Evaluation of the size of cardiac structures in patients with high body mass index.

AIMS: Isometric indexation of cardiac structures fails in patients with overweight. The aim of the study was to evaluate the LA indexed volume (LAVOL), left ventricular end-diastolic diameter (LVEDD), left ventricular mass index (LVMI), and the aortic sinus diameter (AOSD) in healthy subjects with normal and high BMI and find the allometric correction exponent. METHODS: Four hundred and thirty patients without cardiac pathology were analyzed. Patients were divided into groups: Group I BMI < 24.9 187 patients, Group II BMI 25-29.9 154 patients, Group III BMI 30-34.9 63 patients, and Group IV 35-39.9 26 patients. A Doppler echocardiogram was performed. The parameters indexed were compared between groups. When allometric growth was verified, the allometric coefficient was calculated. RESULTS: Male sex 242 p (56%), mean age: 44.87 ± 13.10 years, better correlation: LAVOL, LV mass, and AOSD with body surface area (BSA) (LAVOL R: .74, R2 .55, LV mass R: .73, R2 : 0.53, AOSD R: .57, R2 : .35), LVEDD with high (R: .63, R2 : .39) were observed. A significant increase was observed in LAVOL and LVMI in the groups with increased BMI. We observed a decrease in the indexed AOSD and a marginal difference between groups in LVEDD. The allometric correction exponent calculated was as follows: LAVOL: 0.96 and for LVMI: 0.97. CONCLUSIONS: Allometric correction is superior to isometric indexation to assess LAVOL and LVMI in obese and overweight patients. Allometric correction would allow differentiating deviations from VOLAI and IMVI attributable to obesity from those attributable to an associated pathology.

Behavior of right atrial strain in high systolic pulmonary artery pressure.

AIMS: Evaluate the ability of right atrial (RA) strain to predict systolic pulmonary artery pressure (SPAP). METHODS AND RESULTS: A total of 102 patients were prospectively enrolled. Conventional echocardiographic measures were performed. RA volume was calculated. Mean maximum right ventricle (RV) strain and lateral RA strain were obtained. Pearson's correlation test was used. A multivariate analysis was performed to compare SPAP with RA strain, RV strain, and baseline characteristics of the patients. RA strain was compared between patients with SPAP ≤ 37 mm Hg with those with SPAP > 37 mm Hg. A receiver operating characteristic (ROC) curve was constructed. A P < 0.01 value was considered statistically significant. AGE: 58.7 ± 15.7 years. Male: 46 (45.1%). The correlation coefficient between SPAP and RA strain was -0.64 (P < 0.01, 95% confidence interval (CI): -0.75 to -0.50). Quadratic R2 coefficient = 0.52. In the multivariate analysis, RA strain was independently associated with SPAP level. There were significant differences in RA strain between patients with SPAP ≤ 37 mm Hg (63.3 ± 13.3%; 95% CI: 59.4%-65.1%) and >37 mm Hg (32.7 ± 11.1%; 95% CI: 26.5%-38.39%) (P < 0.01). RA strain < 42.5% was capable to predict a SPAP > 37 mm Hg with 93% sensitivity and 94% specificity, area under the curve (AUC) of 98% (95% CI: 94%-100%). CONCLUSIONS: Right atrial strain is independently associated with SPAP level. RA strain lower than 42.5% can predict a SPAP > 37 mm Hg with high sensitivity and specificity.

Coronary flow velocity reserve during pharmacologic stress echocardiography with normal contractility adds important prognostic value in diabetic and nondiabetic patients.

BACKGROUND: Coronary flow velocity reserve (CFVR) increases the diagnostic sensitivity of stress echocardiography. The aim of this study was to evaluate the prognostic value of CFVR in patients without new wall motion abnormalities during pharmacologic stress echocardiography. METHODS: The outcomes of 651 patients with normal wall motion response during stress echocardiography with dobutamine up to 50 µg/kg/min (n = 351) or dipyridamole up to 0.84 mg/kg over 4 min (n = 300) were evaluated. CFVR was calculated simultaneously in the distal territory of the left anterior descending coronary artery. CFVR ≥ 2 was defined as normal. Major events considered during follow-up were cardiovascular death, myocardial infarction, and late myocardial revascularization. RESULTS: Normal CFVR was recorded in 523 patients and reduced CFVR in 128. During a mean follow-up period of 34.6 ± 18 months, 48 major events occurred, in 25 patients (4.8%) with normal and 23 patients (18%) with reduced CFVR; event-free survival was significantly different between patients with normal versus abnormal CFVR (P < .0001). Diabetes increased risk only in patients with abnormal CFVR (P = .05). In the multivariate analysis, CFVR and history of smoking were the only independent predictors of combined morbidity and mortality. Abnormal CFVR was associated with a higher event rate, independently of the pharmacologic stress technique used. The event hazard ratio was inversely proportional to CFVR. CONCLUSIONS: CFVR was an independent predictor of mortality after pharmacologic stress echocardiography with normal wall motion, and the degree of decrease was associated with increased risk. Diabetes worsened prognosis only with abnormal CFVR.

