CAPONE, VALENTINA Advanced cardiovascular imaging: new insights into early detection of left and right ventricular dysfunction. [Tesi di dottorato]

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Abstract

In this thesis we present a summary of the CardioPath program-related activities carried out in the last 3 years. During this period, I have been committed in clinical activities in the “Antonio Cardarelli” Hospital, Naples, Italy, as a full-time Medical Doctor assigned to the Cardiology Unit. The main areas of clinical interest have been the following: • Cardiac Intensive Care Unit (ICU) inpatient and outpatient clinical assistance • Advanced Cardiovascular Imaging [i.e., transthoracic Doppler echocardiography (TTE), comprehensive of global longitudinal strain (GLS) technique, trans-esophageal echocardiography (TEE), stress echocardiography], as Italian Society of Cardiovascular Imaging (SIECVI) transthoracic echocardiography Tutor • Consultation for both patients referring to the Emergency Department and for cardiac assessment and management of patients undergoing non-cardiac surgery • Cardio-oncology as hospital referral for cardiac assessment and management of patients occurring cancer therapy-related cardiovascular (CV) toxicity, with special focus on breast cancer patients experiencing cancer therapy-related cardiac dysfunction (CTRCD). Concerning research fields, during the period in exam, our research was targeted to different areas, but we always kept the focus both on study of left ventricular (LV) and right ventricular (RV) physiology, physiopathology and therapeutics, through advanced cardiac imaging techniques, to early detect and treat LV and RV and pulmonary circulation dysfunction. Lastly, we have generally analyzed “real-world” populations to provide further insights respect to daily clinical practices. In the field of advanced echocardiography LV evaluation, we focused on understanding LV physiology and physiopathology and their reference values through advanced echocardiographic techniques as myocardial Mechano-Energetic Efficiency (MEE) and LV hemodynamic forces trough Speckle-Tracking Echocardiography. Therefore, we provided insights in the management of LV dysfunction (LVD) both in the acute and chronic setting. We focused on LVD due to the cardiotoxicity of anti-cancer treatments, with particular interest on CTRCD related to anthracyclines and anti-HER2-inhibitors in breast cancer patients. Lastly, we focused on LVD and CV risk in the context of cardiometabolic syndrome, addressing physiopathology and exploring newer therapeutic possibilities including sodium-glucose cotransporter 2 inhibitors (SGLT2i) and analogue of Glucagon-like peptide-1 (aGLP1). In this research context, we provided research collaboration with University Hospital of Zurich, Switzerland, where I spent some days as fellow, to discuss the projects related to some international registers: the International Takotsubo Registry (InterTAK) and the International Spontaneous Coronary Arteries Dissection Registry (InterSCAD). Moreover, regarding the InterSCAD Registry, I’ve been identified as the Italian contact person for the involved centers, under the coordination of Prof. Christian Templin, University Hospital Zurich, Switzerland. In the field of echocardiographic evaluation of RV and pulmonary function, we deeply analyzed stress exercise echocardiography technique to assess pulmonary circulation and right ventricular function and limits of normal and disease-specific changes. These issues were addressed by both a meta-analysis (which has been submitted and under revision) and from studies on data by the RIGHT-NET (RIGHT Heart International NETwork), a prospective, observational, multicenter clinical study including healthy subjects, elite athletes, and subjects with overt pulmonary hypertension (PH) or at risk of PH, conducted at different European and American centers in which I’m still involved as Investigator, under the guide of Prof. Eduardo Bossone, University of Federico II of Naples, Italy. Lastly, we provided some issues from our in-Hospital daily clinical practice, including case-reports and systematic stepwise approaches to clinical issues, always based on current scientific evidence and guidelines.

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