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Strain echocardiography is able to detect subclinical ventricular systolic and diastolic dysfunction. Prolonged survival to cystic fibrosis favors heart and vessel involvement. The purpose of the present study was to compare clinically stable adult patients affected by cystic fibrosis without overt pulmonary hypertension with controls to evaluate right ventricular (RV) systolic and diastolic function by means of strain and tissue Doppler imaging (TDI), respectively. 22 adults affected by cystic fibrosis and 24 healthy volunteers matched for age and sex were enrolled. None had known cardiovascular risk factors or overt pulmonary hypertension. All people underwent blood pressure measurement and transthoracic echocardiography. Cystic fibrosis patients showed higher sPAP [median 25 (IQR 21-30) vs 22 (22-22) mmHg; p = 0.02] and more frequent RV diastolic dysfunction (p < 0.001). Among cases, some RV systolic parameters were significantly altered than controls, such as TAPSE [20 (18-24) vs. 23 (21-28) mm; p = 0.001], FAC [34 (26-44) vs. 49 (48-50)%; p < 0.001], midwall tissue strain [- 25.0 (- 31.3 to - 22.8) vs. - 30.5 (- 31.8 to - 29.3)%; p = 0.03], apical tissue strain [- 22 (- 29.3 to - 19.0) vs. - 30.5 (- 32.8 to - 28.3)%; p = 0.001] and 2D strain [- 22.0 (- 25.1 to - 19.0) vs. - 29.5 (- 31.8 to - 27.3)%; p < 0.001]. Finally, 2D strain correlated with spirometric FEV1 (ρ = - 0.463, p = 0.03) and nearly with FEF25-75% (ρ = - 0.393, p = 0.07). Our study confirmed a RV subclinical systo-diastolic dysfunction in clinically stable patients affected by cystic fibrosis without overt pulmonary hypertension nor cardiovascular risk factors. This may be due to systemic inflammation and temporary recurrent pulmonary hypertension. We retain that RV 2D strain and TDI echocardiography could become an important tool in the follow-up of these patients.

Objectives: Myocardial fibrosis is associated with adverse clinical outcome in adults. Our aim was to investigate using echocardiographic calibrated integrated backscatter (cIBS) the presence of myocardial and/or aortic fibrosis in asymptomatic women with a history of early-onset (EO) or late-onset (LO) pre-eclampsia (PE)., Methods: Thirty non-pregnant women whose most recent pregnancy was complicated by EO-PE, 30 with previous LO-PE pregnancy and 30 controls who had experienced only uncomplicated pregnancy previously were selected retrospectively from our electronic database and recalled between 6 months and 4 years after delivery. Data regarding gestational age (GA) and mean uterine artery (UtA) pulsatility index (PI) at diagnosis of PE were collected from their medical records. The women underwent cardiovascular assessment, during which the presence of fibrosis was investigated, by means of cIBS, at the basal interventricular septum (cIBS IVS ), the basal posterior wall (cIBS PW ) and the anterior wall of the ascending aorta, 3 cm above the valve (cIBS AO ). These findings were compared between the three patient groups., Results: Using cIBS imaging, we found significant left ventricular (LV) fibrosis in women with a history of EO-PE compared with those with previous LO-PE pregnancy and controls (intergroup ANOVA P < 0.001 for cIBS IVS and P = 0.005 for cIBS PW ), whereas aortic fibrosis did not differ significantly among cases and controls. Stepwise multivariate regression analysis showed that LV fibrosis was associated independently with lower GA and higher mean UtA-PI at diagnosis of PE, while cIBS AO correlated with aortic diameters, stiffness and ventricular-arterial coupling., Conclusions: Women with a history of EO-PE show LV fibrosis in the short-medium term after delivery compared with women with previous LO-PE pregnancy and controls. LV fibrosis is associated with GA and mean UtA-PI at onset of PE. Larger studies using cardiac magnetic resonance imaging are needed to validate and confirm our findings. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd., (Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.)

