Ventricular Dysfunction In Patients Research Articles

Relationship between preoperative left ventricular longitudinal strain and survival after cardiovascular surgery in patients with preserved ejection fraction: a preliminary result

Introduction Left ventricular longitudinal strain is reportedly able to detect early ventricular dysfunction in patients with preserved ejection fraction.¹ However, it remains unclear whether this concept can be applied to predict postoperative outcomes. The aim of this study is to investigate the relationship between preoperative left ventricular longitudinal strain and survival after cardiovascular surgery in patients with preserved ejection fraction. Methods This observational study included 823 adult patients with preserved ejection fraction (ejection fraction >50%) who underwent cardiovascular surgery between January 2015 and December 2016 at a tertiary academic hospital. The patients were divided into the normal strain group ( = −18.0%). The primary outcome was postoperative 1-year all-cause mortality. Propensity matching was performed to minimize differences in baseline characteristics between patients with normal and abnormal left ventricular longitudinal strain. Kaplan-Meier survival analysis and Cox proportional hazard regression were used to evaluate the association between preoperative left ventricular longitudinal strain and primary outcome. Results Of the 823 patients (40.3 % women; median age, 64 years), 30 patients (3.6 %) died within one year. Cumulative 1-year mortality rate was 3.4% (95% confidence interval; 1.5–5.2%) in the normal strain group and 3.9% (95% confidence interval; 2.1–5.6%) in the abnormal strain group. After propensity score matching (a total of 606 patients in matched cohort), there was no statistically significant difference in 1-year mortality between strain groups; 3.3% (95% confidence interval; 1.3–5.3%) in the normal strain group, 3.6% (95% confidence interval; 1.5–5.7%) in the abnormal group, hazard ratio of 1.11 (95% confidence interval; 0.47–2.61, P-value = 0.81). Discussion Preoperative left ventricular longitudinal strain does not have statistically significant association with postoperative 1-year mortality in patients undergoing cardiovascular surgery with preserved ejection fraction in this preliminary analysis.

Correlations Between Oxidative Stress Biomarkers, h-FABP and Left Ventricular Dysfunction in Patients With Acute Myocardial Infarction Undergoing Primary PCI

Correlations Between Oxidative Stress Biomarkers, h-FABP and Left Ventricular Dysfunction in Patients With Acute Myocardial Infarction Undergoing Primary PCI

Pulmonary Obstruction Index in Multidetector Computed Tomographic Imaging for the Risk Assessment of Right Ventricular Dysfunction in Patients with Pulmonary Embolism

Objectives: Rapid and accurate risk assessment is critical in selecting the appropriate treatment strategy in the management of pulmonary embolism. This study was designed to assess the relationship between multidetector computed tomographic (MDCT) imaging and the pulmonary obstruction index, right ventricular dysfunction, and serum D-dimer levels in normotensive patients with pulmonary embolism. Patients and Methods: In 74 patients with suspected pulmonary embolism (38 men, 36 women), two readers in consensus assessed the central clot score and the signs of right ventricular dysfunction using MDCT by quantifying right ventricular diameter (RVD), left ventricular diameter (LVD), the ratio of the right ventricle to left ventricle short-axis diameters (RV/LV), and septal deviation. Results: The patients were divided into three groups. Thirty five patients had negative CT pulmonary angiography (CTPA) and deep vein thrombosis (DVT) findings (group 1), 29 had positive CTPA and negative DVT findings of pulmonary embolism (PE) (group 2), and 10 patients had positive DVT and CTPA findings (group 3). Serum D-dimer levels were statistically higher in group 3 than in the other groups. It was found as 329.2 ± 46.9, 461.3 ± 70.5, and 1726.6 ± 543.5 in groups 1, 2, and 3 (P = 0.0001), respectively. We found a significant positive correlation between the lower extremity clot load score and the pulmonary artery obstruction index, and pulmonary artery clot volumes. The right ventricle (RV)/left ventricle (LV) short-axis ratio, azygos vein diameter, the RV wall thickness (RVW), reflux of contrast medium into the inferior vena cava (IVC), leftward septal bowing, and interventricular septal thickness were statistically different in group 1 compared to groups 2 and 3. Conclusion: Evaluation of the total pulmonary artery clot load and morphologic findings of the right heart obtained using CTPA are extremely important in order to follow up patients with suspected venous thrombosis.

