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BackgroundPrehypertension predicts established hypertension. In this study, the aim was to analyze left ventricular (LV) mechanics in borderline prehypertensive (pre-HT) and hypertensive (HT) subjects through two-dimensional (2D)-strain echocardiography and then evaluate possible relations between cardiac parameters and insulin metabolism (homeostasis model assessment of insulin resistance (HOMAIR)).MethodsSeventy-four consecutive newly diagnosed, untreated HT were divided, on the basis of their office blood pressure (BP) measurements, confirmed by ambulatory BP monitoring (ABPM), in 41 borderline pre-HT (ABPM: 122.5 ± 6.7/76.2 ± 5.2 mm Hg) and 33 never-treated mild HT (ABPM: 138.3 ± 7.3/87.6 ± 7.1 mm Hg). Thirty-three healthy normotensive (NT) controls (ABPM: 114.8 ± 6.3/73.1 ± 6.1 mm Hg) (P < 0.0001) were also studied (NT). All subjects performed 2D color Doppler and pulsed-wave tissue Doppler imaging (PW-TDI).ResultsLeft ventricular mass (LVM) was significantly higher in pre-HT (39.2 ± 8.7 g/m2.7) and in HT (43.6 ± 8.5 g/m2.7) compared with NT (30.9 ± 7.4 g/m2.7) (P < 0.0001). A mild LV diastolic dysfunction was found both with Doppler mitral flow velocity and PW-TDI at mitral annulus level analysis. Longitudinal 2D strain in pre-HT (−18.9% ± 3.4) and in HT (−18.0% ± 3.3) was significantly lower than in NT (−23.9% ± 3.0) (P < 0.002). These LV abnormalities were associated with systolic ABPM, LVM, and HOMAIR.ConclusionsEarly abnormalities of LV longitudinal systolic deformation were found both in pre-HT and HT, together with a mild LV diastolic dysfunction. In both groups this early cardiac systolic and diastolic dysfunction is associated to insulin resistance, systolic pressure load, and cardiac remodeling.American Journal of Hypertension 2010; doi:10.1038/ajh.2009.258 [ABSTRACT FROM AUTHOR]

The recent development of transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS) treatment offers a viable option for high-risk patient categories. Our aim is to evaluate whether 2D strain and strain rate can detect subtle improvement in global and regional LV systolic function immediately after TAVI. 2D conventional and 2D strain (speckle analysis) echocardiography was performed before, at discharge and after three months in thirty three patients with severe AS. After TAVI, we assessed by conventional echocardiography an immediate reduction of transaortic peak pressure gradient (p<0.0001), of mean pressure gradient (p<0.0001) and a concomitant increase in aortic valve area (AVA: 1.08±0.31 cm(2)/m(2); p<0.0001). 2D longitudinal systolic strain showed a significant improvement in all patients, both at septal and lateral level, as early as 72 h after procedure (septal: -14.2±5.1 vs -16.7±3.7%, p<0.001; lateral: -9.4±3.9 vs -13.1±4.5%, p<0.001; respectively) and continued at 3 months follow-up (septal: -18.1±4.6%, p<0.0001; lateral: -14.8±4.4%, p<0.0001; respectively). Conventional echocardiography after TAVI proved a significant reduction of LV end-systolic volume and of LV mass with a mild improvement of LV ejection fraction (EF) (51.2±11.8 vs 52.9±6.4%; p<0.02) only after three months. 2D strain seems to be able to detect subtle changes in LV systolic function occurring early and late after TAVI in severe AS, while all conventional echo parameters seem to be less effective for this purpose. Further investigations are needed to prove the real prognostic impact of these echocardiographic findings.

