Search

Background: Right ventricular‐pulmonary artery coupling (RVPAC) is a predictor of outcome in pulmonary hypertension. However, the role of this parameter in dilated cardiomyopathy (DCM) remains to be established. The aim of this study was to assess the contribution of RVPAC to the occurrence of severe heart failure (HF) symptoms in patients with DCM using three‐dimensional (3D) echocardiography. Methods: We prospectively screened 139 outpatients with DCM, 105 of whom were enrolled and underwent 3D echocardiographic assessment. RVPAC was estimated non‐invasively as the 3D right ventricular stroke volume (SV) to end‐systolic volume (ESV) ratio. Severe HF symptoms were defined by New York Heart Association (NYHA) class III or IV. We evaluated differences in RVPAC across NYHA classes and the ability of RVPAC to predict severe symptoms. Results: Mean left ventricular (LV) ejection fraction was 28±7%. Mean RVPAC was 0.77±0.30 and it was significantly more impaired with increasing symptom severity (p = 0.001). RVPAC was the only independent determinant of severe HF symptoms, after adjusting for age, diuretic use, LV systolic function, LV diastolic function, and pulmonary artery systolic pressure (OR 0.035 [95% CI, 0.004–0.312], p = 0.003). By receiver‐operating characteristic analysis, the RVPAC cut‐off value for predicting severely symptomatic status was 0.54 (area under the curve = 0.712, p < 0.001). Conclusion: 3D echocardiographic SV/ESV ratio is an independent correlate of severe HF symptoms in patients with DCM. 3D RVPAC might prove to be a useful risk stratification tool for these patients, should it be further validated in larger studies. [ABSTRACT FROM AUTHOR]

Objectives - To provide preliminary data on practice of stress perfusion cardiovascular magnetic resonance (CMR) in a single center in Romania. Methods - We retrospectively reviewed the clinical files and CMR reports of patients who underwent stress perfusion CMR in our institution between January 2018 and December 2020. Results - A total of 1036 patients underwent CMR examinations during this period in our institution. Of these, 120 patients had stress perfusion CMR. The most common indication was the assessment of myocardial ischaemia in patients with established coronary artery disease (CAD) (77 patients, 64.16%), with either a history of myocardial infarction or previous coronary revascularization, or with intermediate lesions on invasive coronary angiography (ICA). The other indications consisted in detection of ischaemia in patients with suspected CAD (36 patients, 30%), characterization of the substrate of ventricular arrhythmia (5 patients, 4.16%) and assessment of the etiology of dilated cardiomyopathy (DCM) (4 patients, 3.33%). All patients had vasodilator stress with adenosine and an adequate stress response was obtained in 113 patients (94.16%). There were 21 patients (18.58%) with an abnormal stress test and patients with intermediate lesions on ICA had the highest prevalence of positive reports (24.32%). Sixty-three patients had myocardial fibrosis (52.5%): 49 patients (40.83%) had subendocardial (ischaemic) scars, while 14 patients (11.66%) had non-ischaemic scars. There were no serious adverse events related to the procedure. Conclusions - This is the first report in Romania on the use of stress perfusion CMR in clinical practice. We report our experience on stress efficiency, acquisition protocol, artifacts, prevalence of positive tests and safety. Most stress CMRs were requested in patients with established CAD. [ABSTRACT FROM AUTHOR]

Due to recent technical developments, magnetic resonance imaging (MRI) has become one of the most attractive imaging modalities for a multitude of pathologies, offering unique information with the potential to modify diagnosis and treatment strategies in a cost-effective manner. Cardiovascular magnetic resonance (CMR) in particular has dramatically evolved to a reliable diagnostic tool bringing unique information for virtually all cardiovascular pathologies1. Patients with coronary stents, prosthetic heart valves or pacemakers and others cardiac implanted electronic devices (CIEDs) have been historically denied the opportunity to undergo clinically indicated MRI scans. As the population ages, it has been suggested that 50% to 75% of patients with CIEDs will have a clinical indication for MRI examination in their lifetimes2,3. As we are facing a growing need for MRI scans in the large population of patients with implanted cardiac devices, it is crucial to accurately inform healthcare professionals about the actually low risk of performing MRI in these patients. As a rule of thumb, virtually all patients with coronary stents, prosthetic heart valves, annuloplasty rings and MR-conditional CIEDs can safely undergo MRI scanning at 1.5 tesla, and some of them at 3 tesla3-5. Moreover, recent studies have led the scientific societies to allow MRI scanning even for patients with non-conditional CIEDs under special circumstances. This review aims to inform physicians of all specialties on how to safely indicate clinical MRI in patients with implanted cardiovascular devices based on an evidence-based approach. [ABSTRACT FROM AUTHOR]

Introduction: We aimed to find new predictive parameters for atrial fibrillation (AF) onset in hypertensive patients using two-dimensional (2D) conventional and speckle tracking echocardiography of the left atrium (LA). Methods: One hundred and eight patients with essential hypertension (HTN) were prospectively enrolled, from which 67 patients had no other important comorbidities (HTN group), while 41 patients had a recent AF episode, but were in sinus rhythm at the moment of enrollment (HTN and AF group). LA diameters and maximal volume, LV mass, LV ejection fraction and diastolic function were assessed through 2D conventional echocardiography. Moreover, peak longitudinal and contractile strain of LA walls (PALS and PACS, respectively) were analyzed by speckle tracking technique. Patients were followed up for 1 year and recurrent 24-h rhythm monitoring was done, in order to identify atrial fibrillation. Results: Age and time from diagnosis of HTN were higher in HTN and AF group than in HTN group (68.02 ± 19 years versus 57.2 ± 1.52 years, p = 0.001 and 62.2 ± 9.2 months versus 40.4 ± 6.4 months, p = 0.04). All LA diameters and LA maximal volume were significantly larger in HTN and AF group (for LA antero-posterior diameter p = 0.02, for all the rest p < 0.0001). LV ejection fraction was preserved in both groups, being significantly lower in HTN and AF patients (58.44 ± 0.79 versus 60.75 ± 0.57, p = 0.02). LV mass was higher in HTN and AF group and these patients had also a more severe diastolic dysfunction, (E/A ratio 1.8 ± 0.51 versus 0.9 ± 0.02, p = 0.04) and lower septal and lateral A′ velocities (p < 0.0001 and p = 0.002). The peak LA longitudinal and contractile strain values were also significantly lower in HTN and AF group versus HTN group (for all p < 0.0001). Among the echocardiographic parameters, we identified PALS and PACS as predictors for AF, with a good discriminating capacity (AUC = 0.88 for PALS and AUC = 0.86 for PACS). Conclusions: Compared to patients with isolated hypertension, patients with hypertension and AF display several echocardiographic differences. Among them, LA strain parameters could be useful predictors of AF occurrence in hypertensive patients. [ABSTRACT FROM AUTHOR]

