1
|
D’Andrea A, Carbone A, Radmilovic J, Russo V, Fabiani D, Maio MD, Ilardi F, Giallauria F, Caputo A, Cirillo T, Bossone E, Picano E. Myocardial Work Efficiency in Physiologic Left Ventricular Hypertrophy of Power Athletes. J Cardiovasc Echogr 2022; 32:154-159. [PMID: 36619770 PMCID: PMC9819612 DOI: 10.4103/jcecho.jcecho_11_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 05/22/2022] [Accepted: 07/12/2022] [Indexed: 01/10/2023] Open
Abstract
Aims The athlete's heart in power training is characterized by physiologic concentric remodeling. Our aim was to analyze left ventricular (LV) myocardial deformation and contractile reserve (CR) in top-level power athletes (PA) at rest and during exercise and their possible correlations with functional capacity. Methods Standard echo, lung ultrasound, and LV 2D speckle-tracking strain were performed at rest and during exercise in PA and in age- and sex-comparable healthy controls. Results 250 PA (male: 62%; 33.6 ± 4.8 years) and 180 age- and sex-comparable healthy controls were enrolled. LV ejection fraction (EF) at baseline was comparable between the two groups, while LV global longitudinal strain (GLS) was reduced in PA (GLS: -17.8 ± 2.4 in PA vs. -21.9 ± 3.8 in controls; P < 0.01). Conversely, myocardial work efficiency (MWE) did not show significant difference between the two groups (94.4 ± 3.2 in PA vs. 95.9 ± 4.6% in controls; P NS). At peak exertion during exercise stress echocardiography (ESE), PA showed better exercise capacity and peak VO2 consumption (51.6 ± 10.2 in EA vs. 39.8 ± 8.2 mL/Kg/min in controls, P < 0.0001), associated with augmented pulmonary artery systolic pressure (PASP). By multivariable analysis, MWE at rest was the most predictive factor of maximal watts (P < 0.0001), peak VO2, (P < 0.0001), PASP (P < 0.001), and number of B-lines (P < 0.001), all measured at peak effort. Conclusions In power athletes, MWE showed less load dependency than GLS. Normal resting values of MWE in PA suggest a physiological LV remodeling, associated with a better exercise capacity and preserved CR during physical stress.
Collapse
Affiliation(s)
- Antonello D’Andrea
- Department of Cardiology, Unit of Cardiology and Intensive Coronary Care, “Umberto I” Hospital, Nocera Inferiore, Naples, Italy
- Department of Traslational Medical Sciences, Unit of Cardiology, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, Naples, Italy
| | - Andreina Carbone
- Department of Traslational Medical Sciences, Unit of Cardiology, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, Naples, Italy
| | - Juri Radmilovic
- Department of Cardiology, Unit of Cardiology and Intensive Coronary Care, “Umberto I” Hospital, Nocera Inferiore, Naples, Italy
| | - Vincenzo Russo
- Department of Traslational Medical Sciences, Unit of Cardiology, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, Naples, Italy
| | - Dario Fabiani
- Department of Traslational Medical Sciences, Unit of Cardiology, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, Naples, Italy
| | - Marco Di Maio
- Department of Cardiology, Unit of Cardiology, “Hospital, Eboli (ASL Salerno), Salerno, Italy
| | - Federica Ilardi
- Department of Cardiology, University of Naples Federico II, Naples, Italy
| | - Francesco Giallauria
- Department of Internal Medicine, University of Naples Federico II, Naples, Italy
| | - Adriano Caputo
- Department of Traslational Medical Sciences, Unit of Cardiology, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, Naples, Italy
| | - Teresa Cirillo
- Department of Cardiology, Unit of Cardiology and Intensive Coronary Care, “Umberto I” Hospital, Nocera Inferiore, Naples, Italy
| | - Eduardo Bossone
- Department of Cardiology, UOC Cardiologia Riabilitativa, Cardarelli Hospital, Naples, Italy
| | - Eugenio Picano
- Department of Cardiology, Institute of Clinical Physiology, CNR, Pisa, Italy
| |
Collapse
|
2
|
Tagliamonte E, Sperlongano S, Montuori C, Riegler L, Scarafile R, Carbone A, Iodice F, Gioia R, Di Vilio A, Serio A, Radmilovic J, Ricciardi S, D"andrea A. Microvascular coronary dysfunction affects global longitudinal strain after stress echocardiography. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
BACKGROUND. Coronary microvascular dysfunction (CMD) is a potential cause of myocardial ischemia and may affect myocardial function at rest and during stress. CMD can be identified, in patients with non-obstructive coronary artery disease (CAD), by a reduced transthoracic Doppler-derived coronary flow reserve (CFR), which is an index of coronary arterial reactivity, and can be impaired in both obstructive CAD and CMD.
