med

  2021 Nov;10(22):. doi: 5264.
  
  Lopez Angela, Dentamaro Ilaria, Galian Laura, Calvo Francisco, Alegret Josep M, Sanchez Violeta, Citro Rodolfo, Moreo Antonella, Chirillo Fabio, Colonna Paolo, Carrero María Celeste, Bossone Eduardo, Moral Sergio, Sao-Aviles Augusto, Gutiérrez Laura, Teixido-Tura Gisela, Rodríguez-Palomares Jose, Evangelista Arturo
  
  Abstract
  
  Bicuspid aortic valve (BAV) patients are at high risk of developing progressive aortic valve dysfunction and ascending aorta dilation. However, the progression of the disease is not well defined. We aimed to assess mid-long-term aorta dilation and valve dysfunction progression and their predictors. Patients were referred from cardiac outpatient clinics to the echocardiographic laboratories of 10 tertiary hospitals and followed clinically and by echocardiography for >5 years. Seven hundred and eighteen patients with BAV (median age 47.8 years [IQR 33-62], 69.2% male) were recruited. BAV without raphe was observed in 11.3%. After a median follow-up of 7.2 years [IQR5-8], mean aortic root growth rate was 0.23 ± 0.15 mm/year. On multivariate analysis, rapid aortic root dilation (>0.35 mm/year) was associated with male sex, hypertension, presence of raphe and aortic regurgitation. Annual ascending aorta growth rate was 0.43 ± 0.32 mm/year. Rapid ascending aorta dilation was related only to hypertension. Variables associated with aortic stenosis and regurgitation progression, adjusted by follow-up time, were presence of raphe, hypertension and dyslipidemia and basal valvular dysfunction, respectively. Intrinsic BAV characteristics and cardiovascular risk factors were associated with aorta dilation and valvular dysfunction progression, taking into account the inherent limitations of our study-design. Strict and early control of cardiovascular risk factors is mandatory in BAV patients.
  
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• Ventricular Changes in Patients with Acute COVID-19 Infection: Follow-up of the World Alliance Societies of Echocardiography (WASE-COVID) Study.
  J Am Soc Echocardiogr

  2022 Mar;35(3):295-304. doi: 10.1016/j.echo.2021.10.015.
  
  Karagodin Ilya, Singulane Cristiane Carvalho, Descamps Tine, Woodward Gary M, Xie Mingxing, Tucay Edwin S, Sarwar Rizwan, Vasquez-Ortiz Zuilma Y, Alizadehasl Azin, Monaghan Mark J, Ordonez Salazar Bayardo A, Soulat-Dufour Laurie, Mostafavi Atoosa, Moreo Antonella, Citro Rodolfo, Narang Akhil, Wu Chun, Addetia Karima, Tude Rodrigues Ana C, Lang Roberto M, Asch Federico M,
  
  Abstract
  
  BACKGROUND:
  COVID-19 infection is known to cause a wide array of clinical chronic sequelae, but little is known regarding the long-term cardiac complications. We aim to report echocardiographic follow-up findings and describe the changes in left (LV) and right ventricular (RV) function that occur following acute infection.
  
  METHODS:
  Patients enrolled in the World Alliance Societies of Echocardiography-COVID study with acute COVID-19 infection were asked to return for a follow-up transthoracic echocardiogram. Overall, 198 returned at a mean of 129 days of follow-up, of which 153 had paired baseline and follow-up images that were analyzable, including LV volumes, ejection fraction (LVEF), and longitudinal strain (LVLS). Right-sided echocardiographic parameters included RV global longitudinal strain, RV free wall strain, and RV basal diameter. Paired echocardiographic parameters at baseline and follow-up were compared for the entire cohort and for subgroups based on the baseline LV and RV function.
  
  RESULTS:
  For the entire cohort, echocardiographic markers of LV and RV function at follow-up were not significantly different from baseline (all P > .05). Patients with hyperdynamic LVEF at baseline (>70%), had a significant reduction of LVEF at follow-up (74.3% ± 3.1% vs 64.4% ± 8.1%, P -20%) at baseline had significant improvement at follow-up (-15.2% ± 3.4% vs -17.4% ± 4.9%, P = .004). Patients with abnormal RV basal diameter (>4.5 cm) at baseline had significant improvement at follow-up (4.9 ± 0.7 cm vs 4.6 ± 0.6 cm, P = .019).
  
  CONCLUSIONS:
  Overall, there were no significant changes over time in the LV and RV function of patients recovering from COVID-19 infection. However, differences were observed according to baseline LV and RV function, which may reflect recovery from the acute myocardial injury occurring in the acutely ill. Left ventricular and RV function tends to improve in those with impaired baseline function, while it tends to decrease in those with hyperdynamic LV or normal RV function.
  
  Copyright © 2021 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.
  
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• [Role of nuclear cardiology in clinical practice: state of art].
  G Ital Cardiol (Rome)

  2021 Nov;22(11):901-913. doi: 10.1714/3689.36749.
  
  Gimelli Alessia, Campana Marco, D'Andrea Antonello, Di Giannuario Giovanna, Khoury Georgette, Mele Donato, Rizzo Massimiliano, Moreo Antonella,
  
  Abstract
  
  Nuclear imaging plays a pivotal role not only in in the evaluation of myocardial ischemia, but also in the evaluation of cardiac infectious, inflammatory, infiltrative and innervation disorders. Myocardial ischemia and viability, cardiac amyloidosis, sarcoidosis, large vessel vasculitis, infective endocarditis, infected cardiac implantable electronic devices, vascular graft infection, and myocardial innervation dysfunction are the main indications for the use of nuclear medicine procedures in both diagnosis and response assessment. With this summarized paper we share a comprehensive review of the role and the use of nuclear cardiology in different cardiac diseases.
  
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• Prevalence of hypertension mediated organ damage in subjects with high-normal blood pressure without known hypertension as well as cardiovascular and kidney disease.
  J Hum Hypertens

  2022 Jul;36(7):610-616. doi: 10.1038/s41371-021-00604-6.
  
  Maloberti Alessandro, Rebora Paola, Occhino Giuseppe, Alloni Marta, Musca Francesco, Belli Oriana, Spano Francesca, Santambrogio Gloria Maria, Occhi Lucia, De Chiara Benedetta, Casadei Francesca, Moreo Antonella, Valsecchi Maria Grazia, Giannattasio Cristina
  
  Abstract
  
  Purpose of our study was to assess the prevalence of hypertension mediated organ damage (HMOD) in healthy subjects with high-normal Blood Pressure (BP) comparing them with subjects with BP values that are considered normal (
  © 2021. The Author(s), under exclusive licence to Springer Nature Limited.
  
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• Emergency cardiac imaging for coronavirus disease 2019 (COVID-19) in practice: a case of takotsubo stress cardiomyopathy.
  Cardiovasc Ultrasound

  2021 Aug;19(1):31. doi: 31.
  
  Belli Oriana, Ardissino Maddalena, Bottiroli Maurizio, Soriano Francesco, Blanda Calogero, Oreglia Jacopo, Mondino Michele, Moreo Antonella
  
  Abstract
  
  BACKGROUND:
  Cardiovascular complications of severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV2) are known to be associated with poor outcome. A small number of case series and reports have described cases of myocarditis and ischaemic events, however, knowledge on the aetiology of acute cardiac failure in SARS-CoV2 remains limited. We describe the occurrence and risk stratification imaging correlates of 'takotsubo' stress cardiomyopathy presenting in a patient with Coronavirus Disease 2019 (COVID-19) in the intensive care unit. An intubated 53-year old patient with COVID19 suffered acute haemodynamic collapse in the intensive care unit, and was thus investigated with transthoracic echocardiography (TTE), 12-lead electrocardiograms (ECG) and serial troponins and blood tests, and eventually coronary angiography due to clinical suspicion of ischaemic aetiology. Echocardiography revealed a reduced ejection fraction, with evident extensive apical akinesia spanning multiple coronary territories. Troponins and NT-proBNP were elevated, and ECG revealed ST elevation: coronary angiography was thus performed. This revealed no significant coronary stenosis. Repeat echocardiography performed within the following week revealed a substantial recovery of ejection fraction and wall motion abnormalities. Despite requirement of a prolonged ICU stay, the patient now remains clinically stable, and is on spontaneous breathing.
  
  CONCLUSION:
  This case report presents a case of takotsubo stress cardiomyopathy occurring in a critically unwell patient with COVID19 in the intensive care setting. Stress cardiomyopathy may be an acute cardiovascular complication of COVID-19 infection. In the COVID19 critical care setting, urgent bedside echocardiography is an important tool for initial clinical assessment of patients suffering haemodynamic compromise.
  
  © 2021. The Author(s).
  
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• [Lung ultrasonography: what the cardiologist should know].
  G Ital Cardiol (Rome)

  2021 Aug;22(8):638-647. doi: 10.1714/3641.36220.
  
  D'Andrea Antonello, Mele Donato, Palermi Stefano, Lombardi Anna, Di Giannuario Giovanna, Rizzo Massimiliano, Campana Marco, Marrazzo Gemma, Scarafile Raffaella, Gimelli Alessia, Khoury Georgette, Moreo Antonella,
  
  Abstract
  
  In recent years, lung ultrasonography has acquired an important role as a valuable diagnostic tool in clinical practice. The lung is usually poorly explorable, but it provides more acoustic information in pathological conditions that modify the relationship between air, water and tissues. The different acoustic impedance of all these components makes the chest wall a powerful ultrasound reflector: this is responsible for the creation of several artifacts providing valuable information about lung pathophysiology. Lung ultrasonography helps in the diagnostic process of parenchymal and pleural pathologies, in the differential diagnosis of dyspnea and in the clinical and prognostic evaluation of the SARS-CoV-2 infection.
  
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• Echocardiographic Correlates of In-Hospital Death in Patients with Acute COVID-19 Infection: The World Alliance Societies of Echocardiography (WASE-COVID) Study.
  J Am Soc Echocardiogr

  2021 Aug;34(8):819-830. doi: 10.1016/j.echo.2021.05.010.
  
  Karagodin Ilya, Carvalho Singulane Cristiane, Woodward Gary M, Xie Mingxing, Tucay Edwin S, Tude Rodrigues Ana C, Vasquez-Ortiz Zuilma Y, Alizadehasl Azin, Monaghan Mark J, Ordonez Salazar Bayardo A, Soulat-Dufour Laurie, Mostafavi Atoosa, Moreo Antonella, Citro Rodolfo, Narang Akhil, Wu Chun, Descamps Tine, Addetia Karima, Lang Roberto M, Asch Federico M,
  
  Abstract
  
  BACKGROUND:
  The novel severe acute respiratory syndrome coronavirus-2 virus, which has led to the global coronavirus disease-2019 (COVID-19) pandemic is known to adversely affect the cardiovascular system through multiple mechanisms. In this international, multicenter study conducted by the World Alliance Societies of Echocardiography, we aim to determine the clinical and echocardiographic phenotype of acute cardiac disease in COVID-19 patients, to explore phenotypic differences in different geographic regions across the world, and to identify parameters associated with in-hospital mortality.
  
  METHODS:
  We studied 870 patients with acute COVID-19 infection from 13 medical centers in four world regions (Asia, Europe, United States, Latin America) who had undergone transthoracic echocardiograms. Clinical and laboratory data were collected, including patient outcomes. Anonymized echocardiograms were analyzed with automated, machine learning-derived algorithms to calculate left ventricular (LV) volumes, ejection fraction, and LV longitudinal strain (LS). Right-sided echocardiographic parameters that were measured included right ventricular (RV) LS, RV free-wall strain (FWS), and RV basal diameter. Multivariate regression analysis was performed to identify clinical and echocardiographic parameters associated with in-hospital mortality.
  
  RESULTS:
  Significant regional differences were noted in terms of patient comorbidities, severity of illness, clinical biomarkers, and LV and RV echocardiographic metrics. Overall in-hospital mortality was 21.6%. Parameters associated with mortality in a multivariate analysis were age (odds ratio [OR] = 1.12 [1.05, 1.22], P = .003), previous lung disease (OR = 7.32 [1.56, 42.2], P = .015), LVLS (OR = 1.18 [1.05, 1.36], P = .012), lactic dehydrogenase (OR = 6.17 [1.74, 28.7], P = .009), and RVFWS (OR = 1.14 [1.04, 1.26], P = .007).
  
  CONCLUSIONS:
  Left ventricular dysfunction is noted in approximately 20% and RV dysfunction in approximately 30% of patients with acute COVID-19 illness and portend a poor prognosis. Age at presentation, previous lung disease, lactic dehydrogenase, LVLS, and RVFWS were independently associated with in-hospital mortality. Regional differences in cardiac phenotype highlight the significant differences in patient acuity as well as echocardiographic utilization in different parts of the world.
  
  Copyright © 2021 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.
  
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• Feasibility of semi-recumbent bicycle exercise Doppler echocardiography for the evaluation of the right heart and pulmonary circulation unit in different clinical conditions: the RIGHT heart international NETwork (RIGHT-NET).
  Int J Cardiovasc Imaging

  2021 Jul;37(7):2151-2167. doi: 10.1007/s10554-021-02243-x.
  
  Ferrara Francesco, Gargani Luna, Naeije Robert, Rudski Lawrence, Armstrong William F, Wierzbowska-Drabik Karina, Argiento Paola, Bandera Francesco, Cademartiri Filippo, Citro Rodolfo, Cittadini Antonio, Cocchia Rosangela, Contaldi Carla, D'Alto Michele, D'Andrea Antonello, Grünig Ekkehard, Guazzi Marco, Kolias Theodore John, Limongelli Giuseppe, Marra Alberto Maria, Mauro Ciro, Moreo Antonella, Ranieri Brigida, Saggar Rajan, Salzano Andrea, Stanziola Anna Agnese, Vriz Olga, Vannan Mani, Kasprzak Jaroslaw D, Bossone Eduardo,
  
  Abstract
  
  Exercise Doppler echocardiography (EDE) is a well-validated tool in ischemic and valvular heart diseases. However, its use in the assessment of the right heart and pulmonary circulation unit (RH-PCU) is limited. The aim of this study is to assess the semi-recumbent bicycle EDE feasibility for the evaluation of RH-PCU in a large multi-center population, from healthy individuals and elite athletes to patients with overt or at risk of developing pulmonary hypertension (PH). From January 2019 to July 2019, 954 subjects [mean age 54.2?±?16.4 years, range 16-96, 430 women] underwent standardized semi-recumbent bicycle EDE with an incremental workload of 25 watts every 2 min, were prospectively enrolled among 7 centers participating to the RIGHT Heart International NETwork (RIGHT-NET). EDE parameters of right heart structure, function and pressures were obtained according to current recommendations. Right ventricular (RV) function at peak exercise was feasible in 903/940 (96%) by tricuspid annular plane systolic excursion (TAPSE), 667/751 (89%) by tissue Doppler-derived tricuspid lateral annular systolic velocity (S') and 445/672 (66.2%) by right ventricular fractional area change (RVFAC). RV-right atrial pressure gradient [RV-RA gradient?=?4?×?tricuspid regurgitation velocity (TRV)] was feasible in 894/954 patients (93.7%) at rest and in 816/954 (85.5%) at peak exercise. The feasibility rate in estimating pulmonary artery pressure improved to more than 95%, if both TRV and/or right ventricular outflow tract acceleration time (RVOT AcT) were considered. In high specialized echocardiography laboratories semi-recumbent bicycle EDE is a feasible tool for the assessment of the RH-PCU pressure and function.
  
  © 2021. The Author(s), under exclusive licence to Springer Nature B.V.
  
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• Uric acid in chronic coronary syndromes: Relationship with coronary artery disease severity and left ventricular diastolic parameter.
  Nutr Metab Cardiovasc Dis

  2021 May;31(5):1501-1508. doi: 10.1016/j.numecd.2021.01.023.
  
  Maloberti Alessandro, Bossi Irene, Tassistro Elena, Rebora Paola, Racioppi Angelo, Nava Stefano, Soriano Francesco, Piccaluga Emanuela, Piccalò Giacomo, Oreglia Jacopo, Vallerio Paola, Pirola Roberto, De Chiara Benedetta, Oliva Fabrizio, Moreo Antonella, Valsecchi Maria Grazia, Giannattasio Cristina
  
  Abstract
  
  BACKGROUND AND AIMS:
  Uric Acid (UA) has been related to the development of Cardio-Vascular (CV) events in patients affected by Chronic Coronary Syndromes (CCS). Among various hypothesis, two arise: UA may negatively act on coronary artery determining a higher degree of atherosclerotic disease, and/or on heart determining a higher prevalence of diastolic dysfunction. Both the above hypothesized effects are object of our investigation.
  
  METHODS AND RESULTS:
  231 patients who were admitted to the cardiological department of the Niguarda Hospital (Milan, Italy) for CCS from January 2017 to June 2018 were enrolled. Coronary atherosclerotic burden was evaluated from coronary angiography as the number and type of involved vessels, as well as with both Gensini and Syntax scores. All subjects underwent a complete echocardiogram. At unadjusted and adjusted/multivariable analysis, UA levels were not significantly associated with variables analysed from the coronary angiography (number and type of vessels involved, neither the Gensini and Syntax scores) as well as with echocardiographic parameters regarding systolic and diastolic function.
  