. The role of N-terminal pro-brain natriuretic peptide in the assessment of right ventricular dysfunction in patients with acute pulmonary embolism: Results from Serbian University Pulmonary Embolism Registry (Super)

. The role of N-terminal pro-brain natriuretic peptide in the assessment of right ventricular dysfunction in patients with acute pulmonary embolism: Results from Serbian University Pulmonary Embolism Registry (Super)

Prevalence and Prognostic Implications of Right Ventricular Dysfunction in Patients With Hypertrophic Cardiomyopathy

Right ventricular (RV) dysfunction is a well-known prognostic factor in several cardiac diseases. However, the prevalence of RV dysfunction in hypertrophic cardiomyopathy (HC) is unclear and its prognostic value is unknown. This study aims at addressing these issues assessing RV function with speckle tracking echocardiography. In 267 HC patients (52 ± 15 years, 68% male), standard and advanced echocardiographic measurements of RV function were performed including RV 4-chamber longitudinal strain (RV4CLS) and RV free wall longitudinal strain (RVFWLS). The primary end point was all-cause mortality and heart failure development. RV dysfunction was observed in 9% of patients based on tricuspid annular plane systolic excursion (≤17 mm), 5% based on fractional area change (<35%), 23% based on RVFWLS ≥-19%, 39% based on RVFWLS ≥-23%, and 55% based on RV4CLS ≥-20%. In total 59 (22%) patients reached the primary end point during a median follow-up of 6.7 (interquartile range 4.2 to 9.8) years. Kaplan-Meier survival curve showed a significant worse survival free of the end point for patients with impaired RV4CLS ≥-20% versus patients with preserved RV4CLS <-20% (log-rank 7.0, p = 0.008) and for patients with impaired RVFWLS ≥-19% versus patients with preserved RVFWLS <-19% (log-rank 4.4, p = 0.037). Multivariable Cox regression analysis showed that E/E' (hazards ratio [HR] 2.26 [1.30 to 3.92], p = 0.004), left ventricular global longitudinal strain LV GLS (HR 1.08 (1.01 to 1.17), p = 0.034) and RV4CLS (HR 1.08 (1.02 to 1.15), p = 0.007) were independently associated with the primary end point. In conclusion, RV dysfunction as measured by longitudinal strain is relatively frequent in HC patients. Impaired RV4CLS is - together with LV GLS and E/E' - associated with adverse outcome, which may indicate a more severe form of HC.

Right Ventricular Function and Sexual Function: Exploring Shadows in Male and Female Patients With Heart Failure

IntroductionSexual health plays an important role in heart failure (HF) patients, and the relationship between HF and sexual dysfunction is well established; however, the role of right ventricular function in sexual dysfunction has not been investigated sufficiently. AimTo investigate the potential association between right ventricular dysfunction and sexual dysfunction in both male and female patients with HF. MethodsPatients with a clinical diagnosis of HF were evaluated in a cross-sectional study. Patients from the whole spectrum of HF were included in the study, regardless of cause, duration, and classification of HF. Sexual function in men was evaluated with the International Index of Erectile Function and in women with the Female Sexual Functioning Index. Main Outcome MeasuresWe demonstrate that right ventricular dysfunction is associated with worse sexual function in both men and women. Results306 consecutive patients with HF participated in the study. Right ventricular systolic dysfunction ranged from 24.2–39.1% and right ventricular diastolic dysfunction from 16.1–83.1%, depending on the echocardiographic parameter that was assessed. Right ventricular systolic dysfunction assessed by tricuspid annular plane systolic excursion (TAPSE), TAPSE/pulmonary artery systolic pressure ratio, and right ventricular basal diameter was associated with a lower International Index of Erectile Function score (P = .031, P = .009, and P < .001, respectively). Multiple linear regression analysis revealed that erectile function was independently associated only with TAPSE/pulmonary artery systolic pressure ratio and tricuspid late tricuspid diastolic flow velocity wave (β = 32.84, P = .006; and β = −0.47, P = .026, respectively), whereas female sexual function was independently associated only with the early tricuspid diastolic flow velocity/late tricuspid diastolic flow velocity ratio (β= −0.47, P = .026). Clinical ImplicationsOur study demonstrates that right ventricular dysfunction in patients with HF reflects an impaired sexual function status. Physicians should be aware of this association and closely evaluate those patients for sexual dysfunction. Strengths & LimitationsWe innovatively assessed the correlation between right ventricular dysfunction and sexual function using validated questionnaires. The main limitation is the relatively small sample size. ConclusionsOur study provides some new insights into the relationship between sexual dysfunction and right ventricular systolic and diastolic dysfunction in HF patients, also suggesting potential interventions to improve sexual and right ventricular function and prognosis in this population.Koutsampasopoulos K, Vogiatzis I, Ziakas A, et al. Right Ventricular Function and Sexual Function: Exploring Shadows in Male and Female Patients With Heart Failure. J Sex Med 2019;16:1199–1211.