The aim of this study was to investigate the dipyridamole-induced changes of left ventricular (LV) global longitudinal strain (GLS) in patients with CMD.
METHODS. 59 patients (39% women, mean age 65.6 ± 6.1 years) with history of chest pain and without obstructive coronary artery disease (CAD) underwent dipyridamole stress echocardiography. Coronary flow was assessed in the left anterior descending coronary artery. Coronary flow reserve (CFR) was determined as the ratio of hyperaemic to baseline diastolic coronary flow velocity. CMD was defined as CFR < 2. GLS was measured at rest and at peak dose, using automated function imaging, through the positioning of three endocardial markers (two markers at the mitral annulus and one at the apex) in each apical view. Subsequently, the obtained segmental values of GLS were visualized as a bull’s-eye map in a quick and feasible manner. We had optimal left ventricular endocardial tracking in the overall population.
In each patient, we used a frame rate of 70 frames/sec for adequate 2D strain analysis. We analyzed GLS at each step of stress test and compared peak-dose values with baseline.
RESULTS. Nineteen patients (32%) among the overall population showed CMD. Baseline GLS was significantly lower in patients with CMD (-16.8 ± 2.7 vs. -19.1 ± 3.1, p < 0.01). A different contractile response to dipyridamole infusion was observed between the two groups: GLS significantly increased up to peak dose in patients without CMD (from -19.1 ± 3.1 to -20.2 ± 3.1, p < 0.01), and significantly decreased in patients with CMD (from -16.8 ± 2.7 to -15.8 ± 2.7, p < 0.01). There was a significant inverse correlation between CFR and DGLS (r = -0.82, p < 0.01).
CONCLUSIONS. GLS analysis, particularly performed by comparing dipyridamole peak-dose with baseline values, shows that in patients with CMD there is a different response of LV myocardium to stress test. It could be assumed that the inverse correlation between CFR and delta GLS reflects a progressive subclinical worsening of LV myocardial function and lack of LV contractile reserve due to underlying myocardial ischemia. Larger studies could confirm our data. Abstract Figure. Abstract Figure.
Collapse
Affiliation(s)
- E Tagliamonte
- Umberto I Hospital, Department of Cardiology, Nocera Inferiore, Italy
| | - S Sperlongano
- university of Campania Luigi Vanvitelli, Department of Cardiology, Naples, Italy
| | - C Montuori
- San Giuliano Hospital, Division of Cardiology, Giugliano (Naples), Italy
| | - L Riegler
- "Umberto I" Hospital, Operative Unit of Cardiology, Nocera Inferiore, Italy
| | - R Scarafile
- "Umberto I" Hospital, Operative Unit of Cardiology, Nocera Inferiore, Italy
| | - A Carbone
- university of Campania Luigi Vanvitelli, Department of Cardiology, Naples, Italy
| | - F Iodice
- "Umberto I" Hospital, Operative Unit of Cardiology, Nocera Inferiore, Italy
| | - R Gioia
- "Umberto I" Hospital, Operative Unit of Cardiology, Nocera Inferiore, Italy
| | - A Di Vilio
- "Umberto I" Hospital, Operative Unit of Cardiology, Nocera Inferiore, Italy
| | - A Serio
- "Umberto I" Hospital, Operative Unit of Cardiology, Nocera Inferiore, Italy
| | - J Radmilovic
- "Umberto I" Hospital, Operative Unit of Cardiology, Nocera Inferiore, Italy
| | - S Ricciardi
- "Umberto I" Hospital, Operative Unit of Cardiology, Nocera Inferiore, Italy
| | - A D"andrea
- "Umberto I" Hospital, Operative Unit of Cardiology, Nocera Inferiore, Italy
| |
Collapse
|
3
|
Serio A, Iodice F, Sperlongano S, Di Vilio A, Radmilovic J, Gambardella F, Picano E, D'andrea A, Golino P, Carbone A. 799 Biventricular dysfunction and lung congestion in athletes on anabolic androgenic steroids: a speckle tracking and stress lung echocardiography analysis. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab144.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Aims
The real effects of the chronic consumption of anabolic–androgenic steroids (AAS) on cardiovascular structures are subjects of intense debate. Aim of the study was to detect by speckle tracking echocardiography (STE) right ventricular (RV) and left ventricular (LV) dysfunction at rest and during exercise stress echocardiography (ESE) in athletes abusing AAS.
