The role of papillary muscle function in severe mitral regurgitation with preserved and reduced left ventricular ejection fraction and the method of choice to evaluate PM have still been the subjects of controversy. To evaluate and compare papillary muscle function in and between patients with severe degenerative and functional mitral regurgitation by using the free strain method. 64 patients with severe mitral regurgitation - 39 patients with degenerative mitral regurgitation (DMR group) and 25 patients with severe functional mitral regurgitation (FMR group) - and 30 control subjects (control group) were included in the study. Papillary muscle function was evaluated through the free strain method from apical four chamber images of the anterolateral papillary muscle (APM) and from apical three chamber images of the posteromedial papillary muscle (PPM). Global left ventricular longitudinal and circumferential strains were evaluated by applying 2D speckle tracking imaging. Global left ventricular longitudinal strain (DMR group, -17 [-14.2/-20]; FMR group, -9 [-7/-10.7]; control group, -20 [-18/-21] p < 0.001), global left ventricular circumferential strain (DMR group, -20 [-14.5/-22.7]; FMR group, -10 [-7/-12]; control group, -23 [-21/-27.5] p < 0.001) and papillary musle strains (PPMS; DMR group, -30.5 [-24/-46.7]; FMR group, -18 [-12/-30]; control group; -43 [-34.5/-39.5] p < 0.001; APMS; DMR group, (-35 [-23.5/-43]; FMR group, -20 [-13.5/-26]; control group, -40 [-32.5/-48] p < 0.001) were significantly different among all groups. APMS and PPMS were highly correlated with LVEF (p < 0.001, p < 0.001; respectively), GLS (p < 0.001, p < 0.001; respectively) and GCS (p < 0.001, p < 0.00; respectively) of LV among all groups. No correlation was found between papillary muscle strains and effective orifice area (EOA) in both groups of severe mitral regurgitation. Measuring papillary muscle longitudinal strain by the free strain method is practical and applicable. Papillary muscle dysfunction plays a small role in severe MR due to degenerative or functional causes and papillary muscle functions in general seems to follow left ventricular function. PPM is the most affected PM in severe mitral regurgitation in both groups of DMR and FMR.

Resumo Fundamento A carga de fibrilação atrial (FA) é definida como a proporção de tempo que o paciente permanece em FA durante um determinado período de tempo; portanto, é teoricamente mais elevado na FA permanente e mais baixo na FA paroxística. A inflamação está associada ao início e à manutenção da FA. No entanto, a relação entre o índice de inflamação imune sistêmica (SII, do inglês systemic immune-inflammation index) e a carga de FA é desconhecida. Objetivo No presente estudo, investigamos a relação entre o SII e a carga de FA. Métodos O presente estudo é uma análise transversal de 453 pacientes (252 do sexo feminino e 201 do sexo masculino, com idade entre 44 e 94 anos) com FA (138 com FA paroxística e 315 com FA permanente) atendidos no ambulatório de cardiologia entre outubro de 2022 e junho de 2023. O SII foi calculado como (neutrófilos × plaquetas/linfócitos). O papel preditivo do SII e de outros marcadores inflamatórios na probabilidade do padrão de FA foi avaliado por análises de regressão logística, sendo considerado estatisticamente significativo o valor de p < 0,05. Resultados Idade, pressão arterial diastólica, frequência cardíaca, diabetes mellitus, neutrófilos, relação plaquetas-linfócitos, relação neutrófilos-linfócitos, SII, proteína C reativa, largura de distribuição de glóbulos vermelhos, hemoglobina A1c e diâmetro do átrio esquerdo foram significativamente maiores no grupo com FA permanente. De acordo com a análise de regressão logística, idade (p = 0,038), diabetes mellitus (p = 0,024), largura de distribuição de glóbulos vermelhos (p = 0,023), proteína C reativa (p = 0,010), SII (p = 0,001) e o diâmetro do átrio esquerdo (p < 0,001) contribuíram significativamente para a predição da probabilidade de FA permanente. Conclusão O SII está independentemente associado à carga de FA. Estudos prospectivos são necessários para determinar se o SII pode ser útil na identificação de pacientes com alto risco de progressão da FA.

