Pedrotti Dott.ssa Patrizia

Pubblicazioni su PubMed

• Clinical parameters of death and heart failure hospitalization in biventricular systolic dysfunction assessed via cardiac magnetic resonance.
  Int J Cardiol

  2024 Nov;419():132709. doi: 10.1016/j.ijcard.2024.132709.
  
  Al'Aref Subhi J, Gautam Nitesh, Mansour Munthir, Alqaisi Omar, Tarun Tushar, Devabhaktuni Subodh, Atreya Auras, Abete Raffaele, Aquaro Giovanni Donato, Baggiano Andrea, Barison Andrea, Bogaert Jan, Camastra Giovanni, Carigi Samuela, Carrabba Nazario, Casavecchia Grazia, Censi Stefano, Cicala Gloria, De Cecco Carlo N, De Lazzari Manuel, Di Giovine Gabriella, Calo Leonardo, Dobrovie Monica, Focardi Marta, Fusini Laura, Gaibazzi Nicola, Gismondi Annalaura, Gravina Matteo, Guglielmo Marco, Lanzillo Chiara, Lombardi Massimo, Lorenzoni Valentina, Lozano-Torres Jordi, Margonato Davide, Martini Chiara, Marzo Francesca, Masci Pier-Giorgio, Masi Ambra, Moro Claudio, Muscogiuri Giuseppe, Mushtaq Saima, Nese Alberto, Palumbo Alessandro, Pavon Anna Giulia, Pedrotti Patrizia, Marra Martina Perazzolo, Pradella Silvia, Presicci Cristina, Rabbat Mark G, Raineri Claudia, Rodriguez-Palomares Jose' F, Sbarbati Stefano, Schoepf U Joseph, Squeri Angelo, Sverzellati Nicola, Symons Rolf, Tat Emily, Timpani Mauro, Todiere Giancarlo, Valentini Adele, Varga-Szemes Akos, Volpe Alessandra, Guaricci Andrea Igoren, Schwitter Juerg, Pontone Gianluca
  
  Abstract
  
  AIMS:
  While factors associated with adverse events are well elucidated in setting of isolated left ventricular dysfunction, clinical and imaging-based prognosticators of adverse outcomes are lacking in context of biventricular dysfunction. The purpose of this study was to establish role of clinical variables in prognosis of biventricular heart failure (HF), as assessed by cardiac magnetic resonance imaging.
  
  METHODS:
  Study cohort consisted of 840 patients enrolled in DERIVATE registry with coexisting CMR-derived right ventricular (RV) and left ventricular (LV) dysfunction, as defined by RV and LV ejection fractions ?45 % and ? 50 %, respectively. The primary objective was to identify factors associated with adverse long-term outcomes, defined as composite of all-cause death and HF hospitalizations (DHFH). Kaplan-Meir curves were plotted for survival analysis. Cox proportional hazard models were constructed to estimate adjusted hazard ratios (aHRs) and associated 95 % confidence intervals for clinical variables and their correlation with adverse events.
  
  RESULTS:
  Mean age was 61.0 years; 83.1 % were male, 26.6 % had diabetes mellitus (DM), and 45.9 % had non-ischemic cardiomyopathy. At median follow-up of 2 years, DHFH occurred in 32.5 % of the cohort. Kaplan-Meir analysis showed higher rate of DHFH in patients with DM (35.2 % vs. 22.6 %, p 
  CONCLUSION:
  In patients with biventricular HF, DM was a strong predictor of DHFH, with ACE-inhibitor/ARB usage having cardioprotective effect.
  
  Copyright © 2024 Elsevier B.V. All rights reserved.
  
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• Long-term prognostic performance of cardiac magnetic resonance imaging markers versus complicated clinical presentation after an acute myocarditis.
  Int J Cardiol

  2024 Dec;417():132567. doi: 10.1016/j.ijcard.2024.132567.
  
  Ammirati Enrico, Varrenti Marisa, Sormani Paola, Bernasconi Davide, Moro Claudio, Grosu Aurelia, D'Elia Saverio, Raineri Claudia, Quattrocchi Giuseppina, Milazzo Angela, Turco Annalisa, Maestroni Alberto, Valsecchi Maria Grazia, Oliva Fabrizio, Garascia Andrea, Giannattasio Cristina, Camici Paolo G, Pedrotti Patrizia
  
  Abstract
  
  BACKGROUND:
  Identifying markers associated with adverse events after acute myocarditis (AM) is relevant to plan follow-up. We assessed the prognostic performance of previously described cardiac magnetic resonance imaging (CMRI) markers and their combination: septal late gadolinium enhancement (LGE) localization and left ventricular ejection fraction (LVEF) 
  METHODS:
  We retrospectively assessed 248 AM patients (median age of 34 years, 87.1 % male) from 6 hospitals with onset of cardiac symptoms
  RESULTS:
  Thirteen patients (5.2 %) experienced at least one major cardiac event after a median follow-up of 4.7 years with a significant hazard ratio of 35.8 for CCP vs. 9.2 for septal LGE vs. 12.4 for LVEF
  CONCLUSIONS:
  Major cardiac events after an AM are relatively low, and CCP, septal LGE, and LVEF
  Copyright © 2024. Published by Elsevier B.V.
  
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• A fearsome evolution of presumed cardiac sarcoidosis: The sarcoid-lymphoma syndrome.
  Int J Cardiol Heart Vasc

  2024 Oct;54():101496. doi: 101496.
  
  Sormani Paola, Ammirati Enrico, Giannattasio Cristina, Garascia Andrea, Pedrotti Patrizia
  
  
  
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• Arrhythmic Mitral Valve Prolapse Phenotype: An Unsupervised Machine Learning Analysis Using a Multicenter Cardiac MRI Registry.
  Radiol Cardiothorac Imaging

  2024 Jun;6(3):e230247. doi: e230247.
  
  Akyea Ralph Kwame, Figliozzi Stefano, Lopes Pedro M, Bauer Klemens B, Moura-Ferreira Sara, Tondi Lara, Mushtaq Saima, Censi Stefano, Pavon Anna Giulia, Bassi Ilaria, Galian-Gay Laura, Teske Arco J, Biondi Federico, Filomena Domenico, Stylianidis Vasileios, Torlasco Camilla, Muraru Denisa, Monney Pierre, Quattrocchi Giuseppina, Maestrini Viviana, Agati Luciano, Monti Lorenzo, Pedrotti Patrizia, Vandenberk Bert, Squeri Angelo, Lombardi Massimo, Ferreira António M, Schwitter Juerg, Aquaro Giovanni Donato, Pontone Gianluca, Chiribiri Amedeo, Rodríguez Palomares José F, Yilmaz Ali, Andreini Daniele, Florian Anca-Rezeda, Francone Marco, Leiner Tim, Abecasis João, Badano Luigi Paolo, Bogaert Jan, Georgiopoulos Georgios, Masci Pier-Giorgio
  
  Abstract
  
  Purpose To use unsupervised machine learning to identify phenotypic clusters with increased risk of arrhythmic mitral valve prolapse (MVP). Materials and Methods This retrospective study included patients with MVP without hemodynamically significant mitral regurgitation or left ventricular (LV) dysfunction undergoing late gadolinium enhancement (LGE) cardiac MRI between October 2007 and June 2020 in 15 European tertiary centers. The study end point was a composite of sustained ventricular tachycardia, (aborted) sudden cardiac death, or unexplained syncope. Unsupervised data-driven hierarchical -mean algorithm was utilized to identify phenotypic clusters. The association between clusters and the study end point was assessed by Cox proportional hazards model. Results A total of 474 patients (mean age, 47 years ± 16 [SD]; 244 female, 230 male) with two phenotypic clusters were identified. Patients in cluster 2 (199 of 474, 42%) had more severe mitral valve degeneration (ie, bileaflet MVP and leaflet displacement), left and right heart chamber remodeling, and myocardial fibrosis as assessed with LGE cardiac MRI than those in cluster 1. Demographic and clinical features (ie, symptoms, arrhythmias at Holter monitoring) had negligible contribution in differentiating the two clusters. Compared with cluster 1, the risk of developing the study end point over a median follow-up of 39 months was significantly higher in cluster 2 patients (hazard ratio: 3.79 [95% CI: 1.19, 12.12], = .02) after adjustment for LGE extent. Conclusion Among patients with MVP without significant mitral regurgitation or LV dysfunction, unsupervised machine learning enabled the identification of two phenotypic clusters with distinct arrhythmic outcomes based primarily on cardiac MRI features. These results encourage the use of in-depth imaging-based phenotyping for implementing arrhythmic risk prediction in MVP. MR Imaging, Cardiac, Cardiac MRI, Mitral Valve Prolapse, Cluster Analysis, Ventricular Arrhythmia, Sudden Cardiac Death, Unsupervised Machine Learning © RSNA, 2024.
  
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• Naphazoline abuse: a rare case of myocardial infarction with nonobstructive coronary arteries.
  J Cardiovasc Med (Hagerstown)

  2024 May;25(5):391-393. doi: 10.2459/JCM.0000000000001604.
  
  Galasso Michele, Cavallotti Cristina, Giannattasio Cristina, Pedrotti Patrizia
  
  
  
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• CMR Mapping: The 4th-Era Revolution in Cardiac Imaging.
  J Clin Med

  2024 Jan;13(2):. doi: 337.
  
  Carrabba Nazario, Amico Mattia Alexis, Guaricci Andrea Igoren, Carella Maria Cristina, Maestrini Viviana, Monosilio Sara, Pedrotti Patrizia, Ricci Fabrizio, Monti Lorenzo, Figliozzi Stefano, Torlasco Camilla, Barison Andrea, Baggiano Andrea, Scatteia Alessandra, Pontone Gianluca, Dellegrottaglie Santo,
  
  Abstract
  
  Cardiac magnetic resonance (CMR) imaging has witnessed substantial progress with the advent of parametric mapping techniques, most notably T1 and T2 mapping. These advanced techniques provide valuable insights into a wide range of cardiac conditions, including ischemic heart disease, cardiomyopathies, inflammatory cardiomyopathies, heart valve disease, and athlete's heart. Mapping could be the first sign of myocardial injury and oftentimes precedes symptoms, changes in ejection fraction, and irreversible myocardial remodeling. The ability of parametric mapping to offer a quantitative assessment of myocardial tissue properties addresses the limitations of conventional CMR methods, which often rely on qualitative or semiquantitative data. However, challenges persist, especially in terms of standardization and reference value establishment, hindering the wider clinical adoption of parametric mapping. Future developments should prioritize the standardization of techniques to enhance their clinical applicability, ultimately optimizing patient care pathways and outcomes. In this review, we endeavor to provide insights into the potential contributions of CMR mapping techniques in enhancing the diagnostic processes across a range of cardiac conditions.
  
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• Author Correction: Consensus Statement on the definition and classification of metabolic hyperferritinaemia.
  Nat Rev Endocrinol

  2024 Mar;20(3):185. doi: 10.1038/s41574-023-00940-2.
  
  Valenti Luca, Corradini Elena, Adams Leon A, Aigner Elmar, Alqahtani Saleh, Arrese Marco, Bardou-Jacquet Edouard, Bugianesi Elisabetta, Fernandez-Real Jose-Manuel, Girelli Domenico, Hagström Hannes, Henninger Benjamin, Kowdley Kris, Ligabue Guido, McClain Donald, Lainé Fabrice, Miyanishi Koji, Muckenthaler Martina U, Pagani Alessia, Pedrotti Patrizia, Pietrangelo Antonello, Prati Daniele, Ryan John D, Silvestri Laura, Spearman C Wendy, Stål Per, Tsochatzis Emmanuel A, Vinchi Francesca, Zheng Ming-Hua, Zoller Heinz
  
  
  
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• [Persistent ST-elevation with elevated myocardial necrosis markers: a case of myocardial contusion].
  G Ital Cardiol (Rome)

  2023 Nov;24(11):911-914. doi: 10.1714/4129.41233.
  
  Stucchi Miriam, Galasso Michele, De Censi Lorenzo, Cirò Antonio, Pedrotti Patrizia, Giannattasio Cristina
  
  Abstract
  
  Myocardial contusion is a rare and potentially fatal complication of chest trauma. There is no unique definition for this entity: some authors define myocardial contusion as a mild increase in cardiac biomarkers in the context of chest trauma, while for others the diagnosis requires evidence of pathologic findings at cardiac imaging. Consequently, the real incidence of myocardial contusion remains unknown, varying in reports between 8% and 71%. We describe a case of cardiac contusion secondary to a low-energy blunt chest trauma, manifesting as persistent ST-elevation associated with elevation of myocardial necrosis markers, with consequent myocardial stunning of the right ventricular free wall. As there is no consensus regarding the diagnostic pathway, it is essential to integrate first-level exams (ECG and laboratory findings) with cardiac magnetic resonance imaging, to define the presence of cardiac contusion and its extent, particularly if the echocardiographic data are unconclusive.
  
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• Cardiovascular Magnetic Resonance in Patients with Cardiac Electronic Devices: Evidence from a Multicenter Study.
  J Clin Med

  2023 Oct;12(20):. doi: 6673.
  
  Barison Andrea, Ricci Fabrizio, Pavon Anna Giulia, Muscogiuri Giuseppe, Bisaccia Giandomenico, Camastra Giovanni, De Lazzari Manuel, Lanzillo Chiara, Raguso Mario, Monti Lorenzo, Vargiu Sara, Pedrotti Patrizia, Piacenti Marcello, Todiere Giancarlo, Pontone Gianluca, Indolfi Ciro, Dellegrottaglie Santo, Lombardi Massimo, Schwitter Juerg, Aquaro Giovanni Donato, On Behalf Of The Ricami Investigators Risonanza Magnetica Cardiaca Nei Portatori di Pm/Icd , On Behalf Of The Working Group On Cardiovascular Magnetic Resonance Of The Italian Society Of Cardiology
  
  Abstract
  
  BACKGROUND:
  Most recent cardiac implantable electronic devices (CIEDs) can safely undergo a cardiovascular magnetic resonance (CMR) scan under certain conditions, but metal artifacts may degrade image quality. The aim of this study was to assess the overall diagnostic yield of CMR and the extent of metal artifacts in a multicenter, multivendor study on CIED patients referred for CMR.
  
  METHODS:
  We analyzed 309 CMR scans from 292 patients (age 57 ± 16 years, 219 male) with an MR-conditional pacemaker ( = 122), defibrillator (n = 149), or loop recorder (n = 38); CMR scans were performed in 10 centers from 2012 to 2020; MR-unsafe implants were excluded. Clinical and device parameters were recorded before and after the CMR scan. A visual analysis of metal artifacts was performed for each sequence on a segmental basis, based on a 5-point artifact score.
  
  RESULTS:
  The vast majority of CMR scans (n = 255, 83%) were completely performed, while only 32 (10%) were interrupted soon after the first sequences and 22 (7%) were only partly acquired; CMR quality was non-diagnostic in 34 (11%) scans, poor (
  CONCLUSIONS:
  CMR is a versatile imaging technique, with a high safety profile and overall good image quality even in patients with MR-conditional CIEDs. Several strategies are now available to optimize image quality, substantially enhancing overall diagnostic yield.
  