Methods and results
115 top-level competitive bodybuilders were selected (70 males), including 65 athletes misusing AAS for at least 5 years (users), 50 anabolic-free bodybuilders (non-users), compared to 50 age- and sex-matched healthy sedentary controls. Standard Doppler echocardiography, STE analysis, and lung ultrasound at rest and at peak supine-bicycle ESE were performed. Athletes showed increased LV mass index, wall thickness, and RV diameters compared with controls, whereas LV ejection fraction was comparable within the groups. LA volume index, LV and RV strain, and LV E/Em were significantly higher in AAS users. Users showed more B-lines during stress (median 4.4 vs. 1.25 in controls and 1.3 in non-users, P < 0.01 vs. users). By multivariable analyses, LV E/Ea (beta coefficient = 0.35, P < 0.01), PASP (beta = 0.43, P < 0.001) at peak effort, and number of weeks of AAS use per year (beta = 0.45, P < 0.001) emerged as the only independent determinants of resting RV lateral wall peak systolic two-dimensional strain. In addition, a close association between resting RV myocardial function and VO2 peak during ESE was evidenced (P < 0.001), with a powerful incremental value with respect to clinical and standard echocardiographic data.
Conclusions
STE represents a promising technique to assess RV myocardial function in athletes abusing steroids. AAS users showed a more impaired RV deformation, closely associated with reduced functional capacity during physical effort, and—during exercise—more pulmonary congestion.
Collapse
Affiliation(s)
- Alessandro Serio
- Unit of Cardiology and Intensive Coronary Care, Umberto I Hospital, Nocera Inferiore, Italy
- University of Naples Federico II, Naples, Italy
| | - Franco Iodice
- Unit of Cardiology, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, Monaldi Hospital, Naples, Italy
| | - Simona Sperlongano
- Unit of Cardiology, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, Monaldi Hospital, Naples, Italy
| | - Alessandro Di Vilio
- Unit of Cardiology, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, Monaldi Hospital, Naples, Italy
| | - Juri Radmilovic
- Unit of Cardiology, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, Monaldi Hospital, Naples, Italy
| | | | | | - Antonello D'andrea
- Unit of Cardiology and Intensive Coronary Care, Umberto I Hospital, Nocera Inferiore, Italy
| | - Paolo Golino
- Unit of Cardiology, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, Monaldi Hospital, Naples, Italy
| | - Andreina Carbone
- Unit of Cardiology, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, Monaldi Hospital, Naples, Italy
| |
Collapse
|
4
|
D'Andrea A, Radmilovic J, Mele D, Di Giannuario G, Rizzo M, Campana M, Riegler L, Gimelli A, Khoury G, Strano S, Moreo A. [Transcranial color Doppler ultrasonography: methodology and usefulness for the study of patent foramen ovale in cryptogenic stroke]. G Ital Cardiol (Rome) 2021; 22:988-999. [PMID: 34845401 DOI: 10.1714/3698.36878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
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.
Collapse
Affiliation(s)
- Antonello D'Andrea
- U.O.C. Cardiologia/UTIC/Emodinamica, P.O. Umberto I, Nocera Inferiore (ASL Salerno), Università "Luigi Vanvitelli" della Campania
| | - Juri Radmilovic
- U.O.C. Cardiologia/UTIC/Emodinamica, P.O. Umberto I, Nocera Inferiore (ASL Salerno), Università "Luigi Vanvitelli" della Campania
| | - Donato Mele
- Dipartimento di Scienze Cardio-Toraco-Vascolari e Sanità Pubblica, Università degli Studi, Padova
| | | | | | - Marco Campana
- U.O.C. Cardiologia, Fondazione Poliambulanza, Brescia
| | - Lucia Riegler
- U.O.C. Cardiologia/UTIC/Emodinamica, P.O. Umberto I, Nocera Inferiore (ASL Salerno), Università "Luigi Vanvitelli" della Campania
| | | | | | - Stefano Strano
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari (SCIAC), Sapienza Università di Roma, Roma
| | - Antonella Moreo
- Dipartimento Cardiotoracovascolare "De Gasperis", ASST Grande Ospedale Metropolitano Niguarda, Milano
| |
Collapse
|
5
|
Palermi S, Serio A, Vecchiato M, Sirico F, Gambardella F, Ricci F, Iodice F, Radmilovic J, Russo V, D'Andrea A. Potential role of an athlete-focused echocardiogram in sports eligibility. World J Cardiol 2021; 13:271-297. [PMID: 34589165 PMCID: PMC8436685 DOI: 10.4330/wjc.v13.i8.271] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/27/2021] [Accepted: 07/14/2021] [Indexed: 02/06/2023] Open
Abstract
Sudden cardiac death (SCD) of an athlete is a rare but tragic event and sport activity might play a trigger role in athletes with underlying structural or electrical heart diseases. Preparticipation screenings (PPs) have been conceived for the potential to prevent SCD in young athletes by early identification of cardiac diseases. The European Society of Cardiology protocol for PPs includes history collection, physical examination and baseline electrocardiogram, while further examinations are reserved to individuals with abnormalities at first-line evaluation. Nevertheless, transthoracic echocardiography has been hypothesized to have a primary role in the PPs. This review aims to describe how to approach an athlete-focused echocardiogram, highlighting what is crucial to focus on for the different diseases (cardiomyopathies, valvulopathies, congenital heart disease, myocarditis and pericarditis) and when is needed to pay attention to overlap diagnostic zone ("grey zone") with the athlete's heart. Once properly tested, focused echocardiography by sports medicine physicians may become standard practice in larger screening practices, potentially available during first-line evaluation.
