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Caprio MV, De Donno F, Bisaccia G, Mantini C, Di Baldassarre A, Gallina S, Khanji MY, Ricci F. Moderate aortic stenosis: Navigating the uncharted. Echocardiography 2024; 41:e15859. [PMID: 38853624 DOI: 10.1111/echo.15859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 05/18/2024] [Accepted: 05/25/2024] [Indexed: 06/11/2024] Open
Abstract
Aortic stenosis (AS) stands as the most common valvular heart disease in developed countries and is characterized by progressive narrowing of the aortic valve orifice resulting in elevated transvalvular flow resistance, left ventricular hypertrophy, and progressive increased risk of heart failure and sudden death. This narrative review explores clinical challenges and evolving perspectives in moderate AS, where discrepancies between aortic valve area and pressure gradient measurements may pose diagnostic and therapeutic quandaries. Transthoracic echocardiography is the first-line imaging modality for AS evaluation, yet cases of discordance may require the application of ancillary noninvasive diagnostic modalities. This review underscores the importance of accurate grading of AS severity, especially in low-gradient phenotypes, emphasizing the need for vigilant follow-up. Current clinical guidelines primarily recommend aortic valve replacement for severe AS, potentially overlooking latent risks in moderate disease stages. The noninvasive multimodality imaging approach-including echocardiography, cardiac magnetic resonance, computed tomography, and nuclear techniques-provides unique insights into adaptive and maladaptive cardiac remodeling in AS and offers a promising avenue to deliver precise indications and exact timing for intervention in moderate AS phenotypes and asymptomatic patients, potentially improving long-term outcomes. Nevertheless, what we may have gleaned from a large amount of observational data is still insufficient to build a robust framework for clinical decision-making in moderate AS. Future research will prioritize randomized clinical trials designed to weigh the benefits and risks of preemptive aortic valve replacement in the management of moderate AS, as directed by specific imaging and nonimaging biomarkers.
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Affiliation(s)
- Maria Vittoria Caprio
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
- SS Annunziata Polyclinic University Hospital, University Cardiology Division, Chieti, Italy
| | - Federica De Donno
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
- SS Annunziata Polyclinic University Hospital, University Cardiology Division, Chieti, Italy
| | - Giandomenico Bisaccia
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Cesare Mantini
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Angela Di Baldassarre
- Department of Medicine and Aging Sciences, and Reprogramming and Cell Differentiation Lab, Center for Advanced Studies and Technology (CAST), G. D'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Sabina Gallina
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
- SS Annunziata Polyclinic University Hospital, University Cardiology Division, Chieti, Italy
| | - Mohammed Y Khanji
- Newham University Hospital, Barts Health NHS Trust, Plaistow, London, UK
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, UK
- NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University, London, UK
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
- SS Annunziata Polyclinic University Hospital, University Cardiology Division, Chieti, Italy
- Department of Clinical Sciences, Lund University, Malmö, Sweden
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2
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Pang L, Colantonio MA, Arvon J, Raybuck B, Balla S. Case report: unravelling the puzzle of unicuspid aortic valve with multimodality imaging. Eur Heart J Case Rep 2024; 8:ytae269. [PMID: 38895171 PMCID: PMC11184979 DOI: 10.1093/ehjcr/ytae269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 05/15/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024]
Abstract
Background Unicuspid aortic valve (UAV) represents a rare congenital anomaly characterized by two subtypes: acommissural unicuspid aortic valve and unicommissural unicuspid aortic valve. Acommissural UAV is often diagnosed and corrected during the neonatal period due to haemodynamic instability. Unicommissural UAV leads to aortic stenosis (AS) in early adulthood. The diagnostic challenge associated with UAV primarily stems from its eccentric orifice opening and valvular calcification, resulting in difficult visualization of the commissures and localization of the orifice plane. This case report aims to demonstrate the unique morphological features of UAV through a comprehensive analysis using multimodality imaging. Case summary A 61-year-old woman presented to the emergency department for recurrent episodes of dyspnoea. Severe AS was diagnosed on transthoracic echocardiography (TTE) by Doppler haemodynamic measurement. However, follow-up transesophageal echocardiography (TEE) and CT transcatheter aortic valve replacement showed moderate AS by planimetry. Following this, patient was monitored closely, but her dyspnoea kept worsening. Cardiovascular magnetic resonance (CMR) was performed due to persistent dyspnoea, identifying UAV with eccentric loophole orifice with unicommissural attachment and opposite free leaflet edge. The patient was managed medically. Discussion TTE is the test of choice for AS that defines valvular morphology by direct visualization and grades the severity by haemodynamic measurement. However, the accuracy of TTE can be limited by poor acoustic windows and heavy valvular calcification. TEE measures aortic valve area (AVA) by planimetry that requires accurate localization of the AV orifice plane. Similarly, it applies to multi-detector computed tomography (MDCT). While CMR is expensive and mainly available in tertiary centres, it can provide additional information when there is discordance.