  CONCLUSIONS:
  In conclusion, the main finding of our work is the absence of a role for UA in determining coronary arteries disease as well as LV diastolic dysfunction in CCS subjects. Taking together the results of previous studies with ours, we hypothesize that UA could act on heart (both on coronary arteries and on LV function) in an early phase of the disease, whereas while in the advanced stages other factors (previous myocardial infarction, previous myocardial revascularization and so on) may overshadow its effects.
  
  Copyright © 2021 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.
  
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• Heart valve calcification and cardiac hemodynamics.
  Echocardiography

  2021 Apr;38(4):525-530. doi: 10.1111/echo.14994.
  
  Rossi Andrea, Barbieri Andrea, Benfari Giovanni, Gaibazzi Nicola, Erlicher Andrea, Mureddu Gianfrancesco, Frattini Silvia, Faden Giacomo, Manicardi Marcella, Beraldi Monica, Agostini Francesco, Lazzarini Valentina, Moreo Antonella, Luigi Temporelli Pier, Magni Giovanna, Pressman Gregg, Faggiano Pompilio
  
  Abstract
  
  PURPOSE:
  Heart valve calcification (VC) is associated with increased cardiovascular risk, but the hemodynamic and functional profile of patients affected by VC has not been fully explored.
  
  METHODS:
  The study population was formed by consecutive unselected patients included in seven echocardiographic laboratories in a 2-week period. A comprehensive echocardiographic examination was performed. VC was defined by the presence of calcification on at least one valve.
  
  RESULTS:
  Population was formed of 1098 patients (mean age 65 ± 15 years; 47% female). VC was present in 31% of the overall population. Compared with subjects without VC, VC patients were older (60 ± 14 vs 75 ± 9; P 
  CONCLUSION:
  Heart valve calcification patients were characterized by a worse functional and hemodynamic profile compared to patients with normal valve. The association between VC and diastolic function and PASP were independent in comprehensive multivariate models.
  
  © 2021 Wiley Periodicals LLC.
  
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• Left atrial volume indexed for height is a new sensitive marker for subclinical cardiac organ damage in female hypertensive patients.
  Hypertens Res

  2021 Jun;44(6):692-699. doi: 10.1038/s41440-021-00614-4.
  
  Airale Lorenzo, Paini Anna, Ianniello Eugenia, Mancusi Costantino, Moreo Antonella, Vaudo Gaetano, Avenatti Eleonora, Salvetti Massimo, Bacchelli Stefano, Izzo Raffaele, Sormani Paola, Arrivi Alessio, Muiesan Maria Lorenza, Esposti Daniela Degli, Giannattasio Cristina, Pucci Giacomo, De Luca Nicola, Milan Alberto,
  
  Abstract
  
  Left atrial enlargement (LAe) is a subclinical marker of hypertensive-mediated organ damage, which is important to identify in cardiovascular risk stratification. Recently, LA indexing for height was suggested as a more accurate marker of defining LAe. Our aim was to test the difference in LAe prevalence using body surface area (BSA) and height definitions in an essential hypertensive population. A total of 441 essential hypertensive patients underwent complete clinical and echocardiographic evaluation. Left atrial volume (LAV), left ventricular morphology, and systolic-diastolic function were evaluated. LAe was twice as prevalent when defined using height (LAe) indexation rather than BSA (LAe) (51% vs. 23%, p?0.001). LAe, but not LAe, was more prevalent in females (p?0.001). Males and females also differed in left ventricular hypertrophy (p?=?0.046) and left ventricular diastolic dysfunction (LVDD) indexes (septal Em/Etdi: p?=?0.009; lateral Em/Etdi: p?=?0.003; mean Em/Etdi: p?0.002). All patients presenting LAe also met the criteria for LAe. According to the presence/absence of LAe, we created three groups (Norm?=?BSA-/h-; DilH?=?BSA-/h+; DilHB = BSA+/h+). The female sex prevalence in the DilH group was higher than that in the other two groups (Norm: p?0.001; DilHB: p?=?0.036). LVH and mean and septal Em/Etdi increased from the Norm to the DilH group and from the DilH to the DilHB group (p?0.05 for all comparisons). These results show that LAe identified twice as many patients as comparing LAe to LAe, but that both LAe and LAe definitions were associated with LVH and LVDD. In female patients, the LAe definition and its sex-specific threshold seem to be more sensitive than LAe in identifying chamber enlargement.
  
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• A multicentric quality-control study of exercise Doppler echocardiography of the right heart and the pulmonary circulation. The RIGHT Heart International NETwork (RIGHT-NET).
  Cardiovasc Ultrasound

  2021 Jan;19(1):9. doi: 9.
  
  Ferrara Francesco, Gargani Luna, Contaldi Carla, Agoston Gergely, Argiento Paola, Armstrong William F, Bandera Francesco, Cademartiri Filippo, Citro Rodolfo, Cittadini Antonio, Cocchia Rosangela, D'Alto Michele, D'Andrea Antonello, Douschan Philipp, Ghio Stefano, Grünig Ekkehard, Guazzi Marco, Guida Stefania, Kasprzak Jaroslaw D, Kolias Theodore John, Limongelli Giuseppe, Marra Alberto Maria, Mazzola Matteo, Mauro Ciro, Moreo Antonella, Pieri Francesco, Pratali Lorenza, Pugliese Nicola Riccardo, Raciti Mauro, Ranieri Brigida, Rudski Lawrence, Saggar Rajan, Salzano Andrea, Serra Walter, Stanziola Anna Agnese, Vannan Mani, Voilliot Damien, Vriz Olga, Wierzbowska-Drabik Karina, Naeije Robert, Bossone Eduardo,
  
  Abstract
  
  PURPOSE:
  This study was a quality-control study of resting and exercise Doppler echocardiography (EDE) variables measured by 19 echocardiography laboratories with proven experience participating in the RIGHT Heart International NETwork.
  
  METHODS:
  All participating investigators reported the requested variables from ten randomly selected exercise stress tests. Intraclass correlation coefficients (ICC) were calculated to evaluate the inter-observer agreement with the core laboratory. Inter-observer variability of resting and peak exercise tricuspid regurgitation velocity (TRV), right ventricular outflow tract acceleration time (RVOT Act), tricuspid annular plane systolic excursion (TAPSE), tissue Doppler tricuspid lateral annular systolic velocity (S'), right ventricular fractional area change (RV FAC), left ventricular outflow tract velocity time integral (LVOT VTI), mitral inflow pulsed wave Doppler velocity (E), diastolic mitral annular velocity by TDI (e') and left ventricular ejection fraction (LVEF) were measured.
  
  RESULTS:
  The accuracy of 19 investigators for all variables ranged from 99.7 to 100%. ICC was?>?0.90 for all observers. Inter-observer variability for resting and exercise variables was for TRV?=?3.8 to 2.4%, E?=?5.7 to 8.3%, e'?=?6 to 6.5%, RVOT Act?=?9.7 to 12, LVOT VTI?=?7.4 to 9.6%, S'?=?2.9 to 2.9% and TAPSE?=?5.3 to 8%. Moderate inter-observer variability was found for resting and peak exercise RV FAC (15 to 16%). LVEF revealed lower resting and peak exercise variability of 7.6 and 9%.
  
  CONCLUSIONS:
  When performed in expert centers EDE is a reproducible tool for the assessment of the right heart and the pulmonary circulation.
  
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• [Imaging in acute aortic syndrome: not just dissection].
  G Ital Cardiol (Rome)

  2020 Sep;21(9):656-668. doi: 10.1714/3413.33961.
  
  Mele Donato, Rizzo Massimiliano, Campana Marco, D'Andrea Antonello, Di Giannuario Giovanna, Gimelli Alessia, Khoury Georgette, Pino Paolo G, Berretta Paolo, Settepani Fabrizio, Chiodi Elisabetta, Di Eusanio Marco, Moreo Antonella,
  
  Abstract
  
  Acute aortic syndrome includes three main pathological conditions: aortic dissection (AD), intramural hematoma (IMH) and penetrating aortic ulcer (PAU). These are life-threatening conditions, therefore early diagnosis and interventional/surgical treatment are fundamental for the survival of affected individuals. While anatomical findings of classical AD provided by imaging techniques are known to all cardiologists, imaging findings of IMH and PAU are less known, as are their prognostic implications and consequences on management and treatment strategies. This review aims to describe and discuss findings and role of imaging techniques in patients with IMH and PAU.
  
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• [Functional tricuspid regurgitation: imaging, surgical indications, reparative techniques and results].
  G Ital Cardiol (Rome)

  2020 Nov;21(11):865-877. doi: 10.1714/3455.34441.
  
  Settepani Fabrizio, Berretta Paolo, Fratto Pasquale, Di Giannuario Giovanna, D'Andrea Antonello, Campana Marco, Murzi Michele, Iafrancesco Mauro, Mangino Domenico, Moreo Antonella, Di Eusanio Marco
  
  Abstract
  
  Although the indications for surgical management of severe functional tricuspid regurgitation (TR) are now generally accepted, controversy persists concerning the role of intervention for moderate TR. However, there is a trend for intervention in this setting, particularly in patients with annular dilation. Echocardiographic imaging is the gold standard to identify functional TR and distinguish it from a primitive or degenerative form. Currently, surgery remains the best approach for the interventional treatment of TR. Ring annuloplasty seems to provide better results than suture annuloplasty (De Vega technique) and rigid rings appear to be more reliable in the long term, in comparison with flexible bands. Tricuspid valve repair is more beneficial compared with replacement, except in highly selected cases of long-standing TR with multifactorial mechanism.
  
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• [Follow-up after surgical treatment of type A acute aortic dissection: current evidence and controversies].
  G Ital Cardiol (Rome)

  2020 Nov;21(11):858-864. doi: 10.1714/3455.34440.
  
  Berretta Paolo, Iafrancesco Mauro, Settepani Fabrizio, Mele Donato, Di Giannuario Giovanna, Murzi Michele, Fratto Pasquale, Pino Paolo Giuseppe, Mangino Domenico, Moreo Antonella, Di Eusanio Marco
  
  Abstract
  
  Type A acute aortic dissection (TA-AAD) is a catastrophic condition for which emergency surgery is the mainstay of therapy. Surgical treatment of TA-AAD is centered on excision of the proximal intimal tear, replacement of the ascending aorta and re-establishment of a dominant flow in the distal true lumen. In patients who survive surgery, a dissected distal and/or proximal aorta remains, posing a risk of subsequent aneurysmal degeneration, rupture and malperfusion, and secondary extensive interventions are often required. However, knowledge regarding the risk factors of progression of residual aortic dissection is limited, and no well-defined recommendations for clinical and imaging follow-up have been generated thus far. The aim of this paper is to review and discuss on the current evidence and controversies on the long-term management of patients operated on for TA-AAD.
  
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• Takotsubo Syndrome in Coronavirus Disease 2019.
  Am J Cardiol

  2021 Jan;138():118-120. doi: 10.1016/j.amjcard.2020.10.005.
  
  Templin Christian, Manka Robert, Cammann Victoria Lucia, Szawan Konrad Andreas, Gotschy Alexander, Karolyi Mihaly, Winnik Stephan, Moch Holger, Meyer Philippe, Moreo Antonella, Bossone Eduardo, D'Ascenzo Fabrizio, Secco Gioel Gabrio, Mancone Massimo, Infusino Fabio, Gaido Luca, Giammaria Massimo, Wittstein Ilan S, Varga Zsuzsanna, Ghadri Jelena R
  
  
  
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• [Non-ischemic ventricular dysfunction in COVID-19 patients: characteristics and implications for cardiac imaging on the basis of current evidence].
  G Ital Cardiol (Rome)

  2020 Oct;21(10):739-749. doi: 10.1714/3431.34196.
  
  Mele Donato, D'Andrea Antonello, Campana Marco, Di Giannuario Giovanna, Flamigni Filippo, Gimelli Alessia, Khoury Georgette, Rizzo Massimiliano, Moreo Antonella
  
  Abstract
  
  Coronavirus 2019 disease (COVID-19), caused by SARS-CoV-2, can lead to cardiac impairment with various types of clinical manifestations, including heart failure and cardiogenic shock. A possible expression of cardiac impairment is non-ischemic ventricular dysfunction, which can be related to different pathological conditions, such as myocarditis, stress and cytokine-related ventricular dysfunction. The diagnosis of these pathological conditions can be challenging during COVID-19; furthermore, their prevalence and prognostic significance have not been elucidated yet. The purpose of this review is to take stock of the various aspects of non-ischemic ventricular dysfunction that may occur during COVID-19 and of the diagnostic implications related to the use of cardiac imaging techniques.
  
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• Takotsubo syndrome as a complication in a critically ill COVID-19 patient.
  ESC Heart Fail

  2020 Dec;7(6):4297-4300. doi: 10.1002/ehf2.12912.
  
  Bottiroli Maurizio, De Caria Daniele, Belli Oriana, Calini Angelo, Andreoni Patrizia, Siragusa Antonio, Moreo Antonella, Ammirati Enrico, Mondino Michele, Fumagalli Roberto
  
  Abstract
  
  Coronavirus disease 2019 (COVID-19) patients with cardiac injury have an increased risk of mortality. It remains to be determined the mechanism of cardiac injury and the identification of specific conditions that affect the heart during COVID-19. We present the case of a 76-year-old woman with COVID-19 pneumonia that developed a takotsubo syndrome (TTS). Although the patient presented normal left ventricular ejection fraction and normal levels of troponin on admission, after 16 days in intensive care unit due to respiratory distress, she suddenly developed cardiogenic shock. Shock occurred few hours after a spontaneous breathing trial through her tracheostomy. Bed-side echocardiographic revealed apical ballooning promptly supporting the diagnosis of TTS. She was successfully treated with deep sedation and low dosage of epinephrine. The relevance of this case is that TTS can occur in the late phase of COVID-19. Awareness of late TTS and bed-side echocardiographic evaluation can lead to prompt identification and treatment.
  
  © 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.
  
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• Thoracic radiotherapy as a risk factor for heart ischemia in subjects treated with chest irradiation and chemotherapy and without classic cardiovascular RISK factors.
  Radiother Oncol

  2020 Nov;152():146-150. doi: 10.1016/j.radonc.2020.07.004.
  
  Vallerio Paola, Maloberti Alessandro, Palazzini Matteo, Occhi Lucia, Peretti Alessio, Nava Stefano, Soriano Francesco, Musca Francesco, De Chiara Benedetta, Belli Oriana, Moreo Antonella, Bisceglia Irma, Lestuzzi Chiara, Giannattasio Cristina
  
  Abstract
  
  BACKGROUND AND PURPOSE:
  Radiation Induced Heart Disease (RIHD) represents a late effect of chest irradiation, contributing in increasing mortality rate in oncological patients by affecting pericardium, myocardium, valvs and coronaries. Currently, regarding the risk of Coronary Artery Disease (CAD), a cardiological screening involving exercise stress electrocardiography after 5-10 years from radiotherapy is advised. We sought to determine the rate of ischemia at exercise stress electrocardiography in a population of patients without cardiovascular risk factors who sustained radiotherapy, using a cohort of patients presenting with at least one cardiovascular risk factor as control group.
  
  DESIGN AND METHODS:
  A population of 115 patients who sustained chest irradiation (and associated chemotherapy), presenting without classic cardiovascular risk factors or typical symptoms suggesting CAD, was evaluated with exercise stress electrocardiography. 135 patients with at least one risk factor for cardiovascular disease candidate to stress testing for primary prevention or for atypical symptoms served as control group.
  
  RESULTS:
  The cohort of irradiated patients without classical cardiovascular risk factors is younger (48.7 ± 10.1 vs 60.5 ± 10.8 years, p 
  CONCLUSIONS:
  Chest irradiation represents a strong cardiovascular risk factor. In fact, prevalence of positive ECG-stress test is not different (nor higher and nor lower) in irradiated subjects without cardiovascular risk and not irradiated patients with classic cardiovascular risk.
  
  Copyright © 2020 Elsevier B.V. All rights reserved.
  
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• [Grey zones in cardiovascular adaptations to physical exercise: how to navigate in the echocardiographic evaluation of the athlete's heart].
  G Ital Cardiol (Rome)

  2020 Jun;21(6):457-468. doi: 10.1714/3359.33330.
  
  D'Andrea Antonello, Mele Donato, Palermi Stefano, Rizzo Massimiliano, Campana Marco, Di Giannuario Giovanna, Gimelli Alessia, Khoury Georgette, Moreo Antonella,
  
  Abstract
  
  "Athlete's heart" represents a series of mechanisms through which cardiac chambers can adapt to physical activity. Echocardiography has a major role in sports cardiology and it can help physicians to investigate the so-called "grey zones", defined as diagnostic overlaps between athlete's heart and several cardiac diseases: wall thickness and left ventricular size in hypertrophic and dilated cardiomyopathy, ventricular trabeculations in left ventricular non-compaction cardiomyopathy, left atrial size and atrial fibrillation, right ventricular systolic dysfunction in arrhythmogenic right ventricular cardiomyopathy. The use of advanced ultrasound methods such as tissue Doppler and two-dimensional strain can be added to the classic echocardiographic assessment to complete a multi-parametric evaluation, guiding the sports physician and cardiologist in the correct framing of these patients.
  