Collapse
Affiliation(s)
- Stefano Palermi
- Public Health Department, University of Naples Federico II, Naples 80131, Italy
| | - Alessandro Serio
- Public Health Department, University of Naples Federico II, Naples 80131, Italy
| | - Marco Vecchiato
- Sport and Exercise Medicine Division, Department of Medicine, University Hospital of Padova, Padova 35128, Italy
| | - Felice Sirico
- Public Health Department, University of Naples Federico II, Naples 80131, Italy
| | | | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti 66100, Italy
| | - Franco Iodice
- Unit of Cardiology, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples 80131, Italy
| | - Juri Radmilovic
- Unit of Cardiology and Intensive Coronary Care, "Umberto I" Hospital, Nocera Inferiore 84014, Italy
| | - Vincenzo Russo
- Unit of Cardiology, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples 80131, Italy
| | - Antonello D'Andrea
- Unit of Cardiology, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples 80131, Italy.
| |
Collapse
|
6
|
D'Andrea A, Radmilovic J, Russo V, Sperlongano S, Carbone A, Di Maio M, Ilardi F, Riegler L, D'Alto M, Giallauria F, Bossone E, Picano E. Biventricular dysfunction and lung congestion in athletes on anabolic androgenic steroids: a speckle tracking and stress lung echocardiography analysis. Eur J Prev Cardiol 2021; 28:1928-1938. [PMID: 34339497 DOI: 10.1093/eurjpc/zwab086] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/29/2021] [Accepted: 05/04/2021] [Indexed: 11/13/2022]
Abstract
AIMS The real effects of the chronic consumption of anabolic-androgenic steroids (AASs) on cardiovascular structures are subjects of intense debate. The aim of the study was to detect by speckle tracking echocardiography (STE) right ventricular (RV) and left ventricular (LV) dysfunction at rest and during exercise stress echocardiography (ESE) in athletes abusing AAS. METHODS AND RESULTS One hundred and fifteen top-level competitive bodybuilders were selected (70 males), including 65 athletes misusing AAS for at least 5 years (users), 50 anabolic-free bodybuilders (non-users), compared to 50 age- and sex-matched healthy sedentary controls. Standard Doppler echocardiography, STE analysis, and lung ultrasound at rest and at peak supine-bicycle ESE were performed. Athletes showed increased LV mass index, wall thickness, and RV diameters compared with controls, whereas LV ejection fraction was comparable within the groups. left atrial volume index, LV and RV strain, and LV E/Em were significantly higher in AAS users. Users showed more B-lines during stress (median 4.4 vs. 1.25 in controls and 1.3 in non-users, P < 0.01 vs. users). By multivariable analyses, LV E/Ea (beta coefficient = 0.35, P < 0.01), pulmonary artery systolic pressure (beta = 0.43, P < 0.001) at peak effort and number of weeks of AAS use per year (beta = 0.45, P < 0.001) emerged as the only independent determinants of resting RV lateral wall peak systolic two-dimensional strain. In addition, a close association between resting RV myocardial function and VO2 peak during ESE was evidenced (P < 0.001), with a powerful incremental value with respect to clinical and standard echocardiographic data. CONCLUSIONS In athletes abusing steroids, STE analysis showed an impaired RV systolic deformation, closely associated with reduced functional capacity during physical effort, and-during exercise-more pulmonary congestion.
