Two-dimensional speckle tracking echocardiography appeared as a useful additional tool for detection of left atrial dysfunction in patients with heart failure who have preserved left ventricular ejection fraction and diabetes mellitus who are especially prone to develop cardiovascular complications.

BACKGROUND:Percutaneous pulmonary valvuloplasty is well established treatment of choice in pulmonary valve stenosis.AIM:The aim of our study was to present our experience with the interventional technique, its immediate and mid-term effectiveness as well as its complication rate.MATERIAL AND METHODS:The study included 43 patients, where 33 (74%) of them were children between the age of 1 month and 15 years.RESULTS:The procedure was successful in 38 patients or 90%. Mean peak to peak transvalvular gradient was reduced from 91.2 mmHg (55-150 mmHg) to 39.1 mmHg (20-80 mmHg). Follow- up of patients was between 2 and 13 years and included echocardiographic evaluation of pulmonary valve gradient, right heart dimensions and function as well as assessment of pulmonary regurgitation. We experienced one major complication pericardial effusion in a 5 months old child that required pericardiocenthesis. Six patients (13.9%) required a second intervention. During the follow up period there was significant improvement of right heart function and echocardiography parameters. Mild pulmonary regurgitation was noted in 24 (55%) patients, and four (9%) patients developed moderate regurgitation, without affecting the function of the right ventricle.CONCLUSIONS:Percutaneous pulmonary valvuloplasty is an effective procedure in treatment of pulmonary stenosis with good short and mid-term results.

Aim. To raise the awareness of adult-onset carnitite palmitoyltransferase II deficiency (CPT II) by describing clinical, biochemical, and genetic features of the disease occurring in early adulthood. Method. Review of the case characteristics and literature review. Results. We report on a 20-year-old man presenting with dyspnea, fatigue, fever, and myoglobinuria. This was the second episode with such symptoms (the previous one being three years earlier). The symptoms occurred after intense physical work, followed by a viral infection resulting in fever treated with NSAIDs. Massive rhabdomyolysis was diagnosed, resulting in acute renal failure necessitating plasmapheresis and hemodialysis, acute hepatic lesion, and respiratory insufficiency. Additionally, our patient had cardiomyopathy with volume overload. After a detailed workup, CPT II deficiency was suspected. We did a sequencing analysis for exons 1, 3, and 4 of the CPT II gene and found that the patient was homozygote for Ser 113 Leu mutation in exon 3 of the CPT II gene. The patient recovery was complete except for the cardiomiopathy with mildly impaired systolic function. Conclusion. Whenever a patient suffers recurrent episodes of myalgia, followed by myoglobinuria due to rhabdomyolysis, we should always consider the possibility of this rare condition. The definitive diagnose of this condition is achieved by genetic testing.

BACKGROUND:Percutaneous transcatheter closure (PTC) of patent foramen ovale (PFO) is implicated in cryptogenic stroke, transitional ischemic attack (TIA) and treatment of a migraine.AIM:Our goal was to present our experience in the interventional treatment of PFO, as well as to evaluate the short and mid-term results in patients with closed PFO.MATERIAL AND METHODS:Transcatheter closure of PFO was performed in 52 patients (67.3% women, mean age 40.7 ± 11.7 years). Patients were interviewed for subjective grading of the intensity of headaches before and after the PFO closure.RESULTS:During 2 years of follow-up, there was no incidence of new stroke, TIA and/or syncope. Follow-up TCD performed in 35 patients showed complete PFO closure in 20 patients (57.1%). Out of 35 patients, 22 (62.9%) reported having a migraine before the procedure with an intensity of headaches at 8.1 ± 1.9 on a scale from 1 to 10. During 2 years of follow-up, symptoms of a migraine disappeared in 4 (18.2%) and the remaining 18 patients reported the significant decrease in intensity 4.8 ± 2.04 (p = 0.0001). In addition, following PFO closure the incidence of the headaches decreased significantly (p = 0.0001).CONCLUSIONS:Percutaneous transcatheter closure of PFO is a safe and effective procedure showing mid-term relief of neurological symptoms in patients as well as significant reduction of migraine symptoms.

Background:Chronic infections in CHD are due to one or both of the organisms Chlamydia pneumoniae and Helicobacter pylori.Aim:To examine the association between serum markers of Chlamydia pneumoniae and Helicobacter pylori infection and markers of myocardial damage. in patients with acute coronary syndrome (ACS), with chronic coronary artery disease (CAD) and in–control group.Material and methods:Sera were taken from a total of 153 subjects. Subjects were divided in three groups: 64 patients with ACS; 53 patients with CAD and a group of 35 conditionally healthy individuals. Analysis of patients’ sera for IgG antibodies to H. pylori and markers for myocardial damage was done on the Immulite system. The presence of specific IgG and IgA antibodies to C. pneumoniae was determined with MIF, Sero FIA (Savyon Diagnostics, Israel). Statistical analysis of data was done using the statistical program SPSS (Statistical Package for Social Sciences), version 13.Results and discussion:There was a high significant difference in troponin levels between the three groups of subjects (p=0.0000). Levels of creatine kinase isoenzyme (CK-MB) were highest in the ACS group (500.0 ng/mL). There was a statistically significant difference between CG subjects and ACS patients due to more frequent detection of antichlamydial IgA antibodies in patients with acute coronary syndrome. Positive serum immune response for Helicobacter pylori was 17 (53.1%) and 29 (80.6%), respectively.Conclusion:Increased IgA antibody titers for C. Pneumoniae, increased CRP values as well as classic markers of myocardial damage are risk factors for coronary events.

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.

Right coronary artery (RCA) emerged as an infarct-related artery (IRA) in patients with right ventricular myocardial infarction (RVMI), which is followed by some degree of RV dysfunction. The aim of our study was to identify significant predictors of IRA among angiographic and/or echocardiographic data of RV dimension and/or function in patients with acute RVMI.Out of 122 hospitalized patients with acute inferior myocardial infarction, on the basis of electrocardiographic (ECG) criteria, RVMI was diagnosed in 58/47.5% of patients. Coronary angiography was applied in 52/89,6% immediately after admission and conventional 2D echocardiography was performed in order to assess right heart dimensions and function according to the professional association recommendations.RCA emerged as IRA in 49/84,5 % of patients with ECG-diagnosed RVMI. Patients with RCA stenosis/occlusion had 4.9 times higher risk for RVMI presence (OR=4.941; 95%CI: 1.727-14.136; p=0.003) than those without and had significantly worse echocardiographic assessed RV global and/or regional systolic function. Logistic stepwise regression analysis confirmed the significant role of enlarged RV dimension (OR=1.1; 95%CI: 1.023-1.182; p=0.010), RCA stenosis/occlusion presence (OR=4.8; 95%CI: 1.649-14.199; p=0.004) and/or LAD stenosis/occlusion absence (OR=0.18; 95%CI: 0.067-0.476; p=0.001) in the prediction of RVMI. The optimal sensitivity of the model was 90% and the specificity was 75%.RCA and conversely lack of LAD stenosis/occlusion presence along with some of the echocardiographic parameters showing RV dysfunction increased the odds for RVMI. Applying immediate and complete reperfusion of RCA is of great importance for the recovery of RV function.

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