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• Cardiac Magnetic Resonance for Prophylactic Implantable-Cardioverter Defibrillator Therapy in Ischemic Cardiomyopathy: The DERIVATE-ICM International Registry.
  JACC Cardiovasc Imaging

  2023 Nov;16(11):1387-1400. doi: 10.1016/j.jcmg.2023.03.015.
  
  Pontone Gianluca, Guaricci Andrea Igoren, Fusini Laura, Baggiano Andrea, Guglielmo Marco, Muscogiuri Giuseppe, Volpe Alessandra, Abete Raffaele, Aquaro Giovanni, Barison Andrea, Bogaert Jan, Camastra Giovanni, Carigi Samuela, Carrabba Nazario, Casavecchia Grazia, Censi Stefano, Cicala Gloria, De Cecco Carlo N, De Lazzari Manuel, Di Giovine Gabriella, Di Roma Mauro, Dobrovie Monica, Focardi Marta, Gaibazzi Nicola, Gismondi Annalaura, Gravina Matteo, Lanzillo Chiara, Lombardi Massimo, Lorenzoni Valentina, Lozano-Torres Jordi, Martini Chiara, Marzo Francesca, Masi Ambra, Memeo Riccardo, Moro Claudio, Nese Alberto, Palumbo Alessandro, Pavon Anna Giulia, Pedrotti Patrizia, Marra Martina Perazzolo, Pica Silvia, Pradella Silvia, Presicci Cristina, Rabbat Mark G, Raineri Claudia, Rodriguez-Palomares José F, Sbarbati Stefano, Schoepf U Joseph, Squeri Angelo, Sverzellati Nicola, Symons Rolf, Tat Emily, Timpani Mauro, Todiere Giancarlo, Valentini Adele, Varga-Szemes Akos, Masci Pier-Giorgio, Schwitter Juerg
  
  Abstract
  
  BACKGROUND:
  Implantable cardioverter-defibrillator (ICD) therapy is the most effective prophylactic strategy against sudden cardiac death (SCD) in patients with ischemic cardiomyopathy (ICM) and left ventricle ejection fraction (LVEF) ?35% as detected by transthoracic echocardiograpgy (TTE). This approach has been recently questioned because of the low rate of ICD interventions in patients who received implantation and the not-negligible percentage of patients who experienced SCD despite not fulfilling criteria for implantation.
  
  OBJECTIVES:
  The DERIVATE-ICM registry (CarDiac MagnEtic Resonance for Primary Prevention Implantable CardioVerter DebrillAtor ThErapy; NCT03352648) is an international, multicenter, and multivendor study to assess the net reclassification improvement (NRI) for the indication of ICD implantation by the use of cardiac magnetic resonance (CMR) as compared to TTE in patients with ICM.
  
  METHODS:
  A total of 861 patients with ICM (mean age 65 ± 11 years, 86% male) with chronic heart failure and TTE-LVEF 
  RESULTS:
  During a median follow-up of 1,054 days, MAACE occurred in 88 (10.2%). Left ventricular end-diastolic volume index (HR: 1.007 [95% CI: 1.000-1.011]; P = 0.05), CMR-LVEF (HR: 0.972 [95% CI: 0.945-0.999]; P = 0.045) and late gadolinium enhancement (LGE) mass (HR: 1.010 [95% CI: 1.002-1.018]; P = 0.015) were independent predictors of MAACE. A multiparametric CMR weighted predictive derived score identifies subjects at high risk for MAACE compared with TTE-LVEF cutoff of 35% with a NRI of 31.7% (P = 0.007).
  
  CONCLUSIONS:
  The DERIVATE-ICM registry is a large multicenter registry showing the additional value of CMR to stratify the risk for MAACE in a large cohort of patients with ICM compared with standard of care.
  
  Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
  
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• Outcome and Morphofunctional Changes on Cardiac Magnetic Resonance in Patients With Acute Myocarditis Following mRNA COVID-19 Vaccination.
  Circ Heart Fail

  2023 Jun;16(6):e010315. doi: 10.1161/CIRCHEARTFAILURE.122.010315.
  
  Ammirati Enrico, Lupi Laura, Palazzini Matteo, Ciabatti Michele, Rossi Valentina A, Gentile Piero, Uribarri Aitor, Vecchio Chiara R, Nassiacos Daniele, Cereda Alberto, Conca Cristina, Tumminello Gabriele, Piriou Nicolas, Lelarge Coline, Pedrotti Patrizia, Stucchi Miriam, Peretto Giovanni, Galasso Michele, Huang Florent, Ianni Umberto, Procopio Antonio, Saponara Gianluigi, Cimaglia Paolo, Tomasoni Daniela, Moroni Francesco, Turco Annalisa, Sala Simone, Di Tano Giuseppe, Bollano Entela, Moro Claudio, Abbate Antonio, Della Bona Roberta, Porto Italo, Carugo Stefano, Campodonico Jeness, Pontone Gianluca, Grosu Aurelia, Bolognese Leonardo, Salamanca Jorge, Diez-Villanueva Pablo, Ozieranski Krzysztof, Tyminska Agata, Sardo Infirri Loren, Bromage Daniel, Cannatà Antonio, Hong Kimberly N, Adamo Marianna, Quattrocchi Giuseppina, Foà Alberto, Potena Luciano, Garascia Andrea, Giannattasio Cristina, Adler Eric D, Sinagra Gianfranco, Ruschitzka Frank, Camici Paolo G, Metra Marco, Pieroni Maurizio
  
  
  
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• Consensus Statement on the definition and classification of metabolic hyperferritinaemia.
  Nat Rev Endocrinol

  2023 May;19(5):299-310. doi: 10.1038/s41574-023-00807-6.
  
  Valenti Luca, Corradini Elena, Adams Leon A, Aigner Elmar, Alqahtani Saleh, Arrese Marco, Bardou-Jacquet Edouard, Bugianesi Elisabetta, Fernandez-Real Jose-Manuel, Girelli Domenico, Hagström Hannes, Henninger Benjamin, Kowdley Kris, Ligabue Guido, McClain Donald, Lainé Fabrice, Miyanishi Koji, Muckenthaler Martina U, Pagani Alessia, Pedrotti Patrizia, Pietrangelo Antonello, Prati Daniele, Ryan John D, Silvestri Laura, Spearman C Wendy, Stål Per, Tsochatzis Emmanuel A, Vinchi Francesca, Zheng Ming-Hua, Zoller Heinz
  
  Abstract
  
  Hyperferritinaemia is a common laboratory finding that is often associated with metabolic dysfunction and fatty liver. Metabolic hyperferritinaemia reflects alterations in iron metabolism that facilitate iron accumulation in the body and is associated with an increased risk of cardiometabolic and liver diseases. Genetic variants that modulate iron homeostasis and tissue levels of iron are the main determinants of serum levels of ferritin in individuals with metabolic dysfunction, raising the hypothesis that iron accumulation might be implicated in the pathogenesis of insulin resistance and the related organ damage. However, validated criteria for the non-invasive diagnosis of metabolic hyperferritinaemia and the staging of iron overload are still lacking, and there is no clear evidence of a benefit for iron depletion therapy. Here, we provide an overview of the literature on the relationship between hyperferritinaemia and iron accumulation in individuals with metabolic dysfunction, and on the associated clinical outcomes. We propose an updated definition and a provisional staging system for metabolic hyperferritinaemia, which has been agreed on by a multidisciplinary global panel of expert researchers. The goal is to foster studies into the epidemiology, genetics, pathophysiology, clinical relevance and treatment of metabolic hyperferritinaemia, for which we provide suggestions on the main unmet needs, optimal design and clinically relevant outcomes.
  
  © 2023. Springer Nature Limited.
  
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• Fulminant Lymphocytic Myocarditis During Pregnancy Treated With Temporary Mechanical Circulatory Supports and Aggressive Immunosuppression.
  Circ Heart Fail

  2022 Dec;15(12):e009810. doi: 10.1161/CIRCHEARTFAILURE.122.009810.
  
  Veronese Giacomo, Nonini Sandra, Cannata Aldo, Aresta Francesca, Olivieri Guido, Montrasio Elisa, De Caria Daniele, Perna Enrico, Calini Angelo, Bottiroli Maurizio, Cislaghi Francesca, Pedrazzini Giovanna, Baltaro Federica, Quattrocchi Giuseppina, Pedrotti Patrizia, Russo Claudio F, Garascia Andrea, Mondino Michele, Ammirati Enrico
  
  
  
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• Acute Myocarditis Associated With Desmosomal Gene Variants.
  JACC Heart Fail

  2022 Oct;10(10):714-727. doi: 10.1016/j.jchf.2022.06.013.
  
  Ammirati Enrico, Raimondi Francesca, Piriou Nicolas, Sardo Infirri Loren, Mohiddin Saidi A, Mazzanti Andrea, Shenoy Chetan, Cavallari Ugo A, Imazio Massimo, Aquaro Giovanni Donato, Olivotto Iacopo, Pedrotti Patrizia, Sekhri Neha, Van de Heyning Caroline M, Broeckx Glenn, Peretto Giovanni, Guttmann Oliver, Dellegrottaglie Santo, Scatteia Alessandra, Gentile Piero, Merlo Marco, Goldberg Randal I, Reyentovich Alex, Sciamanna Christopher, Klaassen Sabine, Poller Wolfgang, Trankle Cory R, Abbate Antonio, Keren Andre, Horowitz-Cederboim Smadar, Cadrin-Tourigny Julia, Tadros Rafik, Annoni Giuseppe A, Bonoldi Emanuela, Toquet Claire, Marteau Lara, Probst Vincent, Trochu Jean Noël, Kissopoulou Antheia, Grosu Aurelia, Kukavica Deni, Trancuccio Alessandro, Gil Cristina, Tini Giacomo, Pedrazzini Matteo, Torchio Margherita, Sinagra Gianfranco, Gimeno Juan Ramón, Bernasconi Davide, Valsecchi Maria Grazia, Klingel Karin, Adler Eric D, Camici Paolo G, Cooper Leslie T
  
  Abstract
  
  BACKGROUND:
  The risk of adverse cardiovascular events in patients with acute myocarditis (AM) and desmosomal gene variants (DGV) remains unknown.
  
  OBJECTIVES:
  The purpose of this study was to ascertain the risk of death, ventricular arrhythmias, recurrent myocarditis, and heart failure (main endpoint) in patients with AM and pathogenic or likely pathogenetic DGV.
  
  METHODS:
  In a retrospective international study from 23 hospitals, 97 patients were included: 36 with AM and DGV (DGV[+]), 25 with AM and negative gene testing (DGV[-]), and 36 with AM without genetics testing. All patients had troponin elevation plus findings consistent with AM on histology or at cardiac magnetic resonance (CMR). In 86 patients, CMR changes in function and structure were re-assessed at follow-up.
  
  RESULTS:
  In the DGV(+) AM group (88.9% DSP variants), median age was 24 years, 91.7% presented with chest pain, and median left ventricular ejection fraction (LVEF) was 56% on CMR (P = NS vs the other 2 groups). Kaplan-Meier curves demonstrated a higher risk of the main endpoint in DGV(+) AM compared with DGV(-) and without genetics testing patients (62.3% vs 17.5% vs 5.3% at 5 years, respectively; P < 0.0001), driven by myocarditis recurrence and ventricular arrhythmias. At follow-up CMR, a higher number of late gadolinium enhanced segments was found in DGV(+) AM.
  
  CONCLUSIONS:
  Patients with AM and evidence of DGV have a higher incidence of adverse cardiovascular events compared with patients with AM without DGV. Further prospective studies are needed to ascertain if genetic testing might improve risk stratification of patients with AM who are considered at low risk.
  
  Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
  
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• Cardiac magnetic resonance abnormalities in patients with acute myocarditis proven by septal endomyocardial biopsy.
  Clin Res Cardiol

  2023 Mar;112(3):392-400. doi: 10.1007/s00392-022-02103-1.
  
  Peretto Giovanni, Merlo Marco, Gentile Piero, Porcari Aldostefano, Palmisano Anna, Vignale Davide, Sormani Paola, Rizzo Stefania, De Gaspari Monica, Basso Cristina, Bella Paolo Della, Sala Simone, Ammirati Enrico, Sinagra Gianfranco, Esposito Antonio, Pedrotti Patrizia
  
  Abstract
  
  BACKGROUND:
  Previous studies suggest low diagnostic sensitivity of cardiac magnetic resonance (CMR) imaging based on Lake Louise criteria (LLC) to identify patients with complicated presentations of acute myocarditis (AM). We evaluated classic and updated LLC in patients with AM proven by right ventricular septal endomyocardial biopsy (RVS-EMB).
  
  METHODS:
  From an initial population of 499 patients with clinically suspected AM from a multicenter retrospective cohort, we included 74 patients with histologically proven myocarditis on RVS-EMB and available CMR within 30 days since admission. The prevalence of total and septal CMR abnormalities [namely, T2-weighted images (T2W), late gadolinium enhancement (LGE), T2 and T1 mapping, and extracellular volume (ECV)] were assessed in patients with complicated vs. uncomplicated AM.
  
  RESULTS:
  Among 74 patients [mean age 38?±?15 years, 65% males, left ventricular ejection fraction (LVEF) 40?±?18%] with RVS-EMB-proven AM, 53 (72%) had a complicated presentation. The classic LLC were positive in 56/74 patients (76%), whereas the updated ones were positive in 41/41 of cases (100%). Septal involvement, documented in 48/74 patients (65%) by conventional T2W/LGE and in 39/41 cases (95%) by mapping techniques (p?0.001), was more common in patients with complicated AM. In the 41 patients undergoing both evaluations, CMR sensitivity for myocarditis was 85% for the classic LLC vs. 100% for the updated LLC (p?=?0.006).
  
  CONCLUSION:
  In patients with myocarditis on RVS-EMB, CMR using updated LLC has high sensitivity in the detection of AM when performed within 30 days. Septal abnormalities are more common in patients with complicated AM.
  
  © 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.
  
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• Myocardial Fibrosis at Cardiac MRI Helps Predict Adverse Clinical Outcome in Patients with Mitral Valve Prolapse.
  Radiology

  2023 Jan;306(1):112-121. doi: 10.1148/radiol.220454.
  
  Figliozzi Stefano, Georgiopoulos Georgios, Lopes Pedro M, Bauer Klemens B, Moura-Ferreira Sara, Tondi Lara, Mushtaq Saima, Censi Stefano, Pavon Anna Giulia, Bassi Ilaria, Servato Maria Luz, Teske Arco J, Biondi Federico, Filomena Domenico, Pica Silvia, Torlasco Camilla, Muraru Denisa, Monney Pierre, Quattrocchi Giuseppina, Maestrini Viviana, Agati Luciano, Monti Lorenzo, Pedrotti Patrizia, Vandenberk Bert, Squeri Angelo, Lombardi Massimo, Ferreira António M, Schwitter Juerg, Aquaro Giovanni Donato, Chiribiri Amedeo, Rodríguez Palomares José F, Yilmaz Ali, Andreini Daniele, Florian Anca, Leiner Tim, Abecasis João, Badano Luigi Paolo, Bogaert Jan, Masci Pier-Giorgio
  
  Abstract
  
  Background Patients with mitral valve prolapse (MVP) may develop adverse outcomes even in the absence of mitral regurgitation or left ventricular (LV) dysfunction. Purpose To investigate the prognostic value of mitral annulus disjunction (MAD) and myocardial fibrosis at late gadolinium enhancement (LGE) cardiac MRI in patients with MVP without moderate-to-severe mitral regurgitation or LV dysfunction. Materials and Methods In this longitudinal retrospective study, 118?144 cardiac MRI studies were evaluated between October 2007 and June 2020 at 15 European tertiary medical centers. Follow-up was from the date of cardiac MRI examination to June 2020; the minimum and maximum follow-up intervals were 6 months and 156 months, respectively. Patients were excluded if at least one of the following conditions was present: cardiomyopathy, LV ejection fraction less than 40%, ischemic heart disease, congenital heart disease, inflammatory heart disease, moderate or worse mitral regurgitation, participation in competitive sport, or electrocardiogram suggestive of channelopathies. In the remainder, cardiac MRI studies were reanalyzed, and patients were included if they were aged 18 years or older, MVP was diagnosed at cardiac MRI, and clinical information and electrocardiogram monitoring were available within 3 months from cardiac MRI examination. The end point was a composite of adverse outcomes: sustained ventricular tachycardia (VT), sudden cardiac death (SCD), or unexplained syncope. Multivariable Cox regression analysis was performed. Results A total of 474 patients (mean age, 47 years ± 16 [SD]; 244 women) were included. Over a median follow-up of 3.3 years, 18 patients (4%) reached the study end point. LGE presence (hazard ratio, 4.2 [95% CI: 1.5, 11.9]; = .006) and extent (hazard ratio, 1.2 per 1% increase [95% CI: 1.1, 1.4]; = .006), but not MAD presence ( = .89), were associated with clinical outcome. LGE presence had incremental prognostic value over MVP severity and sustained VT and aborted SCD at baseline (area under the receiver operating characteristic curve, 0.70 vs 0.62; = .03). Conclusion In contrast to mitral annulus disjunction, myocardial fibrosis determined according to late gadolinium enhancement at cardiac MRI was associated with adverse outcome in patients with mitral valve prolapse without moderate-to-severe mitral regurgitation or left ventricular dysfunction. © RSNA, 2022 See also the editorial by Gerber in this issue.
  
