Introduction: Right ventricular function has been recognised as an important determinant for the progression of systolic heart failure. Tissue Doppler imaging (TDI) has been recognized as a useful echocardiographic tool for quantitative assessment of both left and right ventricle function. In this study we sought to evaluate the role of systolic right ventricular function through tissue Doppler derived indexes with the clinical outcome in patients with newly diagnosed heart failure. Methods: We enrolled 180 consecutive patients (17% females, mean age 63 + /− 14years old) with newly diagnosed heart failure. Echocardiographic assessment was performed during the third day of their initial hospitalization. Mitral inflow velocities were recorded by standard pulsed-wave Doppler at the tip of the mitral valve (E and A). The pulsed TDI was characterized by the myocardial systolic wave (Smv or Stv) and two diastolic waves (Emv or Etv and Amv or Atv). Systolic function of mitral and tricuspid annulus was characterized by the systolic waves Smv and Stv respectively. Multiple logistic regression analysis was used to evaluate the association between systolic right ventricular function and the long-term (2 years) outcome (death or rehospitalisation), after adjustment for several confounders (age, sex, BMI, Smv, Ejection fraction, LAKE and E/Emv). Results: In the two years after hospital discharge, 79 patients (44%) had a clinical event (25 fatal). Inverse relationship was observed between the height of Stv and clinical events (b = -0.17, p = 0.13, OR = 84% and CI:0.737-0.965). The aforementioned relationship remained even after controlling for potential confounders.Conclusion: This study revealed the prognostic significance of Doppler-derived index Stv, which reflects right ventricular systolic performance, in patients with newly diagnosed heart failure in the long term follow-up. These results demonstrate the important role of impaired right ventricular systolic function, evaluated by TDI, on the clinical outcome of patients with newly diagnosed left ventricular systolic heart failure.

Background L-arginine, being the substrate for endothelial nitric oxide synthase, is essential for normal endothelial function. Endothelial dysfunction is accompanied by increased arterial stiffness. Aim of the study was to investigate in healthy smokers the effect of a short-term daily L-arginine administration on vascular function. Methods We studied the effect of a 3-day oral administration of L-arginine in 12 healthy smokers (aged 24±3 yrs) on 3 occasions (day 0: baseline measurements, day 1 and day 3). The study was carried out on two separate arms, one with L-arginine (7 g tid) and one with placebo according to a randomized, placebo-controlled, double-blind, cross-over design. All measurements were performed one hour after L-arginine or placebo intake. Endothelial function was evaluated with flow-mediated dilatation (FMD) of the brachial artery. Carotid-femoral pulse wave velocity (PWV) was measured as an index of aortic stiffness and augmentation index (AIx) as a measure of wave reflections Results Compared to placebo, L-arginine led to a progressive increase of FMD (by 1.74%, p = NS at day 1 and by 1.96%, p < 0.05 at day 3), indicating a favorable effect on endothelial function. Moreover, L-arginine intake led to a progressive decrease of PWV (by 0.32 m/s at day 1 and by 0.36 m/s at day 3, both p < 0.01) and of AIx (by 5.1%, p < 0.01 at day 1 and by 9.3%, p < 0.001 at day 3), indicating a decrease in aortic stiffness and wave reflections. Conclusion Short-term daily administration of L-arginine, improves arterial performance in healthy smokers. These findings provide further insights into the cardiovascular profile of this molecule.