OBG-like ATPase 1 inhibition attenuates angiotensin II-induced hypertrophic response in human ventricular myocytes via GSK-3beta/beta-catenin signalling.

Obg-like ATPase 1 (OLA1) that possesses both GTP and ATP hydrolyzing activities has been shown to be involved in translational regulation of cancer cell growth and survival. Also, GSK3β signalling has been implicated in cardiac development and disease. However, the role of OLA1 in pathological cardiac hypertrophy is unknown. We sought to understand the mechanism by which OLA1 regulates GSK3β-β-Catenin signalling and its functional significance in angiotensin-II (ANG II)-induced cardiac hypertrophic response. OLA1 function and its endogenous interaction with GSK3β/β-catenin signalling in cultured human ventricular cardiomyocytes (AC16 cells) and mouse hearts (in vivo) was evaluated with/without ANG II-stimulated hypertrophic response. ANG II administration in mice increases myocardial OLA1 protein expression with a corresponding increase in GSK3β phosphorylation and decrease in β-Catenin phosphorylation. Cultured cardiomyocytes treated with ANG II show endogenous interaction between OLA1 and GSK3β, nuclear accumulation of β-Catenin and significant increase in cell size and expression of hypertrophic marker genes such as atrial natriuretic factor (ANF; NPPA) and β-myosin heavy chain (MYH7). Intriguingly, OLA1 inhibition attenuates the above hypertrophic response in cardiomyocytes. Taken together, our data suggest that OLA1 plays a detrimental role in hypertrophic response via GSK3β/β-catenin signalling. Translation strategies to target OLA1 might potentially limit the underlying molecular derangements leading to left ventricular dysfunction in patients with maladaptive cardiac hypertrophy.

Prevalence and determinants of exercise-induced left ventricular dysfunction in patients with coronary artery disease.

The phenomenon of exercise-induced left ventricular dysfunction (LVD) is incompletely understood. Better understanding of its prevalence and determinants might help to address the current potential oversimplification of the relation between physical activity and cardiac health in patients with coronary artery disease (CAD). We prospectively assessed the prevalence and determinants of exercise-induced LVD in patients with stable CAD and normal LV function at rest undergoing bicycle rest/stress myocardial perfusion imaging single-photon emission computed tomography (MPI-SPECT). Exercise-induced LVD was defined as a relevant (5% or more) drop in left ventricular ejection fraction after maximal exercise. High-sensitivity cardiac troponin I/T (Hs-cTnI/T) and N-terminal probrain natriuretic peptide (NT-proBNP) concentrations were measured before exercise to quantify cardiomyocyte injury and hemodynamic cardiac stress, respectively. Among 317 patients, exercise-induced LVD was present in 83 (26%) patients. Exercise-induced LVD was associated with the extent of exercise-inducible myocardial ischaemia as well as transient ischaemic dilatation. Still, 43% of patients developing exercise-induced LVD did not have functionally relevant CAD. Neither baseline characteristics, nor the quantification of the extent of cardiomyocyte injury and hemodynamic cardiac stress using hs-cTnI/T and NT-proBNP concentrations, respectively, allowed predicting exercise-induced LVD. One out of four patients with stable CAD develops exercise-induced LVD after bicycle exercise test. While the extent of exercise-inducible myocardial ischaemia is a predictor, other still unrecognized mechanisms also seem to play a major role, as nearly half of all patients with exercise-induced LVD do not have functionally relevant CAD.

