Carmine Siniscalchi

Visceral adiposity and arterial stiffness: echocardiographic epicardial fat thickness reflects, better than waist circumference, carotid arterial stiffness in a large population of hypertensives

AIMS Relationship between obesity and cardiovascular (CV) disease depends not only on the amount of body fat, but also on its distribution. For example, individuals with increased fat accumulation in the abdominal region have atherogenic lipid profiles and are at increased CV risk. The loss of elasticity in medium and large arteries is an early manifestation of atherosclerosis. The aim of this study was to evaluate whether echocardiographic epicardial adipose tissue, an index of cardiac adiposity, is related to carotid stiffness and carotid intima-media thickness (IMT), indexes of subclinical atherosclerosis, better than waist circumference in hypertensive patients. METHODS AND RESULTS We studied 459 patients with Grade I and II essential hypertension who were referred to our outpatient clinic over a period from May 2007 to March 2008. The population was first sorted by waist circumference and then by epicardial fat < or = 7 or >7 mm. We measured epicardial fat thickness, waist circumference, carotid artery stiffness, and carotid IMT in all patients. Patients divided according to waist circumference showed no statistical differences in carotid artery stiffness between the two groups. Subjects with epicardial fat >7 mm were older, had higher systolic, diastolic, and pulse pressure, increased left ventricular mass index, carotid IMT, diastolic parameters, and stiffness parameters compared with those with epicardial fat < or = 7 mm (P < 0.001). A positive correlation was found between epicardial fat and age, pulse pressure, stiffness parameters, carotid IMT, systolic blood pressure, and duration of hypertension, and a negative correlation was found with diastolic parameters. Age, carotid IMT, and stiffness parameters were independently related to epicardial fat. CONCLUSION Our findings indicate that epicardial fat reflects carotid artery stiffness in hypertension-induced organ damage.

Vasodilator Stress Single-Photon Emission Computed Tomography or Contrast Stress Echocardiography Association with Hard Cardiac Events in Suspected Coronary Artery Disease

Background We compared the long‐term outcome of subjects without prior cardiac disease who underwent either vasodilator single‐photon emission computed tomography (SPECT) or contrast stress‐echocardiography (cSE) for suspected coronary artery disease (CAD). Methods Subjects who underwent vasodilator SPECT or cSE between 2008 and 2012 for suspected CAD but no history of cardiac disease were included. We retrospectively compared the association of each method with combined all‐cause death and nonfatal myocardial infarction and their positive predictive value (PPV) for angiographically obstructive CAD. Results A total of 1,387 subjects were selected: 497 who underwent SPECT and 890 who underwent cSE. During 4 years of mean follow‐up there were 78 hard events in the cSE group and 51 in the SPECT group. Event‐free survival in subjects testing positive for ischemia, either with SPECT or cSE, was significantly worse both in the overall population and after propensity matching patients. In multivariable analyses, vasodilator SPECT or cSE demonstrated significant stratification capability with an ischemic test doubling (SPECT) or more than doubling (cSE) the risk of future hard events independently from other variables. PPV of vasodilator SPECT for the diagnosis of obstructive CAD was inferior to vasodilator cSE (PPV = 63% vs 89%, respectively; P < .001). Conclusions Our study suggests that the associations of vasodilator SPECT or cSE with outcome are comparable, with cSE demonstrating better diagnostic PPV for CAD. The absence of ionizing radiation and anticipated lower costs from higher PPV suggest that vasodilator cSE is a valid alternative to vasodilator SPECT as a gatekeeper in subjects without a prior history of CAD. HighlightsVasodilators cSE and SPECT are both associated with outcome in suspected CAD.cSE has a higher positive predictive value for CAD and is radiation‐free.cSE is a valid alternative to SPECT in subjects with suspect CAD.

The Heart Sentinel™ app for detection and automatic alerting in cardiac arrest during outdoor sports: Field tests and ventricular fibrillation simulation results

Abstract Introduction The Heart Sentinel™ app (HS-app) is conceived to detect cardiac arrest during outdoor sports, automatically alerting contacts via SMS with GPS position data. It automatically starts the chain of survival in case no bystander has witnessed the event, using commercially-available chest strap heart monitor and a smartphone. The heart rate analysis arm of the algorithm is extremely sensitive, with specificity being addressed by motion analysis through smartphone sensors, since only unexpected prolonged absence of motion would confirm true cardiac arrest and start an alert code. We assessed the accuracy of such HS-app with simulated exercise-associated ventricular fibrillation (VF), and possible false positives in real-world athletes. Methods The occurrence of false positive alerts was tested in the outdoor field, through athletes regularly running and cycling, and with ECG simulators. The occurrence of false negatives for VF detection was assessed with 3 different ECG simulators, using VF simulation protocols. Results The false positive initiation of an alert countdown was recorded twice during 829 h of outdoor sports. Both athletes were able to stop such false positive 15-second countdown before the alert SMS was dispatched. No false positive SMS was dispatched. False negatives were not recorded under any simulation protocol. Conclusion A simple smartphone app, using commercially-available heart rate monitors, is promising to detect cardiac arrest caused by VF during sports, triggering automatic dispatch of emergency SMS with GPS position. During outdoor exercise, HS-app would be helpful for cases of exercise-associated cardiac arrest.

