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Background: Patients with isolated left ventricular (LV) noncompaction (IVNC) exhibit a unique form of spheric LV remodeling in which the ventricular walls remain thick and the chamber does not dilate in proportion to the remodeling. This study assessed the systolic myocardial shortening properties of the long axis (LA) and short axis (SA) of the LV as determined from pulsed Doppler tissue imaging in two groups of patients with similar degrees of LV dysfunction and similar LV sphericity: patients with IVNC and patients with idiopathic dilated cardiomyopathy (DCMP). Methods: Pulsed Doppler tissue imaging was used to record systolic myocardial velocities along the LA and SA of the LV in a group with IVNC (n = 13) and a group with DCMP (n = 13). The groups were matched for mean extent of LV dysfunction and mean sphericity index. In all 26 patients, the systolic myocardial velocity pattern for each axis featured two distinct peaks (SW1 and SW2). These peak velocities and the intervals from the electrocardiographic Q wave to each peak (Q-SW1, Q-SW2) were recorded for each axis, and group means were calculated and statistically compared. Results: There were no significant differences between the IVNC and DCMP groups with respect to any of the pulsed Doppler tissue imaging variables. Concerning the data for SW1 and SW2, intragroup comparisons revealed no significant differences in either group. In each of the two groups, LA-Q-SW1 was significantly shorter than LA-Q-SW2, SA-Q-SW1, and SA-Q-SW2. Each group's LA-Q-SW2 and SA-Q-SW2 values were also statistically similar. Conclusion: The results indicate that, given comparable degrees of spheric remodeling and comparable LV dysfunction, patients with IVNC and patients with DCMP show similar contraction properties along the LA and SA of the LV.

Background: The hemodynamic factors contributing to the clinical symptomatology in patients with mitral stenosis (MS) have been under investigation. The objective of this study was to evaluate the use of the Valsalva maneuver in patients with MS and whether there is an association between the degree of the hemodynamic changes in transmitral gradient (TG) in response to Valsalva maneuver and functional status, systolic pulmonary artery pressure, and left atrial function in patients with MS in sinus rhythm. Methods: The study prospectively evaluated 42 patients (37 female, mean age 40 +/- 10 years) with a diagnosis of pure MS in sinus rhythm. Patients were divided into 3 groups according to their New York Heart Association (NYHA) functional class. In all, 12 patients were in NYHA functional class I, 17 patients in class II, and 13 patients in class III. TG, including the mitral peak, mean, and late filling gradients, were calculated by the modified Bernoulli equation at rest and during the strain phase of Valsalva maneuver. The percentage changes in all TG in response to Valsalva were calculated. Traditional echocardiographic parameters for atrial function were also measured. Results: We found that, in patients who were more symptomatic according to NYHA classification, a reduction in TG in response to Valsalva maneuver was blunted and associated with higher systolic pulmonary artery pressure compared with those who were asymptomatic or had mild symptoms. Patients in NYHA class III decreased mitral mean pressure gradient by only 13.5%, significantly less (P < .001) than those in classes I (53.9%) and II (41.7%). However, despite the fact that left atrial ejection fraction was low in all patients, it was not associated with functional status in patients with MS. Conclusion: This study, for the first time, suggests that echocardiographically determined changes in TG in response to the Valsalva maneuver may provide an objective, noninvasive means of evaluating patients with MS.

Background: Systemic sclerosis (SSc) is a rare connective tissue disease that can lead to severe heart complications, i.e. congestive heart failure, arrhythmia and sudden cardiac death. The latter are associated with poor prognosis in SSc. The aim of this study was to test whether infra-clinical myocardial dysfunction can be detected in patients with SSc free from cardiovascular symptoms. Methods: Global LV, and segmental right ventricular longitudinal strain (2D-speckle tracking strain) were quantified by transthoracic echocardiography to assess ventricular deformations in 48 patients suffering from SSc and 40 matched control subjects. Results: Despite normal LVEF, patients presenting SSc had significantly impaired LV GLS in compared to controls (17.9 +/- 3.04 % vs -19.4+/- 2.3 %; p= 0.01). By contrast, there was no significant difference on lateral and inferior RV strain between patients and controls. Decreased LV deformation was detected in patients regardless of pulmonary injury, i.e. restrictive syndrome and pulmonary arterial hypertension (PAH). Patients with diffuse cutaneous SSc had impaired (GLV?) LV and RV strains in 4 and 2 chamber views compared to those presenting a limited form of cutaneous SSc, with respectively, -18.9 +/- 3.47% vs -16.6+/- 3.70%, p=0.039 and -19.7+/- 2.93% versus -17.6+/- 3.40% p=0.047. Conclusion: Speckle-tracking strain analysis can detect infra-clinical impairment of LV myocardial function in patients with SSc who are free from any cardiovascular symptoms regardless of SSc impact on pulmonary function. Right and Left ventricular strain in Ssc

Two cases of acute pericarditis presented with interesting electrocardiograms resembling Brugada-like or early repolarisation patterns. This report emphasises that proper interpretation of the electrocardiogram in patients with ST-segment elevation assists the clinician in arriving at the correct diagnosis in making appropriate diagnostic and therapeutic decisions, and also that the saddleback-type ST-segment elevation cannot be a sensitive finding for the Brugada syndrome.