P333 Left ventricular rotational abnormalities in hypereosinophilic syndrome as assessed by three-dimensional speckle-tracking echocardiography

Introduction

Hypereosinophilic syndrome (HES) is a very heterogeneous group of disorders with varied etiologies characterized by peripheral eosinophilia and eosinophilic tissue/end-organ damage. In the present study, the ability of a novel non-invasive clinical tool, three-dimensional speckle-tracking echocardiography (3DSTE) was investigated to reveal any change in left ventricular (LV) rotational mechanics in clinically asymptomatic HES patients without manifest organ damage as determined by conventional diagnostic methods.

Methods

The present study comprised 13 patients established diagnosis of HES. However, one patient with idiopathic HES has been excluded due to insufficient image quality. The remaining patient population contained 11 cases with idiopathic HES and one patient with acute T-lymphoma associated HES (mean age: 59.7 ± 13.7 years, 8 males). The control group consisted of 36 healthy volunteers (mean age: 52.9 ± 8.3 years, 23 males). All HES patients and controls underwent complete two-dimensional Doppler echocardiography and 3DSTE.

Results

Both LV apical rotation (4.86 ± 1.92 degree vs. 10.07 ± 3.92 degree, p < 0.0001) and LV twist (8.52 ± 2.79 degree vs. 14.41 ± 4.26 degree, p < 0.0001) showed significant deteriotations in most of HES patients. In 2 subjects absence of LV twist called as LV „rigid body rotation’ (RBR) was detected. One patient had 1.77 degree counterclockwise (abnormally directed) LV basal rotation and 14.29 degree counterclockwise (normally directed) LV apical rotation resulting in 12.59 degree LV apico-basal gradient. The other patient had normally directed -2.09 degree LV basal rotation and almost zero (-0.27 degree) LV apical rotation resulting in 1.82 degree LV apico-basal gradient.

Conclusions

Reduced LV apical rotation and twist could be demonstrated in HES. LV-RBR could be detected in some HES patients.

P1562 Normal reference values of three-dimensional speckle-tracking echocardiography-derived right atrial volumes and volume-based functional properties in healthy adult subjects

Introduction

The right atrium (RA) has several roles including a systolic reservoir, early diastolic conduit and late-diastolic booster pump functions. The present study aimed to assess normal reference values of three-dimensional speckle-tracking echocardiography (3DSTE)-derived RA volumetric data and volume-based functional properties (stroke volumes, SVs and emptying fractions, EFs) in healthy adult subjects.

Methods

260 healthy adult subjects in sinus rhythm with complete clinical and demographic dataset have been included in the present study. However, due to inferior image quality 110 subjects have been excluded. The remaining population comprised 150 cases (31.0 ± 11.6 years, 79 males). Complete two-dimensional Doppler echocardiography and 3DSTE have been performed in all subjects.

Results

While systolic maximum RA volume did not change over age decades, early and late-diastolic RA pre-atrial contraction volume and minimum RA volume increased over time. Significantly larger values could be detected in more than 50 year-old healthy subjects as compared to younger subjects. Total atrial SV remained almost unchanged over age decades with a significant reduction in subjects aged >50 years. Passive atrial SV showed a continuous reduction over age decades and significant difference could be demonstrated between subjects aged 18-29 years and >50 years. Active atrial SV increased over age decades with a significant reduction in subjects aged >50 years. Total atrial EF did not show any changes over age decades, but a significant reduction could be demonstrated in cases aged >50 years. Passive atrial EF showed significant continuous reduction over age decades. Active atrial EF did not change in younger ages, it was the highest at ages 40-49 years with a significant impairment after 50 years. Females proved to have tendentiously higher RA volumes respecting the cardiac cycle regardless of age. No significant differences could be demonstrated between RA stroke volumes between genders except between 40-49 years when females had tendentiously higher values. RA emptying fractions were non-significantly, but tendentiously higher in females as compared to that of males regardless of age.

Conclusions

Normal reference values of 3DSTE-derived RA volumes and volume-based functional properties and their age- and gender dependency were defined in healthy adult subjects.

P1406 Normal reference values of right atrial strain parameters using three-dimensional speckle-tracking echocardiography in healthy adults

Introduction

Classic echocardiographic methodologies offer limited opportunities in assessing right atrial (RA) morphology and function. Three-dimensional (3D) speckle-tracking echocardiography (3DSTE) is a novel imaging method with objective 3D capability in assessing volumetric and functional properties of heart chambers. Normal reference values of different 3DSTE-derived RA strains are not available, therefore the aim of this prospective study was to establish these parameters in healthy subjects.

