Introduction: The right atrium (RA) roles include being a systolic reservoir, an early diastolic conduit, and a late-diastolic booster pump. The present study aimed to assess normal reference values of three-dimensional speckle-tracking echocardiography (3DSTE)-derived RA volumetric data and volume-based functional properties in healthy adult subjects. Methods: We included 260 healthy adult subjects in sinus rhythm with complete clinical and demographic dataset, but excluded 110 of them because of inferior image quality. The remaining population sample comprised 150 subjects (31.0 ± 11.6 years, 79 males). Complete two-dimensional Doppler echocardiography and 3DSTE have been performed in all subjects.Results: Systolic RA volumetric variables did not show changes over time, but after 50 years, a significant reduction could be demonstrated in RA stroke volume and emptying fraction. While early diastolic RA volume increased over time, RA stroke volume and emptying fraction decreased. While late-diastolic RA volume increased over age decades, similar increase could be detected in RA stroke volume but a reduction occurred in older ages. Late-diastolic RA emptying fraction showed an increasing (after the 40s)-decreasing (after the 50s) pattern. Conclusions:Our study provides normal reference values of 3DSTE-derived RA volumes and volume-based functional properties and their age-and gender dependency in healthy adult subjects. K E Y W O R D S echocardiography, healthy subjects, right atrium, speckle-tracking, three-dimensional

Introduction: Hypereosinophilic syndrome (HES) is a very heterogeneous group ofdisorders with varied etiologies characterized by peripheral eosinophilia and eosinophilic tissue/end-organ damage. Three-dimensional speckle-tracking echocardiography (3DSTE) was used for assessment of left ventricular (LV) rotational mechanics in HES patients. Methods:The study comprised 13 HES patients, from which one patient was excluded due to insufficient image quality. The remaining patient population consisted of 12 HES cases (mean age: 59.7 ± 13.7 years, eight males). The control group consisted of 36 healthy volunteers (mean age: 52.9 ± 8.3 years, 23 males). 3DSTE was used for the evaluation of LV rotational abnormalities.Results: Both LV apical rotation (4.86 ± 1.92 degree vs 10.07 ± 3.92 degree, P < .0001) and LV twist (8.52 ± 2.79 degree vs 14.41 ± 4.26 degree, P < .0001) showed significant deteriorations in most of HES patients. Time-to-peak LV apical rotation (380 ± 115 ms vs 344 ± 69 ms, P = .56), LV basal rotation (335 ± 148 ms vs 337 ± 111 ms, P = .89), and LV twist (348 ± 91 ms vs 320 ± 60 ms, P = .64) were not significantly different between HES patients and controls. No correlations could be detected between absolute eosinophil count and eosinophil ratio and apical LV rotation (r = 0.12, P = .51 and r = 0.23, P = .45, respectively) and LV twist (r = 0.24, P = .39 and r = 0.31, P = .34, respectively). In two subjects, the absence of LV twist called LV "rigid body rotation" (RBR) was detected. Conclusions: Reduced LV apical rotation and twist could be demonstrated in HES.LV-RBR could be detected in some HES patients. K E Y W O R D S echocardiography, hypereosinophilic syndrome, left ventricular, rotation, speckle-tracking, three-dimensional, twist | 2065 NEMES Et al.

Introduction Lipedema is a barely recognized and poorly diagnosed, but common disease affecting almost exclusively female patients. The pathomechanism of lipedema is not known, and clinically, it is a bilateral, symmetrical, disproportional fatty enlargement of the lower half of the body, the disease does not affect the feet, and the upper extremities are often involved. Since lipedema is associated with increased aortic stiffness and altered left ventricular (LV) rotational mechanics, the present study was designed to compare the size and function of the mitral annulus (MA) between lipedema patients and controls by three‐dimensional speckle‐tracking echocardiography (3DSTE). Methods Twenty‐four patients with stage 2 lipedema and 48 age‐, gender‐, and body mass index‐matched healthy control patients were included in the study. Each person from the lipedema and the control groups underwent two‐dimensional Doppler echocardiography and 3DSTE. Results Significantly enlarged left atrial diameter, LV end‐diastolic diameter and volume, and LV end‐systolic volume could be detected in lipedema patients as compared to controls. None of the lipedema patients and controls showed ≥grade 1 mitral or tricuspid regurgitation. Dilated end‐systolic and end‐diastolic MA diameter, area, and perimeter could be demonstrated in lipedema patients as compared to controls, and these changes were accompanied by impaired MA fractional area change at rest. Following 1‐hour use of compression stockings, no significant improvement was seen in these parameters. Conclusions Lipedema is associated with MA enlargement and functional impairment. The use of compression stockings does not improve these alterations.

Introduction Left ventricular (LV) rotation and twist are essential parts of LV function. Three‐dimensional speckle tracking echocardiography (3DSTE) is a relatively new method and is useful for the quantification of LV wall deformation and rotational parameters. The aim of the present study was to examine LV rotation and twist differences between different age‐groups and genders in a healthy population. Methods The present study is comprised of 297 healthy adults; 120 adults have been excluded due to inferior image quality. The population was further divided into 4 subgroups based on age decades. Results Only the LV twist of all patients (13.5 ± 3.7 degree vs 15.6 ± 4.9 degree, P = 0.02) and the LV twist of females (13.0 ± 3.6 degree vs 15.5 ± 5.6 degree, P = 0.03) differed significantly between the age‐group of 18–29 years and 50+ years. LV basal and apical rotation were not significantly different between the age‐groups; however, they tendentiously increased with aging. No significant differences could be demonstrated regarding LV rotational and twist parameters between genders in any group. A phenomenon called LV rigid body rotation (LV‐RBR)—where the base and apex of the LV rotate in the same direction—was present in 10 cases. Conclusions Three‐dimensional speckle tracking echocardiography seems to be a reasonably viable tool for the quantification of LV rotation and twist. Both LV basal and apical rotation and LV twist increase with aging, regardless of gender. LV‐RBR is also present in the normal population.

Classic echocardiographic methodologies offer limited opportunities in assessing right atrial (RA) morphology and function. Three-dimensional (3D) speckle-tracking echocardiography (3DSTE) is a novel imaging method with objective 3D capability in assessing volumetric and functional properties of heart chambers. Normal reference values of different 3DSTEderived RA strains are not available, therefore the aim of this prospective study was to establish these parameters in healthy subjects. The present study comprised 295 healthy volunteers, from which 110 were excluded due to inadequate image quality. The final population consisted of 185 healthy subjects in the present study (mean age: 32.1 ± 12.2 years, 89 males). Complete two-dimensional echocardiography and 3DSTE have been performed in all cases. While radial strain (RS) does not change significantly over the years in males, in female subjects it increases with age most significantly between at the age of 40-49, and it starts to decline at the age of 50 in females. While females have higher circumferential (CS) and area (AS) strain values, CS and AS decrease with age in both gender. While LS remains almost unchanged in females until ages 40-49 years with a decline above the age of 50, it decreases over the decades in males. 3D strain (3DS) increases with age in both gender, but almost doubles in females in older ages. Specific pattern of strains at atrial contraction could also be demonstrated. 3DSTE-derived RA normal reference values with age-, gender-dependency and regional values are demonstrated in a healthy population.