Publications by authors named "Alessandro Malagoli"

Heart and lung sharing the same anatomical space are influenced by each other. Spontaneous breathing induces dynamic changes in intrathoracic pressure, impacting cardiac function, particularly the right ventricle. In intensive care units (ICU), mechanical ventilation (MV) and therefore positive end-expiratory pressure (PEEP) are often applied, and this inevitably influences cardiac function.

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Interest in advanced echocardiographic imaging methods is growing. Left atrial strain (LAS) is among recently developed echocardiographic parameters. LAS represents an index of tissue deformation of the left atrium (LA).

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Article Synopsis
  • Heart failure (HF) is a condition marked by structural and functional heart issues that lead to poor blood flow and elevated heart pressures, often stemming from injuries or diseases affecting the heart.
  • Early detection of the causes of HF is crucial for accurate diagnosis and treatment; echocardiography is the primary tool for identifying both obvious and subtle heart problems.
  • Stress echocardiography (SE) is gaining recognition not just for diagnosing ischemic heart disease, but also for assessing other types of heart failure and guiding treatment plans, highlighting its added value in patient management.
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  • International Guidelines use left ventricular ejection fraction (LVEF) to classify heart failure patients and determine treatments, but LVEF has technical limitations and may not predict outcomes in advanced cases.
  • Analysis of left ventricular flow metrics and non-invasive pressure evaluations can provide better prognostic insights for heart failure patients.
  • Speckle tracking echocardiography (STE) effectively reveals underlying myocardial dysfunction, particularly in patients with preserved LVEF, and offers valuable metrics like global peak atrial longitudinal strain (PALS) for assessing left ventricular filling pressure and function.*
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Cardiac resynchronization therapy (CRT) is a device-based treatment applied to patients with a specific profile of heart failure. According to current guidelines, indication for CRT is given on the basis of QRS morphology and duration, and traditional transthoracic echocardiography is mainly used to estimate left ventricular (LV) ejection fraction. However, the identification of patients who may benefit from CRT remains challenging, since the application of the above-mentioned guidelines is still associated with a high rate of non-responders.

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Article Synopsis
  • The Italian Society of Echography and Cardiovascular Imaging (SIECVI) conducted a national survey to investigate stress echocardiography (SE) practices across Italy, collecting data from 228 laboratories in November 2022.
  • The survey revealed that out of 179 centers performing SE, most were located in northern Italy, and the study categorized them into low, moderate, and high volume of activity based on the number of SE examinations.
  • Key findings indicated differences in the use of stressors, with a tendency for high-volume centers to employ multiple stress techniques and incorporate advanced evaluations like coronary flow velocity reserve (CFVR) more frequently than low and moderate volume centers.
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  • This review focuses on the use of exercise stress echocardiography (ESE) to evaluate cardiovascular health in athletes, who may show both normal adaptations and potential health issues due to intense training.
  • ESE provides valuable information about heart function, reserve, and arrhythmias, helping to differentiate between athlete's heart and other cardiovascular diseases.
  • The review discusses advanced techniques like LV global longitudinal strain and myocardial work for detecting hidden heart problems, while also addressing the limitations and challenges of accurately interpreting ESE results.
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Mitral valve prolapse (MVP) is usually regarded as a benign condition though the proportion of patients with a life-threatening arrhythmic MVP form remains undefined. Recently, an experts' consensus statement on arrhythmic MVP has proposed approaches for risk stratification across the spectrum of clinical manifestation. However, sudden cardiac death may be the first presentation, making clinicians focused to early unmasking this subset of asymptomatic patients.

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Background: The Italian Society of Echocardiography and Cardiovascular Imaging (SIECVI) conducted a national survey to understand better how different echocardiographic modalities are used and accessed in Italy.

Methods: We analyzed echocardiography laboratory activities over a month (November 2022). Data were retrieved via an electronic survey based on a structured questionnaire, uploaded on the SIECVI website.

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Echocardiography has been included as a first-line tool in several international guidelines for the management of patients with various cardiac diseases. Beyond diagnosis, echocardiographic examination helps in characterizing the severity of the condition since the very first stages. In particular, the application of second-level techniques, speckle tracking echocardiography in particular, can also reveal a subclinical dysfunction, while the standard parameters are in the normality range.

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Aims: Sacubitril/valsartan has changed the treatment of heart failure with reduced ejection fraction (HFrEF), due to the positive effects on morbidity and mortality, partly mediated by left ventricular (LV) reverse remodelling (LVRR). The aim of this multicenter study was to identify echocardiographic predictors of LVRR after sacubitril/valsartan administration.

Methods And Results: Patients with HFrEF requiring therapy with sacubitril/valsartan from 13 Italian centres were included.

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Few studies analyzed left atrial (LA) peak atrial longitudinal strain (PALS) determinants, particularly across heart failure (HF) stages. We aimed to analyze the pathophysiological and clinical PALS correlates in a large multicentric prospective study. This is a multicenter prospective observational study enrolling 745 patients with HF stages.

