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T-20 Tissue Doppler imaging analysis, a new method for the diagnosis of diastolic dysfunction in cirrhotic cardiomyopathy
S20
Abstracts of the A.I.S.F. Annual Meeting 2012 / Digestive and Liver Disease 44S (2012), S1–S48
genetic background and risk factors might differ from Northern Europeans. We performed a cohort study to describe the clinical course of PBC in Sicilian patients. Patients and Methods: We collected socio-demographic, clinical, biochemical, immunological and histological data at onset, and disease progression of 81 consecutive patients. All subjects were treated with Ursodeoxycholic acid (UDCA) at a dose of 15-25 mg/kg. HLA class II DRB1 alleles, available in 28 patients, were compared with those of 237 control healthy subjects. Results: PBC patients were predominantly females (96.3%) with a mean age at diagnosis of 53.2 years (range 31-84). At onset most of the patients were asymptomatic (66.7%) and anti-mitochondrial antibodies (AMA) were detected in 71 patients (87.7%). Histological findings of 55 patients (71.4%) showed an early stage disease (I-II Scheuer). HLA-DRB1*07 (RR 5.03, p=0.0008) and HLA-DRB1*08 (RR n.c., p=0.0005) were significantly associated with risk of PBC development. Patients younger than 45 years (n=24) had higher alanine aminotransferase (p=0.038) and alkaline phosphatase levels (p=0.047) than older cases. Among patients in follow-up (mean duration 61 months), three died and one underwent liver transplantation. Sixteen patients (21.9%) had a disease progression with no differences between frequency of AMA-positive and AMA-negative subjects. Patients who progressed toward advanced disease had more often persistence of pruritus than patients with stable disease (81.3% vs. 24.6%; RR 1.8; p<0.001). At multivariate analysis extrahepatic autoimmune disease (p=0.04), pruritus for more than one year (p=0.008) and advanced histological stage (p <0.0001) were independent risk factors associated with disease progression. Conclusions: In our cohort of patients with PBC higher biochemical activity at onset was observed in younger patients. Presence of HLA-DRB1*07 and HLA-DRB1*08 alleles confer susceptibility for disease development. Persistence of pruritus and presence of extrahepatic autoimmune liver disease were significantly associated with disease progression.
T-19 Vitamin D–PTH axis in HCV infection F. Morisco 1 , M. Guarino 1 , I. Loperto 1 , L. Donnarumma 1 , A. Mariniello 1 , C. Pivonello 2 , F. Cariati 2 , M. Rubino 2 , A. Colao 2 , N. Caporaso 1 1 Department of Clinical and Experimental Medicine, Gastroenterology Unit, University of Naples "Federico II", Italy; 2 Department of Molecular and Clinical Endocrinology and Oncology, University of Naples "Federico II", Italy
Background: Several studies investigating Vitamin D status have often outlined the significant relationships between serum parathyroid hormone (PTH) and Vitamin D. Recent studies report low levels of Vitamin D in chronic hepatitis C (CHC). This phenomenon seems to be unrelated to liver function, diet and sun exposure. We aimed to determine the levels of Vitamin D and PTH in a population of patients with CHC without cirrhosis to evaluate the disturbance of Vitamin D–PTH axis. Materials and methods: Fifty-nine patients with CHC (M/F 32/27, median age 56 yrs) and 59 controls (M/F 18/41, median age 44 yrs), observed at the Gastroenterology Unit of the University of Naples "Federico II" were enrolled in a cross-sectional study. Serum concentration of Vitamin D, PTH, calcium and phosphate were determined. Serum concentrations of Vitamin D <30 ng/ml were defined as Vitamin D insufficiency, <10 ng/ml as deficiency, whereas a range of 30-100 ng/ml was defined as normal. The laboratory PTH reference range was 6.5-36.8 pg/ml. Results: The mean value of Vitamin D was 26.28 and 28.43 ng/ml in HCV patients and controls respectively (p<0,31). The distribution of the severity of Vitamin D deficit in HCV population was the following: 5% had deficiency, 64% insufficiency and 31% normal levels; similar results were observed in the control group. The mean values of PTH were 17.04 and 26.7 pg/ml in HCV patients and controls respectively (p<0,0004). Furthermore calcium and phosphate were in the range of normality in both. The percentage of patients with increased PTH levels was 5% in HCV patients and 22.5% in controls. Conclusion: Although the HCV patients are characterized by low serum levels of vitamin D, this deficit is similar to that observed in the general population. Therefore we can state that this is a public health.