Collapse
Affiliation(s)
- Antonello D'Andrea
- Unit of Cardiology, Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Via Bianchi 6, 80131, Italy.,Unit of Cardiology and Intensive Coronary Care, "Umberto I" Hospital, Nocera Inferiore, Viale S. Francesco 84014, Italy
| | - Juri Radmilovic
- Unit of Cardiology and Intensive Coronary Care, "Umberto I" Hospital, Nocera Inferiore, Viale S. Francesco 84014, Italy
| | - Vincenzo Russo
- Unit of Cardiology, Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Via Bianchi 6, 80131, Italy
| | - Simona Sperlongano
- Unit of Cardiology, Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Via Bianchi 6, 80131, Italy
| | - Andreina Carbone
- Unit of Cardiology, Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Via Bianchi 6, 80131, Italy
| | - Marco Di Maio
- Unit of Cardiology, "SS Addolorata" Hospital, Eboli (ASL Salerno), Piazza Scuola Medica Salernitana 84025, Italy
| | - Federica Ilardi
- Cardiology and Internal Medicine, University of Naples Federico II, Naples, Via Pansini 5, 80131, Italy
| | - Lucia Riegler
- Unit of Cardiology and Intensive Coronary Care, "Umberto I" Hospital, Nocera Inferiore, Viale S. Francesco 84014, Italy
| | - Michele D'Alto
- Unit of Cardiology, Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Via Bianchi 6, 80131, Italy
| | - Francesco Giallauria
- Cardiology and Internal Medicine, University of Naples Federico II, Naples, Via Pansini 5, 80131, Italy
| | - Eduardo Bossone
- UOC Cardiologia Riabilitativa, Cardarelli Hospital, Naples, Via Cardarelli 9, 80131, Italy
| | - Eugenio Picano
- Institute of Clinical Physiology, CNR, Pisa, Via G. Moruzzi, Pisa 56121, Italy
| |
Collapse
|
7
|
D'Andrea A, Radmilovic J, Carbone A, Forni A, Tagliamonte E, Riegler L, Liccardo B, Crescibene F, Sirignano C, Esposito G, Bossone E. Multimodality imaging in COVID-19 patients: A key role from diagnosis to prognosis. World J Radiol 2020; 12:261-271. [PMID: 33362917 PMCID: PMC7745467 DOI: 10.4329/wjr.v12.i11.261] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/30/2020] [Accepted: 10/19/2020] [Indexed: 02/06/2023] Open
Abstract
The integrated clinical, laboratory and ultrasound approach is essential for the diagnosis, evaluation and monitoring of the patient's therapy in coronavirus disease 2019 pneumonia. The ideal imaging approach in this context is not yet well defined. Chest X-ray is characterized by low sensitivity in identifying earlier lung changes. The "bedside" pulmonary ultrasound has an undeniable series of advantages in the patient at high infectious risk and can provide incremental data in the respiratory intensive care for the serial control of the individual patient as well as for the home delivery of the stabilized subjects. 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 the imaging findings may not change the therapeutic approach. Echocardiography should be limited to patients with hemodynamic instability to assess ventricular function and pulmonary pressures.
Collapse
Affiliation(s)
- Antonello D'Andrea
- Department of Cardiology, Chair of Cardiology–Luigi Vanvitelli University–Monaldi Hospital-Association of Operating Room Nurses Ospedali Dei Colli–Naples, Naples 80131, Italy
| | - Juri Radmilovic
- Department of Cardiology and Intensive Coronary Unit, “Umberto I” Hospital, Nocera Inferiore 84014, Salerno, Italy
| | - Andreina Carbone
- Department of Cardiology, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, Naples 80131, Italy
| | - Alberto Forni
- Department of Cardiology and Intensive Coronary Unit, “Umberto I” Hospital, Nocera Inferiore 84014, Salerno, Italy
| | - Ercole Tagliamonte
- Department of Cardiology and Intensive Coronary Unit, “Umberto I” Hospital, Nocera Inferiore 84014, Salerno, Italy
| | - Lucia Riegler
- Department of Cardiology and Intensive Coronary Unit, “Umberto I” Hospital, Nocera Inferiore 84014, Salerno, Italy
| | - Biagio Liccardo
- Department of Cardiology, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, Naples 80131, Italy
| | - Fabio Crescibene
- M. Scarlato COVID Hospital, Scafati Hospital, Scafati 84018, Italy
| | - Cesare Sirignano
- Institute of Biostructures and Bioimaging of National Research Council, National research Council, Naples 80145, Italy
| | - Giovanna Esposito
- Department of Cardiology and Intensive Coronary Unit, “Umberto I” Hospital, Nocera Inferiore 84014, Salerno, Italy
| | - Eduardo Bossone
- Division of Cardiology, Cardarelli Hospital, Naples 80131, Italy
| |
Collapse
|
8
|
Tagliamonte E, Montuori C, Riegler L, Forni A, Scarafile R, Di Vilio A, Radmilovic J, Astarita R, Gambardella F, Sperlongano S, Cice G, D'Andrea A. Inverse response of global longitudinal strain after dipyridamole stress echocardiography in patients with microvascular coronary dysfunction. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Coronary microvascular dysfunction (CMD) is a potential cause of myocardial ischemia and may affect myocardial function at rest and during stress. CMD can be identified, in patients with non-obstructive coronary artery disease (CAD), by a reduced transthoracic Doppler-derived coronary flow reserve (CFR), which is an index of coronary arterial reactivity, and can be impaired in both obstructive CAD and CMD.
