Aorfix™ device for abdominal aortic aneurysm with challenging anatomy.

Anatomical characteristics of abdominal aortic aneurysms (AAA) are the most critical factors for successful endovascular aortic repair (EVAR). Of these, severe proximal aortic neck angulation and iliac axis tortuosity increase the complexity of EVAR. Neck angulation seems to have a pivotal potential for fixation failure, a situation that may lead to complications, including endoleak and late rupture. Bench-test studies identified that the relative stiffness of a stent-graft was responsible for its inability to conform to neck angulation, therefore creating leaks through gaps between the stent graft and the neck. Aorfix™ stent graft (Lombard Medical, Didcot, UK) is a flexible stent-graft designed and manufactured with the purpose of overcoming the issue of stent-graft stiffness. Many studies have shown good results in term of procedural success and mid-term type-I endoleak. PYTHAGORAS trial evaluated mainly patients with highly angulated infrarenal neck and showed that high performance of Aorfix™ stent graft did not present any significant difference between neck >60° and <60°. In the series of 27 patients treated at our Institution we had a primary technical success of 96.3% and an assisted primary technical success of 100%. In this review we will analyze the available data in literature regarding Aorfix™ stent graft and will discuss the outcome of the patients treated with Aorfix™ stent graft at our centre.

From the abluminal biodegradable polymer stent to the polymer free stent. Clinical evidence.

The implementation of methods of the coronary angioplasty was one of the most important achievement in the field of treatment of coronary artery disease. Abluminal biodegradable polymer stents (BDS) and polymer free stent are the newest and the most promising research concerning coronary stent technology. In this article we discuss the perceived need for BDS-polymer free stents, the current clinical evidence, limits and future perspectives.

Low-molecular-weight heparins vs. unfractionated heparin in the setting of percutaneous coronary intervention for ST-elevation myocardial infarction: a meta-analysis.

BACKGROUND: The aim of the current study was to perform two separate meta-analyses of available studies comparing low-molecular-weight heparins (LMWHs) vs. unfractionated heparin (UFH) in ST-elevation myocardial infarction (STEMI) patients treated (i) with primary percutaneous coronary intervention (pPCI) or (ii) with PCI after thrombolysis. METHODS: All-cause mortality was the pre-specified primary endpoint and major bleeding complications were recorded as the secondary endpoints. Relative risk (RR) with a 95% confidence interval (CI) and absolute risk reduction (ARR) were chosen as the effect measure. RESULTS: Ten studies comprising 16,286 patients were included. The median follow-up was 2 months for the primary endpoint. Among LMWHs, enoxaparin was the compound most frequently used. In the pPCI group, LMWHs were associated with a reduction in mortality [RR (95% CI) = 0.51 (0.41-0.64), P < 0.001, ARR = 3%] and major bleeding [RR (95% CI) = 0.68 (0.49-0.94), P = 0.02, ARR = 2.0%] as compared with UFH. Conversely, no clear evidence of benefits with LWMHs was observed in the PCI group after thrombolysis. Meta-regression showed that patients with a higher baseline risk had greater benefits from LMWHs (r = 0.72, P = 0.02). CONCLUSIONS: LMWHs were associated with greater efficacy and safety than UFH in STEMI patients treated with pPCI, with a significant relationship between risk profile and clinical benefits. Based on this meta-analysis, LMWHs may be considered as a preferred anticoagulant among STEMI patients undergoing pPCI.

Ischaemic and bleeding complications with new, compared to standard, ADP-antagonist regimens in acute coronary syndromes: a meta-analysis of randomized trials.

