Andrea Segreti
@virgilio.it
Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
RESEARCH, TEACHING, or OTHER INTERESTS
Cardiology and Cardiovascular Medicine, Respiratory Care
Scopus Publications
Scopus Publications
Mihail Celeski, Andrea Segreti, Dajana Polito, Daniele Valente, Luisa Vicchio, Giuseppe Di Gioia, Gian Paolo Ussia, Raffaele Antonelli Incalzi, and Francesco Grigioni
Elsevier BV
Francesco Piccirillo, Sara Mastroberardino, Vincenzo Nafisio, Matteo Fiorentino, Andrea Segreti, Annunziata Nusca, Gian Paolo Ussia, and Francesco Grigioni
MDPI AG
Myocarditis is a polymorphic and potentially life-threatening disease characterized by a large variability in clinical presentation and prognosis. Within the broad spectrum of etiology, eosinophilic myocarditis represents a rare condition characterized by eosinophilic infiltration of the myocardium, usually associated with peripheral eosinophilia. Albeit uncommon, eosinophilic myocarditis could be potentially life-threatening, ranging from mild asymptomatic disease to multifocal widespread infiltrates associated with myocardial necrosis, thrombotic complications, and endomyocardial fibrosis. Moreover, it could progress to dilated cardiomyopathy, resulting in a poor prognosis. The leading causes of eosinophilic myocarditis are hypersensitivity reactions, eosinophilic granulomatosis with polyangiitis, cancer, hyper-eosinophilic syndrome variants, and infections. A thorough evaluation and accurate diagnosis are crucial to identifying the underlying cause and defining the appropriate therapeutic strategy. On these bases, this comprehensive review aims to summarize the current knowledge on eosinophilic myocarditis, providing a schematic and practical approach to diagnosing, evaluating, and treating eosinophilic myocarditis.
Giuseppe Di Gioia, Lorenzo Buzzelli, and Andrea Segreti
Oxford University Press (OUP)
Abstract Background Congenital left ventricular diverticula (LVDs) and aneurysms (LVAs) are rare, developmental, cardiac anomalies, which are often asymptomatic. Sometimes they can cause life-threatening complications like arrhythmias, syncope, embolic events, ventricular wall rupture, valvular regurgitation, congestive heart failure, and various symptoms. Diagnosis is usually made after exclusion of acquired causes, from cardiac or non-cardiac disorders. Specific guidelines for LVD/LVA management are not available and treatment options are guided by different case-by-case clinical presentation and possible complications. Case summary We present a series of two patients with occasional diagnosis of diverticula of the inferior basal left ventricular wall in the context of cardiological evaluations for competitive sport certificate. Symptoms were present at clinical evaluation only in Patient 1, together with electrocardiogram (ECG) abnormality. We performed transthoracic echocardiography as a first-line examination and secondly, we confirmed the diverticula by cardiac magnetic resonance. A maximal stress test and 24 h ECG Holter were also performed. In our case, in light of the clinical-instrumental findings, periodic medical and echocardiographic follow-up without therapy was established, together with the resumption of sports activities. Discussion Nowadays, no specific recommendations exist in athletes and no studies are available on how regular sport practice can influence natural history of LVD/LVA. The current case series highlights the importance of risk stratification for cardiac events, of a multimodal imaging approach in diagnostic procedure and of a tailored treatment strategy.
Simone Pasquale Crispino, Andrea Segreti, Ylenia La Porta, Paola Liporace, Myriam Carpenito, Valeria Cammalleri, and Francesco Grigioni
PAGEPress Publications
A 55-year-old male affected by heart failure with reduced ejection fraction and a history of a transient cerebrovascular accident was accepted to the Cardiology Department for worsening dyspnoea. A cardiopulmonary exercise testing was performed after therapy optimization to further evaluate exercise intolerance. A rapid increase in VE/VCO2 slope, PETO2, and RER, with a concomitant decrease in PETCO2 and SpO2, were observed during the test. These findings indicate exercise-induced pulmonary hypertension leading to a right-to-left shunt. Subsequent echocardiography with a bubble test unveiled the presence of an unknown patent foramen ovale. It is, therefore, necessary to exclude a right-to-left shunt by cardiopulmonary exercise testing, particularly in patients predisposed to develop pulmonary hypertension during exercise. Indeed, this eventuality might potentially provoke severe cardiovascular embolisms. However, the patent foramen ovale closure in patients with heart failure with reduced ejection fraction is still debated because of its potential hemodynamic worsening.