The Effect of Chorionicity on Maternal Cardiac Adaptation to Uncomplicated Twin Pregnancy: A Prospective Longitudinal Study

Objective: The objective of this study was to longitudinally evaluate maternal echocardiographic findings in uncomplicated twin gestations according to chorionicity. Methods: Healthy women with twin pregnancy were assessed with transthoracic echocardiography across the first, second, and third trimesters. Cardiac findings were compared within each group and between monochorionic (MC) and dichorionic (DC) pregnancies. Results: Overall, 19 MC and 48 DC uncomplicated twin pregnancies were included. In the MC group, no significant maternal haemodynamic changes were documented across gestation, with the exception of a decrease in ejection fraction. Compared to DC pregnancies, in the MC set lower cardiac output (second and third trimester, p = 0.001 and p = 0.006, respectively) and higher total vascular resistance (first trimester, p = 0.032) were observed. Regarding the diastolic function in MC twins, significantly higher values were observed for mitral E/A ratio (third trimester, p = 0.014), septal mitral E1/A1 ratio (third trimester, p = 0.030), lateral mitral E1 (second and third trimester, p = 0.014 and p = 0.029, respectively), and E1/A1 ratio (third trimester, p = 0.006). Conclusions: Maternal cardiac adaptation in twin pregnancy seems to differ significantly according to chorionicity. In particular, in MC pregnancies the impairment of diastolic function is less pronounced, presumably due to the lower circulating volume.

The Schmidt Syndrome

Addisons disease (AD) is a rare endocrine condition related to adrenal insufficiency. Autoimmune adrenalitis is commonly associated with autoimmune diseases. Autoimmune Addison’s Disease (AAD) describes Autoimmune Polyendocrine Syndrome (APS) in 60% of patients with an important immunitary pathogenesis imprinting. We describes a case of Autoimmune Polyendocrine Syndrome charachterize by adrenal insufficiency and thyroid disease (Schmidt Syndrome). In this case report, Addison’s disease had a slow onset in absence of the typical weight loss. In our considerations this is due to the concomitant hypothyroidism that masked some typical signs and also limited acute presentation. (www.actabiomedica.it)

C4. Maternal cardiac changes during uncomplicated twin pregnancy: does the chorionicity matter?

Abstract Objectives: To assess longitudinally the echocardiographic findings in a cohort of women carrying an uncomplicated monochorionic (MC) twin pregnancy and compare them with those obtained from dichorionic (DC) twin gestations. Methods: Healthy women with MC twin pregnancies were submitted to serial transthoracic maternal echocardiography during the first, second and third trimester. Cases with severe obstetric complications after enrollment were eventually excluded. The cardiac findings obtained at different time frames within the MC group were compared. Moreover, these data were compared with those obtained longitudinally in a cohort of uncomplicated DC twin pregnancies. Results: From 2012 to 2016, 19 women with an uncomplicated MC twin pregnancy were included in this study group. Among this group no significant changes were documented from 1st to 3rd trimester with the exception of an ejection fraction decrease. In respect of 48 DC uneventful twin gestations in the MC set the following significant differences were observed: reduced cardiac output (midtrimester) and ejection fraction (1st and 2nd trimester), increased total vascular resistance (1st trimester). Regarding the diastolic function in the MC versus DC twins a significant increase of the following parameters was noted: mitral valve E/A (early diastolic – atrial contraction) ratio (3rd trimester); MSE1 (1st and 2nd trimester), MS E1/A1 (3rd trimester); ML E1 (2nd and 3rd trimester); ML E1/A1 (3rd trimester). The longitudinal trend of the following data showed a significant difference between the MC and the DC set: increase of ML E1 and MLE1/A1, decrease of ML A1. Conclusions: In uncomplicated MC twin pregnancies maternal cardiac changes seem to differ significantly from the DC set. In particular, in the former group the diastolic function impairment is less pronounced presumably due to the lower circulating volume.

Contrast echocardiography to uncover right ventricular-type myocardial bridging

A 71-year-old woman presented with long-standing stable angina related to exercise. A treadmill exercise electrocardiogram shows 1-mm borderline ST-segment depression in the anterior precordial leads. The lady underwent high-dose dipyridamole (0.84 mg/kg/6 min) contrast-echocardiography that demonstrated normal wall motion, but chest pain and worsening of electrocardiographic ST-segment depression. At rest, wall motion was normal and …

History-taking still the best diagnostic modality? The case of a threatening mass in the right ventricle

A 37-year-old woman affected by anti-phospholipid antibody syndrome (APS), underwent routine transthoracic (TT) echocardiography for pregnancy planning. She had had deep vein thrombosis and pulmonary embolism about a decade earlier, when she was treated with 6-month oral anti-coagulation. Transthoracic-echocardiography unexpectedly revealed a round-shaped, pedunculated, hyperechoic mass 11 × 16 mm in size fluctuating in the right ventricle ( Panel A …