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Objectives - To estimate the prevalence of high normal blood pressure (HNBP) and to find if subjects with HNBP have more often other cardiovascular risk factors. Methods - A representative sample of 1970 Romanian adults was enrolled in SEPHAR III survey. Blood pressure measurements were performed according to current guidelines and all subjects were evaluated by a 71-item survey questionnaire together with extensive evaluation for target organ damage. Results - Prevalence of HNBP was 11% [45.1% high blood pressure (HBP), 43.9% normal blood pressure (NBP)]. Values of weight, waist circumference, body mass index, total and LDL cholesterol, triglycerides, fasting blood glucose, glycosylated hemoglobin - HbA1c, uric acid, serum creatinine, glomerular filtration rate estimate by CKD-EPI Equation, albumin/creatinine ratio, intimae-media thickness, rates of arterial stiffness and diastolic dysfunction, left ventricular mass, interventricular septum and posterior left ventricle wall thickness, left atrial volume and dilatation were significantly highest in HNBP subjects than in NBP. Conclusions - Subjects with HNBP represent ~11% of the population and most of thems had an elevated cardiovascular risk. It's essential to educate the general public and health care providers to be aware of these individuals and of steps that should be taken to treat modifiable cardiovascular risk factors. [ABSTRACT FROM AUTHOR]

Objectives - We thought to evaluate left atrium (LA) as an attempt to fi nd an echocardiographic marker of paroxysmal atrial fi brillation (AF) in hypertensive patients without any significant disease. Methods - We prospectively enrolled two groups of hypertensives: forty six patients with hypertension (HTN) without history of arrhythmia (group 1) and twenty three patients with HTN and a recent episode of documented paroxysmal AF (group 2). Left atrial (LA) diameters (anteroposterior, transversal and longitudinal) and LA phasic volumes (maximal, minimal and before atrial contraction) were assessed by 2D echocardiography and left atrial emptying functions (LAEF) (global, active and passive) were calculated; also 3D acquisitions of maximal and minimal volumes of LA were performed. Using the current recommendations of speckle tracking technique, peak longitudinal strain of left atrial walls (PALS) and peak atrial contraction strain (PACS) (mean value from apical four chambers and two chambers view) were analyzed. Results - Age (59.5y+-12 vs 67.7ys+-8, p=0.003) and the mean time of HTN diagnosis (42 mo+-6 vs 80 mo+8, p=0.007) were significantly higher in group 2; the other cardiovascular risk factors (smoking, dyslipidemia) were similar as prevalence. We found all 2D and 3D LA volumes significantly greater in group 2 (for all p<0.0001) and global, active and passive LA EF significantly lower in the same group, compared with the other (p<0.0001, p<0.0001 and p<0.02). In comparison with 2D values, 3D volumes and emptying fractions were lower, but with no statistical significance. The peak longitudinal strain values were also significantly lower in AF group versus HTN control (26.1+-7.4 vs 15.7+-5.6, p<0.0001) while peak contraction strain was nonsignificant in the two groups. Conclusion - The echocardiographic evaluation of LA function using 2D and 3D volumetric and speckle tracking methods can be successfully used in identifying hypertensive patients at risk of atrial fi brillation. [ABSTRACT FROM AUTHOR]

