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Background: Doppler-driven net atrioventricular compliance (C n ), which represents left atrial (LA) compliance, is an important determinant of pulmonary hypertension in mitral stenosis (MS)., Hypothesis: We hypothesized that decreases in C n during early-stage exercise underlie exercise intolerance in patients with MS., Methods: Thirty-three asymptomatic patients with significant MS (valve area 1.24 ± 0.16 cm 2 ) underwent resting and bicycle exercise echocardiography. LA compliance and conventional parameters were assessed at each workload. The patients were classified into two groups based on whether they developed dyspnea during exercise: an exercise-intolerance group (n = 22) and an exercise-tolerance group (n = 11). Moreover, "50 W" was defined as an early exercise stage., Results: Although the groups had similar resting characteristics, there were striking differences in their echocardiographic parameters from the early stages of exercise. The relative C n decrease at 50 W (expressed as a percentage of the resting C n ) was significantly greater in the exercise-intolerance group (70.3 ± 15.4% vs 49.7 ± 9.7%, P < .001). The overall decrease in relative C n was significantly greater in the exercise-intolerance group (P = .0005). Furthermore, differences in the trends in this parameter were observed between the two groups (P < .0001 for interaction). Multivariate analysis revealed that the relative C n decrease at 50 W was an independent predictor of exercise intolerance (adjusted OR 1.105, 95% CI 1.030-1.184) after adjustment for other conventional parameters., Conclusions: Decreases in C n during early-stage exercise are an important mechanism underlying exercise intolerance in MS., (© 2017, Wiley Periodicals, Inc.)

Here, we report a rare case of isolated leukemic infiltrate of the myocardium (extramedullary involvement) presenting as restrictive cardiomyopathy in a patient in complete remission of acute myeloid leukemia. It was evaluated with multimodality imaging studies (echocardiography and cardiac MRI) and further confirmed by pathology. The present case highlights the importance of maintaining a high degree of clinical suspicion when evaluating patients with progressive ventricular hypertrophy of unknown cause, including recognition of the potential involvement by recurrent hematologic malignancy., (© 2016, Wiley Periodicals, Inc.)

Background Prehypertension has a high risk of progression to hypertension, and intensive lifestyle modification including regular exercise is recommended for the management of prehypertensive individuals. However, data on the association between exercise capacity and hypertension status are limited. Therefore, we aimed 1) to define the characteristics of prehypertension, focusing on metabolic aspects and exercise capacity, and 2) to elucidate determinants of exercise capacity in healthy individuals without hypertension. Methods We retrospectively identified 741 normotensive healthy subjects (mean age, 52.6 ± 8.8 years; 57.9% men) who underwent consecutive cardiopulmonary exercise testing. The participants were categorized into two groups: the optimal blood pressure (BP) (systolic BP < 120 mmHg and diastolic BP < 80 mmHg, n = 364) and prehypertension (systolic BP 120–139 mmHg and/or diastolic BP 80–89 mmHg, n = 377) groups. Exercise capacity was assessed with peak oxygen consumption. Results The prehypertension group showed metabolic syndrome characteristics, and had increased left ventricular mass index and impaired diastolic function. However, no significant differences in exercise capacity were found between the optimal BP and prehypertension groups (peak VO 2 , 25.3 ± 7.2 vs. 25.8 ± 7.3 mL/kg/min, p = 0.327). Age, resting heart rate, and fat percentage were identified as independent determinants of exercise capacity ( p < 0.001 for all). Conclusions Prehypertension is associated with metabolic disarrangement and preclinical target organ damage but not with exercise capacity. Exercise capacity is determined by age, resting heart rate, and body composition in relatively healthy individuals who do not have hypertension. [ABSTRACT FROM AUTHOR]

Background Left ventricular apical aneurysm ( LVAA) is a serious complication associated with myocardial infarction. However, the effects of a previously formed LVAA on long-term left ventricular ( LV) geometry and clinical outcomes have not been fully evaluated. Methods From January 2009 to May 2015, we retrospectively identified 70 patients (mean age, 66 ± 12 years; males, 72.9%) with an LVAA due to ischemia. These patients were classified into two groups according to the initial apical conicity ratio ( ACR): large LVAA group ( ACR ≥ 1.5, n = 40) and small LVAA group ( ACR < 1.5, n = 30). An adverse outcome was defined as a composite of fatal arrhythmia, embolic infarction, and readmission due to heart failure. Results The ACR significantly decreased over the first month and then increased after 1 and 3 years of follow-up. The other examined echocardiographic indexes did not exhibit temporal changes. During the follow-up period (median 1138 days), the large LVAA group experienced a lower event-free survival (P = 0.016). In a multivariate Cox model, the presence of a large LVAA (adjusted hazard ratio [ HR] = 2.795, 95% confidence interval [ CI] = 1.118-6.986, P = 0.028) and the initial LV ejection fraction ( EF) (adjusted HR = 0.964, 95% CI = 0.932-0.997, P = 0.034) were independent predictors of adverse outcomes. Conclusions This study demonstrates that LVAAs undergo a dynamic process and that large LVAAs are associated with adverse outcomes. Our results suggest that the ACR could be helpful for predicting adverse outcomes in patients with apical aneurysm. [ABSTRACT FROM AUTHOR]