Cardiology and Cardiovascular Medicine Unit

Clinical activity

Clinical activity is patient-centered and geared towards the criteria of continuous cultural updating and appropriateness as well as clinical and translational research. The areas covered are:

1. cardiovascular risk conditions, with screening and diagnostic work, especially in outpatient and day-service  settings (dyslipidaemia, diabetes mellitus, arterial hypertension, genetically determined conditions predisposing to atherosclerotic disease, sudden death, cardiomyopathies), under the supervision of Dr. Roberta Poletti, Manager of the Outpatients Activities and the Day Hospital, in collaboration with the Molecular Cardiology Unit, with the Lipoapheresis Unit for cases of familial dyslipidaemia 
2. overt cardiovascular pathology, with screening and diagnostic work, especially in outpatient, day-service and inpatient settings, under the supervision of Prof. Claudio Passino, for acute management, in collaboration with the 118 service of the AVNO and with the Emergency Department/Emergency Medicine Unit and the AOUP University Emergency Medicine Unit, in coordination with the Diagnostic and Interventional Cardiology Unit, the Interventional Electrophysiology Unit and the Respiratory Medicine Unit. 

In particular, 

1. ischaemic heart disease related to atherosclerotic and non-atherosclerotic macro- and microvascular coronary artery disease, the classification of which makes use of the most refined invasive and non-invasive tools (stress echo, nuclear cardiology, coronary angio-CT, stress CMR, OCT, FFR, IVUS), 
2. peripheral atherosclerotic disease, epiaortic vessels, renal arteries, arteries of the lower limbs with percutaneous transradial revascularisation integrated with coronary revascularisation, thanks to the special expertise of the Diagnostic and Interventional Cardiology Unit. In this context, there is extensive collaboration and discussion with internal medicine and the AVNO diabetologists.
3. supraventricular and ventricular arrhythmogenic cardiomyopathies, with the possibility of performing endocavitary electrophysiological studies and ablation procedures using the most up-to-date methods, in conjunction with the overall diagnostic/therapeutic classification of the cardiomyopathy, and of the underlying clinical situation, to which two specific outpatient clinics have been dedicated:
   • Cardiomyopathy outpatient clinic*, dedicated to the diagnosis and treatment of patients suffering from dilated, hypertrophic, arrhythmogenic cardiomyopathy and other rarer forms such as restrictive and non-compaction cardiomyopathies;
   • Channelopathy outpatient clinic in collaboration with the Interventional Electrophysiology Unit.
   • The identification and management of cardiac involvement in the context of hereditary myopathies takes place in collaboration with the Neurology Unit headed by Prof. Gabriele Siciliano in the AOUP.
   • Particular attention has been paid to cardiac involvement from chemotherapy or radiotherapy treatments in the course of cancer with the establishment of a CardiOncology Outpatient Clinic, coordinated by Dr. Iacopo Fabiani
   • Modern Next Generation Sequencing equipment in the Molecular Cardiology Laboratory of the Laboratory Medicine Unit enables diagnostic definition of the disease genotype. The Unit has also promoted (JUST Project, supported by the Pisa Foundation) a Regional Registry of Juvenile Sudden Death in collaboration with the Forensic Medicine of the University of Pisa (Prof. Marco Di Paolo) and the University of Florence (Prof. Iacopo Olivotto and Elisabetta Cerbai).
4. complex cardiovascular disease worthy of multispecialist classification at a Level III Center, for example:
• Diagnostic – therapeutic path coordinated by Dr Chrysanthos Grigoratos, for myocarditis, myopericarditis in the aetiological characterisation phase, possibility for complementary virological, microbiological, and instrumental (with CMR and nuclear imaging) classification, in collaboration with the units involved and pathology, especially with an endomyocardial biopsy approach (collaboration with Diagnostic and Interventional Cardiology Unit and the AOUP Experimental Pathology Department), as well as multi-specialist aetiological classification (infectious and rheumatological/immunoallergological;
• dilated, hypertrophic, infiltrative cardiomyopathy in correlation with the internal medicine, haematology, nephrology, immunology, microbiology and rheumatology specialist units of the university hospital centre and with other regional and national reference centres.
5. In recent years, a Centre for the Diagnosis and Treatment of Cardiac Amyloidosis has been established at the Unit, in liaison with the Regional Reference Centre (Dr. Federico Perfetto and Dr. Francesco Cappelli). In particular, in the characterisation of amyloidosis, the Unit collaborates with the Haematology Unit of the University of Pisa. There is a specific amyloidosis clinic in operation at the outpatient clinic. Coordinated by Dr. Giuseppe Vergaro

Clinical classification benefits from close collaboration with the respiratory, metabolic, endocrinological, anaesthesiological, radiological and imaging departments present within the Monasterio:

1. the management of patients with chronic liver disease with an indication for liver transplantation, and patients referred from the Liver Surgery and Liver Transplantation Unit of the AOUP are assessed from a cardiological point of view with the help of the Monasterio’s Diagnostic Imaging Unit for proper prognostic stratification
2. management of heart failure :
   • Unit that functions to coordinate the activities of dedicated Integrated Home Care in the Pisa area, in increasing collaboration with the General Practitioners Regional Association
   • Refractory unit with classification in the Advanced Heart Failure Outpatient Clinic coordinated by Dr. Valentina Spini and Dr. Alessandro Valleggi, in line with the patient’s transition towards an intervention (TAVI, percutaneous mitral intervention, VAD implant or heart transplant, in collaboration with the Siena Centre), or palliative care with collaboration in the context of End-of-Life with Integrated Home Care and Hospices (in collaboration with the Director, Dr Angela Gioia, Nordovest Local Healthcare Authority)

The excellence of our clinical activity

1. has been met with recognition on a large scale (AGENAS, MES, ARS RT), in quantitative and qualitative terms
2. it benefits from dedicated instrumental diagnostic clinics (in particular, Echocardiography and Stress Echocardiography, with an adjoining post-processing laboratory with Tomtech and Ecopac instruments), the Physiolab Laboratory (exercise test, cardiopulmonary test, polygraphic signal diagnosis, Holter ECG, autonomic dysfunction diagnosis, syncope diagnosis, central and obstructive apnoea diagnosis).
3. it is based on multidisciplinary collaboration between cardiologists and radiologists: in particular, dr. Andrea Barison coordinates the group of cardiologists with cardiac magnetic resonance skills it benefits from human resources and multidisciplinary methodologies that combine the activity of doctors with engineering, physics, IT, statistical, and epidemiological expertise and with cutting-edge diagnostic tools, contributing to and coordinating continuous innovation activities in the diagnosis and treatment process, in particular in the further development, validation and development of the computerised medical record.