Objective: The role of right ventricular longitudinal strain for assessing patients with repaired tetralogy of Fallot is not fully understood. In this study, we aimed to evaluate its relation with other structural and functional parameters in these patients. Methods: Patients followed-up in a grown-up CHD unit, assessed by transthoracic echocardiography, cardiac MRI, and treadmill exercise testing, were retrospectively evaluated. Right ventricular size and function and pulmonary regurgitation severity were assessed by echocardiography and MRI. Right ventricular longitudinal strain was evaluated in the four-chamber view using the standard semiautomatic method. Results: In total, 42 patients were included (61% male, 32 ± 8 years). The mean right ventricular longitudinal strain was −16.2 ± 3.7%, and the right ventricular ejection fraction, measured by MRI, was 42.9 ± 7.2%. Longitudinal strain showed linear correlation with tricuspid annular systolic excursion (r = − 0.40) and right ventricular ejection fraction (r = − 0.45) (all p < 0.05), which in turn showed linear correlation with right ventricular fractional area change (r = 0.50), pulmonary regurgitation colour length (r = 0.35), right ventricular end-systolic volume (r = − 0.60), and left ventricular ejection fraction (r = 0.36) (all p < 0.05). Longitudinal strain (β = − 0.72, 95% confidence interval −1.41, −0.15) and left ventricular ejection fraction (β = 0.39, 95% confidence interval 0.11, 0.67) were independently associated with right ventricular ejection fraction. The best threshold of longitudinal strain for predicting a right ventricular ejection fraction of <40% was −17.0%. Conclusions: Right ventricular longitudinal strain is a powerful method for evaluating patients with tetralogy of Fallot. It correlated with echocardiographic right ventricular function parameters and was independently associated with right ventricular ejection fraction derived by MRI.

Serial transthoracic echocardiographic (TTE) assessment of 2D left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) are the gold standard screening methods for cancer therapeutics-related cardiac dysfunction (CTRCD). Non-invasive left ventricular (LV) pressure-strain loop (PSL) provides a novel method of quantifying myocardial work (MW) with potential advantages to evaluate the impact of cardiotoxic treatments on heart function. We prospectively assessed breast cancer female patients undergoing cancer therapy through serial monitoring by 2D and 3D TTE. Patients were evaluated at T0, T1 and T2 (before, 4–6 and 12–14 months after starting therapy, respectively). Through PSL analysis, MW indices were calculated. A total of 122 patients, with a mean age of 54.7 years, who received treatment with anthracyclines (77.0%) and anti-HER2 (75.4%) were included. During a mean follow-up of 14.9 ± 9.3 months, LVEF and GLS were significantly diminished, and 29.5% developed CTRCD. All MW indices were significantly reduced at T1 compared with baseline and tended to return to baseline values at T2. Global work index and global work efficiency showed a more pronounced variation in patients with CTRCD. The presence of more than one cardiovascular risk factor, obesity and baseline left atrium volume were predictors of changes in MW parameters. In conclusion, breast cancer treatment was associated with LV systolic dysfunction as assessed by MW, with its peak at 4–6 months and a partial recovery afterwards. Assessment of myocardial deformation parameters allows a more detailed characterization of cardiac remodelling and could enhance patient screening and selection for cardioprotective therapeutics.

An increase in exercise capacity after CRT implantation is associated with improvement in myocardial remodeling and inflammatory biomarkers. This finding highlights the importance of improvement in functional capacity after CRT implantation, not commonly considered a criterion of CRT response.

VE/VCO slope was the most accurate parameter for risk stratification in patients with heart failure and reduced ejection fraction. Those with VE/VCO slope ≥39.0 may benefit from heart transplantation.

