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Background Right ventricular (RV) failure is a major determinant of symptoms and shortened survival in pulmonary arterial hypertension (PAH). This study assessed the prognostic relevance of increased right heart (RH) dimensions determined by echocardiography and RH reverse remodeling (RHRR) with targeted therapies in idiopathic PAH (IPAH). Methods The study prospectively monitored 102 therapy-naive IPAH patients for the presence of clinical worsening. Baseline evaluation included RH catheterization and echocardiography. RHRR at the 1-year follow-up was defined by a decrease in RV end-diastolic area, right atrial area, and the left ventricular systolic eccentricity index. Results At the 1-year follow-up, 18 of 102 patients (17.6%) presented with RHRR. A decrease in pulmonary vascular resistance was the only independent determinant of RHRR. The 94 surviving patients were monitored for 995 ± 529 days. RHRR was an independent prognostic factor and significantly improved the power of the prognostic model based on traditional clinical and hemodynamic parameters. The respective event-free survival rates at 1, 3, and 5 years were 94%, 94%, and 94% in patients with RHRR and 75%, 55%, and 24% in those without RHRR (p = 0.0001). Interestingly, RHRR was able to further stratify patients’ risk assessment through the Registry to Evaluate Early And Long-term PAH Disease Management risk score. Conclusions RHRR after 1 year of treatment is an independent predictor of prognosis in IPAH. The likelihood of RHRR is proportional to decreased pulmonary vascular resistance.

Objectives: The aim of this study was to determine the prevalence of right intraventricular dyssynchrony, its determinants and prognostic impact in idiopathic, heritable, and anorexigen-ind...

BACKGROUNDS It's still unclear if different patterns of intraventricular flow dynamics may be detected in patients nonresponders to cardiac resynchronization therapy (CRT) as compared to responders ones. Aim of this study was to evaluate the characteristics of left ventricular (LV) flow dynamics 6-months after CRT to identify Echo-particle imaging velocity (PIV) patterns were more frequently detected in nonresponders patients. METHODS Thirty-two patients with dilated cardiomyopathy, undergoing CRT, were enrolled in this study. All patients underwent 2D and 3D echo and fluid dynamics assessment 6 months after CRT, during active CRT (CRT-ON) and during a temporarily discontinued state (CRT-OFF). LV volumes systolic and diastolic volumes (LVESV and LVEDV), ejection fraction (LVEF), global longitudinal strain (GLS), systolic dyssynchrony index (SDI), and several geometrical and functional Echo-PIV-derived parameters were calculated. Patients were divided in two groups: "responders" to CRT (decrease in LVESV>15% 6 months after CRT) and "nonresponders." RESULTS During CRT-OFF, LVEF, GLS were lower, while SDI and LVESV were higher in nonresponders group (P=.030, P=.051, P=.035, and P=.025, respectively). Energy dissipation, vortex area, and vorticity fluctuation were higher in "nonresponders" patients during CRT-OFF (P=.038, P=.054, and P=.035, respectively). During CRT-ON, energy dissipation, vortex area, and vorticity fluctuation further increase in nonresponders patients (P=.020, P=.038, and P=.030, respectively) with a concomitant worsening of SDI (P=.045). CONCLUSION Our data show a significant worsening in flow-derived parameters in CRT "nonresponders" patients as compared with responders. Further larger longitudinal studies are necessary to assess whether these more chaotic intraventricular flow-patterns may contribute to a persistent adverse remodeling observed in this subset of patients.

Survival in patients with pulmonary arterial hypertension (PAH) is determined by right ventricular (RV) function adaptation to afterload. How altered RV function impacts on exercise capacity in PAH is not exactly known.104 idiopathic PAH (IPAH) patients aged 52±14 years underwent a diagnostic right heart catheterisation, a comprehensive echocardiography including two-dimensional speckle tracking for RV dyssynchrony evaluation and a cardiopulmonary exercise test. Multivariate analyses were performed to identify independent predictors of peak oxygen uptake (peakV′O2).A first multivariate analysis of only resting haemodynamic variables identified cardiac index, right atrial (RA) pressure and pulmonary arterial compliance as independent predictors, with low predictive capacity (r2=0.31; p2=0.35; p2=0.48; pV′O2(r2=0.53; p=0.001).A comprehensive echocardiography with speckle tracking-derived assessment of the heterogeneity of RV contraction improves the prediction of aerobic exercise capacity in IPAH.

