RV longitudinal deformation correlates with myocardial fibrosis in patients with end-stage heart failure

Objectives This study was performed to determine the accuracy of right ventricular (RV) longitudinal strain (LS) in predicting myocardial fibrosis in patients with severe heart failure (HF) undergoing heart transplantation. Background RVLS plays a key role in the evaluation of its systolic performance and clinical outcome in patients with refractory HF. Methods We studied 27 patients with severe systolic HF (ejection fraction 25% and New York Heart Association functional class III to IV, despite full medical therapy and cardiac resynchronization therapy) using echocardiography before heart transplantation. RV free wall LS, right atrial LS, sphericity index (SI), and tricuspid annular plane systolic excursion (TAPSE) were all measured. Upon removal of the heart, from the myocardial histologic analysis, the ratio of the fibrotic to the total sample area determined the extent of fibrosis (%). Results RV myocardial fibrosis correlated with RV free wall LS (r = 0.80; p < 0.0001), SI (r = 0.42; p = 0.01) and VO max (r = -0.41; p = 0.03), with a poor correlation with TAPSE (r = -0.34; p = 0.05) and right atrial LS (r = -0.37; p = 0.03). Stepwise multivariate analysis showed that RV free wall LS (β = 0.701, p < 0.0001) was independently associated with RV fibrosis (overall model R= 0.64, p < 0.0001). RV free wall LS was the main determinant of myocardial fibrosis. In the subgroup of patients with severe RV fibrosis, RV free wall LS had the highest diagnostic accuracy for detecting severe myocardial fibrosis (area under the curve = 0.87; 95% confidence interval: 0.80 to 0.94). Conclusions In late-stage HF patients, the right ventricle is enlarged, with reduced systolic function due to significant myocardial fibrosis. RV free wall myocardial deformation is the most accurate functional measure that correlates with the extent of RV myocardial fibrosis and functional capacity

Atrial septal defect and training-induced changes in loading conditions: Clinical management and implications for competitive athletes

Atrial septal defect (ASD) is the most common congenital heart disease in adults. When right heart dilation occurs, prompt closure should be considered. In the athletic population, however, the management of ASD can be challenging. Indeed, while the traininginduced haemodynamic effects on the right heart of an athlete with open ASD are not well known, possible device-related consequences may occur after percutaneous closure. We report the case of a competitive athlete with secundum ASD in which changes in the training regime significantly affected the right heart. Prompt normalisation of right ventricular size and of pulmonary artery pressures was demonstrated 2 months after percutaneous ASD closure

Current therapeutic strategies in cardiorenal syndrome

Cardiorenal syndromes (CRS) are disorders of the heart and kidneys in which an acute or chronic dysfunction in one organ may induce acute or chronic dysfunction of the other. Primary disorders of one of these two organs often result in secondary dysfunction or injury of the other. The lack of specific trials in this field highlights the need for further studies aimed to assess titration and appropriate dosages of drugs, according to both the etiology of chronic heart failure (CHF) and also the severity of underlying renal dysfunction. Moreover, the most recent clinical trials evaluating clinical and renal outcome in acute heart failure syndromes (AHFS), failed to demonstrate an improvement in renal function and perfusion. Therefore, Current American and European Guidelines for AHFS does not provide specific recommendation for patients with renal impairment. In this scenario several questions regarding the drugs, their recommended dosage and potential adverse effects on cardiac and renal outcome need to be addressed. Subsequently, therapy inducing an improvement in the renal function, a reduction of neurohormonal activation and an improvement of renal blood flow, could lead to a reduction in mortality and hospitalization in patients with CR

Training-induced right ventricular remodelling in pre-adolescent endurance athletes: The athlete's heart in children