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• Report from the Cardio-Oncology Symposium at the Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO) Annual Congress.
  Future Cardiol

  2023 Sep;19(11):519-522. doi: 10.2217/fca-2022-0063.
  
  Camilli Massimiliano, Cardinale Daniela M, Pedrotti Patrizia, Turazza Fabio M, Aspromonte Nadia, Canale Maria Laura, Bisceglia Irma, Oliva Fabrizio, Colivicchi Furio
  
  Abstract
  
  Overview of the meeting The Cardio-Oncology Symposium at the Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO) Annual Meeting mainly focused on the diagnosis, management and prevention of cardiovascular toxicity of cancer drugs, in particular, cardiac dysfunction induced by anthracyclines. Although a variety of cardiac biomarkers and imaging modalities are available, there remains no consensus regarding their appropriate use to identify early and late cardiotoxicity and to guide preventive strategies. At the same time, the multitude of pharmacological trials, aimed at preventing cardiac damage through a neurohormonal blockade, provided conflicting results. Nevertheless, the advent of novel heart failure medications can change the decision-making of the cardio-oncologist. This symposium attempted to harmonize these issues.
  
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• A heart of iron: juvenile haemochromatosis presents with cardiac failure.
  Lancet

  2022 Aug;400(10352):616. doi: 10.1016/S0140-6736(22)01285-5.
  
  Cartella Iside, Tavecchia Giovanni A, Quattrocchi Giuseppina, Giannattasio Cristina, Volpato Elisabetta, Palazzini Matteo, Garascia Andrea, Cipriani Manlio, Frigerio Maria, Ammirati Enrico, Pedrotti Patrizia
  
  
  
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• Cardiac magnetic resonance for prophylactic implantable-cardioverter defibrillator therapy international study: prognostic value of cardiac magnetic resonance-derived right ventricular parameters substudy.
  Eur Heart J Cardiovasc Imaging

  2023 Mar;24(4):472-482. doi: 10.1093/ehjci/jeac124.
  
  Al'Aref Subhi J, Altibi Ahmed M, Malkawi Abdallah, Mansour Munthir, Baskaran Lohendran, Masri Ahmad, Rahmouni Hind, Abete Raffaele, Andreini Daniele, Aquaro Giovanni, Barison Andrea, Bogaert Jan, Camastra Giovanni, Carigi Samuela, Carrabba Nazario, Casavecchia Grazia, Censi Stefano, Cicala Gloria, Conte Edoardo, De Cecco Carlo N, De Lazzari Manuel, Di Giovine Gabriella, Di Roma Mauro, Dobrovie Monica, Focardi Marta, Gaibazzi Nicola, Gismondi Annalaura, Gravina Matteo, Guglielmo Marco, Lanzillo Chiara, Lombardi Massimo, Lorenzoni Valentina, Lozano-Torres Jordi, Margonato Davide, Martini Chiara, Marzo Francesca, Masci Piergiorgio, Masi Ambra, Memeo Riccardo, Moro Claudio, Mushtaq Saima, Nese Alberto, Palumbo Alessandro, Pavon Anne Giulia, Pedrotti Patrizia, Pepi Mauro, Perazzolo Marra Martina, Pica Silvia, Pradella Silvia, Presicci Cristina, Rabbat Mark G, Raineri Claudia, Rodriguez-Palomares Jose' F, Sbarbati Stefano, Schoepf U Joseph, Squeri Angelo, Sverzellati Nicola, Symons Rolf, Tat Emily, Timpani Mauro, Todiere Giancarlo, Valentini Adele, Varga-Szemes Akos, Volpe Alessandra, Fusini Laura, Guaricci Andrea Igoren, Schwitter Jurg, Pontone Gianluca
  
  Abstract
  
  AIMS:
  Right ventricular systolic dysfunction (RVSD) is an important determinant of outcomes in heart failure (HF) cohorts. While the quantitative assessment of RV function is challenging using 2D-echocardiography, cardiac magnetic resonance (CMR) is the gold standard with its high spatial resolution and precise anatomical definition. We sought to investigate the prognostic value of CMR-derived RV systolic function in a large cohort of HF with reduced ejection fraction (HFrEF).
  
  METHODS AND RESULTS:
  Study cohort comprised of patients enrolled in the CarDiac MagnEtic Resonance for Primary Prevention Implantable CardioVerter DefibrillAtor ThErapy registry who had HFrEF and had simultaneous baseline CMR and echocardiography (n = 2449). RVSD was defined as RV ejection fraction (RVEF)
  CONCLUSION:
  RV systolic dysfunction is an independent predictor of ACM in HFrEF, with a more pronounced prognostic value in select subgroups, likely reflecting the importance of RVSD in the early stages of HF progression.
  
  © The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.
  
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• Prevalence, Characteristics, and Outcomes of COVID-19-Associated Acute Myocarditis.
  Circulation

  2022 Apr;145(15):1123-1139. doi: 10.1161/CIRCULATIONAHA.121.056817.
  
  Ammirati Enrico, Lupi Laura, Palazzini Matteo, Hendren Nicholas S, Grodin Justin L, Cannistraci Carlo V, Schmidt Matthieu, Hekimian Guillaume, Peretto Giovanni, Bochaton Thomas, Hayek Ahmad, Piriou Nicolas, Leonardi Sergio, Guida Stefania, Turco Annalisa, Sala Simone, Uribarri Aitor, Van de Heyning Caroline M, Mapelli Massimo, Campodonico Jeness, Pedrotti Patrizia, Barrionuevo Sánchez Maria Isabel, Ariza Sole Albert, Marini Marco, Matassini Maria Vittoria, Vourc'h Mickael, Cannatà Antonio, Bromage Daniel I, Briguglia Daniele, Salamanca Jorge, Diez-Villanueva Pablo, Lehtonen Jukka, Huang Florent, Russel Stéphanie, Soriano Francesco, Turrini Fabrizio, Cipriani Manlio, Bramerio Manuela, Di Pasquale Mattia, Grosu Aurelia, Senni Michele, Farina Davide, Agostoni Piergiuseppe, Rizzo Stefania, De Gaspari Monica, Marzo Francesca, Duran Jason M, Adler Eric D, Giannattasio Cristina, Basso Cristina, McDonagh Theresa, Kerneis Mathieu, Combes Alain, Camici Paolo G, de Lemos James A, Metra Marco
  
  Abstract
  
  BACKGROUND:
  Acute myocarditis (AM) is thought to be a rare cardiovascular complication of COVID-19, although minimal data are available beyond case reports. We aim to report the prevalence, baseline characteristics, in-hospital management, and outcomes for patients with COVID-19-associated AM on the basis of a retrospective cohort from 23 hospitals in the United States and Europe.
  
  METHODS:
  A total of 112 patients with suspected AM from 56?963 hospitalized patients with COVID-19 were evaluated between February 1, 2020, and April 30, 2021. Inclusion criteria were hospitalization for COVID-19 and a diagnosis of AM on the basis of endomyocardial biopsy or increased troponin level plus typical signs of AM on cardiac magnetic resonance imaging. We identified 97 patients with possible AM, and among them, 54 patients with definite/probable AM supported by endomyocardial biopsy in 17 (31.5%) patients or magnetic resonance imaging in 50 (92.6%). We analyzed patient characteristics, treatments, and outcomes among all COVID-19-associated AM.
  
  RESULTS:
  AM prevalence among hospitalized patients with COVID-19 was 2.4 per 1000 hospitalizations considering definite/probable and 4.1 per 1000 considering also possible AM. The median age of definite/probable cases was 38 years, and 38.9% were female. On admission, chest pain and dyspnea were the most frequent symptoms (55.5% and 53.7%, respectively). Thirty-one cases (57.4%) occurred in the absence of COVID-19-associated pneumonia. Twenty-one (38.9%) had a fulminant presentation requiring inotropic support or temporary mechanical circulatory support. The composite of in-hospital mortality or temporary mechanical circulatory support occurred in 20.4%. At 120 days, estimated mortality was 6.6%, 15.1% in patients with associated pneumonia versus 0% in patients without pneumonia (=0.044). During hospitalization, left ventricular ejection fraction, assessed by echocardiography, improved from a median of 40% on admission to 55% at discharge (n=47;
  CONCLUSIONS:
  AM occurrence is estimated between 2.4 and 4.1 out of 1000 patients hospitalized for COVID-19. The majority of AM occurs in the absence of pneumonia and is often complicated by hemodynamic instability. AM is a rare complication in patients hospitalized for COVID-19, with an outcome that differs on the basis of the presence of concomitant pneumonia.
  
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• Effusive-constrictive pericarditis after the second dose of BNT162b2 vaccine (Comirnaty): a case report.
  Eur Heart J Case Rep

  2022 Feb;6(2):ytac012. doi: ytac012.
  
  Viani Giacomo Maria, Pedrotti Patrizia, Seregni Romano, Antonio Brucato
  
  Abstract
  
  BACKGROUND:
  Whereas effusive-constrictive pericarditis (ECP) can rarely occur in coronavirus disease 2019 (COVID-19), to date no cases of ECP related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) vaccine have been documented.
  
  CASE SUMMARY:
  A 59-year-old Caucasian man presented to our emergency department with ECP. Symptoms occurred shortly after the second dose of BNT162b2 (Comirnaty) vaccine. No other aetiological causes were identified. Guidelines-directed therapy for acute pericarditis was implemented, with clinical benefit.
  
  DISCUSSION:
  Systemic inflammatory response to COVID-19 can rarely trigger pericarditis. In our case, a strong temporal relationship between the second dose of BNT162b2 vaccine and symptoms occurrence was documented, indicating a possible rare adverse reaction to the vaccine, similarly to natural infection. Further research is needed to confirm a causal relationship.
  
  © The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.
  
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• A method for T and T relaxation times validation and harmonization as a support to MRI mapping.
  J Magn Reson

  2022 Jan;334():107110. doi: 10.1016/j.jmr.2021.107110.
  
  Cicolari Davide, Lizio Domenico, Pedrotti Patrizia, Moioli Monica Teresa, Lascialfari Alessandro, Mariani Manuel, Torresin Alberto
  
  Abstract
  
  We present a proof-of-concept study focusing on a method for the intra- and inter-center validation and harmonization of data obtained from MRI T and T maps. The method is based on a set of MnCl samples that provide in-scan ground-truth reference values regardless of the details of the MRI protocol. The relaxation times of MnCl aqueous solutions were first measured by means of an NMR laboratory relaxometer, as a function of concentration and temperature. The obtained T and T values, once renormalized at the scanner temperature, were used as reference values for the MRI mapping measurements of the MnCl relaxation times. By using different clinical MRI scanners and sequences, we found a good agreement for standard and turbo sequences (limits of agreement: 5% for IR, SE, IR-TSE; 10% for TSE), while an under-estimation and an over-estimation were found respectively for MOLLI and T-prep TrueFISP, as already reported in the literature. The linearity of the relaxation rates with the concentration predicted by the Solomon-Bloembergen-Morgan theory was observed for every dataset at all temperatures, except for T-prep TrueFISP maps results. Some preliminary results of an in vivo experiment are also presented.
  
  Copyright © 2021 Elsevier Inc. All rights reserved.
  
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• Prevalence and outcome of patients with acute myocarditis and positive viral search on nasopharyngeal swab.
  Eur J Heart Fail

  2021 Jul;23(7):1242-1245. doi: 10.1002/ejhf.2247.
  
  Ammirati Enrico, Varrenti Marisa, Veronese Giacomo, Fanti Diana, Nava Alice, Cipriani Manlio, Pedrotti Patrizia, Garascia Andrea, Bottiroli Maurizio, Oliva Fabrizio, Bramerio Manuela, Veronese Silvio, Giannattasio Cristina, Bonoldi Emanuela, Perno Carlo F, Camici Paolo G, Frigerio Maria
  
  
  
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• Temporal Relation Between Second Dose BNT162b2 mRNA Covid-19 Vaccine and Cardiac involvement in a Patient with Previous SARS-COV-2 Infection.
  Int J Cardiol Heart Vasc

  2021 Apr;():100778. doi: 100778.
  
  Ammirati Enrico, Cavalotti Cristina, Milazzo Angela, Pedrotti Patrizia, Soriano Francesco, Schroeder Jan W, Morici Nuccia, Giannattasio Cristina, Frigerio Maria, Metra Marco, Camici Paolo G, Oliva Fabrizio
  
  Abstract
  
  The Publisher regrets that this article is an accidental duplication of an article that has already been published, https://doi.org/10.1016/j.ijcha.2021.100774. The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at
  
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• Temporal relation between second dose BNT162b2 mRNA Covid-19 vaccine and cardiac involvement in a patient with previous SARS-COV-2 infection.
  Int J Cardiol Heart Vasc

  2021 Jun;34():100774. doi: 100774.
  
  Ammirati Enrico, Cavalotti Cristina, Milazzo Angela, Pedrotti Patrizia, Soriano Francesco, Schroeder Jan W, Morici Nuccia, Giannattasio Cristina, Frigerio Maria, Metra Marco, Camici Paolo G, Oliva Fabrizio
  
  
  
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• CarDiac magnEtic Resonance for prophylactic Implantable-cardioVerter defibrillAtor ThErapy in Non-Ischaemic dilated CardioMyopathy: an international Registry.
  Europace

  2021 Jul;23(7):1072-1083. doi: 10.1093/europace/euaa401.
  
  Guaricci Andrea Igoren, Masci Pier Giorgio, Muscogiuri Giuseppe, Guglielmo Marco, Baggiano Andrea, Fusini Laura, Lorenzoni Valentina, Martini Chiara, Andreini Daniele, Pavon Anna Giulia, Aquaro Giovanni D, Barison Andrea, Todiere Giancarlo, Rabbat Mark G, Tat Emily, Raineri Claudia, Valentini Adele, Varga-Szemes Akos, Schoepf U Joseph, De Cecco Carlo N, Bogaert Jan, Dobrovie Monica, Symons Rolf, Focardi Marta, Gismondi Annalaura, Lozano-Torres Jordi, Rodriguez-Palomares Josè F, Lanzillo Chiara, Di Roma Mauro, Moro Claudio, Di Giovine Gabriella, Margonato Davide, De Lazzari Manuel, Perazzolo Marra Martina, Nese Alberto, Casavecchia Grazia, Gravina Matteo, Marzo Francesca, Carigi Samuela, Pica Silvia, Lombardi Massimo, Censi Stefano, Squeri Angelo, Palumbo Alessandro, Gaibazzi Nicola, Camastra Giovanni, Sbarbati Stefano, Pedrotti Patrizia, Masi Ambra, Carrabba Nazario, Pradella Silvia, Timpani Mauro, Cicala Gloria, Presicci Cristina, Puglisi Sara, Sverzellati Nicola, Santobuono Vincenzo Ezio, Pepi Mauro, Schwitter Juerg, Pontone Gianluca
  
  Abstract
  
  AIMS:
  The aim of this registry was to evaluate the additional prognostic value of a composite cardiac magnetic resonance (CMR)-based risk score over standard-of-care (SOC) evaluation in a large cohort of consecutive unselected non-ischaemic cardiomyopathy (NICM) patients.
  
