The Role of Cardiac Magnetic Resonance Imaging in Hypertrophic Cardiomyopathy.

Until recently, the only imaging technique for the diagnosis and management of hypertrophic cardiomyopathy (HCM) was two-dimensional echocardiography, and the use of cardiac magnetic resonance imaging (cMRI) was limited to patients with poor acoustic windows. Now, cMRI has gained an essential role in the diagnosis of HCM, providing superior visualization of myocardial hypertrophy-even in remote zones of the left ventricle-and visualization of subtle changes in thickness and contractility over time. The morphologic accuracy of cMRI allows for the differentiation of HCM from other pathologic conditions with hypertrophic phenotype. Moreover, cMRI sheds light on the in vivo fibrotic changes in cardiac ultrastructure, offering an important advantage in the understanding of pathologic mechanisms of the disease, allowing early identification, risk stratification, and timely therapeutic management.

Speckle-tracking global longitudinal strain as an early predictor of cardiotoxicity in breast carcinoma.

PURPOSE: Recent development in anticancer therapies for breast carcinoma allowed an improvement in patients' survival, notwithstanding a parallel increase of cardiovascular morbidity. Cardiotoxicity of anticancer therapies represents a relevant problem due to its insidious onset and potentially irreversible cardiac damage. The aim of the present study was to test whether 2D speckle tracking analysis can help in predicting overt systolic dysfunction. METHODS: A "real world" cohort of 69 patients with breast carcinoma undergoing adjuvant and/or neo-adjuvant chemotherapy was tested 2D-speckle tracking analysis before the beginning of chemotherapy and every 3 months for 1 year. Clinical data, 12-lead ECGs, and lab tests were collected according to the same visit protocol. RESULTS: Over 1-year follow-up, 19 patients (27 %) developed cardiac dysfunction according to the CREC criteria, with an average onset time from enrolment of 6.8 months. A global longitudinal strain (GLS) threshold ≥-16 % at 3 months from chemotherapy was able to predict subsequent systolic dysfunction development with high sensitivity (80 %) and specificity (90 %) and a negative predictive value of 92 %. After the introduction of cardioprotective drugs, left ventricular ejection fraction (LVEF) progressively recovered, while alterations of GLS persisted at 1-year follow-up. CONCLUSIONS: Strain imaging with 2D speckle tracking allows the identification of patients at low-risk for chemotherapy-related systolic dysfunction and can help optimizing resources allocations and improving follow-up quality. GLS can also provide a more accurate prognostic index of resolved systolic dysfunction when compared to standard LVEF.

Cardiac resynchronization therapy improves ejection fraction and cardiac remodelling regardless of patients' age.

AIMS: Cardiac resynchronization therapy (CRT) improves symptoms and reduces mortality in heart failure (HF) patients, but little data exist on the efficacy of CRT in the elderly. The aim of our study is to define CRT-related benefits in terms of left ventricular ejection fraction (LVEF) improvement in two subgroups of patients (<75 and ≥75 years old) and test possible differences between these two groups. METHODS AND RESULTS: Single-centre prospective observational study including 65 patients with optimally treated, advanced HF and indication to CRT. All patients were investigated with clinical evaluation, Minnesota Living with Heart Failure Questionnaire (MLHFQ), 12-lead electrocardiogram, and full echocardiographical study before CRT implant and 3 and 12 months after. Left ventricular ejection fraction showed a time-related improvement in the whole population (+10.6% over 12 months) as well as in each subgroup. The magnitude of LVEF improvement was similar in elderly and non-elderly patients (+13.6 vs. +7.9%; P = ns). Left ventricular diameters, pulmonary artery systolic pressure, New York Heart Association class, MLHFQ score, and QRS width all showed a time-related improvement in the whole population as well as in each subgroup. End-diastolic left ventricular diameter remodelling and QRS width reduction were significantly more pronounced in the elderly, whereas other clinical and instrumental secondary endpoints showed a similar improvement between ≥75 and <75 years old patients. There was no significant difference regarding mortality between elderly and non-elderly patients. CONCLUSION: Cardiac resynchronization therapy is as effective in improving LVEF in elderly as in non-elderly patients. Age alone should not be a determinant to restrict resynchronization therapy in HF patients.

Pollen record of the Late Pleistocene-Holocene stratigraphic sequence and current plant biodiversity from Grotta Mora Cavorso (Simbruini Mountains, Central Italy).

