Objective: Treatment of subclinical hypothyroidism (ScH), especially the mild form of ScH, is controversial because thyroid hormones influence cardiac function. We investigate left ventricular systolic and diastolic function in ScH and evaluate the effect of 5-month levothyroxine treatment. Subjects and methods: Fifty-four patients with newly diagnosed mild ScH (4.2 < TSH < 10.0 mU/L) and 30 euthyroid subjects matched by age were analysed. Laboratory analyses and an echocardiography study were done at the first visit and after 5 months in euthyroid stage in patients with ScH. Results: Compared to healthy controls, patients with ScH had a lower E/A ratio (1.03 ± 0.29 vs. 1.26 ± 0.36, p < 0.01), higher E/e' sep. ratio (7.62 ± 2.29 vs. 6.04 ± 1.64, p < 0.01), higher myocardial performance index (MPI) (0.47 ± 0.08 vs. 0.43 ± 0.07, p < 0.05), lower global longitudinal strain (GLS) (-19.5 ± 2.3 vs.-20.9 ± 1.7%, p < 0.05), and lower S wave derived by tissue Doppler imaging (0.077 ± 0.013 vs. 0.092 ± 0.011 m/s, p < 0.01). Levothyroxine treatment in patients with ScH contributed to higher EF (62.9 ± 3.9 vs. 61.6 ± 4.4%, p < 0.05), lower E/e' sep. ratio (6.60 ± 2.06 vs. 7.62 ± 2.29, p < 0.01), lower MPI (0.43 ± 0.07 vs. 0.47 ± 0.08%, p < 0.01), and improved GLS (-20.07 ± 2.7 vs.-19.55 ± 2.3%, p < 0.05) compared to values in ScH patients at baseline. Furthermore, in all study populations (ScH patients before and after levothyroxine therapy and controls), TSH levels significantly negatively correlated with EF (r =-0.15, p < 0.05), E/A (r =-0.14, p < 0.05), GLS (r =-0.26, p < 0.001), and S/TDI (r =-0.22, p < 0.01) and positively correlated with E/e' sep. (r = 0.14, p < 0.05). Conclusion: Patients with subclinical hypothyroidism versus healthy individuals had subtle changes in certain parameters that indicate involvement of systolic and diastolic function of the left ventricle. Although the values of the parameters were in normal range, they were significantly different compared to ScH and the control group at baseline, as well as to the ScH groups before and after treatment. The results of our study suggest that patients with ScH must be followed up during treatment to assess improvement of the disease. Some of the echocardiography obtained parameters were reversible after levothyroxine therapy.

Introduction The left ventricular ejection fraction (LVEF) is commonly used as a marker of aortic stenosis (AS) disease severity and to indicate surgical intervention. However, an LVEF <50% identifies mainly advanced disease. Hence, earlier detection of subclinical LV systolic dysfunction may improve clinical decision-making. The global longitudinal strain (GLS) can identify subclinical systolic dysfunction at earlier stages of AS progression even in the presence of preserved LVEF. To this end, we evaluated the preoperative prognostic significance of the LVGLS to identify patients who will undergo a more extensive postoperative LV reverse remodeling as a surrogate marker for clinical recovery. Methods We performed a prospective observational study based on detailed pre- and postoperative 2D transthoracic echocardiographic examinations, including strain analysis with speckle tracking. We screened 60 consecutive patients with severe AS and a preoperative LVEF ≥50% indicated for surgery; 39 patients met the study entry criteria and consented to their participation. Results The median age was 67 (range 30-79) years; 56.4% were female. At baseline, the GLS was 61.64±7.22%. Surgery led to an improvement in the GLS; the mean difference was 3.23% [95% CI=1.96 to 4.49%] during a median follow up time of 5 (interquartile range 4-6) months. The preoperative GLS correlated with the postoperative LV mass index (LVMI) r=0.526, P =0.001 and the intraventricular septal thickness in diastole (IVSd) r=0.462, P =0.003. Furthermore, patients with a normal GLS (≤-18.9%) at baseline experienced a better recovery of their LV morphology and systolic function during the postoperative course compared to those with an abnormal GLS (>-18.9%). The effect size, hedges g, was at least >0.75 for the LVMI, IVSd, intraventricular septal thickness in systole (IVSs), left ventricular posterior wall thickness in diastole (LVPWd) and LVEF, suggesting a clinically significant difference between subgroups at follow-up. Conclusion A normal preoperative left ventricular global longitudinal strain is associated with an improved left ventricular reverse remodeling and systolic function following surgery to resolve aortic stenosis.