Prognostic Role of Left Ventricular Dysfunction in Patients With Coronary Artery Disease After an Ambulatory Cardiac Rehabilitation Program

The relationship between left ventricular ejection fraction (LVEF) and outcomes after cardiac rehabilitation (CR) is not well established; therefore we assessed the prognostic role of LVEF at the end of ambulatory CR program in patients (pts) who received coronary revascularization. LVEF was evaluated at hospital discharge and re-assessed at the end of CR in all ST-elevation myocardial infarction and coronary artery bypass graft pts, while in pts with non-ST-elevation MI or elective percutaneous coronary intervention the echocardiography was repeated if they had an impaired LVEF at discharge. New hospitalizations for cardiovascular causes at 1-year, and cardiovascular mortality during long-term follow-up were analyzed. We enrolled in CR 3078 pts, 86% showed LVEF ≥40% and 9% LVEF <40%. Of those with a discharge LVEF <40%, 56% improved LVEF (LVEF ≥40%) after CR. At 1-year, heart failure was the main cause of new hospitalizations in LVEF <40% group compared with LVEF ≥40% group (5% vs 0.4%, p <0.01). During a mean follow up of 48 ± 25 months, cardiovascular death occurred in 9% of pts with LVEF <40% and in 2% with LVEF ≥40% (p = 0.014). At Cox multivariate analysis, LVEF <40% at the end of CR and age were independent predictors of hospitalization and mortality for cardiovascular causes, while coronary artery bypass graft was a protective factor. In conclusion, during CR the improvement of LVEF occurs in a relevant proportion of patients, the re-assessment of LVEF at the end of the CR is helpful for risk stratification because left ventricle dysfunction at the end of CR is associated with worse cardiovascular outcomes.

Atteinte coronarienne et syndrome néphrotique au cours du lupus systémique : à propos d’une observation

IntroductionHeart failure during systemic lupus erythematosus has various causes. Case reportA 29-year-old female presented with a systemic lupus flare and a nephrotic syndrome, followed by cardiogenic shock requiring extra-corporeal membranous oxygenation. Ventricular dysfunction was related to massive myocardial infarction due to an anterior interventricular artery thrombosis and an underlying atheroma. The young age and the absence of chest pain were not suggestive of coronary artery disease initially. Coronary thrombosis was probably favored by the nephrotic syndrome, in which the arterial thrombotic risk is increased. ConclusionCoronary artery disease should be systematically evoked in the presence of ventricular dysfunction in patients with systemic lupus, including when they are young and in the absence of chest pain. Nephrotic syndrome should be identified as a risk factor for arterial thrombosis.

Epicardial adipose tissue and right ventricular dysfunction in patients with acute pulmonary embolism

Epicardial adipose tissue and right ventricular dysfunction in patients with acute pulmonary embolism

Epicardial adipose tissue and right ventricular dysfunction in patients with acute pulmonary embolism

Epicardial adipose tissue and right ventricular dysfunction in patients with acute pulmonary embolism

Incidence of Right Ventricular Dysfunction in Adult Patients Submitted to Heart Transplantation According to the Presence of Pre-Transplant Pulmonary Hypertension