  METHODS AND RESULTS:
  In the DERIVATE registry (www.clinicaltrials.gov/registration: RCT#NCT03352648), 1000 (derivation cohort) and 508 (validation cohort) NICM patients with chronic heart failure (HF) and left ventricular ejection fraction 3 segments with midwall fibrosis on late gadolinium enhancement (LGE) were the only independent predictors of all-cause mortality (HR: 1.036, 95% CI: 1.0117-1.056, P?0.001 and HR: 2.077, 95% CI: 1.211-3.562, P?=?0.008, respectively). For MAACE, the independent predictors were male gender, left ventricular end-diastolic volume index by CMR (CMR-LVEDVi), and >3 segments with midwall fibrosis on LGE (HR: 2.131, 95% CI: 1.231-3.690, P?=?0.007; HR: 3.161, 95% CI: 1.750-5.709, P?0.001; and HR: 1.693, 95% CI: 1.084-2.644, P?=?0.021, respectively). A composite clinical and CMR-based risk score provided a net reclassification improvement of 63.7% (P?0.001) for MAACE occurrence when added to the model based on SOC evaluation. These findings were confirmed in the validation cohort.
  
  CONCLUSION:
  In a large multicentre, multivendor cohort registry reflecting daily clinical practice in NICM work-up, a composite clinical and CMR-based risk score provides incremental prognostic value beyond SOC evaluation, which may have impact on the indication of implantable cardioverter-defibrillator implantation.
  
  Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: journals.permissions@oup.com.
  
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• [ANMCO/SIC Consensus document on the management of myocarditis].
  G Ital Cardiol (Rome)

  2020 Dec;21(12):969-989. doi: 10.1714/3472.34551.
  
  Cipriani Manlio, Merlo Marco, Gabrielli Domenico, Ammirati Enrico, Autore Camillo, Basso Cristina, Caforio Alida, Caldarola Pasquale, Camici Paolo, Di Lenarda Andrea, Frustaci Andrea, Imazio Massimo, Oliva Fabrizio, Pedrotti Patrizia, Perazzolo Marra Martina, Rapezzi Claudio, Urbinati Stefano, Zecchin Massimo, Filardi Pasquale Perrone, Colivicchi Furio, Indolfi Ciro, Frigerio Maria, Sinagra Gianfranco
  
  Abstract
  
  Myocarditis is an inflammatory heart disease that can occur acutely, as in acute myocarditis, or persistently, as in chronic myocarditis or chronic inflammatory cardiomyopathy. Different agents can induce myocarditis, with viruses being the most common triggers. Generally, acute myocarditis affects relatively young people and men more than women. Myocarditis has a broad spectrum of clinical presentations and evolution trajectories, although most cases resolve spontaneously. Patients with reduced left ventricular ejection fraction, heart failure symptoms, advanced atrioventricular block, sustained ventricular arrhythmias or cardiogenic shock (the latter known as fulminant myocarditis) are at increased risk for death and heart transplantation. The presentation of chronic inflammatory cardiomyopathy may be more subtle, with progressive symptoms of heart failure or appearance of rhythm disturbance, not rarely preceded by an infective episode. Autoimmune disorder or systemic inflammatory conditions can be another significant predisposing substrate of myocarditis, especially in women. Emerging causes of myocarditis are drug-related like the new anticancer therapies, the immune checkpoint inhibitors. In this Italian Association of Hospital Cardiologists (ANMCO) and Italian Society of Cardiology (SIC) expert consensus document on myocarditis, we propose diagnostic strategies for identifying possible causes of the disease and factors associated with increased risk. Finally, we propose potential treatments and when referring patients to tertiary centers, especially for high-risk patients. Even if endomyocardial biopsy is the invasive diagnostic tool for making definitive diagnosis and differentiation of histological subtypes (i.e., lymphocytic vs eosinophilic vs giant cell myocarditis), it is not always readily available in all centers. Thus, we propose when this exam is mandatory or when it can be postponed or substituted by cardiac magnetic resonance imaging. This document reflects the Italian perspective on managing patients with myocarditis and their follow-up, considering also current US and European scientific position statements.
  
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• Management of Acute Myocarditis and Chronic Inflammatory Cardiomyopathy: An Expert Consensus Document.
  Circ Heart Fail

  2020 Nov;13(11):e007405. doi: 10.1161/CIRCHEARTFAILURE.120.007405.
  
  Ammirati Enrico, Frigerio Maria, Adler Eric D, Basso Cristina, Birnie David H, Brambatti Michela, Friedrich Matthias G, Klingel Karin, Lehtonen Jukka, Moslehi Javid J, Pedrotti Patrizia, Rimoldi Ornella E, Schultheiss Heinz-Peter, Tschöpe Carsten, Cooper Leslie T, Camici Paolo G
  
  Abstract
  
  Myocarditis is an inflammatory disease of the heart that may occur because of infections, immune system activation, or exposure to drugs. The diagnosis of myocarditis has changed due to the introduction of cardiac magnetic resonance imaging. We present an expert consensus document aimed to summarize the common terminology related to myocarditis meanwhile highlighting some areas of controversies and uncertainties and the unmet clinical needs. In fact, controversies persist regarding mechanisms that determine the transition from the initial trigger to myocardial inflammation and from acute myocardial damage to chronic ventricular dysfunction. It is still uncertain which viruses (besides enteroviruses) cause direct tissue damage, act as triggers for immune-mediated damage, or both. Regarding terminology, myocarditis can be characterized according to etiology, phase, and severity of the disease, predominant symptoms, and pathological findings. Clinically, acute myocarditis (AM) implies a short time elapsed from the onset of symptoms and diagnosis (generally
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• Late-sequalae of Kawasaki disease characterized by optical coherence tomography.
  J Cardiovasc Med (Hagerstown)

  2021 Jul;22(7):597-599. doi: 10.2459/JCM.0000000000001083.
  
  Soriano Francesco, Veas Nicolas, Nava Stefano, Piccinelli Enrico, Pedrotti Patrizia, Oreglia Jacopo, Vignati Gabriele, Winter José, Ammirati Enrico, Burns Jane C, Gordon John B
  
  
  
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• Liver damage and sickle cell disease: genotype relationship.
  Ann Hematol

  2020 Sep;99(9):2065-2072. doi: 10.1007/s00277-020-04113-3.
  
  Bortolotti Marta, D'Ambrosio Roberta, Fraquelli Mirella, Pedrotti Patrizia, Consonni Dario, Migone De Amicis Margherita, Scaramellini Natalia, Di Pierro Elena, Graziadei Giovanna
  
  Abstract
  
  Sickle hepatopathy is a severe and not rare complication of sickle cell disease (SCD), showing mainly a cholestatic pattern. So far, no effective approaches to prevent or treat this condition have been recognized. We conducted a single-center observational study in 68 adult sickle cell patients, encompassing 17 with sickle cell anemia (SCA), 38 with sickle cell thalassemia (HbS/?-Thal), and 13 with HbSC disease. The aim of our study was to assess liver damage in the three main forms of SCD, through the evaluation of clinical, laboratory, and imaging findings. In our population, the role of hepatotropic viruses, high BMI, and alcohol consumption in liver damage was ruled out. SCA and HbS/?-Thal patients with lower Hb (p?0.001), higher HbS (p?0.001), and frequent vaso-occlusive crises showed functional (GGT values: SCA and HbS/?-Thal vs HbSC p?=?0.047 and p?=?0.009, respectively) and structural liver abnormalities, defined by abdominal ultrasound and vibration-controlled transient elastography (liver stiffness values: SCA and HbS/?-Thal vs HbSC p 0.022 and p 0.19, respectively), more severe than HbSC patients. Through univariate and multivariate analyses, male sex, SCA genotype, lower HbF, frequent transfusions, increased GGT values, and abnormal liver ultrasound and stiffness were identified as potentially early markers of sickle hepatopathy.
  
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• Update on acute myocarditis.
  Trends Cardiovasc Med

  2021 Aug;31(6):370-379. doi: 10.1016/j.tcm.2020.05.008.
  
  Ammirati Enrico, Veronese Giacomo, Bottiroli Maurizio, Wang Dao Wen, Cipriani Manlio, Garascia Andrea, Pedrotti Patrizia, Adler Eric D, Frigerio Maria
  
  Abstract
  
  Acute myocarditis (AM), a recent-onset inflammation of the heart, has heterogeneous clinical presentations, varying from minor symptoms to high-risk cardiac conditions with severe heart failure, refractory arrhythmias, and cardiogenic shock. AM is moving from being a definitive diagnosis based on histological evidence of inflammatory infiltrates on cardiac tissue to a working diagnosis supported by high sensitivity troponin increase in association with specific cardiac magnetic resonance imaging (CMRI) findings. Though experts still diverge between those advocating for histological definition versus those supporting a mainly clinical definition of myocarditis, in the real-world practice the diagnosis of AM has undoubtedly shifted from being mainly biopsy-based to solely CMRI-based in most of clinical scenarios. It is thus important to clearly define selected settings where EMB is a must, as information derived from histology is essential for an optimal management. As in other medical conditions, a risk-based approach should be promoted in order to identify the most severe AM cases requiring appropriate bundles of care, including early recognition, transfer to tertiary centers, aggressive circulatory supports with inotropes and mechanical devices, histologic confirmation and eventual immunosuppressive therapy. Despite improvements in recognition and treatment of AM, including a broader use of promising mechanical circulatory supports, severe forms of AM are still burdened by dismal outcomes. This review is focused on recent clinical studies and registries that shed new insights on AM. Attention will be paid to contemporary outcomes and predictors of prognosis, the emerging entity of immune checkpoint inhibitors-associated myocarditis, updated CMRI diagnostic criteria, new data on the use of temporary mechanical circulatory supports in fulminant myocarditis. The role of viruses as etiologic agents will be reviewed and a brief update on pediatric AM is also provided. Finally, we summarize a risk-based approach to AM, based on available evidence and clinical experience.
  
  Copyright © 2020. Published by Elsevier Inc.
  
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• Fulminant myocarditis triggered by OC43 subtype coronavirus: a disease deserving evidence-based care bundles.
  J Cardiovasc Med (Hagerstown)

  2020 Jul;21(7):529-531. doi: 10.2459/JCM.0000000000000989.
  
  Veronese Giacomo, Cipriani Manlio, Bottiroli Maurizio, Garascia Andrea, Mondino Michele, Pedrotti Patrizia, Pini Daniela, Cozzi Ottavia, Messina Antonio, Droandi Ginevra, Petrella Duccio, Frigerio Maria, Ammirati Enrico
  
  
  
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• Usefulness of Cardiac Magnetic Resonance for Recurrent Pericarditis.
  Am J Cardiol

  2020 Jan;125(1):146-151. doi: 10.1016/j.amjcard.2019.09.026.
  
  Imazio Massimo, Pivetta Emanuele, Palacio Restrepo Sara, Sormani Paola, Pedrotti Patrizia, Quarta Giovanni, Brucato Antonio, Bubbico Elisa, Dal Corso Maria, Milazzo Angela, Quattrocchi Giuseppina, Andriani Monica, Lobetti Bodoni Luisa, Davini Ottavio, Sironi Sandro, Giannattasio Cristina, Giustetto Carla, Bogaert Jan, Adler Yehuda, Bucciarelli Ducci Chiara, De Ferrari Gaetano Maria
  
  Abstract
  
  Cardiac magnetic resonance (CMR) offers the capability to objectively detect pericarditis by identifying pericardial thickening, edema/inflammation by Short-TI Inversion Recovery-T2 weighted (STIR-T2w) imaging, edema/inflammation or fibrosis by late gadolinium enhancement (LGE), and presence of pericardial effusion. This is especially helpful for the diagnosis of recurrent pericarditis. Aim of the present paper is to assess the diagnostic accuracy of CMR findings as well as their potential prognostic value for the diagnosis of recurrent pericarditis. Multicenter cohort study of consecutive patients with recurrent pericarditis evaluated by CMR. We included 128 consecutive cases (60 males, 47%; mean age 48 ± 14 years). CMR was performed at a mean time of 12 days (95% confidence interval 15 to 21) after the clinical diagnosis. We evaluated the diagnostic accuracy and areas under the receiver operating characteristic (ROC) curve for CMR diagnostic criteria and complications (additional recurrences, cardiac tamponade, and constrictive pericarditis). Areas under the ROC curve were respectively 64% for pericardial thickening, 84% for pericardial edema, 82% for pericardial LGE, and 71% for pericardial effusion. After a mean follow-up of 34 months, recurrences occurred in 52% of patients, tamponade in 6%, and constrictive pericarditis in 11%. Using a multivariable Cox model, elevation of CRP and presence of CMR pericardial thickening were predictors of adverse events, whereas the presence of CMR LGE was associated with a lower risk. The prognostic model for adverse events using gender, age, CRP level, and all CMR variables showed a C-index of 0.84. In conclusion, CMR findings show high diagnostic accuracy and may help identifying patients at higher risk of complications.
  
  Copyright © 2019 Elsevier Inc. All rights reserved.
  
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• [Myocardial infarction with non-obstructive coronary arteries (MINOCA): diagnosis, pathogenesis, therapy and prognosis].
  G Ital Cardiol (Rome)

  2019 Sep;20(9):499-511. doi: 10.1714/3207.31839.
  
  Buono Andrea, Pedrotti Patrizia, Soriano Francesco, Veas Nicolas, Oliva Fabrizio, Oreglia Jacopo, Ammirati Enrico
  
  Abstract
  
  The term MINOCA (myocardial infarction with non-obstructive coronary arteries) defines acute myocardial infarction with angiographic evidence of no significant coronary artery stenosis. Heterogeneous diseases are labelled as MINOCA. Incidence and epidemiological aspects differ on the basis of etiological causes. MINOCA include plaque (causing
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• Getting to the heart of the matter in a multisystem disorder: Erdheim-Chester disease.
  Lancet

  2019 Aug;394(10198):e19. doi: 10.1016/S0140-6736(19)31787-8.
  
  Buono Andrea, Bassi Ilaria, Santolamazza Caterina, Moreo Antonella, Pedrotti Patrizia, Sacco Alice, Morici Nuccia, Giannattasio Cristina, Oliva Fabrizio, Ammirati Enrico
  
  
  
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• Recurrent cardiac sarcoidosis after heart transplantation.
  Clin Res Cardiol

  2019 Oct;108(10):1171-1173. doi: 10.1007/s00392-019-01485-z.
  
  Veronese Giacomo, Cipriani Manlio, Petrella Duccio, Geniere Nigra Stefano, Pedrotti Patrizia, Garascia Andrea, Masciocco Gabriella, Bramerio Manuela A, Klingel Karin, Frigerio Maria, Ammirati Enrico
  
  
  
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• Iron overload in congenital haemolytic anaemias: role of hepcidin and cytokines and predictive value of ferritin and transferrin saturation.
  Br J Haematol

  2019 May;185(3):523-531. doi: 10.1111/bjh.15811.
  
  Barcellini Wilma, Zaninoni Anna, Gregorini Anna I, Soverini Giulia, Duca Lorena, Fattizzo Bruno, Giannotta Juri A, Pedrotti Patrizia, Vercellati Cristina, Marcello Anna P, Fermo Elisa, Bianchi Paola, Cappellini Maria Domenica
  
  Abstract
  
  Iron overload (IO) is poorly investigated in the congenital haemolytic anaemias (CHAs), a heterogeneous group of rare inherited diseases encompassing abnormalities of the erythrocyte membrane and metabolism, and defects of the erythropoiesis. In this study we systematically evaluated routine iron parameters and cardiac and hepatic magnetic resonance imaging, together with erythropoietin, hepcidin, non-transferrin bound iron (NTBI), and cytokine serum levels in patients with different CHAs. We found that 40% of patients had a liver iron concentration (LIC) >4 mg Fe/g dry weight. Hepatic IO was associated with ferritin levels (P = 0·0025), transferrin saturation (TfSat, P = 0·002) and NTBI (P = 0·003). Moreover, ferritin >500 ?g/l plus TfSat >60% was demonstrated as the best combination able to identify increased LIC, and TfSat alteration as more important in cases with discordant values. Possible confounding factors, such as transfusions, hepatic disease, metabolic syndrome and hereditary haemochromatosis-associated mutations, had negligible effects on IO. Erythropoietin and hepcidin levels were increased in CHAs compared with controls, correlating with LIC and ferritin, respectively. Regarding cytokines, ?-interferon (IFN-?) was increased, and both interleukin 6 and IFN-? levels positively correlated with ferritin and hepcidin levels. Overall, these findings suggest the existence of a vicious cycle between chronic haemolysis, inflammatory response and IO in CHAs.
  