BACKGROUND: Platelets play a pivotal role in the pathogenesis of acute coronary syndromes (ACS) and their inhibition remains a mainstay therapy in this setting. We aimed to perform a meta-analysis of randomized trials to evaluate the benefits of new oral antiplatelet regimens to block platelet ADP-receptors compared to standard-dose clopidogrel (300 mg loading dose followed by 75 mg/daily). METHODS: We obtained results from all randomized trials enrolling patients with ACS. Primary endpoint was mortality. Secondary endpoints were myocardial infarction and definite in-stent thrombosis. Safety endpoint was the risk of major bleeding complications. We prespecified subanalyses according to new antiplatelet drugs (prasugrel/ticagrelor), high-dose clopidogrel (600 mg) and patients undergoing percutaneous coronary intervention. RESULTS: A total of seven randomized trials were finally included in the meta-analysis (n = 58 591). We observed a significant reduction in mortality (2.9% vs. 3.4%, OR = 0.87, 95% CI 0.79-0.95, P = 0.002), recurrent myocardial infarction (4.2% vs. 5.2%, OR = 0.80, 95% CI 0.74-0.87, P < 0.0001), definite in-stent thrombosis (0.9% vs. 1.7%, OR = 0.52, 95% CI 0.43-0.63, P < 0.0001). The benefits in mortality and reinfarction were driven by the treatment with prasugrel or ticagrelor, without a significant difference in terms of major bleeding complications as compared to standard-dose clopidogrel (5% vs. 4.7%, OR = 1.06 95% CI 0.96-1.17, P = 0.25). CONCLUSION: This meta-analysis showed that new oral antiplatelet regimens are associated with a significant reduction in mortality, reinfarction and in-stent thrombosis in ACS patients without an overall increase of major bleeding when treated with new antiplatelet drugs.

Early vs. delayed invasive strategy in patients with acute coronary syndromes without ST-segment elevation: a meta-analysis of randomized studies.

Although early percutaneous coronary intervention has been demonstrated to reduce the risk of mortality in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS), there are emerging conflicting data as to whether the catheterization needs to be done very early or whether it could be delayed while the patient receives medical therapy. The aim of the current study was to perform a meta-analysis of randomized controlled trials (RCTs) comparing early vs. delayed invasive strategies for NSTE-ACS patients. Medline/CENTRAL and the Web were searched for RCTs comparing early vs. delayed invasive strategies for NSTE-ACS patients. The primary endpoint was all cause mortality, whereas myocardial infarction (MI), coronary revascularizations and 30-day major bleeding complications were secondary end points. Fixed or random effects models were used based on statistical heterogeneity. As a sensitivity analysis, Bayesian random effects meta-analysis was performed in addition to the classical random effects meta-analysis. A total of 5 RCTs were finally included, enrolling 4155 patients. As compared with a delayed strategy, an early invasive approach did not significantly reduce the rates of death [odds ratio (OR) 95% confidence interval (95% CI) = 0.81 (95% CI 0.60-1.09), P = 0.17], MI [OR = 1.18 (95% CI 0.68-2.05), P = 0.55] or revascularizations [OR = 0.97 (0.77-1.24), P = 0.82]. There was a not significant trend toward fewer major bleeding complications for the early invasive approach [OR (95% CI) = 0.76 (0.55-1.04), P = 0.08]. The present meta-analysis shows that for NSTE-ACS patients a routine early invasive strategy does not significantly improve survival nor reduce MI and revascularization rates as compared with a delayed approach.

Are there predictive risk factors for complications after carotid artery stenting?

AIM: The aim of this study was to identify predictive risk factors for complications during and after carotid artery stenting (CAS). METHODS: A multivariate analysis was performed on the databases of 4 European high-volume centers regarding risk factor distribution between patients presenting with or without neurological complications 30 days after CAS. The cumulative 30-day neurological complication rate (death, major stroke, minor stroke and transient ischemic attack) was 2.8% in the total examined cohort of 3 179 consecutive CAS procedures. The following risk factors were taken into consideration for statistical analysis: age, symptomatic, male gender, nicotine abuse, hypertension, hypercholesterolemia, polyvascular disease, diabetes, restenosis after carotid endarterectomy (CEA)/CAS, calcified internal carotid artery. RESULTS: Symptomatic (P=0.02) or hypercholesterolemic (P=0.02) patients are at significantly increased risk for neurological events 30 days after CAS. Asymptomatic women and men without hypercholesterolemia have the lowest risk on any 30-day neurological complications after CAS. CONCLUSIONS: CAS is a safe technique in experienced hands. Preprocedural neurological complaints and hypercholesterolemia can be defined as predisposing factors for 30-day neurological complications after CAS.

Does free cell area influence the outcome in carotid artery stenting?