Methods

The present study comprised 295 healthy volunteers, from which 110 were excluded due to inadequate image quality. The final population consisted of 185 healthy subjects in the present study (mean age: 32.1 ± 12.2 years, 89 males). Complete two-dimensional echocardiography and 3DSTE have been performed in all cases.

Results

While radial strain (RS) does not change significantly over the years in males, RS increases with age most significantly between 40-49 years, and it starts to decline at the age of 50 years in females. While females have higher circumferential strain (CS) and area strain (AS) values, RS decreases with age in both gender. While longitudinal strain (LS) remains almost unchanged in females until 40-49 years and declines above the age of 50 years in females, it decreases over decades in males. 3D strain (3DS) increases with ages in both gender, but almost doubles in females in older ages. While RS at atrial contraction does not change over decades in males, an obvious increase could be seen in females with a higher value between 40-49 years and a decline over 50 years. A decrease could be seen in CS at atrial contraction in males over decades, it is almost tripled in value between 40-49 years in females. Although LS at atrial contraction is higher in females, it decreases over decades in both genders. AS decreases over decades in males, while females have almost doubled AS values at the ages 40-49 years. 3DS is almost unchanged in males, while doubled in older ages in females. During evaluations, 110 subjects were excluded due to inferior image quality from the total of 295 enrolled subjects, therefore the overall feasibility of 3DSTE-derived RA quantification was 185 out of 295 (63% overall feasibility).

Conclusion

3DSTE-derived RA normal reference values with age- and gender-dependency are demonstrated in a healthy population.

P946 Right atrial volumetric and functional analysis by three-dimensional speckle-tracking echocardiography in acromegaly

Introduction

Acromegaly is a chronic, rare hormonal disease associated with major cardiovascular comorbidities. The disease, in the majority of the cases, is caused by a benign human growth hormone secreting adenoma. Cardiovascular involvement is especially common in acromegaly patients from the most common hypertension to cardiomyopathy. It was set out to quantify right atrial (RA) morphology and function in a group of acromegaly patients using three-dimensional (3D) speckle-tracking echocardiography (3DSTE).

Methods

The study comprised 30 patients from which 8 patients were excluded due to inadequate image quality. Mean age of the remaining acromegaly patients were 53.7 ± 14.5 years (7 males). Ten patients were in active phase, while 12 subjects had inactive acromegaly. In the control group 40 healthy adults were enrolled (mean age: 52.3 ± 8.2 years, 15 males). In each case, complete two-dimensional Doppler echocardiography was performed followed by 3DSTE.

Results

Maximum (54.5 ± 14.4 ml vs. 47.2 ± 11.6 ml, p <0.05) and minimum (35.5 ± 10.2 ml vs. 29.2 ± 9.1 ml, p <0.05) RA volumes and RA volume before atrial contraction (45.1 ± 11.1 ml vs. 38.2 ± 10.3 ml, p <0.05) were significantly higher in case of acromegaly compared to the healthy controls. Both global and mean segmental peak 3D strain (-11.94 ± 7.52% vs. -8.07 ± 5.03%, p <0.05 and -17.16 ± 6.13% vs. -13.78 ± 5.35%, p <0.05) were higher in the acromegaly group compared to the controls. At atrial contraction, mean segmental radial strain (-13.22 ± 6.45% vs. -9.74 ± 4.58%, p <0.05) was significantly higher and mean segmental 3D strain (-9.78 ± 5.44% vs. -13.78 ± 5.35%, p <0.05) was significantly lower in the acromegaly group compared to the controls. Between the active and inactive group of acromegaly patients, mean segmental longitudinal strain (28.17 ± 4.89% vs. 35.34 ± 9.75%, p <0.05) was significantly different. Numerous independent strain parameters had significant correlations with different hormonal variables in the active acromegaly group. These correlations were not present in the inactive acromegaly subgroup.

Conclusion

Acromegaly is associated with significant RA volumetric and functional abnormalities.

Left ventricular rotational mechanics in hypereosinophilic syndrome-Analysis from the three-dimensional speckle-tracking echocardiographic MAGYAR-Path Study

INTRODUCTION

Hypereosinophilic syndrome (HES) is a very heterogeneous group of disorders with varied etiologies characterized by peripheral eosinophilia and eosinophilic tissue/end-organ damage. Three-dimensional speckle-tracking echocardiography (3DSTE) was used for assessment of left ventricular (LV) rotational mechanics in HES patients.