Objectives: To investigate cardiovascular (CV) performance status several years after early-onset (EO) or late-onset (LO) pre-eclampsia (PE), using echocardiography to assess myocardial strain and left ventricular (LV) torsional mechanics and ventricular-arterial coupling (VAC)., Methods: Thirty non-pregnant women with a previous singleton pregnancy complicated by EO-PE, 30 who had experienced LO-PE and 30 controls underwent echocardiography with two-dimensional (2D) speckle tracking between 6 months and 4 years after delivery and their findings were compared. All women were free from CV risk factors. VAC was defined as the ratio between aortic elastance (Ea) and LV end-systolic elastance (Ees)., Results: Women in the EO-PE group showed a persistent subclinical impairment in LV systole and a slight alteration in right ventricular function, with reductions in LV 2D strain (circumferential, radial and longitudinal) and right ventricular 2D strain and impairment of LV torsional mechanics, when compared both with women in the LO-PE group and with healthy controls. Although VAC was within the normal range in the whole study cohort, its individual components Ea and Ees were significantly altered more often in the EO-PE group than in both the LO-PE group and controls. All parameters investigated (except right ventricular 2D strain) were associated independently with gestational age at the time of diagnosis of PE., Conclusions: Women with a history of EO-PE are more likely to have subclinical impairment of systolic biventricular function than are those with a history of LO-PE and controls. The components of VAC (Ea and Ees) show subclinical alterations which are more significant in women with a history of EO-PE than in those with a history of LO-PE and controls, although VAC itself is maintained. Our study supports the use of closer CV monitoring in previously pre-eclamptic women, particularly those in whom PE was preterm. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd., (Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.)

Cardiac resynchronization therapy (CRT) is an important tool for the treatment of patients with chronic heart failure, as it can correct the heterogeneity of regional left ventricular mechanical contraction, known as dyssynchrony. Although this therapy is strongly indicated in patients with both heart failure with left ventricular systolic dysfunction and wide Q-, R- and S-waves (QRS) on electrocardiogram, about one-third of these patients are non-responders. Since the degree of mechanical dyssynchrony can vary greatly, it is interesting to quantify dyssynchrony by means of imaging methods, such as echocardiography, which might be able to lead to a better selection of CRT candidates. This article will review the role of old and new echocardiographic techniques to predict CRT response.

Background: Aortic dilation is an independent predictor of cardiovascular disease. The association between hypertension and aortic dilation is still controversial. Also, most previous research has investigated this relationship regarding only the aortic root, and no information is available for the ascending aorta (AscAo)., Methods: To assess AscAo dimensions in hypertensive patients, 1,027 patients with hypertension and 1,002 healthy volunteers were prospectively enrolled. Aortic diameters at four levels were measured using the leading edge-to-leading edge convention at end-diastole: the sinuses of Valsalva, sinotubular junction (STJ), AscAo, and aortic arch (AoArch), using two-dimensional echocardiography., Results: All four diameters were significantly larger in hypertensive patients than in control subjects, with positive correlations with age, body size, and male sex. On multivariate analysis, gender and body surface area were independently associated with aortic diameters. The general linear model showed that after adjusting for age, sex, and body surface area, hypertension was positively associated (P < .01) with higher aortic diameter at every level. Hypertension was associated with increases of 1.7 mm (95% CI, 1.2-2.1 mm) at the sinuses of Valsalva, 4.1 mm (95% CI, 3.6-4.6 mm) at the STJ, 1.6 mm (95% CI, 1.1-2.1 mm) at the AscAo, and 2.2 mm (95% CI, 1.7-2.6 mm) at the AoArch. On the basis of nomograms, an abnormally high prevalence of aortic dilation in hypertensive patients was observed for the STJ (14%) and the AoArch (7%)., Conclusions: Systematic analysis of the AscAo in hypertensive patients showed that, together with age, sex, and body surface area, hypertension is an independent factor associated with increases in all four aortic diameters and that aortic dilation occurred more frequently at the level of the STJ and AoArch., (Copyright © 2016 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.)

