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Sacubitril/valsartan (S–V) has been shown to reduce clinical outcomes in patients with heart failure with reduced ejection fraction (HFrEF). This benefit has been mostly attributed to an improvement in systolic function. This study aimed to evaluate longitudinal changes in several echocardiographic parameters of diastolic function in a cohort of patients with HFrEF receiving S–V. Echocardiographic parameters of consecutive patients receiving S–V, such as diastolic dysfunction (DD) grade and other individual diastolic and systolic function parameters, were prospectively collected at baseline and at 6-month follow-up. New York Heart Association (NYHA) functional class was also recorded. 65 patients (73.9% males; 61.5 ± 13 years) with HFrEF in NYHA class II–IV were evaluated. There was a significant reduction in DD grade after treatment with maximal tolerated doses (p

Background Chronic aortic regurgitation can be well tolerated for a long time. Some patients with normal ventricular function can even reach high levels of sporting performance. How the severity of regurgitation may change during exercise, however, is little known, although some studies suggest it diminishes. The present work examines, during exercise, the functional capacity, ventricular function, and regurgitation fraction (RF) in asymptomatic subjects with moderate or severe aortic regurgitation with preserved ejection fraction. Methods The study subjects ( n =32; 23 men, 9 women) were patients referred to our echocardiography laboratory with moderate or severe aortic regurgitation, preserved left ventricular systolic function, and sinus rhythm into NYHA functional class I. All underwent transthoracic echocardiography at rest and at peak effort during an exercise protocol involving an inclined cycloergometer. Left atrial and ventricular volume indices were recorded, along with diastolic and systolic function, cardiac index, peripheral resistance, and RF. Results The mean age of the subjects was 43.8±18.2years; 59% suffered moderate regurgitation, 41% severe aortic regurgitation, and 84% had a dilated left ventricle. All subjects managed exercise loads adequate for their age. Peak effort was associated with a significant reduction (mean 44.5% [range 10–95%]) in the RF (21.8±13.2 vs. 39.3%±14.7% at rest; p =0.0001). The absolute reduction in the RF at peak effort was greater among the subjects with severe aortic regurgitation (21.2% vs. 13.3% in those with moderate regurgitation; p =0.018). Conclusions The RF becomes smaller during exercise in asymptomatic subjects with moderate or severe aortic regurgitation and preserved ventricular function.

Cardiac imaging continues to reveal new anatomical and functional insights into heart disease. In echocardiography, both transesophageal and transthoracic three-dimensional imaging have been fully developed and optimized, and the value of the techniques that have increased our understanding of cardiac mechanics and ventricular function is well established. At the same time, the healthcare industry has released new devices onto the market which, although they are easier to use, have limitations that restrict their use for routine assessment. Tomography's diagnostic and prognostic value in coronary artery disease continues to increase while radiation exposure becomes progressively lower. With cardiac magnetic resonance imaging, myocardial injury and recovery in ischemic heart disease and following acute coronary syndrome can be monitored in exquisite detail. The emergence of new combined tomographic and gamma camera techniques, exclusively developed for nuclear cardiology, have improved the quality of investigations and reduced radiation exposure. The hybrid or fusion images produced by combining different techniques, such as nuclear cardiology techniques and tomography, promise an exciting future.

La rotura de musculo papilar es una afeccion poco frecuente, normalmente secundaria a una complicacion mecanica del infarto agudo de miocardio o a un traumatismo toracico. Presentamos el caso clinico de una paciente que presento una rotura espontanea completa de musculo papilar posteromedial e insuficiencia mitral severa secundaria, por necrosis aislada del papilar, sin lesiones coronarias angiograficas, que evoluciono a shock cardiogenico, requiriendo cirugia emergente de sustitucion valvular mitral, realizada con exito. Se ha revisado la escasa bibliografia clinica e histopatologica al respecto y se comentan los posibles mecanismos de dicha rotura.

Se presenta el caso de una paciente portadora de dos protesis valvulares de disco, en posicion mitral y aortica, que presento un cuadro de endocarditis infecciosa postoperatoria precoz, creando un doble trayecto fistuloso que comunicaba el seno aortico no coronario con la auricula y el ventriculo izquierdo. La presencia de un soplo diastolico aspirativo sugeria disfuncion protesica aortica, pero los estudios ecocardiograficos transtoracicos practicados revelaban que la misma era aparentemente normofuncionante, mientras que se registraba una senal Doppler sistolica de alta velocidad que se interpreto como de regurgitacion protesica o periprotesica mitral. La presencia de insuficiencia cardiaca congestiva e hipertension arterial pulmonar importante indujo a la practica de una ecocardiografia transesofagica con sonda multiplanar, que puso de manifiesto la presencia del mencionado trayecto fistuloso, confirmado posteriormente por angiohemodinamica, asi como en el acto quirurgico.

We analyzed data from 78 Majorcan patients with familial amyloidotic polyneuropathy (FAP): 57 confirmed and 21 non-confirmed. Diagnosis was established in the first group by histopathological study or detection of the biochemical marker in serum, and in the second was sup-ported by clinical information and family history.Eighteen confirmed patients were isolated cases and 39 had a family history of FAP. Age of onset was 46. 7 years; later in males; predominance of males (72%) and late on-set cases (65%). The TTR variant was Met 30 associated with haplotype I. Initial sensorimotor syndrome was present only in 55% of patients. Multiple progressive handicaps appeared. Duration averaged 10.5 years and was longer in males. Prevalence rate was 3.3 patients per 100,000 and asymptomatic carriers were 83. Twelve patients underwent liver transplantation.Since 1989, the number of FAP families, patients, prevalence, isolated cases and municipalities with affected families was increased. One founder hypothesis is supp...