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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Nuclear Medicine & Radiology".

Deadline for manuscript submissions: closed (20 December 2021) | Viewed by 35940

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Prof. Dr. Eugenio Picano

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Institute Clinical Physiology of National Research Council, Pisa, Italy
Interests: cardiac functional testing; cardiovascular imaging; cost-effectiveness; personalized medicine; sustainability of health care systems; stress imaging; radioprotection; lung imaging in cardiology
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

In the COVID-19 era, cardiac imaging is rapidly changing. The redundant, expensive, inappropriate use of imaging testing for diagnostic carpet bombing is losing ground. There is increasing awareness that the small individual waste of a single imaging examination multiplied by billions of tests each year becomes a significant cost for society, a health risk for the population, and an environmental burden for the planet. We need a more integrated approach to addressing patient vulnerability, which includes myocardial ischemia and viability but also many other phenotypes—from mitral regurgitation to pulmonary congestion and from autonomic unbalance to coronary microcirculatory damage. Research in cardiac imaging is oriented towards a more comprehensive assessment of patient vulnerability matched by progressive near-zero radiation and de-carbonization of testing with climate-neutral choices. More with less. More information but with less cost, less time, less risk, and less carbon dioxide production through building of a green cardiac imaging lab.

Prof. Dr. Eugenio Picano
Guest Editor

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Keywords

artificial intelligence
cardiac imaging
coronary artery disease
environment and imaging
heart failure
hypertrophic cardiomyopathy
stress echocardiography
sustainability
heart donors
valvular heart disease

Published Papers (13 papers)

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10 pages, 1976 KiB

Open AccessArticle

Biventricular Myocardial Strain Analysis in Patients with Pulmonary Arterial Hypertension Using Cardiac Magnetic Resonance Tissue-Tracking Technology

by Jibin Cao, Simiao Li, Lingling Cui, Kexin Zhu, Huaibi Huo and Ting Liu

J. Clin. Med. 2022, 11(8), 2230; https://doi.org/10.3390/jcm11082230 - 15 Apr 2022

Cited by 3 | Viewed by 1421

Abstract

To evaluate both left and right ventricular (LV and RV) function in patients with pulmonary arterial hypertension (PAH) using cardiac magnetic resonance tissue-tracking (CMR-TT) technology and explore its clinical value. Methods: A total of 79 participants (including 47 patients with PAH and 32 healthy controls) underwent cardiac magnetic resonance imaging (CMRI) with a short-axis balanced steady-state free precession (SSFP) sequence. The biventricular cardiac function parameters and strain parameters were obtained by postprocessing with CVI42 software. A comparative analysis was performed between the LV and RV strain parameters in all PAH patients and in PAH patients with reduced or preserved cardiac function. Results: The results showed preferable repeatability of CMR-TT in analyzing the global radial strain (GRS), circumferential strain (GCS), and longitudinal strain (GLS) of the left and right ventricles in the PAH group. The GRS, GCS, and GLS of the left and right ventricles except for LV GRS (LVGRS) of PAH patients were significantly lower than those of healthy controls (p < 0.05 for all). The GRS and GCS of the left and right ventricles showed a moderate correlation in the PAH group (r = 0.323, p = 0.02; r = 0.301, p = 0.04, respectively). PAH patients with preserved RV function (n = 9) showed significantly decreased global and segmental RS, CS, and LS of the right ventricles than healthy controls (p < 0.05 for all), except for basal RVGCS (RVGCS-b, p = 0.996). Only the LVGLS was significantly different between the PAH patients with preserved LV function (n = 32) and the healthy controls (−14.23 ± 3.01% vs. −16.79 ± 2.86%, p < 0.01). Conclusions: As a nonradioactive and noninvasive technique, CMR-TT has preferable feasibility and repeatability in quantitatively evaluating LV and RV strain parameters in PAH patients and can be used to effectively detect early biventricular myocardial damage in patients with PAH. Full article

(This article belongs to the Special Issue Imaging Research in Cardiovascular Diseases)

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14 pages, 2155 KiB

Open AccessArticle

Vasodilator Strain Stress Echocardiography in Suspected Coronary Microvascular Angina

by Hugo Rodriguez-Zanella, Rosina Arbucci, Juan Francisco Fritche-Salazar, Xochitl Arely Ortiz-Leon, Domenico Tuttolomondo, Diego Haber Lowenstein, Karina Wierzbowska-Drabik, Quirino Ciampi, Jarosław D. Kasprzak, Nicola Gaibazzi, Jorge Lowenstein, Edith Liliana Posada-Martinez, Jose Antonio Arias-Godinez, Juan C. de la Fuente-Mancera, Eugenio Picano and on behalf of the Stress Echo 2020 Study Group of the Italian Society of Echocardiography and Cardiovascular Imaging (SIECVI)

