Biomedical subjects
Publications and source records attributed to Sebastiano Coglitore.
The current case report illustrates a comprehensive assessment with different imaging techniques, as echocardiography, magnetic resonance and computer tomography, of a rare cardiac mass known as caseous calcification of mitral annulus. Transesophageal echocardiography was able to identify and characterize the caseous calcification of mitral annulus.
Early diagnosis of focal myocarditis can be difficult. We report two cases of myocarditis in young patients diagnosed by cardiac magnetic resonance imaging. The method was able to recognise the focal edema in the early phase of inflammation.
BACKGROUND: Most patients with growth hormone deficiency (GHD) show high body mass index. Overweight subjects, but GHD patients, were demonstrated to have high left ventricular mass index (LVMi) and abnormal LV geometric remodeling. We sought to study these characteristics in a group of GHD patients, in an attempt to establish the BMI-independent role of GHD. METHODS: Fifty-four patients, 28 F and 26 M, aged 45.9 +/- 13.1, with adult-onset GHD (pituitary adenomas 48.2%, empty sella 27.8%, pituitary inflammation 5.5%, cranio-pharyngioma 3.7%, not identified pathogenesis 14.8%) were enrolled. To minimize any possible interferences of BMI on the aim of this study, the control group included 20 age- and weight-matched healthy subjects. The LV geometry was identified by the relationship between LVMi (cut-off 125 g/m2) and relative wall thickness (cut-off 0.45) at echocardiography. RESULTS: There was no significant between-group difference in resting cardiac morphology and function, nor when considering age-related discrepancy. The majority of patients had normal-low LVM/LVMi, but about one fourth of them showed higher values. These findings correlated to relatively high circulating IGF-1 and systolic blood pressure at rest. The main LV geometric pattern was eccentric hypertrophy in 22% of GHD population (26% of with severe GHD) and in 15% of controls (p = NS). CONCLUSION: Though the lack of significant differences in resting LV morphology and function, about 25% of GHD patients showed high LVMi (consisting of eccentric hypertrophy), not dissimilarly to overweight controls. This finding, which prognostic role is well known in obese and hypertensive patients, is worthy to be investigated in GHD patients through wider controlled trials.
In this report the authors analyzed the usefulness of live 3-dimensional echocardiography in association with conventional 2-dimensional method to improve the recognition of left ventricular midcavitary obliteration in a patient with hypertrophic cardiomyopathy.
BACKGROUND: The assessment of coronary flow velocity is becoming crucial in the diagnosis and management of several cardiac dysfunctions and conventional Doppler echocardiography is currently the technique most widely used for detecting their abnormalities noninvasively. METHODS: We sought to evaluate the differences in coronary flow velocity using conventional transthoracic Doppler echocardiography, measuring both the left anterior descending and such intramural (IM) coronary arteries' flow, among the following 4 categories of patients with myocardial hypertrophy: group A, obstructive hypertrophic cardiomyopathy (n = 12); group B, nonobstructive hypertrophic cardiomyopathy (n = 10); group C, left ventricular hypertrophy (LVH) due to hypertension (n = 10); and group D, LVH due to aortic valve stenosis (n = 10). RESULTS: No significant difference between the 4 groups was found with respect to the left anterior descending velocity. Diastolic peak (P < .01) and mean (P < .05) velocities in the IM arterioles were significantly higher in patients from groups A and D than in groups B and C. At multivariate analysis, both dynamic (group A) and fixed (group D) systolic peak gradients, measured by continuous wave Doppler sampling through the left ventricular (LV) outflow tract or the aortic valve, respectively, were found to be major determinants of the IM diastolic velocity, independently on the LV mass. About 75% of patients with obstructive hypertrophic cardiomyopathy showed IM peak and mean velocity >100 cm/s and >70 cm/s, respectively (P = .005). CONCLUSION: These findings likely suggest [corrected] a role for the LV systolic obstruction within the intricate adaptive mechanisms of coronary blood flow to LVH.
AIM: We sought to evaluate the relationship between left ventricular systolic wall stress (LV-SWS) and coronary artery blood flow velocity in patients with LV hypertrophy (LVH). METHODS AND RESULTS: The study population comprised 38 patients, aged 66.7 +/- 12.7, who were divided into two groups based on the LV-SWS median value. Group A included 19 patients at "low-stress" (92.0 +/- 18.0 mmHg/cm2) and group B other 19 patients at "high-stress" (134.2 +/- 32.3 mmHg/cm2) (P < 0.002). Coronary blood flow velocities were measured both in the left anterior descending (LAD) and in the intramural (IM) arteries. There were no significant between-group differences in the main clinical and echocardiographic parameters. Diastolic velocity in the LAD was also comparable, while it was higher in the IM arterioles of patients from group B than from group A (peak velocity 110.9 +/- 35.2 cm/s vs 92.0 +/- 29.4 cm/s, P < 0.02; mean velocity 78.6 +/- 28.8 vs. 56.0 +/- 20.2 cm/s, P < 0.01, respectively). Overall, moderate, but significative, linear correlation was found between IM peak and mean diastolic velocity and LV-SWS (r = 0.41, P = 0.01, and r = 0.44, P = 0.007, respectively), whereas there was no correlation with wall thickening and LV mass. CONCLUSIONS: Main findings from the present study likely suggest that in patients with mild-to-moderate LVH, high blood flow velocity in the IM arterioles, but not in the LAD, may be related to an increase in LV-SWS, rather independent on the absolute LV mass.