OBJECTIVES: To identify if carotid stent design, especially free cell area, impacts on the 30-day rates for stroke, death and TIA after carotid artery stenting (CAS). MATERIAL AND METHODS: A CAS database of 3179 consecutive CAS patients was retrospectively assessed. The distribution of neurological complications were analysed for association with the different stent types and designs. Events where subdivided into procedural and postprocedural events. RESULTS: The overall combined rate of TIA, stroke and death was 2.8% at 30 days (late events 1.9%). The post-procedural event rate analyzed for differences stents varied from 1.2% using BSCI Carotid Wallstent to 5.9% using Medtronic Exponent. The late event rates varied from 1.2% to 3.4% for free cell areas <2.5mm(2) and >7.5mm(2) respectively (p<0.05). Post-procedural event rate was 1.3% for closed cells and 3.4% for open cells. All these differences were highly pronounced among symptomatic patients (p<0.0001). CONCLUSIONS: After carotid stenting, complication rates vary according to stent type, free cell area and cell design. In the symptomatic population (and also in the total population), post-procedural complication rates are highest for the open cell types and increase with larger free cell area.

PRIAMUS--proximal flow blockage cerebral protectIon during carotid stenting: results from a multicenter Italian registry.

AIM: The aim of this Italian prospective registry was to evaluate the applicability and efficacy of the Mo.Ma Device (Invatec, Roncadelle, Italy) for the prevention of cerebral embolization during carotid artery stenting (CAS) in a real world population. METHODS: In 4 Italian centers, 416 patients (300 men; mean age 71.6+/-9 years) between October 2001 and March 2005 were enrolled in a prospective registry. Two-hundred and sixty-four symptomatic (63.46%) with >50% diameter stenosis and 152 (36.54%) asymptomatic patients with >70% diameter stenosis were included. The Mo.Ma Proximal Flow Blockage Embolic Protection System was used to perform protected CAS, achieving cerebral protection by endovascular clamping of the common carotid artery (CCA) and of the external carotid artery (ECA). RESULTS: Technical success, defined as the ability to establish protection with the Mo.Ma device and to deploy the stent, was achieved in 412 cases (99.03%). The mean duration of flow blockage was 4.91+/-1.1 min. Transient intolerances to flow blockage were observed in 24 patients (5.76%), but in all cases the procedure was successfully completed. No peri-procedural strokes and deaths were observed. Complications during hospitalization included 16 minor strokes (3.84%), 3 transient ischemic attacks (0.72%), 2 deaths (0.48%) and 1 major stroke (0.24%). This resulted in a cumulative rate at discharge of 4.56% all strokes and deaths, and of 0.72% major strokes and deaths. All the patients underwent thirty-day follow-up. At thirty-day follow-up, there were no deaths and no minor and major strokes, confirming the overall cumulative 4.56% incidence of all strokes and deaths rate, and of 0.72% rate of major strokes and deaths at follow up. In 245 cases (58.89%) there was macroscopic evidence of debris after filtration of the aspirated blood. CONCLUSIONS: This Italian multicenter registry confirms and further supports the efficacy and applicability of the endovascular clamping concept with proximal flow blockage in a broad patient series. Results match favorably with current available studies on carotid stenting with cerebral protection.

Does carotid artery stenting work on the long run: 5-year results in high-volume centers (ELOCAS Registry).

AIM: Although the first long-term results of Carotid Artery Stenting (CAS) became available only recently, CAS has become an accepted treatment for carotid artery disease. We report CAS data up to 5 years, both late stroke rate and patency rates as observed in 4 high-volume European centers. METHODS: Between February 1, 1993 and December 31, 2004, 2 172 patients were selected over the 4 participating centres, with intention to treat endovascularly. Conscientious follow-up was done according to the in-hospital stipulations of each centre and was entered into a database both retrospectively and prospectively. Long-term restenosis and stroke-death rates were investigated and statistically analysed and stratified using the Kaplan-Meier method. RESULTS: Of the 2 172 patients with intention to treat 2 165 (99.7%) were technically successful. Of these 306 (14.1%) were performed without and 1 859 (85.9%) with embolic protection device (EPD); 96 patients (4.4%) received balloon dilation only and stenting was performed in 2 069 (95.6%) cases. Kaplan-Meier analysis of major stroke/all death and of significant restenosis (>50%) for the total population showed stroke/death rates of 4.1% (nar=1 356), 10.1% (nar=476) and 15.5% (nar=138); and restenosis rates of 1% (nar=1 363), 2% (nar=480) and 3.4% (nar=139), after 1, 3 and 5 years respectively. CONCLUSIONS: The patency and stroke/death rates resulting from our database analysis are pleasing and indicate that CAS also on longer term is a valuable treatment method for carotid artery disease. Due to the fact that our dataset contains prospective as well as retrospective data, it may have its limitations. Until this moment, data indicating that certain patient subgroups are at increased risk for neurological complications and in-stent restenosis during and after CAS are sparse. Further multivariant analysis on this unique dataset is mandatory in order to identify any potential links in between plaque morphology, preprocedural neurological complications, risk factor distribution, procedural steps and clinical outcome.

