Abstract Funding Acknowledgements Type of funding sources: None. Background In advanced stages of dilated cardiomyopathy (DCM), both atrial function and left ventricle (LV) myocardial mechanics are blunted. Left atrial reservoir strain (LASr) is a sensitive parameter for left atrial (LA) function evaluation. Our study aimed to find a correlation between LASr depression and rotational parameters damage in patients with DCM, using 4-Dimensional automated LA and LV quantification. Methods We enrolled 75 patients with DCM and narrow QRS and 30 healthy volunteers. The evaluation consisted of clinical examination, laboratory tests, 12 leads electrocardiography. All participants underwent a complete transthoracic echocardiogram to determine cardiac structure and function according to the current guidelines. Measurement of LA and LV strain was performed using 4D Auto-quantification software. The study evaluated LASr by 4D Auto Atrial Quantification. 4D LV Quantification measured twist and torsion. Results 1. We divided the patients into two groups: 27 with DCM and atrial fibrillation (AF) and 48 with DCM and sinus rhythm (SR). 2. Mean values of LASr were 10.20 in patients with DCM and 30.36 in the healthy volunteers’ group. (P<0.0001). Rotational parameters were LV twist=1.66, LV torsion=0.44 in DCM patients, LV twist=10.1, and LV torsion=1,73 in the healthy group. (P<0.0001). In DCM patients with AF, mean values were lower ( LASr =9.52, LV twist=0.97, LV torsion=0.28, LV torsion=0.4) than in patients with SR (LASr=10.59, LVtwist=1.93, LV torsion=0.5) 3. A correlation was found between LASr and LV twist (r=-0.8), between LASr and torsion (r=-0.78), in patients with AF, and also in those with DCM and SR ( r=-0.74 for the twist, r=-0.73 for torsion). Conclusions 1. LASr reduction was related to rotational damage of the left ventricle in DCM patients. 2. LASr, LV twist, and LV torsion were lower in cases with AF. 3. LA function is a parameter of chronic increased LV filling pressure. The correlation between LASr decrease and anomalies of twist and torsion may suggest a link between increased LV filling pressure and rotational dysfunction in patients with dilated cardiomyopathy phenotype.

Abstract Funding Acknowledgements Type of funding sources: None. Background 4D echocardiography is a useful tool to identify both decreasing of mitral annular excursion (MAE) and left ventricle (LV) strain damage in patients with dilated cardiomyopathy (DCM). Our study aimed to identify a correlation between MAE decreasing and LV strain parameters in patients with DCM. Methods We enrolled 75 patients with DCM and 30 healthy volunteers. The evaluation consisted of clinical examination, laboratory tests, 12 leads electrocardiography. All participants underwent a complete transthoracic echocardiogram to determine cardiac structure and function according to the current guidelines. The study evaluated MAE by 4D Auto Mitral Valve Quantification (4D - MVQ). 4D LV Quantification (4D-LVQ) measured global longitudinal strain (GLS), global circumferential strain (GCS), global area strain (GAS), and global radial strain (GRS). Results 1. We divided the patients into two groups: 27 with DCM and atrial fibrillation (AF) and 48 with DCM and sinus rhythm (SR). 2. Mean values of MAE were 3.89 (SD=2.2, CV=0.56) in patients with DCM and 11.1 (SD 1.08, CV 0.09) in the healthy volunteers’ group. (P<0.0001). In patients with DCM and RS MAE mean value was 4.24 (SD=2.34, CV=0.54), and in the AF group was 2.98 (SD=1.38, CV=0.45) (p = 0.0125). 3. Mean values of strain in patients with DCM and RS compared with those in AF were: GLS −6,63 vs. −4,1 (P = 0.0005), GCS −6.08 vs. −5,2 (P = 0.1931), GAS −11.22 vs. −8.47 (P = 0.0181), GRS = 14.5 vs. 10.89 (P = 0.0493). 4. The correlations obtained between MAE and LV strain in patients with DCM were: GLS (r=-0.67), GAS (r=-0.61), GRS (r=0.5), and GCS (r=-0.39). Conclusions 1. MAE was significantly reduced in patients with DCM compared with healthy volunteers. 2. The patients with DCM and AF presented the lowest values of MAE and LV global strain parameters. 3. MAE correlated better with GLS and GAS, moderate with GRS, and weak with GAS in patients with dilated cardiomyopathy phenotype.