The aim of this study was to investigate the dipyridamole-induced changes of global longitudinal strain (GLS) in patients with CMD.
Methods
43 patients (29M, 14F; mean age 68±7 years) without obstructive CAD, assessed by invasive coronary angiogram, underwent dipyridamole stress echocardiography. Coronary flow was assessed in the left anterior descending coronary artery (LAD) and was identified as the colour signal directed from the base to the apex of the left ventricle, containing the characteristic biphasic pulsed-Doppler flow signals. CFR were determined as the ratio of hyperaemic to baseline diastolic coronary flow velocity. CMD was defined as CFR <2.
GLS was measured using automated function imaging, through the positioning of three endocardial markers (two markers at the mitral annulus and one at the apex) in each apical view. Subsequently, the obtained segmental values of GLS were visualized as a bull's-eye map in a quick and feasible manner. We had optimal left ventricular endocardial tracking in the overall population.
In each patient, we used a frame rate of 70 frames/sec for adequate 2D strain analysis. We analyzed GLS at each step of stress test and compared peak-dose values with baseline.
Results
Thirteen patients (30%) among the overall population showed CMD. There were no significant differences in baseline characteristics between patients with or without CMD. GLS, at baseline, was significantly lower in patients with CMD (−16.9±3.78 vs. −17.8±3.77 – p<0.01). We observed a different response to dipyridamole stress echocardiography, between the two groups: GLS significantly increased up to peak dose in patients without CMD (from −17.8±3.77 to −19.3±4.09 – p<0.01), whereas on the other hand, a significant decrease from rest to peak dose was observed in patients with CMD (from −16.9±3.78 to −15.5±4.18 – p<0.01). There was a significant inverse correlation between CFR and delta GLS measured at rest and after dipyridamole peak dose (r=−0.82 – p<0.01).
Conclusions
GLS analysis, particularly performed by comparing dipyridamole peak-dose with baseline values, shows that in patients with CMD there is a different response of left ventricular myocardiim to stress test.
It could be assumed that the inverse correlation between CFR and delta GLS reflects a progressive subclinical worsening of left ventricular myocardial function in these patients. Larger studies could confirm our data.
Funding Acknowledgement
Type of funding source: None
Collapse
Affiliation(s)
- E Tagliamonte
- Hospital Umberto I, Department of Cardiology, Nocera Inferiore, Italy
| | - C Montuori
- Hospital Umberto I, Department of Cardiology, Nocera Inferiore, Italy
| | - L Riegler
- Hospital Umberto I, Department of Cardiology, Nocera Inferiore, Italy
| | - A Forni
- Hospital Umberto I, Department of Cardiology, Nocera Inferiore, Italy
| | - R Scarafile
- Hospital Umberto I, Department of Cardiology, Nocera Inferiore, Italy
| | - A Di Vilio
- university of Campania Luigi Vanvitelli, Department of Cardiology, Naples, Italy
| | - J Radmilovic
- Santa Maria della Misericordia Hospital, Operative Unit of Cardiology, Sorrento, Italy
| | - R Astarita
- Hospital Umberto I, Department of Cardiology, Nocera Inferiore, Italy
| | - F Gambardella
- university of Campania Luigi Vanvitelli, Department of Cardiology, Naples, Italy
| | - S Sperlongano
- university of Campania Luigi Vanvitelli, Department of Cardiology, Naples, Italy
| | - G Cice
- Polyclinic Casilino of Rome, Department of Cardiology, Rome, Italy
| | - A D'Andrea
- Polyclinic Casilino of Rome, Department of Cardiology, Rome, Italy
| |
Collapse
|
9
|
Radmilovic J, D'Andrea A, D'Amato A, Tagliamonte E, Sperlongano S, Riegler L, Scarafile R, Forni A, Muscogiuri G, Pontone G, Galderisi M, Russo MG. Echocardiography in Athletes in Primary Prevention of Sudden Death. J Cardiovasc Echogr 2019; 29:139-148. [PMID: 32089993 PMCID: PMC7011488 DOI: 10.4103/jcecho.jcecho_26_19] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Echocardiography is a noninvasive imaging technique useful to provide clinical data regarding physiological adaptations of athlete's heart. Echocardiographic characteristics may be helpful for the clinicians to identify structural cardiac disease, responsible of sudden death during sport activities. The application of echocardiography in preparticipation screening might be essential: it shows high sensitivity and specificity for identification of structural cardiac disease and it is the first-line imagining technique for primary prevention of SCD in athletes. Moreover, new echocardiographic techniques distinguish extreme sport cardiac remodeling from beginning state of cardiomyopathy, as hypertrophic or dilated cardiomyopathy and arrhythmogenic right ventricle dysplasia. The aim of this paper is to review the scientific literature and the clinical knowledge about athlete's heart and main structural heart disease and to describe the rule of echocardiography in primary prevention of SCD in athletes.