Obesity-related atrial cardiomyopathy is a clinical entity characterized by a variety of functional and structural abnormalities in the atria's myocardium. This study aimed to investigate the morphological and functional alterations of the left atrium (LA) in overweight and obese subjects.The study included 56 subjects aged 47+9.6 years, categorized into 4 groups according to their body mass index (BMI): group 1 -overweight (BMI 25-29.9 kg/m 2 ); group 2 -class I obesity (BMI 30-34.9 kg/m2); group 3 -class II obesity (BMI 35-39.9 kg/m 2 ) and group 4 -class III obesity (BMI >40 kg/m 2 ). All subjects underwent two-dimensional (2D) conventional echocardiography and speckle tracking myocardial deformation assessment. Left atrial enlargement (LAE) was registered in all four groups, with an average value of LA diameter 40.0±4.9 mm and LA volume (LAV) indexed to height (LAVh) 35.0 +7.8 ml. Global longitudinal strain (GLS%) and circumferential strain (GCS%) of LA were lower than reference normal values in all groups. LAV indexed to body surface area (LAVI) correlated with hip circumference (r=0.264; p=0.049), whereas LAVh correlated with waist and hip circumference (r=0.378; p=0.004). Linear regression analysis showed that hip circumference was a predictive factor for increasing LAVI (B=0.114; p=0.049; 95%CI 0.000-0.227) and LAVh (B=0.266; p =0.0001; 95%CI 0.129-0.403).LAVh is a clinically useful echocardiographic parameter to assess LA size in obese population. A sensitive method for detecting subclinical functional alterations of LA is assessment of its speckle tracking longitudinal strain.

Funding Acknowledgements Type of funding sources: None. Introduction Paradoxical aortic stenosis (AS) is low-flow (SVi ≤ 35ml/m2) , low- gradient (Mean PG ≤ 40mmHg) severe aortic stenosis (AVA &lt; 1cm2) in patients with preserved ejection fraction (EF ≥ 50%) usually associated with female gender, advanced age, small body size and history of hypertension. Left ventricular (LV) reverse remodeling presents with LV hypertrophy reversal following aortic valve replacement (AVR) and is associated with better long term prognosis. Purpose The purpose of our study was to asses echocardiographic predictors of better outcome in patients with paradoxical severe AS following AVR. Methods Detailed transthoracic echocardiographic (TTE) evaluation with left ventricular strain analysis was performed using 2D Philips Epique 7 in patients with severe aortic stenosis with AVR indication before and 4 months after the intervention. Results Among 75 patients with severe AS and indication for AVR, 20 (31, 7%) were paradoxical AS with low- flow, low –gradient and preserved ejection fraction. Sixty percent were female and eighty percent had hypertension where all echocardiographic parameters improved following AVR including improvement of LV global longitudinal strain (LS) as well as reduction of left ventricular mass indicating left ventricular reverse remodeling (Figure 1). The patients with paradoxical AS compared to the other forms of severe AS had the lowest values for MAPSE and s’TDI before and after AVR. Independent predictors of LV reverse remodeling before AVR were end systolic LV volume (ESV) , AVA/BSA and the number of segments with LS &lt; 13%. Conclusion Paradoxical severe AS is associated with worse post AVR prognosis compared to the high gradient severe AS.  Echocardiographic predictors of LV reverse remodeling in patients with paradoxical severe AS following AVR are LV ESV, AVA/BSA and number of segments with LS &lt; 13%. Timely diagnosis and AVR referral of patients with paradoxical severe AS is of major importance in the management of aortic valvular disease. Abstract Figure. Descriptive of 20pts with paradoxical AS  Abstract Figure. Predictors of LV reverse remodeling