Abstract Funding Acknowledgements Type of funding sources: None. Background Left atrial (LA) dimension is a marker of LV filling pressure, reflecting the severity and chronicity of diastolic dysfunction. LA is a stable parameter that combines chronic cardiovascular conditions effects and acute increase in filling pressure in acute myocardial infarction. Patients with acute coronary syndrome and increased left atrial volume index (LAVI) have a worse long-term prognosis. In patients with hypertension and diabetes, an increase in the LA dimension predicts cardiovascular events. There are limiting data about the impact of LAVI on the outcome in diabetic hypertensive patients with ST-elevation myocardial infarction (STEMI). Purpose: of the study was to compare LAVI in diabetic and nondiabetic hypertensive patients admitted with STEMI. Methods: ninety-eight hypertensive patients admitted with STEMI were enrolled, sixty-seven with diabetes mellitus and thirty-one without diabetes. The patients with atrial fibrillation and significant valvular disease were not included in the study. The evaluation consisted in clinical examination, echocardiographic measurements, laboratory tests, and 12 leads electrocardiography. 2D Echocardiography area-length technique was used for LA volume measurement. The LA endocardial borders were traced in both the apical four- and two-chamber views, and the results were body surface area indexed. The cut of value was 34ml/m2. The Devereaux formula determined left ventricle mass index (LVMI), and the ranges were: 125 kg/m2 for males and 95 mg/m2 for females. Left ventricle ejection fraction (LVEF) was < 50% in all cases. Measurements were obtained in the first week after STEMI. The patients were divided into two groups: the first was between 40 and 60 years and the second was above 60 years. According to the age group, mean values (MV) and standard deviation (SD) were calculated, obtaining a comparison between diabetic and nondiabetic patients. Results: LAVI had higher values in diabetic patients: MV: 37.37 (SD: 3.39, CV: 9.07%) compare with nondiabetic patients: MV: 31.07 (SD: 2.67, CV 8.59%), p < 0.0001. Between 40-60 years LAVI MV were 36.43 +/- 3.21 in diabetic patients vs. 29.62+/-1.89 in nondiabetic patients (p = 0.0001); above 60 years of age LAVI MV were: 38.99 +/- 3.04 in diabetic patients and 31.14 +/- 2.8 in nondiabetics patients (p < 0.0001). In both group of age LAVI also correlated with body mass index, LVMI, LV volumes, LV diastolic dysfunction, LVEF, dyslipidemia and smoking. Conclusions: 1. In hypertensive patients admitted with STEMI, diabetes mellitus was an additional factor contributing to increased left atrium dimensions. 2. This study showed a correlation between LAVI and other factors involved in increasing LV filling pressure in hypertensive diabetic patients admitted with STEMI, underlying the importance of LA enlargement evaluation. Further studies with a larger number of patients are need to confirm these results.