Purpose: Introduction Pre-transplant irreversible pulmonary hypertension (PH) is a contraindication to heart transplantation (HTx) due to the high risk of post-transplant right ventricular (RV) dysfunction. When ventricular assist devices (VAD) are not available, HTx may be considered in selected patients PH. Objective To evaluate the incidence of right ventricular dysfunction in patients with reversible PH compared to patients with no PH submitted to HT. Methods We performed a retrospective analysis of all HTx performed from Jan-13 to Oct-17 at Heart Institute using RedCap database. PH was defined according to the presence of at least one of the following criteria at baseline: pulmonary systolic artery pressure (PSAP) > 50mmHg or pulmonary vascular resistance (PVR) >5uW or transpulmonary gradient (TPG) >15. Patients with PVR below 5uW at baseline or after the reversibility test were submitted to HTx. Early RV and LV dysfunctions and 30-day mortality were evaluated in patients with and without PH. Diastolic pulmonary gradient (DPG) was also evaluated in this cohort. Results 200 patients were submitted to HTx, 126(63%) were male, 127(63.5%) self-declared white, and with average age of 46.3±12.2 years-old. Of these patients, 180 had underwent to pre-transplant right heart catheterization. Considering criteria described above, 87(48.3%) patients had PH and were compared to patients with no PH (n=93,51.7%). Moderate/severe RV dysfunction was present in 16(18.8%) patients in PH group and 10(11.1%) patients in no HP group (p=0.152). There was also no difference in LV dysfunction (p=0.621) or 30-day mortality (p=0.534) between groups. All RV catheterization measures were higher in PH group (p Conclusion In our cohort, the incidence of RV as well as LV dysfunction and 30-day mortality were similar in patients with and without PH. In a population where VAD is not available, HTx could be an alternative to patients with PH, especially if DPG is low. Larger prospective studies should be performed to test the role of DPG in patient evaluation to HTx.

Tricuspid annular diameter and right ventricular volume on preoperative cardiac CT can predict postoperative right ventricular dysfunction in patients who undergo tricuspid valve surgery

BackgroundWe investigated the predictive value of preoperative computed tomography (CT)-derived tricuspid annular and right ventricular (RV) parameters for postoperative RV dysfunction in patients undergoing tricuspid valve (TV) surgery. MethodsWe retrospectively reviewed clinical, transthoracic echocardiography (TTE), and CT data of 100 consecutive patients who underwent cardiac CT and subsequently received TV surgery. Preoperative cardiac CT and TTE parameters were analyzed, including TV annulus diameter and RV size. Univariate and multivariate logistic regression analyses were performed to identify significant predictors for postoperative RV dysfunction, both in the entire study population and in the subgroup of patients without preoperative RV dysfunction. ResultsPostoperative RV dysfunction occurred in 46% of all patients. In the multivariate logistic regression analysis, longer TV annulus diameter (>29.3 mm/m2 on four-chamber view; (odds ratio [OR] 3.56, 95% confidence interval [CI] 1.13–11.24), larger RV volume (RV end-diastolic volume/body surface area > 128.8 ml/m2) on CT (OR 3.85, 95% CI 1.24–11.98) and presence of preoperative RV dysfunction on TTE (OR 11.96, 95% CI 2.8–50.99) were independent predictors for postoperative RV dysfunction in the entire study population (P < 0.05). Among patients without preoperative RV dysfunction, longer TV annulus diameter (OR 4.02, 95% CI 1.20–13.41) and larger RV volume on CT (OR 6.09, 95% CI 1.87–19.80) were independent predictors for postoperative RV dysfunction (P < 0.05). ConclusionsPreoperative assessment of cardiac CT imaging–based TV annular diameter and RV volume can provide independent information for predicting postoperative RV dysfunction in patients undergoing TV surgery.

Right Ventricular Dysfunction in Patients with Acute STEMI, Radionuclide-Based Assessment

