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Heart failure (HF) is a common disease that requires appropriate tools to correctly predict cardiovascular outcomes. Echocardiography represents the most commonly used method for assessing left ventricular ejection fraction and a cornerstone in the detection of HF, but it fails to procure an optimal level of inter-observer variability, leading to unsatisfactory prediction of cardiovascular outcomes. In this review, we discuss emerging clinical tools (global longitudinal strain of the left ventricle, the right ventricle, and the left atrium) that permitted an improvement in the diagnosis and ameliorated the risk stratification across different HF phenotypes. The review analyzes the speckle-tracking contributions to the field, discussing the limitations and advantages in clinical practice.

Blood pressure (BP) measurement at the forearm (FA) has been proposed as alternative site to upper arm (UA) in people with morbid obesity (MO). We compared nocturnal BP readings simultaneously taken at FA and UA by ambulatory blood pressure monitoring (ABPM). Fourteen individuals with MO and seven normal‐weight controls underwent nocturnal ABPM with two devices placed at the UA and contralateral FA, respectively. Agreement between FA‐UA BP, diagnosis of nocturnal hypertension, and potential determinants of BP differences were evaluated. BP at the FA was significantly higher than UA in both people with MO and controls. FA‐UA differences in systolic and diastolic BP were similar in people with MO and controls. Nocturnal hypertension was diagnosed in 10 subjects (48%) according to UA BP and in 13 subjects (62%) according to FA BP (concordance 76%, moderate agreement). ΔFA‐UA systolic BP was associated with ratio between FA/UA circumferences (R = 0.45, P

Background Mid- and long-term sequelae of COVID-19 on cardiorespiratory fitness are unknown. Aim of the study was to assess the mid-term impact of mild-moderate COVID-19 on cardiorespiratory fitness evaluated by cardiopulmonary exercise testing (CPET) in elite athletes. Methods 13 elite cross-country skiers with previous mild-moderate COVID-19 symptoms underwent CPET before resuming seasonal training (COVID athletes). 13 elite detrained cross-country skiers, matched for principal confounding factors, were taken as controls (control group). Resting peripheral oxygen saturation, pulmonary function test, echocardiography, bioelectrical impedance analysis and CPET (modified XELG2, Woodway, USA) were performed in all participants. Results Median recovery time in COVID athletes was 34 days (IQR 33-38 days). COVID athletes reached earlier the onset of the aerobic threshold (4'48" vs 6'28", R2=0.15, F=4.37, p Conclusions Elite cross-country athletes, previously affected by mild-moderate COVID-19, reached earlier the aerobic threshold than controls, whereas the remaining CPET parameters did not differ between groups. Such changes were not associated with any detectable difference in resting pulmonary and cardiac examination. Subjects affected by mild-moderate COVID-19 may require a longer time course of re-adaptation to aerobic exercise.

BACKGROUND AND AIMS Ideal Cardiovascular Health (ICH), defined as optimal levels of cardiovascular (CV) health factors and behaviors, has been reported to be very low in adults and children, with consequent several negative health outcomes and higher CV risk. The present study investigated the burden of ICH among Italian adolescents and its association with carotid-femoral pulse wave velocity (cf-PWV). METHODS AND RESULTS 387 healthy adolescents (mean age 17.1 ± 1.4 years) attending the "G. Donatelli" High School in Terni, Italy, were evaluated. ICH was assessed through clinical evaluation, laboratory measures and interviewer-administered questionnaires. Cf-PWV was measured by arterial tonometry (SphygmoCor). For each ICH metric, a score of 2 was assigned for ideal levels, 1 for intermediate, and 0 for poor. All subjects showed at least one ICH metric, whereas none showed all ICH 7 metrics. The average number of ICH metrics was 4.3 ± 1.1. The highest rates were observed for fasting blood glucose (98%), whereas an ideal healthy diet was achieved only by 8% of subjects. The Cf-PWV was inversely and linearly associated with the sum of ICH metrics (p = 0.03) and the ICH score (p

Background Coronavirus disease 2019 (COVID-19) has spread worldwide determining a dramatic impact on the healthcare system. Aim of this study is to evaluate mid-term clinical impact of COVID-19 on respiratory function. Methods 379 patients were evaluated 4 months after SARS-COV-2 diagnosis. Patients were divided in two groups based on the presence of pneumonia during COVID. Clinical conditions, quality of life, symptomatology, 6-min walking test, pulmonary function test with spirometry and diffusing capacity of carbon monoxide were analysed. Data were compared to clinical evolution during COVID (development of acute respiratory distress syndrome [ARDS], needing of invasive mechanical ventilation [IMV], partial oxygen saturation/ fraction of inspired oxygen [SpO2/FiO2] ratio and pneumonia severity index [PSI]). Results After a median of 135 days, 260 (68.6%) of 379 patients referred almost one symptom. Patients who developed pneumonia during COVID-19 showed lower SpO2 at rest (p, COVID-19 severe lung involvement can reduce respiratory performance at a mid/long-term. Respiratory rehabilitation is recommended in COVID-19 survivors who showed severe clinical and radiological signs of the disease.