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• [Clinical and diagnostic key points of left ventricular hypertrophy in adults: insights from the ANMCO Lombardy experience].
  G Ital Cardiol (Rome)

  2020 Jun;21(6):447-456. doi: 10.1714/3359.33329.
  
  Iacovoni Attilio, De Chiara Benedetta, Sormani Paola, Campana Marco, Agostini Francesco, Faggiano Pompilio, Occhi Lucia, Dadone Viola, Raineri Claudia, Moreo Antonella, Di Tano Giuseppe,
  
  Abstract
  
  Left ventricular hypertrophy is a common complication of different diseases. Among these, cardiac involvement of amyloidosis or Anderson-Fabry disease are often unrecognized. Early diagnosis is therefore crucial because new therapies can impact the progression of these diseases. Different specific signs unmasked by clinical, laboratory, and non-invasive diagnostic tests such as echocardiography or cardiac magnetic resonance could guide clinicians towards an appropriate diagnosis. The aim of this review is to underline the major diagnostic clues of different forms of left ventricular hypertrophy in adult patients, guiding clinicians towards a more appropriate diagnosis.
  
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• Prognostic Value of Lung Ultrasound B-Lines in Systemic Sclerosis.
  Chest

  2020 Oct;158(4):1515-1525. doi: 10.1016/j.chest.2020.03.075.
  
  Gargani Luna, Bruni Cosimo, Romei Chiara, Frumento Paolo, Moreo Antonella, Agoston Gergely, Guiducci Serena, Bellando-Randone Silvia, Lepri Gemma, Belloli Laura, Della Rossa Alessandra, Delle Sedie Andrea, Stagnaro Chiara, De Nes Michele, Salvadori Stefano, Mosca Marta, Falaschi Fabio, Epis Oscar, Picano Eugenio, Matucci-Cerinic Marco
  
  Abstract
  
  BACKGROUND:
  A high percentage of systemic sclerosis (SSc) patients experience interstitial lung disease (ILD) during the disease course. Recent data have shown that lung ultrasound (LUS) can assess ILD by the evaluation of B-lines, the sonographic sign of pulmonary interstitial involvement.
  
  RESEARCH QUESTION:
  To establish the prognostic value of B-lines in a large number of patients with SSc.
  
  STUDY DESIGN AND METHODS:
  A total of 396 consecutive patients with SSc, who were enrolled at three Rheumatology Departments, underwent a comprehensive LUS examination on the anterolateral and posterior chest for a total of 58 scanning sites. All available clinical, imaging, and functional data were recorded. Patients were followed after enrolment to establish the prognostic role of LUS.
  
  RESULTS:
  The median number of B-lines was higher in patients with the diffuse cutaneous subset (44 vs 17 B-lines; P 
  INTERPRETATION:
  Lung ultrasound B-lines are associated with worsening or development of pulmonary deterioration. In the near future, LUS might become part of the diagnostic and prognostic armamentarium in patients with SSc, which would allow a more sustainable and user-friendly approach to this very fragile population.
  
  Copyright © 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
  
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• [The role of multimodality imaging in COVID-19 patients: from diagnosis to clinical monitoring and prognosis].
  G Ital Cardiol (Rome)

  2020 May;21(5):345-353. doi: 10.1714/3343.33132.
  
  D'Andrea Antonello, Di Giannuario Giovanna, Marrazzo Gemma, Riegler Lucia, Mele Donato, Rizzo Massimiliano, Campana Marco, Gimelli Alessia, Khoury Georgette, Moreo Antonella,
  
  Abstract
  
  The integrated clinical, laboratory and ultrasound approach is essential for the diagnosis, monitoring and evaluation of the patient's therapy in COVID-19 pneumonia. The ideal imaging strategy in this setting is not yet well defined. Bedside pulmonary ultrasound presents an undeniable series of advantages in patients at high risk of infection, and can provide incremental data in the respiratory intensive care for the serial control of the individual patient, as well as for home delivery of stabilized patients. Chest X-ray is characterized by low sensitivity in identifying earlier lung changes. Pulmonary computed tomography shows high sensitivity but should not be routinely performed in all patients, because in the first 48 h it can be absolutely negative, and in the late phase imaging findings may not change the therapeutic approach. Echocardiography should be limited to patients with hemodynamic instability.
  
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• [ANMCO/SICI-GISE/SIC/SIECVI/SIRM Consensus document: Appropriateness of multimodality imaging in cardiovascular disease].
  G Ital Cardiol (Rome)

  2020 Jan;21(1):34-88. doi: 10.1714/3285.32588.
  
  Nardi Federico, Pino Paolo Giuseppe, Gabrielli Domenico, Colivicchi Furio, Abrignani Maurizio Giuseppe, Amico Antonio Francesco, Aspromonte Nadia, Benedetto Francesco Antonio, Bertella Erika, Boccardi Lidia Maria, Bucciarelli Ducci Chiara, Caldarola Pasquale, Campana Marco, Caso Pio, Citro Rodolfo, Costante Anna Maria, De Chiara Benedetta Carla, Di Cesare Ernesto, Di Fusco Stefania Angela, Domenicucci Stefano, Enea Iolanda, Erba Paola, Faganello Giorgio, Favilli Silvia, Geraci Giovanna, Giubbini Raffaele, Giunta Nicola, Guido Vincenzo, Imazio Massimo, Khoury Georgette, La Canna Giovanni, Mele Donato, Moreo Antonella Maurizia, Mercuro Giuseppe Guglielmo, Musumeci Giuseppe, Neglia Danilo, Parrini Iris, Pinamonti Bruno, Pollarolo Luigi, Pontone Gianluca, Privitera Carmelo, Riccio Carmine, Sinagra Gianfranco, Urbinati Stefano, Varbella Ferdinando, Berisso Massimo Zoni, Zuin Guerrino, Di Lenarda Andrea, Gulizia Michele Massimo
  
  Abstract
  
  The complexity of cardiovascular diseases has led to an extensive use of technological instruments and the development of multimodality imaging. This extensive use of different cardiovascular imaging tests in the same patient has increased costs and waiting times.The concept of appropriateness has changed over time. Appropriateness criteria address the need for specific cardiovascular imaging tests in well-defined clinical scenarios, and define the kind of cardiovascular imaging that is appropriated for each clinical scenario in different stages of the disease. The concept of appropriateness criteria has replaced the old idea of appropriate use criteria and reflects the increasing effort of the international Scientific Societies to create and review in a critical way the management of diagnostic tests used by clinicians.The aim of this Italian consensus document is to address the use of multimodality imaging in the diagnosis and management of the major cardiovascular clinical scenarios, taking into consideration not only the international guidelines and scientific documents already published, but also the reality of Italian laws as well as the various professional profiles involved in patient management and availability of technological diagnostic instruments.
  
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• [Role of multimodality imaging in the clinical evaluation of hypertrophic cardiomyopathy].
  G Ital Cardiol (Rome)

  2019 Dec;20(12):746-761. doi: 10.1714/3271.32383.
  
  Guido Vincenzo, Campana Marco, Pino Paolo Giuseppe, Moreo Antonella, De Chiara Benedetta, Bertella Erika, Khoury Georgette,
  
  Abstract
  
  Sarcomeric hypertrophic cardiomyopathy is the most common cardiovascular genetic disease. Clinical evaluation and comprehensive echocardiography are crucial for the diagnosis and early evaluation of the hypertrophic phenotype, but multimodality imaging approach is often required to better define diagnosis and differential diagnosis from phenocopies. This review aims to assess the role of multimodality imaging and, in particular, advanced echocardiography and cardiac magnetic resonance in relation to differential diagnosis and preclinical diagnosis, identification of different phenotypes, and assessment of disease progression and risk of sudden cardiac death. A multimodality imaging approach is also crucial for the selection of patients amenable to surgical or percutaneous septal myectomy and for guiding both procedures.
  
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• [Physiological and paraphysiological echocardiographic findings in neonatal and pediatric age].
  G Ital Cardiol (Rome)

  2019 Nov;20(11):627-631. doi: 10.1714/3254.32223.
  
  Russo Maria Giovanna, Cirillo Annapaola, Rinelli Gabriele, Vairo Ugo, Favilli Silvia, Moreo Antonella, Domenicucci Stefano, Gulizia Michele Massimo, Gabrielli Domenico
  
  Abstract
  
  Echocardiographic quantification is crucial for the diagnosis and management of patients with acquired and congenital heart disease (CHD). In neonatal and pediatric age, the echocardiogram begins with subxiphoid, or subcostal, imaging instead of left parasternal views. This allows for the determination of visceral situs (site or location) at the beginning of an examination. Regardless of where the examination starts, the segmental approach is used to describe all of the major cardiovascular structures in sequence. Patent foramen ovale is a normal interatrial communication during fetal life. Complete anatomic closure of the foramen ovale occurs in 70-75% of adults, which means that almost 25% of the population has a patent foramen ovale. Atrial septal defects are a common congenital disorder with a prevalence of approximately 2 per 1000 live births. The reported rate of spontaneous atrial septal defect closure in the first year of life ranges from 4% to 96%. The most important predictor for spontaneous closure is the size of the defect, with smaller defects more likely to close. Systemic-to-pulmonary collateral arteries can occur in premature infants without chronic lung disease and may represent a transient phenomenon. They may be present normally after birth and then gradually disappear. Physiological valvular regurgitation is most commonly observed in the tricuspid valve among children (32.8%), followed by pulmonary regurgitation (17.2%). The ductus arteriosus usually is functionally closed within 48 h of birth, although some authors consider the patent ductus to be abnormal only after 3 months of age. Prematurity clearly increases the incidence of patent ductus arteriosus.
  
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• Practical implementation of the Endocarditis Team in 'functional' reference centres: the Italian hospital network experience and recommendations of the Italian Society of Echocardiography and Cardiovascular Imaging.
  J Cardiovasc Med (Hagerstown)

  2019 Jul;20(7):414-418. doi: 10.2459/JCM.0000000000000810.
  
  Cecchi Enrico, Chirillo Fabio, Moreo Antonella, Graziosi Maddalena, De Michele Lucrezia, Faggiano Pompilio, Mattioli Roberto, Polizzi Vincenzo, Labanti Graziana, Benedetto Frank A, Colonna Paolo,
  
  Abstract
  
  : The 2015 European Society of Cardiology (ESC) guidelines for the management of infective endocarditis recommend the use of a multidisciplinary team in the care of patients with infective endocarditis. A standardized collaborative approach should be implemented in centres with immediate access to different imaging techniques, cardiac surgery and health professionals from several specialties. This position paper has been produced by the Task Force for Management of Infective Endocarditis of Italian Society of Echocardiography and Cardiovascular Imaging (SIECVI) with the aim of providing recommendations for the implementation of the Endocarditis Team within the Italian hospital network. On the basis of the Italian hospital network with many cardiology facilities encompassing a total of 405 intensive cardiac care units (ICCUs) across the country, 224 (3.68 per million inhabitants) of which have on-site 24-h PCI capability, but with relatively few centres equipped with cardiac surgery and nuclear medicine, in the present article, the SIECVI Task Force for Management of Infective Endocarditis develops the idea of a network where 'functional' reference centres act as a link with the periphery and with 'structural' reference centres. A number of minimum characteristics are provided for these 'functional' reference centres. Outcome and cost analysis of implementing an Endocarditis Team with functional referral is expected to be derived from ongoing Italian and European registries.
  
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• [Aortic valve repair: state of the art].
  G Ital Cardiol (Rome)

  2019 Sep;20(9):481-490. doi: 10.1714/3207.31837.
  
  Di Eusanio Marco, Berretta Paolo, Rubino Antonino S, Moreo Antonella, Miceli Antonio, Montalto Andrea, Savini Carlo, Troise Giovanni, Patanè Leonardo, Pino Paolo G
  
  Abstract
  
  Mechanical or bioprosthetic aortic valve replacement has traditionally been the treatment of choice for patients with aortic valve insufficiency. However, prosthetic valve replacement has significant limitations being associated with a substantial cumulative risk of thromboembolism, anticoagulation-related hemorrhage, prosthetic valve endocarditis, and structural or non-structural valve dysfunction requiring reoperation. In this setting, aortic valve repair, by avoiding the long-term risks associated with prosthetic valve implantation, has emerged as a valid alternative treatment to conventional aortic valve replacement. In the last decade, improvements in the understanding of the mechanisms of valve disease, development of a classification system for aortic insufficiency and advances in surgical procedures have allowed for more effective and reproducible techniques for aortic valve repair. The aim of the present review is to assess the principles, the surgical techniques, and the role of echocardiographic imaging in the setting of aortic valve repair surgery.
  
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• Getting to the heart of the matter in a multisystem disorder: Erdheim-Chester disease.
  Lancet

  2019 Aug;394(10198):e19. doi: 10.1016/S0140-6736(19)31787-8.
  
  Buono Andrea, Bassi Ilaria, Santolamazza Caterina, Moreo Antonella, Pedrotti Patrizia, Sacco Alice, Morici Nuccia, Giannattasio Cristina, Oliva Fabrizio, Ammirati Enrico
  
  
  
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• Sequencing of NOTCH1 gene in an Italian population with bicuspid aortic valve: Preliminary results from the GISSI OUTLIERS VAR study.
  Gene

  2019 Oct;715():143970. doi: 10.1016/j.gene.2019.143970.
  
  Pileggi Silvana, De Chiara Benedetta, Magnoli Michela, Franzosi Maria Grazia, Merlanti Bruno, Bianchini Francesca, Moreo Antonella, Romeo Gabriella, Russo Claudio Francesco, Rizzo Stefania, Basso Cristina, Martinelli Luigi, Maseri Attilio,
  
  Abstract
  
  BACKGROUND:
  Bicuspid aortic valve (BAV) formation is genetically determined, with reduced penetrance and variable expressivity. NOTCH1 is a proven candidate gene and its mutations have been found in familial and sporadic cases of BAV.
  
  METHODS:
  66 BAV patients from the GISSI VAR study were genotyped for the NOTCH1 gene.
  
  RESULTS:
  We identified 63 variants, in heterozygous and homozygous states. Fifty-two are common polymorphisms present in almost all patients. Eleven variants are new and never yet reported: two are non-synonymous substitutions, Gly540Asp in exon 10 and Glu851Gln in exon 16; one is in the 3'UTR region and seven in introns, one corresponds to a T allele insertion in intron 27. We selected four statistically noteworthy and seven new variants identified in six BAV patients and correlated them with clinical and demographic variables and with imaging and histological parameters. Preliminary data show that four were BAV patients with isolated stenosis in patients over 60 aged. These variants may correlate with a later need for surgery for the presence of stenosis and not aortic valve regurgitation or ascending aortic aneurysm.
  
  CONCLUSIONS:
  Completing the genotyping of 62 BAV patients we found 11 new variants in the NOTCH1 gene never yet reported. These findings confirm that the identification of new, clinically remarkable biomarkers for BAV requires a deeper genetic understanding of the NOTCH1 gene variants, which could be targeted by future diagnostic and therapeutic strategies.
  
  Copyright © 2019 Elsevier B.V. All rights reserved.
  
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• Could two-dimensional radial strain be considered as a novel tool to identify pre-clinical hypertrophic cardiomyopathy mutation carriers?
  Int J Cardiovasc Imaging

  2019 Dec;35(12):2167-2175. doi: 10.1007/s10554-019-01668-9.
  
  Santambrogio Gloria Maria, Maloberti Alessandro, Vallerio Paola, Peritore Angelica, Spanò Francesca, Occhi Lucia, Musca Francesco, Belli Oriana, De Chiara Benedetta, Casadei Francesca, Facchetti Rita, Turazza Fabio, Manfredini Emanuela, Giannattasio Cristina, Moreo Antonella
  
  Abstract
  
  Treatment of overt form of hypertrophic cardiomyopathy (HCM) is often unsuccessful. Efforts are focused on a possible early identification in order to prevent or delaying the development of hypertrophy. Our aim was to find an echocardiographic marker able to distinguish mutation carriers without left ventricular hypertrophy (LVH) from healthy subjects. We evaluated 28 patients, members of eight families. Three types of mutation were recognized: MYBPC3 (five families), MYH7 (two families) and TNNT2 (one family). According to genetic (G) and phenotypic (Ph) features, patients were divided in three groups: Group A (10 patients), mutation carriers with LVH (G+/Ph+); Group B (9 patients), mutation carriers without LVH (G+/Ph-); Group C (9 patients), healthy subjects (G-/Ph-). Echocardiography examination was performed acquiring standard 2D, DTI and 2D-strain imaging. Global longitudinal strain (GLS) and global radial strain (GRS) at basal and mid-level were measured. GRS was significantly different between group B and C at basal level (32.18%?±?9.6 vs. 44.59%?±?12.67 respectively; p-value?0.0001). In basal posterior and basal inferior segments this difference was particularly evident. ROC curves showed for both the involved segments good AUCs (0.931 and 0.861 for basal posterior and inferior GRS respectively) with the best predictive cut-off for basal posterior GRS at 43.65%, while it was 38.4% for basal inferior GRS. Conversely, GLS values were similar in the three group. 2D longitudinal strain is a valid technique to study HCM. Radial strain and particularly basal posterior and inferior segmental reduction could be able to identify mutation carriers in a pre-clinical phase of disease.
  