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Affiliation(s)
- Li Pang
- Heart and Vascular Institute, West Virginia University, 1 Medical Center Drive, Morgantown, WV 26505, USA
| | - Mark A Colantonio
- Department of Medicine, West Virginia University, 1 Medical Center Drive, Morgantown, WV 26505, USA
| | - Jessica Arvon
- Department of Medicine, West Virginia University, 1 Medical Center Drive, Morgantown, WV 26505, USA
| | - Bryan Raybuck
- Heart and Vascular Institute, West Virginia University, 1 Medical Center Drive, Morgantown, WV 26505, USA
| | - Sudarshan Balla
- Heart and Vascular Institute, West Virginia University, 1 Medical Center Drive, Morgantown, WV 26505, USA
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Mantini C, Corradi F, Ricci F, Jensen B, Tana C, Di Mascio V, Mastrodicasa D, Bucciarelli B, Procaccini L, Saba L, Marco Tana, Cademartiri F, De Caterina R. A highly-detailed anatomical study of left atrial auricle as revealed by in-vivo computed tomography. Heliyon 2023; 9:e20575. [PMID: 37842578 PMCID: PMC10568352 DOI: 10.1016/j.heliyon.2023.e20575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 09/19/2023] [Accepted: 09/29/2023] [Indexed: 10/17/2023] Open
Abstract
The left atrial auricle (LAA) is the main source of intracardiac thrombi, which contribute significantly to the total number of stroke cases. It is also considered a major site of origin for atrial fibrillation in patients undergoing ablation procedures. The LAA is known to have a high degree of morphological variability, with shape and structure identified as important contributors to thrombus formation. A detailed understanding of LAA form, dimension, and function is crucial for radiologists, cardiologists, and cardiac surgeons. This review describes the normal anatomy of the LAA as visualized through multiple imaging techniques such as computed tomography (CT), magnetic resonance imaging (MRI), and echocardiography. Special emphasis is devoted to a discussion on how the morphological characteristics of the LAA are closely related to the likelihood of developing LAA thrombi, including insights into LAA embryology.
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Affiliation(s)
- Cesare Mantini
- Department of Neuroscience, Imaging and Clinical Sciences, “G. D'Annunzio” University, Chieti, Italy
| | | | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, “G. D'Annunzio” University, Chieti, Italy
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Bjarke Jensen
- Department of Medical Biology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centres, Amsterdam, the Netherlands
| | - Claudio Tana
- Geriatrics Clinic, SS. Annunziata Hospital of Chieti, 66100, Chieti, Italy
| | - Valeria Di Mascio
- Department of Neuroscience, Imaging and Clinical Sciences, “G. D'Annunzio” University, Chieti, Italy
| | | | - Benedetta Bucciarelli
- Department of Pediatrics, Politechnic University of Marche, G. Salesi Children's Hospital, Ancona, Italy
| | | | - Luca Saba
- Department of Radiology, University Hospital of Cagliari, Cagliari, Italy
| | - Marco Tana
- Internal Medicine Unit and Department of Vascular Medicine and Cardiovascular Ultrasound, SS. Annunziata Hospital of Chieti, Italy
| | | | - Raffaele De Caterina
- Cardiology, University of Pisa and University Cardiology Division, Pisa University Hospital, Pisa, Italy
- Fondazione Villa Serena per la Ricerca, Città Sant’Angelo-Pescara, Italy
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4
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Mantini C, Khanji MY, D'Ugo E, Olivieri M, Caputi CG, Bufano G, Mastrodicasa D, Calvo Garcia D, Rotondo D, Candeloro M, Tana C, Cademartiri F, Ionescu A, Caulo M, Gallina S, Ricci F. Aliased Flow Signal Planimetry by Cardiovascular Magnetic Resonance Imaging for Grading Aortic Stenosis Severity: A Prospective Pilot Study. Front Cardiovasc Med 2021; 8:752340. [PMID: 34733896 PMCID: PMC8558301 DOI: 10.3389/fcvm.2021.752340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/15/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives: Transthoracic echocardiography (TTE) is the standard technique for assessing aortic stenosis (AS), with effective orifice area (EOA) recommended for grading severity. EOA is operator-dependent, influenced by a number of pitfalls and requires multiple measurements introducing independent and random sources of error. We tested the diagnostic accuracy and precision of aliased orifice area planimetry (AOAcmr), a new, simple, non-invasive technique for grading of AS severity by low-VENC phase-contrast cardiovascular magnetic resonance (CMR) imaging. Methods: Twenty-two consecutive patients with mild, moderate, or severe AS and six age- and sex-matched healthy controls had TTE and CMR examinations on the same day. We performed analysis of agreement and correlation among (i) AOAcmr; (ii) geometric orifice area (GOAcmr) by direct CMR planimetry; (iii) EOAecho by TTE-continuity equation; and (iv) the "gold standard" multimodality EOA (EOAhybrid) obtained by substituting CMR LVOT area into Doppler continuity equation. Results: There was excellent pairwise positive linear correlation among AOAcmr, EOAhybrid, GOAcmr, and EOAecho (p < 0.001); AOAcmr had the highest correlation with EOAhybrid (R 2 = 0.985, p < 0.001). There was good agreement between methods, with the lowest bias (0.019) for the comparison between AOAcmr and EOAhybrid. AOAcmr yielded excellent intra- and inter-rater reliability (intraclass correlation coefficient: 0.997 and 0.998, respectively). Conclusions: Aliased orifice area planimetry by 2D phase contrast imaging is a simple, reproducible, accurate "one-stop shop" CMR method for grading AS, potentially useful when echocardiographic severity assessment is inconclusive or discordant. Larger studies are warranted to confirm and validate these promising preliminary results.
