The aim of the paper is to investigate the utility of left atrial longitudinal strain (LALS) in the diagnosis of heart failure with preserved ejection fraction (HFpEF) when left ventricular diastolic function is indeterminable and the assessment of natriuretic peptides is not routinely performed.Method. The study included 180 patients with signs and symptoms suggestive of non-acute heart failure, examined clinically and echocardiographically, both conventionally and via speckle tracking method.Results. 33 patients had a normal echocardiographic examination. Diastolic dysfunction (DD) was present in 116 patients of whom 32 patients had grade I, 66 patients grade II, 18 patients grade III DD. Diastolic function could not be determined in 31 patients. The mean value of LALS and NTproBNP in patients with normal echocardiography was significantly different from the group with DD for both variables (p<0.001). LALS was inversely correlated with the grade of DD (r=-0.83, p<0.001). The cut-off value of LALS for predicting DD was 25%. Applying this value in patients with indeterminate diastolic function we identified 21 patients with HFpEF (p<0.001).Conclusions. LALS can help in the diagnosis of HFpEF when other echocardiographic criteria are irrelevant and NTproBNP is not routinely performed. LALS was correlated with the presence and severity ofDDwith a cut-off value of 25%.

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Objective – To examine the utility of global longitudinal strain imaging diastolic index (SI-DI) in the assessment of patients with suspected obstructive coronary artery disease (CAD). Methods – We performed rest 2D standard echocardiography and strain imaging in 30 healthy subjects and in 148 patients with normal or mildly reduced ejection fraction and indication for coronarography for suspected obstructive CAD. Standard echocardiographic and strain parameters were analysed. Results – Global SI-DI was signifi cantly lower in the selected vs control group (p <0.001). After coronarography patients were divided in three subgroups: 74 patients with more than 50% obstruction in any major artery, 26 patients with previous revascularisation but no significant obstructive lesions at present and 48 patients without obstructive artery disease. Average global SI-DI was significantly lower in the subgroup with obstructive CAD vs the other two subgroups (p<0.05). Global SI-DI lower than 0.5 had a good sensitivity (84%) and a reasonable positive predictive value (52%) for detection of obstructive CAD. Conclusions – Global SI-DI is significantly lower in patients with obstructive CAD and normal or mildly reduced ejection fraction compared with normal subjects. A cut off value lower than 0.5 selects patients with a higher probability of obstructive CAD.

Background Venous thromboembolism (VTE) prophylaxis is recommended for all hospitalized COVID-19 patients in the absence of contraindications. Although D-dimer is a recognized biomarker for disease severity, there are insufficient data to recommend using this parameter to guide therapeutic decisions. Purpose The aim of the study is to investigate whether D-dimer guided anticoagulant therapy (ACT) is associated with a better evolution in moderate and severe COVID 19 illness. Methods We retrospectively analysed 120 consecutive patients (71 men, mean age 62.8±14 years old), hospitalised for moderate or severe COVID-19 illness. All patients were clinically examined, thoracic CT was performed, hematologic parameters were measured. Presence of VTE in patients with risk factors was excluded with doppler imaging and/or contrast thoracic CT. Patients with D-dimer ≤0.5 mg/L received prophylactic ACT (enoxaparin 40 mg daily), patients with D-dimer between 0.5 mg/L and 1 mg/L received 40 mg bid and those with D dimer ≥1mg/L were treated with full dose ACT (enoxaparin 1mg/kg bid). During hospitalization D-dimer was measured and the ACT was adapted accordingly. In all patients COVID-19 disease was managed according to current guidelines. After discharge patients were followed up 30±7 days. Prophylactic ACT was continued in patients with high thrombotic risk. Results 76 patients (63.3%) had moderate, and 44 patients (36.6%) had severe disease. Comorbidities were present in 71.5% patients (61.5% with cardiovascular disease, 16.6% with diabetes mellitus, 16.6% with obesity, 6.6% with renal failure, 4.1% with neoplastic disease). Average D-dimer was 1.3±0.8 mg/L. D-dimer elevation&gt;0.5 mg/L was seen in 79 patients (65.8%). D-dimer was higher in patients with severe vs moderate illness 1.5±0.9 mg/L vs 1.01±0.9 mg/l (p&lt;0.05) and in patients with comorbidities vs patients with no comorbidities (1.2±0.8 mg/L vs 0.7±0.6 mg/L, p&lt;0.05). During hospitalization and subsequent follow up no VTE was recorded. 10 patients (0.83%) initially on prophylactic doses were switched to full dose ACT. Haemorrhagic complications were recorded in 5 patients (4.1%) and were minor. 4 patients (3.3%) with moderate illness at admission and comorbidities, were transferred to intensive care unit (ICU) and subsequently died (two patients with severe respiratory failure, one patient with respiratory failure and myocarditis and one patient with coma after resuscitated cardiac arrest). 116 patients (96.7%) were discharged after a median hospitalization of 12±3 days and there were no complications recorded during the short term follow up. Conclusions D-dimer guided therapy is associated with a lower incidence of TVP complications and mortality in moderate and severe hospitalized patients (0% vs 10% and 3.3% vs 20.3% respectively in literature data base) with nonsignificant haemorrhagic complications. This small observational study needs to be validated by further research. Funding Acknowledgement Type of funding sources: None.