  © 2019 British Society for Haematology and John Wiley & Sons Ltd.
  
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• [Clinical applications of cardiac magnetic resonance imaging: coronary heart disease, myocarditis, pericardial diseases, arrhythmias, valvular heart disease, congenital heart disease and cardiac masses].
  G Ital Cardiol (Rome)

  2019 Jan;20(1):8-19. doi: 10.1714/3079.30716.
  
  Pedrotti Patrizia, Pedretti Stefano, Imazio Massimo, Quattrocchi Giuseppina, Sormani Paola, Milazzo Angela, Quarta Giovanni
  
  Abstract
  
  Cardiac magnetic resonance is an accurate and versatile tool for multiparametric morphologic and functional evaluation of the heart and great vessels, with a wide range of clinical applications: from acute and chronic ischemic heart disease to the assessment of the substrate of complex ventricular arrhythmias and the follow-up of patients with valvular and congenital heart disease. The accuracy in cardiac volume and ejection fraction quantification, tissue characterization, valvular regurgitant fraction and cardiac shunt assessment, pharmachologic stress myocardial perfusion and three-dimensional reconstruction of great vessels are the points of strength that have made Cardiac magnetic resonance an invaluable tool for diagnostic, classification and follow-up of patients with various cardiac diseases.
  
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• [Clinical applications of cardiac magnetic resonance imaging: heart failure and cardiomyopathies].
  G Ital Cardiol (Rome)

  2018 Dec;19(12):679-691. doi: 10.1714/3027.30252.
  
  Pedrotti Patrizia, Pedretti Stefano, Imazio Massimo, Quattrocchi Giuseppina, Sormani Paola, Quarta Giovanni
  
  Abstract
  
  Cardiac magnetic resonance (CMR) has proved to be a powerful tool in the assessment of several cardiac diseases, thanks to its capability to offer multiparametric morphologic and functional evaluation of the heart and great vessels, using neither ionizing radiations nor nephrotoxic contrast medium. The accuracy in quantification of cardiac volumes and ejection fraction (gold standard) together with native and post-contrast myocardial tissue characterization have made CMR an invaluable tool for the diagnosis, prognosis and therapeutic planning in patients with heart failure and cardiomyopathy.
  
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• Not every fulminant lymphocytic myocarditis fully recovers.
  J Cardiovasc Med (Hagerstown)

  2018 Aug;19(8):453-454. doi: 10.2459/JCM.0000000000000664.
  
  Veronese Giacomo, Cipriani Manlio, Petrella Duccio, Pedrotti Patrizia, Giannattasio Cristina, Garascia Andrea, Oliva Fabrizio, Klingel Karin, Frigerio Maria, Ammirati Enrico
  
  
  
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• Clinical Presentation and Outcome in a Contemporary Cohort of Patients With Acute Myocarditis: Multicenter Lombardy Registry.
  Circulation

  2018 Sep;138(11):1088-1099. doi: 10.1161/CIRCULATIONAHA.118.035319.
  
  Ammirati Enrico, Cipriani Manlio, Moro Claudio, Raineri Claudia, Pini Daniela, Sormani Paola, Mantovani Riccardo, Varrenti Marisa, Pedrotti Patrizia, Conca Cristina, Mafrici Antonio, Grosu Aurelia, Briguglia Daniele, Guglielmetto Silvia, Perego Giovanni B, Colombo Stefania, Caico Salvatore I, Giannattasio Cristina, Maestroni Alberto, Carubelli Valentina, Metra Marco, Lombardi Carlo, Campodonico Jeness, Agostoni Piergiuseppe, Peretto Giovanni, Scelsi Laura, Turco Annalisa, Di Tano Giuseppe, Campana Carlo, Belloni Armando, Morandi Fabrizio, Mortara Andrea, Cirò Antonio, Senni Michele, Gavazzi Antonello, Frigerio Maria, Oliva Fabrizio, Camici Paolo G,
  
  Abstract
  
  BACKGROUND:
  There is controversy about the outcome of patients with acute myocarditis (AM), and data are lacking on how patients admitted with suspected AM are managed. We report characteristics, in-hospital management, and long-term outcome of patients with AM based on a retrospective multicenter registry from 19 Italian hospitals.
  
  METHODS:
  A total of 684 patients with suspected AM and recent onset of symptoms (70 years of age and those >50 years of age without coronary angiography were excluded. The final study population comprised 443 patients (median age, 34 years; 19.4% female) with AM diagnosed by either endomyocardial biopsy or increased troponin plus edema and late gadolinium enhancement at cardiac magnetic resonance.
  
  RESULTS:
  At presentation, 118 patients (26.6%) had left ventricular ejection fraction
  CONCLUSIONS:
  In this contemporary study, overall serious adverse events after AM were lower than previously reported. However, patients with left ventricular ejection fraction
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• Complexity of scar and ventricular arrhythmias in dilated cardiomyopathy of any etiology: Long-term data from the SCARFEAR (Cardiovascular Magnetic Resonance Predictors of Appropriate Implantable Cardioverter-Defibrillator Therapy Delivery) Registry.
  Clin Cardiol

  2018 Apr;41(4):494-501. doi: 10.1002/clc.22911.
  
  Pedretti Stefano, Vargiu Sara, Baroni Matteo, Dellegrottaglie Santo, Lanzarin Barbara, Roghi Alberto, Milazzo Angela, Quattrocchi Giuseppina, Lunati Maurizio, Pedrotti Patrizia
  
  Abstract
  
  BACKGROUND:
  Late gadolinium enhancement (LGE) assessed with cardiovascular magnetic resonance (CMR) correlates with ventricular arrhythmias and survival in patients with structural heart disease. Whether some LGE characteristics may specifically improve prediction of arrhythmic outcomes is unknown.
  
  HYPOTHESIS:
  We sought to evaluate scar characteristics assessed with CMR to predict implantable cardioverter-defibrillator (ICD) interventions in dilated cardiomyopathy of different etiology.
  
  METHODS:
  96 consecutive patients evaluated with CMR received an ICD. Biventricular volumes, ejection fraction, and myocardial LGE were evaluated. LGE was defined as "complex" (Cx-LGE) in presence of ?1 of the following: ischemic pattern, involving ?2 different coronary territories; epicardial pattern; global endocardial pattern; and presence of ?2 different patterns. The primary endpoint was occurrence of any appropriate ICD intervention. A composite secondary endpoint of cardiovascular death, cardiac transplantation, or ventricular assist device implantation was also considered.
  
  RESULTS:
  During a median follow-up of 75 months, 30 and 25 patients reached the primary and secondary endpoints, respectively. Cx-LGE was correlated with a worse primary endpoint survival (log-rank P
  CONCLUSIONS:
  Cx-LGE identified at CMR imaging seems promising as an independent and specific prognostic factor of ventricular arrhythmias requiring ICD therapy in dilated cardiomyopathy of different etiologies.
  
  © 2018 Wiley Periodicals, Inc.
  
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• Changes of late gadolinium enhancement extension compared with native T1 mapping early after acute myocarditis.
  Int J Cardiol

  2018 Apr;257():227. doi: 10.1016/j.ijcard.2017.12.056.
  
  Ammirati Enrico, Sormani Paola, Moroni Francesco, Camici Paolo G, Pedrotti Patrizia
  
  
  
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• Role of T1 mapping as a complementary tool to T2* for non-invasive cardiac iron overload assessment.
  PLoS One

  2018 ;13(2):e0192890. doi: e0192890.
  
  Torlasco Camilla, Cassinerio Elena, Roghi Alberto, Faini Andrea, Capecchi Marco, Abdel-Gadir Amna, Giannattasio Cristina, Parati Gianfranco, Moon James C, Cappellini Maria D, Pedrotti Patrizia
  
  Abstract
  
  BACKGROUND:
  Iron overload-related heart failure is the principal cause of death in transfusion dependent patients, including those with Thalassemia Major. Linking cardiac siderosis measured by T2* to therapy improves outcomes. T1 mapping can also measure iron; preliminary data suggests it may have higher sensitivity for iron, particularly for early overload (the conventional cut-point for no iron by T2* is 20ms, but this is believed insensitive). We compared T1 mapping to T2* in cardiac iron overload.
  
  METHODS:
  In a prospectively large single centre study of 138 Thalassemia Major patients and 32 healthy controls, we compared T1 mapping to dark blood and bright blood T2* acquired at 1.5T. Linear regression analysis was used to assess the association of T2* and T1. A "moving window" approach was taken to understand the strength of the association at different levels of iron overload.
  
  RESULTS:
  The relationship between T2* (here dark blood) and T1 is described by a log-log linear regression, which can be split in three different slopes: 1) T2* low, 30ms, weak relationship. All subjects with T2*20ms, 38% had low T1 with most of the subjects in the T2* range 20-30ms having a low T1.
  
  CONCLUSIONS:
  In established cardiac iron overload, T1 and T2* are concordant. However, in the 20-30ms T2* range, T1 mapping appears to detect iron. These data support previous suggestions that T1 detects missed iron in 1 out of 3 subjects with normal T2*, and that T1 mapping is complementary to T2*. The clinical significance of a low T1 with normal T2* should be further investigated.
  
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• Cardiovascular magnetic resonance imaging in hypertrophic cardiomyopathy: the importance of clinical context.
  Eur Heart J Cardiovasc Imaging

  2018 Jun;19(6):601-610. doi: 10.1093/ehjci/jex323.
  
  Quarta Giovanni, Aquaro Giovanni Donato, Pedrotti Patrizia, Pontone Gianluca, Dellegrottaglie Santo, Iacovoni Attilio, Brambilla Paolo, Pradella Silvia, Todiere Giancarlo, Rigo Fausto, Bucciarelli-Ducci Chiara, Limongelli Giuseppe, Roghi Alberto, Olivotto Iacopo
  
  Abstract
  
  In patients with suspected or established hypertrophic cardiomyopathy (HCM), cardiovascular magnetic resonance (CMR) is widely employed for clinical management, given its multimodality approach capable of providing unique information on cardiac morphology, function, and tissue characterization. Guidance regarding all aspects of HCM diagnosis and management is provided by the comprehensive 2014 European Society of Cardiology (ESC) guidelines on HCM. CMR should be performed in centres with recognized expertise in heart muscle diseases, by physicians who are familiar with the whole HCM disease spectrum, differential diagnoses, and pitfalls. Because CMR is usually performed and interpreted by physicians not directly involved in patient care, detailed, bidirectional, and standardized communication becomes essential to obtain best results and avoid misinterpretation. In order to maximize the potential of CMR, it is of paramount importance that reporting physicians are provided with the essential clinical information and that, in turn, referring physicians are given a core set of CMR morphological, functional, and tissue characterization results following the test. This article aims to summarize the current knowledge on the role of CMR in managing HCM and, in addition, to review the importance of the clinical context in which the report is provided, in both adult and paediatric population, highlighting implications for clinical research.
  
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• Survival and Left Ventricular Function Changes in Fulminant Versus Nonfulminant Acute Myocarditis.
  Circulation

  2017 Aug;136(6):529-545. doi: 10.1161/CIRCULATIONAHA.117.026386.
  
  Ammirati Enrico, Cipriani Manlio, Lilliu Marzia, Sormani Paola, Varrenti Marisa, Raineri Claudia, Petrella Duccio, Garascia Andrea, Pedrotti Patrizia, Roghi Alberto, Bonacina Edgardo, Moreo Antonella, Bottiroli Maurizio, Gagliardone Maria P, Mondino Michele, Ghio Stefano, Totaro Rossana, Turazza Fabio M, Russo Claudio F, Oliva Fabrizio, Camici Paolo G, Frigerio Maria
  
  Abstract
  
  BACKGROUND:
  Previous reports have suggested that despite their dramatic presentation, patients with fulminant myocarditis (FM) might have better outcome than those with acute nonfulminant myocarditis (NFM). In this retrospective study, we report outcome and changes in left ventricular ejection fraction (LVEF) in a large cohort of patients with FM compared with patients with NFM.
  
  METHODS:
  The study population consists of 187 consecutive patients admitted between May 2001 and November 2016 with a diagnosis of acute myocarditis (onset of symptoms
  RESULTS:
  In the whole population (n=187), the rate of in-hospital death or heart transplantation was 25.5% versus 0% in FM versus NFM, respectively (
  CONCLUSIONS:
  Patients with FM have an increased mortality and need for heart transplantation compared with those with NFM. From a functional viewpoint, patients with FM have a more severely impaired LVEF at admission that, despite steep improvement during hospitalization, remains lower than that in patients with NFM at long-term follow-up. These findings also hold true when only the viral forms are considered and are different from previous studies showing better prognosis in FM.
  
  © 2017 American Heart Association, Inc.
  
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• Myocardial deformation in iron overload cardiomyopathy: speckle tracking imaging in a beta-thalassemia major population.
  Intern Emerg Med

  2017 Sep;12(6):799-809. doi: 10.1007/s11739-017-1670-4.
  
  Di Odoardo Luca Antonio Felice, Giuditta Marianna, Cassinerio Elena, Roghi Alberto, Pedrotti Patrizia, Vicenzi Marco, Sciumbata Veronica Maria, Cappellini Maria Domenica, Pierini Alberto
  
  Abstract
  
  Traditional echocardiography is unable to detect neither the early stages of iron overload cardiomyopathy nor myocardial iron deposition. The aim of the study is to determine myocardial systolic strain indices in thalassemia major (TM), and assess their relationship with T2*, a cardiac magnetic resonance index of the severity of cardiac iron overload. 55 TM cases with recent cardiac magnetic resonance (CMR-T2*) underwent speckle tracking analysis to assess regional myocardial strains and rotation. The results were compared with a normal control group (n = 20), and were subsequently analyzed on the basis of the CMR-T2* values. Two TM groups were studied: TM with significant cardiac iron overload ("low" T2*, ?20 ms; n = 21), and TM with normal T2* values ("normal" T2*, >20 ms; n = 34). TM patients show significant, uniform decrease in circumferential and radial strain (P 
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• [Catecholamine-induced myocarditis in pheochromocytoma].
  G Ital Cardiol (Rome)

  2017 Feb;18(2):164-168. doi: 10.1714/2663.27302.
  
  Muratori Davide, Pedrotti Patrizia, Baroni Matteo, Belloni Armando, Quattrocchi Giuseppina, Milazzo Angela, Giannattasio Cristina, Roghi Alberto
  
  Abstract
  
  Pheochromocytoma is a rare tumor, usually benign, potentially lethal in case of crisis with acute release of catecholamines. The heart is a target and the clinical presentation can mimic various cardiac conditions, thus rendering diagnosis elusive. Cardiac magnetic resonance is a valuable non-invasive diagnostic tool for the evaluation of cardiomyopathies; it allows the identification of catecholamine-induced myocarditis pattern and, in some cases, it can detect the primary tumor. The definitive treatment of pheochromocytoma is surgical, while the acute crisis may require mechanical support to circulation. We here report a case of pheochromocytoma in a 25-year-old man complicated by catecholamine-induced myocarditis and heart failure.
  