Tako-Tsubo cardiomyopathy is a transient left ventricular apical ballooning syndrome also known as stress-induced cardiomyopathy. This reversible cardiomyopathy without epicardial coronary artery disease mimics acute myocardial infarction. Right ventricular involvement, which has been infrequently reported, is present in about a quarter of cases of Tako-Tsubo cardiomyopathy and is associated with a more severe clinical outcome. We report the case of a 55-year-old postmenopausal woman with transient biventricular apical ballooning. She recently had acute exacerbation of multiple sclerosis. Regional and global function of both ventricles was estimated using two-dimensional speckle tracking strain echocardiography., (Copyright © 2013 Wiley Periodicals, Inc.)

Objective: Previous studies revealed that hypertrophic cardiomyopathy (HCM) patients have impaired aortic elastic properties with contrasting data about aortic dimensions. We aimed to extend our knowledge about this topic, considering tissue Doppler imaging (TDI) and tissue strain., Patients and Methods: 25 HCM patients and 25 healthy volunteers matched for age and sex were enrolled. They underwent transthoracic echocardiography to measure aortic dimensions at four levels (Valsalva sinuses, sinotubular junction, tubular tract, aortic arch), elastic properties (i.e., distensibility, stiffness, M-mode strain, tissue strain), and TDI aortic wall velocities (S', E', A' waves)., Results: Aortic dimensions differed between the two groups only at sinotubular junction (18 ± 6 vs. 15 ± 3 mm/m2; p = 0.039) and aortic arch levels (19 ± 5 vs. 11 ± 8 mm/m2; p < 0.001). Aortic stiffness was significantly higher among patients (16.4 ± 23.2 vs. 5.9 ± 3.4; p = 0.034), and TDI waves greater (S': 5.2 ± 1.9 vs. 8.0 ± 2.7 cm/s, p < 0.001; E': -5.3 ± 2.4 vs. -7.2 ± 2.7 cm/s, p = 0.012; A': -5.3 ± 1.6 vs. -8.6 ± 4.5 cm/s, p = 0.002). M-mode and tissue strains, and aortic distensibility did not reach statistical significance, although showing a tendency to altered values in the HCM group., Conclusions: Patients affected by HCM show a larger aorta and altered aortic elastic properties compared with healthy volunteers. These findings could help to investigate treatment response and prognosis of these alterations.