Abstract Background The majority of cases of right sided infective endocarditis involve the tricuspid valve. Isolated pulmonary valve (PV) endocarditis is rare. Congenital heart disease are risk factors. Material and methods: We present the case of 36 years old male, without any known cardiovascular disease, who was admitted with signs and symptoms of heart failure, pulmonary embolism and fever. He was evaluated clinically, 12 lead ECG, pulmonary radiography, thoracic computer tomography (CT) scan, transthoracic and transesophageal echocardiography, laboratory investigations. Results: Transthoracic and transesophageal echocardiogram revealed large vegetations located on pulmonary valve, pulmonary regurgitation and dilation of the pulmonary valve, patent ductus arteriosus (PDA) with bidirectional shunt and local complications: fistula between right ventricle outflow tract (RVOT) and aorta, pleural and pericardial effusion. Blood cultures were negative. ECG aspect was right bundle branch block. Radiography and thoracic CT scan revealed pulmonary embolism aspect. The patient was treated with antibiotics and surgical option included debridement of the infected area, vegetation excision with valve replacement, relief of RVOT, fistula closure with pericardial patch and ligature of PDA. Evolution after surgical intervention was good.Conclusions: This presentation reveals a favorable evolution of a patient with infective endocarditis located to pulmonary valve. In most of cases, right heart endocarditis presents with signs and symptoms of respiratory disease and fever; these are due to septic pulmonary embolization. Isolated PV endocarditis still remains a challenging and needs carefully echocardiographic evaluation for a correct diagnosis and risk factors identification.

A strong association between functional mitral regurgitation severity and all-cause mortality and hospitalization was found in patients with dilated cardiomyopathy and left ventricular systolic dysfunction, with or without an implanted device. Many studies revealed a bidirectional link between the decrease in functional mitral regurgitation severity and the response to cardiac resynchronization therapy. This emphasizes the importance to find methods for mitral regurgitation evaluation in heart failure patients after device implantation. In this complex pathology, adequate measurement remains a challenge for clinicians. Echocardiography is the key technique used to confirm the diagnosis and to assess the severity and prognosis. In this review, we discuss the echocardiographic challenges in the evaluation of functional mitral regurgitation after cardiac resynchronization therapy. An integrated approach including various criteria is strongly recommended. The assessment includes the integration of data from 2D/3D echocardiography imaging, as well as Doppler measures of severity. For quantifying the regurgitation degree, the vena contracta width and the parameters derived from the PISA method, effective regurgitant orifice area and regurgitant volume, are the most useful. There is also important to provide information about the left ventricle and right ventricle dimensions and ejection fraction, as well as the left atrium, right atrium dimensions and the pulmonary arterial systolic pressure.

Objective: The left atrium volume index (LAVi) is a recognized prognostic marker in conditions as heart failure, myocardial infarction and atrial fibrillation. Dilatation of left atrium (DLA) in the absence of chronic arrhythmia, mitral valve disease or heart transplantation, is marker of chronic elevation of left atrium pressure. Numerous epidemiological studies have shown that the presence of arterial hypertension increases the risk of coronary heart disease especially in at risk populations. LA enlargement in hypertensive patients is related to overweight, diabetes and metabolic syndrome. Aim of the study was to find the presence of risk factors among the hypertensive patients with acute myocardial infarction (AMI) and the correlation with LAVi. Design and method: A number of 98 hypertensive patients (56 males and 42 females), aged 41- 85 years, admitted with ST-segment elevation AMI were evaluated during the first week of hospitalization before discharge by: clinical and laboratory examination, 12 lead standard ECG. LAVi echocardiographic measurement was made using disk summation algorithm, tracing endocardial borders in apical four and two chamber view and indexing by body surface area; cut off value was 34 ml/m2. Results: 1. In lot of study 57,14% were males (78,57% DLA) and 42,86% females (73,82% DLA). 2. Most of patients were aged 60–69 years: 34 patients (67,83% DLA). 3. Looking for age and sex distribution of patients, in all groups male sex was dominant: highest incidence between 50–59 years group: 71,42%, followed by 69–69 years group age: 55,88%. 4. Most of patients: 56,12% were stage 3 of hypertension (81,81% DLA) 5.68,36% of patients were diabetics (74,62% DLA) 6. Obesity was found in 68,36% of hypertensive patients with AMI. (73,13% % DLA). 7. Dyslipidemia was found in 77,55% of patients (66,31% DLA) 8. Smoking was present in 53,06% of patients. (76,92% DLA when patients associated supplementary this risk factor) Conclusions: 1. We found an association between risk factors as: male sex, age, obesity,dyslipidemia, the level of blood pressure, diabetes, and smoking and the incidence of AMI in hypertensive patients. 2. In hypertensive patients with AMI a correlation between and risk factors and left atrium enlargement was present.