J. Clin. Med. 2022, 11(3), 711; https://doi.org/10.3390/jcm11030711 - 28 Jan 2022

Cited by 10 | Viewed by 2682

Abstract

Background: In patients with Ischemia and non-obstructive coronary artery stenosis (INOCA) wall motion is rarely abnormal during stress echocardiography (SE). Our aim was to determine if patients with INOCA and reduced coronary flow velocity reserve (CVFR) have altered cardiac mechanics using two-dimensional speckle-tracking echocardiography (2DSTE) during SE. Methods: In a prospective, multicenter, international study, we recruited 135 patients with INOCA. Overall, we performed high dose (0.84 mg/kg) dipyridamole SE with combined assessment of CVFR and 2DSTE. The population was divided in patients with normal CVFR (>2, group 1, n = 95) and abnormal CVFR (≤2, group 2, n = 35). Clinical and 2DSTE parameters were compared between groups. Results: Feasibility was high for CFVR (98%) and 2DSTE (97%). A total of 130 patients (mean age 63 ± 12 years, 67 women) had complete flow and strain data. The two groups showed similar 2DSTE values at rest. At peak SE, Group 1 patients showed lower global longitudinal strain (p < 0.007), higher mechanical dispersion (p < 0.0005), lower endocardial (p < 0.001), and epicardial (p < 0.0002) layer specific strain. Conclusions: In patients with INOCA, vasodilator SE with simultaneous assessment of CFVR and strain is highly feasible. Coronary microvascular dysfunction is accompanied by an impairment of global and layer-specific deformation indices during stress. Full article

(This article belongs to the Special Issue Imaging Research in Cardiovascular Diseases)

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14 pages, 2540 KiB

Open AccessArticle

Long Term Prognostic Value of Contractile Reserve Assessed by Global Longitudinal Strain in Patients with Asymptomatic Severe Aortic Stenosis

by Rosina Arbucci, Diego M. Lowenstein Haber, María Graciela Rousse, Ariel K. Saad, Liliana Martínez Golleti, Natalio Gastaldello, Miguel Amor, Cristian Caniggia, Pablo Merlo, Gustavo Zambrana, Marcela Galello, Esteban Clos, Vicente Mora and Jorge A. Lowenstein

J. Clin. Med. 2022, 11(3), 689; https://doi.org/10.3390/jcm11030689 - 28 Jan 2022

Viewed by 1629

Abstract

Background. Left ventricle (LV) global longitudinal strain (GLS) at rest has shown prognostic value in patients (pts) with severe aortic stenosis (SAS). Contractile reserve (CR) during exercise stress echo (ESE) estimated via GLS (CR-GLS) could better stratify the asymptomatic patients who could benefit from early intervention. Aims. To determine the long-term prognostic value of CR-GLS in patients with asymptomatic SAS with an ESE without inducible ischemia. Additionally, to compare the prognostic value of CR assessed via ejection fraction (CR-EF) and CR-GLS. Methods. In a prospective, single-center, observational study between 2013 and 2019, 101 pts with asymptomatic SAS and preserved left ventricular ejection fraction (LVEF) > 55% were enrolled. CR was considered present with an exercise-rest increase in LVEF (Simpson’s rule) ≥ 5 points and > 2 absolute points in GLS. Patients were assigned to 2 groups (G): G1: 56 patients with CR-GLS present; and G2: 45 patients CR-GLS absent. All patients were followed up. Results. G2 Patients were older, with lower exercise capability, less aortic valve area (AVA), a higher peak aortic gradient, and less LVEF (71.5% ± 5.9 vs. 66.8% ± 7.9; p = 0.002) and GLS (%) at exercise (G1: −22.2 ± 2.8 vs. G2: −18.45 ± 2.4; p = 0.001). During mean follow-up of 46.6 ± 3.4 months, events occurred in 45 pts., with higher incidence in G2 (G2 = 57.8% vs. G1 = 42.2%, p < 0.01). At Cox regression analysis, CR-GLS was an independent predictor of major cardiovascular events (HR: 1.98, 95% CI 1.09–3.58, p = 0.025). Event-free survival was lower for patients with CR-GLS absent (log rank test p = 0.022). CR-EF was not outcome predictive (log rank test p 0.095). Conclusions: In patients with asymptomatic SAS, the absence of CR-GLS during ESE is associated with worse prognosis. Additionally, CR-GLS was a better predictor of events than CR-EF. Full article

(This article belongs to the Special Issue Imaging Research in Cardiovascular Diseases)

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13 pages, 2238 KiB

Open AccessArticle

Coronary Flow Velocity Reserve Using Dobutamine Test for Noninvasive Functional Assessment of Myocardial Bridging

by Srdjan B. Aleksandric, Ana D. Djordjevic-Dikic, Vojislav L. Giga, Milorad B. Tesic, Ivan A. Soldatovic, Marko D. Banovic, Milan R. Dobric, Vladan Vukcevic, Miloje V. Tomasevic, Dejan N. Orlic, Nikola Boskovic, Ivana Jovanovic, Milan A. Nedeljkovic, Goran Stankovic, Miodrag C. Ostojic and Branko D. Beleslin

