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Aims: An elevated left ventricular (LV) filling pressure is the main finding in patients with heart failure with preserved ejection fraction, which is estimated with an algorithm by the recent ASE/EACVI guideline. In this study, we sought to determine the efficacy of the LA global longitudinal strain to estimate the elevated LV filling pressure. Methods and Results: Consecutive patients who underwent left ventricular catheterization between January 2016 and December 2018 were included. Transthoracic echocardiography was performed within 24hrs before the catheterization. The LV filling pressure was estimated using echo parameters based on the 2016 ASE/EACVI algorithm. Moreover, to evaluate left atrial function, the LA GLS was measured using 2D speckle tracking echocardiography on four chamber-view (GE, Vivid E9 USA). Invasive LV pre-A pressure corresponding to mean left atrial pressure (LAP) was used as a reference, and >12 mm Hg was defined as elevated.71 patients (mean age of 63.2±9.75, 70.4% male) underwent left heart catheterization. Invasive LV filling pressure was defined as elevated in 41 (57.8%) and normal in 30 patients (42.2%). 9(12.7%) patients of 71 were defined as indeterminate based on the 2016 algorithm. Using the ROC method, the accuracy of the algorithm was found as AUC:0.75 with 77% specificity and 70% sensitivity. The accuracy of 25.5 % cut point of LASr was found as AUC:0.79 with 77% specificity and 80% sensitivity for estimating LAP.Conclusions: LASr with higher sensitivity may add an incremental value to estimate LV filling pressure, and hence may be used for HFpEF diagnosis.

PURPOSE An elevated left ventricular (LV) filling pressure is the main finding in heart failure patients with preserved ejection fraction, which is estimated with an algorithm using echocardiographic parameters recommended by the recent American Society of Echocardiography (ASE)/European Association of Cardiovascular Imaging (EACVI) guidelines. In this study, we sought to determine the efficacy of the LV global longitudinal strain (GLS) in predicting an elevated LV filling pressure. METHODS AND RESULTS A total of 73 prospectively selected patients undergoing LV catheterization (mean age 63.19 ± 9.64, 69% male) participated in this study. Using the algorithm, the LV filling pressure was estimated using the echocardiographic parameters obtained within 24 hours before catheterization. The LV GLS was measured using an automated functional imaging system (GE, Vivid E9 USA). Invasive LV pre-A pressure corresponding to the mean left atrial pressure (LAP) was used as a reference, and a LAP of >12 mm Hg was defined as elevated. Invasive LV filling pressure was elevated in 43 patients (59%) and normal in 30 patients (41%). Nine of 73 (12%) patients were defined as indeterminate based on the 2016 algorithm. Using the ROC method, -18.1% of LV GLS determined the elevated LAP (AUC =0.79; specificity, 73%; sensitivity, 84%) with better sensitivity compared to that by the algorithm (AUC =0.76; specificity, 77%; sensitivity, 72%). CONCLUSIONS We demonstrated that LV GLS was an independent predictor of elevated LAP as the E/e' ratio and TR jet velocity and may be used as a major criterion for the diagnosis of HFpEF.

Purpose: An elevated left ventricular (LV) filling pressure is the main finding in patients with heart failure with preserved ejection fraction, which is estimated with an algorithm using echocardiographic parameters recommended by the recent American Society of Echocardiography (ASE)/European Association of Cardiovascular Imaging (EACVI) guideline. In this study, we sought to determine the efficacy of LV global longitudinal strain (GLS) to estimate the elevated LV filling pressure. Methods and Results: 73 prospectively selected patients undergoing left ventricular catheterization (mean age 63.19±9.64, 68.5% male) participated in this study. Using the algorithm, the LV filling pressure was estimated with the echo parameters obtained within 24hrs before the catheterization. The LV GLS was measured using the automated functional imaging system (GE, Vivid E9 USA). Invasive LV pre-A pressure corresponding to mean left atrial pressure (LAP) was used as a reference, and >12 mm Hg was defined as elevated. The invasive LV filling pressure was elevated in 43 (58.9%) and normal in 30 patients (41.1%). In 9 (12.3%) patients of 73 are defined as indeterminate based on the 2016 algorithm. Using the ROC method, -18.1% of LV GLS estimated the LV filling pressure (AUC=0.79, 73% specificity, 84% sensitivity) with higher sensitivity compared with the algorithm (AUC=0.76, 77% specificity, 72% sensitivity). Conclusions: We confirmed that the LV GLS is feasible and reproducible in estimating LV filling pressure. In addition, LV GLS highly predicts elevated LAP as E/e’ and TR jet velocity and may be used as major criteria for the diagnosis of HFpEF

An 82-year-old female patient was admitted for catheter ablation of drug-refractory atrial tachycardia (AT). Initially, during right atrial mapping, only a small portion (100 ms) of the tachycardia cycle length (TCL) (200 ms) could be mapped. Mapping of the left atrium (LA) revealed the critical

OBJECTIVE Heart failure (HF) has a high prevalence and mortality rate in elderly patients; however, there are few studies that have focused on patients older than 80 years. The aim of this study is to describe and compare the age-specific demographics and clinical features of Turkish elderly patients with HF who were admitted to cardiology clinics. METHODS The Epidemiology of Cardiovascular Disease in Elderly Turkish population (ELDER-TURK) study was conducted in 73 centers in Turkey, and it recruited a total of 5694 patients aged 65 years or older. In this study, the clinical profile of the patients who were aged 80 years or older and those between 65 and 79 years with HF were described and compared based on the ejection fraction (EF)-related classification: HFrEF and HFpEF (is considered as EF: ≥50%). RESULTS A total of 1098 patients (male, 47.5%; mean age, 83.5+-3.1 years) aged ≥80 years and 4596 patients (male, 50.2 %; mean age, 71.1+-4.31 years) aged 65-79 years were enrolled in this study. The prevalence of HF was 39.8% for patients who were ≥80 years and 27.1% for patients 65-79 years old. For patients aged ≥80 years with HF, the prevalence rate was 67% for hypertension (HT), 25.6% for diabetes mellitus (DM), 54.3% for coronary artery disease (CAD), and 42.3% for atrial fibrilation. Female proportion was lower in the HFrEF group (p=0.019). The prevalence of HT and DM was higher in the HFpEF group (p

Diabetic ketoacidosis (DKA) and myocardial infarction (MI), which are the leading coexisting causes of death in ketoacidosis, are both major medical emergencies. Troponin is the most valuable indicator of myocardial necrosis, but it is known that it may also elevate in a series of non-cardiac situations. DKA may imitate electrocardiogram (ECG) findings of MI (pseudoinfarction pattern). DK is a serious complication requiring emergent medical therapy. DKA may be the initial manifestation of type 1 diabetes mellitus (DM) or may result from increased insulin requirements in patients with type 1 DM during the course of infection, myocardial infarction, surgery or trauma. Mortality rate for DKA varies between 2% and 0% with age (1,2). MI is a well recognized precipitating cause and the leading coexisting cause of death in this entity. However, DKA may imitate some electrocardiographic findings similar to MI (pseudoinfarction pattern) (3). We aimed to present the case of a patient with DKA whose initial electrocardiography (ECG) showed ST segment depression in the lateral and inferior derivations and who had significant positive troponin values with no obstructive lesion in the coronary arteries.