Objective: Pseudonormal and restrictive diastolic pattern of mitral inflow were associated with dilatation and cardiac mortality in first year after acute myocardial infarction (AMI). Arterial hypertension before the acute coronary event is known to be a factor linked to an increased enddiastolic pressure. Purpose of the study was to find a correlation between echocardiographic parameters of filling pressure at discharge and pattern of mitral inflow at one year after AMI in hypertensive patients. Design and method: A number of 98 hypertensive patients (56 males and 42 females), admitted with acute myocardial infarction with ST-segment elevation were evaluated during the first week by: clinical examination, 12 lead standard ECG, echocardiographic measurement of: left atrium volume index (LAVi), left ventricular mass index (LVMi) using transthoracic echocardiography; cut off levels for left ventricular hypertrophy (LVH) were LVMi>115 g/m2 in males and>95 g/m2 in females; mitral inflow, pulmonary venous inflow measurement using Doppler echocardiography, tissue Doppler echocardiography at lateral and medial corner of mitral annulus, color Mmode echocardiography. E/E’ average ratio, E/vp ratio and ar-A duration were calculated. After one year the pattern of mitral inflow was evaluated using transthoracic Doppler echocardiography. All patients received fibrinolytic therapy. LVEF measured by Simpson method was less than 45%. Results: 1. Mean values of parameters of filling pressure in hypertensive patients with LVH and without reperfusion were: VASi:35,04, p = 0,00007, E/E’:14,81, p = 0,03992, E/vp:1,99, p = 0,00197, ar-A:28,79, p = 0,00726. 2. Using chi squared (CS), odd ratio (OR) and relative risk (RR) significant correlations were found between mitral pattern and: VASi>32 ml/m2 CS:6,512834; E/E’>14, CS:10,179653, E/vp < 1,5, CS:10,637642, ar-A>30ms, CS:40,105. Conclusions: 1. The highest mean values of echocardiographic parameters of increased filling pressure at discharge after an acute myocardial infarction were found in hypertensive patients with LVH and without reperfusion. 2. A correlation was found between these increased mean values at discharge and mitral inflow after one year suggesting a worse evolution in these patients.

Objective: Atrial mechanical dysfunction is correlated to paroxismal atrial fibrillation (PAF) prevalence. A’ wave velocity of mitral annulus evaluated with tissue Doppler echocardiography is linked to left ventricle diastolic pressure (LVEDP). Purpose of the study was to find a correlation between LA contractile dysfunction evaluation using tissue Doppler echocardiography and the risk of PAF during first week of acute myocardial infarction (AMI) in hypertensive patients. Design and method: 98 hypertensive patients (56 males and 42 females), admitted with AMI with ST-segment elevation were evaluated during the first week by: clinical examination, 12 lead standard ECG, echocardiographic measurements of: left ventricle mass index (LVMi); cut off values for left ventricular hypertrophy (LVH) were LVMi > 115 g/m2 in males and > 95 g/m2 in females; pulsed tissue Doppler echocardiography of mitral valve ring was used for mean values A wave velocities evaluation. Normal median values were 10 ± 2 cm/s. Standard deviation (SD) and coefficient of variation (CV) were calculated. LVEF measured by Simpson method was less than 45%. All patients received fibrinolytic therapy. Patients were in sinus rhythm, without history of prior AMI, valvular heart disease or PAF. 24 hours monitoring using Holter recordings were used for PAF detection. Patients were divided in 4 groups: 1.LVH+ and reperfusion 2.LVH+ without reperfusion 3.LVH- and reperfusion 4.LVH- without reperfusion. Results: 1.LVH was find in 68,36% of patients. 2.Velocities mean values at lateral corner of mitral ring: A’ = 8,62 cm/s; SD:1,00, CV:11,85 in cases with LVH without reperfusion and 8,32 cm/s in those without LVH and with successful fibrinolysis; SD:0,96, CV:11,31. 3.At medial corner: A” = 8,54 cm/s in cases with LVH without reperfusion; SD:1,13, CV:13,92 and 7,03 cm/s in those without LVH and with successful fibrinolysis, SD:1,34, CV:15,68. 4.Incidence of PAF was: 55,01% in patients with A’ mean values > 8,62 cm/s compare to 11,22% in those with A’ mean values<8,32 cm/s and 42,85% in patients with A” mean values > 8,54 cm/s compare to 8,16% in those with A” mean values<7,03 cm/s. Conclusions: 1.A’ and A” waves mean values were higher in hypertensive patients with LVH without reperfusion. 2.LA contractile function evaluation using tissue Doppler echocardiography predicted the risk of PAF during first week of myocardial infarction in hypertensive patients.

