function is considered to be precisely measurable only by invasive hemodynamics. We aimed to correlate strain values measured by speckle-tracking echocardiography (STE) with sensitive contractility parameters of pressure-volume (P-V) analysis in a rat model of exercise-induced left ventricular (LV) hypertrophy. LV hypertrophy was induced in rats by swim training and was compared with untrained controls. Echocardiography was performed using a 13-MHz linear transducer to obtain LV long-and short-axis recordings for STE analysis (GE EchoPAC). Global longitudinal (GLS) and circumferential strain (GCS) and longitudinal (LSr) and circumferential systolic strain rate (CSr) were measured. LV P-V analysis was performed using a pressure-conductance microcatheter, and load-independent contractility indices [slope of the end-systolic P-V relationship (ESPVR), preload recruitable stroke work (PRSW), and maximal dP/dt-enddiastolic volume relationship (dP/dtmax-EDV)] were calculated. Trained rats had increased LV mass index (trained vs. control; 2.76 Ϯ 0.07 vs. 2.14 Ϯ 0.05 g/kg, P Ͻ 0.001). P-V loop-derived contractility parameters were significantly improved in the trained group (ESPVR: 3.58 Ϯ 0.22 vs. 2.51 Ϯ 0.11 mmHg/ l; PRSW: 131 Ϯ 4 vs. 104 Ϯ 2 mmHg, P Ͻ 0.01). Strain and strain rate parameters were also supernormal in trained rats (GLS: Ϫ18.8 Ϯ 0.3 vs. Ϫ15.8 Ϯ 0.4%; LSr: Ϫ5.0 Ϯ 0.2 vs. Ϫ4.1 Ϯ 0.1 Hz; GCS: Ϫ18.9 Ϯ 0.8 vs. Ϫ14.9 Ϯ 0.6%; CSr: Ϫ4.9 Ϯ 0.2 vs. Ϫ3.8 Ϯ 0.2 Hz, P Ͻ 0.01). ESPVR correlated with GLS (r ϭ Ϫ0.71) and LSr (r ϭ Ϫ0.53) and robustly with GCS (r ϭ Ϫ0.83) and CSr (r ϭ Ϫ0.75, all P Ͻ 0.05). PRSW was strongly related to GLS (r ϭ Ϫ0.64) and LSr (r ϭ Ϫ0.71, both P Ͻ 0.01). STE can be a feasible and useful method for animal experiments. In our rat model, strain and strain rate parameters closely reflected the improvement in intrinsic contractile function induced by exercise training. speckle-tracking echocardiography; pressure-volume analysis; athlete's heart; contractility; strain LONG-TERM EXERCISE TRAINING induces physiological left ventricular (LV) hypertrophy, a molecular and cellular growth process of the heart in response to altered loading conditions (6). In contrast to pathological hypertrophy, this adaptation leads to maintained or even enhanced cardiac function (2, 14). Hemodynamic changes of exercise-induced hypertrophy were characterized by our research group in a rat model, focusing also on the improved LV inotropic state (23). Contractility is the intrinsic ability of the myocardium to generate force and to shorten independently of changes in preload or afterload with fixed heart rates. In the past few decades, efforts have been made to transfer the physiological concept of contractility to the intact beating heart (4).Pressure-volume (P-V) analysis recently became the gold standard to investigate in vivo hemodynamics in animal models. During preload reduction maneuvers such as gradual occlusion of vena cava inferior, load-independent indices of myocardial contractility could be obtained (20). Th...