Giuseppe Di Gioia, Simone Pasquale Crispino, Viviana Maestrini, Sara Monosilio, Maria Rosaria Squeo, Erika Lemme, Andrea Segreti, Andrea Serdoz, Roberto Fiore, Domenico Zampaglione,et al.
MDPI AG
Uricemia has been identified as an independent risk factor for cardiovascular disease. In the general population, hyperuricemia is associated with hypertension, endothelial dysfunction, and other cardiovascular risk (CVR) factors. Our aim was to explore the prevalence of hyperuricemia among Olympic athletes, evaluating the influence of sporting discipline and its correlation with CVR factors. We enrolled 1173 Olympic athletes classified into four disciplines: power, skill, endurance, and mixed. Clinical, anthropometric data, and complete blood test results were collected. Hyperuricemia was present in 4.4% of athletes, 0.3% were hypertensive, 11.7% had high-normal blood pressure values, 0.2% were diabetic, 1.2%. glucose intolerance, 8.2% active smokers, and 3% were obese. Males had a higher prevalence of hyperuricemia (5.3%) than females (3.4%) with no significant differences between different sporting disciplines (male, p = 0.412; female p = 0.561). Males with fat mass >22% presented higher uricemia (5.8 ± 1 vs. 5.3 ± 1 mg/dL, p = 0.010) like hypertensive athletes (6.5 ± 0.3 vs. 5.3 ± 1 mg/dL, p = 0.031), those with high-normal blood pressure (5.13 ± 1 vs. 4.76 ± 1.1 mg/dL, p = 0.0004) and those with glucose intolerance (6 ± 0.8 vs. 5.3 ± 1 mg/dL, p = 0.066). The study provides a comprehensive evaluation of hyperuricemia among Olympic athletes, revealing a modest prevalence, lower than in the general population. However, aggregation of multiple CVR factors could synergistically elevate the risk profile, even in a population assumed to be at low risk. Therefore, uric acid levels should be monitored as part of the CVR assessment in athletes.
Giuseppe Di Gioia, Dajana Polito, Simone Pasquale Crispino, Viviana Maestrini, Antonio Nenna, Andrea Segreti, Maria Rosaria Squeo, Erika Lemme, and Antonio Pelliccia
Wiley
AbstractBackgroundCardiovascular adaptations in elite athletes involve both ventricular and atrial changes. Nowadays, limited research exists on right ventricular (RV) remodeling, particularly in female athletes and across different types of exercise training.MethodsOur study evaluated 370 athletes (61% males) participated at 2020 Tokyo and 2022 Beijing Olympic Games. Athletes were categorized according to main type of exercise into isometric and isotonic. Comprehensive echocardiographic assessments were conducted to analyze RV morpho‐functional parameters, comparing genders and different sporting exercise.ResultsSignificant differences in RV parameters were observed based on exercise type and gender. Isotonic athletes showed greater RV remodeling with larger RV outflow tract (15.1 ± 2.1 vs. 14.5 ± 1.7 mm, p < .0001) end‐diastolic and end‐systolic area (respectively, 24.6 ± 5.5 vs. 21.7 ± 5 mm, p < .000 and 11.7 ± 3.2 vs. 10.1 ± 2.8 mm, p < .0001) and right atrium size (11.7 ± 3.2 vs. 10.2 ± 2.3 mm2, p = .0001). Functional parameters, such as TDI velocities, were similar between groups. Males showed larger RV area and right atrium size (p < .0001) and lower RV TDI velocities with reduced E′ (15.4 ± 2.9 vs. 16.1 ± 3.2 m/s in females, p = .031), resulting in lower E′/A′ ratio (1.69 ± .6 vs. 1.84 ± .6 m/s, p = .021), while S′ was lower females (14.6 ± 2.3 vs. 14.1 ± 2.4 m/s, p = .041). RV TDI velocities were similar in isotonic and isometric both in male and females.ConclusionsIn elite athletes, RV morphological changes are influenced by exercise modality but do not translate into functional differences. Female athletes present distinct RV functional profiles, with lower S′ velocities and a higher E′/A′ ratio. Functional RV TDI parameters are not affected by the typology of exercise practiced.