Background: Recent data suggest that the mechanisms contributing to ischaemic mitral regurgitation (IMR) in the setting of acute myocardial infarction (MI) are different compared to chronic IMR. However, little is known about the dynamic changes over time of mitral valve (MV) geometry after acute MI. Methods and results: Comprehensive three-dimensional (3D) assessment of the MV geometry was performed in 30 patients in the first 7 days after a first ST elevation myocardial infarction (STEMI), and after 4 years of follow-up. The MV annulus diameters and area remained unchanged over time, however the MA became progressively flatter (mean difference of annular height 0.19±0.33 cm, p<0.05), independently of the presence or severity of IMR. The posterior leaflet length and area got smaller over time (1.53±0.51 cm vs 1.27±0.33 cm; p<0.05 and 5.65±1.58 cm2 vs 4.88±1.65 cm2; p<0.05, respectively). The tenting height and area were smaller at follow-up (9.06±2.6 mm vs 7.84±2.61 mm, p<0.05; and 1.88±0.6 cm2 vs 1.57±0.5 cm2; p<0.05, respectively). A larger tenting at follow-up correlated with 3D left atrial (LA) volumes, but not with LV volumes and ejection fraction. Conclusions: MV geometry changes over time even in patients with non-severe IMR. The MV healing process consists in annulus flattening associated with improved tenting. [ABSTRACT FROM AUTHOR]

It is often said that cardiac magnetic resonance (CMR) has the diagnostic power of a noninvasivemyocardial biopsy.We illustrate this concept by stepwise analysis of a CMR exam in 65-year-old patient referred to our department for tissue characterization of a left ventricular (LV) hypertrophy of unknown etiology. The subsequent complete laboratory work- up has diagnosed cardiac amyloidosis (CA) of AL type (light chain CA). The reader will become acquaintedwith the common sequences of the clinical CMR protocol in CA. [ABSTRACT FROM AUTHOR]

Secondary mitral regurgitation (MR) is more frequent, portends a worse prognosis and its diagnostic and management are more difficult in comparison with primary MR. The mechanism of secondary MR is linked to the left ventricle remodeling, while the valve morphology is normal. Surgical treatment of severe secondary MR consists either in mitral valve replacement or in mitral valve repair. The most commonly used repair technique is represented by undersized mitral annuloplasty. This surgical technique implieslowersurgical risk but associates a higher rate of postoperative MR recurrence, compared to mitral valve replacement. Echocardiography provides geometric parameters related to mitral apparatus deformation, which are able to predict the success or failure of mitral valve repair and thus helps in selecting the best surgical strategy for each patient. In this paper we try to make an inventory of the echocardiographical parameters which proved predictive power for unsuccessful mitral valve repair techniques. [ABSTRACT FROM AUTHOR]

Objectives: To assess the additive diagnostic value of longitudinal strain (LS) analysis during stress echocardiography and discuss the pathophysiological base and the role of LS alterations in coronary artery disease (CAD) detection. Methods: We performed stress echocardiography 24 hours after admission in 10 patients presented with acute chest pain (ACP), stratified as low risk acute coronary syndrome (ACS) by GRACE score. Dypiridamole was used in 5 of the patients, while dobutamine-atropine protocol was employed in the other 5 patients, using state of the art protocols. Two dimensional (2D) speckle tracking derived LS was assessed using a semiautomated function imaging software at baseline, peak dose ant recovery. All studies were negative by conventional 2D echocardiographical criteria but LS analysis showed altered values at peak stress in two cases suggestive of ischemic myocardium. All patients were referred to coronary angiography, due to the fact that they developed angina or ECG changes during the test, in the absence of wall motion abnormalities. Only those with altered LS values during stress showed significant CAD. Conclusions: Our pilot study highlights that quantitative analysis of myocardial deformation appeared to be superior over conventional visual analysis of contractility for myocardial ischemia detection. Addition of LS analysis at conventional 2D echocardiographical criteria could lead to an increased sensitivity of pharmacological stress echocardiography. This hypothesis should be checked on a larger group of patients. [ABSTRACT FROM AUTHOR]

Coronary artery disease (CAD) is the leading cause of cardiovascular mortality worldwide. Non-invasive diagnosis of CAD is essential for lowering the number of unnecessary invasive coronary angiograms (ICA). Due to the low diagnostic accuracy of electrocardiographic exercise testing (EET), the current practice has shifted to the use of non-invasive imaging testing where available. Cardiovascular magnetic resonance (CMR) is unique among the current non-invasive imaging tests because it offers equally accurate information about cardiac morphology, function, myocardial ischaemia and viability in one single examination, without exposing patients to ionizing radiation. This is particularly important in complex clinical scenarios such as patients with multi-vessel CAD, total chronic occlusions or prior revascularization, in which precise knowledge of ischaemic territories, viability and left ventricular (LV) function are necessary to determine the appropriate treatment. This review is focused on myocardial perfusion CMR imaging while briefl y discussing the other CMR methods relevant to the assessment of CAD. We also provide practical information on how to perform stress myocardial perfusion CMR as well as the current guideline indications of CMR in CAD detection. [ABSTRACT FROM AUTHOR]