Background: An acute myocardial infarction, particularly one that is large and transmural, can produce alterations in the topography of both the infarcted and noninfarcted regions of the ventricle. Cardiac remodeling after acute myocardial infarction (AMI) is characterized by molecular and cellular mechanisms involving both left and right ventricles. Objective: To study the right ventricular affection in patients with acute myocardial infarction of the left ventricle and treated with primary PCI. Methods: The study was done in the critical care department, Cairo University (in which 2,500 primary percutaneous coronary interventions (PCIs) are done annually). Forty patients with acute ST-elevation myocardial infarction (STEMI) were subjected to primary (PCI), we excluded all patients with RV infarction and patients with pulmonary hypertension. RV function was assessed by first pass radionuclide angiocardiography within 48 hours of admission. Results: Regarding the incidence of right ventricular dysfunction in patients with acute left ventricular STEMI who treated with 1ry PCI, there were 21 patients (52.5%) with RV EF% patients (47.5%) with RV time to peak filling rate (TPFR) > 180 msec. There was a significant relationship between right ventricular dysfunction and duration of ICU stay, impairment of LV systolic function, failure of complete resolution of ST segment elevation, failure of early peaking of cardiac enzymes, occurrence of in-hospital complications and one year mortality. Conclusion: The incidence of right ventricular dysfunction in patients with acute left ventricular STEMI is higher than expected and has a negative impact on their outcome.

Impact of Ventricular Morphology on Myocardial Deformation in Patients with Single Ventricle

Introduction: Functional single ventricle represent a heterogeneous group of anomalies sharing a common feature which is a functional single cardiac chamber. (1) In different series of congenital heart disease patients, cases of UVH represent about 1–2% of total congenital heart diseases. (2) Two-dimensional speckle-tracking echocardiography has recently emerged as a novel technique for objective and quantitative evaluation of global and regional myocardial function. Objectives: To determine impact of ventricular morphology on myocardial deformation in patients with single ventricle. Patients and Methods: The study included 47 patients with functional single ventricle whether they underwent cavopulmonary anastomosis or not. All patients were referred for elective cardiac catheterization or follow up echocardiography in Ain Shams university hospitals, Cardiology department, from November 2017 to July 2018. All patients underwent full echocardiographic assessment including assessment of the dominant ventricular function by STE. Results: The study included 47 patients, 30 males (63.8%) and 17 females (36.2%). Their age ranged between 6-12 years, with mean age of 8.22 ± 1.94. The morphology of the dominant ventricle determined ventricular function by both 2D parameters and STE. Patients with a dominant LV had higher strain values. Patients who underwent a cavopulmonary shunt also had better ventricular functions. All patients included in the study showed impaired dominant ventricular function by STE even those who had normal EF by standard 2D TTE suggesting that subtle ventricular dysfunction in patients with single ventricle can be unmasked by STE.

The use of speckle tracking echocardiography and cardiac biomarkers for diagnosis of patients with peripartum cardiomyopathy

Context Peripartum cardiomyopathy (PPCM) is a well-known though poorly understood disease. Aim We aimed to provide new diagnostic tools for patients with PPCM using speckle tracking echocardiography (STE) and cardiac biomarkers. Patients and methods This is a case–control study. We recruited 20 patients with newly discovered PPCM and 20 control women. They were subjected to 2D traditional echocardiography, STE, and serum analysis for N-terminal probrain natriuretic peptide (NT-proBNP) and cardiac troponin I (cTn-I). Results The mean age of the patients was 29.7 ± 7.63 years. Overall, 75% of them presented in the postpartum period. Patient's left ventricular ejection fraction (LVEF) was impaired compared with controls at presentation (34.2 ± 8.84 vs. 62.65 ± 5.61%,P Conclusion Global longitudinal and circumferential strains are depressed in patients with PPCM. GLS apical four chamber view, GLS apical two chamber view, and GCS had high sensitivity and 40–80% specificity for LVEF changes, so strain can be used as an objective marker of left ventricular dysfunction in patients with PPCM. NT-proBNP and cTn-I can help in the diagnosis of peripartum patients presented to emergency room with symptoms and signs of heart failure.

The role of natriuretic peptides in the management, outcomes and prognosis of sepsis and septic shock.