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Affiliation(s)
- Cesare Mantini
- Department of Neuroscience, Imaging and Clinical Sciences, “G. d'Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Mohammed Y. Khanji
- Newham University Hospital, Barts Health NHS Trust, London, United Kingdom
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
- National Institute for Health Research (NIHR) Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Emilia D'Ugo
- Azienda Sanitaria Locale (ASL) 2 Lanciano Vasto Chieti, Regione Abruzzo, Italy
| | - Marzia Olivieri
- Department of Neuroscience, Imaging and Clinical Sciences, “G. d'Annunzio” University of Chieti-Pescara, Chieti, Italy
| | | | - Gabriella Bufano
- Department of Neuroscience, Imaging and Clinical Sciences, “G. d'Annunzio” University of Chieti-Pescara, Chieti, Italy
| | | | - Darien Calvo Garcia
- Department of Neuroscience, Imaging and Clinical Sciences, “G. d'Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Domenico Rotondo
- Azienda Sanitaria Locale (ASL) 2 Lanciano Vasto Chieti, Regione Abruzzo, Italy
| | - Matteo Candeloro
- Department of Innovative Technologies in Medicine and Dentistry, “G. d'Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Claudio Tana
- Azienda Sanitaria Locale (ASL) 2 Lanciano Vasto Chieti, Regione Abruzzo, Italy
| | - Filippo Cademartiri
- SDN Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Naples, Italy
| | - Adrian Ionescu
- Department of Cardiology, Morriston Cardiac Regional Centre, Swansea Bay Health Board, Swansea, United Kingdom
| | - Massimo Caulo
- Department of Neuroscience, Imaging and Clinical Sciences, “G. d'Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Sabina Gallina
- Department of Neuroscience, Imaging and Clinical Sciences, “G. d'Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, “G. d'Annunzio” University of Chieti-Pescara, Chieti, Italy
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Casa di Cura Villa Serena, Città Sant'Angelo, Pescara, Italy
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Mantini C, Corradi F, Mastrodicasa D, Procaccini L, Olivieri M, Ricci F, Cademartiri F, Caulo M, De Caterina R. A highly-detailed anatomical study of normal pericardial structures as revealed by in-vivo computed tomography and magnetic resonance images and ex-vivo novel 3D reconstructions from Visible Human Server. IMAGING 2021. [DOI: 10.1556/1647.2021.00017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
AbstractThe pericardial cavity, sinuses, and recesses are frequently depicted on Computed Tomography (CT) and Magnetic Resonance (MR).We here review the normal human pericardial structures as provided by MR imaging of young, healthy subject and CT scans acquired after iatrogenic coronary dissection. We compared such radiological information with cadaveric axial and sagittal sections of the human body provided by the Visible Human Server (VHS), Ecole Polytechnique Federale de Lousanne (EPFL), Switzerland.
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Affiliation(s)
- Cesare Mantini
- Department of Neuroscience, Imaging and Clinical Sciences, “G. D’Annunzio” University, Chieti, Italy
| | | | | | - Luca Procaccini
- Department of Neuroscience, Imaging and Clinical Sciences, “G. D’Annunzio” University, Chieti, Italy
| | - Marzia Olivieri
- Department of Neuroscience, Imaging and Clinical Sciences, “G. D’Annunzio” University, Chieti, Italy
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, “G. D’Annunzio” University, Chieti, Italy
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Casa di Cura Villa Serena, Città Sant’Angelo, Pescara, Italy
| | | | - Massimo Caulo
- Department of Neuroscience, Imaging and Clinical Sciences, “G. D’Annunzio” University, Chieti, Italy
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Tana C, Mantini C, Donatiello I, Mucci L, Tana M, Ricci F, Cipollone F, Giamberardino MA. Clinical Features and Diagnosis of Cardiac Sarcoidosis. J Clin Med 2021; 10:1941. [PMID: 34062709 PMCID: PMC8124502 DOI: 10.3390/jcm10091941] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/09/2021] [Accepted: 04/13/2021] [Indexed: 12/12/2022] Open
Abstract
Cardiac sarcoidosis (CS) is an unusual, but potentially harmful, manifestation of systemic sarcoidosis (SA), a chronic disease characterized by organ involvement from noncaseating and nonnecrotizing granulomas. Lungs and intrathoracic lymph nodes are usually the sites that are most frequently affected, but no organ is spared and CS can affect a variable portion of SA patients, up to 25% from post-mortem studies. The cardiovascular involvement is usually associated with a bad prognosis and is responsible for the major cause of death and complications, particularly in African American patients. Furthermore, the diagnosis is often complicated by the occurrence of non-specific clinical manifestations, which can mimic the effect of more common heart disorders, and imaging and biopsies are the most valid approach to avoid misdiagnosis. This narrative review summarizes the main clinical features of CS and imaging findings, particularly of CMR and 18-Fluorodeoxyglucose Positron Emission Tomography (18F-FDG PET) that can give the best cost/benefit ratio in terms of the diagnostic approach. Imaging can be very useful in replacing the endomyocardial biopsy in selected cases, to avoid unnecessary, and potentially dangerous, invasive maneuvers.
