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BackgroundTo evaluate the possibility of left atrial (LA) remodeling using speckle tracking echocardiography (STE) in patients with interatrial block (IAB).MethodsWe performed a cross-sectional study with three groups of patients: 56 without IAB, 21 with partial IAB (pIAB), and 22 with advanced IAB (aIAB). Transthoracic echocardiographic (TTE) STE was performed and clinical and echocardiographic findings were analyzed.ResultsTTE showed higher LA volume/body surface area in the patients with IAB. With STE, the absolute value of strain rate during atrial booster pump function (SRa) and early reservoir period (SRs) decreased in the pIAB group and even more in the aIAB group, compared to the group without IAB. The independent variables were the echocardiographic measures of LA size and function. After adjusting for confounders, both multiple linear regression and multivariate multinomial regression showed good correlation with dependent variables: longer P-wave duration on electrocardiography and with the type of IAB, respectively. SRa (p < 0.001), SRs (p < 0.001), and maximal peak LA longitudinal strain in the reservoir period (p = 0.009) were independently associated with P-wave duration. SRa was also associated with the presence of pIAB (OR = 11.5; 95% confidence interval (CI): 2.7–49.0; p = 0.001) and aIAB, (OR = 98.2; 95% CI: 16–120.4; p < 0.001) and SRs was associated with pIAB (OR: 0.03; CI: 0.003–0.29; p = 0.003) and with aIAB (OR: 0.008; CI: 0.001–0.12; p = 0.004).ConclusionsIAB correlates directly with structural remodeling and a decrease in the absolute value of LA SRa and SRs determined using STE.Electronic supplementary materialThe online version of this article (10.1186/s12872-018-0776-6) contains supplementary material, which is available to authorized users.

Heart failure poses an increasing problem for global health care systems. The epidemiological data which have been accrued over the last 30 years have predominantly been accumulated from experience within North America and Europe. The European experience in heart failure, although similar to that in North America, has recently demonstrated differences in hospitalization which may underlie the differences between health care system configurations. Despite the predicted increase in the number of patients affected by heart failure, over the last 30 years a clear management algorithm has evolved for the use of pharmacotherapies, device-based therapies, and mechanical therapies, including left ventricular assist devices and cardiac transplantation. Although the treatment of such patients has been clearly delineated in national and international guidelines, the underuse of all available and appropriate therapies remains a significant problem. The purpose of this review is to provide a European perspective on management of heart failure.

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Abstract:We describe a 62--year--old patient with a 4--year history of myelodysplasia who later developed striking features that included massive splenomegaly, rapidly evolving visual loss and a sensorimotor polyneuropathy. This led us to consider the diagnosis of haemophagocytic lymphohistiocytosis (HLH).Upon further investigation, we found that he fulfilled the necessary diagnostic criteria for HLH, including the presence of haemophagocytosis of erythroid precursors on bone marrow smear.