Lorenzo Buzzelli, Andrea Segreti, Daniela Di Gioia, Erika Lemme, Maria Rosaria Squeo, Antonio Nenna, and Giuseppe Di Gioia
Elsevier BV
Giuseppe Di Gioia, Federica Coletti, Lorenzo Buzzelli, Viviana Maestrini, Sara Monosilio, Andrea Segreti, Maria Rosaria Squeo, Erika Lemme, Antonio Nenna, and Antonio Pelliccia
Elsevier BV
Andrea Segreti, Francesco Piccirillo, Simone Pasquale Crispino, Francesca Cocchia, Arianna Martucciello, Vito Calabrese, Fiorella Gurrieri, and Francesco Grigioni
PAGEPress Publications
In the present article, we describe the case of a 21-year-old male presenting to the Emergency Department following a syncopal episode. Physical examination revealed a distinctive facial appearance in the context of an overgrowth syndrome. Also, an ajmaline test was performed because of the evidence of an incomplete right bundle branch block with ST-T segment elevation in the right precordial derivations, revealing a type-1 Brugada electrocardiographic pattern. Considering the high cardiovascular risk phenotype, the patient underwent subcutaneous cardiac defibrillator implantation. The subsequent comprehensive genomic testing analysis led to the diagnosis of a variant of an uncertain significance of the nuclear receptor binding SET domain protein 1 (NSD1) gene and a heterozygous mutation of the calsequestrin 2 (CASQ2) gene. NSD1 gene alterations are usually responsible for the Sotos syndrome, characterized by distinctive facial appearance, learning disability, and overgrowth, in addition to cardiac anomalies, ranging from single self-limiting alterations to more severe, complex cardiac abnormalities. On the contrary, a compound heterozygous or homozygous alteration of the CASQ2 gene is usually associated with catecholaminergic polymorphic ventricular tachycardia; however, the significance of a merely heterozygous alteration in CASQ2 gene, as in the present case report, is not yet clear. In conclusion, to the best of our knowledge, this is the first description of the coexisting presence of Brugada and overgrowth syndromes in a single patient.
Giuseppe Di Gioia, Simone Pasquale Crispino, Sara Monosilio, Viviana Maestrini, Antonio Nenna, Andrea Segreti, Maria Rosaria Squeo, Erika Lemme, Gian Paolo Ussia, Francesco Grigioni,et al.
Wiley
AbstractIntroductionBilirubin was supposed to have cardio‐metabolic protective role by signaling functions. Indeed, mild hyperbilirubinemia has immunosuppressive and endocrine activities and may offer protection against oxidative stress‐mediated diseases. Gilbert syndrome (GS) has been hypothesized to provide cardio‐metabolic benefits.ObjectiveTo investigate the prevalence of hyperbilirubinemia and its cardio‐metabolic effects in a cohort of elite Italian athletes engaged in different sports disciplines.MethodsWe enrolled 1492 elite athletes (age 25.8 ± 5.1) practising different disciplines (power, skills, endurance, and mixed) underwent blood, echocardiographic, and exercise tests. GS was diagnosed per exclusionem in athletes with isolated asymptomatic unconjugated hyperbilirubinemia.ResultsGS was highlighted in 91 athletes (6%; globally 9% male and 2.4% female); 82% were males (p < 0.0001) showing higher indirect bilirubin (0.53 ± 0.4 vs. 0.36 ± 0.24 mg/dL in females, p < 0.0001). GS athletes had fewer platelets (201 ± 35 vs. 214 ± 41, p = 0.01), higher iron (male: 124 ± 44 vs. 100.9 ± 34 mcg/dL, p < 0.0001; female: 143.3 ± 35 vs. 99.9 ± 42 mcg/dL, p < 0.0001), and lower erythrocyte sedimentation rate, (1.93 ± 0.9 vs. 2.80 ± 2.7 mm/H, p = 0.03). At multivariate analysis, male (OR 3.89, p = 0.001) and iron (OR 3.47, p = 0.001) were independently associated with GS. No significant differences were found in cardiac remodeling, heart rate, blood pressure, arrhythmias, or power capacity at stress test. Endurance athletes (313) presented higher total (p = 0.003) and indirect bilirubin (p = 0.001).ConclusionBilirubin has several metabolic effects (including immunosuppressive and endocrine) and plays a role in regulating antioxidant pathways exercise‐related with hematological consequences but seems not to affect significantly cardiovascular remodeling. Endurance athletes present higher bilirubin concentrations, likely as an adaptive mechanism to counteract increased oxidative stress.
