The interest in Cardiomyopathies in Florence was born in 1972 from the observation of the first 3 patients with a strange form of obstruction to the outflow of the LV, then called "Hypertrophic Subaortic Stenosis", now Obstructive Hypertrophic Cardiomyopathy (CMIO). But it was only in 1977, with the introduction into clinical practice of ECHOcardiography, which made it possible to obtain images and the measurement of wall thicknesses and diameters of the heart cavities, that an increasing number of patients with different types of Cardiomyopathy began to be observed. , especially Hypertrophic and Dilated. The news that in Canada an epidemic of patients with dilated cardiomyopathy, beer drinkers, had been observed, in which a small amount of Cobalt had been added from the local factory, increased our interest in this then little known field of Cardiology. .
Relations with colleagues interested in the subject (Trieste) began, and study periods in London and finally in the United States (NIH, Bethesda) where methods were learned which were then not very common in Italy, such as myocardial biopsy, and fruitful collaborative relationships established. still in place today. The data of the observed patients were collected in a systematic and precise way and were published in the most prestigious international journals.
Research projects were initiated together with other Italian and European Centers. One of the most important was the establishment of the Italian Register of Hypertrophic Cardiomyopathy, funded by the Istituto Superiore di Sanità, which made it possible to establish a network with over 40 Italian centers and the collection of data from over 1600 patients.
Great progress was made in the therapeutic field. In the 80s, beta-blocking drugs were introduced in the therapy of heart failure due to dilated cardiomyopathy. In 1992 the first ICD was implanted (the first defibrillator models were implanted in the abdomen!) "; in the same year Dr. Olivotto began his collaboration. In 1999 the septal alcoholization procedure was activated for the reduction of the obstruction to the outflow in the percutaneous hypertrophic obstructive cardiomyopathy, with partially optimal results. In 2004 myectomy operations began with Prof. Stefano, performed for 5 years together with Prof. Magdi Yacoub, one of the most famous heart surgeons in the world. A fruitful scientific collaboration and a training period for his young Egyptian collaborators began in Florence with Prof. Yacoub, which contributed to the development of the Aswan Cardiovascular Center, mainly dedicated to the treatment of cardiomyopathies and ischemic heart disease in the Egyptian and African population.
There are also many research projects financed by the then Body, now the Cassa di Risparmio di Firenze Foundation. From 1999, in the laboratory directed by Dr. Torricelli at the time, the genetic analysis of patients with HCM began, initially, with the analysis of a single small gene, which encoded Troponin T. With the commitment of Dr. Francesca Girolami and the new NGS methods, the Genetics laboratory has identified the genetic basis of pediatric and adult cardiomyopathies in over 1600 patients, and therefore to provide a more precise therapy, such as in Fabry's disease.
Other projects in collaboration with the most famous international centers have made it possible, among other things, to confirm:
- the usefulness of the procedure for assessing the risk of sudden death in patients with hypertrophic cardiomyopathy
- the effectiveness of the subcutaneous defibrillator (S ICD) in detecting threatening ventricular arrhythmias and their interruption with an appropriate shock
- the importance of not delaying the intervention to resolve the outflow obstruction in hypertrophic obstructive cardiomyopathy
- the clinical course of hypertrophic cardiomyopathy based on age, diagnosis and genetic mutations
Today Florence is a national and international reference point for the genetic analysis of these patients and for the management of cardiomyopathies, in particular obstructive and dilated hypertrophic cardiomyopathy, Fabry disease and cardiac amyloidosis.