311 Intraventricular flow patterns after percutaneous mitral valve repair with MitraClip implantation {#article-title-2} Background: Percutaneous Mitral valve repair using MitraClip implantation has become a valid alternative for patients with severe mitral regurgitation (MR) and high surgical risk. After mitral valve (MV) replacement with mechanical prosthesis, vortex reversal flow and increase in energy dissipation was observed by Echo-PIV analysis. Aim of the present study was to evaluate if the revised valve anatomy with a generated double or multi-orifice configuration after MitraClip implantation may alter intraventricular flow patterns during diastole. Methods: From May 2015 to April 2016, 13 consecutive patients with severe MR undergoing MitraClip implantation were enrolled. All pts underwent contrast echocardiography before and after the procedure (2±1 days) for Echo-PIV analysis and vortex quantification. Acute procedural success (APS) was defined as successful clip implantation with residual MR grade ≤2+. Following parameters were evaluated by 2D/3D echocardiography: the etiology of MR (functional, ischemic and degenerative), MV anatomic characteristics, tricuspid regurgitation (TR) and pulmonary artery systolic pressure (PASP), LV dimension and function. Following parameters were evaluated by Echo-PIV analysis: vortex area, intensity and geometry, energy dissipation, flow force momentum (φ) and flow force dispersion. Results: Study population was divided in two groups according to the success of the procedure (APS in 7 and failure in 6 pts). No difference in MR etiology and severity, leaflets’ length and valve area was found. Patients with APS presented with a less pre-interventional PASP (28±6 vs 53±11 mmHg, p=0.005). By comparing vortex data before and after the procedure, in all patients vortex area and intensity were significantly lower after MitraClip implantation (0.39±0.07 vs 0.32±0.11; p=0.006 and -0.53±0.1 vs-0.30±0.34; p=0.009), confirmed in both sub-groups analysis. Contrary to what observed after MV replacement with mechanical prosthesis, vortex reversal flow was not detected. Finally, only in APS subgroup, a significant flow force dispersion reduction (50±3.4 vs 45±5; p=0.01) was found. Conclusion: The results of this study showed significant changes in intraventricular flow patterns following MitraClip implantation with different characteristics as compared to patients undergoing surgical MV replacement. A significant reduction of flow turbulence (flow force dispersion) in APS group was found. Further longitudinal studies are necessary to assess the impact of these intraventricular flow patterns on functional outcome. # 312 Papillary muscles contribute significantly to shortening of dilated left ventricles {#article-title-3} Background: Dilated left ventricles (LV) have a more spherical shape and displaced papillary muscles (PM). We hypothesized that this altered geometry may influence the contribution of PM to LV function. We therefore assessed the regional myocardial work by measuring the myocardial glucose uptake by 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) in an animal model of normal and dilated LVs. Methods: Fifteen animals were included in the study. Ten sheep were subjected to 8 weeks of rapid (180 bpm) pacing to induce LV dilatation. Five sheep served as control. Imaging was performed at a heart rate of 110 bpm. Cardiac magnetic resonance imaging (MRI) was performed in all animals to assess end-diastolic (EDV), end-systolic (ESV) volumes and LV ejection fraction (LVEF). LV sphericity index was defined as mid-ventricular septal-to-lateral width divided by LV length. Mitral regurgitation (MR) was graded visually on the MRI cine images as no (0), minimal (0.5), mild (1), moderate (2), moderate to severe (3), severe (4). ECG- and respiratory gating was used to obtain high resolution PET images. Regional metabolism was measured in the PM and compared to the remaining LV myocardium (MYO) (Figure). Results: Animals subjected to rapid pacing had a higher EDV and ESV compared to controls (105±20 vs. 76±7 ml and 76±16 vs. 41±6 ml, resp., both p

Background Previous studies evaluating the progression of the necrotic wave in relation to heart rate were carried out only in animal models of ST-elevated myocardial infarction (STEMI). Aim of the study was to investigate changes of myocardial salvage in relation to different heart rates at hospital admission in timely reperfused patients with STEMI by using cardiovascular magnetic resonance (CMR). Methods One hundred-eighty-seven patients with STEMI successfully and timely treated with primary coronary angioplasty underwent CMR five days after hospital admission. According to the heart rate at presentation, patients were subcategorized into 5 quintiles

