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In mitral regurgitation (MR), left atrium (LA) and left ventricle (LV) undergo remodeling even if the patient is asymptomatic. The aim of our study was to identify the best echo index that correlates with MR severity in asymptomatic patients affected by MR. We enrolled 150 MR patients (50: mild, 50: moderate, 50: severe), asymptomatic for exertional dyspnea and 50 healthy controls. MR was graded using Doppler quantitative method. All underwent standard and Speckle Tracking Echocardiography (STE) with analysis of global peak atrial longitudinal strain (PALS), LV longitudinal strain (LS) and global atrio-ventricular strain (GAVS). LA dimensions showed significant differences between the groups while LV end-diastolic diameter did not significantly differ, although having a slight increase. PALS was slightly higher in patients with mild MR, while decreased in moderate and, mainly, in severe MR (controls 37.4 ± 12.2%, mild MR 38.2 ± 9%, moderate MR 29.1 ± 9%, severe MR 19.8 ± 10.6%, p < 0.0001 by ANOVA); the same was found for GAVS (56.1 ± 13%, 57.6 ± 9.7%, 48.2 ± 9% 39 ± 9.4%, p < 0.0001 by ANOVA). LV LS showed a tendency for gradual reduction in the three groups. In multivariate analysis, PALS and GAVS were far superior than GLS as predictors of MR groups. PALS emerged as an added value to the LA indexed volumes as predictor of MR severity. STE-derived PALS and GAVS emerged as promising tools to investigate heart longitudinal function in patients with chronic MR and no symptoms. PALS can represent a surplus in the prediction of severity of MR, in addition to the assessment of LA volumes.

Background Oesophageal changes and injuries were recorded after atrial fibrillation(AF) ablation procedures. The reduction of power in the posterior left atrial(LA) wall(closest to the oesophagus) and the monitoring of temperature in the oesophagus(OE) reduced oesophageal injuries. The intracardiac-echocardiography(ICE) with a Cartosound module provides two-dimensional imaging (2D) to assess detailed cardiac anatomy and its relationship with the OE. The aim of this study was to highlight the safety and feasibility of 3D-reconstruction of the oesophageal course in left atrial catheter ablation(CA) procedures without OE temperature probe or quadripolar catheter to guide ICE OE reconstruction. Methods 180 patients(PT) underwent left atrial ablation. AF ablation were 125(69.5%); incisional left atrial tachycardias(IAFL) were 37(20.6%); left atrial tachycardias(LAT) were 19(10.6%). The LA and pulmonary vein anatomies were rendered by traditional electroanatomic mapping(EAM) and merged with an ICE anatomic map. In 109 PT ICE imaging was used to create a geometry of the OE(group A). A quadripolar catheter was used in 71 PT to show OE course associated to ICE(group B). Results Ablation energy delivery was performed outside the broadest OE anatomy borders. The duration of procedures was longer in group B vs group A Fluoroscopy time was lower in Group A than Group B(Group A 7 ± 3.2 vs 19.2 ± 2.4 min; p < 0.01). Conclusions OE monitoring with ICE is safe and feasible. Oesophageal anatomy is complex and variable. Many PT will have a broad oesophageal boundary, which increases the risk of untoward thermal injury during posterior LA ablation. ICE with 3D construction of the OE enhances border detection of the OE, and as such, should decrease the risk of oesophageal injury by improving avoidance strategies without intra-oesophageal catheter visualization.

Right ventricular failure (RVF) after left ventricular assist device (LVAD) implant is associated with increasing morbidity and mortality. The aim of this study was to identify the best predictors of RVF post LVAD-implant among biochemical, haemodynamic and echocardiographic parameters. From 2009 to 2019, 38 patients who underwent LVAD implantation at our centre were prospectively enrolled. Preoperative clinical, laboratory, echocardiographic and haemodynamic parameters were reported. Overall, eight patients (21%) developed RVF over time, which revealed to be strongly related to overall mortality. Pulmonary artery pulsatility index (PAPi) resulted to be the most significant right heart catheterization index in discriminating RVF vs no RVF patients [(1.32 ± 0.26 vs. 3.95 ± 3.39 respectively) p = 0.0036]. Regarding transthoracic echocardiography, RVF was associated with reduced free wall right ventricular longitudinal strain (fw-RVLS) (− 7.9 ± 1.29 vs. − 16.14 ± 5.83) (p < 0.009), which was superior to other echocardiographic determinants of RVF. Among laboratory values, N-terminal pro-brain natriuretic peptide (NT-proBNP) was strongly increased in RVF patients [(10,496.13 pg/ml ± 5272.96 pg/ml vs. 2865, 5 pg/ml ± 2595.61 pg/ml) p = 0.006]. PAPi, NT-proBNP and fwRVLS were the best pre-operative predictors of RVF, a post-LVAD implant complication which was confirmed to have a great impact on survival. In particular, fwRVLS has been proven to be the strongest independent predictor.