Introduction: Acute, gravity-induced blood pressure (BP) changes during head-up tilt may generate concomitant variations in carotid-femoral pulse wave velocity (cf-PWV). We aimed to separate the pressure-dependent and -independent components of cf-PWV changes observed during head-up tilt. Methods: 30 healthy individuals (age 48 ± 18 years (mean ± SD), 38% males, BP 130/74 ± 12/8 mmHg) underwent head-up passive tilting at a = 0°, 30°, and 60°. BP was taken at the upper arm, constantly kept at heart level. Aortic BP was reconstructed from radial tonometry (SphygmoCor). Stiffness index b0 was estimated at 0°. 1 Assumptions: [1] from MRI2, the effective cf-PWV travel distance (ETD, 80% of straight carotid-to-femoral distance) begins at heart level; [2] the change in DBP along the aorta is predictable from the hydrostatic pressure gradient (0.73 mmHg/cm) 3; [3] cf-PWV and hydrostatic pressure relate linearly, hence predicted cf-PWV can be calculated as the average of aortic (PWVaorta, using b0 and aortic DBP) and femoral (PWVfem, using b0 and femoral DBP, corresponding to aortic DBP + (ETD × sin(a)*0.73)) PWVs. Results: Both young (24–48 years) and old (48–82 years) individuals showed increasing trends for peripheral SBP, DBP, PP, and central DBP with tilting; central SBP remained unchanged. Heart rate (HR) and cf-PWV increased with body tilt in both groups (Figure, left). b0 linearly correlated with age (R = 0.70, p < 0.01). After adjustment for HR4, observed-vs-predicted cf-PWV exponentially increased as a function of age (R2 = 0.38, p < 0.01 for quadratic equation, p = 0.04, vs. linear; Figure, right). Conclusion: With aging, the acute relationship between BP and cf-PWV becomes progressively nonlinear.

OBJECTIVE An excess morning blood pressure surge (MBPS) may portend an increased cardiovascular risk, but the mechanisms thereof have been little investigated. The link between MBPS, short-term blood pressure (BP) variability, and arterial stiffness has not been entirely defined. METHODS In 602 consecutive untreated hypertensive patients (48 ± 12 years, 61% men, office BP 149/93 ± 17/10 mmHg), we measured carotid-femoral pulse wave velocity (cf-PWV, SphygmoCor) and 24-h ambulatory BP. Using self-reported sleep and wake times, MBPS was defined as sleep-trough (ST-MBPS), prewaking, rising. Short-term BP variability was calculated as weighted 24-h SBP SD and average real variability of 24-h SBP (ARV), that is, average of absolute differences between consecutive SBP readings. RESULTS ST-MBPS (r = 0.16, P

Background: the MACISTE study (Metabolic and Cardiovascular Investigation at School, Terni) aimed at evaluating the metabolic and cardiovascular abnormalities and behaviors in healthy adolescents attending a High School. We evaluated the prevalence of smoking habits and the relationship between smoking and physical activity. Methods: 539 students (302 boys, 237 girls) were evaluated through: 1- self-reported questionnaires about lifestyles, smoking and physical habits, 2-measurement of exaled carbon-monoxide. Results: 65 subjects (12%) did not answer about smoking. Among the 474 subjects, 125 subjects (26%) were smokers, and 349 (74%) were non-smokers. Smoking prevalence significantly increased among the female sex and age-groups (R. 14 - 19)(Figure). 97 subjects (21%) reported sedentary lifestyle, 157 (33%) were involved in non-competitive physical activities, and 220 (46%) were involved in competitive sports. Smoking was more prevalent in sedentaries (37%), than in non-agonistic athletes (27%), and in athletes (21%, ANOVA p=0.009). The measurement of exaled carbon-monoxide, available in 250 subjects, was in agreement with self-reported data about smoking habits. Conclusions: smoking prevalence is disproportionately high among young Italian adolescents. Phisical activity is associated with a lower prevalence of smoking. However, the unacceptably high rate of smokers among athletes requires dedicated educational interventions.

