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Objectives: We sought to investigate left atrial (LA) structural and functional abnormalities in a group of optimal treated hypertensives, in comparison to a control group. Methods: This study included 35 prospectively enrolled subjects with treated, uncomplicated, essential hypertension (HTN). Left atrial diameters (anteroposterior, transversal and longitudinal) and left atrial phasic volumes [maximal (LAV max), minimal (LAV min) and before atrial contraction (LAVpreA)] were assessed by echocardiography and LA emptying functions (LAEF) (global, active and passive) were calculated. Using the current recommendations of speckle tracking technique, peak longitudinal strain of LA walls (PALS)(mean value from apical four chambers and two chambers view) were analysed. The results were compared with a group of 37 age-matched healthy controls. Results: LA anteroposterior diameter as well as all three phasic LA volumes were significantly greater in HTN group (39.54±4.6 mm vs 35.43±4.5 mm for anteroposterior diameter, 60.51±14.9 ml vs 45.22±13.4 ml for LAV max, 25.48±10.3 ml vs 14.64±5.3 ml for LAVmin and 42.14±11.4 vs 24.86±8.5 for LAVpreA , for all p<0.0001), while the transversal and longitudinal diameters were similar. We found significantly lower total and passive EF in hypertensives than in control group (total LAEF 49.78±8.4% vs 66.05±7.44, p<0.001and passive LAEF 44.62±8.36% vs 58.79± 8.14%, p<0.001), but the active LAEF was preserved. The peak systolic strain values were also significantly lower in HTN group versus control (22.7% versus 35.1%, p<0.0001) Conclusion: Hypertension, even correctly treated, affects the mechanical function of left atrium. In our hypertensive group we observed the dilation of left atrium and an altered passive and total atrial function, with preservation of atrial pump function compared to control group. LA dysfunction was also demonstrated through low peak strain values. [ABSTRACT FROM AUTHOR]

Objectives: We sought to investigate by speckle tracking technique the longitudinal function of the left atrium in patients with reentrant paroxysmal supraventricular tachycardia with narrow QRS complex, in order to identify early functional changes that these arrhythmias may induce even when paroxysmal. Methodology: 23 patients with reentrant paroxysmal supraventricular tachycardia with narrow QRS complex have been evaluated by echocardiographic speckle tracking techniques in the first week after pharmacological conversion to sinus rhythm. The subsequent electrophysiology study identified 13 of these patients with atrioventricular nodal reentrant tachycardia (AVNRT), and 10 patients with atrioventricular reentrant tachycardia (AVRT). The echocardiographic examinationby speckle tracking technique was performed considering current standards, in apical 4 and 2 chamber views, using narrow sector angles, single focus imaging and optimal depth. Left atrium contour was traced defining the region of interest and the longitudinal strain was obtained for 12 segments. The average longitudinal strain obtained in each apical view was represented by a curve allowing the peak-strain quantification. Results: The peak longitudinal strain values assessed in the apical 4 chamber view in the AVNRT group (most frequent value 16% (mod = 16%)) and in the AVRT group (most frequent value 8.5% (mod = 8.5%)(were significantily lower than the peak longitudinal strain values measured in the control group (most frequent value 39% (mod = 39%)), with no significant difference in peak longitudinal strain between the two different types of tachycardia groups (F = 30,19; p < 0,0001). In a similar manner, the peak longitudinal strain measured in the apical 2 chamber view were significantly lower in the tachycardia group than in the control group (most frequent value in the control group 38% (mod = 38%), in the AVNRT group 19% (mod = 19%), in the AVRT group 19% (mod = 19%)(F = 36,68; p < 0,0001). Conclusions: Tachycardia irrespective of the type - AVNRT or AVRT results in the impairment of left atrial mechanical function. The peak positive strain is significantly lower in patients with tachycardia, denoting a decrease in left atrial compliance in these patients compared to the control group. [ABSTRACT FROM AUTHOR]