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Affiliation(s)
- Claudio Tana
- COVID-19 Medicine Unit and Geriatrics Clinic, SS Annunziata Hospital of Chieti, 66100 Chieti, Italy; (F.C.); (M.A.G.)
| | - Cesare Mantini
- Department of Neuroscience, Imaging and Clinical Sciences, Institute of Radiology, “SS Annunziata” Hospital, “G. d’Annunzio” University, 66100 Chieti, Italy; (C.M.); (F.R.)
| | - Iginio Donatiello
- Internal Medicine Unit, University Hospital of Salerno, 84121 Salerno, Italy;
| | - Luciano Mucci
- Internal Medicine Unit, Hospital of Fano, Azienda Ospedaliera Ospedali Riuniti Marche, 61032 Fano, Italy;
| | - Marco Tana
- 2nd Medicine Unit and Department of Vascular Medicine and Cardiovascular Ultrasound, SS Annunziata Hospital of Chieti, 66100 Chieti, Italy;
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, Institute of Radiology, “SS Annunziata” Hospital, “G. d’Annunzio” University, 66100 Chieti, Italy; (C.M.); (F.R.)
| | - Francesco Cipollone
- COVID-19 Medicine Unit and Geriatrics Clinic, SS Annunziata Hospital of Chieti, 66100 Chieti, Italy; (F.C.); (M.A.G.)
- Department of Medicine and Science of Aging, and CAST, G D’Annunzio University of Chieti, 66100 Chieti, Italy;
| | - Maria Adele Giamberardino
- COVID-19 Medicine Unit and Geriatrics Clinic, SS Annunziata Hospital of Chieti, 66100 Chieti, Italy; (F.C.); (M.A.G.)
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Choe YH, Kim SM, Park SJ. Computed tomography and magnetic resonance imaging assessment of aortic valve stenosis: an update. PRECISION AND FUTURE MEDICINE 2020. [DOI: 10.23838/pfm.2020.00093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
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8
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Clemente A, Seitun S, Mantini C, Gentile G, Federici D, Barison A, Rossi A, Cuman M, Pizzuto A, Ait-Ali L, Bossone E, Cademartiri F, Chiappino D. Cardiac CT angiography: normal and pathological anatomical features-a narrative review. Cardiovasc Diagn Ther 2020; 10:1918-1945. [PMID: 33381435 DOI: 10.21037/cdt-20-530] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The normal and pathological anatomy of the heart and coronary arteries are nowadays widely developed topics and constitute a fundamental part of the cultural background of the radiologist. The introduction of cardiac ECG-gated synchronized CT scanners with an ever-increasing number of detectors and with increasingly high structural characteristics (increase in temporal resolution, increase in contrast resolution with dual-source, dual energy scanners) allows the virtual measurement of anatomical in vivo structures complying with heart rate with submillimetric precision permitting to clearly depict the normal anatomy and follow the pathologic temporal evolution. Accordingly to these considerations, cardiac computed tomography angiography (CCTA) asserts itself as a gold standard method for the anatomical evaluation of the heart and permits to evaluate, verify, measure and characterize structural pathological alterations of both congenital and acquired degenerative diseases. Accordingly, CCTA is increasingly used as a prognostic model capable of modifying the outcome of diseased patients in planning interventions and in the post-surgical/interventional follow-up. The profound knowledge of cardiac anatomy and function through highly detailed CCTA analysis is required to perform an efficient and optimal use in real-world clinical practice.