J. Clin. Med. 2022, 11(1), 204; https://doi.org/10.3390/jcm11010204 - 30 Dec 2021

Cited by 2 | Viewed by 1381

Abstract

Background: It has been shown that coronary flow velocity reserve (CFVR) measurement by transthoracic Doppler echocardiography (TTDE) during dobutamine (DOB) provocation provides a more accurate functional evaluation of myocardial bridging (MB) compared to adenosine. However; the cut-off value of CFVR during DOB for identification of MB associated with myocardial ischemia has not been fully clarified. Purpose: This prospective study aimed to determine the cut-off value of TTDE-CFVR during DOB in patients with isolated-MB, as compared with stress-induced wall motion abnormalities (VMA) during exercise stress-echocardiography (SE) as reference. Methods: Eighty-one symptomatic patients (55 males [68%], mean age 56 ± 10 years; range: 27–74 years) with the existence of isolated-MB on the left anterior descending artery (LAD) and systolic MB-compression ≥50% diameter stenosis (DS) were eligible to participate in the study. Each patient underwent treadmill exercise-SE, invasive coronary angiography, and TTDE-CFVR measurements in the distal segment of LAD during DOB infusion (DOB: 10–40 μg/kg/min). Using quantitative coronary angiography, both minimal luminal diameter (MLD) and percent DS at MB-site at end-systole and end-diastole were determined. Results: Stress-induced myocardial ischemia with the occurrence of WMA was found in 23 patients (28%). CFVR during peak DOB was significantly lower in the SE-positive group compared with the SE-negative group (1.94 ± 0.16 vs. 2.78 ± 0.53; p < 0.001). ROC analyses identified the optimal CFVR cut-off value ≤ 2.1 obtained during high-dose dobutamine (>20 µg/kg/min) for the identification of MB associated with stress-induced WMA, with a sensitivity, specificity, positive and negative predictive value of 96%, 95%, 88%, and 98%, respectively (AUC 0.986; 95% CI: 0.967–1.000; p < 0.001). Multivariate logistic regression analysis revealed that MLD and percent DS, both at end-diastole, were the only independent predictors of ischemic CFVR values ≤2.1 (OR: 0.023; 95% CI: 0.001–0.534; p = 0.019; OR: 1.147; 95% CI: 1.042–1.263; p = 0.005; respectively). Conclusions: Noninvasive CFVR during dobutamine provocation appears to be an additional and important noninvasive tool to determine the functional severity of isolated-MB. A transthoracic CFVR cut-off ≤2.1 measured at a high-dobutamine dose may be adequate for detecting myocardial ischemia in patients with isolated-MB. Full article

(This article belongs to the Special Issue Imaging Research in Cardiovascular Diseases)

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8 pages, 1129 KiB

Open AccessArticle

Reduced Sympathetic Reserve Detectable by Heart Rate Response after Dipyridamole in Anginal Patients with Normal Coronary Arteries

by Lauro Cortigiani, Clara Carpeggiani, Laura Meola, Ana Djordjevic-Dikic, Francesco Bovenzi and Eugenio Picano

J. Clin. Med. 2022, 11(1), 52; https://doi.org/10.3390/jcm11010052 - 23 Dec 2021

Cited by 1 | Viewed by 2120

Abstract

Background. Patients with ischemia and normal coronary arteries (INOCA) may show abnormal cardiac sympathetic function, which could be unmasked as a reduced heart rate reserve (HRR) during dipyridamole stress echocardiography (SE). Objectives. To assess whether HRR during dipyridamole SE predicts outcome. Methods. Dipyridamole SE was performed in 292 patients with INOCA. HRR was measured as peak/rest heart rate and considered abnormal when ≤1.22 (≤1.17 in presence of permanent atrial fibrillation). All-cause death was the only endpoint. Results. HRR during SE was normal in 183 (63%) and abnormal in 109 patients (37%). During a follow-up of 10.4 ± 5.5 years, 89 patients (30%) died. The 15-year mortality rate was 27% in patients with normal and 54% in those with abnormal HRR (p < 0.0001). In a multivariable analysis, a blunted HRR during SE was an independent predictor of outcome (hazard ratio 1.86, 95% confidence intervals 1.20–2.88; p = 0.006) outperforming inducible ischemia. Conclusions. A blunted HRR during dipyridamole SE predicts a worse survival in INOCA patients, independent of inducible ischemia. Full article

(This article belongs to the Special Issue Imaging Research in Cardiovascular Diseases)

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13 pages, 1572 KiB

Open AccessArticle

Clinical Significance of Serum Lactate in Acute Myocardial Infarction: A Cardiac Magnetic Resonance Imaging Study

by Ik Hyun Park, Hyun Kyu Cho, Ju Hyeon Oh, Woo Jung Chun, Yong Hwan Park, Mirae Lee, Min Sun Kim, Ki Hong Choi, Jihoon Kim, Young Bin Song, Joo-Yong Hahn, Seung-Hyuk Choi, Sang-Chol Lee, Hyeon-Cheol Gwon, Yeon Hyeon Choe and Woo Jin Jang

