Publications by authors named "Marco Penso"

Background: In the multiparametric framework for diagnosing atrial secondary tricuspid regurgitation (A-STR), an end-systolic (ES) right atrial (RA) to right ventricular (RV) volume or area ratio ≥1.5 supports the diagnosis of A-STR over the ventricular STR phenotype (V-STR). However, this threshold value has never been tested.

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Background: Although the correction of the proximal isovelocity surface area (PISA) method has been shown to improve the accuracy of assessing the severity of secondary tricuspid regurgitation (STR), its clinical impact remains to be investigated. The aim of this study was to compare the association of the quantitative parameters of STR severity obtained from the corrected and conventional PISA methods with outcomes.

Methods: Both conventional and corrected effective regurgitant orifice area (EROA) (EROA vs corrected EROA [EROAc]), regurgitant volume (RegVol) (RegVol vs corrected RegVol [RegVolc]), and regurgitant fraction (RegFr) (RegFr vs corrected RegFr [RegFrc]) were measured in 519 consecutive patients (mean age, 75 ± 12 years; 44% men; 74% with ventricular STR) with moderate and severe STR.

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This work proposes a convolutional neural network (CNN) that utilizes different combinations of parametric images computed from cine cardiac magnetic resonance (CMR) images, to classify each slice for possible myocardial scar tissue presence. The CNN performance comparison in respect to expert interpretation of CMR with late gadolinium enhancement (LGE) images, used as ground truth (GT), was conducted on 206 patients (158 scar, 48 control) from Centro Cardiologico Monzino (Milan, Italy) at both slice- and patient-levels. Left ventricle dynamic features were extracted in non-enhanced cine images using parametric images based on both Fourier and monogenic signal analyses.

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Aims: To assess the accuracy of measuring the right atrial volume (RAV) using two-dimensional echocardiography (2DE) in a right ventricular focused (RVF) view compared to the conventional apical four-chamber (4Ch) view in patients with secondary tricuspid regurgitation (STR). We also compared the clinical correlates of the measures obtained using different methods.

Methods And Results: The accuracy of RAV measurements obtained between 2DE-4Ch and RVF views in 384 patients with STR were compared using three-dimensional echocardiography (3DE) as a reference.

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Article Synopsis
  • The study aimed to determine if feature-tracking strain measurements during stress cardiac MRI could help predict long-term risks of major adverse cardiac events (MACE) in patients with coronary artery disease (CAD) without needing contrast agents.
  • After analyzing 729 patients over about 6 years, the presence of late gadolinium enhancement (LGE) and stress global circumferential strain (GCS) were found to be independent indicators of MACE, occurring in 9.6% of the patients.
  • Ultimately, the research demonstrated that a contrast-free stress cardiac MRI with stress GCS could provide similar prognostic information as traditional myocardial perfusion assessments, highlighting its importance for patients with severe renal issues.
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Article Synopsis
  • This study evaluated the significance of epicardial adipose tissue (EAT) volume in predicting major cardiovascular events (MACE) in patients undergoing stress cardiac MRI.
  • A total of 730 patients were divided into two groups to develop and validate a risk assessment model that incorporates EAT volume alongside other factors like left ventricular ejection fraction and stress perfusion defects.
  • The results indicated that including EAT volume significantly improves the prediction of MACE, suggesting that automated measurements of EAT can enhance existing cardiac risk assessments.
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Background: Although cuff blood pressure measurement is a critical parameter to calculate myocardial work noninvasively, there is no recommendation about when and how to measure it. Accordingly, we sought to evaluate the effects of the timing during the echo study and the patient's position on the scanning bed during the cuff blood pressure measurement on myocardial work parameter calculations.

Methods: One hundred one consecutive patients (44 women, 66 ± 14 years) undergoing clinically indicated echocardiography were prospectively enrolled.

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Aims: We sought to investigate the association of left atrial strain with the outcome in a large cohort of patients with at least moderate aortic stenosis (AS).

Methods And Results: We analysed 467 patients (mean age 80.6 ± 8.

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Background: The assessment of ventricular secondary mitral regurgitation (v-SMR) severity through effective regurgitant orifice area (EROA) and regurgitant volume (RegVol) calculations using the proximal isovelocity surface area (PISA) method and the two-dimensional echocardiography volumetric method (2DEVM) is prone to underestimation. Accordingly, we sought to investigate the accuracy of the three-dimensional echocardiography volumetric method (3DEVM) and its association with outcomes in v-SMR patients.

Methods: We included 229 patients (70 ± 13 years, 74% men) with v-SMR.

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Background: In patients with secondary tricuspid regurgitation (STR), right atrial remodeling (RAR) is a proven marker of disease progression. However, the prognostic value of RAR, assessed by indexed right atrial volume (RAVi) and reservoir strain (RAS), remains to be clarified. Accordingly, the aim of our study is to investigate the association with outcome of RAR in patients with STR.

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Circulating small extracellular vesicles (sEVs) contribute to inflammation, coagulation and vascular injury, and have great potential as diagnostic markers of disease. The ability of sEVs to reflect myocardial damage assessed by Cardiac Magnetic Resonance (CMR) in ST-segment elevation myocardial infarction (STEMI) is unknown. To fill this gap, plasma sEVs were isolated from 42 STEMI patients treated by primary percutaneous coronary intervention (pPCI) and evaluated by CMR between days 3 and 6.

