Sergio Mondillo

Comparison between a cisplatin-containing regimen and a carboplatin-containing regimen for recurrent or metastatic bladder cancer patients : A randomized phase II study

The aim of this randomized Phase II study was to compare the efficacy and toxicity of a cisplatin‐containing regimen with a carboplatin‐containing regimen for patients with recurrent or metastatic bladder cancer.

Chronic Mitral Regurgitation: Left Atrial Deformation Analysis by Two‐Dimensional Speckle Tracking Echocardiography

Background: Speckle tracking echocardiography (STE) is a novel method for the angle‐independent and objective quantification of myocardial deformation; it has recently evolved, enabling the quantification of longitudinal myocardial left atrial (LA) deformation dynamics. To investigate the effects of chronic mitral regurgitation (MR) on these functional atrial indices, we analyzed LA function by STE in a group of asymptomatic patients with chronic degenerative MR. Methods: The study population included 36 patients with mild MR, 38 with moderate MR, and 42 with severe MR. 52 age‐matched controls were also recruited. Global peak atrial longitudinal strain (global PALS) was measured in all subjects by averaging all atrial segments. Results: Age, gender, and LV ejection fraction in all pathological groups were comparable to those in the controls. Global PALS was higher in the mild MR group (46.7 ± 9.1%) in comparison with the controls (40.5 ± 6.2%; P < 0.001); instead global PALS was lower in the moderate MR group (25.7 ± 7.1%) and further reduced in the severe MR group (13.2 ± 5.2%) in comparison with the controls (40.5 ± 6.2%; overall P < 0.0001 by ANOVA, P < 0.05 for all pairwise comparisons). In multivariate analysis, E/Em ratio emerged as the principal independent determinant of global PALS. Conclusions: Our study provides new insight for the LA function analysis in response to different degrees of MR, showing that STE measurements of LA longitudinal strain may be considered a promising tool for the early detection of impairment of LA compliance in patients with asymptomatic chronic MR. (Echocardiography 2011;28:327‐334)

Right Atrial Speckle Tracking Analysis as a Novel Noninvasive Method for Pulmonary Hemodynamics Assessment in Patients with Chronic Systolic Heart Failure

Background: The right atrium (RA) plays multiple roles in the cardiac cycle. The reservoir phase of the RA is a dynamic rather than a static phase of cardiac cycle and RA deformation is dependent on pulmonary pressures exerted on the right ventricle and, therefore, backwards on the RA. The purpose of this study was to assess the accuracy and the clinical applicability of the speckle tracking echocardiography (STE) evaluation of the RA in predicting the invasive systolic pulmonary artery pressure (SPAP) in patients with systolic heart failure (HF) undergoing right heart catheterization (RHC). Methods: Thirty‐one hemodynamically stable, in‐clinic HF patients who were undergoing RHC were included. Doppler echocardiography and RHC catheterization were simultaneously performed. Echocardiographic measures and STE where obtained as peak atrial longitudinal strain (PALS), RA strain rate, and time to peak longitudinal strain (TPLS). RA PALS was inversely correlated with invasively assessed SPAP (r =–0.81; P < 0.001) while RA strain directly correlated with SPAP (r = 0.82; P < 0.001). RA PALS and strain rate retained this correlation even after nitroprusside challenge test (r =–0.81; P < 0.001 and r = 0.91; P < 0.001, respectively). Area under the curve optimal cutoffs for predicting the SPAP > 50 mmHg were for RA PALS 10.3% (AUC:0.93, sensitivity: 100%, specificity: 78%). Conclusion: RA STE showed a significant correlation with pulmonary pressure. RA assessment with STE can predict pulmonary artery hypertension in HF patients. This result is consistent with nitroprusside challenge test. Although RA STE is not routinely used, its evaluation may implement right heart evaluation in HF patients. (Echocardiography 2011;28:658‐664)

Physiologic determinants of left ventricular systolic torsion assessed by speckle tracking echocardiography in healthy subjects.