Collapse
Affiliation(s)
- Juri Radmilovic
- Department of Cardiology, Umberto I, Nocera Inferiore, Italy.,Department of Cardiology, Luigi Vanvitelli University of Naples, Monaldi Hospital, Naples, Italy
| | - Antonello D'Andrea
- Department of Cardiology, Umberto I, Nocera Inferiore, Italy.,Department of Cardiology, Luigi Vanvitelli University of Naples, Monaldi Hospital, Naples, Italy
| | - Andrea D'Amato
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | | | - Simona Sperlongano
- Department of Cardiology, Luigi Vanvitelli University of Naples, Monaldi Hospital, Naples, Italy
| | - Lucia Riegler
- Department of Cardiology, Umberto I, Nocera Inferiore, Italy
| | | | - Alberto Forni
- Department of Cardiology, Umberto I, Nocera Inferiore, Italy
| | | | - Gianluca Pontone
- Department of Radiology, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Maria Giovanna Russo
- Department of Cardiology, Luigi Vanvitelli University of Naples, Monaldi Hospital, Naples, Italy
| |
Collapse
|
10
|
D’Andrea A, Radmilovic J, Caselli S, Carbone A, Scarafile R, Sperlongano S, Tocci G, Formisano T, Martone F, Liccardo B, D’Alto M, Bossone E, Galderisi M, Golino P. Correction to: Left atrial myocardial dysfunction after chronic abuse of anabolic androgenic steroids: a speckle tracking echocardiography analysis. Int J Cardiovasc Imaging 2018; 34:1561. [DOI: 10.1007/s10554-018-1409-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
11
|
D’Andrea A, Radmilovic J, Caselli S, Carbone A, Scarafile R, Sperlongano S, Tocci G, Formisano T, Martone F, Liccardo B, D’Alto M, Bossone E, Galderisi M, Golino P. Left atrial myocardial dysfunction after chronic abuse of anabolic androgenic steroids: a speckle tracking echocardiography analysis. Int J Cardiovasc Imaging 2018; 34:1549-1559. [DOI: 10.1007/s10554-018-1370-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|
12
|
D'Andrea A, Radmilovic J, Mele D, D'Ascenzi F, Agricola E, Carbone A, Lo Iudice F, Novo G, Ancona F, Righini FM, Mondillo S, Bossone E, Galderisi M. Speckle tracking analysis in intensive care unit: A toy or a tool? Echocardiography 2018; 35:506-519. [PMID: 29600543 DOI: 10.1111/echo.13879] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The use of conventional echocardiography in the intensive care unit (ICU) is today established to assess left and right ventricular systolic function, for preload determination and procedural guidance. Next step in ICU echocardiography could be the use of novel ultrasound techniques such as strain echocardiography to assist in the management of patients with acute coronary syndrome, heart failure, or pulmonary embolism. This review has gathered the available evidence supporting the incremental value of strain in the diagnostic workup of cardiac diseases treated in ICU.
