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Article: Left Atrial Cavity Thrombus and Fatal Systemic Embolization in a Stroke Patient with Nonvalvular Atrial Fibrillation: A Caveat against Left Atrial Appendage Closure for Stroke Prevention.

Sonaglioni, Andrea / Vincenti, Antonio / Lombardo, Michele / Anzà, Claudio

2020 Volume 30, Issue 1, Page(s) 41–43

Abstract: An 88-year-old male with nonvalvular atrial fibrillation (NVAF) and severe congestive heart failure (HF), was admitted to the Neurological Intensive Care Unit because of the acute onset of aphasia and left hemiplegia. Transthoracic echocardiography ... ...

Abstract	An 88-year-old male with nonvalvular atrial fibrillation (NVAF) and severe congestive heart failure (HF), was admitted to the Neurological Intensive Care Unit because of the acute onset of aphasia and left hemiplegia. Transthoracic echocardiography revealed a left atrial (LA) cavity thrombus. Its "fatal" distal embolization to abdominal aorta occurred in a few days. These observations should lead to a cautious approach in proposing a percutaneous closure of LA appendage in older NVAF patients, with HF and/or left ventricular dysfunction and larger LA volumes, who are not adequately anticoagulated.
Language	English
Publishing date	2020-04-13
Publishing country	India
Document type	Case Reports
ZDB-ID	2734045-4
ISSN	2347-193X ; 2211-4122
ISSN (online)	2347-193X
ISSN	2211-4122
DOI	10.4103/jcecho.jcecho_46_19
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Article ; Online: Incremental diagnostic role of left atrial strain analysis in thrombotic risk assessment of nonvalvular atrial fibrillation patients planned for electrical cardioversion.

Sonaglioni, Andrea / Lombardo, Michele / Nicolosi, Gian Luigi / Rigamonti, Elisabetta / Anzà, Claudio

The international journal of cardiovascular imaging

2021 Volume 37, Issue 5, Page(s) 1539–1550

Abstract: During the COVID-19 pandemic, transesophageal echocardiography (TEE) for left atrial appendage thrombosis (LAAT) detection should be limited to situations of absolute necessity. We sought to identify the main conventional and functional echocardiographic ...

Abstract	During the COVID-19 pandemic, transesophageal echocardiography (TEE) for left atrial appendage thrombosis (LAAT) detection should be limited to situations of absolute necessity. We sought to identify the main conventional and functional echocardiographic parameters associated with LAAT on TEE in non-valvular atrial fibrillation (NVAF) patients planned for electrical cardioversion (ECV). This retrospective study included 125 consecutive NVAF patients (71.5±7.8 yrs, 75 males), who underwent TEE at our Institution between April 2016 and January 2020, to exclude LAAT before scheduled ECV. All patients underwent a transthoracic echocardiography (TTE) implemented with speckle tracking echocardiography (STE) analysis of left atrial (LA) strain and strain rate (SR) parameters. 28% of patients were diagnosed with LAAT, while 72% without LAAT. Compared to controls, patients with LAAT had significantly higher CHA
MeSH term(s)	Aged ; Atrial Appendage/diagnostic imaging ; Atrial Appendage/physiopathology ; Atrial Fibrillation/physiopathology ; Case-Control Studies ; Echocardiography ; Echocardiography, Transesophageal ; Electric Countershock ; Female ; Humans ; Male ; Retrospective Studies ; Risk Assessment ; Stroke Volume/physiology ; Thrombosis/diagnostic imaging ; Thrombosis/physiopathology
Language	English
Publishing date	2021-01-03
Publishing country	United States
Document type	Journal Article ; Observational Study
ZDB-ID	2055311-0
ISSN	1875-8312 ; 1573-0743 ; 1569-5794 ; 0167-9899
ISSN (online)	1875-8312 ; 1573-0743
ISSN	1569-5794 ; 0167-9899
DOI	10.1007/s10554-020-02127-6
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Article: A Nonfatal Massive Pulmonary Embolism in a Very Old Patient: The Protective Filter-Effect of the Chiari Network.

