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Heart failure is still an important public health problem despite important advances regarding its treatment. Several new treatment strategies are being investigated in order to contend with this disease. Strategies proved to be safe and effective in clinical trials are being adapted to clinical practice. In this review, we will first focus on most recent treatment strategies that are recommended to be used in clinical practice and then try to mention novel strategies which are still being explored in preclinical studies.

Right heart catheterization (RHC) is required for confirmation of the diagnosis of pulmonary hypertension (PH) and to asses the prognosis and etiology. Pulmonary vasoreactivity testing (PVT) is one of the most crucial parts of RHC especially in the suitable patient subsets of pulmonary arterial hypertension (PAH) defined by the most recent guidelines. PVT has substantial importance in defining the most appropriate treatment modality. The aim of this review is to provide a comprehensive review of the literature about PVT and the agents used in PVT, to emphasize the importance of this procedure when done with correct indications with a correct technique and to contribute in the accurate management of PH patients.

Objective: Obesity is a nutritional disorder, which is associated with impaired left and right ventricular function. Impaired heart rate recovery (HRR) following a treadmill exercise test is an indicator of cardiovascular mortality. We investigated the utility of impaired HRR on the tissue Doppler imaging (TDI) echocardiographic estimates of left and right ventricular function in an obese/overweight cohort., Methods: Eighty consecutive patients with body mass index >27 kg/m(2) were evaluated for their post exercise HRR in this cross-sectional study. The results were compared with the tissue Doppler and conventional echocardiographic findings of the same cohort. Tricuspid annular TDI peak systolic velocities (RVs) were evaluated with receiver operating characteristic (ROC) analysis to predict the insufficient heart rate recovery (18/min or less). Logistic regression analysis was used to identify the independent predictors of significant right ventricular systolic dysfunction (RVs <10 cm/sec) among the clinical and echocardiographic parameters., Results: There was a positive correlation between HRR and tricuspid annulus peak systolic velocity, exercise distance, and METs. The patients with impaired HRR at post-exercise first minute had lower exercise distance (p<0.0001), METs (p=0.001), RVs (p=0.037), and basal septal peak systolic velocity (p=0.041) than the patients with normal HRR. A tricuspid annulus TDI peak systolic velocity of 10 cm/sec predicted post-exercise preserved HRR with 70% sensitivity and 55% specificity with ROC analysis (AUC=0.638, 95% CI- 0.509-0.767, p=0.037). The subjects with tricuspid annulus peak systolic velocity (RVs) <10cm/sec were found to have larger body mass indices, impaired post-exercise first minute HRR, shorter total exercise distance, and lower total METs than the subjects with tricuspid annulus peak systolic velocity >10cm/sec. Impaired HRR and septum TDI late diastolic velocity were found as the independent predictors of right ventricular systolic function (RVs<10cm/sec) by logistic regression analysis., Conclusion: Post-exercise first minute impaired HRR is associated with right ventricular systolic dysfunction in obese patients. Both HRR and right ventricular systolic function correlate well with the exercise distance and METs. Obese patients with impaired HRR should be evaluated with echocardiography to assess their right ventricular systolic function.

Objective: Mitral regurgitation (MR) increases mortality in dilated cardiomyopathy (DCM). We investigated the prevalence of functional MR in non-ischemic DCM patients with narrow QRS intervals and its association with papillary muscle dyssynchrony., Methods: Ninety-three patients were enrolled consecutively in this cross-sectional study. Patients were evaluated for the presence of intraventricular (DYS Sep-Lat Sys) and papillary muscle (DYS Inter PAP Sys) systolic dyssynchrony using tissue Doppler echocardiographic imaging (TDI). Two-dimensional and Doppler echocardiography were used for quantification of MR. Statistical analyses were performed using unpaired t test, Mann-Whitney U test, correlation and logistic regression analyses., Results: Thirty-seven patients (39%) had significant DYS Sep-Lat Sys and 25 patients (26%) had DYS Inter PAP Sys. Patients with DYS Inter PAP Sys had lower basal septum systolic (p=0.007) and late diastolic velocities (p=0.049), greater MR volume (p=0.01), effective regurgitant orifice (ERO) (p=0.01), and E/A ratios (p=0.03) than the patients without DYS Inter PAP Sys. Fifty-five patients with narrow QRS intervals were also evaluated for DYS Inter PAP Sys. Patients with DYS Inter PAP Sys and narrow QRS had lower basal septum TDI peak systolic velocities (p=0.038), higher MR volume (p=0.03) and ERO (p=0.03). Logistic regression analysis revealed that NYHA Class III-IV (OR=6.4, 95% CI: 1.1-37.1, p=0.038) and DYS Inter PAP Sys (OR=9.5, 95% CI: 1.17-75.78, p=0.034) were the independent predictors of functional MR >20 ml., Conclusion: Papillary muscle systolic dyssynchrony is common and correlated with functional MR in non-ischemic DCM patients with sinus rhythm and narrow QRS. Papillary muscle systolic dyssynchrony may help predict patients who will benefit from cardiac resynchronization therapy.