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• The key clues to reach the diagnosis of Loeffler endomyocardial fibrosis associated with eosinophilic granulomatosis with polyangiitis.
  J Cardiovasc Med (Hagerstown)

  2017 Oct;18(10):831-832. doi: 10.2459/JCM.0000000000000496.
  
  Ammirati Enrico, Sirico Domenico, Brevetti Linda, Scudiero Laura, Artioli Diana, Pedrotti Patrizia, Frigerio Maria
  
  
  
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• Quantitative changes in late gadolinium enhancement at cardiac magnetic resonance in the early phase of acute myocarditis.
  Int J Cardiol

  2017 Mar;231():216-221. doi: 10.1016/j.ijcard.2016.11.282.
  
  Ammirati Enrico, Moroni Francesco, Sormani Paola, Peritore Angelica, Milazzo Angela, Quattrocchi Giuseppina, Cipriani Manlio, Oliva Fabrizio, Giannattasio Cristina, Frigerio Maria, Roghi Alberto, Camici Paolo G, Pedrotti Patrizia
  
  Abstract
  
  BACKGROUND:
  The presence of late gadolinium enhancement (LGE) at cardiac magnetic resonance (CMR) has diagnostic and prognostic value in patients with acute myocarditis (AM). Aim of our study was to quantify the changes in LGE extension (LGE%) early after AM and evaluate its relations with biventricular function and morphology.
  
  METHODS:
  We investigated 76 consecutive patients with AM (acute onset of chest pain/heart failure/ventricular arrhythmias not explained by other causes, and raised troponin) that met CMR criteria based on myocardial oedema at T2-weighted images and LGE on post-contrast images at median time of 6days from onset of symptoms. We quantified LGE% at baseline and after 148days in 49 patients.
  
  RESULTS:
  Median left ventricular (LV)-ejection fraction (EF) was 64% (interquartile range [Q1-Q3]: 56-67%), and LGE% 9.4% (Q1-Q3: 7.5-13.2%). LGE% was correlated with LV end-systolic volume index (LV-ESVi; r=+0.34; p=0.003). LGE% was inversely correlated with LV-EF (r=-0.31; p=0.009) and time to CMR scan (r=-0.25; p=0.028). In the 49 patients with a second CMR scan, despite no significant variations in LV-EF, a significant decrease of LGE% was observed (p
  CONCLUSIONS:
  In the acute phase of AM the LGE extension is a dynamic process that reflects impairment of LV function and is time dependent. LGE% appears one of the CMR parameters with the largest relative variations in the first months after AM.
  
  Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
  
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• Nondilated Left Ventricle as an Adding Clue Helping Discrimination Between Acute Myocarditis From Other Cardiomyopathies.
  J Am Coll Cardiol

  2016 Oct;68(16):1817-1818. doi: 10.1016/j.jacc.2016.05.101.
  
  Ammirati Enrico, Pedrotti Patrizia, Roghi Alberto
  
  
  
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• Comprehensive evaluation of cardiac involvement in eosinophilic granulomatosis with polyangiitis (EGPA) with cardiac magnetic resonance.
  Eur J Intern Med

  2017 Apr;39():51-56. doi: 10.1016/j.ejim.2016.09.014.
  
  Cereda Alberto Francesco, Pedrotti Patrizia, De Capitani Lucio, Giannattasio Cristina, Roghi Alberto
  
  Abstract
  
  BACKGROUND:
  Eosinophilic granulomatosis with polyangiitis (EGPA) is a systemic necrotizing vasculitis characterized by hypereosinophilia. EGPA typically develops in three clinical phases, beginning with asthma, followed by tissue eosinophilia and finally systemic vasculitis. Cardiac involvement is the most important predictor of mortality; it occurs in approximately 15-60% of EGPA patients, a significant proportion of whom are asymptomatic and have normal electrocardiogram (ECG) and echocardiogram. Early detection and management of cardiac disease could positevely affect prognosis. Cardiovascular magnetic resonance (CMR) has emerged as the gold standard cardiac imaging technique in the evaluation of cardiomyopathies, due to its ability to reliably assess anatomy, function, and tissue characterization.
  
  AIM:
  Purpose of this study was to assess the role of CMR in detecting cardiac disease in patients with EGPA in clinical remission.
  
  METHODS:
  A dedicated CMR protocol including functional analysis, and pre and post-contrast tissue characterization was performed in 11 patients with EGPA and the results were compared with 11 healthy subjects.
  
  RESULTS:
  EGPA patients had lower left ventricular ejection fraction compared to controls (56±19 vs 68.7±5.2, p value 0.02). Late gadolinium enhancement (LGE), representing replacement fibrosis, was positive in 9/11 (82%) patients, mainly with a non-ischemic pattern. In 3/11 (27%) patients a left ventricular thrombus was detected; in 3/11 (27%) patients myocardial edema was detected. CMR parameters of interstitial fibrosis were significantly more elevated in EGPA patients compared to controls.
  
  CONCLUSIONS:
  Patients with EGPA in clinical remission showed a high cardiovascular burden as demonstrated by lower EF, signs of active inflammation, presence of interstitial and replacement fibrosis and intraventricular thrombosis. Further studies on wider populations are warranted to better understand how these findings could impact on prognosis and eventually guide therapy.
  
  Copyright © 2016 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
  
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• Prognostic impact of late gadolinium enhancement in the risk stratification of heart transplant patients.
  Eur Heart J Cardiovasc Imaging

  2017 Feb;18(2):130-137. doi: 10.1093/ehjci/jew186.
  
  Pedrotti Patrizia, Vittori Claudia, Facchetti Rita, Pedretti Stefano, Dellegrottaglie Santo, Milazzo Angela, Frigerio Maria, Cipriani Manlio, Giannattasio Cristina, Roghi Alberto, Rimoldi Ornella
  
  Abstract
  
  AIMS:
  The aim of the present study was to assess the association of the presence and amount of late gadolinium enhancement (LGE) at cardiac magnetic resonance (CMR) with cardiovascular adverse events in patients with orthotopic heart transplantation (HTx).
  
  METHODS AND RESULTS:
  We enrolled 48 patients (mean age, 54.7 ± 14.6 years; 37 men) at various stages after HTx. All patients underwent standard CMR at 1.5 T, to characterize both cardiac anatomy and LGE. Late gadolinium enhancement was detected in 26 patients (54%). All-cause and cardiovascular mortalities, and a composite of major adverse cardiovascular events (MACE) recurrence were evaluated during the follow-up period for a median of 5.16 years. Ten patients (21%) died and 26 (54%) were readmitted because of MACE. Multivariate Cox analysis identified as independent predictors of MACE a diagnosis of cardiac allograft vasculopathy (CAV) (HR 3.63; 1.5-8.7 95% CI; P = 0.0039), left ventricular end systolic volume index (HR 1.04; 95% CI 1.01-1.079; P = 0.008), LGE mass (HR 1.04; 1.01-1.06 95% CI; P = 0.0007), LGE % of left ventricular mass (HR 1.083; 1.03-1.13 95% CI; P = 0.0002). Independent predictors of all-cause death were CAV (HR 6.33; 95% CI 1.33-30.03; P = 0.0201), LGE mass (HR 1.04; 1.01-1.07 95% CI; P = 0.005), LGE % of left ventricular mass (HR 1.075; 1.02-1.13 95% CI; P = 0.007). Patients with CAV had a risk of MACE by 5 years of 67% (95% CI 0.309-0.851%); the addition of 7.9 LGE % to the risk model increased the predicted risk to 88% (95% CI 0.572-0.967%).
  
  CONCLUSIONS:
  The current study demonstrated that the presence of CAV and the total amount of LGE have a significant independent association with MACE and mortality in HTx patients.
  
  Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.
  
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• Multimodality imaging of pericardial diseases.
  J Cardiovasc Med (Hagerstown)

  2016 Nov;17(11):774-82. doi: 10.2459/JCM.0000000000000427.
  
  Imazio Massimo, Pedrotti Patrizia, Quattrocchi Giuseppina, Roghi Alberto, Badano Luigi, Faletti Riccardo, Bogaert Jan, Gaita Fiorenzo
  
  
  
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• Total pericardial agenesis mimicking arrhythmogenic right ventricular dysplasia.
  J Cardiovasc Med (Hagerstown)

  2016 Dec;17 Suppl 2():e216-e217. doi: 10.2459/JCM.0000000000000425.
  
  Pedrotti Patrizia, Peritore Angelica, Cereda Alberto, Giannattasio Cristina, Imazio Massimo
  
  Abstract
  
  : We report the incidental finding of pericardial agenesis in a patient with electrocardiographic and echocardiographic abnormalities mimicking arrhythmogenic right ventricular dysplasia. The anatomic findings were clearly depicted by cardiac magnetic resonance. The patient was asymptomatic and the clinical relevance of this finding would be raised in case a possible differential diagnosis of right heart overload should be necessary. Diagnosis may be easily suspected from the ECG and echocardiography; MRI will provide definite diagnosis.
  
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• Partial Anomalous Pulmonary Venous Return as Rare Cause of Right Ventricular Dilation: A Retrospective Analysis.
  Congenit Heart Dis

  2016 Jul;11(4):365-8. doi: 10.1111/chd.12382.
  
  Sormani Paola, Roghi Alberto, Cereda Alberto, Peritore Angelica, Milazzo Angela, Quattrocchi Giuseppina, Giannattasio Cristina, Pedrotti Patrizia
  
  Abstract
  
  INTRODUCTION:
  Partial anomalous pulmonary venous return (PAPVR) is an uncommon cause of right ventricular dilation. It may be difficult to identify and often remains undiagnosed.
  
  METHODS:
  We reviewed the database of the Cardiac Magnetic Resonance (CMR) Laboratory of Niguarda Hospital, in order to identify the cases of PAPVR between 2008 and 2014.
  
  RESULTS:
  On a total number of 7832 CMR scans, we identified 24 patients with PAPVR (14 male, age 41?±?18 y) corresponding to 0.31% of the total population. Only 30% of patients had been referred for known or suspected PAPVR, 33% of patients had been referred for suspected right ventricular arrhythmogenic dysplasia and 37% had been referred for other cardiac disease. PAPVR involved mainly the right pulmonary veins (18 patients, 75%) and in 62% of our cases was associated with an atrial septal defect. Eight patients underwent corrective surgery in our institution, which confirmed and successfully repaired the anomalies.
  
  CONCLUSIONS:
  PAPVR is a rare congenital cardiac pathology which should be suspected in case of unexplained right chambers enlargement. CMR imaging allows an accurate anatomic and functional definition of this pathology and associated abnormalities. Early correction has an excellent prognosis and prevents long term complications like pulmonary hypertension, right ventricular failure and atrial fibrillation.
  
  © 2016 Wiley Periodicals, Inc.
  
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• Allogeneic peripheral blood stem cell transplantation and accelerated atherosclerosis: An intriguing association needing targeted surveillance. Lessons from a rare case of acute anterior myocardial infarction.
  Eur Heart J Acute Cardiovasc Care

  2020 Oct;9(7):NP3-NP7. doi: 10.1177/2048872616652311.
  
  Scudiero Laura, Soriano Francesco, Morici Nuccia, Grillo Giovanni, Belli Oriana, Sacco Alice, Cipriani Manlio, Pedrotti Patrizia, Quattrocchi Giuseppina, Klugmann Silvio, Oliva Fabrizio
  
  Abstract
  
  We report the case of a 23-year-old man who developed an acute ST-elevation myocardial infarction secondary to acute thrombotic occlusion of the proximal left anterior descending coronary artery five years after undergoing chemotherapy, radiotherapy, haematopoietic stem cell transplantation for acute lymphoblastic leukaemia and bulky mediastinal mass involving the pleura and pericardium. His medical history also included Graft versus Host Disease developed 13 months after transplantation and acute myocarditis three months before the actual hospital admission. To the best of our knowledge, coronary artery disease as a complication of haematopoietic stem cell transplantation and low-dose mediastinal radiation therapy in young patients has been rarely reported in the medical literature. Clinicians should have a high degree of suspicion of coronary artery disease in patients treated with allogeneic haematopoietic stem cell transplantation, especially in patients previously treated with target mediastinal radiotherapy, as a group at risk of premature and significantly accelerated atherosclerosis, in order to make a timely and correct diagnosis.
  
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• The role of cardiac magnetic resonance in assessing the cardiac involvement in Gaucher type 1 patients: morphological and functional evaluations.
  J Cardiovasc Med (Hagerstown)

  2017 Apr;18(4):244-248. doi: 10.2459/JCM.0000000000000326.
  
  Roghi Alberto, Poggiali Erika, Cassinerio Elena, Pedrotti Patrizia, Giuditta Marianna, Milazzo Angela, Quattrocchi Giuseppina, Cappellini Maria Domenica
  
  Abstract
  
  BACKGROUND:
  Type 1 Gaucher disease (GD1) is the most common lysosomal disorder, characterized by the accumulation of beta-glucocerebroside into the macrophages of several organs. Cardiac involvement is rare and referred to as restrictive cardiomyopathy, pulmonary hypertension, and calcifications of the valves and the aortic arch.
  
  AIM:
  To assess the cardiovascular status by cardiac magnetic resonance, including evaluation of tissue characterization, in GD1 patients.
  
  METHODS:
  Nine GD1 patients were recruited at the Tertiary Care Centre for Rare Diseases at Ca' Granda Foundation IRCCS Hospital, Milan. The patients' records were available for a mean time of 6?±?3 years. Medical history of cardiac disease and cardiovascular risk factors were surveyed by direct interview. Patients were scanned with a 1.5 Avanto Siemens using a comprehensive cardiovascular evaluation protocol, including morphologic and functional sequences with gadolinium contrast media, to assess early and late enhancement (late gadolinium enhancement). Echocardiography was performed to study the cardiac morphology and function, including the measurement of pulmonary pressure.
  
  RESULTS:
  Three patients showed left atrial enlargement, one patient showed moderate aortic stenosis in bicuspid valve with mild aortic dilatation, and one patient showed moderate mitral regurgitation. No evidence of myocardial late gadolinium enhancement was detected after gadolinium contrast media. Seven patients received enzyme replacement therapy for a median of 1 year, and two patients were evaluated at diagnosis.
  
  CONCLUSION:
  Although cardiac disease in Gaucher disease is considered rare and associated with particular genotypes, we have found two valvular diseases and mild left atrial enlargement in three out of nine patients. Further studies to evaluate the prognostic value of these findings are warranted.
  
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• A life-threatening presentation of eosinophilic granulomatosis with polyangiitis.
  J Cardiovasc Med (Hagerstown)

  2016 Dec;17 Suppl 2():e109-e111. doi: 10.2459/JCM.0000000000000330.
  
  Ammirati Enrico, Cipriani Manlio, Musca Francesco, Bonacina Edgardo, Pedrotti Patrizia, Roghi Alberto, Astaneh Arash, Schroeder Jan W, Nonini Sandra, Russo Claudio F, Oliva Fabrizio, Frigerio Maria
  
  Abstract
  
  : Necrotizing eosinophilic myocarditis (NEM) is a life-threatening condition that needs rapid diagnosis by endomyocardial biopsy and hemodynamic support usually by mechanical circulatory systems. We present the case of a 25-year-old Caucasian man who developed a refractory cardiogenic shock due to a NEM that was supported with a peripheral veno-arterial extracorporeal membrane oxygenation associated with intravenous steroids and recovered after 2 weeks. Further instrumental investigations lead to the final diagnosis of NEM as first presentation of eosinophilic granulomatosis with polyangiitis (formerly Churg-Strauss syndrome), remarking the importance of identifying the systemic disorder that usually triggers the eosinophilic damage of the myocardium.
  