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• Unusual presence of 'ghosts' following lead extraction for recurrent reactive pericarditis: a case report.
  Eur Heart J Case Rep

  2018 Dec;2(4):yty127. doi: yty127.
  
  Bentivegna Riccardo, Cattafi Giuseppe, Giannattasio Cristina, Moreo Antonella
  
  Abstract
  
  BACKGROUND:
  The presence of a persistent fibrous sheath in right-sided heart chambers after transvenous lead extraction has already been described in some studies as echocardiographic tubular mobile masses called 'ghosts'. Their presence has been associated with cardiac device-related infective endocarditis or local device infection, but to the best of our knowledge, this is the first case where 'ghosts' have been reported among non-infected patients.
  
  CASE SUMMARY:
  We present a case of a 73-year-old woman hospitalized due to worsening dyspnoea and a significant pericardial effusion, relapsed after pericardiocentesis with removal of about 1500?mL of non-haemorrhagic fluid. The patient's history revealed a previous dual-chamber pacemaker implantation due to symptomatic sick sinus syndrome. Transoesophageal echocardiography (TOE), essential to exclude endocarditis vegetations suggested an etiopathogenesis of mechanical irritation caused by the distal end of the passive fixation atrial lead on the right atrial appendage wall. Considering the echocardiographic report and the condition of reactive pericarditis with the early relapse of the significant pericardial effusion after pericardiocentesis, we opted for a lead removal procedure to eliminate the stimulus causing the irritation, with transoesophageal echocardiographic monitoring, thus the early detection of a 'ghost' was possible.
  
  DISCUSSION:
  This is the first clinical case describing the presence of fibrin 'ghosts' sometime after the implantation of a pacemaker, highlighting a non-exclusively infectious genesis, and emphasizing the importance of TOE for the early detection of this post-extraction complication and its monitoring.
  
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• Relationship between vascular damage and left ventricular concentric geometry in patients undergoing coronary angiography: a multicenter prospective study.
  J Hypertens

  2019 Jun;37(6):1183-1190. doi: 10.1097/HJH.0000000000002052.
  
  Salvetti Massimo, Paini Anna, Facchetti Rita, Moreo Antonella, Carerj Scipione, Maloberti Alessandro, Gaibazzi Nicola, Faggiano Pompilio, Mureddu Gianfranco, Rigo Fausto, Giannattasio Cristina, Muiesan Maria Lorenza,
  
  Abstract
  
  BACKGROUND:
  Vascular structural (intima-media thickness) and functional (carotid pulse wave velocity, cPWV) alterations are related to different patterns of left ventricular (LV) geometry in general population samples and in hypertensive patients. The relationship between vascular damage, evaluated by both echotracking ultrasound and coronary angiography, and LV geometry has not been prospectively analyzed.
  
  METHODS:
  In eight Italian centers, 399 consecutive patients, without history of prior coronary artery disease and with clinical indication to coronary angiography, prospectively underwent cardiac standard ultrasound examination for the evaluation of LV mass, indexed by height to 2.7 power (LVMi?g/m) and relative wall thickness (RWT), the measurement of Doppler flow in the left anterior descending artery (LAD) and the echocardiographic calcium score (eCS). In all patients measurement of common carotid intima-media thickness (cIMT) and cPWV by carotid ultrasound, with the realtime echotracking system was performed. The noninvasive evaluations were performed blindly to clinical information, before coronary angiography.
  
  RESULTS:
  cIMT and cPWV were higher in patients with concentric LV hypertrophy (LVH) (LVMi???49?g/m in men and ?47?g/m in women and RWT???0.42) as compared with those with normal LVMi and geometry (N: LVMi?49?g/m in men and 50%) was greater in patients with concentric LVH and concentric remodeling, as compared with N. Patients with both concentric LVH and concentric remodeling showed higher values of cIMT and cPWV and distal LAD velocity and a greater prevalence of coronary stenosis (>50%) than patients with RWT less than 0.42.
  
  CONCLUSION:
  Our results further reinforced the observation that in patients undergoing elective coronary angiography, concentric geometry is associated with structural and functional carotid alterations, with higher distal LAD flow velocity and eCS. In this large group of patients, concentric geometry is associated with a greater prevalence of coronary stenosis, as assessed by coronary angiography. These results might contribute to explain the greater cardiovascular risk associated with concentric remodeling and LVH.
  
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• Safety of centrifugal left ventricular assist device in patients previously treated with MitraClip system.
  Int J Cardiol

  2019 May;283():131-133. doi: 10.1016/j.ijcard.2019.02.039.
  
  Ammirati Enrico, Van De Heyning Caroline M, Musca Francesco, Brambatti Michela, Perna Enrico, Cipriani Manlio, Cannata Aldo, Mondino Michele, Moreo Antonella, De Bock Dina, Pretorius Victor, Claeys Marc J, Adler Eric D, Russo Claudio F, Frigerio Maria
  
  Abstract
  
  INTRODUCTION:
  No data regarding the safety of continuous-flow left ventricular assist device (CF-LVAD) implantation in patients with previous MitraClip have been reported. Thus, it remains unknown whether an initial treatment strategy with MitraClip therapy might complicate future heart failure management in patients who are also considered for CF-LVAD.
  
  METHODS:
  We retrospectively identified 6 patients (median age of 62?years; 2 women) who had been treated with MitraClip, that were eventually implanted with a CF-LVAD (all Heartware HVAD) in 3 hospitals between 2013 and 2018.
  
  RESULTS:
  Patients were treated in 4 cases with 2 clips, and in 2 cases with 1 clip. Median time from MitraClip implantation to CF-LVAD implant was 282?days (interquartile range 67 to 493), and median time on CF-LVAD support was 401?days (interquartile range 105 to 492?days). Two patients underwent a heart transplant, 3 patients died on support, and 1 is alive on support. In all cases, there was a reduction of functional mitral regurgitation without MitraClip-related complications.
  
  CONCLUSIONS:
  Based on this small case series, implantation of a CF-LVAD appears safe in patients with a previously positioned MitraClip system, at least, with 1 or 2 clips in place, with no need for additional mitral valve surgery.
  
  Copyright © 2019 Elsevier B.V. All rights reserved.
  
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• Mycotic coronary aneurysms.
  J Cardiovasc Med (Hagerstown)

  2019 Jan;20(1):10-15. doi: 10.2459/JCM.0000000000000734.
  
  Buono Andrea, Maloberti Alessandro, Bossi Irene M, Piccaluga Emanuela, Piccalò Giacomo, Oreglia Jacopo A, Moreo Antonella, Russo Claudio F, Oliva Fabrizio, Giannattasio Cristina
  
  Abstract
  
  : Mycotic coronary aneurysm is a rare infective disease of arterial vessel walls. Their development could be linked to the presence of an infective endocarditis or could represent a primary infection at the site of an implanted intracoronary stent. Bacterial agents, particularly Staphylococcus aureus, are the most common etiological agents. Due to an aspecific clinical presentation and examination, diagnosis could be challenging. Multiple imaging techniques (both invasive and noninvasive) are often required to reach the final diagnosis. Prognosis is characterized by high morbidity and mortality rates and, in fact, a tempestive treatment is required, although, to date, scanty data concerning the optimal treatment choice are present in literature.
  
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• Prevalence of proximal ascending aorta and target organ damage in hypertensive patients: the multicentric ARGO-SIIA project (Aortic RemodellinG in hypertensiOn of the Italian Society of Hypertension).
  J Hypertens

  2019 Jan;37(1):57-64. doi: 10.1097/HJH.0000000000001844.
  
  Milan Alberto, Degli Esposti Daniela, Salvetti Massimo, Izzo Raffaele, Moreo Antonella, Pucci Giacomo, Bruno Giulia, Pareo Ilenia, Parini Angelo, Paini Anna, Laurino Flora I, Sormani Paola, Sgariglia Raffaella, Avenatti Eleonora, De Luca Nicola,
  
  Abstract
  
  AIM:
  The aim of this study was to assess the prevalence of ascending aortic dilatation and to evaluate the possible association between proximal aorta dilatation and structural or functional markers of cardiac organ damage in hypertensive patients.
  
  BACKGROUND:
  Dilatation of the sinus of valsalva (SoV) is a common finding in clinical practice and it is associated with an increased cardiovascular risk in hypertensive patients: less is known about the dilatation prevalence of the subsequent portion, the proper ascending aorta and its relationship with cardiovascular organ damage.
  
  METHODS:
  This multicentric study included 582 hypertensive and 104 normotensive control individuals. All individuals underwent clinical evaluation and two-dimensional transthoracic echocardiography focused on the evaluation of the aorta. Aortic diameters at three levels were measured: SoV, sinotubular junction and ascending aorta.
  
  RESULTS:
  The prevalence of ascending aorta dilatation was 13%. Patients with ascending aorta dilatation were on average 10 years older than hypertensive patients without aortic dilatation and control individuals.Left ventricular mass was significantly increased (P?0.0001) in patients with ascending aorta dilatation with (113.29?±?3?g/m) or without (109.16?±?3?g/m) SoV dilatation compared with patients with isolated SoV dilatation (98.80?±?21.8?g/m) or normal aorta (96.04?±?26.5?g/m), with left ventricular hypertrophy (LVH) being twice as common in this group compared with the latter (60 vs. 28%, P?0.0001).
  
  CONCLUSION:
  Prevalence of ascending aorta dilatation in hypertensive patients reaches 13%. Hypertensive individuals with enlarged ascending aorta showed significantly increased left ventricular mass, a well known sign of hypertension related cardiac damage and could thus represent a subset of hypertensive patients at an increased cardiovascular risk.
  
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• The Right Heart International Network (RIGHT-NET): Rationale, Objectives, Methodology, and Clinical Implications.
  Heart Fail Clin

  2018 Jul;14(3):443-465. doi: 10.1016/j.hfc.2018.03.010.
  
  Ferrara Francesco, Gargani Luna, Armstrong William F, Agoston Gergely, Cittadini Antonio, Citro Rodolfo, D'Alto Michele, D'Andrea Antonello, Dellegrottaglie Santo, De Luca Nicola, Di Salvo Giovanni, Ghio Stefano, Grünig Ekkehard, Guazzi Marco, Kasprzak Jaroslaw D, Kolias Theodore John, Kovacs Gabor, Lancellotti Patrizio, La Gerche Andrè, Limongelli Giuseppe, Marra Alberto Maria, Moreo Antonella, Ostenfeld Ellen, Pieri Francesco, Pratali Lorenza, Rudski Lawrence G, Saggar Rajan, Saggar Rajeev, Scalese Marco, Selton-Suty Christine, Serra Walter, Stanziola Anna Agnese, Voilliot Damien, Vriz Olga, Naeije Robert, Bossone Eduardo
  
  Abstract
  
  The Right Heart International Network is a multicenter international study aiming to prospectively collect exercise Doppler echocardiography tests of the right heart pulmonary circulation unit (RHPCU) in large cohorts of healthy subjects, elite athletes, and individuals at risk of or with overt pulmonary hypertension. It is going to provide standardization of exercise stress echocardiography of RHPCU and explore the full physiopathologic response.
  
  Copyright © 2018 Elsevier Inc. All rights reserved.
  
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• Pulmonary Circulation on the Crossroads Between the Left and Right Heart in Systemic Sclerosis: A Clinical Challenge for Cardiologists and Rheumatologists.
  Heart Fail Clin

  2018 Jul;14(3):271-281. doi: 10.1016/j.hfc.2018.02.004.
  
  Gargani Luna, Voilliot Damien, D'Alto Michele, Agoston Gergely, Moreo Antonella, Serra Walter, Pieri Francesco, Mori Fabio, Wierzbowska-Drabik Karina, Matucci-Cerinic Marco, Moggi-Pignone Alberto
  
  Abstract
  
  Involvement of the right heart-pulmonary circulation system in systemic sclerosis is a typical feature, with critical prognostic implications. Pulmonary hypertension may occur in association with interstitial lung disease or as a result of an isolated pulmonary vascular disease that may affect both the precapillary arterioles and the postcapillary venules, as well as a consequence of left heart involvement. These apparently different phenotypes often underlie a significant pathophysiologic overlap, which makes the diagnosis and management of these patients highly complex and uncertain.
  
  Copyright © 2018 Elsevier Inc. All rights reserved.
  
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• Impact of serial echocardiography in the management of primary cardiac lymphoma.
  J Saudi Heart Assoc

  2018 Apr;30(2):160-163. doi: 10.1016/j.jsha.2017.08.001.
  
  Cereda Alberto Francesco, Moreo Antonella Maurizia, Sormani Paola, De Chiara Benedetta, Casadei Francesca, Zancanella Michelle, Rusconi Chiara, Cairoli Roberto, Giannattasio Cristina
  
  
  
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• Refined 4-group classification of left ventricular hypertrophy based on ventricular concentricity and volume dilatation outlines distinct noninvasive hemodynamic profiles in a large contemporary echocardiographic population.
  Echocardiography

  2018 Sep;35(9):1258-1265. doi: 10.1111/echo.14031.
  
  Barbieri Andrea, Rossi Andrea, Gaibazzi Nicola, Erlicher Andrea, Mureddu Gian Francesco, Frattini Silvia, Faden Giacomo, Manicardi Marcella, Beraldi Monica, Agostini Francesco, Lazzarini Valentina, Moreo Antonella, Temporelli Pier Luigi, Faggiano Pompilio
  
  Abstract
  
  BACKGROUND:
  Left ventricular hypertrophy (LVH) may reflect a wide variety of physiologic and pathologic conditions. Thus, it can be misleading to consider all LVH to be homogenous or similar. Refined 4-group classification of LVH based on ventricular concentricity and dilatation may be identified. To determine whether the 4-group classification of LVH identified distinct phenotypes, we compared their association with various noninvasive markers of cardiac stress.
  
  METHODS:
  Cohort of unselected adult outpatients referred to a seven tertiary care echocardiographic laboratory for any indication in a 2-week period. We evaluated the LV geometric patterns using validated echocardiographic indexation methods and partition values.
  
  RESULTS:
  Standard echocardiography was performed in 1137 consecutive subjects, and LVH was found in 42%. The newly proposed 4-group classification of LVH was applicable in 88% of patients. The most common pattern resulted in concentric LVH (19%). The worst functional and hemodynamic profile was associated with eccentric LVH and those with mixed LVH had a higher prevalence of reduced EF than those with concentric LVH (P 
  CONCLUSIONS:
  The new 4-group classification of LVH system showed distinct differences in cardiac function and noninvasive hemodynamics allowing clinicians to distinguish different LV hemodynamic stress adaptations in patients with LVH.
  
  © 2018 Wiley Periodicals, Inc.
  
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• Mortality and timing of surgery in the left-sided infective endocarditis: an Italian multicentre study.
  Interact Cardiovasc Thorac Surg

  2018 Apr;26(4):602-609. doi: 10.1093/icvts/ivx394.
  
  Cecchi Enrico, Ciccone Giovannino, Chirillo Fabio, Imazio Massimo, Cecconi Moreno, Del Ponte Stefano, Moreo Antonella, Faggiano Pompilio, Cialfi Alessandro, Squeri Angelo, Enia Francesco, Forno Davide, De Rosa Francesco Giuseppe, Rinaldi Mauro, Castiglione Anna
  
  Abstract
  
  OBJECTIVES:
  Observational studies on early surgery in infective endocarditis have conflicting results. This study aims to compare the treatment strategies for early surgery (within 2?weeks of diagnosis) and late surgery/medical therapy in terms of survival among patients with the left-sided infective endocarditis.
  
  METHODS:
  This study included patients with the left-sided infective endocarditis registered between 2006 and 2010 in the Italian Registry of Infective Endocarditis (RIEI). A Cox proportional hazards model was used to estimate the effect of these treatment strategies on overall survival and included sociodemographic and clinical characteristics associated with treatment, risk factors for mortality and early surgery as a time-dependent covariate to avoid indication and immortal time biases.
  
  RESULTS:
  Among the 502 patients included, 184 (36.7%) underwent early surgery. Of the remaining 318 patients, 138 underwent late surgery. The early surgery group had fewer patients with comorbidities and with enterococcus as the causative microorganism, but this group had more complicated cardiac conditions. No difference in mortality risk was estimated between the treatment groups including early surgery as time-dependent variables (adjusted hazard ratio ?=?0.95, 95% confidence interval 0.55-1.63), while a distorted and overestimated beneficial effect of surgery was estimated considering surgery as a non-time-dependent variable (adjusted hazard ratio 0.41, 95% confidence interval 0.25-0.70).
  
  CONCLUSIONS:
  Our study did not confirm a better overall survival in patients undergoing early surgery. However, even with the use of statistical techniques to control biases, we could not draw definitive conclusions that early surgery is not beneficial. Our results need to be assessed by randomized trials before any changes in clinical practice can be recommended.
  