J. Clin. Med. 2021, 10(22), 5278; https://doi.org/10.3390/jcm10225278 - 13 Nov 2021

Cited by 5 | Viewed by 2004

Abstract

Little is known about causality and the pathological mechanism underlying the association of serum lactate with myocardial injury in patients with acute myocardial infarction (AMI). We evaluated data from 360 AMI patients undergoing percutaneous coronary intervention (PCI) using cardiovascular magnetic resonance imaging (CMR). Of these, 119 patients had serum lactate levels > 2.5 mmol/L on admission (high serum lactate group), whereas 241 patients had serum lactate levels ≤ 2.5 mmol/L (low serum lactate group). We compared the myocardial infarct size assessed by CMR between the two groups and performed inverse probability of treatment weighting (IPTW). In CMR analysis, myocardial infarct size was significantly greater in the high serum lactate group than in the low serum lactate group (22.0 ± 11.4% in the high serum lactate group vs. 18.9 ± 10.5% in the low serum lactate group; p = 0.011). The result was consistent after IPTW adjustment (21.5 ± 11.1% vs. 19.2 ± 10.4%; p = 0.044). In multivariate analysis, high serum lactate was associated with larger myocardial infarct (odds ratio 1.59; 95% confidence interval 1.00–2.51; p = 0.048). High serum lactate could predict advanced myocardial injury in AMI patients undergoing PCI. Full article

(This article belongs to the Special Issue Imaging Research in Cardiovascular Diseases)

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36 pages, 787 KiB

Open AccessArticle

Stress Echo 2030: The Novel ABCDE-(FGLPR) Protocol to Define the Future of Imaging

by Eugenio Picano, Quirino Ciampi, Lauro Cortigiani, Adelaide M. Arruda-Olson, Clarissa Borguezan-Daros, José Luis de Castro e Silva Pretto, Rosangela Cocchia, Eduardo Bossone, Elisa Merli, Garvan C. Kane, Albert Varga, Gergely Agoston, Maria Chiara Scali, Doralisa Morrone, Iana Simova, Martina Samardjieva, Alla Boshchenko, Tamara Ryabova, Alexander Vrublevsky, Attila Palinkas, Eszter D. Palinkas, Robert Sepp, Marco A. R. Torres, Hector R. Villarraga, Tamara Kovačević Preradović, Rodolfo Citro, Miguel Amor, Hugo Mosto, Michael Salamè, Paul Leeson, Cristina Mangia, Nicola Gaibazzi, Domenico Tuttolomondo, Costantina Prota, Jesus Peteiro, Caroline M. Van De Heyning, Antonello D’Andrea, Fausto Rigo, Aleksandra Nikolic, Miodrag Ostojic, Jorge Lowenstein, Rosina Arbucci, Diego M. Lowenstein Haber, Pablo M. Merlo, Karina Wierzbowska-Drabik, Jaroslaw D. Kasprzak, Maciej Haberka, Ana Cristina Camarozano, Nithima Ratanasit, Fabio Mori, Maria Grazia D’Alfonso, Luigi Tassetti, Alessandra Milazzo, Iacopo Olivotto, Alberto Marchi, Hugo Rodriguez-Zanella, Angela Zagatina, Ratnasari Padang, Milica Dekleva, Ana Djordievic-Dikic, Nikola Boskovic, Milorad Tesic, Vojislav Giga, Branko Beleslin, Giovanni Di Salvo, Valentina Lorenzoni, Matteo Cameli, Giulia Elena Mandoli, Tonino Bombardini, Pio Caso, Jelena Celutkiene, Andrea Barbieri, Giovanni Benfari, Ylenia Bartolacelli, Alessandro Malagoli, Francesca Bursi, Francesca Mantovani, Bruno Villari, Antonello Russo, Michele De Nes, Clara Carpeggiani, Ines Monte, Federica Re, Carlos Cotrim, Giuseppe Bilardo, Ariel K. Saad, Arnas Karuzas, Dovydas Matuliauskas, Paolo Colonna, Francesco Antonini-Canterin, Mauro Pepi, Patricia A. Pellikka and The Stress Echo 2030 Study Group of the Italian Society of Echocardiography and Cardiovascular Imaging (SIECVI) Show full author list Hide full author list

