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Aims: Little is known about whether resting left ventricular global longitudinal strain (GLS) impairment is associated with myocardial perfusion abnormalities evaluated using 13N‐ammonia positron emission tomography (13N‐NH3‐PET)‐myocardial perfusion imaging (MPI). This study aimed to investigate the correlation between resting GLS and myocardial perfusion parameters in patients with a normal left ventricular ejection fraction (LVEF). We evaluated whether resting GLS can predict myocardial perfusion abnormalities in these patients. Methods and Results: We selected 157 patients with suspected stable angina pectoris who underwent both ATP‐stress NH3‐PET‐MPI and 2‐dimentional speckle tracing echocardiography. All subjects had a preserved LVEF and no known history of myocardial infarction. Patients were stratified into Group N (normal perfusion; summed stress score [SSS], 0–3; n = 101), Group M (mildly to moderately abnormal perfusion; SSS, 4–11; n = 41), or Group S (severely abnormal perfusion; SSS, 12+; n = 15). GLS was more impaired as myocardial perfusion abnormality severity increased (–17.9 ± 2.9% for Group N, –16.8 ± 3.1% for Group M, and –14.2 ± 3.5% for Group S; p <.001). GLS was weakly but significantly correlated with SSS (R =.32, p <.001), summed difference score (R =.32, p <.001), and myocardial blood flow during stress (R = –0.27, p <.001). Multivariate logistic regression analysis showed that male sex, diabetes mellitus, systolic blood pressure, and GLS were independent predictors of myocardial perfusion abnormality defined as Groups M and S. Additionally, the area under the curve for GLS for detecting myocardial perfusion abnormality was.65, and the optimal cutoff value for GLS was –16.5%, with sensitivity and specificity of 59% and 66%, respectively. Conclusion: In patients with suspected angina pectoris, resting GLS impairment despite a normal LVEF might aid the detection of hemodynamically significant coronary artery disease. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to identify which resting echocardiographic parameters can detect asymptomatic or mildly symptomatic patients with primary mitral regurgitation (MR) who require exercise stress echocardiography (ESE) to determine their suitability for surgery., Methods: We examined 56 consecutive patients with primary moderate/severe MR who underwent ergometer-based ESE. Patients who met the surgical indications at rest were excluded. Eligible patients were divided into Group I (pulmonary artery systolic pressure [PASP] during exercise >60 mmHg; n=11) and Group II (PASP during exercise ≤60 mmHg; n=30)., Results: Forty-one patients were included. Group I was significantly older (65±12 vs. 54±14 years, P=0.042) and had significantly higher serum N-terminal pro-B-type natriuretic peptide concentrations than Group II (351±278 vs. 125±163 pg/mL, P=0.002). The univariate analysis demonstrated that peak E wave velocity (Group I vs. Group II: 125±45 vs. 101±24 cm/sec, P=0.050), left ventricular (LV) end-diastolic diameter index (32±4 vs. 30±3 mm/m 2 , P=0.035), and left atrial volume index (LAVI; 45±14 vs. 30±11 mL/m 2 , P=0.008) were predictors of increased PASP during exercise. In the multivariate analysis, resting LAVI best predicted exercise-induced pulmonary hypertension (hazard ratio 1.081 [95% confidence interval 1.009-1.158], P=0.028), with a cutoff value of 37 mL/m 2 ., Conclusions: In asymptomatic or mildly symptomatic patients with primary moderate/severe MR, increased resting LAVI indicates the requirement for ESE, even without LV dilatation., Competing Interests: The authors declare no conflicts of interest.

Background: Transcatheter edge-to-edge mitral valve repair (TMVr) has been developed as an alternative therapeutic approach to patients with severe mitral regurgitation (MR) at high-surgical risks. Single leaflet device attachment (SLDA) is a well-known complication after the TMVr procedure, while an autopsy case experiencing haemolytic anaemia has been scarcely reported., Case Summary: A 79-year-old woman presented with New York Heart Association Class 3 congestive heart failure due to severe MR. The Heart Team planned TMVr using the MitraClip considering a high-surgical risk due to the history of open-chest surgery. The procedure was successful with two clips and a significant reduction of MR was confirmed. On the 12th day after the procedure, congestive heart failure was worsened and a transthoracic echocardiogram revealed severe MR suggestive of SLDA. Blood test showed normocytic anaemia with serum lactate dehydrogenase level elevation and renal function deterioration. We diagnosed as mechanical haemolysis induced by recurrent MR because of a decrease in serum haptoglobin level and the presence of schizocyte in the blood smear. Despite our intensive medical treatment, she died on the 119th day after the procedure. The pathological autopsy demonstrated that the ruptured leaflet was thickened with layered structure and severe fibrosis, while there were no findings of calcification, vegetations, or abscesses., Discussion: Single leaflet device attachment and subsequent mechanical haemolysis are rare but fatal complications after TMVr with the MitraClip. Not only degenerative MR but also functional MR may be associated with valve leaflet degeneration. A possibility of mechanical haemolysis should be considered when recurrent MR is observed after TMVr., (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.)