Despite recent advances in clinical imaging, echocardiography remains as the most accessible and reliable noninvasive. Since knowledge of left ventricular systolic function remains so critically important in determining prognosis; every effort should be made to prevent subjective estimations. The advent of strain imaging echocardiography now offers a readily available and portable imaging tool that not only offers an objective characterization of myocardial dynamics; but also allows for early detection of subclinical left ventricular dysfunction. This review outlines the basic concepts of strain imaging to better understand the mechanism of myocardial function as well their applicability in the least common cardiac diagnosis among current clinical practice.

Obstructive sleep apnea (OSA) is one of the most common and serious sleep-related breathing disorders with a high prevalence among patients with cardiovascular (CV) diseases. Despite its widespread presence, OSA remains severely undiagnosed and untreated. CV mortality and morbidity are significantly increased in the presence of OSA as it is associated with an increased risk of resistant hypertension, heart failure, arrhythmias, and coronary artery disease. Evaluation and treatment of OSA should focus on recognizing patients at risk of developing OSA. The use of screening questionnaires should be routine, but a formal polysomnography sleep study is fundamental in establishing and classifying OSA. Recognition of OSA patients will allow for the institution of appropriate therapy that should alleviate OSA-related symptoms with the intent of decreasing adverse CV risk. In this review, we focus on the impact OSA has on CV disease and evaluate contemporary OSA treatments. Our goal is to heighten awareness among CV practitioners.

Background It is now well known that timing of right ventricular outflow tract (RVOT) spectral Doppler signals change with increasing pulmonary hypertension severity. We devised a study to determine whether visual assessment of these RVOT Doppler signals can be useful identifying the severity of pulmonary hypertension. Methods Visual inspection of pulsed RVOT Doppler signals from 120 consecutive patients (mean age of 55 ± 12, range 29–89 years; 45 males); with a mean pulmonary artery systolic pressure (PASP) of 59 ± 29, (ranging from 18 to 150 mmHg), of whom 78 patients had PASP >40 mmHg, was performed and correlated with standard echo Doppler variables of right ventricular performance. Results Visual inspection of RVOT spectral Doppler signals from the 120 patients showed four dynamic patterns and on a stepwise multiple regression analysis, PASP was the only echocardiographic variable that correlated with these different types of RVOT spectral Doppler signals. Furthermore, receiver operator curve analysis of these RVOT spectral Doppler signals correlated well with different ranges of PASP. Conclusions Visual assessment of RVOT spectral signals demonstrates the presence of four dynamic patterns, independent of the aetiology of the pulmonary hypertension, that not only correlate with the severity of pulmonary hypertension, but also are useful in identifying a range of PASP with great accuracy that minimizes subjective interpretation. These simple visual assessments of RVOT Doppler signals can be done routinely when evaluating patients with pulmonary hypertension without the need of additional sophisticated equipment.

Serum uric acid (SUA) has garnered an increased interest in recent years as an important determinant of cardiovascular disease. Uric acid, a degradation product of purine metabolism, is affected by several inheritable and acquired factors, such as genetic mutation, metabolic syndrome, chronic kidney disease, and medication interactions. Even though elevated SUA have been commonly associated with the development of gout, it has significant impact in the development of hypertension, metabolic syndrome, and cardiovascular disease. Uric acid, in both crystalline and soluble forms, plays a key role in the induction of inflammatory cascade and development of atherosclerotic diseases. This concise reappraisal emphasizes key features about the complex and challenging role of uric acid in the development and progression of atherosclerosis and cardiovascular disease. It explores the pathogenesis and historical significance of uric acid, highlights the complex interplay between uric acid and components of metabolic syndrome, focuses on the pro-inflammatory and pro-atherogenic effects of uric acid, as well as discusses the role of urate lowering therapies in mitigating the risk of cardiovascular disease while providing the latest evidence to the healthcare professionals focusing on the clinical importance of SUA levels with regards to cardiovascular disease.