METHODS

The study comprised 13 HES patients, from which one patient was excluded due to insufficient image quality. The remaining patient population consisted of 12 HES cases (mean age: 59.7 ± 13.7 years, eight males). The control group consisted of 36 healthy volunteers (mean age: 52.9 ± 8.3 years, 23 males). 3DSTE was used for the evaluation of LV rotational abnormalities.

RESULTS

Both LV apical rotation (4.86 ± 1.92 degree vs 10.07 ± 3.92 degree, P < .0001) and LV twist (8.52 ± 2.79 degree vs 14.41 ± 4.26 degree, P < .0001) showed significant deteriorations in most of HES patients. Time-to-peak LV apical rotation (380 ± 115 ms vs 344 ± 69 ms, P = .56), LV basal rotation (335 ± 148 ms vs 337 ± 111 ms, P = .89), and LV twist (348 ± 91 ms vs 320 ± 60 ms, P = .64) were not significantly different between HES patients and controls. No correlations could be detected between absolute eosinophil count and eosinophil ratio and apical LV rotation (r = 0.12, P = .51 and r = 0.23, P = .45, respectively) and LV twist (r = 0.24, P = .39 and r = 0.31, P = .34, respectively). In two subjects, the absence of LV twist called LV "rigid body rotation" (RBR) was detected.

CONCLUSIONS

Reduced LV apical rotation and twist could be demonstrated in HES. LV-RBR could be detected in some HES patients.

Mitral annulus is enlarged and functionally impaired in adult patients with repaired tetralogy of Fallot as assessed by three-dimensional speckle-tracking echocardiography-results from the CSONGRAD Registry and MAGYAR-Path Study

Background

Fibrous mitral annulus (MA) is an important part of the mitral valve having a role in forwarding blood from the left atrium (LA) to the left ventricle (LV). MA can be assessed by three-dimensional speckle-tracking echocardiography (3DSTE) respecting the cardiac cycle. The present study was designed to test whether repaired Tetralogy of Fallot (TOF) is associated with morphological and functional alterations of the MA. The role of the type of treatment (early total reconstruction vs. early palliation, late correction) was also assessed.

Methods

The study population consisted of 29 consecutive adults repaired TOF patients (mean age: 35.4±15.5 years, 18 men), from which 13 patients underwent early total reconstruction (etrTOF), while 16 patients were firstly palliated and later corrected (pcTOF). Their data were compared to that of 76 age- and gender-matched healthy controls (mean age: 35.9±7.6 years, 33 men). All repaired TOF patients and controls were assessed by two-dimensional (2D) Doppler echocardiography and 3DSTE.

Results

Dilated end-systolic and end-diastolic MA diameter, area and perimeter and reduced MA fractional area change and MA fractional shortening could be demonstrated in repaired TOF patients as compared to controls. Increased body surface area-indexed end-diastolic and end-systolic MA diameter and perimeter could be demonstrated in pcTOF patients as compared to that of etrTOF cases.

Conclusions

MA enlargement and functional impairment could be detected in adult patients with repaired TOF regardless of the type of correction. However, pcTOF patients have worse results.

P6141Associations between atmospheric parameters and haemostatic factors: a case control study

Background

One of the biggest health challenges in the 21st century is global climate change. The health effect of climate change is partly mediated through atmospheric parameters. There is a growing concern that atmospheric parameters might increase cardiovascular (CV) morbidity. Increased levels of haemostatic factors are predictors of CV events. The associations between CV diseases and atmospheric parameters have been widely reported, however there are few studies of atmospheric parameters' effects on markers of haemostasis.

Purpose

We examined the possible association between atmospheric parameters and several haemostatic markers.

Methods

The study consisted of 3800 hospitalized patients with acute CV diseases (ACVDs) and 260 healthy blood donors. We examined the relationship of haemoglobin (Hgb), white blood cells (WBC), thrombocytes (THR) and local atmospheric parameter conditions (temperature, atmospheric pressure, humidity, wind speed, atmospheric front) on a day-to-day basis in a 5-year period (2009–2013) using a General Additive Model with cubic splines of covariates, regularized by a ridge penalty, and employing generalized cross validation. Atmospheric parameters were allowed to have a lagged effect by up to 21 days.

