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Pulmonary hypertension (PH) is a common and debilitating medical condition with high mortality. PH research has traditionally focused on pulmonary arterial hypertension and its management in expert PH centres. Other forms of PH such as PH associated with cardiac or respiratory disease are more common, less well‐understood and associated with higher mortality. Epidemiology of PH in disadvantaged, remote and rural regions, remains largely undocumented. In this review, we discuss the unique challenges in identifying PH in rural and disadvantaged populations using the Top End region of the Northern Territory of Australia as an example. We propose a simple diagnostic approach, ideally suited to regions where resource allocation is scarce, using clinical skills, echocardiography, and an escalation algorithm. The brief history, epidemiology and current literature on PH are summarised to inform the busy clinicians. We highlight two case examples from the Top End to illustrate the challenges and potential solutions. [ABSTRACT FROM AUTHOR]

The article reports that cardiac amyloidosis is a rare condition that has several different causes. Topics include considered that the management involves pharmaceutical treatment of heart failure, which is fundamentally related to diastolic dysfunction, and treatment of the underlying disease process.

Purpose: Left ventricular mechanical dispersion (LVMD) is a novel speckle tracking parameter for prognostic assessment of arrhythmic risk prediction. There is growing evidence to support its use in a variety of cardiomyopathic processes. There is paucity of data addressing any presence of inter‐vendor discrepancies for LVMD. The aim of this study was to assess inter‐vendor variability of LVMD in vendor specific software (VSS) and vendor independent software (VIS) in subjects with preserved and reduced left ventricular function. Methods: Fifty‐nine subjects (14 normal subjects and 45 subjects with cardiac disease) were recruited and 2D speckle tracking echocardiographic images were acquired on two different ultrasound machines (GE and Philips). LVMD was measured by two different VSS (EchoPac GE and QLAB Philips) and one VIS (TomTec Arena). Results: There was significant bias and wide limits of agreement (LOA) in the overall cohort observed between two different VSS (17.6 ms; LOA: ‐29.6 to 64.8; r:.47). There was acceptable bias and narrower LOA with good agreement for LVMD between images obtained on different vendors when performed on VIS (‐3.1 ms; LOA: ‐27.6 to 21.4; r:.75). QLAB LVMD was consistently higher than GE LVMD and TomTec LVMD in both preserved and reduced left ventricular function. LVMD measurements have high intra‐vendor reproducibility with excellent inter and intra‐observer agreement. Conclusions: There was acceptable bias and narrower LOA for LVMD assessment on a VIS. Inter‐vendor variability exists for LVMD assessment between VSS. Serial measurements of LVMD should be performed using a single vendor for consistent and reliable results. [ABSTRACT FROM AUTHOR]

Objective: This study sought to determine the contractile reserve (CR) response to exercise stress echocardiography (ESE) quantified by the novel parameter, non‐invasive myocardial work (MW), in subjects with angiographically proven coronary artery disease (CAD). Methods: CR was measured by the relative change in ejection fraction (EF), global longitudinal strain (GLS) and MW indices from rest to peak exercise in 304 patients referred for clinically indicated ESE. Positive ESE patients proceeded to coronary angiography and further risk stratified based on either percutaneous or surgical intervention. Results: CRGLS and global work index (CRGWI) significantly decreased with exercise induced ischemia and angiographically proven significant CAD (CRGLS −1.6±3.5%; CRGWI −8.6±511 mm Hg% decrement, p < 0.001) compared to non‐ischemic patients (CRGLS 1.4±2.2%; CRGWI 398±404 mm Hg% improvement). Global constructive work (CRGCW) was significantly higher (p < 0.0001) in non‐ischemic (818±457 mm Hg%) and blunted in ischemic patients (208±550 mm Hg%). CRGCW (AUC.81; 95%CI:.75–.86) demonstrated the most association for inducible ischemia followed by CRGLS (AUC.75; 95%CI:.69–.80), CRGWI (AUC.73, 95%CI:.67–.79) and CREF (AUC.71; 95%CI:.65–.77, p < 0.001). Subgroup analysis showed patients requiring surgical revascularization demonstrated a significantly lower CRGWE (−11.5±7.6%, p < 0.05) as a result of reduced CRGCW (281±573 mm Hg%, p < 0.05) and increased global wasted work (CRGWW, 289±151 mm Hg%, p = 0.09). Conclusion: Multivessel disease requiring surgical revascularization have the greatest reduction in CR. MW may potentially improve detection of ischemia and further risk stratification during ESE to maximize the benefits of revascularization. [ABSTRACT FROM AUTHOR]

