Background: Mitral annular calcification (MAC) and aortic annular calcification (AVC) may represent a manifestation of generalized atherosclerosis in the elederly. Alterations in vascular structure, as indexed by the intima media thickness (IMT), are also recognized as independent predictors of adverse cardiovascular outcomes.

TDI evaluation showed a ventricular systolic dysfunction in pts with hypertensive cardiomyopathy; in addition, an early mild systo-diastolic dysfunction was detected in subjects with hypertension but no evidence of hypertensive cardiomyopathy.

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The 6-min walk test (6MWT) is a simple and inexpensive exercise test to evaluate physical functional capacity that is widely used in heart failure (HF) patients. With the 6MWT, a distance <350 m is associated with increased mortality in patients with HF, and change in walking distance >50 m is considered clinically relevant. To our knowledge, information on improvement in physical functional capacity with sacubitril/valsartan, as assessed by the 6MWT, is still scant. In our daily practice, we apply this test to all patients whenever possible; therefore, we report here the findings observed in a small series of 5 patients with HF with reduced ejection fraction after a 1-month treatment with sacubitril/valsartan at full dose. The mean distance walked on the 6MWT at baseline was 129 m (±64 SD), and this value increased to 436 m (±156) after 1 month of therapy with sacubitril/valsartan 97/103 mg b.i.d. The mean difference from baseline was 305 m (±110). According to these preliminary findings, in clinical practice, a 1-month therapy of sacubitril/valsartan optimized at a 97/103-mg b.i.d. dose appears to be associated with a relevant improvement in the 6MWT.

There is a lack of detailed data regarding the effect of exercise training in pharmacologically treated hypertensive patients. Therefore, the aim of this study was to evaluate the effects of exercise training on left and right ventricular morphologic and functional parameters by means of conventional echocardiography and sensitive new echocardiographic techniques including tissue Doppler velocity and strain imaging, that were performed in pharmacologically treated hypertensive patients at baseline and at the end of a specific exercise training protocol for primary prevention of cardiovascular disease. We selected 116 pharmacologically treated hypertensive patients who completed the exercise training protocol. All patients underwent a clinical history and examination; transthoracic echocardiography and exercise testing were performed at baseline and at the end of the exercise training protocol. Conventional echocardiography revealed a mild degree of diastolic dysfunction without significant differences or variations from baseline to the end of the exercise training protocol. In contrast, tissue Doppler velocity and strain imaging measurements demonstrated and highlighted the positive influence of exercise training: for both left and right ventricle myocardial early peak diastolic velocities (Em), the ratio of myocardial early-late peak diastolic velocity (Em/Am), myocardial peak systolic velocities (Sm) and peak strain and strain rate values significantly increased at the end of the exercise training protocol, suggesting a relationship between exercise capacity and both left and right ventricular systo-diastolic function. Our study, by means of newer more sensitive echocardiographic techniques, clearly demonstrated the positive impact of exercise training on both left and right ventricular systo-diastolic function, in terms of adjunctive subclinical improvement, in pharmacologically treated hypertensive patients.