Two-dimensional strain is a new simple, rapid, and reproducible method to measure different components of systolic strain. This technique identified early abnormalities in patients with HCM that have apparently normal left ventricular systolic function.

Background-Although dual-chamber pacing improves cardiac function in patients with complete congenital atrioventricular block (CCAVB) by restoring physiological heart rate and atrioventricular synchronization, the long-term detrimental effect of asynchronous electromechanical activation induced by apical right ventricular pacing (RVP) has not been well clarified.

P rosthetic valve thrombosis (PVT) is a rare but serious complication of valve replacement, most often encountered with mechanical prostheses. The significant morbidity and mortality associated with this condition warrants rapid diagnostic evaluation. However, diagnosis can be challenging, mainly because of variable clinical presentations and the degree of valvular obstruction. Cinefluoroscopy (for mechanical valves) and transthoracic and transoesophageal echocardiography represent the main diagnostic procedures.Although surgical treatment is usually preferred in cases of obstructive PVT, optimal treatment remains controversial. The different therapeutic modalities available for PVT (heparin treatment, fibrinolysis, surgery) will be largely influenced by the presence of valvular obstruction, by valve location (left-or right-sided), and by clinical status. Hence, treatment of an obstructive left-sided PVT will differ from that of non-obstructive or right-sided PVT. The purpose of this article is to review the physiopathology, diagnosis and treatment of PVT and to provide recommendations for management. EPIDEMIOLOGY c Mechanical valve thrombosisThe incidence of obstructive PVT for mechanical valves varies between 0.3-1.3% patient years. 1 Thromboembolic complications, including systemic emboli, are more frequent and occur at a rate of 0.7-6% patient years. Non-obstructive PVT is a relatively frequent finding in the postoperative period, 2 with a reported incidence as high as 10% in recent transoesophageal echocardiography (TOE) studies. Although these are usually small non-obstructive thrombi, they underline the necessity of optimal anticoagulation in the postoperative period. According to a series of surgical interventions for PVT, the first postoperative year is marked by a 24% incidence of thrombosis, with a stable incidence between the second to fourth years of approximately 15%, with a subsequent decrease thereafter. 3Bioprosthetic valve thrombosis Thrombosis of a bioprosthetic valve 4 is a rare occurrence when compared to mechanical prostheses. Bioprosthetic PVT is usually diagnosed in the early postoperative period, when endothelialisation of the suture zone is not yet complete. Hence, this has led to the recommendation of anticoagulating patients with bioprostheses for the first three months postoperatively, particularly for mitral prostheses. PHYSIOPATHOLOGY Predisposing factorsAccording to Virchow's triad, factors predisposing to thrombus formation can be divided into endothelial, haemodynamic and haemostatic factors.5 Endothelial factors represent biocompatibility of the prosthesis itself and interaction between the prosthesis and the suture zone. Tissue cicatrisation and endothelialisation characteristically require a few weeks to be complete. Haemodynamic factors include both haemodynamic characteristics of the prosthesis, as well as overall cardiac haemodynamic status. Although the profile of new generation mechanical bileaflet valves is largely superior to that of earlier generation prostheses (and ...

Background-Isolated atrial fibrillation (AF) is associated with mild enlargement of the left atrium (LA) and left ventricular (LV) diastolic dysfunction. The impact of ablation of isolated AF on left chamber size and function is unclear, and whether diastolic dysfunction is the cause or the consequence of AF remains unknown. The objective of this prospective study was to evaluate the impact of sinus rhythm restoration by catheter ablation on LV diastolic dysfunction, LA morphology, and mechanical function. Methods and Results-Forty-eight patients with isolated AF were studied by serial echocardiographic studies at baseline and at 1-, 3-, 6-, 9-, and 12-month intervals after radiofrequency ablation. LA dimensions and mechanical function and LV systolic and diastolic functions were evaluated at each time interval. Diastolic function was assessed with conventional Doppler parameters and new indexes such as tissue Doppler imaging, mitral flow propagation velocity, and combined criteria. LV diastolic dysfunction was present in paroxysmal and chronic AF patients with a reduction of tissue Doppler imaging lateral early diastolic peak velocity in 37% (PϽ0.001) and 48% (PϽ0.01), respectively, compared with healthy control subjects. At the end of the follow-up, LA area decreased significantly by 18% (PϽ0.001) in paroxysmal and 23% (PϽ0.05) in chronic AF patients. Diastolic function improved significantly with an increase in lateral early diastolic peak velocity of 29% (PϽ0.001) in paroxysmal AF and 46% (PϽ0.05) in chronic AF patients. A significant increase in LV ejection fraction was also noted for both groups: 7.7% and 18.8%, respectively. Conclusions-This study demonstrates reverse morphological remodeling of the LA and improvement of LV diastolic and systolic functions after restoration of sinus rhythm by ablation for isolated AF. Because patients with isolated AF have none of the traditional causes of LV diastolic dysfunction, our findings suggest that AF may be partly the cause rather than the consequence of diastolic dysfunction.

The pacing site is a primary determinant of the hemodynamic response to LV pacing in patients with nonischemic dilated cardiomyopathy. Pacing at the best LV site is associated acutely with fewer nonresponders and twice the improvement in +dP/dT(max) observed with CS pacing.

Unenhanced echocardiography resulted in slight underestimation of EF and only moderate correlation compared with cineventriculography and MRI. Contrast echocardiography resulted in more accurate EF and significantly improved correlation with cineventriculography and MRI. Contrast echocardiography significantly improved inter-observer agreement on EF compared with unenhanced echocardiography. Inter-observer reliability on EF using contrast echocardiography reaches a level comparable to MRI and is better than those obtained by cineventriculography.

The FRANCE TAVI registry provided reassuring data regarding trends in TAVR performance in an all-comers population on a national scale. Nonetheless, given that TAVR indications are likely to expand to patients at lower surgical risk, concerns remain regarding potentially life-threatening complications and pacemaker implantation. (Registry of Aortic Valve Bioprostheses Established by Catheter [FRANCE TAVI]; NCT01777828).

In asymptomatic patients with severe AS, impaired longitudinal contraction assessed by 2D strain is associated with abnormal exercise response and with an increased risk of cardiac events during follow-up.