Results

Among blood donors, the average of daily temperature lagged by 8–14 days had a significant effect on Hgb, exhibiting a U-shaped relationship, where higher Hgb values were associated with extremities of the observed temperature interval. For ACVD patients, all examined blood test variables has a significant association with at least some of the atmospheric parameters. Hgb was shown to have a negative linear relationship with mean daily humidity, and the average of daily temperature lagged by 15–21 days, while the average of daily temperature variation lagged by 2–7 days had highly non-linear effect. The relative strength of the association with Hgb was largest for daily temperature variation. WBC values had a slightly non-linear positive relationship with atmospheric pressure lagged by 1 day, with WBC being significantly increased above 1030 hPa. THR values decreased linearly with an increase in mean daily temperature averaged for days lagged 15–21. Atmospheric pressure lagged by 1 day also had a significant effect on THR, with a positive linear effect under 1010 and over 1020 hPa but no effect between. The relative effect of atmospheric pressure on THR was twice as large compared to temperature.

Conclusions

Our study showed that exposure to certain atmospheric parameters is associated with significant changes in haemostatic marker levels. In the context of global climate change, the importance of focusing on atmospheric parameters as minor CV risk factor is substantially growing. A better understanding of the fluctuation of the examined markers, in light of atmospheric parameters, appears to be of particular importance for future studies and could help establish new CV prevention strategies.

P6146Atmospheric front patterns and acute cardiovascular diseases, a new perspective in the cardiovascular threat of global climate change

Background

There is substantial evidence that the health threat of global climate change is real and it could be a medical emergency. The impact of climate change on health is mediated through atmospheric parameters which are direct environmental stressors on the human body and have a potential cardiovascular (CV) morbidity and mortality effect. Acute cardiovascular diseases (ACVDs) are already major public health issues and in the future unfavourable atmospheric situations, such as increasingly volatile fronts and their negative effects can further increase this problem. Despite evidence about the importance of different atmospheric parameters on health outcomes, there have been few results for atmospheric front patterns' CV effects. Weather fronts are the most complex atmospheric phenomena therefore these atmospheric parameters might have the greatest influence on ACVDs.

Purpose

We aimed to explore the effects of atmospheric front patterns on ACVDs.

Methods

A time series Poisson-regression analysis was used to analyse 6499 ACVD hospital admissions, during a five-year period (2009–2013), in light of front patterns. Covariates were three-day (target day and the two previous days) front sequence patterns comprised of the five major front types (no front, warm front, occluded front, cold front, stationary front). Relative risk (RR) estimates for front effects were adjusted for seasonality. The relationship on all ACVDs combined and separately on patient groups by major CV risk factors (hypertension, hyperlipidaemia, diabetes, previous CV diseases) was examined.

Results

We found that in general, front patterns containing warm front days had a detrimental effect. A warm front, when followed by two days with no fronts present, increased RR by 46% (CI: 4–89%, p=0,015). Cold fronts however were protective. A no front – cold front – occluded front pattern corresponded to a 28% (CI: 8–49%, p=0,037) decrease in RR, with this pattern being present in 1.1% of all days of the study period. Out of the group specific results an occluded front, following days with no fronts present, showed to have the largest effect on hyperlipidaemic patients, increasing RR by 144% (CI: 51–295%, p<0.001).

Conclusions

This work provides both independent evidence of front patterns' CV effects and a novel tool to investigate and help the understanding of complex associations between atmospheric fronts and ACVDs. The importance of our findings is growing in the context that extreme atmospheric conditions and changes are likely to become more common in the future as a result of climate change. Medical meteorology may open up a new horizon and become an important field of preventive cardiology in the future. In conclusion, a better understanding of atmospheric front effects is of particular importance in order to help identify possible targets for future prevention strategies.

Atmospheric fronts as minor cardiovascular risk factors, a new approach to preventive cardiology

BACKGROUND

Cardiovascular diseases are the number one cause of death globally and represent 31% of all global deaths. The aim of our study was to determine the influence of front effects on acute cardiovascular diseases (ACVDs).

METHODS

We obtained all ACVD admissions in a Central-European region, Hungary, Budapest. A time-series analysis was applied to 6499 morbidity cases during a five-year period (2009-2013). Poisson-regression model was used and adjusted for air temperature, pressure, humidity, wind velocity, their interactions and seasonality to assess the association of fronts and ACVDs.

RESULTS

There is a positive significant association between ACVDs and a cold front effect lagged by one day (p=0.018) with a relative risk (RR) of 1.095 [95% CI (1.021,1.181)]. Our findings show that among patient subgroups with major cardiovascular risk factors (hypertension, diabetes, hyperlipidemia, history of CVDs) the patterns are similar, but occluded fronts also have a significant effect.

