Publications by authors named "Isabel G Scalia"

The assessment of left atrial strain (LAS) has emerged as an essential component in the evaluation of cardiac function, especially in pathologies such as heart failure and atrial fibrillation. This narrative review aims to outline the available methods for assessing LAS with a major emphasis on speckle-tracking echocardiography techniques. Other imaging modalities, including cardiac magnetic resonance and cardiac computed tomography, also provide important information on LA dynamics but have disadvantages with respect to cost and availability.

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Lipoprotein (a) is a complex lipid molecule that has sparked immense interest in recent years, after studies demonstrated its significant association with several cardiovascular conditions. Lp(a) promotes cardiovascular disease through its combined proatherogenic, pro-inflammatory, and prothrombotic effects. While the measurement of Lp(a) has become widely available, effective methods to reduce its concentration are currently limited.

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Coronary CT angiography (CCTA) is now endorsed by all major cardiology guidelines for the investigation of chest pain and assessment for coronary artery disease (CAD) in appropriately selected patients. CAD is a leading cause of morbidity and mortality. There is extensive literature to support CCTA diagnostic and prognostic value both for stable and acute symptoms.

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The long-term survivorship of patients diagnosed with cancer has improved due to accelerated detection and rapidly evolving cancer treatment strategies. As such, the evaluation and management of cancer therapy related complications has become increasingly important, including cardiovascular complications. These have been captured under the umbrella term "cardiotoxicity" and include left ventricular dysfunction and heart failure, acute coronary syndromes, valvular abnormalities, pericardial disease, arrhythmia, myocarditis, and vascular complications.

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Background: Residual mitral regurgitation (MR) is frequent after transcatheter edge-to-edge repair (TEER). There is controversy regarding the clinical impact of residual MR and its quantitative assessment by transthoracic echocardiography (TTE), which is often challenging with multiple eccentric jets and artifact from the clip. The utility of the velocity time integral (VTI) ratio between the mitral valve (MV) and left ventricular outflow tract (LVOT), (VTI), a simple Doppler measurement that increases with MR, has not been assessed post TEER.

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Article Synopsis
  • The study looked at Lipoprotein(a) [Lp(a)] and its connection to a type of heart problem called in-stent restenosis (ISR) after a procedure called PCI.
  • Researchers tracked 1,209 adult patients who had their Lp(a) levels checked before the PCI and found more ISR in patients with high Lp(a) levels.
  • The study concluded that high Lp(a) levels are a strong predictor for developing ISR over time, so doctors should pay attention to Lp(a) when treating patients.
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Apical hypertrophic cardiomyopathy (HCM) is a rare variant of HCM. A 43-year-old female with a past medical history significant for hypertension and kidney transplantation presented with recurrent syncopal episodes and dyspnea on exertion. Electrocardiogram showed characteristic diffuse giant T-waves inversion, and cardiac magnetic resonance showed HCM with circumferential apical thickening.

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Article Synopsis
  • The study focuses on cardiac amyloidosis (CA) in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement (TAVR), highlighting that CA commonly leads to poor outcomes for these patients.
  • The researchers analyzed data from 1,426 TAVR patients using an ECG AI model to predict CA risk, discovering that 24.4% had a high probability of CA, yet only 1.2% were clinically diagnosed.
  • Results showed that a high CA probability significantly correlated with increased all-cause mortality and rates of major adverse cardiovascular events, particularly heart failure hospitalizations, suggesting that these patients should undergo further diagnostic assessment for CA.
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Cardiac amyloidosis (CA) is an underdiagnosed form of infiltrative cardiomyopathy caused by abnormal amyloid fibrils deposited extracellularly in the myocardium and cardiac structures. There can be high variability in its clinical manifestations, and diagnosing CA requires expertise and often thorough evaluation; as such, the diagnosis of CA can be challenging and is often delayed. The application of artificial intelligence (AI) to different diagnostic modalities is rapidly expanding and transforming cardiovascular medicine.

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Article Synopsis
  • Systemic vasculitides are rare diseases that can impact multiple organs and are difficult to diagnose due to their vague symptoms.
  • They are categorized based on the size of the blood vessels involved—large, medium, and small—each associated with specific conditions like giant cell arteritis and Kawasaki disease.
  • Advances in imaging techniques, such as ultrasound and PET scans, have significantly improved the diagnosis and evaluation of these complex diseases.
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Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiomyopathy. It follows an autosomal dominant inheritance pattern in most cases, with incomplete penetrance and heterogeneity. It is familial in 60% of cases and most of these are caused by pathogenic variants in the core sarcomeric genes (, , , , , , , ).