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• Survival and Left Ventricular Function Changes in Fulminant Versus Nonfulminant Acute Myocarditis.
  Circulation

  2017 Aug;136(6):529-545. doi: 10.1161/CIRCULATIONAHA.117.026386.
  
  Ammirati Enrico, Cipriani Manlio, Lilliu Marzia, Sormani Paola, Varrenti Marisa, Raineri Claudia, Petrella Duccio, Garascia Andrea, Pedrotti Patrizia, Roghi Alberto, Bonacina Edgardo, Moreo Antonella, Bottiroli Maurizio, Gagliardone Maria P, Mondino Michele, Ghio Stefano, Totaro Rossana, Turazza Fabio M, Russo Claudio F, Oliva Fabrizio, Camici Paolo G, Frigerio Maria
  
  Abstract
  
  BACKGROUND:
  Previous reports have suggested that despite their dramatic presentation, patients with fulminant myocarditis (FM) might have better outcome than those with acute nonfulminant myocarditis (NFM). In this retrospective study, we report outcome and changes in left ventricular ejection fraction (LVEF) in a large cohort of patients with FM compared with patients with NFM.
  
  METHODS:
  The study population consists of 187 consecutive patients admitted between May 2001 and November 2016 with a diagnosis of acute myocarditis (onset of symptoms
  RESULTS:
  In the whole population (n=187), the rate of in-hospital death or heart transplantation was 25.5% versus 0% in FM versus NFM, respectively (
  CONCLUSIONS:
  Patients with FM have an increased mortality and need for heart transplantation compared with those with NFM. From a functional viewpoint, patients with FM have a more severely impaired LVEF at admission that, despite steep improvement during hospitalization, remains lower than that in patients with NFM at long-term follow-up. These findings also hold true when only the viral forms are considered and are different from previous studies showing better prognosis in FM.
  
  © 2017 American Heart Association, Inc.
  
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• Clinical imaging in patients with fever and suspected endocarditis.
  Minerva Cardioangiol

  2017 Dec;65(6):629-637. doi: 10.23736/S0026-4725.17.04423-1.
  
  DE Chiara Benedetta, Moreo Antonella
  
  Abstract
  
  Echocardiography remains the cornerstone of the diagnostic of anatomic lesions and consequences on cardiac function caused by infective endocarditis (IE). There is now evidence that other imaging techniques are useful in reducing the number of non-conclusive diagnoses, in particular when IE is suspected on prosthetic material or devices. Besides diagnosis, cardiac imaging strongly contributes to prognostic assessment, indications for early surgery and patient follow-up. It is required a specific expertise for implementing and interpreting all imaging techniques and the complexity of decision-making highlights the need for a multidisciplinary management of difficult cases in specialized endocarditis teams.
  
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• HeartWare-HVAD for end-stage heart failure: a review of clinical experiences with ?50 patients.
  Expert Rev Med Devices

  2017 Jun;14(6):423-437. doi: 10.1080/17434440.2017.1325318.
  
  Botta Luca, De Chiara Benedetta, Macera Francesca, Cannata Aldo, Costetti Alessandro, Voltolini Alessandra, Moreo Antonella, Cipriani Manlio, Frigerio Maria, Russo Claudio Francesco
  
  Abstract
  
  Despite the improvements in medical and surgical treatments, the incidence of end-stage heart failure (ESHF) continues to increase. Different mechanical systems have been adopted to support failing left ventricles. Among continuous-flow devices, the HeartWare-HVAD was the first to use a centrifugal pump rather than an axial one. Areas covered: In this review article, we provide an overview of the HeartWare-HVAD as a ventricular assist device for ESHF, discussing indications, echocardiographic assessment, surgical techniques, outcomes, concerns and controversies. Scientific literature was reviewed with a MEDLINE search strategy combining 'HeartWare' or 'HVAD' with 'heart failure'. A total of 263 papers were found using the reported search. From these, 16 were identified to provide the best evidence on the subject reporting outcomes in ?50 patients. Expert commentary: HeartWare-HVAD is a minute device that provides full circulatory support in patients with ESHF. Its main indication remains bridge to heart transplantation (HTx). Median sternotomy is the preferred technique of implantation although less invasive procedures have been described. Early outcomes are satisfactory. Nevertheless, some fearing complications still occur during the mid- and long-term follow-up. Further technical developments and optimal medical management will guarantee better outcomes.
  
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• Late Echocardiographic Study of Aortic Valve and Aortic Root after Surgery for Type A Acute Aortic Dissection.
  J Cardiovasc Echogr

  2016 ;26(3):78-82. doi: 10.4103/2211-4122.187948.
  
  Molteni Martina, De Chiara Benedetta, Casadei Francesca, Botta Luca, Merlanti Bruno, Russo Claudio Francesco, Giannattasio Cristina, Moreo Antonella
  
  Abstract
  
  OBJECTIVE:
  In case of concomitant aortic regurgitation (AR) valve, sparing operation is considered the first choice in selected patients. The aim of this retrospective clinical and echocardiographic study was to evaluate the long-term survival results of conservative approach and the determinants of recurrent AR.
  
  METHODS:
  From 2000 to 2011, fifty patients (median: 63 years and interquartile range: 53-72) underwent an aortic valve-sparing procedure for acute aortic dissection, and discharged alive. The long-term clinical and echocardiographic outcome was analyzed.
  
  RESULTS:
  Late all-causes mortality was 18% (nine patients) at a median follow-up of 55.8 months. Ten patients (20%) underwent re-operations, five of them for aortic valve/root recurrent disease; freedom from proximal re-operation was 90%. Two-third of the patients had a preoperative AR grade
  CONCLUSIONS:
  Preoperative AR and late aortic root diameter were not the predictors of late AR. Late AR is higher in patients who underwent aortic commissures and cusps resuspension compared to the only replacement of the ascending aorta.
  
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• Mitral periprosthetic leakage: contemporary results of surgical correction at a single centre.
  Interact Cardiovasc Thorac Surg

  2017 Aug;25(2):185-190. doi: 10.1093/icvts/ivx101.
  
  Botta Luca, De Chiara Benedetta, Quattrocchi Salvina, Casadei Francesca, Borgia Francesco, Giannattasio Cristina, Moreo Antonella, Russo Claudio Francesco
  
  Abstract
  
  OBJECTIVES:
  Mitral periprosthetic leakage (PPL) is a serious complication following valve replacement. Conflicting outcomes of surgical treatment have been reported in the presence of multiple previous cardiac operations and associated co-pathological conditions.
  
  METHODS:
  Sixty-five symptomatic patients (37 women, mean age 64.8 years) underwent conventional operations at our hospital from 2006 to 2015. Mitral PPL was the leading surgical indication, although associated procedures were included. Previous transcatheter procedures and leaks involving multiple prostheses were excluded. The median number of past mitral operations was 2 (range 1-5). PPL recurrence was observed in 29% of cases. A previous operation on the aortic or tricuspid valve was performed in 31 patients.
  
  RESULTS:
  Mitral PPL involved one-, two- or three-quarters of the mitral perimeter in 46, 43 and 11% of cases. Prosthetic refixation or replacement was performed in 24 and 41 patients, respectively. Annular reconstruction was necessary in 17% of prosthetic replacements. Associated procedures were performed in 19 patients. The operation was executed through a right minithoracotomy (unclamped aorta) in 20% of patients. In-hospital deaths occurred in 3.1%. After a median follow-up of 60 months, freedom from all-cause mortality was 96.8, 91.5 and 88.8% at 1, 3 and 5 years. Lateral leaks [P?=?0.03; hazard ratio (HR)?=?4.57, 95% confidence interval (CI): 1.13-18.3] and PPL relapse (P?=?0.03; HR?=?4.33, 95% CI: 1.12-16.7) were independently associated with death. At follow-up, 4 patients had a?>2+ recurrent leak and 2 were reoperated.
  
  CONCLUSIONS:
  A customized conventional mitral reoperation still represents a satisfactory and effective treatment option for PPL and should be considered even in patients with very complex issues.
  
  © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
  
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• Arterial Stiffness in Aortic Stenosis: Relationship with Severity and Echocardiographic Procedures Response.
  High Blood Press Cardiovasc Prev

  2017 Mar;24(1):19-27. doi: 10.1007/s40292-016-0176-x.
  
  Bruschi Giuseppe, Maloberti Alessandro, Sormani Paola, Colombo Giulia, Nava Stefano, Vallerio Paola, Casadei Francesca, Bruno Jolie, Moreo Antonella, Merlanti Bruno, Russo Claudio, Oliva Fabrizio, Klugmann Silvio, Giannattasio Cristina
  
  Abstract
  
  INTRODUCTION:
  Aortic stenosis (AS) is more than only a degenerative disease, it could be also an atherosclerotic-like process involving the valve instead of the vessels. Little is known about the relation of arterial stiffness and AS.
  
  AIM:
  We sought to determine wether pulse wave velocity (PWV), is related to AS severity and to the procedures response, both as surgical aortic-valve-replacement (AVR) and trascatheter-aortic-valve-implantation (TAVI).
  
  METHODS:
  30 patients with severe AS were treated (15 AVR, 15 TAVI). Before the procedures (t0) and after 1 week (t1) echocardiography and PWV were evaluated.
  
  RESULTS:
  On the whole population, subjects with higher PWV showed higher transvalvular pressure gradient at baseline (mean: 56.5 ± 15.1 vs 45.4 ± 9.5; peak: 93.3 ± 26.4 vs 73.3 ± 14.9, p = 0.02) and, a significantly greater response to the procedures (mean: -42.9 ± 17.2 vs -27.9 ± 10.1, peak: -68.7 ± 29.2 vs -42.8 ± 16.4, p = 0.02). When the two different procedures groups were separated, data were confirmed only in the TAVI subgroup.
  
  CONCLUSIONS:
  In patients undergoing procedures for AS, PWV is correlated with transvalvular gradient and, in TAVI subjects, is able to predict the echocardiographic response. Baseline evaluation of PWV in patients candidates to TAVI can help the selection of subjects, even if larger and longer studies are needed before definitive conclusion can be drawn.
  
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• Extreme giant aneurysms of three coronary arteries causing heart failure as late sequelae of Kawasaki disease.
  Eur Heart J

  2017 Mar;38(10):759-760. doi: 10.1093/eurheartj/ehw510.
  
  Ammirati Enrico, Burns Jane C, Moreo Antonella, Daniels Lori B, Oliva Fabrizio
  
  
  
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• Predisposing cardiac conditions, interventional procedures, and antibiotic prophylaxis among patients with infective endocarditis.
  Am Heart J

  2016 Sep;179():42-50. doi: 10.1016/j.ahj.2016.03.028.
  
  Chirillo Fabio, Faggiano Pompilio, Cecconi Moreno, Moreo Antonella, Squeri Angelo, Gaddi Oscar, Cecchi Enrico,
  
  Abstract
  
  UNLABELLED:
  Efficacy and safety of antibiotic prophylaxis (AP) for prevention of infective endocarditis (IE) in patients with predisposing cardiac condition (PCC) undergoing invasive procedures is still debated. We sought to assess the prevalence of PCC, the type of interventional procedures preceding the onset of symptoms, and the usefulness of AP in a large cohort of consecutive patients with definite IE.
  
  METHODS:
  We examined 677 (median age 65.34 years; male 492 [73%]) consecutive patients with IE enrolled from July 2007 through 2010 into the Italian Registry of Infective Endocarditis.
  
  RESULTS:
  Predisposing cardiac condition was present in 341 patients (50%).Thirty-two patients (4.7%) underwent dental procedures. Of 20 patients with PCC undergoing dental procedure, 13 had assumed AP. Viridans group streptococci were isolated from blood cultures in 8 of 20 patients with PCC and prior dental procedure. Nondental procedures preceded IE in 139 patients (21%). They were significantly older and had more comordibities compared with patients undergoing dental procedures. Predisposing cardiac condition was identified in 91 patients. Perioperative antimicrobial prophylaxis was administered to 67 patients. Staphylococcus aureus was the most frequent causative agent. Cardiac surgery was necessary in 85 patients (20 with prior dental and 65 with nondental procedure). Surgical mortality (12% vs 0%, P = .03) and hospital mortality (23% vs 3%, P = .001) were significantly larger among patients with nondental procedures.
  
  CONCLUSIONS:
  In a large unselected cohort of patients with IE, the incidence of preceding dental procedures was minimal. The number of cases potentially preventable by means of AP was negligible. Nondental procedures were more frequent than dental procedures and were correlated with poorer prognosis.
  
  Copyright © 2016 Elsevier Inc. All rights reserved.
  
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• Long-Term Effects of Radiotherapy on Arterial Stiffness in Breast Cancer Women.
  Am J Cardiol

  2016 Sep;118(5):771-6. doi: 10.1016/j.amjcard.2016.06.001.
  
  Vallerio Paola, Sarno Laura, Stucchi Miriam, Musca Francesco, Casadei Francesca, Maloberti Alessandro, Lestuzzi Chiara, Mancia Giuseppe, Moreo Antonella, Palazzi Mauro, Giannattasio Cristina
  
  Abstract
  
  Radiotherapy for breast cancer may expose heart and vessels to late radiation-induced complications. Although recent technical progress in radiation therapy (RT) has been associated with drastic reduction in cardiovascular (CV) mortality, the prolonged life expectancy of patients with cancer requires CV evaluation for many years. The aim of our study was to evaluate local changes in vascular and cardiac function because of previous breast RT. We enrolled 43 patients treated with RT 15 years ago for breast cancer. CV risk factors and atherosclerotic carotid damage were investigated in all women. We divided patients into 2 groups: R (n = 25) treated to right breast and L (n = 18) to left breast. All subjects were submitted to standard echocardiography and functional arteries evaluation by carotid-radial pulse-wave velocity (crPWV; Complior) and AIx (Sphygmocor; Atcor Medical). Global mean age was 69.5 ± 8 years old. CV risk factors were equally allocated in 2 groups. No patients had history of cardiac or artery disease. R had a significantly increased crPWV (9.9 ± 1.4 vs 8.9 ± 1.1, p = 0.001) on right arm compared with left arm, and in L group, crPWV was similarly higher on the left arm than on right arm (9.6 ± 1.5 vs 8.9 ± 1.4, p = 0.011). AIx was significantly increased in the ipsilateral arm only in L (32.1 ± 7.6 vs 28.3 ± 6.8, p = 0.05). Central blood pressure estimation was not different in the right and left arms. No correlations were found with hormone therapy or chemotherapy. Our data show a local arterial stiffening because of radiation that can be involved in increased CV risk in breast cancer-treated patients.
  
  Copyright © 2016 Elsevier Inc. All rights reserved.
  
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• Infective endocarditis of an aortic intimal flap due to Streptococcus agalactiae in a patient with Sjögren's syndrome: an unusual clinical case report.
  Echocardiography

  2016 Sep;33(9):1434-5. doi: 10.1111/echo.13274.
  
  De Chiara Benedetta, Peritore Angelica, Sara Roberto, Giannattasio Cristina, Moreo Antonella
  
  
  
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• Giant apparently not dissecting aneurysm and severe aortic valve insufficiency in an elite athlete.
  Eur Heart J

  2016 Aug;37(32):2527. doi: 10.1093/eurheartj/ehv683.
  
  Cereda Alberto, Sormani Paola, Russo Claudio F, Moreo Antonella, Giannattasio Cristina
  
  
  
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• [Syncope: an untreated symptom with a lifesaving intervention].
  G Ital Cardiol (Rome)

  2015 Sep;16(9):517-8. doi: 10.1714/1988.21532.
  
  Giupponi Luca, De Chiara Benedetta, Spanò Francesca, Giannattasio Cristina, Taglieri Corrado, Moreo Antonella
  
  Abstract
  
  We report the case of a 61-year-old woman referred to our center for cardiac evaluation after a syncope, with echocardiographic findings of a papillary fibroelastoma on the edge of the non-coronary aortic cusp. The three-dimensional transesophageal approach provided a unique understanding of the size and shape of the mass and it favorably directed the surgeon towards treatment with conservative surgery.
  
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• Differential incremental value of ultrasound carotid intima-media thickness, carotid plaque, and cardiac calcium to predict angiographic coronary artery disease across Framingham risk score strata in the APRES multicentre study.
  Eur Heart J Cardiovasc Imaging

  2016 Sep;17(9):991-1000. doi: 10.1093/ehjci/jev222.
  
  Gaibazzi Nicola, Rigo Fausto, Facchetti Rita, Carerj Scipione, Giannattasio Cristina, Moreo Antonella, Mureddu Gian Francesco, Salvetti Massimo, Grolla Elisabetta, Faden Giacomo, Cesana Francesca, Faggiano Pompilio
  
  Abstract
  
  AIMS:
  According to recent data, more accurate selection of patients undergoing coronary angiography for suspected coronary artery disease (CAD) is needed. From the Active PREvention Study multicentre prospective study, we further analyse whether carotid intima-media thickness (cIMT), carotid plaques (cPL), and echocardiographic cardiac calcium score (eCS) have incremental discriminatory and reclassification predictive value for CAD over clinical risk score in subjects undergoing coronary angiography, specifically depending on their low, intermediate, or high class of clinical risk.
  