Assessment of right ventricular (RV) function using conventional echocardiography might be inadequate as the radial motion of the RV free wall is often neglected. Our aim was to quantify the longitudinal and the radial components of RV function using three-dimensional (3D) echocardiography in heart transplant (HTX) recipients. Fifty-one HTX patients in stable cardiovascular condition without history of relevant rejection episode or chronic allograft vasculopathy and 30 healthy volunteers were enrolled. RV end-diastolic (EDV) volume and total ejection fraction (TEF) were measured by 3D echocardiography. Furthermore, we quantified longitudinal (LEF) and radial ejection fraction (REF) by decomposing the motion of the RV using the ReVISION method. RV EDV did not differ between groups (HTX vs control; 96 ± 27 vs 97 ± 2 mL). In HTX patients, TEF was lower, however, tricuspid annular plane systolic excursion (TAPSE) decreased to a greater extent (TEF: 47 ± 7 vs 54 ± 4% [-13%], TAPSE: 11 ± 5 vs 21 ± 4 mm [-48%], P < .0001). In HTX patients, REF/TEF ratio was significantly higher compared to LEF/TEF (REF/TEF vs LEF/TEF: 0.58 ± 0.10 vs 0.27 ± 0.08, P < .0001), while in controls the REF/TEF and LEF/TEF ratio was similar (0.45 ± 0.07 vs 0.47 ± 0.07). Current results confirm the superiority of radial motion in determining RV function in HTX patients. Parameters incorporating the radial motion are recommended to assess RV function in HTX recipients.

IntroductionDespite the significant contribution of circumferential shortening to the global ventricular function, data are scarce concerning its prognostic value on long-term mortality. Accordingly, our study aimed to assess both left (LV) and right ventricular (RV) global longitudinal (GLS) and global circumferential strain (GCS) using three-dimensional echocardiography (3DE) to determine their prognostic importance.MethodsThree hundred fifty-seven patients with a wide variety of left-sided cardiac diseases were retrospectively identified (64 ± 15 years, 70% males) who underwent clinically indicated 3DE. LV and RV GLS, and GCS were quantified. To determine the prognostic power of the different patterns of biventricular mechanics, we divided the patient population into four groups. Group 1 consisted of patients with both LV GLS and RV GCS above the respective median values; Group 2 was defined as patients with LV GLS below the median while RV GCS above the median, whereas in Group 3, patients had LV GLS values above the median, while RV GCS was below median. Group 4 was defined as patients with both LV GLS and RV GCS below the median. Patients were followed up for a median of 41 months. The primary endpoint was all-cause mortality.ResultsFifty-five patients (15%) met the primary endpoint. Impaired values of both LV GCS (HR, 1.056 [95% CI, 1.027–1.085], p &lt; 0.001) and RV GCS (1.115 [1.068–1.164], p &lt; 0.001) were associated with increased risk of death by univariable Cox regression. Patients with both LV GLS and RV GCS below the median (Group 4) had a more than 5-fold increased risk of death compared with those in Group 1 (5.089 [2.399–10.793], p &lt; 0.001) and more than 3.5-fold compared with those in Group 2 (3.565 [1.256–10.122], p = 0.017). Interestingly, there was no significant difference in mortality between Group 3 (with LV GLS above the median) and Group 4, but being categorized into Group 3 versus Group 1 still held a more than 3-fold risk (3.099 [1.284–7.484], p = 0.012).DiscussionThe impaired values of both LV and RV GCS are associated with long-term all-cause mortality, emphasizing the importance of assessing biventricular circumferential mechanics. Reduced RV GCS is associated with significantly increased risk of mortality even if LV GLS is preserved.

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The occurrence of tricuspid insufficiency (TI) is common after orthotropic heart transplantation (OHT). Sometimes it can be serious and lead to mortality. We investigated possible variables influencing TI after OHT and identified possible risk factors responsible for clinical significant TI development and progression. Methods: We identified an incidence of tricuspid insufficiency in 857 from 1515 patients who underwent OHT between years 1986-2010, survived at least 12 months and had echocardiographic assessments available. The variables that can influence tricuspid insufficiency statistically analysed on representative group of 152 patients. The patients of representative group, according to severity of TI divided into two groups, patients with TI≤ 2 grade and with TI > 2 grade. Results: We found no significant difference among the groups in terms of recipient gender, basic disease, recipient weight, recipient's BMI, BSA, preoperative pulmonary arterial pressure, donor organ ischemia time, donor gender, age, height, weight, BMI, BSA, chest X-Ray thorax width, chest X-ray heart width, chest X-Ray thorax/heart ratio, highest rejection grade on biopsy and vascular reaction. In univariate analysis study variables such as age of recipient (p= 0.027), donor to recipient right atrium anterior wall ratio (p< 0.001), tricuspid annulus anterior to septal leaflet excursion ratio (p= 0.001), dialysis (p= 0.026), total biopsy number (p= 0.003) showed significance and variables height of recipient (p= 0.080), BMI donor to BMI recipient ratio (p= 0.080) and number of biopsies with more than moderate grade (p= 0.067) showed trend to significance for developing severe TI after OHT. In multivariate analysis we found that, there is an independent significant association between TI after OHT and donor to recipient right atrium anterior wall ratio, number of biopsies and dialysis. Moderate to severe and severe TI have no significance for mortality after OHT. Conclusion: Donor to recipient right atrium front wall ratio, number of biopsy, and dialysis act as major risk factor for TI after OHT. Which shows that preserving annular geometry, decreasing biopsy number and preventing functional tricuspid insufficiency is essential for freedom from respectively further progression of tricuspid insufficiency after cardiac transplantation.