Quadricuspid aortic valve is an uncommon congenital valve disease mostly occurring as isolated lesion or sometimes in association with truncal anomalies. Approximately 50% of patients with quadricuspid aortic valve have aortic regurgitation. Before the advent of echocardiography most cases were diagnosed at the time of surgery or at post-mortem examination. We describe 2 cases of patients with quadricuspid aortic valve diagnosed by echocardiography. The first case, a quadricuspid aortic valve with four equal-sized cusps (type A, according to the classification of Hurwitz and Roberts), was identified in a 26-year-old man undergoing echocardiography because of a heart murmur. The second case, a quadricuspid aortic valve with three relatively equal cusps and one smaller cusp (type B, according to the classification of Hurwitz and Roberts), was identified in a 47-year-old man with a history of murmur. The identification and periodical non-invasive evaluation of a quadricuspid aortic valve is important, because such valves are more vulnerable to infection and need adequate prophylaxis against endocarditis.
The autonomic nervous system has been evaluated in myotonic dystrophy with contradictory results and its relationship with heart disturbances remains unclear. Twenty-three patients with myotonic dystrophy type 1 were investigated by a battery of six cardiovascular autonomic tests and power spectral analysis of heart rate variability. Although 15 patients (65%) revealed abnormal or borderline results in some tests, only one patient had a definite autonomic damage, as indicated by two or more abnormal tests. As a group, myotonic dystrophy type 1 patients showed a significant reduction of heart rate variability during deep breathing (P < 0.0001). The exclusive involvement of parasympathetic tests suggests that a mild vagal dysfunction occurs in some myotonic dystrophy type 1 patients. The results indicate that such autonomic abnormalities are not: (1) part of a peripheral neuropathy; (2) related to cytosine-thymine-guanine repeat size or breathing pattern. Power spectral analysis showed a reduction of supine low-frequency band, which is, but not exclusively, a marker of sympathetic activity. It was inversely correlated to disease duration (P < 0.04), suggesting a progression as the disease advances. A low-frequency power, recorded after standing, was significantly associated (P < 0.02) with presence of heart involvement. Our findings suggest that a mixed, especially parasympathetic, autonomic dysfunction may occur in myotonic dystrophy type 1, although it is not a major finding. It could play a role in the occurrence of cardiac abnormalities, or increase the risk of sudden cardiovascular events.
The noninvasive determination of the blood flow velocity in the left anterior descending coronary artery (LAD) at color Doppler echocardiography may provide useful clinical information. In this report, the authors describe the case of a patient with left ventricular hypertrophy secondary to hypertension in whom a critical but asymptomatic LAD stenosis was diagnosed at conventional echocardiography without resorting to pharmacological stress.
Explore the source record for details and available documents.
The M-mode (motion mode) technique has improved the diagnostic possibilities of echocardiography due to its high temporal resolution. The use of a two-dimensional (2D) image as a basis for M-mode analysis at a defined line, independent of the transducer orientation, namely the anatomic M-mode (AMM), has been proposed from the beginning of 2D echocardiography. For several years, however, this could not be accomplished due to several reasons including the limited digital memory, the relatively rough pixels of 2D images, and the low temporal resolution of the screen. The AMM has been improved by the "fully digital" machines. These are able to provide a series of digital data (direction, position, and timing) relative to any single echo received from any point of the tissue. AMM analysis, thus, can be performed in any direction, as a "normal" monodimensional echocardiogram. With respect to traditional M-mode, AMM permits a more detailed analysis of cardiac chambers diameters obtained by linear measurements, regional wall motion of the left ventricle (both at rest and during stress), and location of accessory pathways. In particular, the assessment of left ventricular regional wall motion represents the most important goal of this new technique, which results in marked reduction or even elimination of the limitations due to the subjective character of wall motion evaluation with 2D echocardiography.
Isolated right ventricular (RV) hypertrophy is a common diagnosis at echocardiography. Mid-ventricular obstructive involvement represents however a really unusual finding. Currently available studies on right-sided hypertrophic cardiomyopathy, regardless of whether they are associated with RV outflow tract obstruction, are usually limited to single cases. Besides, there is still no agreement about the clinical relevance and management of RV hypertrophy. In the present study the authors describe the echocardiographic findings of a patient presenting with RV hypertrophy in whom a rare coexistence of both fixed RV outflow tract and intraventricular dynamic obstruction was observed. Some functional effects of verapamil treatment are also discussed.
Explore the source record for details and available documents.
Dyspnea and angina have been described in patients with hypertrophic cardiomyopathy (HCM). Given the complexity of the coronary microcirculation, the pathophysiological mechanisms of angina are discussed. The last generation of echo devices allows the investigation of epicardial coronary flow by means of the standard transthoracic approach (TTE). In the present study we describe 5 patients affected by HCM (with outflow tract dynamic obstruction in 2 cases, intraventricular dynamic obstruction in the other 2, no obstruction in the last one) in whom both the epicardial and intramyocardial coronary flows were assessed at high-resolution TTE. Regular flow velocities were shown in epicardial coronary arteries, while in intramyocardial branches the diastolic peak velocity was > 75 cm/s in all patients. Besides, the systolic flow was found to be inverted. Similar to what suggested by the few data presently available in the literature, the main findings of this study confirm the appropriateness of investigating the intramyocardial coronary circulation in patients with HCM by means of high-resolution Doppler echocardiography. In order to explain this clinical finding, an interesting hypothesis of a diastolic "milking-like" phenomenon associated with systolic "blood squeezing" in the intramural coronary arteries was taken into consideration. The noninvasive study of the intramyocardial coronary flow may be clinically relevant even in the evaluation of the effectiveness of the adopted therapeutic strategy in reducing myocardial wall stress in severe ventricular hypertrophy.