Two methods are currently available for left atrial (LA) strain measurement by speckle tracking echocardiography, with two different reference timings for starting the analysis: QRS (QRS-LASr) and P wave (P-LASr). The aim of MASCOT HIT study was to define which of the two was more reproducible, more feasible, and less time consuming. In 26 expert centers, LA strain was analyzed by two different echocardiographers (young vs senior) in a blinded fashion. The study population included: healthy subjects, patients with arterial hypertension or aortic stenosis (LA pressure overload, group 2) and patients with mitral regurgitation or heart failure (LA volume–pressure overload, group 3). Difference between the inter-correlation coefficient (ICC) by the two echocardiographers using the two techniques, feasibility and analysis time of both methods were analyzed. A total of 938 subjects were included: 309 controls, 333 patients in group 2, and 296 patients in group 3. The ICC was comparable between QRS-LASr (0.93) and P-LASr (0.90). The young echocardiographers calculated QRS-LASr in 90% of cases, the expert ones in 95%. The feasibility of P-LASr was 85% by young echocardiographers and 88% by senior ones. QRS-LASr young median time was 110 s (interquartile range, IR, 78-149) vs senior 110 s (IR 78-155); for P-LASr, 120 s (IR 80-165) and 120 s (IR 90-161), respectively. LA strain was feasible in the majority of patients with similar reproducibility for both methods. QRS complex guaranteed a slightly higher feasibility and a lower time wasting compared to the use of P wave as the reference.

underwent transcatheter closure showed that prominent EV was significantly associated with recurrent neurologic events. The authors reported that all patients with prominent EV who experienced recurrent neurologic events had residual shunting. 6 This might be associated with malpositioning of the RA disk because of EV. Schuchlenz et al. 7 found that EV was more common in paradoxical embolism patients with PFO. In our study, the DB(+) pediatric patients had a larger defect and higher rate of diuretic prescription than the DB(À) pediatric patients. A larger defect causes greater RA volume load. RA enlargement due to volume load may affect the position of IVC and CS. This may help to explain the association of the larger defect and DB view. Larger studies are necessary to examine this hypothesis. This study has limitations due to its retrospective nature. Some DB views might have been missed because appropriate images from such DB views were not stored. In conclusion, the prevalence of the DB view in TEE, which comprises IVC, CS, and prominent EV, is not rare in ASD patients. In the pediatric cases, the DB(+) group had larger defects and the prevalence of diuretic prescription was higher than in the DB(À) group. Larger studies are necessary to confirm these findings.

Previous beta-blockade therapy in patients presenting with ADHF decreases intra-hospital mortality and the incidence of CV events and stroke/transient ischemic attacks. Moreover, nonwithdrawal of beta-blockers during hospitalization has a favorable outcome.

Coronary perforation is a potentially fatal complication during percutaneous coronary intervention. Reports have shown that it occurs in 0.2 to 0.6% of all patients undergoing the procedures. Although the frequency of coronary perforation is low, it is a serious and potentially life-threatening situation that warrants prompt recognition and management. Here we present a case of distal coronary perforation, and review the management of coronary perforation in the current practice.

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