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.)

SUMMARYLeft ventricular (LV) dysfunction generally occurs early in the course of subarachnoid hemorrhage (SAH). We evaluated the prognostic value of electrocardiographic (ECG) abnormalities and echocardiographic LV dysfunction evaluated shortly after SAH.We prospectively enrolled 47 SAH patients (62 ± 14 years, mean ± SD) who were admitted to the neurosurgical care unit of our institute. Neurological status was rated on the day of admission. Twelve-lead ECG and 2-dimensional echocardiography were recorded 2 ± 1 day after onset of SAH. ECG abnormalities (pathological Q-wave, ST-segment deviation, T-wave inversion, and QT prolongation) were evaluated and the incidences of global (LV ejection fraction < 50%) and segmental (regional wall motion abnormality [RWMA]) LV dysfunction were measured.During a follow-up period of 44 ± 23 days, 17 (36%) patients died. ECG abnormalities, LV ejection fraction < 50%, and RWMA were observed in 62%, 11%, and 28% of patients, respectively. Univariate Cox proportional hazards regression analysis revealed that neurological status, rate-corrected QT interval, LV ejection fraction, and RWMA were significant predictors of death. After adjustment for these significant clinical variables, and age and sex, independent predictors of mortality were neurological status and RWMA.RWMA may provide significant prognostic information in patients with SAH. (Int Heart J 2008; 49: 75-85)

ransient thickening of the ventricular wall sometimes develops in patients with acute myocarditis, 1-17 and we have shown that it is the result of interstitial edema. 1 However, the influence of the ventricular wall thickening per se on left ventricular function in acute myocarditis has not been elucidated, so we reviewed serial echocardiograms of patients with acute myocarditis and attempted to determine the relationship between ventricular wall thickening and left ventricular function. Methods Study PatientsDuring the 12-year period from 1987 to 1998, 60 patients at Fujita Health University Hospital or Nagoya Dai-ni Red Cross Hospital were diagnosed as having acute myocarditis based on clinical symptoms and endomyocardial biopsy findings. Echocardiography and right ventricular endomyocardial biopsies were performed during both the acute (≤2 weeks after onset) and convalescent (≥1 month after onset) phases in 29 of the patients. Of these, 9 patients with second or third degree atrioventricular block were excluded, and the remaining 20 patients comprised the current study group (12 men, 8 women; mean age, 36.5±16.1 years) ( Table 1). In addition to the conventional pharmacological therapies, steroids, catecholamines, and diuretics were being taken by 5, 13, and 16 patients, respectively. Percutaneous cardiopulmonary support and intraaortic balloon pumping were used in 2 patients each. Endomyocardial BiopsiesRight ventricular endomyocardial biopsies were performed, and at least 3 tissue fragments were obtained in each patient. The samples were fixed immediately in 10% buffered formalin, and multiple sections were stained with hematoxylin-eosin, Azan-Mallory, and elastica van Gieson stains for light microscopic examination. The histologic sections were analyzed by 3 observers, and a diagnosis of myocarditis was reached by consensus. The final diagnosis of lymphocytic myocarditis [18][19][20] was based on the Dallas criteria. 18 Only patients with histologic evidence of "active" myocarditis were included.Eosinophilic myocarditis [21][22][23][24] was defined as the development of cardiac symptoms in the presence of peripheral blood eosinophilia and endomyocardial biopsy evidence of eosinophilic infiltration, degranulation, and myocyte necrosis. Using the Azan-Mallory-stained specimens, myocardial

We compared the diagnostic utility of serum concentrations of human heart-type cytoplasmic fatty acid-binding protein (H-FABPc), myoglobin, and their ratio for the early diagnosis of acute myocardial infarction (AMI) in 104 healthy volunteers and 165 patients at admission within 6 h of the onset of chest pain. The ROC curves of the H-FABPc [0.946, 95% confidence interval (CI) = 0.913–0.979] and myoglobin (0.895, 95% CI = 0.846–0.944) between patients with AMI and healthy volunteers were significantly greater than the area under the ratio of myoglobin to H-FABPc (0.823, 95% CI = 0.765–0.881). In 165 patients, the sensitivity (81.8%, 95% CI = 74.2–89.4%), specificity (86.4%, 95% CI = 78.1–94.6%), and predictive accuracy (83.6%, 95% CI = 78.0–89.3%) of H-FABPc &gt;12 μg/L in diagnosing AMI were significantly higher than those of myoglobin, and were similar to those of the combination of H-FABPc &gt;12 μg/L and the ratio ≤14. We conclude that H-FABPc is a more sensitive and specific marker than myoglobin for the early diagnosis of AMI, and that their ratio cannot give a clear advantage over the measurement of H-FABPc alone.

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.