Background: Prehypertension predicts established hypertension. In this study, the aim was to analyze left ventricular (LV) mechanics in borderline prehypertensive (pre-HT) and hypertensive (HT) subjects through two-dimensional (2D)-strain echocardiography and then evaluate possible relations between cardiac parameters and insulin metabolism (homeostasis model assessment of insulin resistance (HOMA(IR))., Methods: Seventy-four consecutive newly diagnosed, untreated HT were divided, on the basis of their office blood pressure (BP) measurements, confirmed by ambulatory BP monitoring (ABPM), in 41 borderline pre-HT (ABPM: 122.5 +/- 6.7/76.2 +/- 5.2 mm Hg) and 33 never-treated mild HT (ABPM: 138.3 +/- 7.3/87.6 +/- 7.1 mm Hg). Thirty-three healthy normotensive (NT) controls (ABPM: 114.8 +/- 6.3/73.1 +/- 6.1 mm Hg) (P < 0.0001) were also studied (NT). All subjects performed 2D color Doppler and pulsed-wave tissue Doppler imaging (PW-TDI)., Results: Left ventricular mass (LVM) was significantly higher in pre-HT (39.2 +/- 8.7 g/m(2.7)) and in HT (43.6 +/- 8.5 g/m(2.7)) compared with NT (30.9 +/- 7.4 g/m(2.7)) (P < 0.0001). A mild LV diastolic dysfunction was found both with Doppler mitral flow velocity and PW-TDI at mitral annulus level analysis. Longitudinal 2D strain in pre-HT (-18.9% +/- 3.4) and in HT (-18.0% +/- 3.3) was significantly lower than in NT (-23.9% +/- 3.0) (P < 0.002). These LV abnormalities were associated with systolic ABPM, LVM, and HOMA(IR)., Conclusions: Early abnormalities of LV longitudinal systolic deformation were found both in pre-HT and HT, together with a mild LV diastolic dysfunction. In both groups this early cardiac systolic and diastolic dysfunction is associated to insulin resistance, systolic pressure load, and cardiac remodeling.

The aim of the present study was to evaluate cardiac function and texture in patients with subclinical hypothyroidism (sHT) both by conventional and new ultrasonic intramyocardial tissue techniques. sHT was characterized by normal serum free tetraiodotironine and free triiodotironine levels and slightly increased serum TSH level. Twenty-four patients affected by sHT and 24 sex- and age-matched healthy volunteers were studied. All subjects were submitted to conventional two-dimensional (2D)-color Doppler echocardiography, pulsed wave tissue Doppler imaging (PWTDI) for the analysis of the diastolic function, color Doppler myocardial imaging (CDMI) for the analysis of regional strain and strain-rate and integrated backscatter (IBS) for the evaluation of intrinsic contractility and tissue characterization. The results of the present study were: (a) the detection in sHT subjects of a lower cyclic variation index (CVI) indicating an altered myocardial intrinsic contractility; (b) a higher ultrasonic myocardial reflectivity indicating an altered myocardial texture; (c) the detection of lower systolic strain and strain-rate indicating an alteration of myocardial regional deformability; (d) an initial impairment of left ventricular diastolic function indicated by a decrease of peak E mitral flow velocity and an increase of peak A mitral flow velocity. All parameters studied with conventional 2D-echo in sHT patients were comparable with controls, except for a mild alteration in diastolic function. A significant correlation among systo-diastolic modifications detected by CDMI and IBS and serum TSH levels were found. The CVI at septum, the PWDTI S-peak wave and the systolic strain at septum were inversely related to the serum TSH levels. In conclusion, the new intramyocardial ultrasonic techniques confirm and extend the previous knowledge on the effect of the sHT on the heart, allowing the detection of early ultrastructural and regional functional systolic and diastolic abnormalities.

A prompt diagnosis is the cornerstone of effective treatment of aortic dissection and it is the single most important determinant of survival in this patient population. New imaging modalities such as transesophageal echocardiography, magnetic resonance imaging, helical computed tomography and electron-beam computed tomography have been introduced during the last decade. These new imaging techniques allow for a better and earlier diagnosis of aortic diseases even in emergency situations. Bearing in mind the high overall mortality of aortic dissection, the role of prevention cannot be overstressed. The main risk factor for aortic dissection/rupture is the aortic diameter; therefore we would like to stress the role of aortic replacement as an effective preventive method for aortic dissection/rupture. Determining the right time for elective surgery, when the operative risk is lower than the risk of dilation-related complications, could contribute to a decrease in urgent surgical procedures on the ascending aorta.