A szívelégtelen beteg életútját számos ponton befolyásolja pszichés állapota és szociális helyzete. Ezen tényezők és a fizikai betegség egymásra hatásai hozzájárulnak a beteg együttműködési készségéhez (adherencia), ezen keresztül is hatva a betegség kimenetelére, a beteg életminőségére. Ugyanakkor, ezen faktorok interdiszciplináris voltuknál fogva a mindennapi gyakorlatban nehezen értékelhetők és kezelhetők az orvos szempontjából, ebben segítséget nyújthat a társszakmákkal való szoros együttműködésen alapuló ellátási forma. Jelen összefoglaló célja az adherenciát befolyásoló lelki és szociális faktorok áttekintése a szívelégtelenségtől a szívtranszplantációig, multidiszciplináris szemléletben.

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Az akut kardiális allograft rejekció a modern immunszuppresszív terápia ellenére jelenleg is az egyik vezető halálok szívtranszplantált betegek körében. Az akut rejekció kimutatásának referenciamódszere az endomiokardiális biopszia, azonban a noninvazív képalkotó diagnosztikus eljárások napjainkban e témában a tudományos kutatások fókuszába kerültek. A szív MR-(CMR) vizsgálat a bal és jobb kamra globális és regionális funkció meghatározásán túl szöveti karakterizációs képessége miatt kiemelkedik ezen modalitások közül. A kevert típusú (celluláris és humorális) rejekció ritka entitás, amelyről csak kevés irodalmi adat áll rendelkezésünkre, diagnosztikája sok esetben kihívást jelenthet. A kevert rejekció okozta CMR-eltérésekről nagyon korlátozottak az ismereteink. Az elmúlt évben három szívtranszplantált betegnél akut kevert típusú rejekciót diagnosztizáltunk, az elvégzett CMR-vizsgálat mindhárom beteg esetében nagyon hasonló eltéréseket mutatott. Egy beteg esetén kontroll CMR-vizsgálatokat is végeztünk, nyomon követve a bal és jobb kamrai ejekciós frakciók, volumenek, valamint az ödéma és késői kontraszthalmozás mintázatának változását a kezelés függvényében. A kutatás az "NVKP_16-1-2016-0017 számú projekt a Nemzeti Kutatási Fejlesztési és Innovációs Alapból biztosított támogatással, az NVKP_16 pályázati program finanszírozásában valósult meg. TheroleofCMRintheevaluationofacutemixedcardiacallograftrejectionDespite of the modern immunosuppressive therapy the acute cardiac allograft rejection is a leading cause of morbidity and mortality in heart transplant patients. Endomyocardial biopsy is considered the current gold standard for the diagnosis of acute cardiac rejection, nevertheless there is an intense research regarding on non-invasive diagnostic methods in this field. Cardiac magnetic resonance imaging (CMR) has an evolving role in the detection of acute rejection among these modalities because of its ability to quantify ventricular function and characterize the complete myocardial tissue. There are only few data of the mixed (cellular and humoral) rejection which is a very rare entity, and the diagnosis remains challenging. Our knowledge about the CMR findings of mixed cardiac rejection is limited as well. In the last year we have made a diagnosis of mixed cardiac rejection in three patients, and the subsequently performed CMR showed very similar features in each patients. We performed serial CMR examinations in one patient to follow-up the changes of left and right ventricular volumes, ejection fractions and the pattern of myocardial oedema and delayed contrast enhancement.