Background Deformation imaging represents a method of measuring myocardial function, including global longitudinal strain (GLS), peak atrial longitudinal strain (PALS) and radial strain. This study aimed to assess subclinical improvements in left ventricular function in patients undergoing transcatheter aortic valve implantation (TAVI) by comparing GLS, PALS and radial strain pre and post procedure. Methods We conducted a single site prospective observational study of 25 patients undergoing TAVI, comparing baseline and post-TAVI echocardiograms. Individual participants were assessed for differences in GLS, PALS and radial strain in addition to changes in left ventricular ejection fraction (LVEF) (%). Results Our results revealed a significant improvement in GLS (mean change pre-post of 2.14% [95% CI 1.08, 3.20] p = 0.0003) with no significant change in LVEF (0.96% [95% CI − 2.30, 4.22], p = 0.55). There was a statistically significant improvement in radial strain pre and post TAVI (mean 9.68% [95% CI 3.10, 16.25] p = 0.0058). There was positive trend towards improvements in PALS pre and post TAVI (mean change of 2.30% [95% CI − 0.19, 4.80] p = 0.068). Conclusion In patients undergoing TAVI, measuring GLS and radial strain provided statistically significant information regarding subclinical improvements in LV function, which may have prognostic implications. The incorporation of deformation imaging in addition to standard echocardiographic measurements may have an important role in guiding future management in patients undergoing TAVI and assessing response.

Background Obstructive sleep apnoea (OSA) is present in 40-80% of patients with cardiovascular morbidity and is associated with adverse effects on cardiovascular health. Continuous positive airway pressure (CPAP) maintains airway patency during sleep and is hypothesised to improve cardiac function. In the present study, we report on the impact of 12 weeks of CPAP and improvements in echocardiographic parameters of the right ventricle (RV). Methods Nineteen newly diagnosed patients with OSA and a respiratory disturbance index (RDI) greater than 10 were enrolled. Echocardiography was performed before treatment and with a follow-up assessment after 12 weeks of CPAP. Echocardiographic and Doppler measurements were made following the American Society for Echocardiography guidelines. The primary outcome was isovolumetric acceleration (IVA). Secondary outcomes include tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), RV % strain, TEI index and RV dimension index (RVDI). Results There significant improvement in isovolumetric acceleration of 0.5ms2 (P=0.0012 (95% CI -0.72, -0.20)) and significant improvement of 2.05mm in TAPSE (p=0.0379 (95% CI -3.98 - -0.13). There was a trend to improvements in FAC, RV % strain, TEI index or RVDI with twelve weeks of CPAP therapy. Conclusion. The present study highlights significant increase in TAPSE and IVA with 12 weeks of CPAP treatment and a trend to improvement in FAC, RVDI and RV % strain. These data indicate favourable characteristics on both load dependent and load independent markers of RV function with CPAP.

The high prevalence of malnutrition among hospitalised patients has been reported in many studies and remains a significant problem (1,2) . Nutritional status can indirectly affect fracture risk in many ways. Low body weight is a risk factor for fracture as the protective padding offered by adipose tissue is reduced and there is also an associated loss of mass and strength of skeletal muscle (3) . The objective of this project was to determine the nutritional status of fracture patients admitted to the orthopaedic ward in a large academic teaching hospital.Data were collected prospectively over a one-month period in spring/summer. Patient demographics and anthropometric measurements were recorded. Nutritional status was categorised according to BMI combined with triceps skinfold thickness (TSF) and mid-arm muscle circumference (MAMC) values in comparison with widely accepted criteria outlined in larger studies in Ireland and Scotland (1,2) . A total of 27 patients were assessed, 63 % male, with a mean age of 60.5 years (median 72, range 16-90 years). The malnutrition universal screening tool was completed on all patients and 14.8% (n 4) were found to be 'at risk' of malnutrition (11.1% medium risk and 3.7% high risk). Handgrip measurement described 51.9 % (n 14) as being protein malnourished ( < 85 % of normal), of which 42.9 % (n 6) also had MAMC < 5th percentile. The same results were obtained irrespective whether BMI alone or combined measurements were used to categorise nutritional status. Undernutrition was prevalent in 11.1% (7.4 % moderate and 3.7% severe) which is very similar to data from a previous study in two large teaching hospitals in Dublin (1) and also to unpublished screening data from this hospital. A similar percentage of patients, both in this study and the previous study by Corish et al. (n 569), had normal BMI or were overweight/obese (40.7 and 48.1 % v. 40 and 46 % respectively).It would appear in this instance that undernutrition and obesity are no more prevalent among fracture patients than the general hospitalised population. To date, studies have focused on the effect of undernutrition as a risk factor for fracture. However, almost half this sample was found to be overweight/obese. Given that obesity levels are continuing to rise among the population, excess body weight may also pose a fracture risk by increasing musculoskeletal strain, especially in those with a low bone mass and low levels of physical activity. Direct comparisons with similar studies are difficult to make as they tend to target specific populations such as elderly, female, hip fracture patients in winter. A longer study assessing elderly patients would yield more specific results eliminating otherwise healthy young patients and account for seasonal variations.