CONCLUSION

Atmospheric fronts could play an important role in the pathogenesis of ACVDs. Our findings might help to provide a better understanding about fronts as minor cardiovascular risk factors and to organize medical prevention more effectively. Our research project may become a basis of a new field of preventive cardiovascular medicine in the future.

Normal reference values of right atrial strain parameters using three-dimensional speckle-tracking echocardiography (results from the MAGYAR-Healthy Study)

Classic echocardiographic methodologies offer limited opportunities in assessing right atrial (RA) morphology and function. Three-dimensional (3D) speckle-tracking echocardiography (3DSTE) is a novel imaging method with objective 3D capability in assessing volumetric and functional properties of heart chambers. Normal reference values of different 3DSTE-derived RA strains are not available, therefore the aim of this prospective study was to establish these parameters in healthy subjects. The present study comprised 295 healthy volunteers, from which 110 were excluded due to inadequate image quality. The final population consisted of 185 healthy subjects in the present study (mean age: 32.1 ± 12.2 years, 89 males). Complete two-dimensional echocardiography and 3DSTE have been performed in all cases. While radial strain (RS) does not change significantly over the years in males, in female subjects it increases with age most significantly between at the age of 40–49, and it starts to decline at the age of 50 in females. While females have higher circumferential (CS) and area (AS) strain values, CS and AS decrease with age in both gender. While LS remains almost unchanged in females until ages 40–49 years with a decline above the age of 50, it decreases over the decades in males. 3D strain (3DS) increases with age in both gender, but almost doubles in females in older ages. Specific pattern of strains at atrial contraction could also be demonstrated. 3DSTE-derived RA normal reference values with age-, gender-dependency and regional values are demonstrated in a healthy population.

New-onset Diabetes Mellitus Following Successful Kidney Transplantation Facilitates Aortic Stiffening

BACKGROUND

Following kidney transplantation (KT), new-onset diabetes mellitus (NODM) is one of the most common complications. NODM usually occurs early after KT, and is diagnosed according to the general guidelines relevant for general diabetes mellitus patients. Arterial stiffness is a surrogate marker of cardiovascular risk. According to the literature, a successful KT has only limited and late beneficial effects on aortic elastic properties. The present study aimed to assess whether NODM has any additive value on the worsening of echocardiography-derived aortic elastic properties in transplanted patients.

METHODS

We have included 28 nondiabetic post-KT patients in the study, older than 18 years (mean age: 48.2 ± 6.9 years; 13 men, 15 women). After an oral glucose tolerance test, 8 patients were diagnosed with NODM, and their results were compared to 23 age-, sex-, and risk factor-matched controls (mean age: 54.9 ± 11.0 years; 9 men, 14 women). All post-KT patients and matched controls underwent a complete transthoracic 2-dimensional Doppler echocardiography, together with an assessment of echocardiographic aortic elastic properties. The assessments included aortic strain, aortic distensibility, and aortic stiffness index.

RESULTS

Aortic elastic properties showed alterations in post-KT patients compared to matched controls (aortic strain: .084 ± .039 vs .057 ± .032, P  <  .05; aortic distensibility: 2.36 ± 1.09 cm²/dynes 10^-6 vs 1.83 ± 1.18 cm²/dynes 10^-6, P = .07; aortic stiffness index: 7.15 ± 3.58 vs 11.2 ± 6.1, P <  .05). Further deterioration in the aortic stiffness index (14.8 ± 7.6 vs 9.68 ± 4.88, P <  .05) was detected in the presence of NODM.

CONCLUSIONS

NODM following successful KT facilitates aortic stiffening.

Dipyridamole-Induced Left Ventricular "Rigid Body Rotation" (A Case from the Three-Dimensional Speckle Tracking Echocardiographic MAGYAR-Stress Study)

Under normal physiological conditions, the direction of systolic rotation of the left ventricular (LV) base is clockwise, and that of the LV apex is counterclockwise resulting in the wringing motion of the LV around its long axis called as LV twist. The present study was designed to present a patient with significant coronary artery disease in whom near absence of LV twist called as LV rigid body rotation could be induced during dipyridamole stress as assessed noninvasively by three-dimensional speckle-tracking echocardiography.