The aim of this study was to determine the prevalence of right intraventricular dyssynchrony, its determinants and prognostic impact in idiopathic, heritable, and anorexigen-induced pulmonary arterial hypertension.Right ventricular dyssynchrony has been described in pulmonary arterial hypertension, but no evidence is available on its prognostic impact and evolution after therapy.In 83 consecutive therapy-naïve patients, right ventricular dyssynchrony was evaluated by 2-dimensional speckle-tracking echocardiography calculating the standard deviation of the times to peak-systolic strain for the 4 mid-basal right ventricular segments (RV-SD4). After baseline (World Health Organization [WHO] class, pulmonary hemodynamics, 6-min walk test [6 MWT]), a second assessment was performed after 12 months or when clinical worsening occurred.Patients with right ventricular dyssynchrony (RV-SD418 ms) had advanced WHO class, worse 6 MWT, right ventricular remodeling, and hemodynamic profile compared with patients ≤ 18 ms. Determinants of dyssynchrony included pulmonary vascular resistance, QRS duration, and right ventricular end-diastolic area (r(2) = 0.38; p0.000001). At 12 months, 32.5% of patients presented clinical worsening (actuarial rates: 19% at 6 months, 31% at 1 year). Multivariable models for clinical worsening prediction showed that the addition of RV-SD4 to clinical and hemodynamic variables (WHO IV, 6 MWT, and cardiac index) significantly increased the prognostic power of the model (0.74 vs. 0.81; p = 0.005, 95% confidence interval [CI]: 0.02 to 0.11). Receiver operating characteristic analysis identified RV-SD4 ≥ 23 ms as the best cutoff value for clinical worsening prediction (95% negative predictive value). At 12 months, normalization of dyssynchrony was achieved in patients with a large reduction of pulmonary vascular resistance (-42 ± 4%).Right ventricular dyssynchrony is frequent in pulmonary arterial hypertension, is an independent predictor of clinical worsening, and might regress during effective treatments.

Background The coinfections HIV/HCV/HBV are an important health issue in penitentiary communities. The aim of the study was to examine HIV, HBV and HCV coinfections determinants amongst prisoners in the jails of Southern Lazio (Central Italy), in the period 1995–2000. Methods Diagnosis of seropositivities for HIV, HBV and HCV was made using ELISA method. A multiple logistic regression analysis was conducted to verify the influence of socio-demographic factors on the HIV/HBV/HCV coinfections. Results HIV/HCV, HBV/HCV and HIV/HBV coinfections were detected in 42 (4%), 203 (17.9%) and 31 (2.9%) inmates, respectively. These coinfections are significantly associated with the status of drug addiction (OR = 16.02; p = 0.012; OR = 4.15; p < 0.001; OR = 23.57; p = 0.002), smoking habits (OR = 3.73; p = 0.033; OR = 1.42; p = 0.088; OR = 4.25; p = 0.053) and Italian nationality (OR = 7.05; p = 0.009; OR = 2.31; p < 0.001; OR = 4.61; p = 0.04). Conclusion The prevalence of HIV, HBV and HCV seropositivity in jails suggests that information and education programs for inmates could be useful to reduce the spread of such infections.

Purpose Idiopathic pulmonary arterial hypertension (IPAH) prognosis depends on the capability of the right ventricle (RV) to preserve function in face of increased afterload. Intraventricular dyssynchrony (IVD) may have a negative effect on the overloaded RV. The aim of the study is to assess right IVD by incorporating activation times longitudinal deformation across all RV segments, as longitudinal deformation represents the major contribution to contraction. Methods and Materials 80 naive IPAH patients, without RBB block, were consecutively enrolled, and underwent WHO evaluation, 6-minute walk test, right heart catheterization and echocardiographic examination within 24 hours from invasive procedure. Assessment of RV myocardial deformation was determined by 2D speckle tracking echocardiography (2DSTE). We defined RV dyssynchrony the standard deviation (SD) of the time-intervals values calculated from mid and basal segments of the RV free wall and interventricular septum and called RV-DS4. Results IPAH patients showed regional abnormalities of RV function expressed by RV-SD4. Multivariate regression analysis revealed that QRS, RV diastolic area and PVR are the independent predictors of RV-SD4 (r²=0.36; p Conclusions Our findings suggest that right IVD can be described by the 2D-STE derived measure RV-DS4, which can help to distinguish those patients with a worse clinical and hemodynamic profile and could be considered among indipendent predictors of CW.