J. Clin. Med. 2021, 10(16), 3641; https://doi.org/10.3390/jcm10163641 - 17 Aug 2021

Cited by 21 | Viewed by 8085

Abstract

With stress echo (SE) 2020 study, a new standard of practice in stress imaging was developed and disseminated: the ABCDE protocol for functional testing within and beyond CAD. ABCDE protocol was the fruit of SE 2020, and is the seed of SE 2030, which is articulated in 12 projects: 1-SE in coronary artery disease (SECAD); 2-SE in diastolic heart failure (SEDIA); 3-SE in hypertrophic cardiomyopathy (SEHCA); 4-SE post-chest radiotherapy and chemotherapy (SERA); 5-Artificial intelligence SE evaluation (AI-SEE); 6-Environmental stress echocardiography and air pollution (ESTER); 7-SE in repaired Tetralogy of Fallot (SETOF); 8-SE in post-COVID-19 (SECOV); 9: Recovery by stress echo of conventionally unfit donor good hearts (RESURGE); 10-SE for mitral ischemic regurgitation (SEMIR); 11-SE in valvular heart disease (SEVA); 12-SE for coronary vasospasm (SESPASM). The study aims to recruit in the next 5 years (2021–2025) ≥10,000 patients followed for ≥5 years (up to 2030) from ≥20 quality-controlled laboratories from ≥10 countries. In this COVID-19 era of sustainable health care delivery, SE2030 will provide the evidence to finally recommend SE as the optimal and versatile imaging modality for functional testing anywhere, any time, and in any patient. Full article

(This article belongs to the Special Issue Imaging Research in Cardiovascular Diseases)

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9 pages, 637 KiB

Open AccessArticle

Reshaping of Italian Echocardiographic Laboratories Activities during the Second Wave of COVID-19 Pandemic and Expectations for the Post-Pandemic Era

by Quirino Ciampi, Francesco Antonini-Canterin, Andrea Barbieri, Agata Barchitta, Frank Benedetto, Alberto Cresti, Sofia Miceli, Ines Monte, Licia Petrella, Giuseppe Trocino, Iolanda Aquila, Giovanni Barbati, Valentina Barletta, Daniele Barone, Monica Beraldi, Gianluigi Bergandi, Giuseppe Bilardo, Giuseppe Boriani, Eduardo Bossone, Amedeo Bongarzoni, Francesca Elisa Bovolato, Francesca Bursi, Valeria Cammalleri, Marco Carbonella, Grazia Casavecchia, Sebastiano Cicco, Giovanni Cioffi, Rosangela Cocchia, Paolo Colonna, Lauro Cortigiani, Umberto Cucchini, Maria Grazia D'Alfonso, Antonello D’Andrea, Luca Dell'Angela, Ilaria Dentamaro, Marcella De Paolis, Paola De Stefanis, Wanda Deste, Maria Di Fulvio, Giovanna Di Giannuario, Daniela Di Lisi, Concetta Di Nora, Iacopo Fabiani, Roberta Esposito, Fabio Fazzari, Luigi Ferrara, Gemma Filice, Davide Forno, Mauro Giorgi, Enrico Giustiniano, Cosimo Angelo Greco, Gian Luca Iannuzzi, Annibale Izzo, Alberto Maria Lanzone, Alessandro Malagoli, Francesca Mantovani, Vincenzo Manuppelli, Simona Mega, Elisa Merli, Margherita Ministeri, Doralisa Morrone, Cosimo Napoletano, Luigi Nunziata, Guido Pastorini, Chiara Pedone, Enrica Petruccelli, Maria Vincenza Polito, Vincenzo Polizzi, Costantina Prota, Fausto Rigo, Dante Eduardo Rivaben, Silvio Saponara, Angela Sciacqua, Chiara Sartori, Virginia Scarabeo, Walter Serra, Sergio Severino, Luciano Spinelli, Gloria Tamborini, Antonio Tota, Bruno Villari, Scipione Carerj, Eugenio Picano, Mauro Pepi and SIECoVId Study Group, on Behalf of the Italian Society of Echocardiography and Cardiovascular Imaging (SIECVI) Show full author list Hide full author list

J. Clin. Med. 2021, 10(16), 3466; https://doi.org/10.3390/jcm10163466 - 05 Aug 2021

Cited by 8 | Viewed by 2815

Abstract

Background: Cardiology divisions reshaped their activities during the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to analyze the organization of echocardiographic laboratories and echocardiography practice during the second wave of the COVID-19 pandemic in Italy, and the expectations for the post-COVID era. Methods: We analyzed two different time periods: the month of November during the second wave of the COVID-19 pandemic (2020) and the identical month during 2019 (November 2019). Results: During the second wave of the COVID-19 pandemic, the hospital activity was partially reduced in 42 (60%) and wholly interrupted in 3 (4%) echocardiographic laboratories, whereas outpatient echocardiographic activity was partially reduced in 41 (59%) and completely interrupted in 7 (10%) laboratories. We observed an important change in the organization of activities in the echocardiography laboratory which reduced the operator-risk and improved self-protection of operators by using appropriate personal protection equipment. Operators wore FFP2 in 58 centers (83%) during trans-thoracic echocardiography (TTE), in 65 centers (93%) during transesophageal echocardiography (TEE) and 63 centers (90%) during stress echocardiography. The second wave caused a significant reduction in number of echocardiographic exams, compared to November 2019 (from 513 ± 539 to 341 ± 299 exams per center, −34%, p < 0.001). On average, there was a significant increase in the outpatient waiting list for elective echocardiographic exams (from 32.0 ± 28.1 to 45.5 ± 44.9 days, +41%, p < 0.001), with a reduction of in-hospital waiting list (2.9 ± 2.4 to 2.4 ± 2.0 days, −17%, p < 0.001). We observed a large diffusion of point-of-care cardiac ultrasound (88%), with a significant increase of lung ultrasound usage in 30 centers (43%) during 2019, extended to all centers in 2020. Carbon dioxide production by examination is an indicator of the environmental impact of technology (100-fold less with echocardiography compared to other cardiac imaging techniques). It was ignored in 2019 by 100% of centers, and currently it is considered potentially crucial for decision-making in cardiac imaging by 65 centers (93%). Conclusions: In one year, major changes occurred in echocardiography practice and culture. The examination structure changed with extensive usage of point-of-care cardiac ultrasound and with lung ultrasound embedded by default in the TTE examination, as well as the COVID-19 testing. Full article