Clinical Experience with the NIR Stent: Retrospective Observation on Acute Results and Follow-up in 709 Patients.

The NIR stent is an expandable cellular coronary prosthesis with high flexibility and excellent trackability. The very low crossing profile, associated to the high flexibility, makes this stent suitable for complex and distal lesions. The aim of this study was to evaluate the feasibility, safety, and long-term (clinical follow-up) efficacy of elective and/or urgent deployment of the NIR stent in a broad patient group with coronary artery disease. Between June 1996 and May 1997, 986 NIR stents were implanted in 781 vessels (de novo or restenotic lesions in native vessels, saphenous vein grafts and internal mammary conduits) of 709 consecutive patients (498 men, 211 women) undergoing coronary angioplasty in two Villa Maria Group Catheterization Laboratories. Procedural angiographic success was achieved in 98.4% of all the lesions treated, ranging from 100% success rate in type A lesion to 97.6% in type C lesions (overall procedural success, 98.4%). Major adverse cardiac events (MACE) were considered from PTCA/stenting time to the patient discharge. The in-hospital MACE were limited and occurred in 15 patients: urgent surgical revascularization 0.8%, death 0.7%, sub-acute stent thrombosis 0.5% (overall in-hospital MACE rate 2.1%). Clinical follow-up data were obtained at 8.6 +/- 2.8 months following the stenting procedure. The event-free survival rate was 87.9%. The late MACE rate evaluation showed death, target lesion revascularization 9.9% (over-all late MACE rate 12.1%). The NIR stent performances in this broad patient population were excellent, showing very high procedural success rate both in normal and complex coronary anatomy. On the basis of the previous data, we can define NIR stent a safe multifunctional device suitable both for easy and complex situations. The clinical late results are very promising in term of event-free survivals and late MACE.

Endovascular treatment of carotid atherosclerotic disease: early and late outcome in a non-selected population.

BACKGROUND: Carotid angioplasty and stenting are still not widely accepted treatments for carotid stenosis. This registry was aimed at investigating the efficacy of endovascular therapy of the extracranial carotid arteries in a non-selected population. METHODS: One hundred nineteen consecutive patients (93 males and 26 females, mean age 70.4 +/- 7.2 years) were enrolled to undergo percutaneous angioplasty and/or stenting of the extracranial carotid artery. The primary endpoint of this study was to evaluate the feasibility, safety and efficacy of carotid elective angioplasty and stenting in a "real life group" of patients (> 50 years, without strict target vessel selection or inclusion criteria) with carotid occlusive disease. During a 6-12 month follow-up period late major adverse events were evaluated, either related to the endovascular treatment or due to other pathological conditions. RESULTS: Percutaneous procedure was effective in 118/119 patients (99.16%). Procedural success rate was 99.16%, in-hospital major neurological symptomatic complications 0%, in-hospital minor neurological symptomatic complications 3.36% (two minor strokes, one transient ischemic attack and one subarachnoid hemorrhage). The follow-up observation time ranged from 6 to 36 months following the percutaneous procedure. Overall follow-up data showed absence of late major adverse events related to carotid disease (stroke, permanent neurological damage, death), in-stent restenosis 5.04%, balloon expandable stent crush 0.84%, stent migration 0.84%. CONCLUSIONS: Our data confirm that percutaneous dilation and stenting of the carotid artery represent an effective method which, during the periprocedural phase and the follow-up, does not expose the patient to any greater risk of complications than traditional surgery.

The use of coronary angioplasty devices in carotid endovascular interventions: encouraging results in 21 consecutive patients.