Normal reference values of three-dimensional speckle-tracking echocardiography-derived left atrial strain parameters (results from the MAGYAR-Healthy Study)

Left atrial (LA) size and function have been demonstrated to be important imaging biomarkers with powerful potential in predicting clinical outcome in several disorders. The angle-independent three-dimensional (3D) speckle-tracking echocardiography (3DSTE) has a capability for quantitative assessment of LA volumes and strains in 3D space at the same time from the same 3D acquired datasets. Therefore, the objective of the present study was to define normal values of 3DSTE-derived LA strains in healthy subjects. It was also examined whether there is any age- and gender-dependency of these parameters. The present study comprised 309 healthy volunteers, from which 87 were excluded due to inadequate image quality. The remaining group consisted of 222 subjects (mean age: 36.3 ± 13.7 years, 112 males). Complete two-dimensional echocardiography and 3DSTE have been performed in all cases. Peak circumferential strain (CS) increased with age with a decline > 50 years in females, in males CS remained almost unchanged. While peak longitudinal strain (LS) increased with age with unchanged parameters > 50 years, parallel increase in peak area strain (AS) with age could be demonstrated in both genders with a decline in females > 50 years. While CS and AS at atrial contraction increased with age in females, parallel decrease could be demonstrated in males. LS at atrial contraction increased with age especially in females. Normal values of 3DSTE-derived LA peak strains and strains at atrial contraction are demonstrated together with their age- and gender-dependency.

A jobb pitvari fülcse echokardiográfiás vizsgálata és annak klinikai jelentősége

Abstract:

In case of atrial fibrillation, there is a higher risk of thrombus formation, which could affect the right heart as well. Visualization of the right atrial appendage is difficult; the aim of the present review was to demonstrate the role of routine echocardiographic techniques and to show related clinical data. Orv Hetil. 2019; 160(12): 443–447.

Normal values of left ventricular rotational parameters in healthy adults-Insights from the three-dimensional speckle tracking echocardiographic MAGYAR-Healthy Study

INTRODUCTION

Left ventricular (LV) rotation and twist are essential parts of LV function. Three-dimensional speckle tracking echocardiography (3DSTE) is a relatively new method and is useful for the quantification of LV wall deformation and rotational parameters. The aim of the present study was to examine LV rotation and twist differences between different age-groups and genders in a healthy population.

METHODS

The present study is comprised of 297 healthy adults; 120 adults have been excluded due to inferior image quality. The population was further divided into 4 subgroups based on age decades.

RESULTS

Only the LV twist of all patients (13.5 ± 3.7 degree vs 15.6 ± 4.9 degree, P = 0.02) and the LV twist of females (13.0 ± 3.6 degree vs 15.5 ± 5.6 degree, P = 0.03) differed significantly between the age-group of 18-29 years and 50+ years. LV basal and apical rotation were not significantly different between the age-groups; however, they tendentiously increased with aging. No significant differences could be demonstrated regarding LV rotational and twist parameters between genders in any group. A phenomenon called LV rigid body rotation (LV-RBR)-where the base and apex of the LV rotate in the same direction-was present in 10 cases.

CONCLUSIONS

Three-dimensional speckle tracking echocardiography seems to be a reasonably viable tool for the quantification of LV rotation and twist. Both LV basal and apical rotation and LV twist increase with aging, regardless of gender. LV-RBR is also present in the normal population.

The role of echocardiography in the management of adult patients with congenital heart disease following operative treatment

Treatment of congenital heart diseases has significantly advanced over the last few decades. Due to the continuously increasing survival rate, there are more and more adult patients with congenital heart diseases and these patients present at the adult cardiologist from the paediatric cardiology care. The aim of the present review is to demonstrate the role of echocardiography in some significant congenital heart diseases.

Left ventricular longitudinal strain is associated with mitral annular fractional area change in healthy subjects-Results from the three-dimensional speckle tracking echocardiographic MAGYAR-Healthy Study

Background

The mitral annulus (MA) plays a significant role in promoting left atrial and left ventricular (LV) filling and emptying, which is dependent on LV functional properties. The present study aimed to investigate the relationship between LV strains, quantitative features of longitudinal contractility and MA size and function in healthy subjects.

Methods

The present study comprised 295 healthy adults; 117 subjects were excluded due to inferior image quality (40%). Finally, 178 healthy adults (mean age: 32.0±11.3 years, 92 males). Complete two-dimensional Doppler echocardiography and three-dimensional speckle-tracking echocardiography were performed in all cases.

