M. Sitges

Myocardial motion and deformation: What does it tell us and how does it relate to function?

The assessment of cardiac pump function and the potential of local myocardium to contribute to the overall performance are of great importance in many cardiovascular abnormalities. Assessing intrinsic cardiac function requires obtaining information on the true contractility of the heart muscle, assessed locally but interpreted in the context of its contribution to the global ejection performance and potential to adapt to changing circumstances. Contemporary imaging techniques offer the possibility of noninvasive quantification of myocardial deformation. These new clinical tools are attractive to use for the assessment of ventricular function. However, it is of great importance to understand cardiac mechanics – a complex interplay between the tissue structure/shape, force development, and interaction with the environment/neighbors – to interpret alterations in deformation and to extract clinically relevant conclusions. The combination of insight into the measurement techniques and their limitations, together with knowledge of myocardial mechanics and physiology, opens new perspectives to improve the assessment and management of fetal, pediatric, and adult patients.

Descriptive analysis of the different phenotypes of cardiac remodeling in fetal growth restriction

To identify different cardiac phenotypes among cases of fetal growth restriction (FGR).

Prognostic Value of Left Atrial Strain in Outpatients with De Novo Heart Failure

BACKGROUNDnLeft atrial (LA) dysfunction has been related to symptom onset in patients with heart failure (HF). However, the potential prognostic role of LA function has been scarcely studied in outpatients with new-onset HF symptoms.nnnMETHODSnConsecutive outpatients with suspected HF onset evaluated at a one-stop clinic were screened. HF diagnosis was performed according to current guidelines. LA function was analyzed in patients in sinus rhythm by speckle-tracking echocardiography, determining LA peak strain rate after atrial contraction (LASRa) as a surrogate of atrial contractile function. Yearly prospective follow-up was conducted to report cardiovascular hospital admission or death. Patients without HF in sinus rhythm were followed as a control group. Survival curves were estimated using the Kaplan-Meier method.nnnRESULTSnOne hundred fifty-four outpatients were included (mean age, 74xa0±xa010xa0years; 67% women) with a median follow-up duration of 44.4xa0months (interquartile range, 31-58xa0months). Final diagnosis was 29.9% non-HF and 70.1% HF. More than two in five patients with HF (44.4%) had AF (nxa0=xa048), and 55.6% (nxa0=xa060) were in sinus rhythm. The latter were divided according to LASRa tertile: highest, -1.93xa0±xa00.39xa0sec-1; middle, -1.08xa0±xa00.21xa0sec-1; and lowest, -0.47xa0±xa00.18xa0sec-1. At the end of follow-up, patients with atrial fibrillation had a low event-free survival rate (56.3%), similar to those in the lower LASRa tertile (55.0%). The non-HF group had the best prognosis, and the higher and middle LASRa tertiles had intermediate prognoses (event-free survival, 85%, 75%, and 70%, respectively).nnnCONCLUSIONSnThe study of contractile LA function in outpatients with new-onset HF provides prognostic stratification. The early identification of patients at higher risk on the basis of their atrial function would allow focusing on them independently of their final diagnoses.

Utility of blood pressure measured during an exercise as a risk factor for new-onset hypertension

Introduction: An exaggerated response of blood pressure (BP) relative to the increase in heart rate during exercise is a marker of risk for developing hypertension in the future. However, the exact methodology used in the exercise test to define an exaggerated response of BP remains controversial. The aim of this study was to compare two methods for defining exaggerated BP during exercise and their potential to predict high BP in the long term follow-up.nnMethod: Data from 160 exercise tests performed 20 years ago was retrospectively analyzed including two subgroups: group A: BP measurement performed during the stages of the exercise (110 tests), group B: measurement of BP performed during the 1st minute of recovery (50 tests). Exaggerated BP was defined according to the percentile 90th of Miyais criteria. Follow-up was obtained by telephone interview in all subjects completing a follow-up 20 years (1992-2012). Hypertension was defined by the diagnosis of their treating physician or by antihypertensive therapy.nnResults: Mean age was 28±11 years, 72% were male. According to Miyais criteria, 31 (%) patients and 1 (%) in group A and B respectively, presented an exaggerated BP during exercise. After 20 years, 21 (18%) and 8 (16%) had hypertension respectively in each group. ROC curves for prediction of hypertension in the long-term according to the finding of an exaggerated BP during exercise in each group are shown.nn![Figure][1] nnnnConclusions: These results indicate that Miyais criteria to define an exaggerated BP during exercise that could predict long term development of hypertension is useful, provided BP measurement is adequately measured at different stages of the exercise test.nn [1]: pending:yes

Remodelado auricular adverso en atletas de alto rendimiento: Estudio de deformación auricular con speckle tracking 2D

Atletas de alto rendimiento tienen un riesgo aumentado de desarrollar fibrilacion auricular (FA) y flutter. La dilatacion y disfuncion auricular po-drian ser el sustrato subyacente para este incremento en el riesgo. El objetivo fue analizar y relacionar el tamano y deformacion auricular en un grupo seleccionado de at-letas y en pacientes con FA paroxistica.

943 Impact of underlying cardiopathy on left ventricular remodelling after cardiac resynchronization therapy

, p<0.02), in the office diastolic blood pressure (83.0±6.2 vs 77.0±7.5 mm Hg, p<0.008) and heart rate (76.1±14.0 vs 66.3±9.7 bpm, p<0.02). No differences were found in left ventricular diameters, volumes, mass, meridional and circumferential end-systolic stress, total peripheral resistence, stroke volume and cardiac output. The relative wall thickness (RWT) was significantly increase in black (0.42±0.04 vs 0.36±0.05, p<0.0001), suggesting a tendency to a concen- tric remodelling. The left systolic function estimated by conventional param- eters was unchanged. Doppler analysis of tissue kinetics showed a signifi- cant increase in black subjects of septal S and E waves, as peak velocity (pv) and time velocity integral (tvi), when compared with white subjects. The MPI in black subjects was significantly increase (0.46±0.05 vs 0.39±0.05, p<0.0003), due to a significant prolongation of ICT (62.1±19.1 vs 51.4±9.9 msec). A significant correlation between MPI and RWT (r=0.54, p<0.001) and left ventricular mass (r=0.54, p<0,001) respectively were demonstrated. Besides, MPI correlate with Spv (r=0.55, p<0.001) and Stvi (r=0.38, p<0.001) waves. In conclusion our data confirm that MPI is increase in black healthy subject and is geometry-dependent, in contrast with current literature. Besides, we found correlations between MPI and systolic indexes derived from DTE. These findings also suggest that racial differences in left ventricular perfor- mance and systolic function exist even in absence of other conventional echocardiographic changes.

1118 Non-invasive estimation of the pulmonary capillary pressure with echo-Doppler in patients without left ventricular dysfunction

s S 181 culated from the SM data to increase correspondently. Fig. 1 shows Strain as a function of deformation amplitude at different crystal positions (C2-5 and L2-5). The crystals C1 and L1 were fixated and continuously measured the distance to the remaining crystals hereby generating data for TDI calculations.