T-20 Tissue Doppler imaging analysis, a new method for the diagnosis of diastolic dysfunction in cirrhotic cardiomyopathy V. Barghini, L. Marzano, V. Bonasia, D. Cappello, A. Carnelutti, L. De Luca, F. Cugini, C. Catena, L. Sechi, G. Soardo Liver Unit, Clinica Medica, DPMSC – University of Udine. Background: Cirrhotic cardiomyopathy is a complex cardiac dysfunction described in cirrhotic patients, that includes diastolic impairment. The most recent reviews indicate to evaluate the diastolic function trough the echocardiographic analysis of the transmitral flow. Aims: The aim of this study was to compare the conventional method of detection of diastolic dysfunctions in cirrhotic patients with that recommended by the American Society of Echocardiography (ASE) that includes also the Tissue Doppler Imaging (TDI) evaluation. We investigated associations between the presence of diastolic dysfunctions determined following the ASE criteria and different etiologies of cirrhosis. Methods: Between 182 cirrhotic patients range age (18-75), we selected 40 without cardiovascular risk factors and history of cardiac diseases. Exclusion criteria were blood hypertension, dyslipidemia, diabetes, severe obesity, heart valve disease, cardiomyopathies, hemochromatosis, any other cardiac disease. Were excluded also patients with alcoholic cirrhosis that were continuing alcohol intake within the last 6 months. All patients underwent echocardiography: transmitral flow parameters and TDI indices as mitral lateral e’ speed and mitral septal e’ speed were obtained. We compared the two diagnostic methods considering the one indicated by ASE as the gold standard for the diagnosis of diastolic dysfunction. Results: The transmitral flow analysis showed diastolic dysfunctions in 24 patients (60%). Left Atrial Index was increased (>34 ml/m2 ) in 15 patients (38%), lateral e’ was reduced (<10 cm/s) in 20 patients (50%) and septal e’ was reduced (<8 cm/s) in 19 patients (48%). According with ASE guidelines diastolic dysfunctions were found in 17 patients (43%). The comparison of conventional diagnostic method with that recommended by ASE showed a sensibility of 59% and a specificity of 39%. There was no association between diastolic dysfunctions and alcoholic etiology of cirrhosis. Conclusion: Tissue Doppler Imaging analysis improves the sensibility and specificity in the diagnosis of diastolic dysfunction in cirrhotic cardiomyopathy.
T-21 Single-step balloon-occluded percutaneous radio-frequency thermal ablation (RFA) plus transcatheter arterial chemoembolization (TACE) for treatment of “complex” unresectable hepatocellular carcinoma R. Iezzi 2 , V. Cesario 1 , M. Campanale 1 , T.A. Di Rienzo 1 , G. Gigante 1 , G. Caracciolo 1 , E. Rinninella 1 , F.R. Ponziani 1 , M. La Torre 2 , B.E. Annicchiarico 1 , M. Siciliano 1 , M. Pompili 1 , A. Grieco 1 , L. Miele 1 , M. Santoro 2 , G.L. Rapaccini 1 , L. Riccardi 1 , M.A. Zocco 1 , A. Milani 1 , A.M. De Gaetano 2 , G. Gasbarrini 3 , L. Bonomo 2 , A. Gasbarrini 1 1 Internal
Medicine, Catholic University of Rome, Gemelli Hospital, Rome; Department, Catholic University of Rome, Gemelli Hospital; 3 Fondazione Ricerca in Medicina “Falcone Borsellino”, Bologna, Italy 2 Radiology
Background and Aims: To evaluate the feasibility and safety of single-step balloon-occluded-RFA followed by TACE in patients with “complex” unresectable HCC, previously not suitable to RFA alone due to their localization. Materials and Methods: 15 consecutive patients with single HCC (mean diameter 4.17±1.02 cm), adjacent to the diaphragm (7 lesions), proximal to the hepatic portal glisson’s capsule (6), or located on the intra-abdominal free surface (2), considered as “complex” for their unfavourable location, and not suitable for RFA alone, were enrolled in our single-center multidisciplinary pilot study. The treatment was composed by RFA (single 2-cm or 3-cm monopolar needle insertion) during occlusion of the feeding artery followed by superselective TACE (conventional-TACE or with DC-BEAD). Adverse events and intra/periprocedural complications were clinically assessed. Tumor response was evaluated on 1-month follow-up multiphasic CT based on mRECIST criteria.