(This article belongs to the Special Issue Imaging Research in Cardiovascular Diseases)

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11 pages, 1705 KiB

Open AccessArticle

Coronary Flow, Left Ventricular Contractile and Heart Rate Reserve in Non-Ischemic Heart Failure

by Clarissa Borguezan Daros, Quirino Ciampi, Lauro Cortigiani, Nicola Gaibazzi, Fausto Rigo, Karina Wierzbowska-Drabik, Jaroslaw D. Kasprzak, Claudio Dodi, Bruno Villari, Francesco Antonini-Canterin, Valentina Lorenzoni, Michele De Nes, Clara Carpeggiani, Eugenio Picano and on behalf of the Stress Echo Study Group of the Italian Society of Echocardiography and Cardiovascular Imaging

J. Clin. Med. 2021, 10(15), 3405; https://doi.org/10.3390/jcm10153405 - 30 Jul 2021

Cited by 9 | Viewed by 2118

Abstract

Background: Left ventricular contractile reserve (LVCR), coronary flow velocity reserve (CFVR), and heart rate reserve (HRR) affect outcome in heart failure (HF). They can be simultaneously measured during dipyridamole stress echocardiography (DSE). Aim: To assess the value of comprehensive DSE in patients with non-ischemic HF. Methods: We evaluated 610 patients with HF, no history of coronary artery disease, and no inducible regional wall motion abnormalities: 270 patients with preserved ejection fraction (≥50%), 146 patients with mid-range ejection fraction (40–49%), and 194 patients with reduced ejection fraction (<40%). All underwent DSE (0.84 mg/kg in 6′) in 7 accredited laboratories. We measured LVCR (abnormal value ≤ 1.1), CFVR in left anterior descending artery (abnormal value: ≤2.0), and HRR (peak/rest heart rate; abnormal value: ≤1.22). All patients were followed up. Results: Abnormal CFVR, LVCR, and HRR occurred in 29%, 45%, and 47% of patients, respectively (p < 0.001). After a median follow-up time of 20 months (interquartile range: 12–32 months), 113 hard events occurred in 105 patients with 41 deaths, 8 myocardial infarctions, 61 admissions for acute HF, and 3 strokes. The annual mortality rates were 0.8% in 200 patients with none abnormal criteria, 1.8% in 184 patients with 1 abnormal criterion, 7.1% in 130 patients with 2 abnormal criteria, 7.5% in 96 patients with 3 abnormal criteria. Conclusions: Abnormal LVCR, CFVR, and HRR were frequent during DSE in non-ischemic HF patients. They target different pathophysiological vulnerabilities (myocardial function, coronary microcirculation, and cardiac autonomic balance) and are useful for outcome prediction. Full article

(This article belongs to the Special Issue Imaging Research in Cardiovascular Diseases)

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11 pages, 1782 KiB

Open AccessFeature PaperArticle

Imaging Quality Control, Methodology Harmonization and Clinical Data Management in Stress Echo 2030

by Ylenia Bartolacelli, Andrea Barbieri, Francesco Antonini-Canterin, Mauro Pepi, Ines Paola Monte, Giuseppe Trocino, Agata Barchitta, Alberto Cresti, Sofia Miceli, Licia Petrella, Frank Benedetto, Concetta Zito, Giovanni Benfari, Francesca Bursi, Alessandro Malagoli, Francesca Mantovani, Quirino Ciampi, Angela Zagatina, Eszter Dalma Palinkas, Attila Palinkas, Szilvia Rostasne Toth, Karina Wierzbowska-Drabik, Ana Djordievic-Dikic, Patricia A. Pellikka, Eugenio Picano and on behalf of the Stress Echo 2030 Study Group of the Italian Society of Echocardiography and Cardiovascular Imaging Show full author list Hide full author list