Background: Cryopreserved homograft is currently considered an excellent choice for the replacement of a diseased aortic valve in adults and it is the first choice for 1 with aortic endocarditis. The aim of this study was to analyze our single institution experience with the cryopreserved aortic homograft by a mid-term follow-up., Methods: Between December 1996 and September 2003, 46 consecutive patients underwent aortic valve replacement using either aortic or pulmonary homograft. The risk profile was moderate-to-high, with a mean log EuroSCORE of 6.33+/-5.12. All patients were periodically evaluated at discharge, at 6 and 12 months, and yearly thereafter, to assess their clinical status and hemodynamic performance by comparing the ejection fraction, left ventricular mass index, mean gradient, effective orifice area index, and diastolic and systolic eccentricity indexes., Results: The overall 30-day mortality was 4.3%. At univariate analysis, the significant determinants of in-hospital mortality were: aortic dissection (p < 0.001), urgent operation (p = 0.05) and a log EuroSCORE > 10 (p = 0.05). At multivariate analysis no independent predictors of in-hospital mortality were found. At 5 years of follow-up, the survival was 91.3+/-5.0%, the freedom from reoperation was 95.8+/-4.1%, the freedom from sudden death was 96.1+/-3.9%, and the freedom from readmission for congestive heart failure was 94.1+/-3.1%. In patients with either prevalent aortic valve stenosis or prevalent aortic valve insufficiency, a significant improvement in the preoperative ejection fraction during follow-up (49+/-4 vs 51+/-7%; F = 5.1, p = 0.04 and 50+/-10 vs 53+/-10%; F = 7.1, p = 0.01 respectively) and a significant reduction in the preoperative left ventricular mass index during follow-up (202+/-55 vs 143+/-28 g/m2; F = 7.5, p = 0.008 and 177+/-49 vs 138+/-24 g/m2; F = 8.8, p < 0.001) were recorded., Conclusions: Replacement of the diseased aortic valve with a cryopreserved homograft offers clear advantages in terms of excellent hemodynamics, resistance to infection, and a negligible incidence of postoperative regurgitation.

We describe the case of a 64-year-old patient admitted to our hospital because of syncope and suspicion of cardiac tamponade. At admission he had temporary alteration of conscience with clinical evidence of sepsis without chest pain. There was a mild pericardial effusion in absence of clinical and echocardiographic signs of cardiac tamponade. About 36 hours later we found evidence of an aortic dissection and in the blood culture an isolation of Clostridium fallax that we consider the probable cause of this lesion.

Left ventricular free wall rupture is a well-recognized complication of myocardial infarction and is a frequent cause of death. Immediate surgical repair is the treatment of choice and many different surgical approaches have been reported. We describe an off-pump sutureless technique with the use of a glutaraldehyde-treated bovine pericardial patch and biological glue (N-butyl-2-cyanoacrylate) in a 60-year-old male patient with echocardiographic evidence of cardiac tamponade and a free wall rupture site on the lateral wall. The recovery was uneventful and the patient was discharged from the hospital on the eleventh postoperative day. At 3 months, he remained well and without any symptoms.

Quantitative myocardial contrast echocardiography was performed with harmonic power Doppler analysis using the background subtraction and Levovist (Schering AG, Berlin, Germany) as contrast agent in a triggered modality. Quantitative analysis of echocontrast was performed offline with PC software, obtaining the transit curves of microbubbles through the coronary capillary system. Coronary microcirculation in athletes showed a behavior substantially comparable with control participants, although at a higher level. Training determines a physiologic left ventricular hypertrophy that counterbalances the dilatation in the left ventricular chambers because of the higher blood volume in athletes compared with control participants. Angiogenesis and several functional adaptations (relaxation of small coronary arteries, increased production of nitric oxide by the coronary endothelium, or both), represent the potential mechanisms that allow an optimal distribution of oxygen and of substrates to the hypertrophied myocardium of the athletes.