Objective: Pseudonormal and restrictive diastolic pattern of mitral inflow were associated with dilatation and cardiac mortality in first year after acute myocardial infarction (AMI). Arterial hypertension before the acute coronary event is known to be a factor linked to an increased enddiastolic pressure. Purpose of the study was to find a correlation between echocardiographic parameters of filling pressure at discharge and pattern of mitral inflow at one year after AMI in hypertensive patients. Design and method: A number of 98 hypertensive patients (56 males and 42 females), admitted with acute myocardial infarction with ST-segment elevation were evaluated during the first week by: clinical examination, 12 lead standard ECG, echocardiographic measurement of: left atrium volume index (LAVi), left ventricular mass index (LVMi) using transthoracic echocardiography; cut off levels for left ventricular hypertrophy (LVH) were LVMi>115 g/m2 in males and>95 g/m2 in females; mitral inflow, pulmonary venous inflow measurement using Doppler echocardiography, tissue Doppler echocardiography at lateral and medial corner of mitral annulus, color Mmode echocardiography. E/E’ average ratio, E/vp ratio and ar-A duration were calculated. After one year the pattern of mitral inflow was evaluated using transthoracic Doppler echocardiography. All patients received fibrinolytic therapy. LVEF measured by Simpson method was less than 45%. Results: 1. Mean values of parameters of filling pressure in hypertensive patients with LVH and without reperfusion were: VASi:35,04, p = 0,00007, E/E’:14,81, p = 0,03992, E/vp:1,99, p = 0,00197, ar-A:28,79, p = 0,00726. 2. Using chi squared (CS), odd ratio (OR) and relative risk (RR) significant correlations were found between mitral pattern and: VASi>32 ml/m2 CS:6,512834; E/E’>14, CS:10,179653, E/vp < 1,5, CS:10,637642, ar-A>30ms, CS:40,105. Conclusions: 1. The highest mean values of echocardiographic parameters of increased filling pressure at discharge after an acute myocardial infarction were found in hypertensive patients with LVH and without reperfusion. 2. A correlation was found between these increased mean values at discharge and mitral inflow after one year suggesting a worse evolution in these patients.