Background: The associations of left ventricular (LV) systolic torsion with clinical and echocardiographic variables in physiological conditions have not been fully investigated. We explored the independent determinants of LV systolic torsion in a population of normal subjects. Methods: In 119 healthy subjects, peak twist angle (LVtw) and torsion (LVtor) during ejection, and the QRS‐LVtw interval (time‐to‐peak LVtw) were measured by speckle tracking. LV twisting rate and rotational deformation delay were also determined. Results: Stepwise multiple regression showed that LVtw was independently associated with indexed end‐systolic volume (β=–0.200, P < 0.0001), peak early diastolic mitral annulus velocity (β=–0.186, P = 0.0001), heart rate (β= 0.178, P = 0.0003), and male gender (β=–0.174, P = 0.0004). Similar results were found for LVtor. Age was the only parameter, which has demonstrated an independent correlation with time‐to‐peak LVtw (β= 0.329, P < 0.0001). Despite significance of these associations, the proportions of variability explained by regression models were relatively low (range 11–26%), and no accurate predictive models were identifiable for LV twisting rate and rotational deformation delay. Conclusion: In normal individuals, indexed end‐systolic LV volume, LV relaxation, heart rate, gender, and age correlate independently with LV torsion mechanics. However, conventional echocardiographic and clinical variables are not able to predict LV torsion mechanics. (Echocardiography 2011;28:641‐648)

Correlation of Left Atrial Strain and Doppler Measurements with Invasive Measurement of Left Ventricular End-Diastolic Pressure in Patients Stratified for Different Values of Ejection Fraction.

This study aimed at exploring the correlation of left atrial longitudinal function by speckle tracking echocardiography (left atrial strain) and Doppler measurements (E/E ratio) with direct measurements of left ventricular (LV) end‐diastolic pressure (LVEDP) in patients stratified for different values of ejection fraction.

Nonsymmetric Myocardial Contribution to Supranormal Right Ventricular Function in the Athlete's Heart: Combined Assessment by Speckle Tracking and Real Time Three-Dimensional Echocardiography

To investigate determinants of right ventricular (RV) function in competitive athletes by a combined assessment of speckle tracking (STE) and real time 3D echocardiography (RT3DE).

Left ventricular strain modifications after maximal exercise in athletes: a speckle tracking study.

The increase in systolic indexes from rest (R) to exercise is achieved by combination of enhanced heart rate (HR) and stroke volume (SV). Aim of this study was to evaluate left ventricular (LV) longitudinal, circumferential, and torsional components immediately after a maximal intensity exercise (ME) by speckle tracking echocardiography (STE).

Detection of Early Left Ventricular and Atrial Dysfunction in Overweight Patients with Preserved Ejection Fraction: A Speckle Tracking Analysis

Little remains known about the role of overweight to promote progressive atrial and ventricular myocardial dysfunction. Aim of this study was to investigate the potential influence of overweight on left ventricular (LV) and atrial (LA) function, as assessed by speckle tracking strain analysis, in patients at low‐to‐moderate global cardiovascular risk.

The Role of Optical Coherence Tomography in Clarifying the Mechanisms for Dobutamine Stress Echocardiography-Induced Takotsubo Cardiomyopathy

Takotsubo cardiomyopathy is a clinical disorder characterized by a transient dilatation and akynesis or dyskinesis of the left ventricular (LV) apex, mimicking an anterior wall acute myocardial infarction in the absence of significant coronary artery disease (CAD). It typically occurs during an episode of severe emotional or physical stress. Recent reports suggested the potential of dobutamine stress echocardiography (DSE) in inducing the aforementioned syndrome. The transient dysfunction of the LV does not fit any known coronary distribution. Furthermore, there is no obstructive CAD demonstrated at angiography to account for the observed dysfunction. Consequently, the pathophysiology of this syndrome is still undetermined. Here, we report a case of DSE‐induced Takotsubo cardiomyopathy in which high‐resolution intracoronary imaging was utilized to exclude possible vessel alterations to help provide potential mechanistic explanations for the development of this condition.

Surgical management of cardiac hydatidosis.

(J Card Surg 2011;26:292‐293)