Results

The global and mean segmental left ventricular longitudinal strain (LV-LS) proved to be -16.1%±2.5% and -16.9%±2.4%, respectively. In the present study, LV-LS ≤-13% was considered to be reduced. In ROC analysis, the cut-off value for MA fractional area change (MAFAC) to predict impaired LV-LS was ≤44%, with 67% sensitivity and 69% specificity and ROC area under curve 0.73 (P=0.0005). Significantly increased LV volumes and LV mass and reduced MAFAC could be demonstrated in healthy subjects with global LV-LS ≤-13%. Significantly larger ratio of subjects with global LV-LS ≤-13% had MAFAC ≤44% (31% vs. 67%, P=0.009). Patients with MAFAC ≤44% had significantly reduced global and mean segmental LV-LS. Significantly larger ratio of subjects with MAFAC ≤44% had global LV-LS ≤-13% (4% vs. 16%, P=0.009).

Conclusions

There is a strong relationship between MA and LV longitudinal function. MA fractional area change predicts global LV-LS.

Left ventricular rotational abnormalities following successful kidney transplantation-insights from the three-dimensional speckle-tracking echocardiographic MAGYAR-Path Study

Background

Kidney transplantation (KTx) is the preferred treatment for virtually all suitable candidates with end-stage renal disease. There is limited information on left ventricular (LV) rotational mechanics post-KTx, therefore the present study aimed to assess it and to compare it to that of age- and gender-matched healthy controls.

Methods

The present study comprised 42 KTx patients, from which 4 patients were excluded due to insufficient image quality (mean age: 46.3±8.2 years, 29 males). Control group consisted of 81 age- and gender-matched healthy individuals (mean age: 43.5±10.8 years, 51 males). All KTx patients and healthy controls successfully underwent transthoracic two-dimensional (2D) Doppler echocardiography and three-dimensional speckle-tracking echocardiography (3DSTE).

Results

Significant differences could be demonstrated in LA diameter, LV end-diastolic diameter and volume, interventricular septum, LV posterior wall thickness, LV ejection fraction and early and late filling transmitral flow velocities and in their ratio between KTx patients and controls; none of the subjects examined showed grade 2-4 mitral and/or tricuspid regurgitations. Three patients following successful KTx showed near absence of LV twist called as LV 'rigid body rotation' (RBR) movement. When the remaining 35 post-KTx patients were analysed separately, reduced basal LV rotation could be demonstrated in post-KTx patients with tendentious increase in apical LV rotation resulting in an unchanged LV twist.

Conclusions

KTx is associated with alterations in LV rotational mechanics with unchanged LV twist suggesting a remodelling of this sort of movement. The near absence of LV twist (LV-RBR) could be demonstrated in some post-KTx cases.

[Risk factors for deterioration of liver functions after successful kidney transplantation]

INTRODUCTION

Increase of liver function is one of the most common complications after kidney transplantation due to the use of immunosuppressive therapy and hyperlipidemia in addition to hepatitis C virus (HCV) infection.

METHOD

Following the selection criteria (n = 59), the study is based on applied immunosuppressive therapy, baseline data of patients, further correlation between HCV and liver function deterioration. Patients were subjected to fasting laboratory examination to monitor serum electrolytes, uric acid and albumin levels. We looked at the effects of immunosuppressive therapy on the lipids (TG, TC, HDL, LDL) and liver enzymes (GOT, GPT, ALP, GGT). The analysis of the relationship between lipids and liver enzymes was also included in our study.

RESULTS

The data basics were not significantly different between the tacrolimus and the cyclosporine groups. In the laboratory results, Mg levels were significantly different between the two groups (p = 0.044). The impact of HCV on the liver function was significantly different on GGT (p = 0.008). We examed the lipids and liver function level between the tacrolimus and the patients receiving cyclosporine-based immunosuppression and the total cholesterol (p = 0.005) and GOT (p = 0.05) were significantly different between the two groups. Hyperlipidemia was associated with 26% of patients taking tacrolimus-based immunosuppression, and 89% of those receiving cyclosporine; the difference was significant (p = 0.002). Regarding the effect of hyperlipidemia on liver enzymes, ALP (p = 0.006) and GGT (p = 0.0001) were significantly higher.

CONCLUSION

Increases in hepatic enzymes, ALT and GGT indicate the damage to hepatocytes. Beside the increase of liver function, which is the main risk factor in hepatitis on HCV soil, the applied immunosuppressive therapy and hyperlipidemia lead to degradation of allograft function and long-term graft loss. Orv hetil. 2019; 160(5): 186-190.

[Borderline left ventricular ejection fraction is associated with alterations in mitral annular size and function. Results from the three-dimensional speckle-tracking echocardiographic MAGYAR-Healthy Study]

INTRODUCTION

Morphology and function of the mitral annulus (MA) shows alterations in different valvular (for instance in mitral regurgitation) and non-valvular disorders (for instance in certain cardiomyopathies, cardiac amyloidosis).