Sonaglioni, Andrea / Nicolosi, Gian Luigi / Lombardo, Michele / Anza, Claudio

Journal of cardiovascular echography

2019 Volume 29, Issue 1, Page(s) 32–34

Abstract: The Chiari network, a net-like structure within the right atrium, has been described as an embryonic remnant of no clinical significance. Its role in facilitating paradoxical arterial embolic events and as a potential site for thrombus formation has been ...

Abstract	The Chiari network, a net-like structure within the right atrium, has been described as an embryonic remnant of no clinical significance. Its role in facilitating paradoxical arterial embolic events and as a potential site for thrombus formation has been reported in the literature. This case illustrates the protective filter-effect of the Chiari network in a 92-year-old women who presented with the clinical signs and symptoms of acute cor pulmonale. Transthoracic echocardiography revealed a large, S-shaped, and extremely mobile right atrial thrombus within the Chiari network. Here, the authors describe how the Chiari network may have prevented the occurrence of a fatal pulmonary embolism acting as a protective factor.
Language	English
Publishing date	2019-04-03
Publishing country	India
Document type	Case Reports
ZDB-ID	2734045-4
ISSN	2347-193X ; 2211-4122
ISSN (online)	2347-193X
ISSN	2211-4122
DOI	10.4103/jcecho.jcecho_65_18
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Article ; Online: Reduced Myocardial Strain Parameters in Subjects With Pectus Excavatum: Impaired Myocardial Function or Methodological Limitations Due to Chest Deformity?

Sonaglioni, Andrea / Nicolosi, Gian Luigi / Granato, Alberto / Lombardo, Michele / Anzà, Claudio / Ambrosio, Giuseppe

Seminars in thoracic and cardiovascular surgery

2020 Volume 33, Issue 1, Page(s) 251–262

Abstract: Pectus excavatum (PE) may cause symptoms and alter cardiopulmonary function. Left ventricular (LV) and right ventricular (RV) function have been reported to be impaired in PE subjects. However, this issue has not been systematically investigated with ... ...

Abstract	Pectus excavatum (PE) may cause symptoms and alter cardiopulmonary function. Left ventricular (LV) and right ventricular (RV) function have been reported to be impaired in PE subjects. However, this issue has not been systematically investigated with respect to the degree of chest wall abnormality. We aimed to evaluate the influence of severity of chest shape abnormality on myocardial strain parameters in PE subjects. We studied 30 healthy subjects (55.8 ± 14.0 year/old, 18 males) with PE, assessed by the ratio of chest transverse diameter over the distance between sternum and spine (modified Haller index, MHI, >2.5), and 30 controls (MHI ≤2.5) matched by age, sex, and cardiovascular risk factors. Participants underwent 2-dimensional (2D) transthoracic echocardiography implemented with 2D-speckle tracking echocardiography. Right-heart and left-heart chamber dimensions, and stroke volume, were significantly reduced in PE subjects (all P< 0.0001). While LV ejection fraction, E/A, and E/e', did not significantly differ between the 2 groups, all LV and RV strain and strain rate parameters were severely reduced in subjects with PE (P < 0.0001). Importantly, in PE subjects, but not in controls, LV global longitudinal strain, LV global circumferential strain, LV global radial strain, and RV free wall systolic strain, were all linearly correlated to MHI (all P < 0.0001). In healthy subjects with PE, abnormal chest anatomy progressively impairs myocardial strain. However, this impairment is not due to subclinical myocardial dysfunction; it might reflect intraventricular dyssynchrony due to compressive phenomena, or technical limitations of strain methodology, due to chest wall abnormality.
MeSH term(s)	Funnel Chest/diagnostic imaging ; Humans ; Male ; Myocardium ; Stroke Volume ; Ventricular Dysfunction, Left/diagnostic imaging ; Ventricular Dysfunction, Left/etiology ; Ventricular Function, Left ; Ventricular Function, Right
Language	English
Publishing date	2020-05-19
Publishing country	United States
Document type	Journal Article
ZDB-ID	1038278-1
ISSN	1532-9488 ; 1043-0679
ISSN (online)	1532-9488
ISSN	1043-0679
DOI	10.1053/j.semtcvs.2020.05.003
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Article ; Online: False-positive electrocardiographic changes during exercise test in a patient with pectus excavatum.