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Affiliation(s)
- Alberto Clemente
- Department of Radiology, CNR (National Council of Research)/Tuscany Region "Gabriele Monasterio" Foundation (FTGM), Massa, Italy
| | - Sara Seitun
- IRCCS Policlinico San Martino Hospital, Genoa, Italy
| | - Cesare Mantini
- Department of Neuroscience, Imaging and Clinical Science, Institute of Radiology, "G. d'Annunzio" University, Chieti, Italy
| | - Giovanni Gentile
- Radiology Unit, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| | - Duccio Federici
- Pediatric Cardiac Surgery, CNR (National Council of Research)/Tuscany Region "Gabriele Monasterio" Foundation (FTGM), Massa, Italy
| | - Andrea Barison
- Cardiology Division, CNR (National Council of Research)/Tuscany Region "Gabriele Monasterio" Foundation (FTGM), Pisa, Italy
| | - Andrea Rossi
- Arrhythmology Unit, Department of Invasive Cardiology, CNR (National Council of Research)/Tuscany Region "Gabriele Monasterio" Foundation (FTGM), Pisa, Italy
| | - Magdalena Cuman
- Pediatric Cardiology and GUCH Unit, CNR (National Council of Research)/Tuscany Region "Gabriele Monasterio" Foundation (FTGM), Massa, Italy
| | - Alessandra Pizzuto
- Pediatric Cardiology and GUCH Unit, CNR (National Council of Research)/Tuscany Region "Gabriele Monasterio" Foundation (FTGM), Massa, Italy
| | - Lamia Ait-Ali
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Eduardo Bossone
- Department of Cardiology, Ospedale Cardarelli, Naples, Italy
| | | | - Dante Chiappino
- Department of Radiology, CNR (National Council of Research)/Tuscany Region "Gabriele Monasterio" Foundation (FTGM), Massa, Italy
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Esposito A, Gallone G, Palmisano A, Marchitelli L, Catapano F, Francone M. The current landscape of imaging recommendations in cardiovascular clinical guidelines: toward an imaging-guided precision medicine. LA RADIOLOGIA MEDICA 2020; 125:1013-1023. [PMID: 32964326 PMCID: PMC7593299 DOI: 10.1007/s11547-020-01286-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/03/2020] [Indexed: 01/06/2023]
Abstract
The purpose of this article is to provide an overview on the role of CT scan and MRI according to selected guidelines by the European Society of Cardiology (ESC) and the American College of Cardiology/American Heart Association (ACC/AHA). ESC and ACC/AHA guidelines were systematically reviewed for recommendations to CT and MRI use in specific cardiovascular (CV) clinical categories. All recommendations were collected in a dataset, including the class of recommendation, the level of evidence (LOE), the specific imaging technique, the clinical purpose of the recommendation and the recommending Society. Among the 43 included guidelines (ESC: n = 18, ACC/AHA: n = 25), 26 (60.4%) contained recommendations for CT scan or MRI (146 recommendations: 62 for CT and 84 for MRI). Class of recommendation IIa (32.9%) was the most represented, followed by I (28.1%), IIb (24%) and III (11.9%). MRI recommendations more frequently being of higher class (I: 36.9%, IIa: 29.8%, IIb: 21.4%, III: 11.9%) as compared to CT (I: 16.1%, IIa: 37.1%, IIb: 27.4%, III: 19.4%). Most of recommendation (55.5%) were based on expert opinion (LOE C). The use of cardiac CT and cardiac MR in the risk assessment, diagnosis, therapeutic and procedural planning is in continuous development, driven by an increasing need to evolve toward an imaging-guided precision medicine, combined with cost-effectiveness and healthcare sustainability. These developments must be accompanied by an increased availability of high-performance scanners in healthcare facilities and should emphasize the need of increasing the number of radiologists fully trained in cardiac imaging.
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Affiliation(s)
- Antonio Esposito
- Experimental Imaging Center, Radiology Unit, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58, 20132, Milan, Italy
| | - Guglielmo Gallone
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Anna Palmisano
- Experimental Imaging Center, Radiology Unit, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58, 20132, Milan, Italy
| | - Livia Marchitelli
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Federica Catapano
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Marco Francone
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
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10
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Palumbo P, Cannizzaro E, Di Cesare A, Bruno F, Schicchi N, Giovagnoni A, Splendiani A, Barile A, Masciocchi C, Di Cesare E. Cardiac magnetic resonance in arrhythmogenic cardiomyopathies. Radiol Med 2020; 125:1087-1101. [PMID: 32978708 DOI: 10.1007/s11547-020-01289-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 09/08/2020] [Indexed: 12/13/2022]
Abstract
Over the past few years, the approach to the 'arrhythmic patient' has profoundly changed. An early clinical presentation of arrhythmia is often accompanied by non-specific symptoms and followed by inconclusive electrocardiographic findings. In this scenario, cardiac magnetic resonance (CMR) has been established as a clinical tool of fundamental importance for a correct prognostic stratification of the arrhythmic patient. This technique provides a high-spatial-resolution tomographic evaluation of the heart, which allows studying accurately the ventricular volumes, identifying even segmental kinetic anomalies and properly detecting diffuse or focal tissue alterations through an excellent tissue characterization, while depicting different patterns of fibrosis distribution, myocardial edema or fatty substitution. Through these capabilities, CMR has a pivotal role for the adequate management of the arrhythmic patient, allowing the identification of those phenotypic manifestations characteristic of structural heart diseases. Therefore, CMR provides valuable information to reclassify the patient within the wide spectrum of potentially arrhythmogenic heart diseases, the definition of which remains the major determinants for both an adequate treatment and a poor prognosis. The purpose of this review study was to focus on the role of CMR in the evaluation of the main cardiac clinical entities associated with arrhythmogenic phenomena and to present a brief debate on the main pathophysiological mechanisms involved in the arrhythmogenesis process.
