Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp that these parameters do not necessarily correlate with invasively measured LV filling pressure in patients with hypertrophic cardiomyopathy, 2 severely reduced LV systolic function, 3 and heart failure with preserved ejection fraction (EF). 4 Editorial p 1104Reasons for inaccuracies with tissue Doppler-derived parameters could include angle dependency and myocardial tethering, levated left ventricular (LV) filling pressure results in shortness of breath, which is both a major symptom and a prognostic predictor for heart failure. Therefore, noninvasive estimation of LV filling pressure is considered a goal of routine echocardiography. Recent recommendations encourage using tissue Doppler-derived early-diastolic mitral annular velocity (e´) as a parameter of LV relaxation and the ratio of early-diastolic LV inflow velocity (E) to e´ (E/e´) to indicate LV filling pressure. Background: Speckle-tracking echocardiography (STE)-derived parameters may have better correlation with left ventricular (LV) relaxation and filling pressure than tissue Doppler-derived parameters. However, it has not been elucidated which parameter -strain or strain rate -and which direction of myocardial deformation -longitudinal or circumferential -is the most useful marker of LV relaxation and filling pressure.

ObjectiveThis longitudinal study was performed to determine changes in echocardiography parameters in association with various biomarker levels in pregnancy/postpartum.MethodsFifty-one healthy pregnant women underwent echocardiography with simultaneous determination of blood levels of five biomarkers at each of the first, second and third trimesters of pregnancy, immediately postpartum within 1 week after childbirth and approximately 1 month postpartum. Data on 255 echocardiography scans (five times per woman) and biomarkers were analysed.ResultsLeft ventricular end-diastolic dimension, left atrial (LA) volume index and left ventricular (LV) mass index increased with advancing gestation and reached the maximum immediately postpartum concomitant with the highest brain natriuretic peptide (BNP), N-terminal pro B-type natriuretic peptide (NT-proBNP), high-sensitivity troponin I (hs-TnI) and creatine kinase MB levels. The inferior vena cava diameter was significantly reduced in the third trimester compared with that in the first trimester and the peak occurred immediately after childbirth. In 255 paired measurements, hs-TnI level was significantly positively correlated with LA volume index and LV mass index; BNP and NT-proBNP were significantly positively correlated with LA volume index and estimated glomerular filtration rate (eGFR) was significantly positively correlated with the average of early diastolic septal and lateral mitral annular velocity (e′).ConclusionsMaximal cardiac changes in morphology occurred postpartum within 1 week after childbirth, not during pregnancy. BNP/NT-proBNP, hs-TnI and eGFR reflected cardiac changes in pregnancy.

Background: When left ventricular filling pressure (LVFP) increases, the mitral valve opens early and precedes tricuspid valve opening in early diastole. The authors hypothesized that a visually assessed time sequence of atrioventricular valve opening could become a new marker of elevated LVFP. The aim of this study was to test the diagnostic ability of a novel echocardiographic scoring system, the visually assessed time difference between mitral valve and tricuspid valve opening (VMT) score, in patients with heart failure.Methods: One hundred nineteen consecutive patients who underwent cardiac catheterization within 24 hours of echocardiographic examination were retrospectively analyzed as a derivation cohort. In addition, a prospective study was conducted to validate the diagnostic ability of the VMT score in 50 patients. Elevated LVFP was defined as mean pulmonary artery wedge pressure (PAWP) $ 15 mm Hg. The time sequence of atrioventricular valve opening was visually assessed and scored (0 = tricuspid valve first, 1 = simultaneous, 2 = mitral valve first). When the inferior vena cava was dilated, 1 point was added, and VMT score was ultimately graded as 0 to 3. Cardiac events were recorded for 1 year after echocardiography.Results: In the derivation cohort, PAWP was elevated with higher VMT scores (score 0, 10 6 5; score 1, 12 6 4; score 2, 22 6 8; score 3, 28 6 4 mm Hg; P < .001, analysis of variance). VMT score $ 2 predicted elevated PAWP with accuracy of 86% and showed incremental predictive value over clinical variables and guidelinerecommended diastolic function grading. These observations were confirmed in the prospective validation cohort. Importantly, VMT score $ 2 discriminated elevated PAWP with accuracy of 82% in 33 patients with monophasic left ventricular inflow in the derivation cohort. Kaplan-Meier analysis demonstrated that patients with VMT scores $ 2 were at higher risk for cardiac events than those with VMT scores # 1 (P < .001).Conclusions: VMT scoring could be a novel additive marker of elevated LVFP and might also be associated with adverse outcomes in patients with heart failure.