MELAS is a systemic hereditary condition that can present as hypertrophic or mixed hypertrophic and dilated phenotype cardiomyopathy in young individuals, although a late-onset form is also described in the literature. Genetic testing is essential for correct diagnosis and appropriate management. We present the case of a 22-year-old male who was referred to our center after being diagnosed with NYHA class III heart failure with a mixed hypertrophic and dilated cardiomyopathy. His medical history included stroke episodes, seizures, progressive hypoacusis, neurocognitive impairment, and muscle atrophy. Lactic acidosis and elevated CK levels were also noted. The ECG revealed short PR interval and delta wave in lateral leads. TTE showed mildly dilated and hypertrophied LV and RV with severe biventricular systolic impairment. The CMR study was relevant for ring-like subepicardial fibrosis, predominantly in the medium and apical segments. Brain MRI showed multifocal supratentorial subcortical stroke-like lesions in both cerebral hemispheres, involving multiple vascular territories and following a migratory pattern. Genetic testing confirmed a pathogenic MT-TL1 mutation (m.324A>G) and the patient was diagnosed with MELAS. Further management included specific lifestyle recommendations and cascade genetic screening, as well as starting GDMT for HFrEF. Three months after discharge, his clinical status improved. However, the LVEF remained reduced. After careful consideration, an ICD was implanted for primary prevention. A red-flag approach in this young patient, which took into consideration the stroke-like episodes, lactic acidosis, seizures, hypoacusis, myopathy, as well as the short PR interval, led to the correct diagnosis, further confirmed by using the appropriate genetic test. Failure to diagnose affects the patient's prognosis, as their prognosis and clinical status are influenced by enforcing specific recommendations. [ABSTRACT FROM AUTHOR]

Cardiac lipomas are generally asymptomatic even in large dimensions. Echocardiograms can identify tumors, but cardiac magnetic resonance imaging or cardiac computerized tomography can differentiate cardiac lipomas from other cardiac tumors. The present study is a case report of an asymptomatic 30-year-old man diagnosed with atrial lipoma. The patient received cardiac surgery and the intervention consisted of exclusion of the right atrial (RA) tumor and reconstruction of the right atrium with 'XenoSure' patch in extracorporeal circulation through a minimally invasive approach. A short PubMed literature review was performed and 26 cases of RA lipomas with available details were found. Cardiac tumors may cause clinical presentation through different pathways. Symptoms related to an RA lipoma were present in 21 out of 26 patients (80%). The symptoms varied greatly, dyspnea being the most common of them. In one case, the lipoma was found during the autopsy of a patient after sudden death. Large cardiac lipomas can lead to complications such as obstruction of ventricular outflow tract, electric disorders, embolism or pericardial effusion. Obstruction of the right ventricular outflow tract was reported in 11 out of 26 patients (42%) diagnosed with RA lipoma. Generally, atrial lipoma can have various sizes. The most useful imaging technique was transthoracic echocardiography. Accurate diagnosis and evaluation of cardiac lipoma is dependent on multimodality imaging methods, including cardiac magnetic resonance. Surgery is the treatment of choice, but the risk-benefit ratio must be considered, and shared decision making must be taken into account. The present review data showed that 23 out of 25 patients (92%) underwent surgery. Among these patients, only 1 out of 23 received a minimally invasive approach in 2021. Cardiac lipomas are rare entities, usually asymptomatic, that can occur at any age. The most useful diagnostic method of cardiac tumors is echocardiography, but nuclear magnetic resonance can also specify the type and characteristics of tumors. [ABSTRACT FROM AUTHOR]

Secondary mitral regurgitation (MR) is more frequent, portends a worse prognosis and its diagnostic and management are more difficult in comparison with primary MR. The mechanism of secondary MR is linked to the left ventricle remodeling, while the valve morphology is normal. Surgical treatment of severe secondary MR consists either in mitral valve replacement or in mitral valve repair. The most commonly used repair technique is represented by undersized mitral annuloplasty. This surgical technique implieslowersurgical risk but associates a higher rate of postoperative MR recurrence, compared to mitral valve replacement. Echocardiography provides geometric parameters related to mitral apparatus deformation, which are able to predict the success or failure of mitral valve repair and thus helps in selecting the best surgical strategy for each patient. In this paper we try to make an inventory of the echocardiographical parameters which proved predictive power for unsuccessful mitral valve repair techniques. [ABSTRACT FROM AUTHOR]

echocardiography and discuss the pathophysiological base and the role of LS alterations in coronary artery disease (CAD) detection. Methods: We performed stress echocardiography 24 hours after admission in 10 patients presented with acute chest pain (ACP), stratified as low risk acute coronary syndrome (ACS) by GRACE score. Dypiridamole was used in 5 of the patients, while dobutamine-atropine protocol was employed in the other 5 patients, using state of the art protocols. Two dimensional (2D) speckle tracking derived LS was assessed using a semiautomated function imaging software at baseline, peak dose ant recovery. All studies were negative by conventional 2D echocardiographical criteria but LS analysis showed altered values at peak stress in two cases suggestive of ischemic myocardium. All patients were referred to coronary angiography, due to the fact that they developed angina or ECG changes during the test, in the absence of wall motion abnormalities. Only those with altered LS values during stress showed significant CAD. Conclusions: Our pilot study highlights that quantitative analysis of myocardial deformation appeared to be superior over conventional visual analysis of contractility for myocardial ischemia detection. Addition of LS analysis at conventional 2D echocardiographical criteria could lead to an increased sensitivity of pharmacological stress echocardiography. This hypothesis should be checked on a larger group of patients. [ABSTRACT FROM AUTHOR]