Background: Left atrial analysis is employed in diastolic assessment with left atrial volume index (LAVI) incorporated in the 2016 ASE/EACVI diastology guideline algorithm. LAVI has sub‐optimal correlation with invasive left ventricular filling pressure (LVFP) and incorporation of left atrial reservoir strain (LASr) may improve diastolic assessment. Methods: A cross‐sectional prospective study of 139 patients was undertaken with all patients undergoing transthoracic echocardiography immediately prior to cardiac catheterization with invasive evaluation of LVFP. LASr by speckle tracking echocardiography and conventional echocardiographic parameters were assessed in relation to invasive LVFP. Modification of the 2016 guideline algorithm was performed with incorporation of LASr in place of LAVI (LASr ≤23% indicating elevated LVFP). Accuracy of the modified and conventional algorithm were assessed for predicting invasive LVFP. Results: The mean age was 63±12 years with 27% female. LASr demonstrated superior correlation and receiver operator characteristic for predicting LVFP than LAVI (LASr: r ‐.46 (p < 0.01), AUC:.82 vs LAVI: r.19 (p 0.02), AUC:.66). LASr of ≤23% was the optimal cut‐off for discriminating elevated LVFP (sensitivity 80%, specificity 77%). Modification of the 2016 algorithm with incorporation of LASr in place of LAVI reclassified 12% of the patient cohort and improved concordance of echocardiographic and invasive LVFP assessment (modified algorithm κ.47 vs 2016 algorithm κ:.33). No patients were incorrectly reclassified by modified algorithm assessment. Conclusions: LASr better predicts invasive LVFP than LAVI. Modification of the 2016 guideline algorithm with incorporation of LASr in place of LAVI improves accuracy of echocardiographic assessment of LVFP. [ABSTRACT FROM AUTHOR]

Aims  To examine the characteristics/prognostic impact of diastolic dysfunction (DD) according to 2016 American Society of Echocardiography (ASE) and European Society of Cardiovascular Imaging (ESCVI) guidelines, and individual parameters of DD. Methods and results  Data were derived from a large multicentre mortality-linked echocardiographic registry comprising 436 360 adults with ≥ 1 diastolic function measurement linked to 100 597 deaths during 2.2 million person-years follow-up. ASE/European Association of Cardiovascular Imaging (EACVI) algorithms could be applied in 392 009 (89.8%) cases; comprising 11.4% of cases with 'reduced' left ventricular ejection fraction (LVEF < 50%) and 88.6% with 'preserved' LVEF (≥50%). Diastolic function was indeterminate in 21.5% and 62.2% of 'preserved' and 'reduced' LVEF cases, respectively. Among preserved LVEF cases, the risk of adjusted 5-year cardiovascular-related mortality was elevated in both DD [odds ratio (OR) 1.31, 95% confidence interval (CI) 1.22–1.42; P  < 0.001] and indeterminate status cases (OR 1.11, 95% CI 1.04–1.18; P  < 0.001) vs. no DD. Among impaired LVEF cases, the equivalent risk of cardiovascular-related mortality was 1.51 (95% CI 1.15–1.98, P  < 0.001) for increased filling pressure vs. 1.25 (95% CI 0.96–1.64, P  = 0.06) for indeterminate status. Mitral E velocity, septal e ' velocity, E : e ' ratio, and LAVi all correlated with mortality. On adjusted basis, pivot-points of increased risk for cardiovascular-related mortality occurred at 90 cm/s for E wave velocity, 9 cm/s for septal e ' velocity, an E :e' ratio of 9, and an LAVi of 32 mL/m2. Conclusion  ASE/EACVI-classified DD is correlated with increased mortality. However, many cases remain 'indeterminate'. Importantly, when analysed individually, mitral E velocity, septal e ' velocity, E : e ' ratio, and LAVi revealed clear pivot-points of increased risk of cardiovascular-related mortality. [ABSTRACT FROM AUTHOR]