Effects of levosimendan in heart failure: The role of echocardiography.

Heart failure (HF) represents a deadly epidemic that nowadays affects more than 2% of the general population, representing a major public health concern that implies a high economic burden for the health system. Levosimendan in HF patients is usually used for its inotropic and vasodilator effects that act without myocardial oxygen consumption, differently from other inotropic drugs. The symptoms and hemodynamic profile improve together with the myocardial function, and this can be demonstrated by an echocardiographic examination.

Effects of levosimendan on heart failure in normotensive patients: does loading dose matter?

Background: Levosimendan is a calcium sensitizer and K(+)-ATP channel opener with inotropic and vasodilatatory effects irrespective of myocardial oxygen consumption, used for treatment of heart failure (HF). A loading dose is usually given by infusion for 12 h; however, profound lowering of blood pressure often disrupts or prolongs the infusion. The aim of this study was to assess clinical, biochemical and myocardial differences between different regimes of levosimendan therapy, with or without loading dose, and compared to standard therapy in heart failure.

Coronary calcification with no flow limiting lesions: A potential cause for ischaemic dysfunction in syndrome X patients.

Aim: Exertional angina in patients with no coronary flow limiting lesions remains a clinical puzzle. We aimed to assess the extent of coronary artery calcification (CAC) and its relationship to ventricular wall motion function using stress echocardiography in a group of patients limited by exertional angina, but no obstructive lesions.

Methods: We compared CT coronary calcium score (CACS) and dobutamine stress echocardiography in 55 patients (age 64.

The impact of gender on fractional flow reserve measurements.

Aims: Fractional flow reserve (FFR) allows accurate investigation of the functional significance of intermediate coronary stenoses. The present study set out to study the impact of gender on FFR measurements.

Methods And Results: Three hundred and seventeen intermediate (40-70% at angiography) stenoses were assessed with FFR in 270 patients (mean age 65.

Effects of levosimendan without loading dose on systolic and diastolic function in patients with end-stage heart failure.

Background: Levosimendan (L) is used in clinical practice for the treatment of severe heart failure (HF); it has inotropic and vasodilatory effects, without increasing myocardial oxygen consumption. In acute HF, levosimendan improves hemodynamic parameters; previous studies have demonstrated that it has favorable effects on left ventricular (LV) diastolic function. The aim of our study was to evaluate the effect of on LV long-axis function that represents the earlier marker of diastolic dysfunction.

Early detection of left atrial strain abnormalities by speckle-tracking in hypertensive and diabetic patients with normal left atrial size.

Background: Systemic hypertension and type 2 diabetes mellitus are associated with impaired left atrial (LA) function, but whether LA functional abnormalities also occur in patients with hypertension and diabetes who have normal LA sizes is unknown. The aim of this study was to explore LA strain using speckle-tracking echocardiography in patients with hypertension or diabetes and normal LA size.

Methods: LA strain was studied by speckle-tracking echocardiography in 155 patients with hypertension or diabetes with LA volume indexes < 28 mL/m(2) (83 with hypertension, 34 with diabetes, and 38 with both diabetes and hypertension) and 36 age-matched controls.

Congenital mitral disease: anomalous mitral arcade in a young man.

We present the case of a 33-year-old man referred to our institution with a diagnosis of severe mitral valvular stenosis and insufficiency. We realized the valvular disease was due to an "anomalous mitral arcade," a rare congenital malformation of the mitral tensor apparatus characterized by enlarged papillary muscles connected to mitral leaflets by a typical fibrous tissue bridge. This arrangement creates a fibrous continuity between valvular and subvalvular apparatus.

Acute effects of low doses of red wine on cardiac conduction and repolarization in young healthy subjects.

Background: Moderate to high blood concentrations of ethanol have been shown to yield acute changes in cardiac electrophysiological properties, but the effect of low concentrations have never been assessed. The role of concomitant changes in clinical variables or cardiac dimensions is also still unknown. This study aimed at exploring the acute effects of low doses of ethanol, administered as Italian red wine, on conduction, depolarization, and repolarization electrocardiographic (ECG) intervals in a population of healthy subjects.

Echocardiographic Assessment of Ebstein's Anomaly in a 60-Year-Old Man.

We present an echocardiographic evaluation of an elderly man affected with Ebstein's anomaly. In the natural history of this congenital disease only 5% of patients survive beyond the fifth decade. The patient presented severe right heart failure and he was refered to our institution for heart transplantation.

Feasibility and reference values of left atrial longitudinal strain imaging by two-dimensional speckle tracking.

Background: The role of speckle tracking in the assessment of left atrial (LA) deformation dynamics is not established. We sought to determine the feasibility and reference ranges of LA longitudinal strain indices measured by speckle tracking in a population of normal subjects.

Methods: In 60 healthy individuals, peak atrial longitudinal strain (PALS) and time to peak longitudinal strain (TPLS) were measured using a 12-segment model for the left atrium.

Acute effects of caffeine and cigarette smoking on ventricular long-axis function in healthy subjects.

Background: Few data exist regarding the direct effects of caffeine and smoking on cardiac function. We sought to explore the acute effects of caffeine assumption, cigarette smoking, or both on left ventricular (LV) and right ventricular (RV) function in a population of young normal subjects.

Methods: Forty-five healthy subjects aged 25 +/- 2 years underwent echocardiography.