Subclinical alterations in myocardial structure and function occur early during the natural disease course. In contrast, clinically overt signs and symptoms occur during late phases, being associated with worse outcomes. Identification of such subclinical changes is critical for timely diagnosis and accurate management. Hence, implementing cost-effective imaging techniques with accuracy and reproducibility may improve long-term prognosis. A growing body of evidence supports using cardiac magnetic resonance (CMR) to quantify deformation parameters. Tissue-tagging (TT-CMR) and feature-tracking CMR (FT-CMR) can measure longitudinal, circumferential, and radial strains and recent research emphasize their diagnostic and prognostic roles in ischemic heart disease and primary myocardial illnesses. Additionally, these methods can accurately determine LV wringing and functional dynamic geometry parameters, such as LV torsion, twist/untwist, LV sphericity index, and long-axis strain, and several studies have proved their utility in prognostic prediction in various cardiovascular patients. More recently, few yet important studies have suggested the superiority of fast strain-encoded imaging CMR-derived myocardial strain in terms of accuracy and significantly reduced acquisition time, however, more studies need to be carried out to establish its clinical impact. Herein, the current review aims to provide an overview of currently available data regarding the role of CMR in evaluating myocardial strain and biomechanics. [ABSTRACT FROM AUTHOR]

Chronic venous disease (CVD) includes various medical conditions of long duration, all involving morphologic and functional abnormalities of the venous system, manifested by symptoms or signs (or both). Chronic venous disease of the legs occurs commonly in the general population and varicose veins and venous ulcers can be a great financial burden to patients and to society. In this review we expose the main mechanisms of the disease, knowing that the signs and symptoms of the disease are related to venous hypertension. Secondary to venous hypertension, a sophisticated physiopathological chain results consisting of: chronic inflammation, prothrombotic status, activation of the endothelial cells, diapedesis of leukocytes, deterioration of the glycocalyx layer, high permeability of the capillary wall, extravasation of macromolecules and red blood cells. All these processes result in the characteristic skin changes: limb swelling, pigmentation, lipodermatosclerosis, eczema or venous ulcerations. By treating chronic venous disease we try to lower venous hypertension and to thus minimize inflammation and endothelial dysfunction. The mainstay of chronic venous disease treatment is compression therapy, but currently a heterogenic group of venoactive drugs have been tried with varying success, the most promising drugs including saponins, flavonoids, the micronized purified flavonoid fraction and other plant extracts. We discuss here the mechanism of action of sulodexide, which is a unique molecule orally active, structured on heparan sulfate and dermatan sulfate, two polysaccharides (glycosaminoglycans) with well-established antithrombotic and profibrinolytic activity. Sulodexide is orally bioavailable having specific pharmacokinetic properties and a smaller effect on systemic clotting and bleeding. At therapeutic doses in patients, sulodexide inhibits activated factor X, exerts a profibrinolytic activity, evidenced by tissue-plasminogen activator (t-PA) activation and plasminogen activator inhibitor (PAl-l) inhibition. Moreover, a large number of preclinical/clinical trials shows that sulodexide exerts anti-inflammatory, hypolipemiant, endothelial-protective and glycocalyx-saving actions. Within this review we present the main evidences which already demonstrated the efficiency and safety of this drug in treating chronic venous disease. In addition, we included the updated guidelines opinion regarding the use of sulodexide in treatment of venous chronic disease, together with the recommended doses and modes of administration. In the end, we summarized the main characteristics of sulodexide, which makes it one of the best pharmacological choices in the treatment of CVD: I. a very good pharmacokinetic and phamacodynamic profile, with a high oral bioavailability and a high affinity for the endothelial cells; II. less interaction with the systemic coagulation cascade in favor of a pronounced local activity; III. an important role in protection and restoration of glycocalyx; IV. a safe and well tolerated action, without hemorrhagic adverse events, according to clinical trials. Due to all its benefits, we can conclude sulodexide can be used in all stages of CVD. [ABSTRACT FROM AUTHOR]

PRKAG2 syndrome (PS) is a rare, early-onset autosomal dominant phenocopy of sarcomeric hypertrophic cardiomyopathy (HCM), that mainly presents with ventricular pre-excitation, cardiac hypertrophy and progressive conduction system degeneration. Its natural course, treatment and prognosis are significantly different from sarcomeric HCM. The clinical phenotypes of PRKAG2 syndrome often overlap with HCM due to sarcomere protein mutations, causing this condition to be frequently misdiagnosed. The syndrome is caused by mutations in the gene encoding for the γ2 regulatory subunit (PRKAG2) of 5′ Adenosine Monophosphate-Activated Protein Kinase (AMPK), an enzyme that modulates glucose uptake and glycolysis. PRKAG2 mutations (OMIM#602743) are responsible for structural changes of AMPK, leading to an impaired myocyte glucidic uptake, and finally causing storage cardiomyopathy. We describe the clinical and investigative findings in a family with several affected members (NM_016203.4:c.905G>A or p.(Arg302Gln), heterozygous), highlighting the various phenotypes even in the same family, and the utility of genetic testing in diagnosing PS. The particularity of this family case is represented by the fact that the index patient was diagnosed at age 16 with cardiac hypertrophy and ventricular pre-excitation while his mother, by age 42, only had Wolff–Parkinson–White syndrome, without left ventricle hypertrophy. Both the grandmother and the great-grandmother underwent pacemaker implantation at a young age because of conduction abnormalities. Making the distinction between PS and sarcomeric HCM is actionable, given the early-onset of the disease, the numerous life-threatening consequences and the high rate of conduction disorders. In patients who exhibit cardiac hypertrophy coexisting with ventricular pre-excitation, genetic screening for PRKAG2 mutations should be considered. [ABSTRACT FROM AUTHOR]