Objective: Atrial mechanical dysfunction is correlated to paroxismal atrial fibrillation (PAF) prevalence. A’ wave velocity of mitral annulus evaluated with tissue Doppler echocardiography is linked to left ventricle diastolic pressure (LVEDP). Purpose of the study was to find a correlation between LA contractile dysfunction evaluation using tissue Doppler echocardiography and the risk of PAF during first week of acute myocardial infarction (AMI) in hypertensive patients. Design and method: 98 hypertensive patients (56 males and 42 females), admitted with AMI with ST-segment elevation were evaluated during the first week by: clinical examination, 12 lead standard ECG, echocardiographic measurements of: left ventricle mass index (LVMi); cut off values for left ventricular hypertrophy (LVH) were LVMi > 115 g/m2 in males and > 95 g/m2 in females; pulsed tissue Doppler echocardiography of mitral valve ring was used for mean values A wave velocities evaluation. Normal median values were 10 ± 2 cm/s. Standard deviation (SD) and coefficient of variation (CV) were calculated. LVEF measured by Simpson method was less than 45%. All patients received fibrinolytic therapy. Patients were in sinus rhythm, without history of prior AMI, valvular heart disease or PAF. 24 hours monitoring using Holter recordings were used for PAF detection. Patients were divided in 4 groups: 1.LVH+ and reperfusion 2.LVH+ without reperfusion 3.LVH- and reperfusion 4.LVH- without reperfusion. Results: 1.LVH was find in 68,36% of patients. 2.Velocities mean values at lateral corner of mitral ring: A’ = 8,62 cm/s; SD:1,00, CV:11,85 in cases with LVH without reperfusion and 8,32 cm/s in those without LVH and with successful fibrinolysis; SD:0,96, CV:11,31. 3.At medial corner: A” = 8,54 cm/s in cases with LVH without reperfusion; SD:1,13, CV:13,92 and 7,03 cm/s in those without LVH and with successful fibrinolysis, SD:1,34, CV:15,68. 4.Incidence of PAF was: 55,01% in patients with A’ mean values > 8,62 cm/s compare to 11,22% in those with A’ mean values<8,32 cm/s and 42,85% in patients with A” mean values > 8,54 cm/s compare to 8,16% in those with A” mean values<7,03 cm/s. Conclusions: 1.A’ and A” waves mean values were higher in hypertensive patients with LVH without reperfusion. 2.LA contractile function evaluation using tissue Doppler echocardiography predicted the risk of PAF during first week of myocardial infarction in hypertensive patients.

Toader, D.; Belu, E.; Radu, R.; Popescu, M.; Musetescu, R.; Ionescu, D.-D. Author Information

Musetescu, R.; Toader, D.; Belu, E.; Musetescu, A. E.; Popescu, M.; Ionescu, D. D Author Information

Belu, E.; Musetescu, R.; Bataiosu, C.; Popescu, M.; Toader, D.; Mustafa, R.; Cosulschi, M.; Florescu, N.; Ionescu, D.-D. Author Information

Background: An increased filling presure is revealed by a severe diastolic dysfunction, associated with a large acute myocardial infarction (AMI) and the risk of acute complications. Aim of the study was to find a correlation between the pattern of distolic mitral inflow and the complications during the first week after AMI in hypertensive patients. Methods: A number of 98 hypertensive patients (56 males and 43 females) aged 36 - 82 years, admitted with acute myocardial infarction with ST-segment elevation were evaluated in the first week of hospitalization by: clinical examination: angina, heart failure symptoms, 12 lead standard ECG, Holter: the presence of arrythmias, echocardiographic measurement of diastolic mitral inflow using Doppler method, the presence of complications: left ventricular aneurysm, left ventricular thrombus, rupture of interventricular septum, using transthoracic echocardiography. Patients were divided in 4 groups: 1. LVH+ and reperfusion 2. LVH+ without reperfusion 3. LVH- and reperfusion 4. LVH- without reperfusion. Results: 1. LVH was found in 67 patients (68,36%). 2. Failled reperfusion was present in 16,33% patients with LVH and 36,73% in patients with LVH which matched not criterias for thrombolitic therapy administration. 3. In hypertensive patients with LVH and without successful reperfusion pseudonormal pattern was found in 10,20% and restrictive pattern in 10,20% percentage. 4. Complications during the first week were more frequent in patients with pseudonormal pattern: angina: 55%, pericarditis: 20%, heart failure classes NYHA III and IV: 80%, aneurysm: 25%, thrombus: 5%, atrial fibrillation: 25% and restrictive pattern: angina: 57,14%, pericarditis: 50%, heart failure classes NYHA III and IV: 100%, aneurysm: 42,85%, thrombus: 35,71%, rupture of interventricular septum: 7,14%, atrial fibrillation: 71,42%. Conclusions 1. The most severe patterns of diastolic dysfunction such as pseudonormal and restrictive were present in hypertensive patients with LVH and without successful reperfusion. 2. In these patients complications during the first week of hospitalization were more frequent. 3. We can conclude that an increased filling pressure revealed by a severe diastolic disfunction were associated with short therm complications after AMI.

