The reduction of LV longitudinal deformation is a sign of early subclinical LV dysfunction. GLS is a prognostic predictor of LV dysfunction and may be potentially useful for optimal timing of surgery for patients with significant AR.

Cardiovascular abnormalities are well-known manifestations of a late form of syphilis - tertiary syphilis. Since the era of antibiotics, the incidence of late manifestations of syphilis has declined almost to a rare entity. The injury of aorta (the aortitis with a dilatation of aortic root and its associated complications) is the most common between all the cardiovascular lesions. A less common manifestation of syphilitic aortitis is coronary artery ostial narrowing related to aortic wall thickening. We present the case of a 37-year-old male who was treated for an acute myocardial infarction due to bilateral coronary artery ostial stenosis secondary to syphilitic aortitis. According to the multidisciplinary decision, surgical revascularization (coronary artery bypass grafting, CABG) was performed. According to dermatologist recommendation, patient postoperative cardiovascular treatment was supplemented with intramuscular doses of benzathine penicillin recommended for tertiary syphilis. Further follow-up visits were also planned to detect possible changes of the aortic wall, dynamics of aortic regurgitation or potential anastomotic restenosis due to progression of aortitis.

Background: The significant role of mitral regurgitation (MR) in development of pulmonary hypertension (PH) has been proved in previous studies. Experts suggest systolic pulmonary arterial pressure (SPAP) ⩾60 mmHg during exercise as a significant threshold of negative prognostic value in patients with MR. Purpose: The aim of this study was to evaluate the changes of SPAP and to ascertain the determinants of exercise induced pulmonary hypertension (EIPH) in patients with asymptomatic primary MR. Methods: We performed a prospective study that included 50 patients with asymptomatic primary moderate to severe MR with preserved left ventricular ejection fraction (LV EF ⩾60%) at rest. They were divided into two groups according to the presence (PH group; n = 13) or absence (non-PH group; n = 37) of EIPH. Rest and stress (bicycle ergometry) echocardiography and speckle-tracking offline analysis were performed. Results: An increment of SPAP from rest to peak stress was higher in PH group ( p < 0.001). Multivariate regression analysis showed that MR effective regurgitation orifice area (EROA; p = 0.008) and regurgitant volume (RVol; p = 0.006) contributed significantly to SPAP at rest. Higher increment of MR EROA during stress and worse parameters of LV diastolic function at rest (E, A, E/e’) correlated significantly with higher SPAP during peak stress and they had a major role in predicting EIPH according to univariate logistic regression analysis. In ROC analysis SPAP >33.1 mmHg at rest could predict EIPH with 84.6% sensitivity and 87.1% specificity (95%CI 0.849–1.000; p < 0.001). Conclusions: Parameters of MR severity (EROA and RVol) were significant determinants of SPAP at rest, while the increment of MR EROA during stress and parameters of resting LV diastolic function were the best predictors of significant EIPH.

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Funding Acknowledgements Type of funding sources: None. Introduction. In patients with chronic mitral regurgitation (MR), left atrium (LA) is one of the first cardiac structures, that are affected by progressive volume overload. Previous studies have shown that higher LA filling index (FI) could be a potential negative prognostic marker and it may provide additional information in cases where surgical valve correction is considered. Purpose. The aim of this study was to evaluate the connection between the LA FI and exercise–induced pulmonary hypertension (EIPH) in patients with asymptomatic primary moderate to severe MR. Methods. The study sample consisted of 50 patients (age 61.88 ± 12.88 years) with asymptomatic primary moderate to severe MR and preserved left ventricular (LV) ejection fraction (EF) (&gt;60%). All of the patients underwent resting and stress (bicycle–ergometry as per protocol 25 + 25W every 3 minutes) echocardiography. The ratio of the early–diastolic mitral inflow peak velocity (E) and LA reservoir strain was calculated as the LA FI. EIPH was considered as systolic pulmonary artery pressure (SPAP) ≥60 mmHg during peak stress. Results. EIPH was identified in 13 (26%) patients with primary asymptomatic MR. LA FI at rest, during initial and peak stress was higher in patients with EIPH (p = 0.041, p = 0.023 and p = 0.036, respectively). LA FI at rest (r = 0.334; p = 0.044), during initial (25W) stress (r = 0.371; p = 0.037) and during recovery phase (r = 0.408; p = 0.023), weakly correlated with SPAP during maximal achieved workload. In univariate logistic regression analysis, LA FI during initial and peak stress was significantly related to EIPH (Table 1). According to ROC analysis, LA FI &gt;6.46 during initial stress could predict EIPH with 70.0% sensitivity and 75.0% specificity (p = 0.023). LA FI &gt;9.59 during peak stress could distinguish the possibility of underlying EIPH with 60.0% sensitivity and 94.3% specificity (p = 0.036). Conclusions. Resting and exercise LA FI was higher in subjects with EIPH. LA FI during stress could be the potential predictor of EIPH in patients with asymptomatic primary MR and preserved LV EF. Table 1 Parameter β Chi-Square Odds ratio Standard error 95% CI p value LA FI at rest 1.21 3.549 3.271 0.106 0.984 - 1.489 0.071 LA FI during initial (25 W) stress 1.535 6.056 4.812 0.195 1.047 - 2.250 0.028 LA FI during peak stress 1.662 7.364 4.646 0.236 1.047 - 2.638 0.031 LA FI during recovery phase 1.257 3.998 3.139 0.129 0.976 - 1.619 0.076 LA - left atrium FI - filling index Abstract Figure. Picture 1