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Aims: Diagnosis of myocardial fibrosis is commonly performed with late gadolinium contrast-enhanced (CE) cardiac magnetic resonance (CMR), which might be contraindicated or unavailable. Coronary computed tomography (CCT) is emerging as an alternative to CMR. We sought to evaluate whether a deep learning (DL) model could allow identification of myocardial fibrosis from routine early CE-CCT images.

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Ischaemic heart disease (IHD) is one of the world's leading causes of morbidity and mortality. Likewise, the diagnosis and risk stratification of patients with coronary artery disease (CAD) have always been based on the detection of the presence and extent of ischaemia by physical or pharmacological stress tests with or without the aid of imaging methods (e.g.

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Background And Objective: In patients with suspected Coronary Artery Disease (CAD), the severity of stenosis needs to be assessed for precise clinical management. An automatic deep learning-based algorithm to classify coronary stenosis lesions according to the Coronary Artery Disease Reporting and Data System (CAD-RADS) in multiplanar reconstruction images acquired with Coronary Computed Tomography Angiography (CCTA) is proposed.

Methods: In this retrospective study, 288 patients with suspected CAD who underwent CCTA scans were included.

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Background: Segmentation of cardiovascular magnetic resonance (CMR) images is an essential step for evaluating dimensional and functional ventricular parameters as ejection fraction (EF) but may be limited by artifacts, which represent the major challenge to automatically derive clinical information. The aim of this study is to investigate the accuracy of a deep learning (DL) approach for automatic segmentation of cardiac structures from CMR images characterized by magnetic susceptibility artifact in patient with cardiac implanted electronic devices (CIED).

Methods: In this retrospective study, 230 patients (100 with CIED) who underwent clinically indicated CMR were used to developed and test a DL model.

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Article Synopsis
  • COVID-19 significantly impacted the healthcare system, leading to a decline in in-hospital admissions for acute myocardial infarction (AMI), but its effect on mechanical complications in ST-elevation myocardial infarction (STEMI) has not been thoroughly examined.
  • A study involving 479 STEMI patients showed a decrease in primary percutaneous coronary intervention (PCI) during the pandemic and longer symptom onset-to-door times, indicating delays in treatment.
  • Mechanical complications and in-hospital mortality for STEMI patients increased during the second wave of the pandemic, highlighting ongoing challenges despite previous healthcare adaptations.
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Background: The right ventricle (RV) plays a pivotal role in cardiovascular diseases and 3-dimensional echocardiography (3DE) has gained acceptance for the evaluation of RV volumes and function. Recently, a new artificial intelligence (AI)-based automated 3DE software for RV evaluation has been proposed and validated against cardiac magnetic resonance. The aims of this study were three-fold: (i) feasibility of the AI-based 3DE RV quantification, (ii) comparison with the semi-automatic 3DE method and (iii) assessment of 2-dimensional echocardiography (2DE) and strain measurements obtained automatically.

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Purpose Of Review: Application of deep learning (DL) is growing in the last years, especially in the healthcare domain. This review presents the current state of DL techniques applied to electronic health record structured data, physiological signals, and imaging modalities for the management of heart failure (HF), focusing in particular on diagnosis, prognosis, and re-hospitalization risk, to explore the level of maturity of DL in this field.

Recent Findings: DL allows a better integration of different data sources to distillate more accurate outcomes in HF patients, thus resulting in better performance when compared to conventional evaluation methods.

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Background: Mitral valve regurgitation (MR) is the most common valvular heart disease and current variables associated with MR recurrence are still controversial. We aim to develop a machine learning-based prognostic model to predict causes of mitral valve (MV) repair failure and MR recurrence.

Methods: 1000 patients who underwent MV repair at our institution between 2008 and 2018 were enrolled.

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MitraClip (MC) is the most common percutaneous treatment for severe mitral regurgitation (MR). An accurate two-dimensional and three-dimensional echocardiographic (3DTEE) imaging is mandatory for the optimal procedural result. Recently transillumination 3DTEE rendering (3DTr) has been introduced integrating a virtual light source into the dataset and with the addition of glass effect (3DGl) allows to adjust tissue transparency improving depth perception and anatomical structure delineation in comparison with the standard 3DTEE (3DSt).

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Background: Whereas transcatheter aortic valve implantation (TAVI) has become the gold standard for aortic valve stenosis treatment in high-risk patients, it has recently been extended to include intermediate risk patients. However, the mortality rate at 5 years is still elevated. The aim of the present study was to develop a novel machine learning (ML) approach able to identify the best predictors of 5-year mortality after TAVI among several clinical and echocardiographic variables, which may improve the long-term prognosis.

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Background And Objective: Segmentation of the left ventricular (LV) myocardium (Myo) and RV endocardium on cine cardiac magnetic resonance (CMR) images represents an essential step for cardiac-function evaluation and diagnosis. In order to have a common reference for comparing segmentation algorithms, several CMR image datasets were made available, but in general they do not include the most apical and basal slices, and/or gold standard tracing is limited to only one of the two ventricles, thus not fully corresponding to real clinical practice. Our aim was to develop a deep learning (DL) approach for automated segmentation of both RV and LV chambers from short-axis (SAX) CMR images, reporting separately the performance for basal slices, together with the applied criterion of choice.

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Cardiovascular imaging is developing at a rapid pace and the newer modalities, in particular three-dimensional echocardiography, allow better analysis of heart structures. Identifying valve lesions and grading their severity represents crucial information and nowadays is strengthened by the introduction of new software, such as transillumination, which provide detailed morphology descriptions. Chambers quantification has never been so rapid and accurate: machine learning algorithms generate automated volume measurements, including left ventricular systolic and diastolic function, which is extremely important for clinical decisions.

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