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• [Cardiac involvement in Churg-Strauss syndrome].
  G Ital Cardiol (Rome)

  2015 Sep;16(9):493-500. doi: 10.1714/1988.21524.
  
  Brucato Antonio, Maestroni Silvia, Masciocco Gabriella, Ammirati Enrico, Bonacina Edgardo, Pedrotti Patrizia
  
  Abstract
  
  Churg-Strauss syndrome, recently renamed eosinophilic granulomatosis with polyangiitis (EGPA), is a rare form of systemic vasculitis, characterized by disseminated necrotizing vasculitis with extravascular granulomas occurring among patients with asthma and tissue eosinophilia. EGPA is classified as a small and medium-sized vessel vasculitis associated with antineutrophil cytoplasmic antibodies (ANCA) and the hypereosinophilic syndrome. Typical clinical features include asthma, sinusitis, transient pulmonary infiltrates and neuropathy. Blood eosinophils are often >1500/µl or more than 10% on the differential leukocyte count. Blood eosinophils should always be tested in unexplained cardiac disorders, and may normalize even after low doses of corticosteroids. ANCA are positive in 40-60% of cases, mainly anti-myeloperoxidase. Heart involvement occurs in approximately 15-60% of EGPA patients, especially those who are ANCA negative. Any cardiac structure can be involved, and patients present with myocarditis, heart failure, pericarditis, arrhythmia, coronary arteritis, valvulopathy, intracavitary cardiac thrombosis. Although cardiovascular involvement is usually an early manifestation, it can also occur later in the course of the disease. A significant proportion of patients with cardiac involvement is asymptomatic. In the absence of symptoms and major ECG abnormalities, cardiac involvement may be detected in nearly 40% of the patients. All patients with EGPA should be studied not only with a detailed history of cardiac symptoms and ECG, but also with echocardiography; if abnormalities are detected, a cardiac magnetic resonance study should be performed. Coronary angiography and endomyocardial biopsy should be reserved to selected cases. Heart involvement carries a poor prognosis and causes 50% of the deaths of these patients. It is often insidious and underestimated. Optimal therapy is therefore important and based on high-dose corticosteroids plus immunosuppressive agents, particularly cyclophosphamide in case of myocardial inflammation. Thus, early diagnosis of cardiac involvement and subsequent therapy may prevent progression of cardiac disease. At present, the role of troponin and brain natriuretic peptide in monitoring and therapy remains unclear. Orthotopic heart transplantation is feasible in case of severe disease, even if the experience is limited in -EGPA, and optimal post-transplantation immunosuppressive strategy has yet to be defined.
  
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• Role of Non-Transferrin-Bound Iron in the pathogenesis of cardiotoxicity in patients with ST-elevation myocardial infarction assessed by Cardiac Magnetic Resonance Imaging.
  Int J Cardiol

  2015 Nov;199():326-32. doi: 10.1016/j.ijcard.2015.07.056.
  
  Roghi Alberto, Poggiali Erika, Duca Lorena, Mafrici Antonio, Pedrotti Patrizia, Paccagnini Stefania, Brenna Sergio, Galli Alessio, Consonni Dario, Cappellini Maria Domenica
  
  Abstract
  
  BACKGROUND:
  Hereditary hemochromatosis, thalassemia and myelodysplastic syndromes represent disease models with evidence of iron-related heart failure. Non-Transferrin Bound Iron (NTBI) induces cardiac toxicity through the production of reactive oxygen species and lipid peroxidation. In ST-elevation acute myocardial infarction (STEMI) with evidence of microvascular obstruction (MVO) and hemorrhage (HEM), HEM may be a source of iron-related cardiac toxicity through NTBI and pro-inflammatory mediators.
  
  AIM OF THE STUDY:
  The study aims to assess NTBI in patients with STEMI and its possible relationship with MVO and HEM.
  
  METHODS AND RESULTS:
  NTBI, LPO-Malondialdehyde (MDA) and interleukin-6 (IL-6) were assessed in 15 patients with STEMI immediately before primary percutaneous coronary intervention (PPCI) and at 3, 6, 9, 12, and 24h post-PPCI. Cardiac Magnetic Resonance (CMR) was performed at 5days and 6months after STEMI. Myocardial edema and HEM were assessed by T2 and T2* mapping. MVO and necrotic area were assessed by early and late gadolinium enhancement (LGE). NTBI was detected in 13/15 patients with the highest values in 4 patients with evidence of MVO and HEM. NTBI levels were significantly related to CK-MB and troponin T values. NTBI kinetics appeared to be different in patients with MVO and HEM (7/15 patients), with a peak value at 6h after PCI, in comparison with those with no evidence of MVO and HEM, in whom NTBI values were lower and remained indeterminable after the first 24h.
  
  CONCLUSIONS:
  The detection of elevated NTBI values in patients with STEMI, MVO and HEM suggests a possible role of iron cardiotoxicity in myocardial damage.
  
  Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
  
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• [The conundrum of therapeutic management in acute myocardial infarction complicated by endoventricular thrombosis: moving between different risks].
  G Ital Cardiol (Rome)

  2015 ;16(7-8):437-41. doi: 10.1714/1954.21248.
  
  Varrenti Marisa, Morici Nuccia, De Chiara Benedetta, Oreglia Jacopo Andrea, Pedrotti Patrizia, Giannattasio Cristina, Klugmann Silvio, Roghi Alberto
  
  Abstract
  
  Coronary artery disease is a rare entity in young patients and accurate assessment of its prevalence is difficult. Although coronary artery disease is frequently a silent process, it may also acutely present with myocardial infarction (MI). One of the most feared complications of MI is left ventricular thrombus formation. Transthoracic echocardiography is recommended for all patients with MI, and cardiac magnetic resonance should be considered because of its higher sensitivity if thrombus cannot clearly be demonstrated. The optimal treatment is based on anticoagulant therapy that should be started early and maintained for 3-4 months after the index event. We report the case of a 35-year-old male patient with anterior MI, complicated by left ventricular thrombus formation, extensive edema, microvascular obstruction and hemorrhagic core of the apical septum on cardiac magnetic resonance assessment.
  
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• [Ventricular aneurysm as a complication of giant cell myocarditis].
  G Ital Cardiol (Rome)

  2015 Jun;16(6):389-90. doi: 10.1714/1934.21040.
  
  Ammirati Enrico, Roghi Alberto, Oliva Fabrizio, Turazza Fabio M, Frigerio Maria, Pedrotti Patrizia
  
  Abstract
  
  Ventricular aneurysm as late complication has been described in cardiac sarcoidosis and occasionally in giant cell myocarditis. The images from the present case of ventricular aneurysm formation as a late complication of giant cell myocarditis underline a potential cause of sudden arrhythmic death in patients who survive this life-threatening condition in the absence of recurrent inflammation and with preserved left ventricular ejection fraction. Follow-up with cardiac magnetic resonance can detect small aneurysms, and an implantable cardioverter-defibrillator may be considered when this complication occurs.
  
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• Paroxysmal supraventricular tachycardia as first manifestation of right atrial hemangioma during endovascular treatment of intracranial arteriovenous fistulas.
  Oncotarget

  2015 Jun;6(16):14060-4.
  
  Spanò Francesca, Cereda Alberto, Moreo Antonella, Bonacina Edgardo, Peritore Angelica, Roghi Alberto, Giannattasio Cristina, Pedrotti Patrizia
  
  Abstract
  
  We report the description of a cardiac mass occupying almost the entire right atrium in a young man who developed paroxysmal supraventricular tachycardia during endovascular treatment of intracranial arteriovenous fistulas. The mass was detected at echocardiographic examination, its tissue characteristics were defined with cardiac magnetic resonance and it was successfully surgically removed. The histopathological findings were consistent with a mixed type cavernous-capillary hemangioma of the heart. The intriguing co-existence of cardiac hemangioma and cerebral arteriovenous fistulas, to the best of our knowledge, has not been previously reported in English Literature.
  
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• [A matter of perspective: multimodality imaging of a giant cardiac mass].
  G Ital Cardiol (Rome)

  2015 Mar;16(3):186-7. doi: 10.1714/1820.19830.
  
  Baroni Matteo, Nava Stefano, Vignati Gabriele, Marianeschi Stefano Maria, Giannattasio Cristina, Pedrotti Patrizia
  
  Abstract
  
  A newborn was suspected of having situs inversus with levocardia based on chest X-ray. Echocardiography ruled out this hypothesis but revealed a giant cardiac mass that was confirmed by magnetic resonance imaging. Coronary angiography showed that the right coronary artery ran on the surface of the mass, and only partial debulking surgery was performed to relieve right heart compression. Histological examination classified the mass as cardiac fibroma. Complex diagnostic work-up allowed correct anatomic definition of the mass as well as its relationship with adjacent structures, and helped guide surgical planning.
  
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• Ventricular aneurysms in cardiac sarcoidosis: From physiopathology to surgical treatment through a clinical case presenting with ventricular arrhythmias.
  Int J Cardiol

  2015 ;186():294-6. doi: 10.1016/j.ijcard.2015.03.256.
  
  Pedrotti Patrizia, Ammirati Enrico, Bonacina Edgardo, Roghi Alberto
  
  
  
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• Cardiac metastatic melanoma: Imaging diagnostic clues.
  J Cardiol Cases

  2015 Aug;12(2):33-36. doi: 10.1016/j.jccase.2015.03.001.
  
  Pedrotti Patrizia, Musca Francesco, Torre Massimo, Pirola Roberto, De Biase Anna Maria, Fieschi Stefano, Quattrocchi Giuseppina, Roghi Alberto, Giannattasio Cristina
  
  Abstract
  
  A 47-year-old male was admitted to hospital for severe pericardial effusion; he had undergone surgical removal of cutaneous melanoma 10 years before. Echocardiography-guided pericardiocentesis revealed the presence of intramyocardial masses, which were better defined and characterized, together with pericardial involvement, by cardiac magnetic resonance. Pericardial fluid drained was negative for malignant cells, so video-assisted thoracoscopy was performed and pathologic tissue was biopsied, leading to the diagnosis of metastatic melanoma. Multidisciplinary approach and multimodality imaging played a key role in allowing the diagnostic workup in this complex case. .
  
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• Pathologic correlates of late gadolinium enhancement cardiovascular magnetic resonance in a heart transplant patient.
  Cardiovasc Pathol

  2015 ;24(4):247-9. doi: 10.1016/j.carpath.2015.02.001.
  
  Pedrotti Patrizia, Bonacina Edgardo, Vittori Claudia, Frigerio Maria, Roghi Alberto
  
  Abstract
  
  We report the histopathologic correlates of late gadolinium enhancement (LGE) at cardiac magnetic resonance (CMR) in a patient with heart transplant who died for graft failure a few months after the scan. Extensive late enhancement was present at CMR, and it correlated with extensive fibrosis at histology. To our knowledge, this is the first time the findings on contrast enhancement CMR are compared to the histology of the whole heart in a heart transplantation patient, and the correspondence between LGE and fibrosis, demonstrated in other cardiac pathologies, is confirmed also in this particular setting.
  
  Copyright © 2015 Elsevier Inc. All rights reserved.
  
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• Successful treatment of subacute constrictive pericarditis with interleukin-1? receptor antagonist (anakinra).
  Clin Exp Rheumatol

  2015 ;33(2):294-5.
  
  D'Elia Emilia, Brucato Antonio, Pedrotti Patrizia, Valenti Anna, De Amici Mara, Fiocca Luigi, Duino Vincenzo, Senni Michele, Imazio Massimo, Martini Alberto
  
  
  
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• Giant cell myocarditis successfully treated with antithymocyte globuline and extracorporeal membrane oxygenation for 21 days.
  J Cardiovasc Med (Hagerstown)

  2016 Dec;17 Suppl 2():e151-e153. doi: 10.2459/JCM.0000000000000250.
  
  Ammirati Enrico, Oliva Fabrizio, Belli Oriana, Bonacina Edgardo, Pedrotti Patrizia, Turazza Fabio Maria, Roghi Alberto, Paino Roberto, Martinelli Luigi, Frigerio Maria
  
  Abstract
  
  : A 31-year-old man presenting with cardiogenic shock and left ventricular ejection fraction of 10% received the diagnosis of giant cell myocarditis by endomyocardial biopsy. The patient was successfully treated with high-dose inotropes, intra-aortic balloon pump and venoarterial extracorporeal membrane oxygenation for 21 days associated with combined immunosuppression (thymoglobulin, steroids, cyclosporine). Immunosuppression including thymoglobulin is the regimen associated with the highest probability of recovery in case of giant cell myocarditis. Immunosuppression needs time to be effective; thus, hemodynamic support must be guaranteed. In the present case, we observed that full recovery can be obtained up to 21 days of support with extracorporeal membrane oxygenation and adequate immunosuppression.
  
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• Myocardial and hepatic iron overload assessment by region-based and pixel-wise T2* mapping analysis: technical pitfalls and clinical warnings.
  J Comput Assist Tomogr

  2015 ;39(1):128-33. doi: 10.1097/RCT.0000000000000159.
  
  Roghi Alberto, Poggiali Erika, Pedrotti Patrizia, Milazzo Angela, Quattrocchi Giuseppina, Cassinerio Elena, Cappellini Maria Domenica
  
  Abstract
  
  OBJECTIVE:
  The aim of this study was to compare myocardial T2* assessment with region-based (RB) T2* multiecho technique (CMRtools) with the pixel-wise (PW) inline myocardial T2* mapping (Siemens) in patients with thalassemia major for myocardial iron characterization.
  
  MATERIALS AND METHODS:
  Forty-three thalassemia major patients were examined on a 1.5-T scanner using conventional gradient multiecho sequence. All the images were analyzed using both RB and PW T2* mapping. Coefficients of reproducibility (CRs) were used to assess the interoperator and intraobserver variability of each software.
  
  RESULTS:
  The mean (SD) myocardial T2* values using RB and PW software resulted significantly different (30.7 [15] milliseconds [range, 4.8-52.6 milliseconds] vs 24.3 [10.5] milliseconds [range 4.6-38.2 milliseconds]; P
  CONCLUSIONS:
  Our data show that RB and PW T2* mapping can be used interchangeably to measure severe myocardial and hepatic iron overload, whereas for borderline T2* values, we observed differences among the 2 methods causing different categorization.
  
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• Non-invasive imaging of vascular inflammation.
  Front Immunol

  2014 ;5():399. doi: 399.
  