During the last decade, studies have raised awareness of the crucial role that the right ventricle plays in various clinical settings, including diseases primarily linked to the left ventricle. The assessment of right ventricular performance with conventional echocardiography is challenging. Novel echocardiographic techniques improve the functional assessment of the right ventricle and they show good correlation with the gold standard represented by cardiac magnetic resonance. This review summarizes the traditional and innovative echocardiographic techniques used in the functional assessment of the right ventricle, focusing on the role of right ventricular dysfunction in heart failure with reduced ejection fraction and providing a perspective on recent evidence from literature. [ABSTRACT FROM AUTHOR]

The present case report describes a mother and son with arrhythmogenic cardiomyopathy (ACM) with early and greater left ventricle (LV) involvement. The presence of curly hair in both, together with the resuscitated sudden cardiac death of the mother, allowed timely genetic testing, which found a pathogenic nonsense mutation of the desmoplakin gene. While asymptomatic from an arrhythmic point of view, the son's evolution was characterized by a well-documented exercise-induced myocarditis-like stage. [ABSTRACT FROM AUTHOR]

Dilated cardiomyopathy (DCM) represents a group of disorders affecting the structure and function of the heart muscle, leading to a high risk of heart failure and sudden cardiac death (SCD). DCM frequently involves an underlying genetic etiology. Genetic testing is valuable for risk stratification, treatment decisions, and family screening. Romanian population data on the genetic etiology of DCM are lacking. We aimed to investigate the genetic causes for DCM among Romanian adult patients at tertiary referral centers across the country. Clinical and genetic investigations were performed on adult patients presenting to tertiary hospitals in Romania. The genetic investigations used next-generation sequencing panels of disease-associated DCM genes. A total of 122 patients with DCM underwent genetic testing. The mean age at DCM diagnosis was 41.6 ± 12.4 years. The genetic investigations identified pathogenic or likely pathogenic variants in 50.8% of participants, while 25.4% had variants of unknown significance. Disease-causing variants in 15 genes were identified in people with DCM, with 31 previously unreported variants. Variants in TTN, LMNA, and DSP explained 75% of genetic causes for DCM. In total, 52.4% of patients had a family history of DCM/SCD. Left ventricular ejection fraction of <35% was observed in 41.9% of patients with disease-causing variants and 55% with negative or uncertain findings. Further genotype-phenotype correlations were explored in this study population. The substantial percentage (50.8%) of disease-causing variants identified in patients with DCM acknowledges the importance of genetic investigations. This study highlights the genetic landscape in genes associated with DCM in the Romanian population. [ABSTRACT FROM AUTHOR]

Frequent premature ventricular complexes (PVCs) are associated with deleterious effects on left ventricular (LV) function in various clinical scenarios. Repaired tetralogy of Fallot (rTOF) is frequently affected by sustained ventricular arrhythmias dependent on complex post-surgical substrates. However, there is limited data regarding the potential of arrhythmogenic isthmuses to generate frequent PVCs and PVC-mediated LV systolic dysfunction development in rTOF. We present a case of rTOF experiencing relatively infrequent episodes of internal shocks for episodes of sustained monomorphic ventricular tachycardia and a high burden of PVCs associated with left ventricular systolic function deterioration, in which the successful substrate ablation of the anatomical VT isthmuses also led to PVC abolition and consequently to LV systolic function normalization. In such cases, understanding the pathogenic mechanisms that lead to LV dysfunction is only possible by rigorous clinical reasoning, which leads to a tailored specific treatment. [ABSTRACT FROM AUTHOR]

Background: Non-invasive assessment of myocardial ischaemia is a cornerstone of the diagnosis of coronary artery disease. Measurement of myocardial blood flow (MBF) using positron emission tomography (PET) is the current reference standard for non-invasive quantification of myocardial ischaemia. Dynamic myocardial perfusion cardiovascular magnetic resonance (CMR) offers an alternative to PET and a recently developed method with automated inline perfusion mapping has shown good correlation of MBF values between CMR and PET. This study assessed the repeatability of myocardial perfusion mapping by CMR in healthy subjects. Methods: Forty-two healthy subjects were recruited and underwent adenosine stress and rest perfusion CMR on two visits. Scans were repeated with a minimum interval of 7 days. Intrastudy rest and stress MBF repeatability were assessed with a 15-min interval between acquisitions. Interstudy rest and stress MBF and myocardial perfusion reserve (MPR) were measured for global myocardium and regionally for coronary territories and slices. Results: There was no significant difference in intrastudy repeated global rest MBF (0.65 ± 0.13 ml/g/min vs 0.62 ± 0.12 ml/g/min, p = 0.24, repeatability coefficient (RC) =24%) or stress (2.89 ± 0.56 ml/g/min vs 2.83 ± 0.64 ml/g/min, p = 0.41, RC = 29%) MBF. No significant difference was seen in interstudy repeatability for global rest MBF (0.64 ± 0.13 ml/g/min vs 0.64 ± 0.15 ml/g/min, p = 0.80, RC = 32%), stress MBF (2.71 ± 0.61 ml/g/min vs 2.55 ± 0.57 ml/g/min, p = 0.12, RC = 33%) or MPR (4.24 ± 0.69 vs 3.73 ± 0.76, p = 0.25, RC = 36%). Regional repeatability was good for stress (RC = 30–37%) and rest MBF (RC = 32–36%) but poorer for MPR (RC = 35–43%). Within subject coefficient of variation was 8% for rest and 11% for stress within the same study, and 11% for rest and 12% for stress between studies. Conclusions: Fully automated, inline, myocardial perfusion mapping by CMR shows good repeatability that is similar to the published PET literature. Both rest and stress MBF show better repeatability than MPR, particularly in regional analysis. [ABSTRACT FROM AUTHOR]