Aims Little is known about the adaptation of the right ventricle (RV) to endurance exercise in children. The aim of this study was to assess the effects of 5&nbsp;months of intensive training on RV morphology and function in preadolescent endurance athletes. Methods Ninety-four children were evaluated in this study. Fifty-seven male competitive swimmers (aged 10.8&nbsp;±&nbsp;0.2&nbsp;years) were evaluated before (baseline) and after 5&nbsp;months of the training (peak-training), and compared to 37 age- and sex-matched non-athlete children evaluated at baseline and after 5&nbsp;months of natural growth. All subjects were asymptomatic, with negative family history for cardiomyopathies. Results At baseline no differences were found between athletes and controls for indexed RV outflow tract (RVOT) (18.5&nbsp;±&nbsp;2.7 vs. 16.8&nbsp;±&nbsp;5.0&nbsp;mm/m2, p&nbsp;=&nbsp;0.18) and RV basal end-diastolic diameter (EDD) (24.9&nbsp;±&nbsp;4.1 vs. 23.6&nbsp;±&nbsp;3.0&nbsp;mm/m2, p&nbsp;=&nbsp;0.15). After 5&nbsp;months, indexed RVOT and RV basal EDD significantly increased in athletes (20.2&nbsp;±&nbsp;2.9&nbsp;mm/m2 and 25.4&nbsp;±&nbsp;3.3&nbsp;mm/m2, p&nbsp;&lt;&nbsp;0.0001 vs. baseline) while no differences were observed in controls (p&nbsp;=&nbsp;0.84 and p&nbsp;=&nbsp;0.25). Despite the increase in RV size, RV function remained normal in athletes, with no changes in RV fractional area change (p&nbsp;=&nbsp;0.97), s′ value (p&nbsp;=&nbsp;0.22), and RV longitudinal strain (p&nbsp;=&nbsp;0.28). Conclusions Endurance training influences the growing heart of male preadolescent athletes with an addictive increase in RV dimensions, with a preserved RV function. Therefore, in children engaged in endurance sports the increase in RV size associated with normal RV function represents a physiological expression of the athlete's heart and should not be misinterpreted as an expression of incipient RV cardiomyopathy. © 2017 Elsevier B.V

Pre-operative left atrial strain predicts post-operative atrial fibrillation in patients undergoing aortic valve replacement for aortic stenosis

Post-operative atrial fibrillation (AF) is a common and serious complication in patients undergoing aortic valve replacement (AVR). Speckle tracking echocardiography (STE) has recently enabled the quantification of longitudinal myocardial left atrial (LA) deformation dynamics. Our aim was to investigate LA preoperative mechanical function in patients undergoing AVR for aortic stenosis using STE and determine predictors of post-operative AF. 76 patients with aortic stenosis in sinus rhythm, undergoing AVR, were prospectively enrolled. Conventional echocardiographic parameters, and peak atrial longitudinal strain (PALS) were measured in all subjects the day before surgery. PALS values were obtained by averaging all segments in the 4- and 2-chamber views (global PALS). All patients received biological valve prostheses and a standard postoperative care. Postoperative AF occurred in 15 patients (19.7 %). On univariate analysis among all clinical and echocardiographic variables, global PALS showed the highest diagnostic accuracy (HR 6.55 p < 0.0001; AUC of 0.89) with a cut-off value <16.9 %, having sensitivity and specificity of 86 and 91 %, respectively, in predicting postoperative AF. LA volume indexed and E/e' ratio had lower diagnostic accuracy (AUC 0.76 and 0.51, respectively). On multivariate analysis global PALS remains a significant predictor of postoperative AF (p < 0.0001). STE analysis of LA myocardial deformation is considered a promising tool for the evaluation of LA subclinical dysfunction in patients undergoing AVR, giving a potentially better risk stratification for the occurrence of postoperative AF

Piano Paesaggistico Regione Piemonte. Indagini e interpretazioni storico-critiche, gruppo di lavoro "ambiti paesaggistici". Qualificazione degli aspetti storico-culturali e individuazione dei sistemi delle testimonianze storiche

Analisi preliminari al primo piano paesaggistico della Regione Piemonte, adottato nel 2009; gruppo di lavoro relativo alla qualificazione storica degli "ambiti di paesaggio" ai sensi del Codice dei beni culturali e del paesaggi