Severe atherosclerotic lesion of carotid artery is the main cause of stroke and transient ischemic attack (TIA). Its incidence may reach 5-7% per annum in patients with carotid artery stenosis higher than 70% with or without symptoms. While time-honored carotid endarterectomy is still regarded as the "gold standard" therapy for most of the patients, carotid angioplasty with stent may be the only alternative to this treatment when endarterectomy is too risky or impossible. Although percutaneous angioplasty has been fully acknowledged as far as coronary or peripheral artery disease is concerned, the issue is still controversial in the endovascular treatment of carotid artery disease with regard to its indications, devices to be used and long-term results. Assessment of risk relating to carotid angioplasty with stent in comparison to carotid endarterectomy continues to be difficult, since materials and methods for this approach have not been standardized yet. Our initial experience in carotid angioplasty with stent performed in 21 consecutive patients by using devices for coronary angioplasty is extremely encouraging.

Femoral Arterial Hemostasis using the Angio-Sealª System after Coronary and Vascular Percutaneous Angioplasty and Stenting.

The procedures of left cardiac catheterization and revascularization by angioplasty are associated with a substantial risk of hemorrhagic complications. This risk increases clearly in patients with an intravascular stent who require early high doses of anticoagulant therapy. The first purpose of our study was to evaluate the effectiveness of a mechanical system of femoral hemostasis (Angio-Sealª, Sherwood Davis & Geck, St. Louis, Missouri) deployed in a group of 411 consecutive patients (302 males, 109 females, mean age 59 +/- 15) who successfully underwent percutaneous angioplasty (PA) and application of an intravascular stent (378 coronary, 33 vascular). The arterial closure system consists of a small absorbable anchor and a collagen pad connected to a suture thread which, at the end of the procedure, is positioned by percutaneous introduction at the site of the femoral puncture. All the patients studied received long-term platelet anti-aggregant therapy (ticlopidine 500 mg/day and ASA 150 mg/day) for 3Ð4 days before and for one month after the procedure, and an anticoagulant regimen of heparin sodium administered via intravenous bolus (10,000 IU) during the procedure, followed by subcutaneous heparin calcium (12,500 IU/day) for 21 days. Thirteen patients were treated intravenously with 10 mg abciximab and seven received pre-procedure coumadin. The ACT when the hemostasis system was positioned was 355 +/- 43 seconds. Successful hemostasis was reached in more than 95% of the patients (394/411 pts., 95.86%). In 17 (4.14%) of the 411 patients studied, the system failed; nine (2.19%) of these were attributed by the operator to a failure of the positioning device procedure, and the remaining 8 (1.95%) were attributed to a malfunction of the system. Overall complications were observed in 23/411 (5.6%) of the patients (pts) studied; eighteen were minor non-surgical hemorrhagic complications (bleeding and/or hematoma) which occurred primarily in the first 4 hours. In 4 cases (1%) vascular surgery was necessary for femoral pseudoaneurysm repair (2 pts) and femoral hematoma (2 pts). One patient (0.24%) complained of severe claudication related to a severe stenosis in the femoral artery caused by a malpositioning of the anchor. This patient was successfully treated with balloon angioplasty and stenting of the femoral artery. The average time to early mobilization was 9 hours, and all the patients without complications were completely mobile within 12 hours after the procedure; 380/411 (92.46%) of the patients were discharged 18Ð24 hours after percutaneous angioplasty. The second purpose of our study was to compare data from 411 consecutive patients treated with the Angio-Sealª device after coronary and vascular angioplasty and stenting (Angio-Seal group), to a group of 387 consecutive patients where the femoral arterial hemostasis was obtained using manual compression after coronary angioplasty and stenting (manual compression group). We found significant differences (p < 0.01) in the most important elements concerning general patient management after the interventional procedure, with excellent improvements using the Angio-Seal device, including: successful hemostasis (95.86% vs. 88.37%); reduction of non-surgical hematomas (1.22% vs. 4.65%); reduction of surgical hematomas (0.49% vs. 2.84%); mobilization time (9 +/- 3 hours vs. 19 +/- 8 hours); and discharge within 18Ð24 hours (92.46% vs. 0.00%).

Intramural posttraumatic hematoma of the ascending aorta in a patient with a double aortic arch.