  METHODS AND RESULTS:
  In eight centres, 445 subjects without history of prior CAD but with chest pain of recent onset and/or a positive/inconclusive stress test for ischaemia prospectively underwent clinically indicated elective coronary angiography after cardiac and carotid ultrasound assessments with measurements of cIMT, cPL, and eCS. The study population was divided into subjects at low (10%), intermediate (10-20%), and high (>20%) Framingham risk score (FRS). Ultrasound parameters were tested for their incremental value to predict CAD over FRS, in each pre-test risk category. No significant difference could be appreciated between the discrimination value of FRS and Diagnostic Imaging for Coronary Artery Disease score for the presence of CAD. eCS or cPL demonstrated significant incremental prediction over FRS, consistently in the three FRS categories (P
  CONCLUSIONS:
  Ultrasound eCS and cPL assessments were significant predictors of angiographic CAD in patients without prior CAD but with signs or symptoms suspect for CAD, independently and incrementally to FRS, across all pre-test risk probability strata, although in high-risk subjects, only eCS maintained an incremental value. The use of cIMT was not significantly incrementally useful in any FRS risk category.
  
  Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.
  
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• Rationale and design of GISSI OUTLIERS VAR Study in bicuspid aortic valve patients: prospective longitudinal, multicenter study to investigate correlation between surgical, echo distinctive features, histologic and genetic findings in phenotypically homogeneous outlier cases.
  Int J Cardiol

  2015 Nov;199():180-5. doi: 10.1016/j.ijcard.2015.06.182.
  
  Merlanti Bruno, De Chiara Benedetta, Maggioni Aldo Pietro, Moreo Antonella, Pileggi Silvana, Romeo Gabriella, Russo Claudio Francesco, Rizzo Stefania, Martinelli Luigi, Maseri Attilio,
  
  Abstract
  
  BACKGROUND/OBJECTIVES:
  Bicuspid aortic valve (BAV) is the most common congenital heart disorder, affecting up to 2% of the population. Involvement of aortic root and ascending aorta (aneurysm or, eventually, dissection) is frequent in patients with pathologic or normal functioning BAV. Unfortunately, there are no well-known correlations between valvular and vascular diseases. In VAR protocol, with a new strategy of research, we analysemultiple aspects of BAV disease through correlation between surgical, echo, histologic and genetic findings in phenotypically homogeneous outlier cases.
  
  METHODS:
  VAR protocol is a prospective, longitudinal, multicenter study. It observes 4 homogeneous small groups of BAV surgical patients (15 patients each): isolated aortic regurgitation, isolated ascending aortic aneurysm, aortic regurgitation associated with aortic aneurysm, isolated aortic stenosis in older patients (>60years). Echo analysis is extended to first-degree relatives and, in case of BAV, genetic test is performed. Patients and relatives are enrolled in 10 cardiac surgery/cardiologic centers throughout Italy.
  
  CONCLUSIONS:
  The aim of the study is to identify predictors of favorable or unfavorable evolution of BAV in terms of valvular dysfunction and/or aortic aneurysm. Correlations between different features could help in identification of various BAV risk groups, rationalizing follow-up and treatment.
  
  Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
  
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• Clinical impact and evolution of mitral regurgitation following transcatheter aortic valve replacement: a meta-analysis.
  Heart

  2015 Sep;101(17):1395-405. doi: 10.1136/heartjnl-2014-307120.
  
  Nombela-Franco Luis, Eltchaninoff Hélène, Zahn Ralf, Testa Luca, Leon Martin B, Trillo-Nouche Ramiro, D'Onofrio Augusto, Smith Craig R, Webb John, Bleiziffer Sabine, De Chiara Benedetta, Gilard Martine, Tamburino Corrado, Bedogni Francesco, Barbanti Marco, Salizzoni Stefano, García del Blanco Bruno, Sabaté Manel, Moreo Antonella, Fernández Cristina, Ribeiro Henrique Barbosa, Amat-Santos Ignacio, Urena Marina, Allende Ricardo, García Eulogio, Macaya Carlos, Dumont Eric, Pibarot Philippe, Rodés-Cabau Josep
  
  Abstract
  
  OBJECTIVES:
  Mitral regurgitation (MR) is a common entity in patients with aortic stenosis undergoing transcatheter aortic valve replacement (TAVR), but its influence on outcomes remains controversial. The purpose of this meta-analysis was to assess the clinical impact of and changes in significant (moderate-severe) MR in patients undergoing TAVR, overall and according to valve design (self-expandable (SEV) vs balloon-expandable (BEV)).
  
  METHODS:
  All national registries and randomised trials were pooled using meta-analytical guidelines to establish the impact of moderate-severe MR on mortality after TAVR. Studies reporting changes in MR after TAVR on an individual level were electronically searched and used for the analysis.
  
  RESULTS:
  Eight studies including 8015 patients (SEV: 3474 patients; BEV: 4492 patients) were included in the analysis. The overall 30-day and 1-year mortality was increased in patients with significant MR (OR 1.49, 95% CI 1.16 to 1.92; HR 1.32, 95% CI 1.12 to 1.55, respectively), but a significant heterogeneity across studies was observed (p
  CONCLUSIONS:
  Concomitant moderate-severe MR was associated with increased early and late mortality following TAVR. A significant improvement in MR severity was detected in half of the patients following TAVR, and the degree of improvement was greater in those patients who had received a BEV.
  
  Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
  
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• Effects of Cancer Therapy Targeting Vascular Endothelial Growth Factor Receptor on Central Blood Pressure and Cardiovascular System.
  Am J Hypertens

  2016 Feb;29(2):158-62. doi: 10.1093/ajh/hpv077.
  
  Moreo Antonella, Vallerio Paola, Ricotta Riccardo, Stucchi Miriam, Pozzi Mattia, Musca Francesco, Meani Paolo, Maloberti Alessandro, Facchetti Rita, Di Bella Sara, Giganti Maria Olga, Sartore-Bianchi Andrea, Siena Salvatore, Mancia Giuseppe, Giannattasio Cristina
  
  Abstract
  
  BACKGROUND:
  In the last 2 decades, new drugs that oppose the effects of vascular endothelial growth factor receptor (VEGFR), and thus angiogenesis, have considerably improved treatment of solid tumors. These anti-VEGFR drugs, however, are burdened by several side effects, particularly relevant on heart and vessels. The aim of this study was to analyze the changes in cardiovascular structure and function associated with use of anti-VEGFR drugs.
  
  METHODS:
  Twenty-nine patients (27 affected by renal and 2 by thyroid cancer), received treatment with anti-VEGFR drugs. Brachial blood pressure (BP), central BP, carotid-femoral pulse wave velocity (cfPWV), augmentation index (Aix), and several echocardiographic markers of systolic and diastolic left ventricular functions including global longitudinal strain were measured before starting treatment (T0), after 2 (T1), and 6 weeks (T2) of treatment.
  
  RESULTS:
  Anti-VEGFR treatment was accompanied by a significant increase of both peripheral (systolic BP +13±15.5mm Hg, diastolic BP +7.1±9.3mm Hg, P
  CONCLUSIONS:
  All the changes regarding BP and cfPWV appear early after treatment initiation and seem to be reversible if treatment is stopped, instead diastolic and systolic left ventricular function are persistently altered by anti-VEGFR drugs.
  
  © American Journal of Hypertension, Ltd 2015. All rights reserved. For Permissions, please email: journals.permissions@oup.com.
  
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• Paroxysmal supraventricular tachycardia as first manifestation of right atrial hemangioma during endovascular treatment of intracranial arteriovenous fistulas.
  Oncotarget

  2015 Jun;6(16):14060-4.
  
  Spanò Francesca, Cereda Alberto, Moreo Antonella, Bonacina Edgardo, Peritore Angelica, Roghi Alberto, Giannattasio Cristina, Pedrotti Patrizia
  
  Abstract
  
  We report the description of a cardiac mass occupying almost the entire right atrium in a young man who developed paroxysmal supraventricular tachycardia during endovascular treatment of intracranial arteriovenous fistulas. The mass was detected at echocardiographic examination, its tissue characteristics were defined with cardiac magnetic resonance and it was successfully surgically removed. The histopathological findings were consistent with a mixed type cavernous-capillary hemangioma of the heart. The intriguing co-existence of cardiac hemangioma and cerebral arteriovenous fistulas, to the best of our knowledge, has not been previously reported in English Literature.
  
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• Clinical epidemiology in Italian Registry of Infective Endocarditis (RIEI): Focus on age, intravascular devices and enterococci.
  Int J Cardiol

  2015 ;190():151-6. doi: 10.1016/j.ijcard.2015.04.123.
  
  Cecchi Enrico, Chirillo Fabio, Castiglione Anna, Faggiano Pompilio, Cecconi Moreno, Moreo Antonella, Cialfi Alessandro, Rinaldi Mauro, Del Ponte Stefano, Squeri Angelo, Corcione Silvia, Canta Francesca, Gaddi Oscar, Enia Francesco, Forno Davide, Costanzo Piera, Zuppiroli Alfredo, Ronzani Giuliana, Bologna Flavio, Patrignani Anna, Belli Riccardo, Ciccone Giovannino, De Rosa Francesco Giuseppe
  
  Abstract
  
  INTRODUCTION:
  The epidemiology of infective endocarditis (IE) is changing due to a number of factors, including aging and health related comorbidities and medical procedures. The aim of this study is to describe the main clinical, epidemiologic and etiologic changes of IE from a large database in Italy.
  
  METHODS:
  We prospectively collected episodes of IE in 17 Italian centers from July 2007 to December 2010.
  
  RESULTS:
  We enrolled 677 patients with definite IE, of which 24% health-care associated. Patients were male (73%) with a median age of 62 years (IQR: 49-74) and 61% had several comorbidities. One hundred and twenty-eight (19%) patients had prosthetic left side IE, 391 (58%) native left side IE, 94 (14%) device-related IE and 54 (8%) right side IE. A predisposing cardiopathy was present in 50%, while odontoiatric and non odontoiatric procedures were reported in 5% and 21% of patients respectively. Symptoms were usually atypical and precocious. The prevalent etiology was represented by Staphylococcus aureus (27%) followed by coagulase-negative staphylococci (CNS, 21%), Streptococcus viridans (15%) and enterococci (14%). CNS and enterococci were relatively more frequent in patients with intravascular devices and prosthesis and S. viridans in left native valve. Diagnosis was made by transthoracic and transesophageal echocardiography in 62% and 94% of cases, respectively. The in-hospital mortality was 14% and 1-year mortality was 21%.
  
  CONCLUSION:
  The epidemiology is changing in Italy, where IE more often affects older patients with comorbidities and intravascular devices, with an acute onset and including a high frequency of enterococci. There were few preceding odontoiatric procedures.
  
  Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
  
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• Echocardiographic Assessment and Successful Valvular Repair of Congenital Mitral Arcade.
  J Cardiovasc Echogr

  2015 ;25(2):57-59. doi: 10.4103/2211-4122.161781.
  
  Sormani Paola, Chiara Benedetta De, Taglieri Corrado, Moreo Antonella
  
  Abstract
  
  Anomalous mitral arcade is a rare congenital anomaly affecting the mitral tensor apparatus. This condition causes a restrictive movement of the leaflets and interferes with the normal closure of the valve during ventricular systole. We report a case of a 15-year-old female with this condition and initial left ventricular dysfunction, who successfully underwent mitral valve repair. This reparative technique is more technically challenging then valve replacement and only few cases are described in literature.
  
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• Multiparametric carotid and cardiac ultrasound compared with clinical risk scores for the prediction of angiographic coronary artery disease: a multicenter prospective study.
  J Hypertens

  2015 Jun;33(6):1291-300. doi: 10.1097/HJH.0000000000000543.
  
  Moreo Antonella, Gaibazzi Nicola, Faggiano Pompilio, Mohammed Moemen, Carerj Scipione, Mureddu Gianfrancesco, Pigazzani Filippo, Muiesan Lorenza, Salvetti Massimo, Cesana Francesca, Faden Giacomo, Facchetti Rita, Giannattasio Cristina, Rigo Fausto
  
  Abstract
  
  OBJECTIVE:
  Cardiovascular risk prediction is deemed fundamental and the assessment of organ damage is emerging as a potentially 'downstream' picture of individual risk. Our aim was to assess the feasibility and value of prediction of coronaropathy [coronary artery disease (CAD)] of integrated cardiovascular ultrasound examination.
  
  METHODS:
  This multicenter study involved eight cardiology centers that enrolled 457 consecutive patients. Blood pressures, carotid intima-media thickness (cIMT), carotid pulse wave velocity (cPWV), semiquantitative score of cardiac calcifications, global myocardial longitudinal strain (GLS), and rest Doppler flow velocity on the left anterior descending (LAD) coronary artery were measured. After coronary angiography, patients were divided in CAD, n?=?273, at least one coronary stenosis higher than 50%, and no CAD, n?=?184.
  
  RESULTS:
  CAD were older (65.9?±?10.7 versus 63.1?±?11.2 years, mean?±?standard deviation, P?=?0.01), and had higher blood pressure (137.0?±?18.8/77.5?±?11.1 versus 130.2?±?17.4/75.1?±?9.7?mmHg, P?0.02), cIMT (791.4?±?165.5 versus 712.0?±?141.5 mcm, P?0.0001), cPWV (median: 9 versus 8.1 m/s, P?0.01), score of calcium (median, 2 versus 1, P?0.0001), LAD velocity (median, 38 versus 36, P?0.07), and lower GLS (-17.6?±?4.3 versus -19.3?±?5.1, P?0.05) than no CAD. Score of calcium was feasible in the totality of patients, cIMT in 97%, cPWV in 86%, GLS in 88%, and LAD in 84%. A combination of at least three variables was measurable in 80% of the patients. All ultrasound parameters significantly predicted CAD. However, in a stepwise logistic regression, the only combined predictors of obstructive CAD were score of calcium, cIMT, and LAD velocity.
  
  CONCLUSION:
  In Echo-Lab, Rome, Italy, the integrated cardiovascular ultrasound study is feasible in a high percentage of patients. The combination of three parameters, that is, score of calcium, cIMT, and LAD velocity, has incremental predictive value for obstructive CAD.
  
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• Ultrasound carotid intima-media thickness, carotid plaque and cardiac calcium incrementally add to the Framingham Risk Score for the prediction of angiographic coronary artery disease: a multicenter prospective study.
  Int J Cardiol

  2014 Dec;177(2):708-10. doi: 10.1016/j.ijcard.2014.09.195.
  
  Gaibazzi Nicola, Rigo Fausto, Facchetti Rita, Carerj Scipione, Giannattasio Cristina, Moreo Antonella, Mureddu Gianfrancesco, Paini Anna, Grolla Elisabetta, Faden Giacomo, Cesana Francesca, Faggiano Pompilio
  
  
  
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• [Right ventricular dysfunction in advanced heart failure].
  G Ital Cardiol (Rome)

  2014 ;15(7-8):430-40. doi: 10.1714/1596.17420.
  
  Cipriani Manlio, De Chiara Benedetta, Ammirati Enrico, Roghi Alberto, D'Angelo Luciana, Oliva Fabrizio, Moreo Antonella, Bonacina Edgardo, Martinelli Luigi
  
  Abstract
  
  The role of the right ventricle has often been underestimated in heart failure. It has been thought that the right cavity has a less prominent impact on symptoms, therapeutic approach, and prognosis. Right ventricular dysfunction is a complex issue and its diagnosis has acquired a relevant role, in particular with the improvement of new therapeutic options such as ventricular assist devices. The complex geometry of the right ventricle and its interaction with the left ventricle are still a matter of debate, leaving several open questions about the best therapeutic approach to manage right ventricular dysfunction. Echocardiography remains the first-line imaging technique, but an integrated multimodality evaluation with clinical, biochemical and hemodynamic parameters, and cardiovascular magnetic resonance imaging can provide a more comprehensive way to choose the most appropriate treatment for patients with heart failure associated with right ventricular dysfunction.
  
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• Clinical Relevance Of Systematic CRT Device Optimization.
  J Atr Fibrillation

  2014 ;7(2):1077. doi: 1077.
  
  Lunati Maurizio, Magenta Giovanni, Cattafi Giuseppe, Moreo Antonella, Falaschi Giacomo, Contardi Danilo, Locati Emanuela
  
  Abstract
  
  Cardiac Resynchronization Therapy (CRT) is known as a highly effective therapy in advanced heart failure patients with cardiac dyssynchrony. However, still one third of patients do not respond (or sub-optimally respond) to CRT. Among the many contributors for the high rate of non-responders, the lack of procedures dedicated to CRT device settings optimization (parameters to regulate AV synchrony and VV synchrony) is known as one of the most frequent. The most recent HF/CRT Guidelines do not recommend to carry-out optimization procedures in every CRT patient; they simply state those procedures "could be useful in selected patients", even though their role in improving response has not been proven. Echocardiography techniques still remain the gold-standard reference method to the purpose of CRT settings optimization. However, due to its severe limitations in the routine of CRT patients management (time and resource consuming, scarce reproducibility, inter and intra-operator dependency), echocardiography optimization is widely under-utilized in the real-world of CRT follow-up visits. As a consequence, device-based techniques have been developed to by-pass the need for repeated echo examinations to optimize CRT settings. In this report the available device-based optimization techniques onboard on CRT devices are shortly reviewed, with a specific focus on clinical outcomes observed in trials comparing these methods vs. clinical practice or echo-guided optimization methods. Particular emphasis is dedicated to hemodynamic methods and automaticity of optimization algorithms (making real the concept of "ambulatory CRT optimization"). In fact a hemodynamic-based approach combined with a concept of frequent re-optimization has been associated - although retrospectively - with a better clinical outcome on the long-term follow-up of CRT patients. Large randomized trials are ongoing to prospectively clarify the impact of automatic optimization procedures.
  