Giant cell arteritis (GCA) is a systemic large vessel vasculitis, with extracranial arterial involvement described in 10---15% of cases, usually affecting the aorta and its branches. Patients with GCA are more likely to develop aortic aneurysms, but these are rarely present at the time of the diagnosis.We report the case of an 80-year-old Caucasian woman, who reported proximal muscle pain in the arms with morning stiffness of the shoulders for eight months. In the previous two months, she had developed worsening bilateral arm claudication, severe pain, cold extremities and digital necrosis. She had no palpable radial pulses and no measurable blood pressure.The patient had normochromic anemia, erythrocyte sedimentation rate of 120 mm/h, and a negative infectious and autoimmune workup. Computed tomography angiography revealed concentric wall thickening of the aorta extending to the aortic arch branches, particularly the subclavian and axillary arteries, which were severely stenotic, with areas of bilateral occlusion and an aneurysm of the ascending aorta (47 mm). Despite corticosteroid therapy there was progression to acute critical ischemia. She accordingly underwent surgical revascularization using a bilateral carotid-humeral bypass. After surgery, corticosteroid therapy was maintained and at six-month follow-up she was clinically stable with reduced inflammatory markers.GCA, usually a chronic benign vasculitis, presented exceptionally in this case as acute critical upper limb ischemia, resulting from a massive inflammatory process of the subclavian and axillary arteries, treated with salvage surgical revascularization. 2174-2049Document downloaded from http://www.elsevier.es, day 15/09/2017. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. Document downloaded from http://www.elsevier.es, day 15/09/2017. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. 237.e2L. Almeida-Morais et al. PALAVRAS-CHAVEArterite de células gigantes; Isquemia crítica dos membros superiores; Bypass carótido-umeral Isquemia crítica dos membros superiores, uma apresentação rara de arterite de células gigantes Resumo A arterite de células gigantes (ACG) é uma vasculite de grandes vasos, com envolvimento extracraniano em 10-15% dos casos, afetando preferencialmente a aorta e os seus ramos. Os aneurismas da aorta ascendente são mais frequentes em doentes com ACG, mas são raros no momento do diagnóstico.Apresentamos o caso de uma doente, caucasiana, com 80 anos de idade, que descrevia dor muscular nos membros superiores, com rigidez matinal dos ombros, desde há oito meses. Nos últimos dois meses referia claudicação intermitente de agravamento progressivo, dor intensa, extremidades frias e o aparecimento de úlceras digitais. Ao exame objetivo não se palpavam pulsos radiais ou cubitais, nem se registavam valores de pressão arterial.Laboratorialmente, destacava-se anemia normocíticanormocrómica, VS de 120 mm/h e ...

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Giant cell arteritis (GCA) is a systemic large vessel vasculitis, with extracranial arterial involvement described in 10---15% of cases, usually affecting the aorta and its branches. Patients with GCA are more likely to develop aortic aneurysms, but these are rarely present at the time of the diagnosis.We report the case of an 80-year-old Caucasian woman, who reported proximal muscle pain in the arms with morning stiffness of the shoulders for eight months. In the previous two months, she had developed worsening bilateral arm claudication, severe pain, cold extremities and digital necrosis. She had no palpable radial pulses and no measurable blood pressure.The patient had normochromic anemia, erythrocyte sedimentation rate of 120 mm/h, and a negative infectious and autoimmune workup. Computed tomography angiography revealed concentric wall thickening of the aorta extending to the aortic arch branches, particularly the subclavian and axillary arteries, which were severely stenotic, with areas of bilateral occlusion and an aneurysm of the ascending aorta (47 mm). Despite corticosteroid therapy there was progression to acute critical ischemia. She accordingly underwent surgical revascularization using a bilateral carotid-humeral bypass. After surgery, corticosteroid therapy was maintained and at six-month follow-up she was clinically stable with reduced inflammatory markers.GCA, usually a chronic benign vasculitis, presented exceptionally in this case as acute critical upper limb ischemia, resulting from a massive inflammatory process of the subclavian and axillary arteries, treated with salvage surgical revascularization. 2174-2049Document downloaded from http://www.elsevier.es, day 15/09/2017. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. Document downloaded from http://www.elsevier.es, day 15/09/2017. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. 237.e2L. Almeida-Morais et al. PALAVRAS-CHAVEArterite de células gigantes; Isquemia crítica dos membros superiores; Bypass carótido-umeral Isquemia crítica dos membros superiores, uma apresentação rara de arterite de células gigantes Resumo A arterite de células gigantes (ACG) é uma vasculite de grandes vasos, com envolvimento extracraniano em 10-15% dos casos, afetando preferencialmente a aorta e os seus ramos. Os aneurismas da aorta ascendente são mais frequentes em doentes com ACG, mas são raros no momento do diagnóstico.Apresentamos o caso de uma doente, caucasiana, com 80 anos de idade, que descrevia dor muscular nos membros superiores, com rigidez matinal dos ombros, desde há oito meses. Nos últimos dois meses referia claudicação intermitente de agravamento progressivo, dor intensa, extremidades frias e o aparecimento de úlceras digitais. Ao exame objetivo não se palpavam pulsos radiais ou cubitais, nem se registavam valores de pressão arterial.Laboratorialmente, destacava-se anemia normocíticanormocrómica, VS de 120 mm/h e ...