We report a case of posttraumatic intramural hematoma (IMH) of the ascending aorta in a patient with a double aortic arch and coronary artery disease. This unusual and asymptomatic finding came to our observation because the patient presented an acute myocardial infarction and underwent coronary angiography. The diagnosis was performed by magnetic resonance imaging (MRI) which defined well the anatomy of aorta and showed the characteristics of the hematoma. The data were useful in planning the surgical repair.

[Diagnostic contribution of magnetic resonance in clinically suspected arrhythmogenic dysplasia of the right ventricle]. / Contributo diagnostico della risonanza magnetica nel sospetto clinico di displasia aritmogena del ventricolo destro.

BACKGROUNDS: Magnetic Resonance (MR) imaging gives information about the complex anatomy of the right ventricle (RV). Because of the capability of tissue characterization, in addition to the functional and morphologic analysis, MR imaging is an optimal technique to investigate patients (pts) with clinical suspicion of arrhythmogenic right ventricular dysplasia (ARVD). METHODS: The purpose of the current study was to investigate a group of 55 pts with ventricular arrhythmias in order to detect ARVD. MR was performed with a 0.5 magnet (MR MAX PLUS G:E. Medical System). Electrocardiographically gated spin-echo and gradient-echo MR images of the heart were obtained in both transverse and sagittal planes. Sustained ventricular tachycardia (SVT) was present in 14 pts, non sustained ventricular tachycardia (NSVT) in 13 pts, left bundle block ventricular premature complexes > 10000/24 h (VPC/LBB) in 28 pts. The abnormalities analyzed were: presence of focal or diffuse fatty replacement of myocardium, segmental or global dilation of the RV, reduction of ejection fraction with akinetic or dyskinetic areas, disarrangement of the trabecular pattern with the hypertrophy of the moderator band. RESULTS: When intramyocardial fatty replacement and at least two of the abnormalities were present we considered the MR aspects compatible with the diagnosis of ARVD. We detected the presence of ARVD in 8/14 pts with SVT, in 4/13 pts with NSVT, in 4/28 pts VPC/LBB: In 10/16 pts with ARVD left ventricular abnormalities (areas of fatty replacement of the myocardial wall and/or reduction of ejection fraction) were also present. The left ventricular involvement was detected in 5 pts with SVT, in 2 pts with NSVT, in 3 pts with VPC/LBB: Even if in 31 pts it was not possible to identify aspects compatible with the diagnosis of ARVD, some structural abnormalities of RV were also present. Because of its non-invasiveness MR is an excellent technique for the detection of ARVD, and of minor right ventricular abnormalities.

[Angioplasty in patients already treated with aortocoronary bypass: immediate and short-term results]. / L'angioplastica nei pazienti già operati di bypass aortocoronarico: risultati immediati e a breve termine.

Percutaneous transluminal coronary angioplasty (PTCA) is performed in patients with prior aortocoronary bypass grafting (CABG) with good results in native vessels and in the coronary graft anastomoses, but with high percentage of restenosis in the body and in the proximal portion of the grafts. The use of intracoronary stents is now spreading, their implantation can improve the immediate outcome and may decrease the incidence of restenosis, mostly in the body of the graft. In order to evaluate PTCA in CABG patients as to numbers and short-term results, the data regarding the year 1993 of 10 Italian Centers are presented. In these Centers 3,519 PTCA were performed, 233 (6.6%) of which on CABG patients. PTCA has been performed in native vessels in 136 patients and in CABG in 126 patients, with 29 patients treated in native vessels as well as in CABG. An angiographic and clinical success was obtained in 215 patients (92%). A major complication occurred in 11 (4.7%) patients with 8 (3.4%) myocardial infarctions, and 3 (1.3%) deaths. Forty-five (19.3%) stents were implanted with considerable differences among the Centers. One hundred seventy-three patients were followed up for 6 months: 110 (63.6%) were asymptomatic and 57 (32.9%) had complained angina; 27 (15.6%) had a second PTCA and 6 (3.5%) had CABG surgery; 1 patient (0.6%) suffered a myocardial infarction and 7 (4%) died (3 due to CABG reinterventions). To evaluate the long-term follow-up, data regarding 58 patients submitted to PTCA in the Institute of Cardiology of Bologna since 1985 to 1993 are showed, with a 3-year follow-up (36 +/- 26 months).(ABSTRACT TRUNCATED AT 250 WORDS)

[Clinical significance of magnetic resonance and echocardiographic correlations in the evaluation of hypertrophic cardiomyopathy]. / Significato clinico della risonanza magnetica e correlazioni ecocardiografiche nella valutazione della cardiomiopatia ipertrofica.