Ilaria Cavallari, Simone Pasquale Crispino, Andrea Segreti, Gian Paolo Ussia, and Francesco Grigioni
Springer Science and Business Media LLC
Andrea SEGRETI, Francesco PICARELLI, Giuseppe DI GIOIA, Federica COLETTI, Simone P. CRISPINO, Valerio FANALE, Chiara FOSSATI, Raffaele ANTONELLI INCALZI, Fabio PIGOZZI, and Francesco GRIGIONI
Edizioni Minerva Medica
Routine or vigorous training, particularly in competitive and elite athletes practicing dynamic sports, leads to a constellation of structural and functional cardiovascular adaptations, facilitating an increased capacity to deliver oxygen to the working muscles during sustained physical exertion. Cardiopulmonary exercise testing is the most accurate and objective method to assess performance in athletes. Although still underutilized, it provides a window into the unique cardiovascular response to exercise in athletes, integrating parameters obtained by the traditional exercise test with breath-by-breath analysis of oxygen consumption, carbon dioxide production, ventilation, and other derived parameters. This review aimed to describe the several applications of cardiopulmonary exercise testing in athletes with a principal focus on the ability to identify cardiovascular adaptations and differentiate an athlete's heart from early cardiomyopathy. In this context, cardiopulmonary exercise testing provides many applications involving exercise physiology in athletes, allowing a precise evaluation of cardiovascular efficiency, the entity of the adaptations, the response to a training program, and identifying early modifications that could reveal early cardiomyopathy. Therefore, thanks to its several applications, this pivotal test allows us to obtain essential information about the athlete's physiology and differentiate between the expected response of a trained athlete from early cardiomyopathy.
Francesco Piccirillo, Simone Pasquale Crispino, Lorenzo Buzzelli, Andrea Segreti, Raffaele Antonelli Incalzi, and Francesco Grigioni
Elsevier BV
Andrea Segreti, Mihail Celeski, Luigi Maria Monticelli, Alfonso Perillo, Simone Pasquale Crispino, Giuseppe Di Gioia, Valeria Cammalleri, Chiara Fossati, Simona Mega, Rocco Papalia,et al.
MDPI AG
Observing mitral or tricuspid valve disease in an athlete raises many considerations for the clinician. Initially, the etiology must be clarified, with causes differing depending on whether the athlete is young or a master. Notably, vigorous training in competitive athletes leads to a constellation of structural and functional adaptations involving cardiac chambers and atrioventricular valve systems. In addition, a proper evaluation of the athlete with valve disease is necessary to evaluate the eligibility for competitive sports and identify those requiring more follow-up. Indeed, some valve pathologies are associated with an increased risk of severe arrhythmias and potentially sudden cardiac death. Traditional and advanced imaging modalities help clarify clinical doubts, allowing essential information about the athlete’s physiology and differentiating between primary valve diseases from those secondary to training-related cardiac adaptations. Remarkably, another application of multimodality imaging is evaluating athletes with valve diseases during exercise to reproduce the sport setting and better characterize the etiology and valve defect mechanism. This review aims to analyze the possible causes of atrioventricular valve diseases in athletes, focusing primarily on imaging applications in diagnosis and risk stratification.
Giuseppe Di Gioia, Viviana Maestrini, Alessandra Colella, Ruggiero Mango, Andrea Segreti, Maria Rosaria Squeo, Erika Lemme, and Antonio Pelliccia
International Scientific Information, Inc.