Abstracts of the A.I.S.F. Annual Meeting 2012 / Digestive and Liver Disease 44S (2012), S1–S48
genetic background and risk factors might differ from Northern Europeans. We performed a cohort study to describe the clinical course of PBC in Sicilian patients. Patients and Methods: We collected socio-demographic, clinical, biochemical, immunological and histological data at onset, and disease progression of 81 consecutive patients. All subjects were treated with Ursodeoxycholic acid (UDCA) at a dose of 15-25 mg/kg. HLA class II DRB1 alleles, available in 28 patients, were compared with those of 237 control healthy subjects. Results: PBC patients were predominantly females (96.3%) with a mean age at diagnosis of 53.2 years (range 31-84). At onset most of the patients were asymptomatic (66.7%) and anti-mitochondrial antibodies (AMA) were detected in 71 patients (87.7%). Histological findings of 55 patients (71.4%) showed an early stage disease (I-II Scheuer). HLA-DRB1*07 (RR 5.03, p=0.0008) and HLA-DRB1*08 (RR n.c., p=0.0005) were significantly associated with risk of PBC development. Patients younger than 45 years (n=24) had higher alanine aminotransferase (p=0.038) and alkaline phosphatase levels (p=0.047) than older cases. Among patients in follow-up (mean duration 61 months), three died and one underwent liver transplantation. Sixteen patients (21.9%) had a disease progression with no differences between frequency of AMA-positive and AMA-negative subjects. Patients who progressed toward advanced disease had more often persistence of pruritus than patients with stable disease (81.3% vs. 24.6%; RR 1.8; p<0.001). At multivariate analysis extrahepatic autoimmune disease (p=0.04), pruritus for more than one year (p=0.008) and advanced histological stage (p <0.0001) were independent risk factors associated with disease progression. Conclusions: In our cohort of patients with PBC higher biochemical activity at onset was observed in younger patients. Presence of HLA-DRB1*07 and HLA-DRB1*08 alleles confer susceptibility for disease development. Persistence of pruritus and presence of extrahepatic autoimmune liver disease were significantly associated with disease progression.
T-19 Vitamin D–PTH axis in HCV infection F. Morisco 1 , M. Guarino 1 , I. Loperto 1 , L. Donnarumma 1 , A. Mariniello 1 , C. Pivonello 2 , F. Cariati 2 , M. Rubino 2 , A. Colao 2 , N. Caporaso 1 1 Department of Clinical and Experimental Medicine, Gastroenterology Unit, University of Naples "Federico II", Italy; 2 Department of Molecular and Clinical Endocrinology and Oncology, University of Naples "Federico II", Italy
Background: Several studies investigating Vitamin D status have often outlined the significant relationships between serum parathyroid hormone (PTH) and Vitamin D. Recent studies report low levels of Vitamin D in chronic hepatitis C (CHC). This phenomenon seems to be unrelated to liver function, diet and sun exposure. We aimed to determine the levels of Vitamin D and PTH in a population of patients with CHC without cirrhosis to evaluate the disturbance of Vitamin D–PTH axis. Materials and methods: Fifty-nine patients with CHC (M/F 32/27, median age 56 yrs) and 59 controls (M/F 18/41, median age 44 yrs), observed at the Gastroenterology Unit of the University of Naples "Federico II" were enrolled in a cross-sectional study. Serum concentration of Vitamin D, PTH, calcium and phosphate were determined. Serum concentrations of Vitamin D <30 ng/ml were defined as Vitamin D insufficiency, <10 ng/ml as deficiency, whereas a range of 30-100 ng/ml was defined as normal. The laboratory PTH reference range was 6.5-36.8 pg/ml. Results: The mean value of Vitamin D was 26.28 and 28.43 ng/ml in HCV patients and controls respectively (p<0,31). The distribution of the severity of Vitamin D deficit in HCV population was the following: 5% had deficiency, 64% insufficiency and 31% normal levels; similar results were observed in the control group. The mean values of PTH were 17.04 and 26.7 pg/ml in HCV patients and controls respectively (p<0,0004). Furthermore calcium and phosphate were in the range of normality in both. The percentage of patients with increased PTH levels was 5% in HCV patients and 22.5% in controls. Conclusion: Although the HCV patients are characterized by low serum levels of vitamin D, this deficit is similar to that observed in the general population. Therefore we can state that this is a public health.
