The Relationship Between Right Ventricular Longitudinal Strain and Adverse Outcome in Hypertensive Patients: 10-year Follow-up.

INTRODUCTION: Previous studies showed the importance of right ventricular (RV) remodeling in patients with arterial hypertension and RV longitudinal strain was recognized as very sensitive parameter for detection of subtle cardiac impairment. However, its clinical importance in arterial hypertension has not been established so far. AIM: The present study aimed to evaluate the association between RV longitudinal strain (global and free-wall) on adverse outcomes measured by MACE in the large group of hypertensive patients who were followed for mean period of 10 years. METHODS: This retrospective study finally included 544 hypertensive patients who underwent full echocardiographic examination including 2D speckle tracking imaging. between January 2010 and December 2014. MACE was considered as the primary outcome and it was defined by all-cause mortality, cardiovascular mortality, myocardial infarction, coronary artery by-pass, coronary stent implantation, stroke, development of heart failure, and occurrence of atrial fibrillation during follow-up. RESULTS: Patients who experienced MACE were older than those who did not. There was no difference in demographic and clinical parameters between MACE and non-MACE patients. There was no difference in RV diameter, but MACE patients had higher RV wall thickness. RV systolic function parameters were similar between the two groups. RV global and free-wall longitudinal strain were significantly lower in MACE patients (-22.3 ± 3.6 vs. -24.7 ± 3.9%, p < 0.001 and - 25.8 ± 4.2 vs. -28.1 ± 4.5%, p < 0.001; respectively). Reduced RV GLS [OR 1.10; 95%: 1.02-1.20] and reduced RV free-wall longitudinal strain [OR 1,21; 95%CI: 1.05-1.39] were independently of clinical and echocardiographic parameters related with adverse outcome measured by MACE. CONCLUSION: RV GLS and RV free-wall longitudinal strain were independently related with adverse outcomes during 10-year follow-up in initially uncomplicated hypertensive patients.

Overweight in trained subjects - are we looking at wrong numbers? (Body mass index compared with body fat percentage in estimating overweight in athletes.).

Body mass index (BMI) is widely used as an index of obesity in adults. In trained population, individual with low body fat could be classified as overweight by BMI. To evaluate this problem, the purposes of this study were to determine the BMI and body fat percentage (BF%) of trained and untrained subjects and to evaluate the accuracy of BMI classification (> or =25 kg.m(-2)) as a prediction of overweight/obesity in trained subjects. The total number of 299 trained (basketball players) and 179 untrained male subjects participated in this study. Body height and body mass were measured; BMI was calculated for all subjects. BF% was determined via Tanita bioimpedance body composition analyzer. BMI >or = 25 kg.m(-2) and BF% > 20% were used to define overweight. There was no significant age differences. Body mass, height (p < 0.01) and BMI (p < 0.05) were significantly higher, although BF% was significantly lower (p < 0.01) in trained group when compared to untrained. Eighty-five trained subjects had a BMI of 25 or higher, indicating overweight. Of these, only three individuls had excess BF%. The results of the present study suggest that a BMI > or = 25 kg.m(-2) is not an accurate predictor of overweight in trained subjects.

Velocity propagation of early diastole is a valuable tool for left ventricular remodelling after the first myocardial infarction.

PURPOSE: Velocity propagation (Vp) of early diastole is a known method for the evaluation of left ventricular (LV) diastolic function. Our purpose was to determine whether Vp is a valuable tool to characterize patients after acute myocardial infarction and LV remodelling (LVR). METHODS: M-mode, two-dimensional and Doppler echocardiography were performed in 71 patients within the first 2 days, 1, 3 and 6 months after acute myocardial infarction. We measured the left atrium, LV diameters and volumes, peak early and late velocity (E, A) deceleration time, Vp, annular velocity (e) and calculated E/e. The patients were divided in two groups: (A) without early LVR (n=39) and (B) with early LVR (n=32). RESULTS: In the first evaluation, Vp was similar in both groups (36.37 vs. 35.49 cm/s, P=0.513). Late LVR (LLVR) (44%) had developed in patients from group A with significantly lower early Vp compared with patients without LLVR (31.52 vs. 40.12 cm/s, P=0.001), with persist values even after 6 months (29.41 vs. 40.85 cm/s, P=0.001). The values of Vp were similar in the first 2 days in patients from group B with developing (78%) and nondeveloping LLVR (35.29 vs. 36.60 cm/s, P=0.614). Differences became significant after 6 months (31.71 vs. 41.80 cm/s, P=0.001). The values of Vp of 35 cm/s or less from the first week in both groups correlated with LLVR (B=3.27, P=0.015). Changing of LV volumes significantly correlated with Vp; for end-diastolic volume/body surface area (r=0.21, P=0.041) and end-systolic volume/body surface area (r=0.30, P=0.014). CONCLUSION: In this study, Vp was the only valuable Doppler echocardiographic tool that reflected early LVR and LLVR.