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Aims: This sub-study deriving from a multicentre Italian register [Deformation Imaging by Strain in Chronic Heart Failure Over Sacubitril-Valsartan: A Multicenter Echocardiographic Registry (DISCOVER)-ARNI] investigated whether sacubitril/valsartan in addition to optimal medical therapy (OMT) could reduce the rate of implantable cardioverter-defibrillator (ICD) indications for primary prevention in heart failure with reduced ejection fraction (HFrEF) according to European guidelines indications, and its potential predictors.

Methods And Results: In this observational study, consecutive patients with HFrEF eligible for sacubitril/valsartan from 13 Italian centres were included. Lack of follow-up or speckle tracking data represented exclusion criteria.

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Background: Acute right ventricular (RV) failure is common in patients hospitalized with COVID-19. Compared to the conventional echocardiographic parameters, right ventricular longitudinal strain (RVLS) is more sensitive and accurate for the diagnosis of RV systolic dysfunction.

Objective: Our purpose was to investigate the sustained RV dysfunction echo-quantified by RVLS in patients recovered from severe COVID-19.

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Aims: The clinical and prognostic importance of functional mitral regurgitation (FMR) in heart failure patients with reduced ejection fraction (HFrEF) has been highly debated. This study aims to define FMR linkage to cardiovascular (CV) outcomes and the interplay with left atrial (LA) function in a prospective cohort of consecutive HFrEF outpatients.

Methods And Results: Overall, 286 consecutive outpatients with chronic HFrEF were prospectively enrolled.

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Background: The COVID-19 pandemic carries a high burden of morbidity and mortality worldwide. We aimed to identify possible predictors of in-hospital major cardiovascular (CV) events in COVID-19.

Methods: We retrospectively included patients hospitalized for COVID-19 from 10 centers.

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Left ventricular (LV) global longitudinal strain (GLS) has established itself in the last decade as a reliable, more objective method for the evaluation of LV systolic function, able to detect subtle abnormalities in LV contraction even in the presence of preserved ejection fraction (EF). However, recent studies have demonstrated that GLS, similar to LV EF, has important load dependency. Non-invasive myocardial work (MW) quantification has emerged in the last years as an alternative tool for myocardial function assessment.

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Background: Patients with coronavirus disease 2019 (COVID-19) exhibit high thrombotic risk. The evidence on a potential independent prognostic role of antiplatelet treatment in those patients is limited. The aim of the study was to evaluate the prognostic impact of pre-admission low-dose acetylsalicylic acid (ASA) in a wide series of hospitalized patients with COVID-19.

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With stress echo (SE) 2020 study, a new standard of practice in stress imaging was developed and disseminated: the ABCDE protocol for functional testing within and beyond CAD. ABCDE protocol was the fruit of SE 2020, and is the seed of SE 2030, which is articulated in 12 projects: 1-SE in coronary artery disease (SECAD); 2-SE in diastolic heart failure (SEDIA); 3-SE in hypertrophic cardiomyopathy (SEHCA); 4-SE post-chest radiotherapy and chemotherapy (SERA); 5-Artificial intelligence SE evaluation (AI-SEE); 6-Environmental stress echocardiography and air pollution (ESTER); 7-SE in repaired Tetralogy of Fallot (SETOF); 8-SE in post-COVID-19 (SECOV); 9: Recovery by stress echo of conventionally unfit donor good hearts (RESURGE); 10-SE for mitral ischemic regurgitation (SEMIR); 11-SE in valvular heart disease (SEVA); 12-SE for coronary vasospasm (SESPASM). The study aims to recruit in the next 5 years (2021-2025) ≥10,000 patients followed for ≥5 years (up to 2030) from ≥20 quality-controlled laboratories from ≥10 countries.

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Article Synopsis
  • This study investigates how echocardiographic laboratories in Italy were organized and operated during the second wave of the COVID-19 pandemic, comparing it to the same period in 2019.
  • Findings show significant reductions in both hospital and outpatient echocardiographic activities, with many labs partially or fully interrupted during the pandemic.
  • Safety measures improved for operators, with a widespread use of personal protective equipment, and the study noted an increase in outpatient waiting times for echocardiograms and a rise in the use of point-of-care cardiac ultrasound during the pandemic.
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Aims: Heart failure with preserved ejection fraction (HFpEF) is a growing public health problem. Impairment in left ventricular (LV) diastolic function has been proposed as a key pathophysiologic determinant. However, the role of concomitant systolic dysfunction despite preserved LV ejection fraction (LVEF) has not been well characterized.

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Stress echo (SE) 2030 study is an international, prospective, multicenter cohort study that will include >10,000 patients from ≥20 centers from ≥10 countries. It represents the logical and chronological continuation of the SE 2020 study, which developed, validated, and disseminated the "ABCDE protocol" of SE, more suitable than conventional SE to describe the complex vulnerabilities of the contemporary patient within and beyond coronary artery disease. SE2030 was started with a recruitment plan from 2021 to 2025 (and follow-up to 2030) with 12 subprojects (ranging from coronary artery disease to valvular and post-COVID-19 patients).

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Anderson-Fabrydisease is an X-linked lysosomal storage disorder caused by a deficiency in the lysosomal enzyme α-galactosidase A. This results in pathological accumulation of glycosphingolipids in several tissues and multi-organ progressive dysfunction. The typical clinical phenotype of Anderson-Fabry cardiomyopathy is progressive hypertrophic cardiomyopathy associated with rhythm and conduction disturbances.

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