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Alberto Bestetti

Publications and source records attributed to Alberto Bestetti.

7 recordsLinked to original sources
PubMed2006

Combined assessment of left ventricular perfusion and function by gated single-photon emission computed tomography for the risk stratification of high-risk hypertensive patients.

OBJECTIVE: This study was aimed at verifying whether combined information on left ventricular perfusion and function by electrocardiogram-gated single-photon emission computed tomography (SPECT) retains its known prognostic value in patients with systemic hypertension. METHODS: A total of 415 hypertensive patients underwent rest and stress (exercise in 278 and dipyridamole in 137) gated 99mTc-sestamibi SPECT and prospective follow-up for the composite endpoint of death and acute coronary syndrome. Patients undergoing revascularization were censored. The individual effect of clinical and stress imaging data on outcome was evaluated by Cox regression analysis. Model validation was performed using bootstrap methods adjusted by the degree of optimism in estimates. Survival analysis was performed using the product-limit Kaplan-Meier method. RESULTS: During a median follow-up of 24 months, 12 cardiac deaths and 32 acute coronary syndromes occurred. After adjusting for the most significant covariates, age [hazard ratio (HR) 1.62, 95% confidence interval (CI) 1.02-2.57], diabetes (HR 7.51, 95% CI 1.61-35.2), summed stress score (HR 2.06, 95% CI 1.07-4), and peak end-systolic volume (HR 3.62, 95% CI 1.35-9.69) were multivariable predictors of outcome. The normal perfusion pattern was associated with a low event rate independently of peak end-systolic volume. Conversely, in the case of moderate to severe perfusion abnormalities, a peak end-systolic volume greater than 74 ml was able to identify an increased risk of adverse outcome. Moreover, peak end-systolic volume was significantly higher among patients who died of a cardiac cause compared with those with different outcomes. CONCLUSION: A combined assessment of left ventricular perfusion and function by gated SPECT significantly improves risk stratification in hypertensive patients.

Aged↗
PubMed2005

Prognostic value of C-reactive protein in patients with stress induced myocardial ischemia.

OBJECTIVE: Inflammation plays a critical role in the pathogenesis of atherosclerosis. Possible association between C-reactive protein (CRP), stress-induced myocardial ischemia and clinical outcome was investigated. DESIGN, PATIENTS AND RESULTS: We correlated scintigraphic scan and CRP values of 101 consecutive out-patients who performed an exercise stress test for evaluation of chest pain (n=49) or scheduled control after myocardial infarction (n=52). CRP levels were determined before and after exercise. Twenty-three patients had reversible defects and presented CRP levels [mean (S.D.) 5.6 (3.3) mg/l] greater than subjects with fixed [mean (S.D.) 4.6 (4.5) mg/l] or no [mean (S.D.) 2.8 (2.9) mg/l] defects. Odds ratio for the association between high (3rd, tertile, >4.7 mg/l) CRP levels and reversible defects was 5.6 (95% CI 1.6 to 20; p=0.009). During a follow-up of 2.3 (0.7) years, 18 patients reached a clinical end-point consisting in one Q-wave myocardial infarction, eight non-Q-wave myocardial infarction or unstable angina and nine percutaneous coronary interventions. When the impact of different risk factors on the development of clinical endpoint was evaluated, the hazard ratio associated with high CRP levels was 11.0 (95% CI 3.0 to 41; p<0.001). CONCLUSIONS: These findings suggest that in ambulatory patients, high CRP levels may predict exercise-induced ischemia and patient outcome.

Aged↗
PubMed2004

Enhanced prognostic stratification of CAD patients with low ejection fraction by stress-rest Tc99m tetrofosmin gated-spect.

OBJECTIVE: This study was performed to assess whether post-stress and rest functional parameters, as measured by gated-SPECT, provide additional predictive value for long-term prognosis, over clinical and perfusion data in patients (pts.) with low left ventricular ejection fraction (LVEF). METHODS: 647 consecutive pts. underwent stress/rest gated-SPECT, and 497 were followed for a mean period of 516 +/- 264 days. Segmental perfusion and motion/thickening (post-stress and rest) were analysed visually, while EF and LV volumes were calculated using an automatic algorithm (QGS). The post-stress and rest ratio were determined for both end-diastolic (EDV) and end-systolic volume (ESV), while the post-stress LVEF change was calculated subtracting rest-EF from stress-EF. RESULTS: 84/497 pts. showed rest EF < 40%, and 15/84 (18%) experienced a cardiac event (3 cardiac deaths, 1 infarction, 3 hospitalized angina and 9 late revascularizations). The perfusion and functional parameters were not significantly more compromised in pts. with cardiac events compared with pts. without events. Post-stress ESV was the only index significantly higher in pts. with low EF and events compared with pts. with low EF without events (150 +/- 72 ml vs. 123 +/- 53 ml, P = 0.02). Univariate Cox analysis of clinical, perfusion and functional data showed that the best predictor of cardiac events was stress-ESV (score 6.5, P = 0.01), followed by rest-ESV, rest-EDV, stress-EDV and stress-LVEF. Multivariate analysis demonstrated that the addition of stress-ESV to stress-EF, yielded a significant increase in the global chi2 in the prediction of hard events (cardiac death/infarction) (score 4.634, P = 0.03). CONCLUSION: In patients with depressed LVEF, stress-ESV was the only independent predictor of long-term outcome.