Background. Heart failure is a rare but serious diagnosis in pediatric patients. While in newborns and infants congenital heart disease is commonly the cause, in older children and in adolescents cardiomyopathies (primary or secondary) take the lead. The diagnosis may be difficult to establish, as the symptoms are nonspecific (especially in young ages). Case presentation. A previously healthy 16-year-old girl had been experiencing heart failure symptoms for the past 10 months, with gradual worsening of symptom severity. Upon evaluation, a diagnosis of class III Ross/NYHA heart failure due to dilated cardiomyopathy with severe left ventricular systolic dysfunction was established. Standard heart failure medication was initiated, alleviating congestion and partially controlling symptoms. There was no family or personal history of heart disease. The patient reported excellent exercise tolerance previously. No exposure to potentially toxic agents has been identified. The initial tests could not establish a definite cause, although a possible respiratory tract infection at the onset of symptoms and certain cardiac magnetic resonance imaging features could suggest previous eosinophilic myocarditis. Current literature to guide the diagnosis process and treatment options are discussed. Conclusions. Dilated cardiomyopathy is rare but severe in children. Even the typical symptoms may be downplayed or ignored for long periods, delaying the diagnosis; a high index of suspicion is therefore required when other more common disorders seem unlikely or have been ruled out. The possible underlying causes vary with age and differ from the adult population. An etiological diagnosis is frequently difficult to achieve, but must nonetheless be sought out, as it may allow for targeted therapy and improve prognosis. However, long-term outcome is usually grim. [ABSTRACT FROM AUTHOR]

Ischemic heart disease is one of the most prevalent diseases with a high impact on mortality and morbidity. The main process implicated in acute coronary syndromes (ACS) including its most severe form, the ST elevation myocardial infarction (STEMI), is the development of thrombosis subsequently of plaque erodation or rupture. The thrombus is formed by aggregates of platelets that furthermore drive the process of coagulation, that in this turn stimulates platelet aderation and aggregation, causing a vicious circle. From these physiopathological mechanims derive the indication and role of antiplatelets and anticoagulation in STEMI. Antiplatelets and anticoagulants play a central role in the therapeutic management of STEMI along with the interventional therapy. Correctly conducted by all physicians involved in the management of patients with STEMI, it reduces the area of ischemia, as well as mortality and other major adverse cardiovascular events. The following article will review the antithrombotic treatment adjuvant to the interventional treatment and the evidence based indications for treatment in STEMI. [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]

Objectives: To evaluate if global and regional longitudinal strain (LS) using two-dimensional speckle tracking echocardiography (2DSTE) could be useful to predict significant coronary artery disease (CAD) in patients with low risk acute coronary syndrome (ACS). We also assessed if LS is compensatory augmented in nonischemic segments and whether the gradient of LS between segments (LSD) would be higher in this category of patients. Methods: 117 consecutive patients presenting with low risk ACS, without wall motion abnormalities on conventional echocardiography underwent LS analysis by 2DSTE and coronary angiography. Global peak systolic longitudinal strain (GLS) of the 18 segments of left ventricle (LV), GLS of 12 segments of LV, LSD and longitudinal strain ratio (LSR), defined as the ratio of LSD to GLS were calculated. Territorial correlation between the segmental LS and angiography was also assessed. Results: GLS18 and GLS12 were significantly decreased, while LSD and LSR were increased in patients with CAD comparative with those without CAD. Moreover GLS18, GLS12, LSD and LSR had moderate predictive value for CAD (AUC 0.631, 0.67, 0.617 and 0.665 respectively). The regional predefined LS had moderate predictive value for left anterior descending artery disease (AUC=0.718) and right coronary artery disease (AUC=0.627), but not for circumflex disease (AUC=0,555). Conclusions: In low-risk ACS, global and regional LS could be a powerful noninvasive diagnostic tool for significant CAD. LSD and LSR are also valuable parameters, and together with standard strain parameters could improve the accuracy of rest echocardiography in the diagnosis of CAD. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate if global and regional longitudinal strain (LS) using two-dimensional speckle tracking echocardiography (2DSTE) could be useful to predict signifi cant coronary artery disease (CAD) in patients with low risk acute coronary syndrome (ACS). We also assessed if LS is compensatory augmented in nonischemic segments and whether the gradient of LS between segments (LSD) would be higher in this category of patients. Methods: 117 consecutive patients presenting with low risk ACS, without wall motion abnormalities on conventional echocardiography underwent LS analysis by 2DSTE and coronary angiography. Global peak systolic longitudinal strain (GLS) of the 18 segments of left ventricle (LV), GLS of 12 segments of LV, LSD and longitudinal strain ratio (LSR), defi ned as the ratio of LSD to GLS were calculated. Territorial correlation between the segmental LS and angiography was also assessed. Results: GLS18 and GLS12 were signifi cantly decreased, while LSD and LSR were increased in patients with CAD comparative with those without CAD. Moreover GLS18, GLS12, LSD and LSR had moderate predictive value for CAD (AUC 0.631, 0.67, 0.617 and 0.665 respectively). The regional predefi ned LS had moderate predictive value for left anterior descending artery disease (AUC=0.718) and right coronary artery disease (AUC=0.627), but not for circumflex disease (AUC=0,555). Conclusions: In low-risk ACS, global and regional LS could be a powerful noninvasive diagnostic tool for signifi cant CAD. LSD and LSR are also valuable parameters, and together with standard strain parameters could improve the accuracy of rest echocardiography in the diagnosis of CAD. [ABSTRACT FROM AUTHOR]