Background:. Red cell distribution width (RDW) is a measurement of size variability of the red blood cells and has been shown to be a powerful predictor of prognosis in heart failure (HF). Recently, global longitudinal strain (GLS) emerged as a more accurate marker of left ventricular (LV) systolic function. Aim: We aimed to assess the relationship between RDW and standard echocardiographic parameters and left ventricular global strain measured by two-dimensional (2D) speckle tracking echocardiography in patients with HF with reduced EF (HFrEF). Methods: Fifty-nine HF patients with an EF of < 50 %, and 40 age-matched controls with normal EF included in the study. Standard and 2D strain imaging examinations were performed. Blood tests including RDW were scheduled at the same day with the echocardiographic study. Results: Left atrial volume index, left ventricular (LV) end-systolic and end-diastolic dimensions, E/A and E/e' ratios were higher and LVEF together with LV GLS were significantly lower in the HFrEF group. RDW showed positive correlations with log BNP (r : 0.45, p : 0.0001), LAVI (r : 0.38, p : 0.001), LVDD (r : 0.37, p : 0.001), E/e' (r : 0.33, p : 0.005) and negative correlations with hemoglobin (r : -0.54, p : 0.0001), LVEF (r : -0.27, p : 0.004) and finally LV GLS (r : -0.41, p : 0.001). HFrEF patients were divided into two groups based on the median RDW value. Patients with higher than median RDW had significantly lower GLS despite similar EF. Conclusion: Elevated RDW is associated with poorer left ventricular deformation assessed by speckle tracking echocardiography in HF patients with similar ejection fraction. Therefore, the degree of anisocytosis could be used as an additional marker to offer these high-risk patients a closer follow-up as well as a more timely and intensive treatment strategy. Background:. Red cell distribution width (RDW) is a measurement of size variability of the red blood cells and has been shown to be a powerful predictor of prognosis in heart failure (HF). Recently, global longitudinal strain (GLS) emerged as a more accurate marker of left ventricular (LV) systolic function. Aim: We aimed to assess the relationship between RDW and standard echocardiographic parameters and left ventricular global strain measured by two-dimensional (2D) speckle tracking echocardiography in patients with HF with reduced EF (HFrEF). Methods: Fifty-nine HF patients with an EF of < 50 %, and 40 age-matched controls with normal EF included in the study. Standard and 2D strain imaging examinations were performed. Blood tests including RDW were scheduled at the same day with the echocardiographic study. Results: Left atrial volume index, left ventricular (LV) end-systolic and end-diastolic dimensions, E/A and E/e' ratios were higher and LVEF together with LV GLS were significantly lower in the HFrEF group. RDW showed positive correlations with log BNP (r : 0.45, p : 0.0001), LAVI (r : 0.38, p : 0.001), LVDD (r : 0.37, p : 0.001), E/e' (r : 0.33, p : 0.005) and negative correlations with hemoglobin (r : -0.54, p : 0.0001), LVEF (r : -0.27, p : 0.004) and finally LV GLS (r : -0.41, p : 0.001). HFrEF patients were divided into two groups based on the median RDW value. Patients with higher than median RDW had significantly lower GLS despite similar EF. Conclusion: Elevated RDW is associated with poorer left ventricular deformation assessed by speckle tracking echocardiography in HF patients with similar ejection fraction. Therefore, the degree of anisocytosis could be used as an additional marker to offer these high-risk patients a closer follow-up as well as a more timely and intensive treatment strategy.

In the early stages of atrial remodeling, aortic stiffness might be an indication of an atrial myopathy, in particular, atrial fibrosis. This study aimed to investigate the association between left atrial (LA) mechanical function, assessed by two-dimensional speckle tracking echocardiography, and aortic stiffness in middle-aged patients with the first episode of nonvalvular atrial fibrillation (AF). This prospective study included 34 consecutive patients with the first episode of AF, who were admitted to Kartal Koşuyolu Research and Training Hospital between May 2013 and October 2015, and 31 age- and gender-matched healthy controls. During the 1st month (mostly in the first 2 weeks) following their first admission, 34 patients underwent the first pulse wave measurements. Then, 21 patients were recalled for their second pulse wave measurement at 11.8 ± 6.0 months following their initial admission. Echocardiographic and pulse wave findings were compared between these 34 patients and 31 healthy controls. We also compared the pulse wave and echocardiographic findings between the first and second measurements in 21 patients. Pulse wave analysis showed no significant differences between the AF patients and healthy controls with respect to PWV (10.2 ± 2.5 m/s vs. 9.7 ± 2.1 m/s; P = 0.370), augmentation pressure (9.6 ± 7.4 mmHg vs. 9.1 ± 5.7 mmHg; P = 0.740), and aortic pulse pressure (AoPP; 40.4 ± 14.0 mmHg vs. 42.1 ± 7.6 mmHg, P = 0.550). The first LA positive peak of strain was inversely related to the augmentation pressure (r = −0.30; P = 0.02) and aortic systolic pressure (r = −0.26, P = 0.04). Comparison between the two consecutive pulse wave measurements in 21 patients showed similar results, except for AoPP. In 21 patients, the AoPP at the second measurement (45.1 ± 14.1 mmHg) showed a significant increase compared with AoPP at the first measurement (39.0 ± 10.6 mmHg, P = 0.028), which was also higher than that of healthy controls (42.1 ± 7.6 mmHg, P = 0.000). The association between aortic stiffness with reduced atrial strain and the key role of AoPP in the development of AF should be considered when treating nonvalvular AF patients with normal LA sizes.