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• Left ventricular or Bi-ventricular assist device? How dobutamine stress echocardiography can untie the dilemma of right ventricular dysfunction.
  Int J Cardiol

  2014 Nov;177(1):e6-8. doi: 10.1016/j.ijcard.2014.07.194.
  
  Ammirati Enrico, Cipriani Manlio, De Chiara Benedetta, D'Angelo Luciana, Belli Oriana, Moreo Antonella, Oliva Fabrizio, Martinelli Luigi, Frigerio Maria
  
  
  
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• Left atrial dysfunction detected by speckle tracking in patients with systemic sclerosis.
  Cardiovasc Ultrasound

  2014 Aug;12():30. doi: 10.1186/1476-7120-12-30.
  
  Agoston Gergely, Gargani Luna, Miglioranza Marcelo Haertel, Caputo Maria, Badano Luigi Paolo, Moreo Antonella, Muraru Denisa, Mondillo Sergio, Moggi Pignone Alberto, Matucci Cerinic Marco, Sicari Rosa, Picano Eugenio, Varga Albert
  
  Abstract
  
  BACKGROUND:
  Cardiac involvement is a relevant clinical finding in systemic sclerosis (SSc) and is associated with poor prognosis. Left atrial (LA) remodeling and/or dysfunction can be an early sign of diastolic dysfunction. Two-dimensional speckle tracking echocardiography (STE) is a novel and promising tool for detecting very early changes in LA myocardial performance.
  
  AIM:
  To assess whether STE strain parameters may detect early alterations in LA function in SSc patients.
  
  METHODS:
  Forty-two SSc patients (Group 1, age 50?±?14 years, 95% females) without clinical evidence for cardiac involvement and 42 age- and gender-matched control subjects (Group 2, age 49?±?13 years, 95% females) were evaluated with comprehensive 2D and Doppler echocardiography, including tissue Doppler imaging analysis. Positive peak left atrial longitudinal strain (? pos peak), second positive left atrial longitudinal strain (sec ? pos peak), and negative left atrial longitudinal strain (? neg peak) were measured using a 12-segment model for the LA, by commercially available semi-automated 2D speckle-tracking software (EchoPac PC version 108.1.4, GE Healthcare, Horten, Norway).
  
  RESULTS:
  All SSc patients had a normal left ventricular ejection fraction (63.1?±?4%). SSc patients did not differ from controls in E/A (Group 1?=?1.1?±?0.4 vs Group 2?=?1.3?±?0.4, p?=?.14) or pulmonary arterial systolic pressure (Group 1?=?24.1?±?8 mmHg vs Group 2?=?21?±?7 mmHg, p?=?.17). SSc patients did not show significantly different indexed LA volumes (Group 1?=?24.9?±?5.3 ml/m2 vs Group 2?=?24.7?±?4.4 ml/m2, p?=?.8), whereas E/e' ratio was significantly higher in SSc (Group 1?=?7.6?±?2.4 vs Group 2?=?6.5?±?1.7, p
  CONCLUSION:
  2D speckle-tracking echocardiography is a sensitive tool to assess impairment of LA mechanics, which is detectable in absence of changes in LA size and volume, and may represent an early sign of cardiac involvement in patients with SSc.
  
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• Renal artery stenosis as the cause of resistant arterial hypertension: an unusual technique for revascularization.
  J Clin Hypertens (Greenwich)

  2014 Jul;16(7):536-7. doi: 10.1111/jch.12331.
  
  De Biase Anna, Varrenti Marisa, Meani Paolo, Cesana Francesca, Pirola Roberto, Giupponi Luca, Alloni Marta, Vallerio Paola, Moreo Antonella, Rampoldi Antonio, Giannattasio Cristina
  
  
  
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• Aortic valve sclerosis as a marker of coronary artery atherosclerosis; a multicenter study of a large population with a low prevalence of coronary artery disease.
  Int J Cardiol

  2014 Mar;172(2):364-7. doi: 10.1016/j.ijcard.2014.01.024.
  
  Rossi Andrea, Gaibazzi Nicola, Dandale Raje, Agricola Eustachio, Moreo Antonella, Berlinghieri Nicola, Sartorio Daniele, Loffi Marco, De Chiara Benedetta, Rigo Fausto, Vassanelli Corrado, Faggiano Pompilio
  
  Abstract
  
  UNLABELLED:
  There are no studies analyzing the association between aortic valve sclerosis (AVS) and coronary artery disease (CAD) in a large and multicenter patient population with an overall low prevalence of CAD. We hypothesized that AVS could predict the presence and degree of CAD in patients with severe organic mitral regurgitation.
  
  METHODS:
  We retrospectively analyzed consecutive patients with flail mitral leaflet who had coronary angiography for pre-surgical screening and not because suspect of CAD. End-points were considered: 1) any degree of CAD (stenosis>20%) and 2) obstructive CAD (stenosis>75% of at least one coronary artery). AVS was defined as focal areas of increased echogenicity and thickening of the leaflets. Traditional clinical risk factors were considered: age, male gender, hypertension (>140/90 mmHg or medical therapy), hypercholesterolemia (total cholesterol>200 mg/dl or statin), diabetes, family history of CAD and smoking habit.
  
  RESULTS:
  675 patients (mean age: 64±12; 27% female) formed the study population. Among patients with AVS, 60% and 39% had any-CAD and ob-CAD respectively, on the opposite among patients without AVS 12% and 7% had any-CAD and ob-cad. After adjustment for clinical risk factors, AVS was associated with a 22.7 fold increased risk of any degree of CAD (95% CI 8.1 63.6 p
  CONCLUSION:
  In a large and multicenter sample of patient with flail mitral leaflet, AVS was strongly associated with the presence and degree of CAD independently of clinical risk factors.
  
  Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
  
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• Response to letter to the editor by Rui Baptista, M.D., Rogério Teixeira, M.D.
  Am Heart J

  2013 Sep;166(3):e15-6. doi: 10.1016/j.ahj.2013.06.015.
  
  Gargani Luna, Agoston Gergely, Pignone Alberto Moggi, Moreo Antonella, Badano Luigi P, Bazzichi Laura, Costantino Marco Fabio, Pieri Francesco, Epis Oscar, Bruschi Eleonora, De Chiara Benedetta, Mori Fabio, Bombardieri Stefano, Cerinic Marco Matucci, Bossone Eduardo, Picano Eugenio
  
  
  
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• Levosimendan reverted severe pulmonary hypertension in one patient on waiting list for heart transplantation.
  Int J Cardiol

  2013 Oct;168(4):4518-9. doi: 10.1016/j.ijcard.2013.06.106.
  
  Ammirati Enrico, Musca Francesco, Oliva Fabrizio, Garascia Andrea, Pacher Valentina, Verde Alessandro, Cipriani Manlio, Moreo Antonella, Martinelli Luigi, Frigerio Maria
  
  
  
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• Comparison of sulfur hexafluoride microbubble (SonoVue)-enhanced myocardial contrast echocardiography with gated single-photon emission computed tomography for detection of significant coronary artery disease: a large European multicenter study.
  J Am Coll Cardiol

  2013 Oct;62(15):1353-61. doi: 10.1016/j.jacc.2013.04.082.
  
  Senior Roxy, Moreo Antonella, Gaibazzi Nicola, Agati Luciano, Tiemann Klaus, Shivalkar Bharati, von Bardeleben Stephan, Galiuto Leonarda, Lardoux Hervé, Trocino Giuseppe, Carrió Ignasi, Le Guludec Dominique, Sambuceti Gianmario, Becher Harald, Colonna Paolo, Ten Cate Folkert, Bramucci Ezio, Cohen Ariel, Bezante Gianpaolo, Aggeli Costantina, Kasprzak Jaroslaw D
  
  Abstract
  
  OBJECTIVES:
  The purpose of this study was to compare sulfur hexafluoride microbubble (SonoVue)-enhanced myocardial contrast echocardiography (MCE) with single-photon emission computed tomography (SPECT) relative to coronary angiography (CA) for assessment of coronary artery disease (CAD).
  
  BACKGROUND:
  Small-scale studies have shown that myocardial perfusion assessed by SonoVue-enhanced MCE is a viable alternative to SPECT for CAD assessment. However, large multicenter studies are lacking.
  
  METHODS:
  Patients referred for myocardial ischemia testing at 34 centers underwent rest/vasodilator SonoVue-enhanced flash-replenishment MCE, standard (99m)Tc-labeled electrocardiography-gated SPECT, and quantitative CA within 1 month. Myocardial ischemia assessments by 3 independent, blinded readers for MCE and 3 readers for SPECT were collapsed into 1 diagnosis per patient per technique and were compared to CA (reference standard) read by 1 independent blinded reader.
  
  RESULTS:
  Of 628 enrolled patients who received SonoVue (71% males; mean age: 64 years; >1 cardiovascular [CV] risk factor in 99% of patients) 516 patients underwent all 3 examinations, of whom 161 (31.2%) had ?70% stenosis (131 had single-vessel disease [SVD]; 30 had multivessel disease), and 310 (60.1%) had ?50% stenosis. Higher sensitivity was obtained with MCE than with SPECT (75.2% vs. 49.1%, respectively; p
  CONCLUSIONS:
  SonoVue-enhanced MCE demonstrated superior sensitivity but lower specificity for detection of CAD compared to SPECT in a population with a high incidence of CV risk factors and intermediate-high prevalence of CAD. (A phase III study to compare SonoVue® enhanced myocardial echocardiography [MCE] to single photon emission computerized tomography [ECG-GATED SPECT], at rest and at peak of low-dose Dipyridamole stress test, in the assessment of significant coronary artery disease [CAD] in patients with suspect or known CAD using Coronary Angiography as Gold Standard-SonoVue MCE vs SPECT; EUCTR2007-003492-39-GR).
  
  Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
  
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• Limited changes in severe functional mitral regurgitation and pulmonary hypertension after left ventricular assist device implantation: a clue to consider concurrent mitral correction?
  Int J Cardiol

  2013 Jul;167(2):e35-7. doi: 10.1016/j.ijcard.2013.03.098.
  
  Ammirati Enrico, Musca Francesco, Cannata Aldo, Garascia Andrea, Verde Alessandro, Pacher Valentina, Moreo Antonella, Oliva Fabrizio, Martinelli Luigi, Frigerio Maria
  
  
  
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• The diagnostic utility of transthoracic echocardiography for the diagnosis of infective endocarditis in the real world of the Italian Registry on Infective Endocarditis.
  Echocardiography

  2013 Sep;30(8):871-9. doi: 10.1111/echo.12173.
  
  Cecchi Enrico, Chirillo Fabio, Faggiano Pompilio, Imazio Massimo, Cecconi Moreno, Moreo Antonella, Cialfi Alessandro, Rinaldi Mauro, Del Ponte Stefano, Squeri Angelo, Gaddi Oscar, Enia Francesco, Ferro Silvia, Costanzo Piera, Zuppiroli Alfredo, Bergandi Gianluigi, Bologna Flavio, Ciampani Nino, De Rosa Francescogiuseppe, Belli Riccardo,
  
  Abstract
  
  BACKGROUND:
  The choice of the imaging modality (transthoracic [TTE] vs. transesophageal echocardiography [TEE]) for the diagnosis of infective endocarditis (IE) depends on different variables. Aim of the present study is to provide updated data on the diagnostic sensitivity and the clinical usefulness of TTE vs. TEE from the Italian Registry on IE (RIEI).
  
  METHODS:
  The RIEI has enrolled consecutive cases of IE in every participating centre, evaluating diagnostic and therapeutic data from a real world practice perspective.
  
  RESULTS:
  From July 2007 to October 2010, 658 consecutive cases with definite IE according to Duke criteria have been enrolled in the RIEI (483 males). The following diagnostic echocardiographic exams were performed: 616 TTE (94%) and 476 TEE (72%). A positive TTE was recorded in 399 cases (65%), an uncertain TTE in 108 cases (17%), and a negative TTE in 109 cases (18%). For TEE, a positive study was reported in 451 cases (95%), uncertain in 13 cases (2.7%), and negative in 12 cases (2.5%) (P 
  CONCLUSIONS:
  In the real world, TTE is performed earlier and more commonly, and it is the major echocardiographic tool for the initial diagnosis. TEE confirms its superior diagnostic sensitivity in most cases, although it is relatively underused.
  
  © 2013, Wiley Periodicals, Inc.
  
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• Jellyfish in the heart.
  Circulation

  2013 Feb;127(6):e443-5. doi: 10.1161/CIRCULATIONAHA.112.116848.
  
  Dieli Maria, Simon Caterina, Brucato Antonio, Pedrotti Patrizia, Colombo Tiziano, Moreo Antonella, Fasolini Giorgio, Gori Mauro, Gianatti Andrea, Medolago Giuseppe, Ferrazzi Paolo
  
  
  
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• Clinical and echocardiographic correlations of exercise-induced pulmonary hypertension in systemic sclerosis: a multicenter study.
  Am Heart J

  2013 Feb;165(2):200-7. doi: 10.1016/j.ahj.2012.10.020.
  
  Gargani Luna, Pignone Alberto, Agoston Gergely, Moreo Antonella, Capati Eugenia, Badano Luigi P, Doveri Marica, Bazzichi Laura, Costantino Marco Fabio, Pavellini Andrea, Pieri Francesco, Musca Francesco, Muraru Denisa, Epis Oscar, Bruschi Eleonora, De Chiara Benedetta, Perfetto Federico, Mori Fabio, Parodi Oberdan, Sicari Rosa, Bombardieri Stefano, Varga Albert, Cerinic Marco Matucci, Bossone Eduardo, Picano Eugenio
  
  Abstract
  
  BACKGROUND:
  Patients with systemic sclerosis (SSc) are at risk for developing pulmonary hypertension, which is associated with a poor prognosis. Exercise Doppler echocardiography enables the identification of exercise-induced increase in pulmonary artery systolic pressure (PASP) and may provide a thorough noninvasive hemodynamic evaluation.
  
  AIM:
  The aim of this study was to evaluate the clinical and echocardiographic determinants of exercise-induced increase in PASP in a large population of patients with SSc.
  
  METHODS:
  We selected 164 patients with SSc (age 58 ± 13 years, 91% female) with normal resting PASP (
  RESULTS:
  Sixty-nine (42%) patients showed a significant exercise-induced increase in PASP. Among them, peak PVR ?3 Wood Units was present only in 11% of patients, about 5% of the total population. Univariate analysis showed that age, presence of interstitial lung disease, and both right and left diastolic dysfunction are predictors of peak PASP ?50 mm Hg, but none of these parameters predict elevated peak PVR.
  
  CONCLUSIONS:
  Exercise-induced increase in PASP occurs in almost one-half of patients with SSc with normal resting PASP. Peak exercise PASP is affected by age, interstitial lung disease, and right and left ventricular diastolic dysfunction and, only in 5% of the patients, is associated with an increase in PVR during exercise, suggesting heterogeneity of the mechanisms underlying exercise-induced pulmonary hypertension in SSc.
  
  Copyright © 2013 Mosby, Inc. All rights reserved.
  
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• Influence of midwall fibrosis on diastolic dysfunction in non-ischemic cardiomyopathy.
  Int J Cardiol

  2013 Mar;163(3):342-344. doi: 10.1016/j.ijcard.2012.09.104.
  
  Moreo Antonella, Ambrosio Giuseppe, De Chiara Benedetta, Tran Tam, Raman Subha V
  
  
  
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• Influence of CoreValve ReValving System implantation on mitral valve function: an echocardiographic study in selected patients.
  Catheter Cardiovasc Interv

  2011 Oct;78(4):638-44. doi: 10.1002/ccd.23045.
  
  De Chiara Benedetta, Moreo Antonella, De Marco Federico, Musca Francesco, Oreglia Jacopo, Lobiati Elisabetta, Bruschi Giuseppe, Belli Oriana, Mauri Francesco, Klugmann Silvio
  
  Abstract
  
  OBJECTIVES:
  The purpose of this study is to verify whether transcatheter aortic valve implantation (TAVI) determined changes in mitral valve (MV) function, in terms of mitral regurgitation (MR) and stenosis.
  
  BACKGROUND:
  Little data is available regarding the effects of TAVI on global MV function, often derived from analysis primarily focused on clinical and aortic related outcomes.
  
  METHODS:
  From May 2008 to March 2010, 73 patients with severe symptomatic aortic stenosis underwent TAVI with the CoreValve ReValving System. The study population consisted of 58 patients (27 males, mean age 82 ± 7 years) who underwent transthoracic echocardiography at least ?1 month after implantation (mean follow-up 7.8 ± 5.4 months).
  
  RESULTS:
  In patients with a left ventricular dysfunction (ejection fraction, EF,
  CONCLUSIONS:
  In the majority of patients no significant changes occurred in the degree of MR in native valve, but we found that if the aortic valve was deeply implanted in the left ventricle outflow tract, a worsening in MR can be observed. A mitral stenosis development must be sought in patients with heavy calcifications of the anterior leaflet.
  