Sonaglioni, Andrea / Nicolosi, Gian Luigi / Lombardo, Michele / Anzà, Claudio / Ambrosio, Giuseppe

Journal of clinical ultrasound : JCU

2020 Volume 48, Issue 9, Page(s) 579–584

Abstract: Exercise-induced ST-segment changes simulating myocardial ischemia have been described in otherwise normal subjects during hyperventilation. We present the case of a 60-year-old man with pectus excavatum showing significant exercise-induced "pseudo- ... ...

Abstract	Exercise-induced ST-segment changes simulating myocardial ischemia have been described in otherwise normal subjects during hyperventilation. We present the case of a 60-year-old man with pectus excavatum showing significant exercise-induced "pseudo-ischaemic" ST-segment changes with neither coronary artery disease nor anxiety-induced hyperventilation. We found no report of the possible causative role of a narrow antero-posterior chest diameter in inducing "pseudo-ischaemic" ST-segment changes during exercise stress test in the literature.
MeSH term(s)	Coronary Angiography ; Coronary Artery Disease ; Electrocardiography/methods ; Exercise Test ; Female ; Funnel Chest/diagnostic imaging ; Funnel Chest/physiopathology ; Humans ; Male ; Middle Aged ; Myocardial Ischemia/diagnostic imaging ; Myocardial Ischemia/physiopathology
Language	English
Publishing date	2020-04-06
Publishing country	United States
Document type	Case Reports
ZDB-ID	189393-2
ISSN	1097-0096 ; 0091-2751
ISSN (online)	1097-0096
ISSN	0091-2751
DOI	10.1002/jcu.22831
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Zs.A 1186: Show issues

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Article ; Online: Prognostic Relevance of Left Ventricular Thrombus Motility: Assessment by Pulsed Wave Tissue Doppler Imaging.

Sonaglioni, Andrea / Nicolosi, Gian Luigi / Lombardo, Michele / Anzà, Claudio / Ambrosio, Giuseppe

Angiology

2020 Volume 72, Issue 4, Page(s) 355–363

Abstract: Pulsed wave tissue Doppler imaging (PW-TDI) easily detects motion of cardiac structures. Hence, PW-TDI could be of value for assessing potentially cardioembolic masses. We sought to evaluate the prognostic value of left ventricular (LV) thrombus mobility ...

Abstract	Pulsed wave tissue Doppler imaging (PW-TDI) easily detects motion of cardiac structures. Hence, PW-TDI could be of value for assessing potentially cardioembolic masses. We sought to evaluate the prognostic value of left ventricular (LV) thrombus mobility assessed by PW-TDI. In 83 consecutive patients with echocardiographically detected LV thrombi, PW-TDI echocardiographic study was performed. At 1-year follow-up, the composite of major adverse cardiovascular events (MACE) defined as all-cause mortality plus hospitalizations for stroke/systemic embolism was evaluated. Seventy-two patients (77.1 ± 13.1 year/old, 32 males) were studied. All thrombi were located at the LV apex. At 1-year follow-up, 17 cardioembolic events occurred. By univariable Cox analysis, variables associated with MACE were heart rate (hazard ratio: 1.02, 95% CI: 1.00-1.05;
MeSH term(s)	Aged ; Aged, 80 and over ; Echocardiography, Doppler, Pulsed ; Embolism/etiology ; Female ; Heart Diseases/complications ; Heart Diseases/diagnostic imaging ; Heart Diseases/physiopathology ; Heart Ventricles/diagnostic imaging ; Heart Ventricles/physiopathology ; Humans ; Male ; Middle Aged ; Predictive Value of Tests ; Prognosis ; Prospective Studies ; Reproducibility of Results ; Risk Assessment ; Risk Factors ; Thrombosis/complications ; Thrombosis/diagnostic imaging ; Thrombosis/physiopathology ; Time Factors
Language	English
Publishing date	2020-11-24
Publishing country	United States
Document type	Journal Article ; Observational Study ; Video-Audio Media
ZDB-ID	80040-5
ISSN	1940-1574 ; 0003-3197
ISSN (online)	1940-1574
ISSN	0003-3197
DOI	10.1177/0003319720974882
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Article ; Online: An unusual case of painless type A aortic dissection.