Patient: Male, 21-year-old Final Diagnosis: Apical hypertrophic cardiomyopathy Symptoms: No symptom Clinical Procedure: Cardiac magnetic resonance imaging • echocardiography Specialty: Cardiology Objective: Unusual clinical course Background: Differential diagnosis between athlete’s heart and hypertrophic cardiomyopathy is sometimes challenging in sport cardiology since endurance training can cause a distinct pattern of functional and structural changes of the cardiovascular system. It is of crucial importance to accurately diagnose it and stratify the arrhythmic risk since hypertrophic cardiomyopathy is one of the leading causes of sudden cardiac death in young athletes. Apical hypertrophic cardiomyopathy is a relatively rare form of hypertrophic cardiomyopathy that predominantly affects the apex of the left ventricle and usually has a nonobstructive physiology. Few data and studies are available on influence of aerobic training (and detraining) on morphological changes in athletes with apical hypertrophic cardiomyopathy. Case Report: We present the case of a 19-year-old male soccer athlete with family history for obstructive hypertrophic cardiomyopathy, with electrocardiographic and morphological left ventricular remodeling in association with sports activity. Intensive aerobic training led to marked T-wave inversion on 12-lead ECG and left ventricular hyper-trophy compatible with apical hypertrophic cardiomyopathy. Genetic testing confirmed the presence of familial variant c853C>T, p.(Arg 285Cys) on TNNT2 gene. After 18 months detraining, we observed a complete regression of ECG abnormalities and a reverse remodeling of the left ventricular hypertrophy. No pharmacological therapy was indicated; periodic cardiological evaluations were advised. Monitoring devices or implantable cardioverter defibrillator were not recommended. Conclusions: This case suggests that intensive aerobic training can affect the pathological hypertrophic cardiomyopathy substrate, facilitating the development of left ventricular hypertrophy and, more interesting, regression of structural changes after detraining.
Andrea Segreti, Giuseppe Verolino, Simone Pasquale Crispino, and Piergiuseppe Agostoni
Elsevier BV
Andrea Segreti, Francesco Grigioni, Jeness Campodonico, Alessandra Magini, Denise Zaffalon, Gianfranco Sinagra, Germano Di Sciascio, Erik Richard Swenson, and Piergiuseppe Agostoni
Oxford University Press (OUP)
Bruno Sposato, Marco Scalese, Alberto Ricci, Paola Rogliani, Pierluigi Paggiaro, B. Sposato, M. G. Migliorini, M. Di Tomassi, C. Olivieri, A. Perrella,et al.
Wiley
This study analysed whether the persistence of both reversible airway obstruction (RAO) and elevated BE counts was associated to reduced asthma control and accelerated lung function decline in treated severe asthmatics.
Andrea Segreti, Raffaele Antonelli Incalzi, Marco Lombardi, Marco Miglionico, Annunziata Nusca, Giorgio Pennazza, Marco Santonico, Simone Grasso, Francesco Grigioni, and Germano Di Sciascio
Ovid Technologies (Wolters Kluwer Health)
AIMS
Exhaled breath contains thousands of volatile organic compounds (VOCs) produced during various metabolic processes both in health and disease.Analysis of breath with electronic nose BIONOTE-V allows modifications of exhaled VOCs to be studied, which are clinically recognized to be a marker for several disorders, including heart failure. New noninvasive tests based on VOCs analysis might be a useful tool for early detection of chronic coronary syndromes (CCS).
METHODS
Exhaled air was collected and measured in individuals with an indication to perform invasive coronary angiography (ICA). All patients' samples were obtained before ICA.
RESULTS
Analysis with BIONOTE-V was performed in a total cohort of 42 patients consecutively enrolled, of whom 19 did not require myocardial revascularization and 23 with indication for myocardial revascularization. BIONOTE-V was able to correctly identify 18 out of 23 patients affected by severe coronary artery disease (sensitivity = 78.3% and specificity = 68.4%). Our predicted model had a tight correlation with SYNTAX score (error of the BIONOTE-V = 15).
CONCLUSION
CCS patients have a distinctive fingerprint of exhaled breath, and analysis by BIONOTE-V has the potential for identifying these patients. Moreover, it seems that this technique can correctly identify patients according to anatomical disease severity at ICA. If the preliminary data of this proof of concept study will be confirmed, this rapid and noninvasive diagnostic tool able to identify CCS might have an impact in routine clinical practice.