T-20 Tissue Doppler imaging analysis, a new method for the diagnosis of diastolic dysfunction in cirrhotic cardiomyopathy V. Barghini, L. Marzano, V. Bonasia, D. Cappello, A. Carnelutti, L. De Luca, F. Cugini, C. Catena, L. Sechi, G. Soardo Liver Unit, Clinica Medica, DPMSC – University of Udine. Background: Cirrhotic cardiomyopathy is a complex cardiac dysfunction described in cirrhotic patients, that includes diastolic impairment. The most recent reviews indicate to evaluate the diastolic function trough the echocardiographic analysis of the transmitral flow. Aims: The aim of this study was to compare the conventional method of detection of diastolic dysfunctions in cirrhotic patients with that recommended by the American Society of Echocardiography (ASE) that includes also the Tissue Doppler Imaging (TDI) evaluation. We investigated associations between the presence of diastolic dysfunctions determined following the ASE criteria and different etiologies of cirrhosis. Methods: Between 182 cirrhotic patients range age (18-75), we selected 40 without cardiovascular risk factors and history of cardiac diseases. Exclusion criteria were blood hypertension, dyslipidemia, diabetes, severe obesity, heart valve disease, cardiomyopathies, hemochromatosis, any other cardiac disease. Were excluded also patients with alcoholic cirrhosis that were continuing alcohol intake within the last 6 months. All patients underwent echocardiography: transmitral flow parameters and TDI indices as mitral lateral e’ speed and mitral septal e’ speed were obtained. We compared the two diagnostic methods considering the one indicated by ASE as the gold standard for the diagnosis of diastolic dysfunction. Results: The transmitral flow analysis showed diastolic dysfunctions in 24 patients (60%). Left Atrial Index was increased (>34 ml/m2 ) in 15 patients (38%), lateral e’ was reduced (<10 cm/s) in 20 patients (50%) and septal e’ was reduced (<8 cm/s) in 19 patients (48%). According with ASE guidelines diastolic dysfunctions were found in 17 patients (43%). The comparison of conventional diagnostic method with that recommended by ASE showed a sensibility of 59% and a specificity of 39%. There was no association between diastolic dysfunctions and alcoholic etiology of cirrhosis. Conclusion: Tissue Doppler Imaging analysis improves the sensibility and specificity in the diagnosis of diastolic dysfunction in cirrhotic cardiomyopathy.
T-21 Single-step balloon-occluded percutaneous radio-frequency thermal ablation (RFA) plus transcatheter arterial chemoembolization (TACE) for treatment of “complex” unresectable hepatocellular carcinoma R. Iezzi 2 , V. Cesario 1 , M. Campanale 1 , T.A. Di Rienzo 1 , G. Gigante 1 , G. Caracciolo 1 , E. Rinninella 1 , F.R. Ponziani 1 , M. La Torre 2 , B.E. Annicchiarico 1 , M. Siciliano 1 , M. Pompili 1 , A. Grieco 1 , L. Miele 1 , M. Santoro 2 , G.L. Rapaccini 1 , L. Riccardi 1 , M.A. Zocco 1 , A. Milani 1 , A.M. De Gaetano 2 , G. Gasbarrini 3 , L. Bonomo 2 , A. Gasbarrini 1 1 Internal
Medicine, Catholic University of Rome, Gemelli Hospital, Rome; Department, Catholic University of Rome, Gemelli Hospital; 3 Fondazione Ricerca in Medicina “Falcone Borsellino”, Bologna, Italy 2 Radiology
Background and Aims: To evaluate the feasibility and safety of single-step balloon-occluded-RFA followed by TACE in patients with “complex” unresectable HCC, previously not suitable to RFA alone due to their localization. Materials and Methods: 15 consecutive patients with single HCC (mean diameter 4.17±1.02 cm), adjacent to the diaphragm (7 lesions), proximal to the hepatic portal glisson’s capsule (6), or located on the intra-abdominal free surface (2), considered as “complex” for their unfavourable location, and not suitable for RFA alone, were enrolled in our single-center multidisciplinary pilot study. The treatment was composed by RFA (single 2-cm or 3-cm monopolar needle insertion) during occlusion of the feeding artery followed by superselective TACE (conventional-TACE or with DC-BEAD). Adverse events and intra/periprocedural complications were clinically assessed. Tumor response was evaluated on 1-month follow-up multiphasic CT based on mRECIST criteria.