Adult↗
PubMed2003

Geometry and bone mass in primary hyperparathyroidism assessed by peripheral Quantitative Computed Tomography (pQCT).

PURPOSE: Non-invasive measurement by peripheral quantitative computed tomography (pQCT) of bone geometry, biomechanics, and mineral content in patients (pts) with primary hyperparathyroidism (PHPT). MATERIALS AND METHODS: Total, trabecular and cortical mineral density (totBMD, cortBMD, trab BMD), bone geometrical properties (total area, trabecular area, cortical area, cortical/total area) and cortical thickness as biomechanical parameters, were assessed by pQCT at distal radius in 38 (32 F; 6 M) consecutive patients with PHPT (mean age: 62 yrs; range: 30-77). In a subgroup of 12 patients, bone mineral density (BMD) was also measured by means of dual X-ray absorptiometry (DXA) at the lumbar spine (L2-L4). RESULTS: Serum biochemical characteristics were: iPTH (269+/-214 pg/ml; range: 107-1438, normal: 30-65), Calcium (11.4+/-1.1 mg/dl; range: 10.6-13.5, normal: 8.1-10.4) and Alkaline Phosphatase (398+/- 392 U/L; range:173-1174, normal: 98-279). Compa-red with 87 healthy age-matched subjects, total, trabecular and cortical bone densities were reduced in all patients (TotBMD: 216+/-92 mg/cm(3) vs ctr 342+/-94, -37%, p<0.05; TrabBMD: 93+/-51 mg/cm(3) vs ctr 140+/-54, -34%, p <0.01; CorBMD: 711+/-178 mg/cm(3) vs ctr 802+/-175, -11%, p<0.02), such as cortical thickness (0.143+/-0.02 cm vs ctr 0.157+/-0.03, -9%, p<0.02). Among geometrical parameters, only cortical/total area was significant different in the two groups (0,29 vs 0.31; p<0.04). A strong correlation was found between peripheral trabecular bone density assessed by pQCT and axial bone mineral density measured by DXA at L2-L4 (r=0.80; p<0.01). CONCLUSIONS: pQCT measurements in PHPT showed: 1) osteopoenia in all bone compartments partly related to age and menopause; 2) reduced cortical density and cortical thickness consistent with "cancellization" of the inner cortex and lower ability of bone to absorb loading forces. DXA measurements showed osteopoenia also at the lumbar spine, a site rich in trabecular bone. PQCT allowing selective assessment of true volumetric cortical and trabecular bone density such as bone geometry, is proposable in clinical practice, in order to evaluate presurgical bone "status" and to monitor the response to parathyroidectomy.

Absorptiometry, Photon↗
PubMed2003

[Enhanced prognostic stratification of cad patients with dilated left ventricle by stress and rest functional parameters and 99mTc-tetrofosmin Gated-SPECT].

PURPOSE: To evaluate whether the post-stress and rest functional parameters, measured by Gated-SPECT, have incremental prognostic value compared with perfusion parameters in predicting cardiac events (CE), in a population of CAD patients with dilated LV. MATERIALS AND METHODS: A total of 670 consecutive patients (mean age: 62; range 29-86 yrs.) underwent conventional diagnostic 2-day gated-SPECT with 99mTc-tetrofosmin (55% exercise stress test, 45% dip stress): 605 patients (mean age: 62 yrs., range: 34-86 yrs.) had known or suspected CAD, whereas 65 (mean age: 60 yrs, range: 29-80 yrs) had low pre-test likelihood of CAD (<10%), a normal post-stress perfusion scan and no hypertension. Fifty-three percent of CAD patients had a history of MI. Perfusion was analyzed on ungated images using 20 segments scored on a 5-point scale (0=normal, 4=no uptake), while wall thickening was assessed visually on stress/rest end-systolic images using a 4-point score (0=normal, 3=absence of WT). LVEF and volumes were calculated using an automatic algorithm. Post-stress and rest ratio were determined for both end-diastolic and end-systolic volume, while the post-stress LVEF change (d-LVEF) was calculated according to the following formula: (Stress LVEF-rest LVEF)/rest LVEF*100. RESULTS: By using a cutoff value of 126 ml for rest-EDV, and of 68 ml for rest-ESV we found a LV dilation in 129/605 patients (21%). These thresholds were the mean values plus two standard deviations obtained in the control group. 111/129 (86%) were followed up for a mean period of 147.0 months. 83 of 111 (75%) patients had a history of MI and forty three (39%) had undergone surgical revascularizations. During the follow-up, 21 events (5 cardiac deaths, 3 nonfatal MI, 13 late revascularizations) occurred. All post-stress perfusion and functional parameters were more compromised in patients with CE compared with patients without events, but only rest EDV, rest ESV, post-stress ESV and WT-SSS reached statistical significance (201 ml vs 176 ml; p=0.035; 137 ml vs 113 ml; p=0.047; 143 ml vs 117 ml; p=0.034, 19 vs 15; p=0.048, respectively). Multivariate Cox proportional analysis demonstrated that stress ESV added significantly prognostic information over WT-SSS in predicting CE (p=0.046). CONCLUSIONS: Stress ESV has incremental prognostic value compared with wall thickening in predicting CE, in CAD patients with dilated cardiomyopathy. Perfusion parameters failed to show prognostic information in these patients.

Adult↗