Análisis de la deformación auricular longitudinal: alteraciones precoces en hipertensos jóvenes controlados / Left Atrial Longitudinal Strain: Early Alterations in Young Patients with Mild Hypertension

Objetivos Evaluar alteraciones precoces del strain auricular longitudinal en base al speckle tracking y el índice de rigidez auricular en hipertensos leves. Material y métodos Ingresaron prospectivamente 101 pacientes de entre 30 y 50 años: 32 sujetos sanos sedentarios (Grupo 1), 35 sanos deportistas (Grupo 2) y 34 hipertensos controlados (Grupo 3). Sexo masculino: 68 (67,3%). Se efectuaron mediciones ecocardiográficas convencionales, se registraron el Doppler tisular color y el Doppler tisular pulsado lateral y septal y se calculó el volumen auricular. Se obtuvieron el strain y el strain rate ventricular sistólico y el strain auricular máximo durante el período de reservorio por speckle tracking. Se calculó el índice de rigidez auricular en base a la relación (E/e)/strain auricular máximo. Se utilizó el análisis de ANOVA seguido de la prueba de Bonferroni, considerándose significativa una p < 0,01. Resultados La relación E/A y la velocidad de la onda e tisular fueron mayores y la relación E/e fue menor en el grupo de deportistas. El índice de masa del ventrículo izquierdo no mostró diferencias significativas. El volumen de la aurícula izquierda fue mayor en deportistas sin alcanzar significación estadística. El strain auricular fue menor en hipertensos (36,94 ± 7,71 vs. 46,17 ± 10,05 en el Grupo 1 y 46,80 ± 8,44 en el Grupo 2; IC 95% 3,96-14,47; p < 0,0001) y el índice de rigidez auricular fue significativamente más alto en este grupo (30,49 ± 11,93 vs. 19,94 ± 8,12 en el Grupo 1 y 18,99 ± 5,88 en Grupo 2; IC 95% 5,05-16,05; p < 0,0001). Conclusiones La deformación auricular longitudinal durante el período de reservorio y el índice de rigidez auricular se hallan alterados en hipertensos leves controlados antes de que se detecten otras alteraciones ecocardiográficas.(AU)

Left Atrial Longitudinal Strain: Early Alterations in Young Patients with Mild Hypertension Objectives The aim of this study was to evaluate early changes in left atrial longitudinal strain based on speckle tracking and the atrial stiffness index in patients with mild hypertension. Methods One hundred and one patients, 30 to 50 years of age, were prospectively enrolled in the study: 32 healthy sedentary patients (Group 1), 35 healthy recreational athletes (Group 2) and 34 mild hypertensive patients (Group 3). Sixty eight patients were men (67.3%). Conventional echocardiographic assessments were performed, color tissue Doppler and lateral and septal pulsed tissue Doppler were recorded and atrial volume was calculated. Left ventricular strain and strain rate and left atrial peak strain during the reservoir period were obtained by speckle tracking. The atrial stiffness index was calculated based on the (E/e)/peak atrial strain ratio. Data was analyzed using ANOVA followed by the Bonferroni test. A p value <0.01 was considered statistically significant. Results The E/A ratio and the tissue e wave velocity were higher and the E/e ratio was lower in the athlete group. Left ventricular mass index did not show statistical differences among groups. Left atrial volume was higher in athletes without attaining significant difference. In hypertensive patients, atrial strain was lower (36.94 ± 7.71 vs. 46.17 ± 10.05 in Group 1 and 46.80 ± 8.44 in Group 2; 95% CI 3.96-14.47; p <0.0001) and the stiffness index was higher (30.49 ± 11.93 vs. 19.94 ± 8.12 in Group 1 and 18.99 ± 5.88 in Group 2; 95% CI 5.05-16.05; p <0.0001). Conclusions Left atrial longitudinal strain during the reservoir period and the atrial stiffness index are altered in patients with mild controlled hypertension before the detection of other echocardiographic changes.(AU)