The relationship between arterial stiffness, measured as pulse wave velocity (PWV), and the left ventricle is confounded by the effects of blood pressure. We evaluated the relationship between carotid-femoral PWV and cardio-ankle vascular index (CAVI), a less pressure-dependent measurement of the stiffness constant (β) of the aorta and the iliac, femoral and tibial arteries, and obtained prognostically relevant measurements of left ventricular structure and systolic function. CAVI, carotid-femoral PWV and echocardiographic left ventricular mass and systolic function were determined in 133 subjects with either hypertension or high-normal blood pressure (33% treated; 56 ± 16 years, blood pressure 145/89 ± 21/12 mm Hg). Carotid-femoral PWV exhibited a direct relationship with systolic and diastolic blood pressure (r = 0.33/0.26, P0.001/0.014), whereas CAVI demonstrated no such relationship (r = 0.12/-0.05, both P0.1). Both CAVI and PWV correlated significantly with left ventricular mass index (r = 0.31, P0.001; r = 0.21, P = 0.014). Subjects with inappropriately high left ventricular masses for a given cardiac workload (n = 44) had higher CAVI values (9.1 ± 2.0 vs. 7.9 ± 1.6, P0.001), but not higher PWV values (8.5 ± 2.5 vs. 8.7 ± 2.4, P0.1). In a multivariate regression model, CAVI was independently associated with inappropriate left ventricular mass (β = 0.40, P0.001), along with body mass index. CAVI also demonstrated a negative relationship with left ventricular midwall fractional shortening (r = -0.41, P = 0.001) that was independent of age, sex, blood pressure and left ventricular mass in a multivariate analysis. In conclusion, a high CAVI is associated with inappropriately high left ventricular mass and low midwall systolic function. As a marker of arterial diastolic-to-systolic stiffening, CAVI may have a relationship with left ventricular structure and function that is independent of blood pressure levels.

Invasively measured left ventricular (LV) dP/dt is the accepted standard for measuring acute and chronic directional changes in LV contractility. Recently, we developed a noninvasive force sensor based on an accelerometer positioned on the chest, which measures the vibrations generated by isovolumic myocardial contraction. The aim of this paper was to compare noninvasive (accelerometer) versus invasive (LV dP/dt) indices of myocardial contractility in a chronic minipig model of pacing-induced heart failure (HF). Comparative assessment was performed both at rest and following dobutamine infusion.In adult male minipigs (n = 6), LV contractility was simultaneously assessed both invasively (LV dP/dt, Millar catheter) and noninvasively (accelerometer) at rest and following dobutamine (up to 7.5 mcg/kg/min), both before and after development of HF by pacing the LV at 180 beats/min for 3 weeks.Invasive and noninvasive assessments were obtained in 24 conditions (12 at rest and 12 after dobutamine infusion). Sensor-based cardiac force changes were significantly related to positive peak LV dP/dt(max) changes following dobutamine infusion both in normal (r = 0.88, P0.001) and failing heart (r = 0.89, P0.001). The force-frequency relation showed a tight correlation between invasive and noninvasive assessment (r = 0.68, P = 0.02).The force-frequency relation can be assessed noninvasively by a transthoracic sensor based on an accelerometer. The method can efficiently detect the development of resting dysfunction and the contractile reserve at different HF steps, with potential for wearable HF monitoring.

Objective:Pulse pressure (PP) is a complex physiologic trait affected by many variables, including left ventricular contractility (reflected by stroke volume), arterial stiffness, and central-to-brachial amplification. The impact of age on the relationship between stroke volume and central or brachi

Background: Although a few studies have suggested an alteration in aortic stiffness in patients with systemic sclerosis (SS), a disease characterized by immunological and microvascular changes and by tissue fibrosis, the functional properties of the large arteries have been understudied in SS. Methods: 34 women with SS [age 60±14 years, BP 123/70±17/10 mmHg] and 34 healthy age- and BP-matched women underwent determination of carotid-femoral pulse wave velocity (PWV, a direct measure of aortic stiffness) and aortic augmentation (SphygmoCor, AtCor). All participants also underwent determination of carotid-radial PWV, as a measure of stiffness of upper-limb arteries. We excluded participants with overt cardiovascular disease and concomitant important disease. Results: Age and brachial BP were nearly identical in the 2 groups. Patients and controls did not differ by carotid-femoral PWV (9.2±3 vs 9.1±2 m/s, p=0.91) or carotid-radial PWV. Aortic augmentation, was higher in women with SS; unadjusted: 16.1±8 vs 11.5±7, p=0.014; adjusted for pulse pressure and heart rate (AIx@75): 30.9±16 vs 22.2±12, p=0.012). SS independently predicted AIx@75 in a multivariate analysis. Among patients with SS, age, brachial mean BP and serum C-reactive protein all predicted carotid-femoral PWV. Age and mean BP were the only predictors of AIx@75. Organ damage scores had no significat correlation with central hemodynamics parameters. Conclusions: SS is associated with an increase in aortic augmentation (as a measure of the contribution of reflected wave to central waveform), but not in aortic or upper-limb arterial stiffness. Microvascular involvement might occur earlier than stiffening of the large arteries in SS.