AIM

The aim of the present study was to examine the relationship between MA morphologic and functional properties and three-dimensional speckle-tracking echocardiography- (3DSTE) derived left ventricular (LV) ejection fraction (EF) in subjects with normal versus borderline LV-EF.

METHOD

The present study comprised 146 volunteers (mean age: 32.0 ± 11.4 years; 74 males) in whom complete two-dimensional Doppler echocardiography was performed with a negative result extended with 3DSTE. The population was further divided into two groups according to their 3DSTE-derived LV-EF (borderline 50-54% versus ≥55%).

RESULTS

In cases with borderline LV-EF, higher LV end-systolic LV volumes and lower LV longitudinal strain could be measured. All end-systolic and end-diastolic MA diameter, area and perimeter data proved to be higher in cases with borderline LV-EF. In these subjects, MA functional parameters proved to be lower as well. In contrast, LV-EF showed correlations neither with end-systolic and end-diastolic MA dimensions nor with MA functional parameters.

CONCLUSIONS

3DSTE-derived borderline LV-EF is associated with MA dilatation and functional impairment. Orv Hetil. 2018; 159(50): 2129-2135.

Climate-induced changes in continental-scale soil macroporosity may intensify water cycle

Soil macroporosity affects field-scale water-cycle processes, such as infiltration, nutrient transport and runoff^1,2, that are important for the development of successful global strategies that address challenges of food security, water scarcity, human health and loss of biodiversity³. Macropores-large pores that freely drain water under the influence of gravity-often represent less than 1 per cent of the soil volume, but can contribute more than 70 per cent of the total soil water infiltration⁴, which greatly magnifies their influence on the regional and global water cycle. Although climate influences the development of macropores through soil-forming processes, the extent and rate of such development and its effect on the water cycle are currently unknown. Here we show that drier climates induce the formation of greater soil macroporosity than do more humid ones, and that such climate-induced changes occur over shorter timescales than have previously been considered-probably years to decades. Furthermore, we find that changes in the effective porosity, a proxy for macroporosity, predicted from mean annual precipitation at the end of the century would result in changes in saturated soil hydraulic conductivity ranging from -55 to 34 per cent for five physiographic regions in the USA. Our results indicate that soil macroporosity may be altered rapidly in response to climate change and that associated continental-scale changes in soil hydraulic properties may set up unexplored feedbacks between climate and the land surface and thus intensify the water cycle.

Right Atrial Deformation Analysis in Cardiac Amyloidosis - Results from the Three-Dimensional Speckle-Tracking Echocardiographic MAGYAR-Path Study

BACKGROUND

Light-chain (AL) cardiac amyloidosis (CA) is characterized by fibril deposits, which are composed of monoclonal immunoglobulin light chains. The right ventricle is mostly involved in AL-CA and impairment of its function is a predictor of worse prognosis.

OBJECTIVES

To characterize the volumetric and functional properties of the right atrium (RA) in AL-CA by three-dimensional speckle-tracking echocardiography (3DSTE).

METHODS

A total of 16 patients (mean age: 64.5 ± 10.1 years, 11 males) with AL-CA were examined. Their results were compared to that of 15 age- and gender-matched healthy controls (mean age: 58.9 ± 6.9 years, 8 males). All cases have undergone complete two-dimensional Doppler and 3DSTE. A two-tailed p value of less than 0.05 was considered statistically significant.

RESULTS

Significant differences could be demonstrated in RA volumes respecting cardiac cycle. Total (19.2 ± 9.3% vs. 27.9 ± 10.7%, p = 0.02) and active atrial emptying fractions (12.1 ± 8.1 vs. 18.6 ± 9.8%, p = 0.05) were significantly decreased in AL-CA patients. Peak global (16.7 ± 10.3% vs. 31.2 ± 19.4%, p = 0.01) and mean segmental (24.3 ± 11.1% vs. 38.6 ± 17.6%, p =0.01) RA area strains, together with some circumferential, longitudinal and segmental area strain parameters, proved to be reduced in patients with AL-CA. Global longitudinal (4.0 ± 5.2% vs. 8.2 ± 5.5%, p = 0.02) and area (7.8 ± 8.1% vs. 15.9 ± 10.3%, p = 0.03) strains at atrial contraction and some circumferential and area strain parameters at atrial contraction were reduced in AL-CA patients.

CONCLUSION

Significantly increased RA volumes and deteriorated RA functions could be demonstrated in AL-CA.