Publications by authors named "Giorgio De Conti"

Arrhythmogenic cardiomyopathy (ACM) is a genetic disorder characterized by fibrofatty replacement of myocardial tissue, predominantly affecting the right ventricle (RV), but often involving the left ventricle (LV) as well. The early detection of fibrosis, crucial for risk stratification, has been enhanced by advanced imaging techniques. Global longitudinal strain (GLS) has shown promise as a surrogate marker for late enhancement (LE) in identifying myocardial fibrosis, yet precise cut-off values for strain are lacking.

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Left ventricular non-compaction (LVNC) is a rare heart muscle disease defined by the presence of prominent left ventricular trabeculation, deep intertrabecular recesses, and a thin compact layer. Several hypotheses have been proposed regarding its pathogenesis, with the most recently accepted one being that compact layer and trabeculated layers develop independently according to an "allometric growth". The current gold-standard diagnostic criteria (in particular, the Petersen index non-compaction/compaction ratio > 2.

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Coronary artery disease (CAD) is the leading global cause of mortality, accounting for approximately 30% of all deaths. It is primarily characterized by the accumulation of atherosclerotic plaques within the coronary arteries, leading to reduced blood flow to the heart muscle. Early detection of atherosclerotic plaques is crucial to prevent major adverse cardiac events.

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Article Synopsis
  • - The study investigates the use of cardiac computed tomography angiography (CCTA) as a non-invasive alternative to invasive coronary angiography (ICA) for assessing cardiac allograft vasculopathy (CAV) after heart transplantation.
  • - Conducted from March 2021 to February 2023, the research included 260 heart transplant patients, revealing that those undergoing CCTA had significantly lower costs and shorter hospital stays compared to those who underwent ICA.
  • - The findings suggest that CCTA is a safer and more cost-effective option for CAV surveillance post-heart transplantation, using less contrast and radiation than ICA.
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: Cardiovascular magnetic resonance (CMR) has emerged as the most accurate, non-invasive method to support the diagnosis of clinically suspected myocarditis and as a risk-stratification tool in patients with cardiomyopathies. We aim to assess the diagnostic and prognostic role of CMR at diagnosis in patients with myocarditis. We enrolled consecutive single-center patients with 2013 ESC consensus-based endomyocardial biopsy (EMB)-proven or clinically suspected myocarditis undergoing CMR at diagnosis.

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  • Mitral valve prolapse (MVP) can lead to ventricular arrhythmias (VA) even without significant valve regurgitation, which might be influenced by conditions like mitral annulus disjunction (MAD), curling, and myocardial fibrosis.
  • A study with 108 MVP patients found that those with arrhythmic MVP had greater MAD, higher prevalence of curling, and more left ventricular fibrosis compared to non-arrhythmic patients.
  • The results suggested that curling directly and indirectly affects VA, while MAD’s association with VA is completely mediated by myocardial fibrosis, indicating that more severe morphologic changes correlate with the severity of VA.
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Motor-vehicle accidents often result in lower limb injuries with biosseous fractures. The present study aimed at comparing multi-slice computed tomography (MS-CT), micro-computed tomography (micro-CT) and external fractography for the analyses of experimentally produced biosseus leg fractures. Briefly, 48 human legs amputated for medical reasons were defleshed and then experimentally fractured using a 3-point dynamic bending model (70,6 J of impact energy at the middle of the anterior surface of the tibia) producing 38 biosseous and 10 mono-osseous fractures with a total of 86 fractured bones.

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The analysis of the sternoclavicular joint holds significant importance in forensic anthropology, especially through the evaluation of medial clavicular ossification stage, which, however, is helpful only in subjects younger than 30 years of age. Given this limitation, the aim of the present work was to examine, through micro-CT, the surface of sternoclavicular joints of deceased individuals across various age groups, aiming to identify age-related degenerative changes applicable to age estimation in adults over 30 years old. A total of 41 deceased subjects were categorized into three age groups (20-39 years; 40-59 years; ≥60 years) for the analysis.

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Article Synopsis
  • Left ventricular fibrosis is important for understanding arrhythmias in patients with mitral valve prolapse (MVP), and cardiac magnetic resonance imaging identifies this using late gadolinium enhancement (LGE) techniques, which currently lack standardized protocols.
  • A study with 66 MVP patients assessed LV fibrosis using different methods, including semi-automated gray-scale thresholding based on standard deviations and compared them to visual assessments.
  • Among the techniques, the 5-standard deviation gray-scale thresholding showed the best correlation with visual assessments and demonstrated high reproducibility in quantifying LGE in these patients.
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Background: The Petersen' index reflects an excess of myocardial trabeculation which is not a specific morpho-functional feature of left ventricular non-compaction (LVNC) cardiomyopathy, but a "phenotypic trait" even observed in association with other myocardial diseases and over-loading conditions. The present study was designed to evaluate the relation between a critical thinning of compact layer and the development of systolic dysfunction and LVNC cardiomyopathy.

Methods: We compared CMR morpho-functional features and measurements of LV wall thickness using a 17 segment model of a cohort of patients fulfilling the Petersen criterion for LVNC with LV systolic dysfunction versus those of a cohort of age- and sex-matched controls with LVNC and preserved LV systolic function.

