Objectives:We planned to assess the right ventricular mechanics in subjects with typical chest pain and angiographically normal coronary arteries (microvascular angina [MVA]) and to search for an association between right ventricular mechanics, coronary flow reserve, and exercise tolerance.Methods: Seventy-one patients with MVA (mean age of 48.5 ± 7.9 years, 63% female) and 30 healthy control subjects were recruited. Right ventricular mechanics were calculated utilizing speckle tracking imaging. The exercise capacity was assessed by metabolic equivalents (METs). Coronary flow reserve (CFR) was calculated as the ratio between hyperemic (in response to intravenous adenosine) diastolic peak flow velocity and the basal diastolic peak velocity. Results: Coronary flow reserve (a surrogate marker of microvascular dysfunction) was diminished in MVA patients compared with the control group (2.41 ± 0.35 vs 3.35 ± 0.5; P < .03). Patients with lower right ventricular global longitudinal strain (RVGLS) and right ventricular global longitudinal strain rate (RVGLSr) had a considerably lower CFR (P < .001) and a significantly lower MET (P < .001) than patients with normal RV mechanics. Right ventricular global longitudinal strain and RVGLSr were significantly correlated with both CFR and METs in subjects with MVA. Receiver operating characteristic (ROC) curve analysis demonstrated that RVGLS ≤ −14.5 was the best cutoff value for the prediction of impaired exercise tolerance in patients with MVA.

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Objective We aimed to evaluate the relationship between fragmented QRS complex and plaque burden in patients presented with typical chest pain and deemed to have intermediate pretest probability of CAD using coronary computed tomography angiography (CCTA). Methods We studied electrocardiograms (ECGs) obtained from 172 subjects (47.5 ± 9.5 years, 125 were men) presented with chest pain and had intermediate pretest probability for CAD. The presence was found and evaluation of CAD was performed with CCTA. Results Seventy four (43%) of the study cohort had CCTA-documented CAD. Meanwhile the frequency of fQRS in our cohort was (57%). 70 (71.4%) patients with fQRS had CAD compared with only 4 (5.4%) patients without fQRS ( p < 0.001). The number of leads with fQRs was correlated with the calcium score ( p < 0.005), segment stenosis score, segment involvement score, total plaque score (TPS), and E/e ratio ( p < 0.001, for all). Multivariate analysis demonstrated that fQRS was a strong independent predictor for CAD (or = 2.15, p < 0.001). ROC analysis showed that the number of leads ≥3 was the optimal number for predicting CAD (AUC = 0.89, sensitivity 88%, and specificity 83%, p < 0.001). Conclusion Fragmented QRS was seen more often in patients with high plaque burden. We suggest that fQRS might provide a useful noninvasive prognosticator for subjects with intermediate pretest probability of CAD for further investigation.

Subjects & methodsEighty subjects with HFpEF were enrolled for the research (mean age 53.5±11.3 y, 45% of them were female). The study included patients with: (1) typical symptoms of HF; (2) LVEF more than 50%;(3) abnormal LV relaxation, blunted early mitral annular velocity (e'); high E/e' and B-type natriuretic peptide (BNP) >400pg/ml. 11,12 They were compared with 80 healthy subjects, who matched with patients in age and sex.We excluded patients with Acute Myocardial Infarction, unstable angina, pacemaker implantation, dilated left ventricle, cardiomyopathy, and valvular heart problems, atrial fibrillation, chronic obstructive and

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