Pulmonary hypertension (PH) is defined as a mean pulmonary artery pressure (PAP) "25 mmHg at rest as assessed by right heart catheterization (RHC), and Doppler-derived systolic PAP (sPAPECHO) or tricuspid regurgitation pressure gradient (TRPG) is widely used to screen for PH. However, the cutoff value of sPAPECHO or TRPG for detecting a mean PAP "25 mmHg that was determined invasively has not been well defined.We studied 189 patients who underwent RHC. Echocardiography was performed within 24 hours of invasive evaluation, and sPAPECHO was defined as the TRPG with right atrial pressure estimated on the basis of the current guideline.From the receiver operating characteristic (ROC) curve analysis, the optimal sPAPECHO, and TRPG cutoffs for detecting PH were 41 mmHg (sensitivity, 92%; specificity, 91%; area under the curve = 0.95) and 36 mmHg (sensitivity, 90%; specificity, 93%; area under the curve = 0.95), respectively. The area under the TRPG ROC curve was similar to the area under the sPAPECHO ROC curve.Given that Doppler echocardiography is required to accurately detect PH rather than to accurately estimate systolic PAP, our results provide useful information with regard to screening patients for PH and recommending further investigations on PH.(Int Heart J 2019; 60: 836-844)

We evaluated the association between visceral adiposity and left ventricular (LV) diastolic function in association with plasma adiponectin levels in 213 subjects without overt cardiac diseases. Abdominal visceral fat area was quantified by computed tomography. Excessive visceral fat was significantly associated with impaired diastolic parameters including E/A, E′ and E/E′. Although serum adiponectin levels decreased with increased visceral adiposity, there was no independent association between serum adiponectin levels and diastolic parameters, which suggest that the role of adiponectin in this association might be indirect.

Association of Echocardiography. 3,4 However, in the clinical setting, sometimes the invasive RAP and RAP estimated from IVC parameters are not concordant. As a matter of fact, despite the widespread use of the IVC approach for RAP assessment, there are no previous studies that have evaluated this technique in comparison with simultaneous invasive methods. 5-8 There is no report that has compared invasive RAP with simultaneously obtained IVC parameters in a large cohort, and only a few small studies 9-11 have been published. The numbers of subjects in those studies were merely 35, 9 71, 10 and 27. 11 Moreover, most of the previous studies that support the current guidelines are derived from US and European populations. Although the current guidelines suggest a maximal IVCD A n elevated right atrial pressure (RAP) is a major prognostic predictor of morbidity and mortality in patients with pulmonary hypertension. 1 Noninvasive assessment of RAP is used to estimate systolic pulmonary artery pressure in conjunction with the tricuspid regurgitation pressure gradient, and this assessment also plays a critical role in the management of volume control in patients with congestive heart failure. 2 Currently, estimation of RAP using ultrasound measurements of the inferior vena cava (IVC) diameter (IVCD), together with its respiratory variation, is commonly performed, because it is simple and noninvasive and recommended in the current guidelines of the American Society of Echocardiography in conjunction with the European

Even in healthy subjects, the heart ages along with other organs of the body. A prominent change is progressive left ventricular (LV) diastolic dysfunction, even though LV mass increases slightly during aging. Accordingly, assessment of LV dysfunction can be employed as a surrogate marker of cardiac age. The clinical factors that may accelerate the cardiac aging process include visceral obesity, diabetes mellitus, dyslipidemia, and hypertension. At the molecular level in cardiac myocytes, reactive oxygen species, transforming growth factor-β, mitochondrial function, and lysosomal function are also related to cardiac age. Furthermore, age-related LV dysfunction has been shown to be one of the main risk factors for future heart failure. Consequently, assessment of LV diastolic function is necessary for both preventing cardiac events and assessing cardiac age. Echocardiography provides a noninvasive assessment of cardiac structure and function. This review describes how to assess cardiac aging using echocardiography, and how to interpret the clinical relevance of the findings.

The prognostic value of the right ventricular (RV) systolic to diastolic duration ratio (S/D ratio) in patients with advanced heart failure is not clear.We enrolled 45 patients with DCM (40 ± 13 years, 33 male) who were admitted to our hospital for evaluation or treatment of heart failure. The RV systolic and diastolic durations were measured using continuous Doppler imaging of tricuspid regurgitation, and the RV S/D ratio was calculated. Cardiac events were defined as cardiac death or left ventricular assist device implantation within the first year. Twenty-eight cardiac events occurred. The RV S/D ratio was significantly higher in the event group than in the event-free group (1.8 ± 0.8 versus 1.2 ± 0.5, P = 0.008). Univariate analysis showed that the RV S/D ratio, plasma brain natriuretic peptide concentration, left atrial volume index, and mitral deceleration time were associated with these events. Receiver operating characteristic curve analysis revealed that the optimal RV S/D cutoff value to predict events was 1.2 (sensitivity 79%, specificity 65%, area under the curve 0.745). Kaplan-Meier analysis indicated a significantly higher event rate in patients with an RV S/D ratio > 1.2 (log-rank test, P = 0.003). The addition of an RV S/D ratio > 1.2 improved the prognostic utility of a model that included conventional variables (P = 0.014).In patients with advanced heart failure with DCM, the RV S/D ratio was higher in patients with events than in those without events. The addition of the RV S/D ratio to conventional parameters may provide better prognostic information.