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Affiliation(s)
- Pierpaolo Palumbo
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Vetoio 1, 67100, L'Aquila, AQ, Italy.
| | | | - Annamaria Di Cesare
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Federico Bruno
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Vetoio 1, 67100, L'Aquila, AQ, Italy
| | - Nicolò Schicchi
- Department of Radiology, Azienda Ospedaliero-Universitaria, Ospedali Riuniti Di Ancona, Ancona, Italy
| | - Andrea Giovagnoni
- Department of Radiology, Azienda Ospedaliero-Universitaria, Ospedali Riuniti Di Ancona, Ancona, Italy
| | - Alessandra Splendiani
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Vetoio 1, 67100, L'Aquila, AQ, Italy
| | - Antonio Barile
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Vetoio 1, 67100, L'Aquila, AQ, Italy
| | - Carlo Masciocchi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Vetoio 1, 67100, L'Aquila, AQ, Italy
| | - Ernesto Di Cesare
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
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11
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Bisaccia G, Ricci F, Mantini C, Tana C, Romani GL, Schiavone C, Gallina S. Nonalcoholic fatty liver disease and cardiovascular disease phenotypes. SAGE Open Med 2020; 8:2050312120933804. [PMID: 32612827 PMCID: PMC7307287 DOI: 10.1177/2050312120933804] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 05/21/2020] [Indexed: 12/12/2022] Open
Abstract
Nonalcoholic fatty liver disease is increasingly recognized as a major global health problem. Intertwined with diabetes, metabolic syndrome, and obesity, nonalcoholic fatty liver disease embraces a spectrum of liver conditions spanning from steatosis to inflammation, fibrosis, and liver failure. Compared with the general population, the prevalence of cardiovascular disease is higher among nonalcoholic fatty liver disease patients, in whom comprehensive cardiovascular risk assessment is highly desirable. Preclinical effects of nonalcoholic fatty liver disease on the heart include both metabolic and structural changes eventually preceding overt myocardial dysfunction. Particularly, nonalcoholic fatty liver disease is associated with enhanced atherosclerosis, heart muscle disease, valvular heart disease, and arrhythmias, with endothelial dysfunction, inflammation, metabolic dysregulation, and oxidative stress playing in the background. In this topical review, we aimed to summarize current evidence on the epidemiology of nonalcoholic fatty liver disease, discuss the pathophysiological links between nonalcoholic fatty liver disease and cardiovascular disease, illustrate nonalcoholic fatty liver disease-related cardiovascular phenotypes, and finally provide a glimpse on the relationship between nonalcoholic fatty liver disease and cardiac steatosis, mitochondrial (dys)function, and cardiovascular autonomic dysfunction.
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Affiliation(s)
- Giandomenico Bisaccia
- Department of Neuroscience, Imaging and Clinical Sciences, Institute for Advanced Biomedical Technologies, "G. d'Annunzio" University of Chieti and Pescara, Chieti, Italy
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, Institute for Advanced Biomedical Technologies, "G. d'Annunzio" University of Chieti and Pescara, Chieti, Italy.,Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Cesare Mantini
- Department of Neuroscience, Imaging and Clinical Sciences, Institute for Advanced Biomedical Technologies, "G. d'Annunzio" University of Chieti and Pescara, Chieti, Italy
| | - Claudio Tana
- Internal Medicine and Critical Subacute Care Unit, Medicine Geriatric-Rehabilitation Department, and Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Gian Luca Romani
- Department of Neuroscience, Imaging and Clinical Sciences, Institute for Advanced Biomedical Technologies, "G. d'Annunzio" University of Chieti and Pescara, Chieti, Italy
| | - Cosima Schiavone
- Department of Internistic Ultrasound, "G. d'Annunzio" University of Chieti and Pescara, Chieti, Italy
| | - Sabina Gallina
- Department of Neuroscience, Imaging and Clinical Sciences, Institute for Advanced Biomedical Technologies, "G. d'Annunzio" University of Chieti and Pescara, Chieti, Italy
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12
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Repanas TI, Papanastasiou CA, Efthimiadis GK, Fragkakis N, Sachpekidis V, Klein RM, Karvounis H, Karamitsos TD. Cardiovascular magnetic resonance as a complementary method to transthoracic echocardiography for aortic valve area estimation in patients with aortic stenosis: A systematic review and meta-analysis. Hellenic J Cardiol 2020; 62:107-111. [PMID: 32535246 DOI: 10.1016/j.hjc.2020.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 05/20/2020] [Accepted: 05/26/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Aortic stenosis (AS) is the most common valvular heart disease. While two-dimensional transthoracic echocardiography (2D-TTE) is the standard imaging modality for AS assessment, cardiac magnetic resonance (CMR) offers a reliable and reproducible alternative. The aim of this study was to compare AVA measurements as determined by TTE and CMR in patients with AS. METHODS Electronic databases were searched to identify studies comparing TTE continuity equation to CMR planimetry for AVA assessment. A meta-analysis of mean difference was conducted by using the random effects model. Sensitivity analysis was performed after excluding studies reporting AVA indexed to body surface area (BSA). Heterogeneity was assessed with I2. RESULTS A total of 12 studies, encompassing 621 patients, were included in our systematic review. In the pooled analysis, measurements of AVA by CMR planimetry were found to be significantly higher than those calculated by the continuity equation in TTE (pooled mean difference: 0.09, 95% confidence intervals (CI): 0.01, 0.17, and I2: 93%). The results remained significant, albeit with moderate heterogeneity this time, after excluding the analysis measurements of AVA indexed to BSA (pooled mean difference: 0.08, 95% CI: 0.03 to 0.13, and I2 = 61%). CONCLUSIONS CMR planimetry slightly overestimates AVA compared to TTE continuity equation. Although, 2D-TTE should be the primary imaging modality for the estimation of AVA, CMR may be useful when there is discrepancy with the clinical assessment or when TTE results are discordant or difficult to obtain.