  Copyright © 2011 Wiley-Liss, Inc.
  
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• Transcatheter aortic valve implantation after heart transplantation.
  Ann Thorac Surg

  2010 Nov;90(5):e66-8. doi: 10.1016/j.athoracsur.2010.08.021.
  
  Bruschi Giuseppe, De Marco Federico, Oreglia Jacopo, Colombo Paola, Moreo Antonella, De Chiara Benedetta, Paino Roberto, Frigerio Maria, Martinelli Luigi, Klugmann Silvio
  
  Abstract
  
  Conventional cardiac surgical procedures after orthotopic heart transplantation are generally uncommon. We report the case of a 67-year-old man who had severe symptomatic aortic stenosis develop 9 years after heart transplantation. After joint evaluation of the cardiovascular team, transcatheter aortic valve implantation was preferred due to patient medical conditions. The CoreValve prosthesis (Medtronic, Minneapolis, MN) was inserted percutaneously into the femoral artery. At 4 months postoperatively, the patient is asymptomatic in New York Heart Association functional class II. This case report provides evidence that transcatheter aortic valve implantation is safe and suitable for selected patients with severe aortic stenosis and a history of heart transplantation that must improve allograft function.
  
  Copyright © 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
  
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• The trans-subclavian retrograde approach for transcatheter aortic valve replacement: single-center experience.
  J Thorac Cardiovasc Surg

  2010 Oct;140(4):911-5, 915.e1-2. doi: 10.1016/j.jtcvs.2010.01.027.
  
  Bruschi Giuseppe, Fratto Pasquale, De Marco Federico, Oreglia Jacopo, Colombo Paola, Botta Luca, Cannata Aldo, Moreo Antonella, De Chiara Benedetta, Lullo Francesca, Paino Roberto, Martinelli Luigi, Klugmann Silvio
  
  Abstract
  
  OBJECTIVE:
  Aortic valve disease is the most common acquired valvular heart disease in adults. With the increasing elderly population, the proportion of patients with symptomatic aortic stenosis who are unsuitable for conventional surgery is increasing. Transcatheter aortic valve implantation has rapidly gained credibility as a valuable alternative to surgery to treat these patients; however, they often have severe iliac-femoral arteriopathy, which renders the transfemoral approach unusable. We report our experience with the trans-subclavian approach for transcatheter aortic valve implantation using the CoreValve (Medtronic CV Luxembourg S.a.r.l.) in 6 patients.
  
  METHODS:
  In May 2008 to September 2009, 6 patients (mean age of 82 ± 5 years), with symptomatic aortic stenosis and no reasonable surgical option because of excessive risk, were excluded from percutaneous femoral CoreValve implantation because of iliac-femoral arteriopathy. These patients underwent transcatheter aortic valve implantation via the axillary artery. Procedures were performed by a combined team of cardiologists, cardiac surgeons, and anesthetists in the catheterization laboratory. The CoreValve 18F delivery system was introduced via the left subclavian artery in 6 patients, 1 with a patent left internal thoracic to left anterior descending artery graft.
  
  RESULTS:
  Procedural success was obtained in all patients, and the mean aortic gradient decreased 5 mm Hg or less immediately after valve deployment. One patient required implantation of a permanent pacemaker. One patient required a subclavian covered stent implantation to treat a postimplant artery dissection associated with difficult surgical hemostasis. One patient was discharged in good condition but died of pneumonia 40 days after the procedure. All patients were asymptomatic on discharge, with good mid-term prosthesis performance.
  
  CONCLUSIONS:
  Transcatheter aortic valve implantation via a surgical subclavian approach seems safe and feasible, offering a new option to treat select, inoperable, and high-risk patients with severe aortic stenosis and peripheral vasculopathy.
  
  Copyright © 2010 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.
  
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• Cavernous hemangioma replacing the septal leaflet of the tricuspid valve.
  J Card Surg

  2010 Sep;25(5):524-7. doi: 10.1111/j.1540-8191.2010.01064.x.
  
  Cannata Aldo, Russo Claudio F, Merlanti Bruno, Pedrotti Patrizia, Moreo Antonella, Botta Luca, Martinelli Luigi
  
  Abstract
  
  Heart valve hemangioma is a rare finding. Here, we report a case of a hemangioma completely replacing the septal leaflet of the tricuspid valve. Preoperative imaging studies and operative anatomy are described.
  
  © 2010 Wiley Periodicals, Inc.
  
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• Influence of myocardial fibrosis on left ventricular diastolic function: noninvasive assessment by cardiac magnetic resonance and echo.
  Circ Cardiovasc Imaging

  2009 Nov;2(6):437-43. doi: 10.1161/CIRCIMAGING.108.838367.
  
  Moreo Antonella, Ambrosio Giuseppe, De Chiara Benedetta, Pu Min, Tran Tam, Mauri Francesco, Raman Subha V
  
  Abstract
  
  BACKGROUND:
  Fibrosis is a common end point of many pathological processes affecting the myocardium and may alter myocardial relaxation properties. By measuring myocardial fibrosis with cardiac magnetic resonance and diastolic function with Doppler echocardiography, we sought to define the influence of fibrosis on left ventricular diastolic function.
  
  METHODS AND RESULTS:
  Two hundred four eligible subjects from 252 consecutive subjects undergoing late postgadolinium myocardial enhancement (LGE) cardiac magnetic resonance and Doppler echocardiography were investigated. Subjects with normal diastolic function exhibited no or minimal fibrosis (median LGE score, 0; interquartile range, 0 to 0). In contrast, the majority of patients with cardiomyopathy (regardless of underlying cause) had abnormal diastolic function indices and substantial fibrosis (median LGE score, 3; interquartile range, 0 to 6.25). Prevalence of LGE positivity by diastolic filling pattern was 13% in normal, 48% in impaired relaxation, 78% in pseudonormal, and 87% in restrictive filling (P
  CONCLUSIONS:
  Severity of myocardial fibrosis by LGE significantly correlates with the degree of diastolic dysfunction in a broad range of cardiac conditions. Noninvasive assessment of myocardial fibrosis may provide valuable insights into the pathophysiology of left ventricular diastolic function and therapeutic response.
  
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• Atorvastatin attenuates post-implant tissue degeneration of cardiac prosthetic valve bovine pericardial tissue in a subcutaneous animal model.
  Int J Cardiol

  2010 May;141(1):68-74. doi: 10.1016/j.ijcard.2008.11.174.
  
  Lorusso Roberto, Corradi Domenico, Maestri Roberta, Bosio Silvia, Curulli Alessandra, Beghi Cesare, Gerometta Piersilvio, Russo Claudio, Gelsomino Sandro, Moreo Antonella, De Cicco Giuseppe, Rosano Giuseppe, Volterrani Maurizio
  
  Abstract
  
  AIMS:
  The aim of our study was to examine the effects of statin therapy (atorvastatin) on post-implant structural changes of bovine pericardial tissue in a subcutaneous animal model.
  
  METHODS AND RESULTS:
  Sixty male C57BL/6 mice underwent subcutaneous dorsal implantation of bovine pericardial fragments. Animals were randomized to treatment with atorvastatin (50 mg/kg) (statin group - SG) or to vehicle (control group - CG). After 1.5 months, all fragments were explanted and submitted to histopathological assessment (semi-quantitative analysis) to elucidate extent of inflammatory infiltrate, signs of tissue injury, or presence of microcalcification. Calcium determination of the implanted pericardial tissue was also performed by inductively coupled plasma mass spectrometry (ICP-MS) assessment. ICP-MS analysis showed that pericardial fragments in SG had significantly (p
  CONCLUSIONS:
  Our findings indicate that atorvastatin significantly attenuates the post-implant structural degeneration of artificial valve bovine pericardial tissue in a subcutaneous animal model. Further observations are mandatory to assess the effects of statins on the implanted bioprosthetic valve tissue in the blood circulation.
  
  Copyright (c) 2008. Published by Elsevier Ireland Ltd.
  
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• Assessment of mitral prosthetic valve thrombosis by live three-dimensional echocardiography: comparison with transesophageal echocardiography.
  Heart Vessels

  2007 Jul;22(4):287-9.
  
  Moreo Antonella, Lobiati Elisabetta, De Chiara Benedetta, Mauri Francesco
  
  Abstract
  
  We report the feasibility of transthoracic live three-dimensional echocardiography in the diagnosis of a thrombus attached to the mitral bioprosthetic valve.
  
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• Functional derangement and cardiac innervation in the apical ballooning syndrome: a 123I-meta-iodobenzylguanidine scintigraphic and dobutamine stress echocardiographic study.
  J Cardiovasc Med (Hagerstown)

  2007 Mar;8(3):205-9.
  
  Moreo Antonella, De Chiara Benedetta, Possa Mario, Sara Roberto, Bossi Irene, Orrego Pedro Silva, Nicolosi Elisa, Mauri Francesco, Parodi Oberdan
  
  Abstract
  
  Several cases of transient left ventricular apical ballooning syndrome have already been described, but the pathophysiological mechanisms of this syndrome still remain unclear. We report the case of a patient evaluated in the acute phase of apical ballooning by coronary angiography and echocardiography who was submitted to I-meta-iodobenzylguanidine (MIBG) myocardial scintigraphy and dobutamine stress echocardiography one month after the discharge. MIBG scintigraphy demonstrated a decreased tracer uptake in the apical and periapical anterior regions, whilst myocardial perfusion at rest was normal. Dobutamine induced an increased left ventricular outflow tract gradient and hypokinesis in the apical and periapical segments, mimicking the findings that occurred in the acute phase, and in agreement with the location of MIBG abnormalities. After a two-month treatment with carvedilol, MIBG uptake increased in the apical and periapical anterior regions.
  
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• Mitral valve periprosthetic leakage: Anatomical observations in 135 patients from a multicentre study.
  Eur J Cardiothorac Surg

  2006 Dec;30(6):887-91.
  
  De Cicco Giuseppe, Russo Claudio, Moreo Antonella, Beghi Cesare, Fucci Carlo, Gerometta Piersilvio, Lorusso Roberto
  
  Abstract
  
  OBJECTIVE:
  Prosthetic valve dysfunction after mitral valve replacement (MVR) may be caused by several factors, which often lead to repeated surgery. One of the most frequent determinants of reoperation is periprosthetic leakage (PPL). A few published reports have analysed PPL incidence and postoperative results after MVR, but no specific attention has been paid towards the potential relation between anatomical factors and PPL occurrence, particularly not bacterial-related. The aim of this study was to evaluate the location of PPL after MVR through a multicentre retrospective study.
  
  METHODS:
  Between January 1985 and November 2005, 135 patients underwent reoperation at four institutions because of PPL after MVR and met the study inclusion criteria. The mitral valve annulus (MVA) was analysed in a clockwise format, indicating 12 o'clock as the mid-point of anterior annulus as viewed from the atrium.
  
  RESULTS:
  Overall hospital mortality was 3.7% (five patients). Repair of PPL was carried out in 83 cases whereas prosthetic valve replacement was necessary in 52 cases. The total number of sectors involved in PPL was 244. PPL occurred more frequently between hour 5 and hour 6, and hour 10 and hour 11, with the risk of leakage being, 2.8 and 2.0 times higher, respectively, than in any other portion of the MVA.
  
  CONCLUSIONS:
  Our study suggests that PPL occurs more frequently at antero-lateral and postero-medial segments of MVA. This finding might be linked to unusual anatomical and functional factors of the MVA and may call for adjunctive care to these sectors of MVA when performing suture placement during MVR.
  
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• [Prognostic value of serial measurements of left ventricular function and exercise performance in chronic heart failure].
  Rev Esp Cardiol

  2006 Sep;59(9):905-10.
  
  Moreo Antonella, de Chiara Benedetta, Cataldo Gabriella, Piccalò Giacomo, Lobiati Elisabetta, Parolini Marina, Frigerio Maria, Ciliberto Guglielma Rita, Mauri Francesco
  
  Abstract
  
  INTRODUCTION AND OBJECTIVES:
  The prognostic value of a single measurement of ejection fraction and peak oxygen uptake in chronic heart failure has been extensively investigated. The aim of our study was to evaluate the prognostic significance of serial changes in ejection fraction and exercise performance in moderate to severe chronic heart failure.
  
  METHODS:
  182 patients (156 men, 53 [47-58] years) underwent echocardiography and cardiopulmonary exercise testing at baseline and after 10 [8-12] months. Most patients had idiopathic dilated cardiomyopathy (69%) and all patients presented left ventricular ejection fraction
  RESULTS:
  During follow-up 18 patients (9.9%) died and 14 (7.7%) underwent heart transplantation. Baseline ejection fraction (HR, 0.94, 95% CI, 0.89-0.98 P=.006) and mitral regurgitation (HR, 4.22, 95% CI, 1.63-10.92, P=.003), and delta (second examination-baseline) ejection fraction (HR, 0.93, 95% CI, 0.88-0.98, P=.01) were the only significant variables at univariate analysis. Both ejection fraction and delta ejection fraction remained independently associated with events at multivariate analysis. The prognostic power significantly increased between a model including ejection fraction alone and another one including ejection fraction plus delta ejection fraction.
  
  CONCLUSIONS:
  In clinically stable patients with chronic heart failure, ejection fraction and its changes were independently associated with outcome; on the contrary, serial cardiopulmonary exercise testing did not provide significant prognostic value. Baseline plus changes in ejection fraction showed better prognostic performance than baseline ejection fraction alone.
  
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• Long-term outcomes in difficult-to-treat patients with recurrent pericarditis.
  Am J Cardiol

  2006 Jul;98(2):267-71.
  
  Brucato Antonio, Brambilla Giovanni, Moreo Antonella, Alberti Antonella, Munforti Carlotta, Ghirardello Anna, Doria Andrea, Shinar Yael, Livneh Avi, Adler Yehuda, Shoenfeld Yehuda, Mauri Francesco, Palmieri Giancarlo, Spodick David H
  
  Abstract
  
  Patients with many recurrences of acute pericarditis are commonly alarmed by the fear of constriction. We studied their long-term outcome and the possible presence of systemic diseases. Sixty-one Italian patients (36 men) were followed for an average of 8.3 years according to a predefined protocol, including testing for autoimmune diseases and familial Mediterranean fever. Symptomatic pericarditis lasted from 1 to 43 years (mean 5.4 years). Fifty-two patients had been referred to us after failure of previous therapies, including steroids. We observed 378 attacks with a mean of 1.6 per patient per year and 156 hospital admissions. Thirteen patients had a post-cardiac injury syndrome. In 43 (70.5%), the pericarditis remained idiopathic, whereas we made a new diagnosis of rheumatoid arthritis in 1 and of Sjogren's syndrome in 4 patients, but in these patients pericarditis represented the dominant clinical manifestation. Cardiac tamponade occurred during the initial attacks in 4 patients (6.5%) but never recurred. Pleural effusions were present during the first attack in 22 patients (36.0%) and liver involvement in 5 (8%). No patients developed constrictive pericarditis. Echocardiographic examination produced no evidence of chronic myocardial disease. Response to therapy was good. Thirty-one patients (50.8%) are in sustained remission, without any therapy; their total observation period has averaged 10.3 years. In idiopathic patients, antinuclear antibodies were present in 56.2% and anti-Ro/SSA in 8.3%. Mutations linked to familial Mediterranean fever were absent. In conclusion, in this large series of difficult patients with recurrent acute pericarditis and a very long follow-up, the long-term prognosis is good.
  
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• An unusual cause of pulmonary edema: acute rupture of noncoronary sinus of valsalva aneurysm into the left atrium.
  J Am Soc Echocardiogr

  2006 Jul;19(7):938.e9-11.
  
  Moreo Antonella, De Chiara Benedetta, Bruschi Giuseppe, Tarelli Giuseppe, Parolini Marina, Mauri Francesco
  
  Abstract
  
  We present the case of a patient admitted to hospital with pulmonary edema and atrial fibrillation. The transthoracic echocardiogram showed noncoronary sinus of Valsalva aneurysm ruptured into the left atrium, with a turbulent flow directed toward the left atrium floor and the pulmonary vein, which explained the clinical presentation. Echocardiography played a crucial role in identification of the cause and correct therapeutic approach.
  
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• [Atrial fibrillation and cardioversion: role of transesophageal echocardiography].
  Ital Heart J Suppl

  2005 Dec;6(12):780-7.
  
  Moreo Antonella, Mauri Francesco
  
  Abstract
  
  The most common cardiac arrhythmia is atrial fibrillation (AF). Echocardiography has been an important tool in the evaluation of patients with AF. Transesophageal echocardiography (TEE) offers excellent visualization of the atria and accurate identification or exclusion of atrial thrombi. Patients undergoing cardioversion are treated conventionally with therapeutic anticoagulation for 3 weeks before and 4 weeks after cardioversion to decrease the risk of thromboembolism. A TEE-guided strategy has been proposed as an alternative that may lower stroke and bleeding events. Patients without atrial thrombus by TEE are cardioverted on achievement of therapeutic anticoagulation, whereas cardioversion is delayed in patients with any thrombus. The two management strategies comparably lower the patient's embolic risk when the guidelines are properly followed. The TEE-guided approach offers the advantage of simplified anticoagulation management and may lower the incidence of bleeding complications.
  
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