Objectives: We sought to investigate left atrial (LA) structural and functional abnormalities in a group of optimal treated hypertensives, in comparison to a control group. Methods: This study included 35 prospectively enrolled subjects with treated, uncomplicated, essential hypertension (HTN). Left atrial diameters (anteroposterior, transversal and longitudinal) and left atrial phasic volumes [maximal (LAV max), minimal (LAV min) and before atrial contraction (LAVpreA)] were assessed by echocardiography and LA emptying functions (LAEF) (global, active and passive) were calculated. Using the current recommendations of speckle tracking technique, peak longitudinal strain of LA walls (PALS)(mean value from apical four chambers and two chambers view) were analysed. The results were compared with a group of 37 age-matched healthy controls. Results: LA anteroposterior diameter as well as all three phasic LA volumes were significantly greater in HTN group (39.54±4.6 mm vs 35.43±4.5 mm for anteroposterior diameter, 60.51±14.9 ml vs 45.22±13.4 ml for LAV max, 25.48±10.3 ml vs 14.64±5.3 ml for LAVmin and 42.14±11.4 vs 24.86±8.5 for LAVpreA , for all p<0.0001), while the transversal and longitudinal diameters were similar. We found significantly lower total and passive EF in hypertensives than in control group (total LAEF 49.78±8.4% vs 66.05±7.44, p<0.001and passive LAEF 44.62±8.36% vs 58.79± 8.14%, p<0.001), but the active LAEF was preserved. The peak systolic strain values were also significantly lower in HTN group versus control (22.7% versus 35.1%, p<0.0001) Conclusion: Hypertension, even correctly treated, affects the mechanical function of left atrium. In our hypertensive group we observed the dilation of left atrium and an altered passive and total atrial function, with preservation of atrial pump function compared to control group. LA dysfunction was also demonstrated through low peak strain values. [ABSTRACT FROM AUTHOR]

Hypertrophic cardiomyopathy (HCM) and arterial hypertension (HTN) are conditions with different pathophysiology, but both can result in left-ventricular hypertrophy (LVH). The role of left-atrial (LA) functional changes detected by two-dimensional speckle-tracking echocardiography (STE) in indicating LVH etiology is unknown. Methods: We aimed to characterize LA mechanics using STE in LVH patients with HCM and HTN. LA 2D volumetric and STE parameters were analyzed in 86 LVH patients (43 HCM and 43 isolated HTN subjects) and 33 age- and sex-matched controls. Results: The volumetric study showed that LA reservoir and conduit function were impaired in the HCM group compared to controls, while, in the HTN group, only LA conduit function was deteriorated. The HCM group had all three STE-derived LA functions impaired compared to controls. The HTN group, consistently with volumetric analysis, had solely LA conduit function reduced compared to controls. Ratios of LA booster-pump strain (S) and strain rate (SR) to interventricular septum (IVS) thickness were the most accurate parameters to discriminate between HCM and HTN. The subgroup harboring sarcomeric pathogenic (P)/likely pathogenic (LP) variants had reduced LA booster-pump S and SR compared with the genotype-negative subgroup. Conclusions: LA reservoir, conduit, and pump functions are decreased in HCM compared to HTN patients with similar LVH. We report the ratios between LA contraction S/SR and IVS thickness as novel parameters with high accuracy in discriminating LVH due to HCM. The presence of P/LP variants in sarcomeric or sarcomeric-associated genes could be associated with more severe LA dysfunction. [ABSTRACT FROM AUTHOR]

Objectives – Mitral valve repair for degenerative mitral regurgitation has a better outcome and a lower mortality when compared with mitral replacement. We have evaluated this technique’s results at one month, 3 months, 6 months, 12 months and then annually. Material and Method – We have retrospectively analyzed 40 patients (30 male, 10 female) with severe mitral regurgitation who have undergone mitral valve repair between 2007-2010. Eighteen patients were in functional NYHA class II, 21 were in NYHA class III and one was in acute pulmonary edema. Th e mean ejection fraction of the left ventricle was 63,78% (±6,81%). Most cases concerned the posterior mitral valve (28 cases), followed by ruptured chordae of the anterior mitral valve (5 cases), Barlow’s disease (4 cases) and a mixed mechanism (1 case). Several types of mitral valve repair were used: quadrangular/triangular resection of the P2 segment with sliding of the P1-P3 segments, chordal replacement, Alfi eri-type suture etc. Edwards-Carpentier rigid annuloplasty rings were placed in all of the cases. Results – Th ere were no in-hospital deaths and no reinterventions. Twenty-six patients had no residual mitral regurgitation and 14 had minor regurgitation. Th e left ventricle ejection fraction showed no modifi cation. Th e follow-up study was 3-48 months; 12 patients were out of study for lack of presentation at periodical evaluation. During this period, the mitral valve function was normal, with no or minor mitral regurgitation. In one case we noticed the progression of initial mitral regurgitation from grade 1 to grade 4 one year after the operation due to development of posterior mitral valve restriction. Eighteen months after the initial operation we reoperated the patient and we performed a mechanical valve replacement. Conclusions – On medium term, mitral valve repair is an effective technique with very low complication rates and mortality. [ABSTRACT FROM AUTHOR]