With the rapid evolution of cardiovascular magnetic resonance imaging (MRI) techniques, cardiovascular MRI has become an important noninvasive diagnostic tool in cardiovascular disease. Cardiac MRI can provide high quality diagnostic information about cardiac and valvular function, coronary anatomy, coronary flow reserve and myocardial perfusion, myocardial viability, contractile reserve and cardiac metabolism. Besides, MRI can also provide prognostic information for certain cardiac diseases. Assessment of the viable myocardium is one of the major issues of the invasive cardiology. Viable myocardium has the potential for contractile recovery after reperfusion. The identification of viable myocardium is useful in predicting which patients will benefit from revascularization and have improved left ventricular ejection fraction and survival. The focus of the present article is on the clinical role of cardiac MRI in the detection of viable myocardium.

Objective: Few data exist regarding the prognostic value of QT dispersion in hypertrophic cardiomyopathy (HCM). In this study, we prospectively investigated the association between baseline QT dispersion and clinical course of HCM., Methods: Overall, 101 patients with asymmetric septal hypertrophy (59 men, mean age 45+/-16 years, range 13-74 years) were included in the study and were followed up for 595+/-367 days for clinical endpoints defined as cardiac death and hospitalization due to worsening in heart failure symptoms. QRS duration, QT interval, and JT interval were manually measured on 12-lead electrocardiogram (ECG). QT dispersion and corrected QT dispersion were calculated accordingly. The ECG findings of the patients with and without clinical endpoints were compared., Results: Twenty-nine patients experienced clinical endpoints (3 sudden deaths, 26 hospitalizations due to worsening heart failure). The measurements of QT, JT and QRS intervals were all comparable between the two groups (p>0.05 for all). QT dispersion and corrected QT dispersion were significantly different between patients with and without clinical endpoints (64+/-30 ms vs. 83+/-18 ms and 71+/-33 ms vs. 90+/-18 ms, respectively, p=0.001 for both). Corrected QT dispersion >80 ms detected patients with clinical endpoints with sensitivity and specificity of 79% and 75%, respectively. Patients with corrected QT dispersion <80 ms were significantly free of clinical endpoints., Conclusion: In conclusion, for patients with hypertrophic cardiomyopathy, measurement of baseline corrected QT dispersion from surface ECG may be used to identify those at risk for clinical deterioration at long-term follow-up.

Objective: Socioeconomic status (SES) is associated with coronary artery disease (CAD) risk factors, coronary morbidity and mortality. In industrialized countries several studies showed that the lowest SES groups have higher coronary morbidity and mortality rates and higher coronary risk factors profile. The aim of our study was to investigate the distribution of risk factors in cases with CAD in different socioeconomic groups., Methods: Our study group consists of 550 consecutive cases with > or = 50% lesions in at least one coronary artery. Educational level and income were taken into consideration for the determination of the SES. In both sexes the distribution of eight risk factors such as, smoking, family history, diabetes mellitus, hypertension, high low-density lipoprotein cholesterol (LDL-C), low high-density lipoprotein cholesterol (HDL-C), body mass index, central obesity was compared in three different groups determined according to the education and income levels., Results: In men, the distribution of risk factors did not differ according to education levels. In women, central obesity was found to be higher in the group with low education level. In men, the prevalence of low HDL-C, high LDL-C and obesity increased with increasing levels of economical status. In women, central obesity was found to be inversely related with the economic status., Conclusion: Our data show a higher risk factor profile in men with higher income level, while in women central obesity was inversely related to the income and educational level. These data should be considered in secondary prevention efforts.