Collapse
Affiliation(s)
| | - Juri Radmilovic
- Monaldi Hospital, Luigi Vanvitelli University of Naples, Naples, Italy
| | - Donato Mele
- University Hospital of Ferrara, Ferrara, Italy
| | | | | | - Andreina Carbone
- Monaldi Hospital, Luigi Vanvitelli University of Naples, Naples, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Carbone A, D'Andrea A, Scognamiglio G, Scarafile R, Tocci G, Sperlongano S, Martone F, Radmilovic J, D'Amato M, Liccardo B, Scherillo M, Galderisi M, Golino P. Mitral Prolapse: An Old Mysterious Entity - The Incremental Role of Multimodality Imaging in Sports Eligibility. J Cardiovasc Echogr 2018; 28:207-217. [PMID: 30746324 PMCID: PMC6341849 DOI: 10.4103/jcecho.jcecho_42_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Mitral valve prolapse is generally a benign condition characterized by fibromyxomatous changes of the mitral leaflet with displacement into the left atrium and late-systolic regurgitation. Although it is an old clinical entity, it still arouses perplexity in diagnosis and clinical management. Complications, such as mitral regurgitation (MR), atrial fibrillation, congestive heart failure, endocarditis, ventricular arrhythmias, and sudden cardiac death (SCD), have been reported. A large proportion of the overall causes of SCD in young competitive athletes is explained by mitral valve prolapse. Recent studies have shown the fibrosis of the papillary muscles and inferobasal left ventricular wall in mitral valve prolapse, suggesting a possible origin of ventricular fatal arrhythmias. Athletes with mitral valve prolapse and MR should undergo annual evaluations including physical examination, echocardiogram, and exercise stress testing to evaluate the cardiovascular risks of competitive sports and obtain the eligibility. In this setting, multimodality imaging techniques – echocardiography, cardiac magnetic resonance, and cardiac computed tomography – should provide a broad spectrum of information, from diagnosis to clinical management of the major clinical profiles of the disease.
Collapse
Affiliation(s)
- Andreina Carbone
- Luigi Vanvitelli University, Monaldi Hospital, AORN Ospedali Dei Colli, Naples, Italy
| | - Antonello D'Andrea
- Luigi Vanvitelli University, Monaldi Hospital, AORN Ospedali Dei Colli, Naples, Italy
| | | | - Raffaella Scarafile
- Luigi Vanvitelli University, Monaldi Hospital, AORN Ospedali Dei Colli, Naples, Italy
| | - Gianpaolo Tocci
- Luigi Vanvitelli University, Monaldi Hospital, AORN Ospedali Dei Colli, Naples, Italy
| | - Simona Sperlongano
- Luigi Vanvitelli University, Monaldi Hospital, AORN Ospedali Dei Colli, Naples, Italy
| | - Francesca Martone
- Luigi Vanvitelli University, Monaldi Hospital, AORN Ospedali Dei Colli, Naples, Italy
| | - Juri Radmilovic
- Luigi Vanvitelli University, Monaldi Hospital, AORN Ospedali Dei Colli, Naples, Italy
| | - Marianna D'Amato
- Luigi Vanvitelli University, Monaldi Hospital, AORN Ospedali Dei Colli, Naples, Italy
| | - Biagio Liccardo
- Luigi Vanvitelli University, Monaldi Hospital, AORN Ospedali Dei Colli, Naples, Italy
| | | | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico Ii University of Naples, Naples, Italy
| | - Paolo Golino
- Luigi Vanvitelli University, Monaldi Hospital, AORN Ospedali Dei Colli, Naples, Italy
| |
Collapse
|
14
|
D'Andrea A, Radmilovic J, Ballo P, Mele D, Agricola E, Cameli M, Rossi A, Esposito R, Novo G, Mondillo S, Montisci R, Gallina S, Bossone E, Galderisi M. Left ventricular hypertrophy or storage disease? the incremental value of speckle tracking strain bull's-eye. Echocardiography 2017; 34:746-759. [DOI: 10.1111/echo.13506] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
|
15
|
Abstract
‘Athlete’s heart’ is a common term for the various adaptive changes induced by intensive exercise. Exercise causes alterations of the heart in hemodynamic response to the increased systemic and pulmonary demand during exercise. The understanding of these adaptations is of high importance, since they may overlap with those caused by pathological conditions. Cardiac imaging assessment of the athlete’s heart should begin with a complete echocardiographic examination. In recent years classical echocardiographic surveys have been joined by new developments: tissue Doppler imaging, strain rate echocardiography, and real-time 3-dimensional echocardiography. This review paper focuses on the importance of these new echocardiographic techniques in delineating the morphological characteristics and functional properties of the athlete’s heart.
Collapse
Affiliation(s)
- Antonello D'Andrea
- Second University of Naples, Monaldi Hospital, Caserta, CE, 81100, Italy
| | | | - Juri Radmilovic
- Second University of Naples, Monaldi Hospital, Caserta, CE, 81100, Italy
| | - Pio Caso
- Second University of Naples, Monaldi Hospital, Caserta, CE, 81100, Italy
| | - Raffaele Calabrò
- Second University of Naples, Monaldi Hospital, Caserta, CE, 81100, Italy
| | | | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, 80138, Italy
| |
Collapse
|