The diagnosis of acute viral myocarditis can be very challenging during the initial evaluation, warranting multiple diagnostic tests to be performed, including a full echocardiographic evaluation to exclude other aetiologies that might present similarly. Acute myocarditis may masquerade as acute myocardial infarction in older patients or as any form of cardiomyopathy in young patients. As a result, all these patients need a thorough evaluation and to be managed at a high cardiac-care setting from the very outset. A wide range of diagnostic tests may be warranted, including conventional echocardiography, to exclude other underlying cardiac diseases, to evaluate cardiac chamber size, wall thickness, ventricular function and the presence of pericardial collections, and to assist in guiding further management. Although left ventricular dysfunction tends to be described more often, right ventricular dysfunction has been reported as the most likely cause of unfavourable outcomes, compared with left ventricular dysfunction. Therefore it is important to thoroughly evaluate and report all echocardiographic parameters for both ventricles and to determine the prognosis.

Although carcinoid syndrome is regarded as a rare entity, carcinoid patients with evidence of cardiac involvement show a markedly reduced survival time. Patients with advanced signs of right-sided heart failure represent a subgroup at particularly high risk. Echocardiography remains the gold standard to diagnose or confirm structural cardiac involvement in patients with underlying carcinoid disease. This is the notion that propelled us to report on cases of carcinoid syndrome with cardiac involvement. We also review carcinoid syndrome and carcinoid heart disease, and challenges regarding the diagnosis and management of carcinoid heart disease.

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Background Chronic heart failure (CHF) is associated with the high ventricular filling pressures with subsequent negative impact on the left (LV) and right ventricular (RV), and left atrium (LA) mechanics, and pulmonary vasculature. All these could lead to poor long-term outcome. Purpose Assess the prognostic implications of LA, LV and RV mechanical dysfunction, and pulmonary hypertension, in CHF based on advanced echocardiographic technology. Methods A total of 2110 CHF patients were retrospectively reviewed and enrolled for the analyses. The 2D-Speckle tracking echocardiographic analysis was used to measure the peak LV, RV and LA longitudinal strain. The long-term outcomes were evaluated for all-cause CVS outcomes and recurrent hospitalization. Results For the 941eligible patients [mean age: 61±4; 62% male sex], 244 reached the combined endpoint. Population was divided into three groups based on the mean pulmonary artery systolic pressure (mPASP): Group 1, 25<mPASP≤40 mmHg; Group 2, 40<mPASP≤55 mmHg and Group 3, >mPASP 55 mmHg. Mean follow-up was 2.5±0.6 years. The higher mPASP was demonstrated in those with higher left atrial volume ndex (LAVI), NYHA ≥II class, pulmonary diseases, presence of at least moderate mitral and/or tricuspid regurgitation (TR) grades, significantly lower LVEF, lower strain values (LA, LV, RV), and tricuspid annular plane systolic excursion (TAPSE), p<0.001). High mPASP, lower LVEF and RV dysfunction were independent predictors of survival after multiple adjustments using different models. Conclusions Multiple factors are associated with poor outcomes in CHF; particularly the presence of RV dysfunction, severe PH and severely impaired, which would guide further manage of CHF and to consider other treatment options including device therapy or even transplantation. All these factors could strongly influence the risk stratification of patients with CHF Funding Acknowledgement Type of funding sources: None.