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Background: Left atrial (LA) size reflects diastolic burden and is a prognostic parameter of common cardiovascular death. However, the association between LA size and function and pulmonary hypertension (PH) in coronary artery disease (CAD) has not been well investigated. We hypothesized that LA size and function are associated with PH in CAD. Methods: One hundred seven patients with CAD were studied. LA size was determined in three different methods; namely, LA volume index (LAV), LA area index, and LA dimension. LAV total emptying fraction was also determined. Pulsed Doppler E, A, E/A, DT, tissue Doppler E′, A′, and E/E′ were measured. Pulmonary artery systolic pressure (PASP) was estimated. Results: All LA size parameters are significantly associated with PH. LAV emptying fraction, age, E, E/A, E/E′, and A′ were also associated with PH significantly. CAD patients with PH showed larger LA size, higher E, E/A, and E/E′ and lower LAV emptying fraction, A and A′ than CAD patients without PH. Multivariate regression analysis revealed that maximum LAV, E, E/A ratio, and age were independent predictors of PH. Maximum LAV > 35.6 mL/m2 predicted PASP > 40 mmHg with a sensitivity of 83.9% and specificity of 62.2%. Conclusion: LAV is associated with PH in CAD patients. (Echocardiography 2012;29:535-540)

Background: Carcinoid heart disease (CHD) is a rare cause of valvular heart disease and carries a poor prognosis. CHD has a unique morphology and echocardiographic features that predominantly involve right-sided valvular structures. The diagnosis of CHD is usually made by two-dimensional transthoracic echocardiography (TTE). With the superior spatial resolution of real time three-dimensional transesophageal echocardiography (3DTEE), structural changes that occur in patients with CHD-associated valvular heart disease can be examined in greater detail. We undertook this study to examine the incremental value of 3DTEE in the diagnosis of CHD. Methods: A total of four patients with CHD underwent TTE, transesophageal echocardiography (TEE), and 3DTEE as part of their routine clinical evaluation. Results: TTE and TEE for all four patients revealed thickened, fibrosed, retracted, and malcoapted tricuspid leaflets with wide-open tricuspid valve regurgitation. 3DTEE en face imaging of the tricuspid valve demonstrated the characteristic morphologic features of CHD more clearly in all four patients. Conclusions: 3DTEE provides substantial incremental value over TTE in the assessment of characteristic CHD pathology and thus enhances the echocardiographic diagnosis of CHD. (Echocardiography 2010;27:1098-1105)