Heart failure (HF) is a clinical syndrome characterized by signs (e.g., pulmonary crackles, peripheral edema, jugular turgor) and symptoms (e.g., breathlessness, fatigue, ankle swelling) caused by structural and/or functional cardiac abnormalities and leading to elevated intracardiac pressure and/or low cardiac output (CO) at rest or during stress. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate maternal hemodynamics in asymptomatic women with a pregnancy complicated by hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome, and compare it with patients with a previous preeclampsia (PE) and controls with uncomplicated pregnancies.Methods: Women with a history of PE (n = 60) or HELLP syndrome (n = 49) and matched healthy controls (n = 60) underwent an echocardiographic examination 6 months-4 years after delivery, recording left ventricular (LV) dimensions, ejection fraction (LVEF) and mass, right ventricular (RV) tricuspid annular plane systolic movement (TAPSE) and fractional area changing (FAC). Diastolic filling (E/A and E/E' ratios) and tissue Doppler imaging were evaluated for both ventricles and the myocardial performance index (MPI) was calculated.Results: Only women with previous HELLP syndrome showed a significant LV concentric hypertrophy (20.4%). On the contrary, LV concentric remodeling (46.9 % and 46.7%, respectively), diastolic dysfunction (expressed as altered E/A and E/E' ratios) and reduced LVEF (14.3% and 21.7%, respectively) were documented in both cases groups. RV variables did not significantly differ between cases and controls, except for FAC and E/E' which were slightly impaired in women with previous HELLP (16.3% vs 10.0%, p = 0.04; 14.3 vs 3.3%, p = 0.03; respectively).Conclusions: The significant overlap among echocardiographic features in women with previous PE or HELLP syndrome suggests that these two conditions share in common the same pathophysiology. However, HELLP syndrome may lead to more severe cardiovascular remodelling at short-medium term after delivery. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the elastic properties of the ascending aorta in women with a previous pregnancy complicated by early-onset (EO) or late-onset (LO) pre-eclampsia (PE) and the correlation with gestational age (GA), systolic/diastolic blood pressure (SBP/DBP) and mean uterine artery pulsatility index (UtA-PI) at diagnosis of the disease as well as with birth weight of the neonate. Methods: Thirty women who had a previous pregnancy complicated by EO-PE, 30 with a previous pregnancy complicated by LO-PE and 30 normal controls were selected retrospectively from our electronic database and then recalled for assessment from 6 months to 4 years after delivery. Data regarding GA, SBP/DBP and mean UtA-PI at the diagnosis of PE were obtained from medical records. At our assessment, aortic M-mode and tissue Doppler imaging (TDI) parameters were measured. Aortic diameters were assessed at end-diastole at four levels: Valsalva sinuses, sinotubular junction, tubular tract and aortic arch. Aortic compliance, distensibility, stiffness index (SI), Peterson's elastic modulus (EM), pulse-wave velocity and M-mode strain were calculated using standard formulae. Aortic expansion velocity, early and late diastolic retraction velocities and peak systolic tissue strain (TDI-ϵ) were determined. Results: Aortic diameters at the four levels were significantly greater in both EO-PE and LO-PE groups than in controls. Aortic compliance and distensibility and TDI-ϵ were lower in EO-PE than in LO-PE (P  = 0.001, P  = 0.002 and P  = 0.011, respectively) and controls (P  = 0.037, P  = 0.044 and P  = 0.013, respectively). SI and EM were higher in EO-PE than in LO-PE (P  = 0.001 and P  < 0.001, respectively) and than in controls (P = 0.035 and P  = 0.036, respectively). Multivariate analysis showed GA, DBP and UtA-PI at diagnosis of PE to be independent predictors of aortic elastic properties. Conclusions: Elastic properties of the ascending aorta were altered in women with a previous pregnancy complicated by EO-PE, but not in those with LO-PE. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

An abstract of the article "Longitudinal assessment of maternal ventricular-arterial coupling in singleton and twin pregnancies," by R. Orabona and colleagues is presented.

Objectives: To assess longitudinally the echocardiographic findings in a cohort of women carrying an uncomplicated monochorionic (MC) twin pregnancy and compare them with those obtained from dichorionic (DC) twin gestations. Methods: Healthy women with MC twin pregnancies were submitted to serial transthoracic maternal echocardiography during the first, second and third trimester. Cases with severe obstetric complications after enrollment were eventually excluded. The cardiac findings obtained at different time frames within the MC group were compared. Moreover, these data were compared with those obtained longitudinally in a cohort of uncomplicated DC twin pregnancies. Results: From 2012 to 2016, 19 women with an uncomplicated MC twin pregnancy were included in this study group. Among this group no significant changes were documented from 1st to 3rd trimester with the exception of an ejection fraction decrease. In respect of 48 DC uneventful twin gestations in the MC set the following significant differences were observed: reduced cardiac output (midtrimester) and ejection fraction (1st and 2nd trimester), increased total vascular resistance (1st trimester). Regarding the diastolic function in the MC versus DC twins a significant increase of the following parameters was noted: mitral valve E/A (early diastolic – atrial contraction) ratio (3rd trimester); MSE1 (1st and 2nd trimester), MS E1/A1 (3rd trimester); ML E1 (2nd and 3rd trimester); ML E1/A1 (3rd trimester). The longitudinal trend of the following data showed a significant difference between the MC and the DC set: increase of ML E1 and MLE1/A1, decrease of ML A1. Conclusions: In uncomplicated MC twin pregnancies maternal cardiac changes seem to differ significantly from the DC set. In particular, in the former group the diastolic function impairment is less pronounced presumably due to the lower circulating volume. [ABSTRACT FROM PUBLISHER]