J. Clin. Med. 2021, 10(14), 3020; https://doi.org/10.3390/jcm10143020 - 07 Jul 2021

Cited by 1 | Viewed by 2414

Abstract

Stress echo (SE) 2030 study is an international, prospective, multicenter cohort study that will include >10,000 patients from ≥20 centers from ≥10 countries. It represents the logical and chronological continuation of the SE 2020 study, which developed, validated, and disseminated the “ABCDE protocol” of SE, more suitable than conventional SE to describe the complex vulnerabilities of the contemporary patient within and beyond coronary artery disease. SE2030 was started with a recruitment plan from 2021 to 2025 (and follow-up to 2030) with 12 subprojects (ranging from coronary artery disease to valvular and post-COVID-19 patients). With these features, the study poses particular challenges on quality control assurance, methodological harmonization, and data management. One of the significant upgrades of SE2030 compared to SE2020 was developing and implementing a Research Electronic Data Capture (REDCap)-based infrastructure for interactive and entirely web-based data management to integrate and optimize reproducible clinical research data. The purposes of our paper were: first, to describe the methodology used for quality control of imaging data, and second, to present the informatic infrastructure developed on RedCap platform for data entry, storage, and management in a large-scale multicenter study. Full article

(This article belongs to the Special Issue Imaging Research in Cardiovascular Diseases)

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14 pages, 1204 KiB

Open AccessArticle

Hemodynamic Heterogeneity of Reduced Cardiac Reserve Unmasked by Volumetric Exercise Echocardiography

by Tonino Bombardini, Angela Zagatina, Quirino Ciampi, Rosina Arbucci, Pablo Martin Merlo, Diego M. Lowenstein Haber, Doralisa Morrone, Antonello D'Andrea, Ana Djordjevic-Dikic, Branko Beleslin, Milorad Tesic, Nikola Boskovic, Vojislav Giga, José Luis de Castro e Silva Pretto, Clarissa Borguezan Daros, Miguel Amor, Hugo Mosto, Michael Salamè, Ines Monte, Rodolfo Citro, Iana Simova, Martina Samardjieva, Karina Wierzbowska-Drabik, Jaroslaw D. Kasprzak, Nicola Gaibazzi, Lauro Cortigiani, Maria Chiara Scali, Mauro Pepi, Francesco Antonini-Canterin, Marco A. R. Torres, Michele De Nes, Miodrag Ostojic, Clara Carpeggiani, Tamara Kovačević-Preradović, Jorge Lowenstein, Adelaide M. Arruda-Olson, Patricia A. Pellikka, Eugenio Picano and on behalf of the Stress Echo 2020 Study Group of the Italian Society of Cardiovascular Imaging Show full author list Hide full author list

J. Clin. Med. 2021, 10(13), 2906; https://doi.org/10.3390/jcm10132906 - 29 Jun 2021

Cited by 5 | Viewed by 2305

Abstract

Background: Two-dimensional volumetric exercise stress echocardiography (ESE) provides an integrated view of left ventricular (LV) preload reserve through end-diastolic volume (EDV) and LV contractile reserve (LVCR) through end-systolic volume (ESV) changes. Purpose: To assess the dependence of cardiac reserve upon LVCR, EDV, and heart rate (HR) during ESE. Methods: We prospectively performed semi-supine bicycle or treadmill ESE in 1344 patients (age 59.8 ± 11.4 years; ejection fraction = 63 ± 8%) referred for known or suspected coronary artery disease. All patients had negative ESE by wall motion criteria. EDV and ESV were measured by biplane Simpson rule with 2-dimensional echocardiography. Cardiac index reserve was identified by peak-rest value. LVCR was the stress-rest ratio of force (systolic blood pressure by cuff sphygmomanometer/ESV, abnormal values ≤2.0). Preload reserve was defined by an increase in EDV. Cardiac index was calculated as stroke volume index * HR (by EKG). HR reserve (stress/rest ratio) <1.85 identified chronotropic incompetence. Results: Of the 1344 patients, 448 were in the lowest tertile of cardiac index reserve with stress. Of them, 303 (67.6%) achieved HR reserve <1.85; 252 (56.3%) had an abnormal LVCR and 341 (76.1%) a reduction of preload reserve, with 446 patients (99.6%) showing ≥1 abnormality. At binary logistic regression analysis, reduced preload reserve (odds ratio [OR]: 5.610; 95% confidence intervals [CI]: 4.025 to 7.821), chronotropic incompetence (OR: 3.923, 95% CI: 2.915 to 5.279), and abnormal LVCR (OR: 1.579; 95% CI: 1.105 to 2.259) were independently associated with lowest tertile of cardiac index reserve at peak stress. Conclusions: Heart rate assessment and volumetric echocardiography during ESE identify the heterogeneity of hemodynamic phenotypes of impaired chronotropic, preload or LVCR underlying a reduced cardiac reserve. Full article

(This article belongs to the Special Issue Imaging Research in Cardiovascular Diseases)