Grotta Mora Cavorso (Jenne, Latium), a complex karstic system in Central Italy, has returned one of the most precious Prehistoric palaeontological and anthropological heritage. Through the analysis of pollen spectra and charcoals from cave stratigraphic levels (Late Pleistocene final phases-Holocene), the overall vegetation trend of the site was pointed out. Although taphonomy and palynology of cave deposits are complex, pollen assemblage represents a reliable source for inferring past vegetation; indeed, climatic, environmental, and cultural interactions determine fossil pollen record. Site formation processes and postdepositional bias should be generally considered in the analysis of stratigraphic sequences used to define paleoenvironmental conditions. The sediment deposits from Grotta Mora Cavorso showed a vegetation pattern point in out a progressive increase in woody plants from lower levels upward. Palynological investigations highlighted a changing environment predominantly characterized by cooler and perhaps more humid conditions than today, with plant subalpine and marsh communities nearby the cave. The ecological requirements of the identified plant taxa supplied useful indications to reconstruct ancient and modern environments of the Simbruini Mounts and the Upper Aniene River valley. This scenario, in accordance with previous faunistic and carpological findings and palynological analyses from Latium, provided a further perspective on the vegetation history, biodiversity, and climate of an important crossroads between the Adriatic and the Tyrrhenian coasts.

Neolithic dental calculi provide evidence for environmental proxies and consumption of wild edible fruits and herbs in central Apennines.

Looking for a biological fingerprint relative to new aspects of the relationship between humans and natural environment during prehistoric times is challenging. Although many issues still need to be addressed in terms of authentication and identification, microparticles hidden in ancient dental calculus can provide interesting information for bridging this gap of knowledge. Here, we show evidence about the role of edible plants for the early Neolithic individuals in the central Apennines of the Italian peninsula and relative cultural landscape. Dental calculi from human and animal specimens exhumed at Grotta Mora Cavorso (Lazio), one of the largest prehistoric burial deposits, have returned an archaeobotanical record made up of several types of palaeoecological proxies. The organic fraction of this matrix was investigated by a multidisciplinary approach, whose novelty consisted in the application of next generation sequencing to ancient plant DNA fragments, specifically codifying for maturase K barcode gene. Panicoideae and Triticeae starches, together with genetic indicators of Rosaceae fruits, figs, and Lamiaceae herbs, suggested subsistence practices most likely still based on wild plant resources. On the other hand, pollen, and non-pollen palynomorphs allowed us to outline a general vegetational framework dominated by woodland patches alternated with meadows, where semi-permanent settlements could have been established.

Ropivacaine versus levobupivacaine for minor breast surgery in outpatients: inversion of postoperative pain relief efficacy.

The number of ambulatory surgical procedures is growing and local anesthesia represents the technique of choice for outpatients undergoing minor surgery. The aim of this study was to verify whether differences exist in postoperative pain relief using equipotent doses of two long-acting local anesthetics, ropivacaine and levobupivacaine, in patients who underwent minor breast surgery. A series of 86 consecutive women (median age=55, range=39-75 years) with small (<2 cm in size) breast masses requiring surgical excision were prospectively enrolled in the study. Patients were randomly selected to receive 7.5 mg/ml ropivacaine (group A, 42 patients) or 5 mg/ml levobupivacaine (group B, 44 patient). For post-surgical measurement of pain intensity a visual analog scale (VAS) was used. The age of the patients (56.4±9.6 vs. 56.7±9.5 years; p=0.88) and operative time (38.4±4.3 vs. 39.8±5.0 min; p=0.16), did not differ significantly between the groups (A vs. B). Transient adverse effects were observed in 5 (11.9%) and 4 (9.1%) patients (p=0.49) of groups A and B, respectively. The pain VAS four (t4) and 24 (t24) hours from the end of surgery was significantly (p<0.05) different between the groups, but an inversion of pain relief efficacy and a crossing point of the two pain-time lines at the sixth hour was observed. In conclusion, ropivacaine results in more effective pain relief at time t4, while levobupivacaine should be the drug of choice when long-term postoperative analgesia is required.

Usefulness of chromogranin A, neuron-specific enolase and 5-hydroxyindolacetic acid measurements in patients with malignant carcinoids.

BACKGROUND: Neuroendocrine tumors (NETs) of the gastro-entero-pancreatic (GEP) system are a heterogeneous group of cancers more common in the small intestine. In patients with malignant NETs, especially carcinoids, a number of prognostic parameters have been considered, such as age, clinical symptoms related to the neoplasm, TNM staging and histological grade, as well as urinary 5-hydroxyindolacetic acid (5-HIAA), chromogranin A (CgA) and neuron-specific enolase (NSE) serum levels. PATIENTS AND METHODS: The data from a series of 14 patients (median age 56 years, range 33-72 years) with gastric (N=8), ileal (N=1), colorectal (N=4) or appendiceal (N=1) malignant carcinoids were retrospectively reviewed. RESULTS: The specificity of CgA, NSE, and 5-HIAA was 86%, 86% and 93%, while the sensitivity was 64%, 36%, and 36%, respectively. There was no relationship between survival and or urinary 5-HIAA (R=0.12, p=0.45), CgA (R=0.22, p=0.21) nor serum NSE (R=0.12, p=0.76) levels. CONCLUSION: The sensitivity of tumor markers is generally low in patients with malignant carcinoids, and both 5-HIAA and CgA levels are independent of survival.