Análisis de la deformación auricular longitudinal: alteraciones precoces en hipertensos jóvenes controlados / Left Atrial Longitudinal Strain: Early Alterations in Young Patients with Mild Hypertension

Objetivos Evaluar alteraciones precoces del strain auricular longitudinal en base al speckle tracking y el índice de rigidez auricular en hipertensos leves. Material y métodos Ingresaron prospectivamente 101 pacientes de entre 30 y 50 años: 32 sujetos sanos sedentarios (Grupo 1), 35 sanos deportistas (Grupo 2) y 34 hipertensos controlados (Grupo 3). Sexo masculino: 68 (67,3%). Se efectuaron mediciones ecocardiográficas convencionales, se registraron el Doppler tisular color y el Doppler tisular pulsado lateral y septal y se calculó el volumen auricular. Se obtuvieron el strain y el strain rate ventricular sistólico y el strain auricular máximo durante el período de reservorio por speckle tracking. Se calculó el índice de rigidez auricular en base a la relación (E/e)/strain auricular máximo. Se utilizó el análisis de ANOVA seguido de la prueba de Bonferroni, considerándose significativa una p < 0,01. Resultados La relación E/A y la velocidad de la onda e tisular fueron mayores y la relación E/e fue menor en el grupo de deportistas. El índice de masa del ventrículo izquierdo no mostró diferencias significativas. El volumen de la aurícula izquierda fue mayor en deportistas sin alcanzar significación estadística. El strain auricular fue menor en hipertensos (36,94 ± 7,71 vs. 46,17 ± 10,05 en el Grupo 1 y 46,80 ± 8,44 en el Grupo 2; IC 95% 3,96-14,47; p < 0,0001) y el índice de rigidez auricular fue significativamente más alto en este grupo (30,49 ± 11,93 vs. 19,94 ± 8,12 en el Grupo 1 y 18,99 ± 5,88 en Grupo 2; IC 95% 5,05-16,05; p < 0,0001). Conclusiones La deformación auricular longitudinal durante el período de reservorio y el índice de rigidez auricular se hallan alterados en hipertensos leves controlados antes de que se detecten otras alteraciones ecocardiográficas.

Left Atrial Longitudinal Strain: Early Alterations in Young Patients with Mild Hypertension Objectives The aim of this study was to evaluate early changes in left atrial longitudinal strain based on speckle tracking and the atrial stiffness index in patients with mild hypertension. Methods One hundred and one patients, 30 to 50 years of age, were prospectively enrolled in the study: 32 healthy sedentary patients (Group 1), 35 healthy recreational athletes (Group 2) and 34 mild hypertensive patients (Group 3). Sixty eight patients were men (67.3%). Conventional echocardiographic assessments were performed, color tissue Doppler and lateral and septal pulsed tissue Doppler were recorded and atrial volume was calculated. Left ventricular strain and strain rate and left atrial peak strain during the reservoir period were obtained by speckle tracking. The atrial stiffness index was calculated based on the (E/e)/peak atrial strain ratio. Data was analyzed using ANOVA followed by the Bonferroni test. A p value <0.01 was considered statistically significant. Results The E/A ratio and the tissue e wave velocity were higher and the E/e ratio was lower in the athlete group. Left ventricular mass index did not show statistical differences among groups. Left atrial volume was higher in athletes without attaining significant difference. In hypertensive patients, atrial strain was lower (36.94 ± 7.71 vs. 46.17 ± 10.05 in Group 1 and 46.80 ± 8.44 in Group 2; 95% CI 3.96-14.47; p <0.0001) and the stiffness index was higher (30.49 ± 11.93 vs. 19.94 ± 8.12 in Group 1 and 18.99 ± 5.88 in Group 2; 95% CI 5.05-16.05; p <0.0001). Conclusions Left atrial longitudinal strain during the reservoir period and the atrial stiffness index are altered in patients with mild controlled hypertension before the detection of other echocardiographic changes.