Filippo Quinzani

How should we measure left atrium size and function

Echocardiographic assessment of left atrial size from M‐mode or 2D echocardiography measurements has been used in clinical and research studies for years, but its accuracy is now questioned. New techniques, such as 3D and tissue Doppler imaging, assessing velocities, strain and strain rate, provide improved prognostic value in a wide range of diseases. 2D strain imaging using speckle tracking on B‐mode images may yield even better, angle‐independent, results than tissue Doppler imaging‐derived strain echocardiography. Finally, velocity vector imaging is a novel image analysis technique that may be used to quantify left atrial volume.

Effects of Oral Amino Acid Supplements on Functional Capacity in Patients with Chronic Heart Failure

Amino acids (AAs) availability is reduced in patients with heart failure (HF) leading to abnormalities in cardiac and skeletal muscle metabolism, and eventually to a reduction in functional capacity and quality of life. In this study, we investigate the effects of oral supplementation with essential and semi-essential AAs for three months in patients with stable chronic HF. The primary endpoints were the effects of AAs supplementation on exercise tolerance (evaluated by cardiopulmonary stress test and six minutes walking test (6MWT)), whether the secondary endpoints were change in quality of life (evaluated by Minnesota Living with Heart Failure Questionnaire—MLHFQJ and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels. We enrolled 13 patients with chronic stable HF on optimal therapy, symptomatic in New York Heart Association (NYHA) class II/III, with an ejection fraction (EF) <45%. The mean age was 59 ± 14 years, and 11 (84.6%) patients were male. After three months, peak VO2 (baseline 14.8 ± 3.9 mL/minute/kg vs follow-up 16.8 ± 5.1 mL/minute/kg; P = 0.008) and VO2 at anaerobic threshold improved significantly (baseline 9.0 ± 3.8 mL/minute/kg vs follow-up 12.4 ± 3.9 mL/minute/kg; P = 0.002), as the 6MWT distance (baseline 439.1 ± 64.3 m vs follow-up 474.2 ± 89.0 m; P = 0.006). However, the quality of life did not change significantly (baseline 21 ± 14 vs follow-up 25 ± 13; P = 0.321). A non-significant trend in the reduction of NT-proBNP levels was observed (baseline 1502 ± 1900 ng/L vs follow-up 1040 ± 1345 ng/L; P = 0.052). AAs treatment resulted safe and was well tolerated by all patients. In our study, AAs supplementation in patients with chronic HF improved exercise tolerance but did not change quality of life.

Long-term prognostic value of the right ventricular myocardial performance index compared to other indexes of right ventricular function in patients with moderate chronic heart failure.

Background: The ventricular myocardial performance index (MPI) is a feasible echocardiographic parameter for the evaluation of patients with chronic heart failure (CHF). The long‐term prognostic role of right ventricular MPI (RV MPI) has been already assessed in patients with more advanced CHF but data are lacking in moderate CHF. The aim of the study is to evaluate the possible prognostic role of RV MPI in moderate CHF patients compared to others traditional RV parameters. Methods: From 2003 to 2004 we enrolled 95 consecutive NYHA class II CHF patients (65 males and 30 females), with the mean age of 66 ± 11 years with left ventricular ejection fraction (LVEF) <40%, on optimal medical treatment. All patients were evaluated clinically and by echocardiography with a follow‐up of 5 years (combined end point: cardiovascular mortality and hospitalization for HF). Results: RV MPI was 0.45 ± 0.36, tricuspid annular plane systolic excursion was 21 ± 8 mm, RV fractional area change was 42 ± 12%, systolic pulmonary artery pressure was 33 ± 9 mmHg, and acceleration time of pulmonic flow was 115.5 + 22.62 msec. After the 5 year follow‐up the total mortality was 24.2% and HF hospitalization rate was 33%. At Cox multivariate analysis only an RV MPI superior to median value (>0.38) and tricuspid annular plane systolic excursion inferior to median value (<18 mm) had shown a significant prognostic role. Conclusion: The RV MPI in a population of moderate CHF showed to have a more long‐term powerful prognostic value than other conventional and traditional echocardiographic right ventricular functional parameters.