Objectives: To analyze the predictive value of new cardiovascular (CV) risk factors for CV risk assessment in the adult Romanian hypertensive (HT) population. Methods: Hypertensive adults aged between 40-65 years of age, identified in national representative SEPHAR II survey were evaluated by anthropometric, BP and arterial stiffness measurements: aortic pulse wave velocity (PWVao), aortic augmentation index (AIXao), revers time (RT) and central systolic blood pressure (SBPao), 12 lead ECGs and laboratory workup. Values above the 4th quartile of mean SBP' standard deviation (s.d.) defined increased BP variability. Log(TG/HDL-cholesterol) defined atherogenic index of plasma (AIP). Serum uric acid levels above 5.70 mg/dl for women and 7.0 mg/dl for males defined hyperuricemia (HUA). CV risk was assessed based on SCORE chart for high CV risk countries. Binary logistic regression using a stepwise likelihood ratio method (adjustments for major confounders and colliniarity analysis) was used in order to validate predictors of high and very high CV risk class. Results: The mean SBP value of the study group was 148.46±19.61 mmHg. Over forty percent of hypertensives had a high and very high CV risk. Predictors of high/very high CV risk category validated by regression analysis were: increased visit-to-visit BP variability (OR: 2.49; 95%CI: 1.67-3.73), PWVao (OR: 1.12; 95%CI: 1.02-1.22), RT (OR: 0.95; 95% CI: 0.93-0.98), SBPao (OR: 1.01; 95%CI: 1.01-1.03) and AIP (OR: 7.08; 95%CI: 3.91-12.82). Conclusion: The results of our study suggests that the new CV risk factors such as increased BP variability, arterial stiffness indices and AIP are useful tools for a more accurate identification of hypertensives patients at high and very high CV risk. [ABSTRACT FROM AUTHOR]

Interferon alpha (IFN-α) is the approved standard of care for chronic hepatitis C and B. Unfortunately, it has neuropsychiatric side-effects that have a major impact upon the quality of life and the drug adherence. The mechanism of IFN-α-induced behavioral changes is complex, involving interactions between the immune system, the endocrine system, the monoaminergic systems and the opioid receptors. Recent studies support the neurodegeneration hypothesis as a possible mechanism of IFN-α-induced depressive behavior. Although a meta-analysis showed that antidepressant pretreatment effectively reduces the incidence and severity of depressive symptoms, irrespective of pre-existing psychiatric disorders, it is not approved for prophylactic use. The "on demand" treatment strategy is justified as the majority of patients have only mild depressive symptoms. Patients with risk factors for depression undergoing IFN-α therapy need to be regularly screened and followed-up by a psychiatric specialist. Further studies should be conducted to show which therapy is the most appropriate to reduce the neuropsychiatric symptoms that are related to the use of IFN-α and to investigate the clinical significance of IFN-α-induced neurodegeneration. [ABSTRACT FROM AUTHOR]

Anti-platelet treatment challenges in Glanzmann thrombasthenia-clinical practice when data lacks Glanzmann thrombasthenia is a rare bleeding disorder characterized by defective or low levels of glycoprotein (GP) IIb/IIIa.1 The GP IIb/IIIa receptor is activated when the platelets are stimulated by adenosine diphosphate (ADP), epinephrine, collagen, or thrombin and its presence is essential for haemostasis since it enables platelet aggregation. Cardiovascular disease treatment in bleeding disorders such as Glanzmann thrombasthenia is challenging seen that the classic treatment consisting in antiplatelets exposes this category of subjects to higher haemorrhagic events. [Extracted from the article]

Background: Right ventricular – arterial (RV‐PA) coupling can be estimated by echocardiography using the ratio between (TAPSE) and pulmonary arterial systolic pressure (PASP). TAPSE/PASP ratio proved to be a prognostic parameter in patients with heart failure and reduced ejection fraction (HFrEF). Objective: To evaluate the significance of RV‐PA coupling in patients with HFrEF undergoing cardiac resynchronization therapy (CRT). Methods: Patients undergoing CRT in our center between January 2017 and November 2019 were eligible. Response to CRT was defined by a reduction of more than 15% of left ventricle systolic volume (LVESV) one year after CRT. Primary endpoint was a composite of HF hospitalizations and death during follow‐up. Results: 54 patients (Age 64.0 ± 13.8 years; 58% male; left ventricular ejection fraction (LVEF) 28.4 ± 1.3%) were prospectively included. After a mean follow‐up of 31 ± 12.9months, the primary endpoint had occurred in 18 (33.3%) patients. A lower TAPSE/PASP ratio was associated with baseline worse HF symptoms, lower LVEF and long‐term less LV reverse remodeling (P <.05). After one year CRT improved RV systolic function (TAPSE, RV global longitudinal strain, P <.05), but not TAPSE/PASP ratio (P =.4). The ratio TAPSE/PASP (AUC=0.834) ≥ 0.58 mm/mm Hg showed good sensitivity (90%) and specificity (81.8%) for predicting response to CRT while a ratio <0.58 mm/mm Hg was associated with a higher risk of death and HF hospitalizations during the follow‐up (HR 5.37 95%CI [1.6–18], P <.001). Conclusion: RV‐PA coupling evaluation using TAPSE/PASP ratio predicts CRT response. A lower TAPSE/PASP ratio is associated with a higher risk of adverse cardiovascular events. [ABSTRACT FROM AUTHOR]

Infective endocarditis (IE) is associated with high mortality if left untreated and is associated with many complications such as: septic emboli, abscesses, valvular rupture or congestive heart failure. We present below the case of a 69-year-old male who presented to the emergency room for exertional dyspnea, malaise and fatigue, symptoms that started for several months with progressive worsening. The cardiac examination highlighted a systolic murmur in the mitral area in concordance with the echocardiographic findings that revealed severe mitral regurgitation along with a degenerative-myxomatous appearance of the mitral valve, suggestive for Barlow's disease, as well as a hyperechogenic mass on the mitral valve. Empirical therapy was initiated intravenously with vancomycin and gentamicin after three blood cultures were harvested. The blood cultures were positive for Staphylococcus (S.) epidermidis and given the antibiogram's susceptibility to vancomycin and daptomycin, the treatment was subsequently continued only with vancomycin. Albeit coagulase negative staphylococci such as S. epidermidis are usually found at patients with risk factors: valvular prostheses, implantable devices, hemodialysis or intravascular catheters, in our case the patient had no such risk factors, but instead developed IE on a native, degenerated valve. The patient was referred to the cardiovascular surgeon and subsequently, a prosthetic, bidisc mitral valve was implanted along with tricuspid annuloplasty. The recovery was uneventful and at 6 months of follow-up the patient was asymptomatic with no complications. [ABSTRACT FROM AUTHOR]

