Publications by authors named "Raffaella Motta"

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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  • Caseous calcification of the mitral annulus (CCMA) is a rare condition that impacts the heart's mitral valve area, requiring various diagnostic methods for accurate identification.
  • An 82-year-old woman with worsening heart failure was found to have a large, fixed mass affecting her mitral valve, leading to severe mitral regurgitation as shown by echocardiograms and CT scans.
  • Due to her age, traditional surgery was deemed unsuitable, so a less invasive transcatheter repair procedure was performed, resulting in only mild residual heart valve leakage.
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  • - 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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  • Complete transposition of the great arteries (C-TGA) is a congenital heart defect where the main arteries are switched, making early detection and management essential for successful outcomes.
  • Imaging techniques, including fetal echocardiography, transthoracic echocardiography (TTE), cardiovascular magnetic resonance (CMR), and cardiac computed tomography (CCT), are crucial for diagnosing, planning treatment, and monitoring C-TGA patients over time.
  • A combined use of TTE, CMR, and CCT can significantly improve the accuracy of assessments, inform surgical and treatment decisions, and enhance long-term care and outcomes for those affected by this condition.
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The current use of intracorporeal left ventricular assist devices in children is still limited by small body dimensions. Many children weighing of less than 30 kg requiring durable mechanical circulatory support are implanted with the Berlin Heart EXCOR, a paracorporeal device. We present the case of a girl aged 10 years with a body surface area of 1.

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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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  • Arrhythmogenic Cardiomyopathy (AC) is a genetic heart disease that leads to heart muscle replacement with fat and fibrous tissue, increasing the risk of sudden cardiac death from irregular heartbeats.
  • A combination of imaging techniques—echocardiography, cardiac magnetic resonance (CMR), and cardiac computed tomography (CCT)—is crucial for diagnosing AC, assessing risks, and monitoring the condition to enhance patient care and prevent sudden cardiac death.
  • Echocardiography is mainly used for evaluating heart structure and function, CMR gives detailed images over time, while CCT helps identify other heart issues early on, making these methods complementary in managing AC.
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Background: Mechanical cardiac support is currently an effective strategy to reduce morbidity and mortality in pediatric patients. However, solid evidence regarding the feasibility of intracorporeal devices in children still needs to be provided. We report our 10-year experience with intracorporeal left ventricular assist devices (LVAD) in children.

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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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Primary sclerosing cholangitis is a chronic cholestatic liver disease characterized by inflammation and fibrosis of intra- and/or extrahepatic bile ducts leading to the formation of multifocal strictures alternated to bile duct dilatations. The diagnosis of the most common subtype of the disease, the large duct PSC, is based on the presence of elevation of cholestatic indices, the association of typical cholangiographic findings assessed by magnetic resonance cholangiography and the exclusion of causes of secondary sclerosing cholangitis. Liver biopsy is not routinely applied for the diagnosis of large duct PSC but is mandatory in the case of suspicion of small duct PSC or overlap with autoimmune hepatitis.

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  • 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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Advanced heart failure (AHF) presents a complex landscape with challenges spanning diagnosis, management, and patient outcomes. In response, the integration of multimodality imaging techniques has emerged as a pivotal approach. This comprehensive review delves into the profound significance of these imaging strategies within AHF scenarios.

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  • * Medical imaging revealed that the pacemaker lead perforated both the right ventricular apex and the left internal mammary artery.
  • * The patient was treated with embolization and lead extraction, and he had a successful recovery, emphasizing the need for clinicians to consider right ventricular perforation as a risk post-pacemaker implantation.
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Vascular inflammation is recognized as the primary trigger of acute coronary syndrome (ACS). However, current noninvasive methods are not capable of accurately detecting coronary inflammation. Epicardial adipose tissue (EAT) and pericoronary adipose tissue (PCAT), in addition to their role as an energy reserve system, have been found to contribute to the development and progression of coronary artery calcification, inflammation, and plaque vulnerability.

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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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Tetralogy of Fallot (TOF) is the most common complex congenital heart disease with long-term survivors, demanding serial monitoring of the possible complications that can be encountered from the diagnosis to long-term follow-up. Cardiovascular imaging is key in the diagnosis and serial assessment of TOF patients, guiding patients' management and providing prognostic information. Thorough knowledge of the pathophysiology and expected sequalae in TOF, as well as the advantages and limitations of different non-invasive imaging modalities that can be used for diagnosis and follow-up, is the key to ensuring optimal management of patients with TOF.

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  • The arterial switch operation (ASO) is now the main surgery for treating d-transposition of the great arteries, leading to better survival rates, but some patients develop a condition called gothic aortic arch (GAA).
  • The GAA is linked to changes in heart function, blood flow, and exercise ability, with studies showing negative effects like reduced aorta flexibility and increased cardiovascular risks.
  • Various imaging techniques are essential for understanding the GAA’s impact, but there are still gaps in knowledge about its long-term effects, prompting research into advanced imaging and modeling for better patient outcomes.
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  • 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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Purpose: To assess the role of muscle composition and radiomics in predicting allograft rejection in lung transplant.

Material And Methods: The last available HRCT before surgery of lung transplant candidates referring to our tertiary center from January 2010 to February 2020 was retrospectively examined. Only scans with B30 kernel reconstructions and 1 mm slice thickness were included.

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Heart valve leaflet's aneurysm is a rare finding, and literature about this topic is sparse. Early recognition is important because their rupture can lead to catastrophic valve regurgitation. An 84-year-old male with chronic ischemic cardiomyopathy was admitted to the coronary intensive care unit for non-ST elevation myocardial infarction.

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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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