A Focus on Antiarrhythmic Properties of Ranolazine

Ranolazine is an antianginal drug that inhibits a number of ion currents that are important for the genesis of transmembrane cardiac action potential. It was initially developed as an antianginal agent but was found to additionally exert antiarrhythmic actions, due to its multichannel-blocking properties. In recent years, several studies about the antiarrhythmic properties of ranolazine were conducted, demonstrating the beneficial effects of this drug in both atrial and ventricular arrhythmias, such as atrial fibrillation, ventricular premature beats, ventricular tachycardia, torsades de pointes, and ventricular fibrillation. Our aim is to briefly review the main points of these studies, most more experimental than clinical.

When Should We Use Nitrates in Congestive Heart Failure

Organic nitrates remain among the oldest and most commonly employed drugs in cardiology. Although, in most cases, their use in acute and chronic heart failure is based on clinical practice, only a few clinical trials have been conducted to evaluate their use in acute and chronic heart failure, most of which compare them with other drugs to evaluate differing endpoints. The purpose of this review is to examine the various trials that have evaluated the use of nitrates in acute and chronic heart failure.

Effects of Ranolazine on Cardiovascular System

Chronic stable angina affects 6-7 million Americans and contributes to a significant reduction in quality of life and life expectancy. Current pharmacotherapy for reducing episodes of exertional angina includes β-blockers, calcium channel blockers and long-acting nitrates. Patients may have contraindications to the use of one or more of these agents or be unable to tolerate initial or larger therapeutic doses. As a result of the inability of current management strategies to optimally control episodes of chronic angina, new therapies have been investigated that do not have some of the limitations of current therapies. New therapies for chronic stable angina are based on a mechanism involving membrane current such as the funny current and the late Na current. Ranolazine (Ran) is an antianginal drug acting on I(Na). After its current indication in the chronic stable angina, the role of this molecule is still being studied for prophylaxis of certain arrhythmias and treatment of heart failure. Moreover, have been recently developed new interesting patents of novel pharmaceutical effects and derivates of Ran.

Echocardiographic elastic properties of ascending aorta and their relationship with exercise capacity in patients with non-ischemic dilated cardiomyopathy

Background : Aortic stiffness, an independent predictor of mortality and cardiovascular events, is common among patients affected by non-ischemic dilated cardiomyopathy (NIDC) and heart failure (HF). Methods : A total of 55 patients with diagnosis of NIDC (aged 60 ± 11 years, mean ejection fraction (EF) 35.2% ± 7.7%) admitted consecutively to our department for mild to moderate HF (NYHA class II–III) underwent an echocardiographic study and cardiopulmonary exercise test (CPX). We evaluated elastic properties of ascending aorta, i.e. aortic stiffness and aortic distensibility (mm Hg− 1), derived from ascending aorta systolic and diastolic diameter (mm/m2) measured 3 cm above the valvular plane through 2D-guided M-mode echocardiography. Results : Mean aortic stiffness was 15.63 ± 14.53 and aortic distensibility was 2.61 ± 2.39 mm Hg− 1. Collected parameters at CPX were peak oxygen consumption (pVO2) (ml/kg/min), anaerobic threshold (AT) and the slope of the relation between minute ventilation (VE) and carbon dioxide production (VCO2). Mean pVO2 was 15.4 ± 3.9 ml/kg/min, VE/VCO2 ratio at AT was 36.1 ± 6.1. Functional capacity measured through peak VO2 was found to be directly correlated with aortic distensibility (r = 0.47, p = − 0.0002) and negatively correlated to aortic stiffness index (r = − 0.51, p = − 0.0001). These results were the same at multivariate analysis, corrected by age, hypertension, diabetes mellitus and ejection fraction (respectively r = 0.27, p = 0.008 and r = − 1.75, p = 0.0002). Conclusions : HF patients due to NIDC elastic properties of ascending aorta, evaluated by echocardiography, are correlated with a reduced functional capacity.