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11 pages, 736 KiB

Open AccessArticle

Prognostic Value of Reduced Heart Rate Reserve during Exercise in Hypertrophic Cardiomyopathy

by Quirino Ciampi, Iacopo Olivotto, Jesus Peteiro, Maria Grazia D’Alfonso, Fabio Mori, Luigi Tassetti, Alessandra Milazzo, Lorenzo Monserrat, Xusto Fernandez, Attila Pálinkás, Eszter Dalma Pálinkás, Róbert Sepp, Federica Re, Lauro Cortigiani, Milorad Tesic, Ana Djordjevic-Dikic, Branko Beleslin, Mariangela Losi, Grazia Canciello, Sandro Betocchi, Luis Rocha Lopes, Ines Cruz, Carlos Cotrim, Marco A. R. Torres, Clarissa C. A. Bellagamba, Caroline M. Van De Heyning, Albert Varga, Gergely Ágoston, Bruno Villari, Valentina Lorenzoni, Clara Carpeggiani, Eugenio Picano and the Stress Echo 2020 Study Group on behalf of the Italian Society of Echocardiography and Cardiovascular Imaging (SIECVI) Show full author list Hide full author list

J. Clin. Med. 2021, 10(7), 1347; https://doi.org/10.3390/jcm10071347 - 24 Mar 2021

Cited by 5 | Viewed by 2301

Abstract

Background: Sympathetic dysfunction can be evaluated by heart rate reserve (HRR) with exercise test. Objectives: To determine the value of HRR in predicting outcome of patients with hypertrophic cardiomyopathy (HCM). Methods: We enrolled 917 HCM patients (age = 49 ± 15 years, 516 men) assessed with exercise stress echocardiography (ESE) in 11 centres. ESE modality was semi-supine bicycle in 51 patients (6%), upright bicycle in 476 (52%), and treadmill in 390 (42%). During ESE, we assessed left ventricular outflow tract obstruction (LVOTO), stress-induced new regional wall motion abnormalities (RWMA), and HRR (peak/rest heart rate, HR). By selection, all patients completed the follow-up. Mortality was the predetermined outcome measure Results: During ESE, RWMA occurred in 22 patients (2.4%) and LVOTO (≥50 mmHg) in 281 (30.4%). HRR was 1.90 ± 0.40 (lowest quartile ≤ 1.61, highest quartile > 2.13). Higher resting heart rate (odds ratio 1.027, 95% CI: 1.018–1.036, p < 0.001), older age (odds ratio 1.021, 95% CI: 1.009–1.033, p < 0.001), lower exercise tolerance (mets, odds ratio 0.761, 95% CI: 0.708–0.817, p < 0.001) and resting LVOTO (odds ratio 1.504, 95% CI: 1.043–2.170, p = 0.029) predicted a reduced HRR. During a median follow-up of 89 months (interquartile range: 36–145 months), 90 all-cause deaths occurred. At multivariable analysis, lowest quartile HRR (Hazard ratio 2.354, 95% CI 1.116–4.968 p = 0.025) and RWMA (Hazard ratio 3.279, 95% CI 1.441–7.461 p = 0.004) independently predicted death, in addition to age (Hazard ratio 1.064, 95% CI 1.043–1.085 p < 0.001) and maximal wall thickness (Hazard ratio 1.081, 95% CI 1.037–1.128, p < 0.001). Conclusions: A blunted HRR during ESE predicts survival independently of RWMA in HCM patients. Full article

(This article belongs to the Special Issue Imaging Research in Cardiovascular Diseases)

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Review

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15 pages, 1049 KiB

Open AccessReview

Radiation-Induced Heart Disease

by Juan A. Quintero-Martinez, Sandra N. Cordova-Madera and Hector R. Villarraga

J. Clin. Med. 2022, 11(1), 146; https://doi.org/10.3390/jcm11010146 - 28 Dec 2021

Cited by 19 | Viewed by 3397

Abstract

Cancer incidence and survivorship have had a rising tendency over the last two decades due to better treatment modalities. One of these is radiation therapy (RT), which is used in 20–55% of cancer patients, and its basic principle consists of inhibiting proliferation or inducing apoptosis of cancer cells. Classically, photon beam RT has been the mainstay therapy for these patients, but, in the last decade, proton beam has been introduced as a new option. This newer method focuses more on the tumor and affects less of the surrounding normal tissue, i.e., the heart. Radiation to the heart is a common complication of RT, especially in patients with lymphoma, breast, lung, and esophageal cancer. The pathophysiology is due to changes in the microvascular and macrovascular milieu that can promote accelerated atherosclerosis and/or induce fibrosis of the myocardium, pericardium, and valves. These complications occur days, weeks, or years after RT and the risk factors associated are high radiation doses (>30 Gy), concomitant chemotherapy (primarily anthracyclines), age, history of heart disease, and the presence of cardiovascular risk factors. The understanding of these mechanisms and risk factors by physicians can lead to a tailored assessment and monitorization of these patients with the objective of early detection or prevention of radiation-induced heart disease. Echocardiography is a noninvasive method which provides a comprehensive evaluation of the pericardium, valves, myocardium, and coronaries, making it the first imaging tool in most cases; however, other modalities, such as computed tomography, nuclear medicine, or cardiac magnetic resonance, can provide additional value. Full article

(This article belongs to the Special Issue Imaging Research in Cardiovascular Diseases)

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