Aims - Baseline mechanical intraventricular dyssynchrony showed only a weak correlation with response to CRT in HF patients with wide QRS. We aimed to evaluate the effects of RV pacing on baseline intraventricular dyssynchrony in patients submitted to CRT. Methods - In 40 consecutive HF patients (LBBB, sinus rhythm, normal PR interval, 22 ischemic etiology, 65.5±10.7 years, 21 women, NYHA class 3.3 ± 0.5, LV ejection fraction 20.1±4.1%), speckle tracking radial strain was performed during sinus rhythm (ODO mode) and during RV pacing (DDD with optimum AV interval) one week after biventricular device implantation. RV lead was placed on interventricular septum (RVS, n=30) and RV apex (RVA, n=10). Patients had significant baseline intraventricular dyssynchrony, (i.e. =130 ms time difference in peak septal wall to infero-lateral wall strain). Maximum LV delay area (MDA) was defined as the segment with the latest systolic peak from the 6 regional color-coded time-strain curves. Midventricular global radial strain (mGRS) was determined averaging the segmental radial strain values. Results - Overall, RV pacing did not significantly increased intraventricular dyssynchrony (350±98 ms vs. 322±90 ms during SR, p=0.08). However, RVA pacing significantly increased LV dyssynchrony (367±58 ms vs. 312±60 ms during SR, p<0.001). mGRS was significantly reduced during RV pacing (13.3±8.5% vs. 18.3±7.4% during SR, p<0.001). The location of MDA shifted during RV pacing in 31 out of 40 patients (77%). Conclusions - In HF patients with wide QRS submitted to CRT, RV pacing alters the pattern of intraventricular dyssynchrony and impairs LV strain. [ABSTRACT FROM AUTHOR]

Infective endocarditis remains a diagnostic challenge, as there are no pathognomonic signs and symptoms for the disease. Intracardiac vegetations are usually found on cardiac valves, but mural, non-valvular vegetations may also be seen, although less frequently. We present the case of a patient with isolated left atrial mural endocarditis complicated with endogenous endophthalmitis, who was successfully treated with antibiotherapy. [ABSTRACT FROM AUTHOR]

Introduction: Coronary artery disease remains (CAD) a major cause of morbidity and mortality worldwide1 . However, the mortality rates of CAD have declined over the past decades, mainly due to improvements in the treatment of acute coronary syndromes, therapies for heart failure or revascularization for chronic angina2 , but also because of awareness-raising and prevention strategies. [ABSTRACT FROM AUTHOR]

Objective-Myocardial perfusion can be safely assessed using contrast echocardiography. Our aim is to demonstrate the diagnostic value of resting myocardial contrast echocardiography (MCE), and its correlation with scintigraphy, transthoracic echocardiography and coronary angiography. Method-For the purpose of this study (case-control) we selected two patients, one control patient having cardiovascular risk factors but no ischemic heart disease and another patient with prior myocardial infarction. Left ventricle microperfusion was quantifi ed using multiple techniques: echocardiography, myocardial contrast echocardiography (MCE) and myocardial scintigraphy with 99mTc- tetrofosmin radiofarmaceutic. Both patients underwent coronary angiography immediately after hospital admission. As a contrast agent for MCE we used sulphur hexafl uoride microbubbles (Sonovue®); myocardial perfusion was assessed using quantitative perfusion parameters (peak intensity and time to peak) and further analyzed by dedicated software. Results-We obtained lower peak intensity and longer time to peak values in case of the ischemic patient compared to control, thus demonstrating myocardial microcirculation dysfunction. Results obtained by MCE are concordant with the results obtained by standard echocardiography, coronary angiography and myocardial scintigraphy regarding perfusion, regional motility and systolic wall thickening. Conclusions-MCE brings useful information regarding myocardial microcirculation. [ABSTRACT FROM AUTHOR]

Objectives -- We set to evaluate the potential utility of right ventricle (RV) Tei-index as a prognostic parameter in patients with pulmonary arterial hypertension (PAH). We investigated its correlation with the clinical status, current treatment, a series of paraclinical parameters, as well as established determinants of prognosis in patients with PAH. Methods -- We enrolled in our study 24 patients with PAH confirmed by right heart catheterization (RHC) over a period of 4 years (2012-2016). We performed complete transthoracic echocardiography and six minute walk distance in all subjects. Results -- The RV TEI index correlated with the World Health Organization functional class (WHO FC) (p=0.05) and right atrial pressure determined by RHC (p=0.01). Patients undergoing diuretic treatment had a statistically significant lower TEI Index (p=0.017). There was also a trend of association between treatment with bosentan and a lower TEI index (p=0.0727). Conclusions -- In PAH patients, the RV TEI Index correlates with clinical parameters (WHO FC, 6MWD) and hemodynamic variables (right atrial pressure). RV TEI Index could improve under treatment with diuretics and possibly bosentan in these patients. [ABSTRACT FROM AUTHOR]