U nlike systolic heart failure (HF), HF with normal left ventricular (LV) ejection fraction (HFNEF) is characterized by a normal LV systolic function often evaluated by the biplane Simpson method.1 However, recent studies have shown that, despite a normal LV ejection fraction (LVEF), patients with HFNEF have a significant impairment of the longitudinal systolic function of the LV, suggesting that in these patients the myocardial systolic function of the LV is not preserved.2-5 Furthermore, several investigations have highlighted the key role of the longitudinal diastolic dysfunction of the LV in the pathophysiology of HFNEF.6-8 Nonetheless, despite these studies, 2-8 whether a longitudinal systolic and diastolic LV dysfunction is associated with an impairment of the global function or myocardial performance of the LV in patients with HFNEF remains poorly understood. In addition, echocardiographic indices that evaluate the systolic and diastolic myocardial performance of the LV (ie, the average value of the longitudinal, radial, and circumferential function of the LV) have not been investigated in these patients. Clinical Perspective on p 620We hypothesized that in patients with HFNEF a significant alteration in the longitudinal function of the LV, and to a lesser extent in the circumferential and radial LV func tion, could lead © 2012 American Heart Association, Inc. Background-The aim of this study was to investigate the myocardial systolic and diastolic performance of the left ventricle (LV) in patients with heart failure with normal LV ejection fraction (HFNEF) through novel LV myocardial indices, which assess the systolic and diastolic function of the whole myocardium of the LV. Methods and Results-LV myocardial systolic and diastolic performance were assessed as the average value of peak systolic strain and peak early-diastolic strain rate, respectively, in longitudinal, circumferential, and radial directions from all LV segments using 2-dimensional speckle-tracking echocardiography. We studied patients with HFNEF and a control group consisting of asymptomatic subjects with LV diastolic dysfunction of similar age, sex, and LV ejection fraction. A total of 322 patients were included (92 with HFNEF and 230 with asymptomatic LV diastolic dysfunction). Myocardial systolic and diastolic LV performance were significantly lower in HFNEF (20.13±6.02% and 1.14±0.27 s −1 Circ Heart Fail) than in patients with asymptomatic LV diastolic dysfunction (25.33±6.06% and 1.37±0.33 s −1 , respectively; all P<0.0001). In addition, patients with HFNEF with low systolic and diastolic LV myocardial performance had significantly higher LV filling pressures (17.1±6.6 and 17.6±6.3 versus 12.0±5.1 and 11.7±4.7, respectively; all P<0.001) and lower cardiac output (4.8±1.0 L/min and 4.9±1.1 L/min versus 5.7±1.2 L/min and 5.8±1.1 L/min, respectively; all P<0.001) than patients with normal LV myocardial performance. In relation to these findings, the symptomatic status (ie, New York Heart Association functional class) was significantly a...

A group of 20 healthy volunteers [10 women, 10 men; median age 25 (20-33) years] were examined by means of pulsed wave Doppler echocardiography, blood sample analysis and psychological testing before and after listening to three different examples of music: a waltz by J. Strauss, a modern classic by H. W. Henze, and meditative music by R. Shankar. To assess small haemodynamic changes, mitral flow, which reflects left ventricular diastolic behaviour, was measured by Doppler ultrasound. Heart rate, arterial blood pressure and plasma concentrations of adrenocorticotropic hormone, cortisol, prolactin, adrenaline, noradrenaline, atrial natriuretic peptide (ANP) and tissue plasminogen activator (t-PA) were determined simultaneously. Transmitral flow profile is characterized by early E-wave and late atrial induced A-wave. Velocity-time integrals were measured and the atrial filling fraction was calculated. The mental state was measured by using a psychological score (Zerssen) with low values (minimum 0) for enthusiastic and high values (maximum 56) for depressive patterns. Music by J. Strauss resulted in an increase of atrial filling fraction (AFF; 29% vs 26%; P < 0.05) and ANP (63 pg.ml-1 vs 60 pg.ml-1; P < 0.05). The mental state was improved (Zerssen: 6.5 vs 11 points; P < 0.05). After the music of H. W. Henze prolactin values were lowered (7.7 ng.ml-1 vs 9.1 ng.ml-1; P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

The aim of this study was to compare the sensitivity and specificity of digital chest radiography alone with digital chest radiography combined with dual-energy chest radiography in the detection of small non-calcified pulmonary nodules. Standard and dual-energy radiographs were obtained with a flat-panel digital chest system. Four radiologists reviewed digital posteroanterior chest radiographs in random order either alone or in conjunction with dual-energy soft tissue and bone images. Twenty patients with a total of 59 pulmonary nodules (median 0.5 cm, range 0.3-2.5 cm) confirmed by computed tomography (HU < or =100) were included. A level of confidence for each diagnosis was documented using a rating scale of 1-5. Brunner and Langer's test was performed for statistical analysis. Subgroup analysis was performed for nodules greater than 1 cm, 1-0.5 cm, and <0.5 cm. For posteroanterior chest radiography, sensitivity was 33%, positive predictive value 83%, specificity 81%, and negative predictive value 30%. Review in conjunction with dual-energy images resulted in a sensitivity of 42%, positive predictive value 88%, specificity 85%, and negative predictive value 34%. The increase of nodule detection overall as well as for different size categories was significant (p<0.05). The increase of the confidence level rating was also significant (p<0.001). Dual energy added to standard posteroanterior chest radiography significantly improves the sensitivity, specificity, and confidence in detection of small non-calcified pulmonary nodules.