Sonaglioni, Andrea / Lombardo, Michele / Rigamonti, Elisabetta / Nicolosi, Gian Luigi / Trevisan, Roberta / Zompatori, Maurizio / Anzà, Claudio

Journal of clinical ultrasound : JCU

2021 Volume 49, Issue 7, Page(s) 682–685

Abstract: The pathogenesis of acute aortic dissection (AAD) is not fully elucidated yet, but it was recently shown that inflammation contributes to the occurrence and development of both Stanford type A and type B AAD. We describe a rare case of a painless type A ... ...

Abstract	The pathogenesis of acute aortic dissection (AAD) is not fully elucidated yet, but it was recently shown that inflammation contributes to the occurrence and development of both Stanford type A and type B AAD. We describe a rare case of a painless type A aortic dissection that occurred in an 85-year-old male, with moderate calcified aortic stenosis and a moderately dilated ascending aorta in 6-month clinical and echocardiographic follow-up. A chronic calculous cholecystitis with neutrophilic leukocytosis and severely increased C reactive protein was diagnosed in the last 3 months. In this patient, a chronic systemic inflammatory state might have contributed to generate the intimal entry tear in the aortic root. In particular, a neutrophil mobilization might have played a causative role in aortic rupture.
MeSH term(s)	Acute Disease ; Aged, 80 and over ; Aneurysm, Dissecting/diagnostic imaging ; Aorta/diagnostic imaging ; Aortic Aneurysm, Thoracic ; Aortic Rupture ; Dilatation, Pathologic ; Echocardiography ; Humans ; Male
Language	English
Publishing date	2021-01-12
Publishing country	United States
Document type	Case Reports
ZDB-ID	189393-2
ISSN	1097-0096 ; 0091-2751
ISSN (online)	1097-0096
ISSN	0091-2751
DOI	10.1002/jcu.22974
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Article ; Online: Mechanical atrial recovery after cardioversion in persistent atrial fibrillation evaluated by bidimensional speckle tracking echocardiography.

Vincenti, Antonio / Genovesi, Simonetta / Sonaglioni, Andrea / Binda, Giulia / Rigamonti, Elisabetta / Lombardo, Michele / Anzà, Claudio

Journal of cardiovascular medicine (Hagerstown, Md.)

2019 Volume 20, Issue 11, Page(s) 745–751

Abstract: Background: Atrial fibrillation induces reversible electrical and mechanical modifications (atrial remodeling). Atrial stunning is a mechanical dysfunction with preserved bioelectrical function, occurring after successful atrial fibrillation electrical ... ...