Background: Before acute myocardial infarction (AMI), hypertensive patients has high filling pressure in left ventricle which is supplementary rised during the infarction by the areas of necrosis and ischemia. Aims of the study: was to evaluate echocardiographic parameters of diastolic dysfunction in hypertensive patients during the first week after AMI. Methods: A number of 98 hypertensive patients (56 males and 43 females), admitted with acute myocardial infarction with ST-segment elevation were evaluated in the first week by: clinical examination, 12 lead standard ECG, echocardiographic measurements of: left atrium volume index (LAVi) and left ventricle mass index (LVMi) using transthoracic echocardiography, pulmonary artery systolic pressure (PAPs) using Doppler echocardiography for tricuspid inflow, E/E’, E/vp and ar-A, using Doppler echocardiography for mitral inflow (E wave velocity, A wave duration), tissue Doppler echocardiography at lateral and medial corner of mitral annulus (E’ wave velocity), colour Mmode (flow propagation velocity vp) and pulmonary venous flow (ar wave duration): cut off levels: LAVi>32 ml/m2, LVMi>131 g/m2 in males and>125 g/m2 in females (left ventricular hypertrophy, LVH), PAPs>35mmHg, E/E’>14, E/vp>1,5, ar-A>25ms. Patients were divided in 4 groups: 1. LVH+ and reperfusion 2. LVH+ without reperfusion 3. LVH- and reperfusion 4. LVH- without reperfusion. Results: 1. LVH was find in 67 patients (68,36%). 2. Mean values of parameters of filling pressure in hypertensive patients with LVH and without reperfusion were: VASi: 35,04, p = 0,00007, PAPs: 45,57, p = 0,00122, E/E’: 14,81, p = 0,03992, E/vp: 1,99, p = 0,00197, ar-A: 28,79, p = 0,00726. 3. Percentages of patients with LVH and without reperfusion which presented filling pressure parameters values higer than cut off level were: VASi: 26,53%, PAPs: 26,53%, E/E’: 15,31%, E/vp:22,45%, ar-A: 16,33%. Conclusions: 1. In hypertensive patients without or failed thrombolitic therapy all echocardiographic parameters of filling pressure mean values were higher than cut off levels and than in hypertensive patients without LVH and with successful medical reperfusion. 2. The highest mean values were find in hypertensive patients with LVH and without reperfusion, which theoretical had the highest values of left ventricle filling pressure.

Objective: Metabolic syndrome consists of several interrelated risk factors that have been shown to increase the risk of heart disease and also the risk of atrial fibrillation. Method: We have included in the study group patients admitted in Cardiology Center in 2006 and we have divided them in 2 subgroups: individuals with hypertension and metabolic syndrome according to NCEP criteria and the second subgroup of hypertensives without metabolic syndrome. The follow-up period lasted for 3 years. We performed multivariate logistic regression analyses in order to assess the relationships between hypertension, metabolic syndrome, atrial fibrillation, dyslipidemia and diabetes mellitus. Results: We have evaluated 542 patients with metabolic syndrome and hypertension mean age of 55,12 years. There were 48,72% men and 51,28% women. The profile of our MS patients was depicted by older age, higher systolic pressure, higher body mass indexes and higher incidence of atrial fibrillation. The procent of patients with diabetes mellitus was 34,19%, but 27,35% from them had impaired fasting glucose. This population had more left ventricular hypertrophy, renal and cardiac diseases were more prevalent (p < 0.01), and they received more antihypertensive drugs (p < 0.05). Conclusions: The study shows the poor adherence to treatment of hypertensive patients with metabolic syndrome. The hypertensive patients with atrial fibrillation are achieving the target values for blood pressure in a very small percent (p < 0.05). The number of important cardiovascular events is increased in the case of these young patients with a very high risk profile.