Relatively few clinical studies have investigated the role of MRI in the patients with hypertrophic cardiomyopathy. To assess MR capabilities in defining the presence, distribution and severity of left ventricular hypertrophy, the prevalence and clinical correlations of right ventricular hypertrophy and the prevalence and clinical implications of structural myocardial abnormalities, MRI and echocardiography were performed on 37 unselected patients with hypertrophic cardiomyopathy. The two methods were in agreement in 100% of cases in diagnosing the disease and classifying left ventricular hypertrophy as asymmetric, concentric or apical, and in 92% of cases in assessing the topographic distribution of hypertrophy of ventricular segments. A statistically significant linear correlation was found between echocardiographic and MR measurements of interventricular septum (r = 0.69, p < 0.0001, SEE = 4) and left posterior wall of the left ventricle (r = 0.67, p < 0.0001, SEE = 2.4). Right ventricular hypertrophy (right anterior wall diastolic thickness > 5 mm) was demonstrated by MRI in 23 of 33 patients (70%). In this group, left posterior wall thickness and left atrial diameter were higher (15 +/- 4 vs 11 +/- 2, p < 0.01 and 45 +/- 9 vs 38 +/- 5 mm, p < 0.05, respectively). On T2-weighted sequences, areas of reduced signal intensity, probably due to myocardial fibrosis, were detected in 16 cases (43%). This group was characterized by higher max. septal thickness (25 +/- 7 vs 21 +/- 6 mm, p < 0.05) and max. left posterior wall thickness (15 +/- 9 vs 7 +/- 8 mm, p < 0.05). All the three cases with dilated and hypokinetic left ventricle showed this kind of tissue abnormality. In conclusion, MRI provided clear, accurate and exhaustive data on the presence and distribution of left ventricular hypertrophy in hypertrophic cardiomyopathy. Right ventricular hypertrophy and structural abnormalities of ventricular myocardium can also be detected and quantified. Right ventricular involvement is associated with more severe hypertrophy of left ventricular posterior wall. Structural myocardial abnormalities, probably due to fibrosis, are related to the extent of left ventricular hypertrophy.

[The role of magnetic resonance in studying hypertrophic cardiomyopathy: the echocardiographic correlations and clinical implications]. / Ruolo della risonanza magnetica nello studio della cardiomiopatia ipertrofica: correlazioni ecocardiografiche ed implicazioni cliniche.

Clinical studies evaluating the role of magnetic resonance imaging (MRI) in patients with hypertrophic cardiomyopathy are scanty. To assess the capability of MRI to define the presence, distribution and severity of left ventricular hypertrophy, the prevalence and clinical implications of right ventricular hypertrophy, the prevalence and clinical implications of myocardial structural abnormalities, MRI and echocardiography were performed in 37 unselected patients (age 10-72 years, mean 38 +/- 19) with hypertrophic cardiomyopathy. The concordance between the two methods was 100% in the diagnosis and classification of left ventricular hypertrophy as asymmetric, concentric or apical. A significant linear correlation was found between echocardiography and MRI measurements of interventricular septum (r = 0.69, p < 0.0001, SEE = 4) and left ventricular posterior wall (r = 0.67, p < 0.0001, SEE = 2.4). Right ventricular hypertrophy (right anterior wall diastolic thickness > 5 mm) was disclosed by MRI in 23/33 patients (70%). In this group, left posterior wall thickness and left atrial diameter were higher (15 +/- 4 versus 11 +/- 2 mm, p < 0.01 and 45 +/- 9 versus 38 +/- 5 mm, p < 0.05 respectively). On T2 weighted sequences, areas of reduction of signal intensity, probably caused by myocardial fibrosis, were detected in 16 cases (43%). This group was characterized by a higher value in maximal septal thickness (26 +/- 7 versus 21 +/- 6 mm, p < 0.05) and in maximal left posterior wall thickness (15 +/- 9 versus 7 +/- 8 mm, p < 0.01). All the 3 cases with dilated and hypokinetic left ventricle showed this type of tissue abnormality.(ABSTRACT TRUNCATED AT 250 WORDS)