Abstract	Background: Atrial fibrillation induces reversible electrical and mechanical modifications (atrial remodeling). Atrial stunning is a mechanical dysfunction with preserved bioelectrical function, occurring after successful atrial fibrillation electrical cardioversion (ECV). Two-dimensional speckle tracking echocardiography is a new technology for evaluating atrial mechanical function. We assessed atrial mechanical function after ECV with serial two-dimensional speckle tracking echocardiography evaluations. The investigated outcome was left atrium mechanical recovery within 3 months. Methods: A total of 36 patients [mean age 73 (7.9) years, 23 males] with persistent atrial fibrillation underwent conventional transthoracic and transesophageal echocardiography before ECV. Positive global atrial strain (GSA+) was assessed at 3 h, 1, 2, 3, 4 weeks and 3 months after ECV. Mechanical recovery was defined as the achievement of a GSA+ value of 21%. Results: Independent predictors of GSA+ immediately after ECV (basal GSA+) were E/e' ratio and left atrial appendage anterograde flow velocity. During the follow-up, 25% of patients suffered atrial fibrillation recurrence. In 12/36 patients (33%) left atrium mechanical recovery was detected (mechanical recovery group), while in 15/36 (42%) recovery did not occur (no atrial mechanical recovery group). At univariate analysis, the variables associated with recovery, were basal GSA+ (P = 0.015) and maximal velocity left atrial appendage (P = 0.022). Female sex (P = 0.038), N-terminal pro-B type natriuretic peptide (P = 0.013), E/e' (P = 0.042) and the indexed left atrium volume (P = 0.019) were associated with the lack of left atrium mechanical recovery. Conclusion: In almost half of the patients, the left atrium did not resume mechanical activity within the 3 months after ECV, despite sinus rhythm recovery. The left atrium of these patients was larger, stiffer and their E/E' was higher, suggesting a higher endocavitary pressure compared with mechanical recovery patients. These findings might suggest an increased thromboembolic risk.
MeSH term(s)	Aged ; Aged, 80 and over ; Atrial Fibrillation/diagnostic imaging ; Atrial Fibrillation/physiopathology ; Atrial Fibrillation/therapy ; Atrial Function, Left ; Atrial Remodeling ; Echocardiography ; Electric Countershock/adverse effects ; Female ; Humans ; Male ; Middle Aged ; Predictive Value of Tests ; Recovery of Function ; Recurrence ; Risk Factors ; Time Factors ; Treatment Outcome
Language	English
Publishing date	2019-09-04
Publishing country	United States
Document type	Comparative Study ; Journal Article ; Observational Study
ZDB-ID	2223461-5
ISSN	1558-2035 ; 1558-2027
ISSN (online)	1558-2035
ISSN	1558-2027
DOI	10.2459/JCM.0000000000000864
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Zs.A 5210: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Exercise and heart failure: an update.

Cattadori, Gaia / Segurini, Chiara / Picozzi, Anna / Padeletti, Luigi / Anzà, Claudio

ESC heart failure

2017 Volume 5, Issue 2, Page(s) 222–232

Abstract: The present update is dedicated to the evolution of the interaction between heart failure (HF) and exercise and how the scientific community has handled it. Indeed, on the one hand, HF is a leading cause of morbidity and mortality with a stable ... ...

Abstract	The present update is dedicated to the evolution of the interaction between heart failure (HF) and exercise and how the scientific community has handled it. Indeed, on the one hand, HF is a leading cause of morbidity and mortality with a stable prevalence from 1998 onward varying between 6.3% and 13.3%. On the other hand, exercise is seen as a diagnostic and prognostic tool as well as a therapeutic intervention in chronic HF. More precisely, the knowledge, the clinical application, and the research interest on the mutual interactions between exercise and HF have different phases in disease progression: Before HF onset (past): exercise provides protective benefit in preventing HF (primary prevention). With HF present: exercise improvement with training provides benefits in HF (secondary prevention). The prediction of future in HF patients: exercise impairment, as a leading characteristic of HF, is used as a prognostic factor.
MeSH term(s)	Exercise/physiology ; Exercise Therapy/methods ; Heart Failure/physiopathology ; Heart Failure/rehabilitation ; Humans ; Prognosis
Language	English
Publishing date	2017-12-13
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2814355-3
ISSN	2055-5822 ; 2055-5822
ISSN (online)	2055-5822
ISSN	2055-5822
DOI	10.1002/ehf2.12225
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Article ; Online: Early left atrial dysfunction in idiopathic pulmonary fibrosis patients without chronic right heart failure.