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Affiliation(s)
- Theodoros I Repanas
- Department of Cardiology, Augusta Hospital Düsseldorf, Academic Teaching Hospital of the University Faculty of Health, Düsseldorf, Germany
| | - Christos A Papanastasiou
- 1st Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios K Efthimiadis
- 1st Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Fragkakis
- 3rd Department of Cardiology, Hippokration University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Rolf Michael Klein
- Department of Cardiology, Augusta Hospital Düsseldorf, Academic Teaching Hospital of the University Faculty of Health, Düsseldorf, Germany
| | - Haralambos Karvounis
- 1st Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Theodoros D Karamitsos
- 1st Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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13
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Coronary artery disease (CAD) extension-derived risk stratification for asymptomatic diabetic patients: usefulness of low-dose coronary computed tomography angiography (CCTA) in detecting high-risk profile patients. Radiol Med 2020; 125:1249-1259. [PMID: 32367320 DOI: 10.1007/s11547-020-01204-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 04/16/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND As one of the most frequent risk factors for cardiovascular disease, type 2 diabetes mellitus (T2DM) is one of the largest causes of death. However, an acute cardiac presentation is not uncommon in diabetic patients, and the current investigative approach remains often inadequate. The aim of our study was to retrospectively stratify the risk of asymptomatic T2DM patients using low-dose 640-slice coronary computed tomography angiography (CCTA). MATERIALS AND METHODS CCTA examinations of 62 patients (mean age, 65 years) with previous diagnosis of type 2 diabetes and without cardiac symptoms were analyzed. Image acquisition was performed using a 640-slice CT. Per-patient, per-vessel and per-plaque analyses were performed. Stratification risk was evaluated according to the ESC guidelines. The patients were followed up after 2.21 ± 0.56 years from CCTA examination. RESULTS Coronary artery disease (CAD) was found in 58 patients (93.55%) presenting 290 plaques. Analysis of all samples showed severe-to-occlusive atherosclerosis in 24 patients (38.7% of cases). However, over the degree of stenosis, 23 patients were evaluated at high risk considering the extension of CAD. Good agreement was shown by the correlation of CAD extension/risk estimation and MACE incidence, according to a Kaplan-Meier survival analysis (p value = 0.001), with a 7.25-fold increased risk (HR 7.25 CI 2.13-24.7; p value = 0.002). CONCLUSION Our study confirms the high capability of CCTA to properly stratify the CV risk of asymptomatic T2DM patients. Its use could be recommended if we consider how current investigative strategies to correctly assess these patients often seem inadequate.
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15
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Third generation dual source CT with ultra-high pitch protocol for TAVI planning and coronary tree assessment: feasibility, image quality and diagnostic performance. Eur J Radiol 2020; 122:108749. [DOI: 10.1016/j.ejrad.2019.108749] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 11/07/2019] [Accepted: 11/12/2019] [Indexed: 01/14/2023]
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16
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De Rubeis G, Galea N, Ceravolo I, Dacquino GM, Carbone I, Catalano C, Francone M. Aortic valvular imaging with cardiovascular magnetic resonance: seeking for comprehensiveness. Br J Radiol 2019; 92:20170868. [PMID: 30277407 PMCID: PMC6732913 DOI: 10.1259/bjr.20170868] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 09/05/2018] [Accepted: 09/23/2018] [Indexed: 12/18/2022] Open
Abstract
Cardiovascular magnetic resonance (CMR) has an emerging role in aortic valve disease evaluation, becoming an all-in-one technique. CMR evaluation of the anatomy and flow through the aortic valve has a higher reproducibility than echocardiography. Its unique ability of in vivo myocardial tissue characterization, significantly improves the risk stratification and management of patients. In addition, CMR is equivalent to cardiac CT angiography for trans-aortic valvular implantation and surgical aortic valve replacement planning; on the other hand, its role in the evaluation of ventricular function improving and post-treatment complications is undisputed. This review encompasses the existing literature regarding the role of CMR in aortic valve disease, exploring all the aspects of the disease, from diagnosis to prognosis.