Sepsis continues to be a leading public health burden in the United States and worldwide. With the increasing use of advanced laboratory technology, there is a renewed interest in the use of biomarkers in sepsis to aid in more precise and targeted decision-making. Natriuretic peptides have been increasingly recognized to play a role outside of heart failure. They are commonly elevated among critically ill patients in the setting of cardiopulmonary dysfunction and may play a role in identifying patients with sepsis and septic shock. There are limited data on the role of these biomarkers in the diagnosis, management, outcomes and prognosis of septic patients. This review seeks to describe the role of natriuretic peptides in fluid resuscitation, diagnosis of ventricular dysfunction and outcomes and the prognosis of patients with sepsis. B-type natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP) have been noted to be associated with left ventricular systolic and diastolic and right ventricular dysfunction in patients with septic cardiomyopathy. BNP/NT-proBNP may predict fluid responsiveness, and trends of these peptides may play a role in fluid resuscitation. Despite suggestions of a correlation with mortality, the role of BNP in mortality outcomes and prognosis during sepsis needs further evaluation.

Chronic myocardial damage in idiopathic pulmonary arterial hypertension: a clinical case

Chronic myocardial injury, determined by a constantly elevated cardiac troponin (cTn) value, may occur in patients with pulmonary arterial hypertension (PAH), indicating the severity of the disease and associated with an adverse prognosis. Increasing of cTn among patients with PAH was registered prior to 2018, but after the Fourth universal definition of myocardial infarction (2018) was released the understanding of this phenomenon has been changed. One of the causes of chronic myocardial injury in patients with PAH is the compression of coronary arteries. Left main coronary artery (LMCA) compression is an uncommon and probably underestimated cause for angina-like chest pain and ventricular dysfunction in patients with severe pulmonary artery hypertension. LMCA compression by an enlarged pulmonary artery trunk has been associated with angina, but appropriate diagnostic and treatment approaches remain poorly defined. This is a case report on a woman with idiopathic PAH and compression of the LMCA by an enlarged pulmonary artery. The diagnosis of LMCA stenosis was confirmed by multi-slice computed tomography and coronary angiography. Biomarkers such as cTn and brain natriuretic peptide have also been identified as criteria of optimal treatment. Percutaneous coronary intervention in conjunction with PAH-specific therapy appears to be a feasible, safe, and effective treatment option for patients with extrinsic compression of the LMCA from pulmonary artery enlargement

Speckle-Tracking Echocardiographic Layer-Specific Strain Analysis on Subclinical Left Ventricular Dysfunction in Patients With Primary Aldosteronism.

Primary aldosteronism (PA) may cause myocardial injury. We investigated myocardial dysfunction using speckle-tracking echocardiographic (STE) layer-specific strain in patients with PA. Our study included 62 patients with PA (33 aldosterone-producing adenoma [APA] and 29 idiopathic hyperaldosteronism [IHA]) and 30 patients with primary hypertension. STE was acquired using the GE Vivid E9 equipment. The longitudinal (LS) and circumferential (CS) layer-specific strains of the endocardium, midmyocardium, and epicardium (LSendo, LSmid, LSepi, CSendo, CSmid, and CSepi) were obtained using the EchoPAC BT13 workstation. Patients with APA, compared with those with primary hypertension and IHA, had a significantly (P < 0.001) lower serum potassium concentration and plasma renin activity, and higher 24-h urinary aldosterone, plasma aldosterone concentration, and aldosterone-to-renin ratio. Left ventricular ejection fraction was normal in all patients (58-60%). Layer-specific strain showed decreasing gradient from the endocardium to epicardium in all 3 groups (P < 0.01). However, LSendo and CSendo were lowest in APA (-20.2 ± 2.3% and -33.3 ± 3.2%), intermediate in IHA (-22.1 ± 1.9% and -35.7 ± 2.8%) and highest in primary hypertension (-24.1 ± 2.1% and -38.9 ± 3.1%, P < 0.001). Similar trends were observed for LSmid, LSepi, CSmid, and CSepi, but statistical significance was only reached for the comparison between APA and primary hypertension (P < 0.001), but not others (P > 0.05). Layer-specific strain was significantly correlated with plasma aldosterone concentration for all echocardiographic parameters (r = -0.69 to -0.53, P < 0.001) in all 3 groups. Patients with PA, especially APA, had impaired regional systolic function with myocardial deformation changes at similar levels of blood pressure, probably because of elevated plasma aldosterone concentration.