Background and Purpose-The majority of patients with ventricular wall motion abnormality (WMA) associated with subarachnoid hemorrhage (SAH) are postmenopausal women. In addition to elevated catecholamine, the role of estrogen in the pathogenesis of WMA has recently been implicated. The objective of this study is to clarify the interrelation among catecholamine, estrogen, and WMA in patients with SAH. Methods-A retrospective analysis was performed on the medical records of 77 patients with SAH (23 men, 54 women) whose plasma levels of epinephrine, norepinephrine, and estradiol had been measured and echocardiograms had been obtained within 48 hours of SAH onset. Results-Twenty-four patients (31%) were found to sustain WMA on admission. Multivariate regression analysis revealed that decreased estradiol (Pϭ0.018; OR, 0.902) and elevated norepinephrine levels (Pϭ0.027; OR, 1.002) were associated with WMA. After quadrichotomization of 77 patients based on sex/WMA, plasma norepinephrine levels were markedly elevated in men with WMA, whereas estradiol levels were markedly decreased in women with WMA. Plasma norepinephrine and estradiol levels were not correlated. Fifty-four female patients with SAH were further quadrichotomized based on norepinephrine/estradiol levels with a threshold value of 1375 pg/mL for norepinephrine and 11 pg/mL for estradiol. The incidence of WMA in the high-norepinephrine/low-estradiol group was significantly higher than the low-norepinephrine/high-estradiol group. Conclusions-To our knowledge, this is the first study to evaluate the interrelation among catecholamine, estrogen, and SAH-induced WMA. Lack of estradiol in postmenopausal women may predispose them to develop WMA after poor-grade SAH. However, the precise role of multiple sex hormones in SAH-induced WMA should be evaluated in future prospective studies. (Stroke. 2012;43:1897-1903.)

SummaryRecently two-dimensional (2D) speckle tracking echocardiography (STE) derived from right ventricular (RV) free wall has been shown to be a very useful tool for the estimation of RV performance. The purpose of this study was to examine whether RV basal free wall strain can detect increased mean pulmonary arterial pressure (mPAP) in patients with chronic thromboembolic pulmonary hypertension (CTEPH). We investigated a total of 126 patients with CTEPH (mean age, 56 ± 12 years). They underwent echocardiography and right heart catheter examination. 2D STE-derived longitudinal strain was measured by placing 2 regions of interests (ROIs) on the RV basal free wall in RV-focused apical 4-chamber view. Peak strain (RV-PS) was acquired between the 2 ROIs. Conventional echocardiographic RV parameters (RV fractional area change, RV myocardial performance index, tricuspid annular plane systolic excursion, tricuspid annular peak systolic velocity, and tricuspid regurgitant pressure gradient) were evaluated as well. Right heart catheterization was performed on the day following of echocardiographic evaluation. Among RV echo parameters, RV-PS showed the best correlation with mPAP (r = 0.75, P < 0.0001). Receiver operating characteristic analysis revealed that a cut-off value of RV-PS -20.8% could detect mPAP ≧ 25 mmHg (sensitivity 78%, specificity 93%, area under the curve 0.90, P < 0.001). RV basal free wall strain was a useful tool for the non-invasive detection of increased mPAP in patients with CTEPH. (Int Heart J 2015; 56: 100-104) Key words: Peak longitudinal strain, Right ventricular function, Mean pulmonary arterial pressure C hronic thromboembolic pulmonary hypertension (CTEPH) is a life-threatening condition characterized by pulmonary thromboemboli that obstruct or obliterate the pulmonary vascular bed, followed by increased pulmonary vascular resistance (PVR) and progressive pulmonary hypertension (PH).Most standard techniques for assessing pulmonary hemodynamics, such as mean pulmonary arterial pressure (mPAP) or PVR, are invasive and impractical for serial assessment. Therefore, a non-invasive method to measure pulmonary hemodynamics accurately is clearly more useful. Echocardiography is a key tool for estimating pulmonary artery pressure in patients with PH. It is valuable in diagnosing, assessing a prognosis, and monitoring the efficacy of treatment.1) However, conventional echocardiographic methods are often challenging to assess right-sided hemodynamics or right ventricular (RV) function because of the complexity of RV anatomy. The recently developed technique, two-dimensional (2D) RV speckle tracking echocardiography (STE), has been introduced for the evaluation of RV function.2,3) The purpose of this study was to examine the utility of 2D RV basal strain in comparison with other RV echocardiographic parameters as well as invasive estimation of pulmonary hemodynamics in patients with CTEPH.

AimsWe evaluated the usefulness of left atrial volume index (LAVI) and the degree of changes in LAVI (delta LAVI) during hospitalization for the prediction of prognosis after acute myocardial infarction (AMI). Methods and resultsWe investigated 205 consecutive patients with first AMI. They underwent echocardiography on admission as well as at discharge. Delta LAVI was calculated by subtracting the value on admission from that at discharge. The primary endpoints were major cardiac events (MACE): cardiac death due to heart failure and heart failure hospitalization. During a mean follow-up of 26 months, MACE occurred in 29 patients. Patients were divided into two groups according to the optimal cut-off values of LAVI (32.0 mL/m 2 ) at discharge and delta LAVI (2.5 mL/m 2 ) derived from receiver operating characteristic curves, respectively; Group I: LAVI ≤ 32.0 mL/m 2 , Group II: LAVI . 32.0 mL/m 2 and Group A: delta LAVI ≤ 2.5 mL/m 2 , Group B: delta LAVI . 2.5 mL/m 2 . In comparisons of two groups, respectively, the incidence of MACE between the groups showed significant differences [Group I (3.8%) vs. Group II (32.0%): P , 0.001, log-rank, Group A (7.4%) vs. Group B (20.0%): P ¼ 0.0079, log-rank]. In multivariate analysis, LAVI at discharge [risk ratio (RR): 1.077, 95% CI: 1.035-1.124, P ¼ 0.0002] and delta LAVI (RR: 1.056, 95% CI: 1.012 -1.108, P ¼ 0.0109) were significant. LAVI . 32.0 mL/m 2 at discharge (sensitivity: 93%, specificity: 69%) and delta LAVI . 2.5 mL/m 2 (sensitivity: 79%, specificity: 50%) were predictors of MACE. ConclusionLAVI at discharge and delta LAVI would be useful predictors for MACE after first AMI.--

DOACs still carry a finite risk of LAT in AF patients. Inappropriately reduced DOAC dose should be avoided to minimize the thromboembolic risk. Regular-dose dabigatran may have therapeutic efficacy against LAT.

LAVI/A' was related to plasma BNP levels in patients with ACS, particularly in those with NSTE-ACS. This index was useful for predicting cardiac events in patients with ACS.