Background: Cardiac resynchronization therapy (CRT) is an established treatment for heart failure with reduced ejection fraction (HfrEF). Etiology may influence the outcome of patients undergoing CRT. Objective: to evaluate whether etiology (ischemic vs non-ischemic) influences the response to CRT and overall outcome. Methods: Our study included HFrEF patients undergoing CRT between January 2017-November 2019. We assessed right ventricle (RV) and left ventricle (LV) function using transthoracic echocardiography at baseline and one year after CRT. The response to CRT was defined by a decrease of more than 15% of left ventricle systolic volume. Patients were divided in two groups: ischemic and non-ischemic based on personal history. Adverse events (HF related hospitalizations and deaths) were tracked for 33± 12.8 months. Results: 52 patients undergoing CRT were included (64±13.5 years, 55.7% male, 70% non-ischemic etiology) The two groups were similar considering LV systolic baseline parameters and volumes. Ischemic etiology was associated with non-LBBB morphology on ECG (p=0.03), a more severe LV diastolic dysfunction using E/e ratio (p<0.05), and a more severe RV dysfunction using TAPSE (p=0.008) and RV fractional area change (FAC) (p<0.05). There was no significant difference in CRT response between ischemic and non-ischemic etiology. 14 (26.9%) patients had events (10 hospitalizations and 4 deaths) with a higher prevalence in the ischemic group (58.33% vs 25%, p=0.01). Univariate Cox regression analysis reported a higher risk of cardiovascular events for ischemic etiology (HR 2.4, 95% CI [0.8-8.1], p <0.05). In our cohort there was no significant difference in use of an implantable cardioverter-defibrillator in addition to CRT between ischemic and non-ischemic group (64.2% respectively 63.3%, p =0.3). Conclusion: Our study shows that ischemic and nonischemic HF patients had similar response to CRT. However, ischemic etiology was associated with a higher risk of adverse cardiovascular events and a worse RV systolic dysfunction at baseline. [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]

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 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: to evaluate the hemodynamic profile of adults with hypertension, reflected by blood pressure (BP) and arterial stiffness measurements and identify factors associated with increased arterial stiffness. Material and methods. 798 adults identified in SEPHAR II survey were assessed by questionnaire interview, anthropometric measurements, blood pressure (SBP/DBP/PP), heart rate (HR) and arterial stiffness: aortic pulse wave velocity (PWVao), aortic augment index (AIXao) and systolic blood pressure (SBPao) measurements, ECG and laboratory work-up. Results. Mean and mod values of hemodynamic parameters are: SBP-149.96±20.49 mmHg, 146 mmHg; DBP-89.18±11.54 mmHg, 9? mmHg; PP - 60.99±17.95mmHg, 55mmHg; HR - 73.75±10.89 hpm, 74 hpm; PWVao 10.19±2.22, 9.80 m/s; AIXao -16.59%±39.17%, 52%; TASao 150.30±23.62 mmHg, 162mmHg. Factors associated with increased arterial stiffness are: over 60 years of age: [PWVao: rs =0.233; AIXao: rs =0.354; TASao: rs =0.284; p <0.0001], increased severity of HT [PWVao: rs =0.194; AIXao: rs =0.1744; TASao: rs =0.439; p < 0.0001], lack of BP control [PWVao: rs =0.213; AIXao: rs = 0.255; TASao: rs = 0.108] and the presence of at least one form of subclinical target organ damage [PWVao: rs-0.587; AIXao: rs "0.219; TASao: rs "0.192;]. Conclusions. Hemodynamic profile most commonly noted among romanian hypertensive adults is: TAS - 146 mmHg,TAD-92 mmHg, PP-55 mmHg, FC-74bpm, PWVao-9.8m,'s,AIXao52%TAsao, 162mmHg. Hypertensive adults with increased arterial stiffness often have over 60 years of age, a high degree of severity of the HTA, often are deprived of an optimal therapeutic control and assign at least one form of subclinical target organ damage. [ABSTRACT FROM AUTHOR]

Background: We aimed to evaluate whether right ventricle (RV) longitudinal strain indexed to pulmonary arterial systolic pressure (PASP) has prognostic significance in patients undergoing cardiac resynchronization therapy (CRT). Methods: Patients undergoing CRT were prospectively included. The primary endpoint was adverse cardiovascular events (death and HF-related hospitalizations). RV global longitudinal strain (RVGLS) and RV free wall strain (RVfwS) were measured by speckle tracking and indexed to echocardiographic estimated PASP. Results: A total of 54 patients (64.0 ± 13.8 years; 58% male) were included. After 33 ± 12.9 months, the primary endpoint occurred in 18 patients. Baseline RVGLS/PASP and RVfwS/PASP showed good discriminative ability for response to CRT (AUC = 0.88, 95% CI (0.74–1) and AUC = 0.87, 95% CI (0.77–1)). RVGLS/PASP and RVfwS/PASP were significantly associated with high risk of events at univariate analysis (HR 0.039, 95% CI (0.001–0.8) p < 0.05, respectively HR = 0.049, 95% CI (0.0033–0.72), p < 0.05). Upon multivariate Cox regression analysis, RVGLS/PASP and RVfwS/PASP remained associated with high risk of events (HR 0.018, 95% CI (0.0005–0.64), p = 0.02 and HR 0.015, 95% CI (0.0004–0.524), p = 0.01) after correction for gender, etiology, QRS duration and morphology. Conclusions: Indexing RV longitudinal strain (global and free wall) by PASP provides a parameter, which independently identifies patients with high risk of cardiovascular events and predicts non-response to CRT. [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]