Danilo Ricciardi, Giampaolo Vetta, Antonio Nenna, Francesco Picarelli, Antonio Creta, Andrea Segreti, Camilla Cavallaro, Myriam Carpenito, Flavio Gioia, Natale Di Belardino,et al.
Ovid Technologies (Wolters Kluwer Health)
BACKGROUND
Twelve-lead ECG represents the most common diagnostic tool in clinical cardiology and allows an immediate screening of left ventricular hypertrophy (LVH), but current criteria might have poor clinical usefulness in everyday clinical practice due to lack of sensitivity.
METHODS
The current study aims to review and compare the clinical performance of known ECG criteria of LVH in a real-life setting; 2134 patients had ECG and echocardiographic exams performed during the same hospitalization. All traces were retrospectively analysed, and the amplitudes of the waves were manually measured. Transthoracic echocardiography was considered as the gold standard to assess LVH.
RESULTS
LVH had a prevalence of 58%. Considering the diagnostic performance of ECG criteria for LVH, the Cornell voltage carried the best area under the receiver operating characteristic curve (0.678), while RaVF (R wave in aVF lead) had the poorer result (0.440). The R5/R6 criterion had the best sensitivity (60%), but with the worst specificity (37.4%). The 'Q or S aVR' had the best specificity (99.9%) but lacks sensitivity (0.80%). The Peguero Lo Presti criterion had a sensitivity of 42.3% and a specificity of 75.8%. The Cornell voltage and the Cornell product had similar area under the receiver operating characteristic curve values which were found to be significantly greater compared with other criteria.
CONCLUSION
Current ECG criteria of LVH have low sensitivity despite an acceptable specificity. Among these, Cornell voltage and Cornell product criteria were equally found to have a more accurate diagnostic performance compared with other criteria. To overcome the intrinsic limitations of the current ECG LVH criteria, a new paradigm in the analysis of electrocardiographic data might be necessary.
Giuseppe Patti, Antonio Rapacciuolo, Andrea Segreti, Gian Paolo Ussia, Costanza Goffredo, and Germano Di Sciascio
Elsevier BV
Bruno Sposato, Marco Scalese, Manlio Milanese, Simonetta Masieri, Carlo Cavaliere, Manuela Latorre, Nicola Scichilone, Alberto Ricci, Alberto Cresti, Pierachille Santus,et al.
Elsevier BV
Paola Rogliani, Luigino Calzetta, Josuel Ora, Roberto Lipsi, Andrea Segreti, Maria Gabriella Matera, and Mario Cazzola
Elsevier BV
Mario Cazzola, Luigino Calzetta, Andrea Segreti, Francesco Facciolo, Paola Rogliani, and Maria Gabriella Matera
Informa UK Limited
Abstract We aimed to explore whether the acute bronchodilation induced by indacaterol 150 μg and glycopyrronium bromide 50 μg is additive or synergistic with respect to monocomponents by testing the type of effect ex vivo on isolated human bronchi and then in vivo in COPD patients. Both indacaterol and glycopyrronium caused a concentration-dependent relaxation of human isolated bronchial tissues sub-maximally pre-contracted with acetylcholine; glycopyrronium was significantly more potent than indacaterol. The analysis of data using the Bliss Independence (BI) criterion indicated that glycopyrronium plus indacaterol produced an additive interaction at the isoeffective concentrations inducing EC20 and a significant synergistic relaxant effect at isoeffective concentrations inducing EC30. In COPD patients, the inhalation of indacaterol and glycopyrronium in combination significantly anticipated at 15 min post-administration the mean peak of bronchodilatory effect compared to the two drugs administered alone. The study of interaction between indacaterol and glycopyrronium by BI analysis evidenced an additive effect for FEV1 between 5 min and 180 min post-inhalation, with synergistic interaction at 15 min post-administration, compared to the bronchodilation induced by these drugs administered alone. This study suggests that the combination ensures a broncholytic effect that is greater than that induced by the single monocomponents.
Federica Novelli, Manuela Latorre, Letizia Vergura, Maria Filomena Caiaffa, Gianna Camiciottoli, Gabriella Guarnieri, Andrea Matucci, Luigi Macchia, Andrea Vianello, Alessandra Vultaggio,et al.
Elsevier BV