  Ammirati Enrico, Moroni Francesco, Pedrotti Patrizia, Scotti Isabella, Magnoni Marco, Bozzolo Enrica P, Rimoldi Ornella E, Camici Paolo G
  
  Abstract
  
  In large-vessel vasculitides, inflammatory infiltrates may cause thickening of the involved arterial vessel wall leading to progressive stenosis and occlusion. Dilatation, aneurysm formation, and thrombosis may also ensue. Activated macrophages and T lymphocytes are fundamental elements in vascular inflammation. The amount and density of the inflammatory infiltrate is directly linked to local disease activity. Additionally, patients with autoimmune disorders have an increased cardiovascular (CV) risk compared with age-matched healthy individuals as a consequence of accelerated atherosclerosis. Molecular imaging techniques targeting activated macrophages, neovascularization, or increased cellular metabolic activity can represent effective means of non-invasive detection of vascular inflammation. In the present review, novel non-invasive imaging tools that have been successfully tested in humans will be presented. These include contrast-enhanced ultrasonography, which allows detection of neovessels within the wall of inflamed arteries; contrast-enhanced CV magnetic resonance that can detect increased thickness of the arterial wall, usually associated with edema, or mural enhancement using T2 and post-contrast T1-weighted sequences, respectively; and positron emission tomography associated with radio-tracers such as [(18)F]-fluorodeoxyglucose and the new [(11)C]-PK11195 in combination with computed tomography angiography to detect activated macrophages within the vessel wall. Imaging techniques are useful in the diagnostic work-up of large- and medium-vessel vasculitides, to monitor disease activity and the response to treatments. Finally, molecular imaging targets can provide new clues about the pathogenesis and evolution of immune-mediated disorders involving arterial vessels.
  
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• Cardiac magnetic resonance imaging of left ventricular apical hypoplasia in two complex congenital clinical syndromes.
  Circ J

  2014 ;78(6):1507-9.
  
  Baroni Matteo, Pedrotti Patrizia, Nava Stefano, Giannattasio Cristina, Roghi Alberto
  
  
  
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• Jellyfish in the heart.
  Circulation

  2013 Feb;127(6):e443-5. doi: 10.1161/CIRCULATIONAHA.112.116848.
  
  Dieli Maria, Simon Caterina, Brucato Antonio, Pedrotti Patrizia, Colombo Tiziano, Moreo Antonella, Fasolini Giorgio, Gori Mauro, Gianatti Andrea, Medolago Giuseppe, Ferrazzi Paolo
  
  
  
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• Recurrent pericarditis: autoimmune or autoinflammatory?
  Autoimmun Rev

  2012 Nov;12(1):60-5. doi: 10.1016/j.autrev.2012.07.023.
  
  Maestroni Silvia, Di Corato Paola Rita, Cumetti Davide, Chiara Di Blasi Lo Cuccio, Ghidoni Silvia, Prisacaru Lilia, Cantarini Luca, Imazio Massimo, Penco Silvana, Pedrotti Patrizia, Caforio Alida L P, Doria Andrea, Brucato Antonio
  
  Abstract
  
  Idiopathic recurrent acute pericarditis (IRAP) represents the most troublesome complication of acute pericarditis and occurs in up to 20-50% of patients. It is generally idiopathic or postcardiac injury. IRAP is a disease of suspected immune-mediated pathogenesis. On the other hand, it has been suggested that some of these patients might have an atypical or subclinical form of an autoinflammatory disease, e.g. genetic disorders characterized by primary dysfunction of the innate immune system and caused by mutations of genes involved in the inflammatory response. We found that IRAP patients were negative for mutations associated with familial Mediterranean fever, but 6% (8/131 patients) carry a mutation in the TNFRSF1A gene, encoding the receptor for tumor necrosis factor-alfa. C-reactive protein (CRP) may be useful to follow the disease activity and guide the appropriate length of therapy, with continuation of the attack doses of the drugs until CRP normalization, at which time tapering may be considered. IRAP often needs a multidrug therapy: NSAIDs or aspirin at high dosages every 6-8h, corticosteroids only rarely, at low dosages and with a very gradual tapering (months) and colchicine at low dosages if tolerated. Anakinra could be a solution for patients who do not tolerate other therapies.
  
  Copyright © 2012 Elsevier B.V. All rights reserved.
  
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• Cardiac iron removal and functional cardiac improvement by different iron chelation regimens in thalassemia major patients.
  Ann Hematol

  2012 Sep;91(9):1443-9. doi: 10.1007/s00277-012-1480-8.
  
  Cassinerio Elena, Roghi Alberto, Pedrotti Patrizia, Brevi Francesca, Zanaboni Laura, Graziadei Giovanna, Pattoneri Paolo, Milazzo Angela, Cappellini Maria Domenica
  
  Abstract
  
  Heart failure due to myocardial iron overload remains the leading cause of morbidity and mortality in adult thalassemia major (TM) patients. We evaluated the removal of cardiac iron and the changes of cardiac function by different iron chelation in TM patients by T2* cardiac magnetic resonance (CMR). Sixty-seven TM patients (27 males/40 females; mean age, 35 ± 6 years) on different chelation regimens underwent T2* CMR at baseline (t (0)), after 6-14 months (t (1)) and after 32 ± 7 months (t (2)). Patients were divided in four groups according to chelation treatment: group A (deferasirox), group B (deferoxamine), group C (combined treatment, deferoxamine plus deferiprone) and group D (deferiprone alone). Myocardial T2* at t (0) was
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• The first Caucasian patient with p.Val122Ile mutated-transthyretin cardiac amyloidosis treated with isolated heart transplantation.
  Amyloid

  2012 Jun;19(2):113-7. doi: 10.3109/13506129.2012.666509.
  
  Ammirati Enrico, Marziliano Nicola, Vittori Claudia, Pedrotti Patrizia, Bramerio Manuela A, Motta Valentina, Orsini Francesco, Veronese Silvio, Merlini Piera A, Martinelli Luigi, Frigerio Maria
  
  Abstract
  
  Effective treatments for mutated transthyretin (TTR)-related cardiac amyloidosis are limited. Heart transplantation or combined liver-heart transplantation are the most successful options, although results rely on underline mechanism and systemic nature of the disease. In this report, we present the first case of a Caucasian patient with the p.Val122Ile mutated TTR-related cardiac amyloidosis treated with heart transplantation due to this gene mutation frequent in Afro-Americans with a prevalent isolated heart involvement. The choice of isolated heart transplantation instead of combined heart and liver transplantations was based on (1) severe and progressive cardiac disease, (2) evidence of a gene mutation generally associated with isolated cardiac disease and (3) absence of relevant extra-cardiac involvement (with the possible exception of mild peripheral neuropathy). In any case, the very short post-transplant observation period of 10 months does not allow any conclusions on the long-term course of the presented strategy. Finally, it is the first European Caucasian family with the p.Val122Ile TTR mutation that has been described. Till now, very few Caucasian cases of p.Val122Ile mutated TTR-related cardiac amyloidosis have been reported. The patient and some members of his family also had mild peripheral neuropathy suggesting a regional phenotypic heterogeneity of European Caucasian TTR p.Val122Ile.
  
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• Regional and global ventricular systolic function in isolated ventricular non-compaction: pathophysiological insights from magnetic resonance imaging.
  Int J Cardiol

  2012 Jul;158(3):394-9. doi: 10.1016/j.ijcard.2011.01.063.
  
  Dellegrottaglie Santo, Pedrotti Patrizia, Roghi Alberto, Pedretti Stefano, Chiariello Massimo, Perrone-Filardi Pasquale
  
  Abstract
  
  BACKGROUND:
  Isolated ventricular non-compaction (IVNC) is frequently, but not invariably, associated with left ventricular (LV) systolic dysfunction. Factors impacting on regional and global LV function are unknown. The aim of the study was to apply magnetic resonance imaging (MRI) to evaluate the impact of extent and severity of ventricular non-compaction on LV systolic function in patients with IVNC.
  
  METHODS:
  Sixteen adult patients with IVNC as defined by previously validated MRI criteria [ratio between end-diastolic thickness of non-compacted and compacted myocardium (NC/C ratio)> 2.3 in ? 1 LV segment] were enrolled. Short-axis cine images were employed for analysis. Applying a 16-segment LV model, regional systolic performance was assessed qualitatively (wall motion score, WMS; 1 = normal, 2 = mild hypokinesia, 3 = moderate-to-severe hypokinesia, and 4 = a/dyskinesia) as well as quantitatively [fractional wall thickening, FWT (%)=100 × (end-diastolic wall thickness-end-systolic wall thickness)/end-diastolic wall thickness)].
  
  RESULTS:
  Mean LV ejection fraction was 43.8 ± 15.4% (range, 17-68%). Regional disease severity, as expressed by the NC/C ratio, revealed a significant correlation with WMS (r=0.26; p=0.018) and FWT (r=-0.30; p=0.006). The total number of non-compacted segments/patient (NoNC) as an index of disease extent was a significant independent correlate of LV ejection fraction by multivariate regression analysis (?=-5.24; p=0.038) and an excellent predictor of global LV dysfunction (ROC analysis, AUC=0.98; p
  CONCLUSIONS:
  In patients with IVNC, disease severity correlates with the degree of LV dysfunction at a regional level. The extent of myocardial non-compaction is an independent predictor of global LV dysfunction.
  
  Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.
  
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• Adrenergic myocarditis in pheochromocytoma.
  J Cardiovasc Magn Reson

  2011 Jan;13(1):4. doi: 10.1186/1532-429X-13-4.
  
  Roghi Alberto, Pedrotti Patrizia, Milazzo Angela, Bonacina Edgardo, Bucciarelli-Ducci Chiara
  
  Abstract
  
  The clinical presentation of pheochromocytoma is variable and many biochemical and imaging methods have been suggested to improve the diagnostic accuracy of what has been termed "the great masquerader". This case-report is of a middle-aged woman with a non-specific clinical presentation suggesting acute coronary syndrome or subacute myocarditis. Cardiovascular magnetic resonance (CMR) at presentation showed myocardial edema and intramyocardial late gadolinium enhancement (LGE). An adrenal mass was seen, which was confirmed as pheochromocytoma and surgically removed. Our case shows evidence for acute adrenergic myocarditis, with resolution of both the edema and the LGE after surgical excision.
  
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• Images in cardiovascular medicine. Bacterial pericarditis due to Providencia stuartii: an atypical case of relapsing pericarditis.
  Circulation

  2010 Jul;122(4):e401-3. doi: 10.1161/CIRCULATIONAHA.110.943118.
  
  Simon Caterina, Dieli Maria, Brucato Antonio, Pedrotti Patrizia, Brambilla Paolo, Curri Silvia Flaminia, Senni Michele, Pericotti Sergio, Suter Fredy, Ferrazzi Paolo
  
  
  
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• Cavernous hemangioma replacing the septal leaflet of the tricuspid valve.
  J Card Surg

  2010 Sep;25(5):524-7. doi: 10.1111/j.1540-8191.2010.01064.x.
  
  Cannata Aldo, Russo Claudio F, Merlanti Bruno, Pedrotti Patrizia, Moreo Antonella, Botta Luca, Martinelli Luigi
  
  Abstract
  
  Heart valve hemangioma is a rare finding. Here, we report a case of a hemangioma completely replacing the septal leaflet of the tricuspid valve. Preoperative imaging studies and operative anatomy are described.
  
  © 2010 Wiley Periodicals, Inc.
  
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• Acute myocardial infarction and cardiac arrest in atypical Takayasu aortitis in a young girl: unusual diagnostic role of cardiac magnetic resonance imaging in emergency setting.
  Circulation

  2010 Apr;121(14):e370-5. doi: 10.1161/CIR.0b013e3181dab9ee.
  
  Roghi Alberto, Pedrotti Patrizia, Milazzo Angela, Vignati Gabriele, Martinelli Luigi, Paino Roberto, Bonacina Edgardo
  
  
  
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• [Combined evaluation of myocardial perfusion and contractility by cardiac magnetic resonance with adenosine stress test: feasibility and accuracy in detecting coronary artery disease].
  G Ital Cardiol (Rome)

  2009 Feb;10(2):101-7.
  
  Dellegrottaglie Santo, Cospite Valentina, Pedrotti Patrizia, Pedretti Stefano, Lanzarin Barbara, Mauri Francesco, Roghi Alberto
  
  Abstract
  
  BACKGROUND:
  Protocols of cardiac magnetic resonance imaging (CMR) during pharmacological stress with adenosine may include scanning sequences for the evaluation of both myocardial perfusion and contractility. The aim of this study was to define the feasibility and diagnostic accuracy of a stress CMR protocol including the combined evaluation of regional myocardial perfusion and contractility in the identification of patients with significant coronary artery disease.
  
  METHODS:
  A total of 184 consecutive patients with known or suspected coronary artery disease underwent stress CMR (adenosine, 140 microg/kg/min). The employed protocol included the application of the following sequences for image acquisition: 1) cine imaging at rest; 2) perfusion imaging (Gd-DTPA, 0.05 mmol/kg) during pharmacological stress; 3) cine imaging during pharmacological stress; 4) perfusion imaging (Gd-DTPA, 0.05 mmol/kg) at rest.
  
  RESULTS:
  Stress CMR was completed in 182 patients (99%). Minor complications were observed in 12 patients (7%) during adenosine infusion, while one patient developed severe bronchospasm and another patient experienced persistent myocardial ischemia. Good/excellent-quality images were obtained in 91% of stress CMR exams. In a subgroup of 37 patients, when compared with the use of perfusion images alone, combination of perfusion and contractility data provided higher levels of sensitivity (74 vs 89%, p
  CONCLUSIONS:
  Adenosine stress CMR including the evaluation of both myocardial perfusion and contractility is feasible and improves diagnostic performance in the recognition of patients with significant coronary artery disease.
  
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• Unexpected myocarditis in thalassaemia major patient screened for iron load cardiomyopathy.
  BMJ Case Rep

  2009 ;2009():. doi: bcr08.2008.0811.
  
  Roghi Alberto, Dellegrottaglie Santo, Pedrotti Patrizia, Pedretti Stefano, Cassinerio Elena, Cappellini Maria Domenica
  
  
  
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• Atrial septal defect combined with partial anomalous pulmonary venous return: complete anatomic and functional characterization by cardiac magnetic resonance.
  J Cardiovasc Med (Hagerstown)

  2008 Nov;9(11):1184-6. doi: 10.2459/JCM.0b013e3283100ec6.
  
  Dellegrottaglie Santo, Pedrotti Patrizia, Pedretti Stefano, Mauri Francesco, Roghi Alberto
  
  Abstract
  
  The presented case regards a 17-year-old male with new-onset right bundle branch block and significantly enlarged right-heart sections as the only pathologic finding on transthoracic echocardiography. Cardiac magnetic resonance (CMR) revealed the presence of a superior sinus venosus atrial septal defect associated with a partial anomalous pulmonary venous return, with the right upper lobe pulmonary vein draining into the superior vena cava. CMR has developed in recent years into an accurate modality for non-invasive evaluation of patients with congenital heart disease, especially through improvements in quality and speed of image acquisition. With echocardiography, sinus venosus defects and anomalous pulmonary vein drainage may be more easily detected by a transoesophageal approach because of the proximity of the transducer to the atrial septum. CMR may be specifically recommended as an alternative to transoesophageal echocardiography in any patient with an unexplained dilatation of the right ventricle.
  
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• Persistent myocardial damage late after cardiac contusion: depiction by cardiac magnetic resonance.
  J Cardiovasc Med (Hagerstown)

  2008 Nov;9(11):1177-9. doi: 10.2459/JCM.0b013e328306f300.
  
  Dellegrottaglie Santo, Pedrotti Patrizia, Pedretti Stefano, Mauri Francesco, Roghi Alberto
  
  Abstract
  
  Cardiac contusion is a potential complication of blunt chest trauma and can be detected in a variable percentage of cases, depending on the method of diagnosis employed. Mechanical and/or ischemic mechanisms may be involved in the occurrence of myocardial injury in patients with cardiac contusion. In the reported case, cardiac magnetic resonance (CMR) was performed late after chest trauma in a 17-year-old man involved in a car accident 4 years earlier. CMR images documented the persistence of severe regional dysfunction involving the left ventricle, associated with a large area of post-contrast myocardial enhancement (representing necrosis and/or fibrosis). Functional and morphologic information derived from CMR appears theoretically to be helpful in defining the nature and severity of myocardial involvement at presentation, as well as during follow-up of patients with cardiac contusion.
  
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