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Cardiac allograft vasculopathy (CAV) is a distinct form of coronary artery disease that represents a major cause of death beyond the first year after heart transplantation. The pathophysiology of CAV is still not completely elucidated; it involves progressive circumferential wall thickening of both the epicardial and intramyocardial coronary arteries. Coronary angiography is still considered the gold-standard test for the diagnosis of CAV, and intravascular ultrasound (IVUS) can detect early intimal thickening with improved sensitivity.

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  • High altitude can reduce oxygen levels, causing problems like shortness of breath and fatigue for some people.
  • A special test called Hypoxic Simulation Testing (HST) was used to see how the heart reacts to lower oxygen levels.
  • The study found that many patients had increased pressure in their heart, and some even had blood flow issues only noticed during low oxygen conditions, which could explain their breathing problems at high altitudes.
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  • Advances in the management of congenital heart disease have led to increased survival rates for patients into adulthood, but this brings potential complications like pulmonary hypertension associated with congenital heart disease (PAH-CHD).
  • PAH-CHD is a complex form of pulmonary hypertension that requires specialized care to enhance patients' quality of life and prognosis.
  • While new treatments have improved outcomes for pulmonary arterial hypertension, the long-term effects on PAH-CHD patients are still unclear, highlighting the need for treatment plans based on healthcare providers' clinical experience.
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Aortic valve stenosis (AS) is increasing in prevalence due to the aging population, and severe AS is associated with significant morbidity and mortality. Echocardiography remains the mainstay for the initial detection and diagnosis of AS, as well as for grading of severity. However, there are important subgroups of patients, for example, patients with low-flow low-gradient or paradoxical low-gradient AS, where quantification of severity of AS is challenging by echocardiography and underestimation of severity may delay appropriate management and impart a worse prognosis.

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Chest radiography (CXR) is the most frequently performed radiological test worldwide because of its wide availability, non-invasive nature, and low cost. The ability of CXR to diagnose cardiovascular diseases, give insight into cardiac function, and predict cardiovascular events is often underutilized, not clearly understood, and affected by inter- and intra-observer variability. Therefore, more sophisticated tests are generally needed to assess cardiovascular diseases.

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Background: Stress echocardiography (SE) is an established technique for assessment of coronary artery disease (CAD) which is difficult to perform and interpret. Left ventricular stroke volume (SV) is readily estimated with Doppler echocardiography. It can be affected by myocardial ischemia, with possible adjunctive value during SE.

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Background: Acute pulmonary embolism (PE) is characterized hemodynamically by abrupt obstruction in trans-pulmonary blood flow. The echocardiographic Pulmonary to Left Atrial ratio (ePLAR, tricuspid regurgitation V/mitral E/e') has been validated as a non-invasive surrogate for trans-pulmonary gradient (TPG) that accurately differentiates from chronic pulmonary hypertension. This study assessed ePLAR as an incremental echocardiographic assessment tool compared with traditional measures of right ventricular pressure and function.

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Background: Exercise stress echocardiography (SE) is well validated for the evaluation of myocardial ischemia. Diastolic stress testing (DST) is recommended in the 2016 American Society of Echocardiography and European Association of Cardiovascular Imaging Guidelines for unexplained dyspnea. This study's aim was to prognostically evaluate the DST prospectively in a large stress testing population.

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Background: The application of left ventricular (LV) global strain by speckle-tracking is becoming more widespread, with the potential for incorporation into routine clinical echocardiography in selected patients. There are no guidelines or recommendations for the training requirements to achieve competency. The aim of this study was to determine the learning curve for global strain analysis and determine the number of studies that are required for independent reporting.

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• A 74 year old male presented with bilateral submassive pulmonary emboli with moderately severe pulmonary hypertension with right ventricular systolic pressure (RVSP) 63 mm Hg. • Echocardiographic pulmonary-to-left atrial ratio (ePLAR) markedly elevated at 0.78 m/s (normal range for age 0.

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Background: Right heart catheterisation is the gold-standard for differentiating pre-capillary pulmonary hypertension (high mean pulmonary artery pressure, normal pulmonary wedge pressure) from post-capillary physiology (elevated pulmonary wedge pressure). The new non-invasive parameter, ePLAR (echocardiographic Pulmonary to Left Atrial Ratio) is calculated from the maximum tricuspid regurgitation continuous wave Doppler velocity (m/s) divided by the transmitral E-wave:septal mitral annular Doppler Tissue Imaging e'-wave ratio (TRVmax/E:e').

Methods: Pulmonary hypertension patients (mean pulmonary artery pressure>25mmHg, n=133, 66 male, average 65.

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