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Article Synopsis
  • Heart transplantation is a key treatment for severe heart failure, improving both survival and quality of life for patients, but requires ongoing monitoring for best results.
  • Current guidelines on monitoring methods are not detailed, especially regarding the use of echocardiograms and cardiac magnetic resonance as alternatives to invasive procedures like endomyocardial biopsies.
  • Recent advancements in non-invasive imaging techniques, such as advanced echocardiography and cardiac computed tomography, show potential for reducing invasive procedures while still providing valuable insights into heart health post-transplant.
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  • - Cardiac computed tomography angiography (CCTA) is an effective and efficient method for identifying coronary artery disease, with the coronary artery calcium (CAC) score being a key measure for evaluating cardiovascular risk.
  • - The CAC score, particularly when analyzed alongside plaque characteristics, provides better risk assessment than traditional methods, especially for asymptomatic patients, indicating that a score of 0 suggests a favorable prognosis and higher scores signal increased cardiovascular risk.
  • - The paper discusses how integrating CAC scoring with machine learning could improve risk stratification and clinical decision-making for patients with cardiovascular concerns.
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Article Synopsis
  • Acute myocardial edema (AME) is an increase in water content in the heart muscle that occurs shortly after an injury.
  • Cardiac magnetic resonance (CMR) imaging is a useful non-invasive tool for detecting AME and helps in diagnosing conditions like acute coronary syndromes and myocarditis.
  • This article discusses the significance of AME in heart diseases and explores evidence suggesting it might have a positive prognostic value in various clinical situations.
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Objective: (1) to describe the frequency of minimal disease activity (MDA) in a real-life psoriatic arthritis (PsA) cohort, (2) to longitudinally explore predictors of MDA; (3) to examine frequency and predictors of low disease activity (LDA) in patients with axial involvement (axPsA).

Methods: consecutive PsA patients in stable biological/targeted-synthetic Disease-Modifying Anti-Rheumatic Drugs (bDMARDs/tDMARDs) who attended our center were enrolled. Disease activity indices, including MDA and ankylosing spondylitis disease activity score-LDA (ASDAS-LDA) for axPsA, were evaluated at baseline and every 6 months, up to 36 months or bDMARDs/tsDMARDs discontinuation.

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  • The study evaluated the coaxial (CX) technique for CT-guided lung percutaneous needle biopsy (PNB) over a 7-year period involving 700 patients to determine its diagnostic effectiveness and complications.
  • The CX technique showed a high diagnostic accuracy of 93%, enabling the collection of multiple tissue specimens from a single puncture, but had a notable incidence of pulmonary hemorrhage (55.4%) and pneumothorax (42.9%).
  • Overall, the study concluded that the CX technique is highly effective for lung biopsies while identifying factors to enhance diagnostic outcomes and reduce complications.
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Aims: We assessed the feasibility of cardiac magnetic resonance (CMR) and the role of myocardial strain in the diagnostic work-up of patients with acute myocardial infarction (AMI) and a clinical suspicion of cardiac rupture (CR).

Methods And Results: Consecutive patients with AMI complicated by CR who underwent CMR were enrolled. Traditional and strain CMR findings were evaluated; new parameters indicating the relative wall stress between AMI and adjacent segments, named wall stress index (WSI) and WSI ratio, were analysed.

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Spontaneous coronary artery dissection (SCAD) is a cause of acute coronary syndrome and myocardial infarction, more frequent among young women. Invasive coronary angiography (ICA) is the gold standard for the diagnosis of SCAD, although the risk of propagating dissection flap is considerable. Therefore, coronary computed tomography angiography (CCTA) is an emerging alternative modality to diagnose SCAD with the advantage of being a non-invasive technique.

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Background: Intra-atrial right coronary artery (RCA) is a rare and generally asymptomatic anomaly of development of the coronary arteries. This malformation could potentially expose the patient to a catastrophic outcome in the case of injury during interventional or surgical procedures. Currently, only a few case reports and no systematic reviews are available in the literature.

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Arrhythmogenic cardiomyopathy (ACM) is a genetically determined heart muscle disease characterized by fibro-fatty myocardial replacement, clinically associated with malignant ventricular arrhythmias and sudden cardiac death. Originally described a disease with a prevalent right ventricular (RV) involvement, subsequently two other phenotypes have been recognized, such as the left dominant and the biventricular phenotypes, for which a recent International Expert consensus document provided upgrade diagnostic criteria (the 2020 "Padua Criteria"). In this novel workup for the diagnosis of the entire spectrum of phenotypic variants of ACM, including left ventricular (LV) variants, cardiac magnetic resonance (CMR) has emerged as the cardiac imaging technique of choice, due to its capability of detailed morpho-functional and tissue characterization evaluation of both RV and LV.

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Clinical evidence has emphasized the importance of coronary plaques’ characteristics, rather than lumen stenosis, for the outcome of cardiovascular events. Coronary computed tomographic angiography (CCTA) has a well-established role as a non-invasive tool for assessing plaques. The aim of this study was to compare clinical characteristics and CCTA-derived information of stable patients with non-severe plaques in predicting major adverse cardiac events (MACEs) during follow-up.

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