Sonaglioni, Andrea / Caminati, Antonella / Lipsi, Roberto / Nicolosi, Gian Luigi / Lombardo, Michele / Anzà, Claudio / Harari, Sergio

The international journal of cardiovascular imaging

2020 Volume 36, Issue 9, Page(s) 1711–1723

Abstract: No data are actually available regarding the left atrial (LA) functional assessment by two-dimensional speckle tracking echocardiography (2D-STE) in early-stage idiopathic pulmonary fibrosis (IPF). The primary end-point of our study was to assess whether ...

Abstract	No data are actually available regarding the left atrial (LA) functional assessment by two-dimensional speckle tracking echocardiography (2D-STE) in early-stage idiopathic pulmonary fibrosis (IPF). The primary end-point of our study was to assess whether global LA peak strain (GLAPS), measured by 2D-STE analysis, may detect early alterations in LA function in IPF patients without right heart failure (RHF). Between September 2017 and January 2019, 50 consecutive IPF patients (73.8 ± 6.8 years, 36 males) without chronic RHF and 30 controls matched by age, sex and cardiovascular risk factors, were enrolled in an observational retrospective case-control study. All patients underwent a complete echocardiographic study implemented with 2D-STE analysis. GLAPS, left ventricular (LV) global longitudinal strain (GLS), right atrial (RA) reservoir strain (GSA+) and right ventricular (RV)-GLS were obtained in each patient. LVFP were significantly increased in IPF patients in comparison to controls (average E/e' ratio 14.4 ± 3.0 vs 9.6 ± 1.5, p < 0.0001), while LV-GLS was slightly reduced in IPF patients compared to controls (19.4 ± 3.6% vs 21.0 ± 2.2%, p = 0.03).Moreover, GLAPS was significantly impaired in IPF patients in comparison to controls (18.4 ± 3.7% vs 28.4 ± 5.6%, p < 0.0001).Finally, the two groups of patients did not show any statistically significant difference in both RA-GSA + (23.9 ± 3.7% vs 24.5 ± 4.0%, p = 0.49) and RV-GLS (- 22.6 ± 3.3% vs - 23.5 ± 3.0%, p = 0.22). Notably, LV-GLS was strongly inversely correlated both with RV/LV basal diameter ratio and TRV in IPF patients (r = - 0.87 and - 0.82, respectively) but not in controls (r = - 0.29 and - 0.27, respectively). This finding highlights a likely process of ventricular interdependence in non-advanced IPF, with consequent LV diastolic dysfunction and secondary impairment in LV-GLS and GLAPS. Early LA reservoir dysfunction in IPF patients may be secondary to LV diastolic dysfunction induced by ventricular interdependence and may develop before RV diastolic and systolic dysfunction.
MeSH term(s)	Aged ; Aged, 80 and over ; Atrial Function, Left ; Atrial Remodeling ; Disease Progression ; Early Diagnosis ; Echocardiography, Doppler, Pulsed ; Female ; Humans ; Idiopathic Pulmonary Fibrosis/complications ; Idiopathic Pulmonary Fibrosis/diagnostic imaging ; Idiopathic Pulmonary Fibrosis/physiopathology ; Male ; Middle Aged ; Observer Variation ; Predictive Value of Tests ; Reproducibility of Results ; Retrospective Studies ; Time Factors ; Ventricular Dysfunction, Left/diagnostic imaging ; Ventricular Dysfunction, Left/etiology ; Ventricular Dysfunction, Left/physiopathology ; Ventricular Function, Left ; Ventricular Function, Right
Language	English
Publishing date	2020-05-25
Publishing country	United States
Document type	Journal Article ; Observational Study
ZDB-ID	2055311-0
ISSN	1875-8312 ; 1573-0743 ; 1569-5794 ; 0167-9899
ISSN (online)	1875-8312 ; 1573-0743
ISSN	1569-5794 ; 0167-9899
DOI	10.1007/s10554-020-01887-5
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