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Affiliation(s)
- Gianluca De Rubeis
- Department of Radiological, Oncological and Pathological Sciences,"Sapienza” University of Rome, Rome, Italy
| | | | - Isabella Ceravolo
- Department of Radiological, Oncological and Pathological Sciences,"Sapienza” University of Rome, Rome, Italy
| | - Gian Marco Dacquino
- Department of Radiological, Oncological and Pathological Sciences,"Sapienza” University of Rome, Rome, Italy
| | - Iacopo Carbone
- Department of Radiological, Oncological and Pathological Sciences,"Sapienza” University of Rome, Rome, Italy
| | - Carlo Catalano
- Department of Radiological, Oncological and Pathological Sciences,"Sapienza” University of Rome, Rome, Italy
| | - Marco Francone
- Department of Radiological, Oncological and Pathological Sciences,"Sapienza” University of Rome, Rome, Italy
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Ghorayeb N, Stein R, Daher DJ, Silveira ADD, Ritt LEF, Santos DFPD, Sierra APR, Herdy AH, Araújo CGSD, Colombo CSSDS, Kopiler DA, Lacerda FFRD, Lazzoli JK, Matos LDNJD, Leitão MB, Francisco RC, Alô ROB, Timerman S, Carvalho TD, Garcia TG. The Brazilian Society of Cardiology and Brazilian Society of Exercise and Sports Medicine Updated Guidelines for Sports and Exercise Cardiology - 2019. Arq Bras Cardiol 2019; 112:326-368. [PMID: 30916199 PMCID: PMC6424031 DOI: 10.5935/abc.20190048] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Nabil Ghorayeb
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brazil
- Hospital do Coração (HCor), Associação do Sanatório Sírio, São Paulo, SP - Brazil
- Programa de Pós-Graduação em Medicina do Esporte da Universidade Federal de São Paulo (UNIFESP), São Paulo, SP - Brazil
- Instituto de Assistência Médica ao Servidor Público Estadual (IAMSPE), São Paulo, SP - Brazil
| | - Ricardo Stein
- Programa de Pós-Graduação em Cardiologia e Ciências Cardiovasculares da Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brazil
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (HCPA/UFRGS), Porto Alegre, RS - Brazil
- Vitta Centro de Bem Estar Físico, Porto Alegre, RS - Brazil
| | - Daniel Jogaib Daher
- Hospital do Coração (HCor), Associação do Sanatório Sírio, São Paulo, SP - Brazil
| | - Anderson Donelli da Silveira
- Programa de Pós-Graduação em Cardiologia e Ciências Cardiovasculares da Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brazil
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (HCPA/UFRGS), Porto Alegre, RS - Brazil
- Vitta Centro de Bem Estar Físico, Porto Alegre, RS - Brazil
| | - Luiz Eduardo Fonteles Ritt
- Hospital Cárdio Pulmonar, Salvador, BA - Brazil
- Escola Bahiana de Medicina e Saúde Pública, Salvador, BA - Brazil
| | | | | | - Artur Haddad Herdy
- Instituto de Cardiologia de Santa Catarina, Florianópolis, SC - Brazil
- Clínica Cardiosport de Prevenção e Reabilitação, Florianópolis, SC - Brazil
| | | | - Cléa Simone Sabino de Souza Colombo
- Hospital do Coração (HCor), Associação do Sanatório Sírio, São Paulo, SP - Brazil
- Sports Cardiology, Cardiology Clinical Academic Group - St George's University of London,14 London - UK
| | - Daniel Arkader Kopiler
- Sociedade Brasileira de Medicina do Esporte e do Exercício (SBMEE), São Paulo, SP - Brazil
- Instituto Nacional de Cardiologia (INC), Rio de Janeiro, RJ - Brazil
| | - Filipe Ferrari Ribeiro de Lacerda
- Programa de Pós-Graduação em Cardiologia e Ciências Cardiovasculares da Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brazil
| | - José Kawazoe Lazzoli
- Sociedade Brasileira de Medicina do Esporte e do Exercício (SBMEE), São Paulo, SP - Brazil
- Federação Internacional de Medicina do Esporte (FIMS), Lausanne - Switzerland
| | | | - Marcelo Bichels Leitão
- Sociedade Brasileira de Medicina do Esporte e do Exercício (SBMEE), São Paulo, SP - Brazil
| | - Ricardo Contesini Francisco
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brazil
- Hospital do Coração (HCor), Associação do Sanatório Sírio, São Paulo, SP - Brazil
| | - Rodrigo Otávio Bougleux Alô
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brazil
- Hospital Geral de São Mateus, São Paulo, SP - Brazil
| | - Sérgio Timerman
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (InCor-FMUSP), São Paulo, SP - Brazil
- Universidade Anhembi Morumbi, Laureate International Universities, São Paulo, SP - Brazil
| | - Tales de Carvalho
- Clínica Cardiosport de Prevenção e Reabilitação, Florianópolis, SC - Brazil
- Departamento de Ergometria e Reabilitação Cardiovascular da Sociedade Brasileira de Cardiologia (DERC/SBC), Rio de Janeiro, RJ - Brazil
- Universidade do Estado de Santa Catarina (UDESC), Florianópolis, SC - Brazil
| | - Thiago Ghorayeb Garcia
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brazil
- Hospital do Coração (HCor), Associação do Sanatório Sírio, São Paulo, SP - Brazil
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