Objective: Metabolic syndrome consists of several interrelated risk factors that have been shown to increase the risk of heart disease and also the risk of atrial fibrillation. Method: We have included in the study group patients admitted in Cardiology Center in 2006 and we have divided them in 2 subgroups: individuals with hypertension and metabolic syndrome according to NCEP criteria and the second subgroup of hypertensives without metabolic syndrome. The follow-up period lasted for 3 years. We performed multivariate logistic regression analyses in order to assess the relationships between hypertension, metabolic syndrome, atrial fibrillation, dyslipidemia and diabetes mellitus. Results: We have evaluated 542 patients with metabolic syndrome and hypertension mean age of 55,12 years. There were 48,72% men and 51,28% women. The profile of our MS patients was depicted by older age, higher systolic pressure, higher body mass indexes and higher incidence of atrial fibrillation. The procent of patients with diabetes mellitus was 34,19%, but 27,35% from them had impaired fasting glucose. This population had more left ventricular hypertrophy, renal and cardiac diseases were more prevalent (p < 0.01), and they received more antihypertensive drugs (p < 0.05). Conclusions: The study shows the poor adherence to treatment of hypertensive patients with metabolic syndrome. The hypertensive patients with atrial fibrillation are achieving the target values for blood pressure in a very small percent (p < 0.05). The number of important cardiovascular events is increased in the case of these young patients with a very high risk profile.

Background: An increased filling pressure in acute phase of myocardial infarction can be identified echocardiography. P-HiRes reveales late atrial potentials (LAP), associated with the risk of reentry arrythmias. Aim of the study was to find a correlation between echocardiographic parameters of increased filling pressure and the presence of LAP. Methods: A number of 98 hypertensive patients (56 males and 43 females), admitted with acute myocardial infarction (AMI) with ST-segment elevation were evaluated in the first week by: clinical examination, 12 lead standard ECG, echocardiographic measurements of: left atrium volume index (LAVi) and left ventricle mass index (LVMi), pulmonary artery systolic pressure (PAPs) (transthoracic and Doppler echocardiography), E/E’ (tissue Doppler echocardiography), E/vp (colour Mmode) and ar-A (pulmonary venous flow): cut off levels: LAVi>32 ml/m2, LVMi>131 g/m2 in males and >125 g/m2 in females (left ventricular hypertrophy, LVH), PAPs>35mmHg, E/E’>14, E/vp>1,5, ar-A>25ms. Criterias for he presence of LAP were evaluated using P-HiRes were: SAPWD>140ms, RMS(LP20)>3,5 μV, integral of p wave>800 μVs, nomber of beats 250, filters 25–40 MHz, noise level<0,1 μV (target). Results: 1. The higher incidence of LAP was found in patients with LVH without reperfusion: 25,51%. 2. Percentages of patients with LVH and without reperfusion which presented filling pressure parameters values higer than cut off levels were: VASi: 26,53%, PAPs: 26,53%, E/E’: 15,31%, E/vp:22,45%, ar-A: 16,33%. 3. Using chi squared (cs), odd ratio(or) and relative risk (rr) we found significant correlation between the presence of LAP and these parameters: VASi>32 ml/m2: cs = 36,64729, or= 19,28205, rr=4,96111, E/E’>14: cs=11,26657, or=5,677419, rr=1,866189, E/vp>1,5: cs=35,39615, or=0,rr=0, ar-A>25ms: cs=14,72762, or=6,08, rr=2,016. Conclusions: 1. The incidence of LAP was higher and echocardiographic parameters of filling pressure were higher than cut off levels in hypertensive patients with LVH without reperfusion. 2. Because of this good correlation between these parameters and the presence of LAP we can conclude that may be a link between increased filling pressure and damage of atrial myocardium which may lead to reentry arrythmias in hypertensive patients with AMI.