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An enlarged LA compensates for LA dysfunction and maintains LASV at rest in patients with HFpEF. However, depressed LA reserve affects LA performance during leg lifts. Evaluation of LA function, including LA strain using leg lifts, might provide incremental diagnostic value for HFpEF.

Three patients diagnosed as having remitting seronegative symmetrical synovitis with pitting edema syndrome, pemphigus erythematosus and idiopathic interstitial pneumonia were treated with oral prednisolone. Several weeks after starting the treatment, they experienced repeated chest pain attacks between midnight and early morning, although none of the patients had a past history of ischemic heart disease. One of the patients exhibited aggravation of symptoms soon after increasing the dose of prednisolone. A definitive diagnosis of vasospastic angina was made using electrocardiograms, coronary angiography and vasospasm provocation tests. These cases emphasize that clinicians should be aware of the possible occurrence of vasospastic angina following the initiation of corticosteroid therapy.

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a b s t r a c tLeft ventricular (LV) false tendons are usually benign, intraventricular myocardial structures, which may cause functional malfunction or deformation of the LV cavity due to mechanical stretching and dilatation of the LV wall. We present a case of non-ischemic cardiomyopathy complicated with intraventricular dyssynchrony that was caused by complete left bundle branch block and the mechanical pressure exerted by the stiff false tendon on the weakened mid-septum during systole.& 2014 Japanese Heart Rhythm Society. Published by Elsevier B.V. All rights reserved. Case reportAn 80-year-old woman with a history of acute myelocytic leukemia in remission was hospitalized to undergo cardiac resynchronization therapy (CRT) for refractory congestive heart failure due to doxorubicin-induced cardiomyopathy. Twelve-lead electrocardiography during sinus rhythm revealed a complete left bundle branch block (CLBBB) and a 156-ms QRS (Fig. 1A). The cardiothoracic ratio on chest radiography was 58%. Transthoracic echocardiography revealed diffuse left ventricular (LV) hypokinesis, an ejection fraction of 34%, a 55-mm end-diastolic diameter, and overt dyssynchrony. An inextensible false tendon, 3 mm in its widest diameter, was visible with a hyperechoic shadow between the mid-septal and mid-lateral walls (Fig. 1C). Two-dimensional speckle trackingderived displacement curves showed that the lateral LV wall contracted during systole and relaxed during diastole, whereas the septum expanded during systole and contracted during diastole ( Fig. 2A). Neither myocardial perfusion scintigraphy nor magnetic imaging revealed the presence of prominent myocardial injury or septal fibrosis. Septal-to-posterior wall motion delay, an index of intraventricular dyssynchrony, was increased to 403 ms (upper normal limit, 129 ms). CRT-D was implanted with leads placed at the right ventricular apex and in the posterolateral tributary of the coronary sinus. After achieving the best V-V delay of 0 mms based on the echographic measurements, the QRS width was shortened to 124 ms (Fig. 1B). The result of a speckle tracking analysis in apical 4-chamber view during CRT showed a nearly unchanged and normal LV lateral wall motion, as well as an unchanged, dyssynchronous, mid-septal motion at the point of attachment of the false tendon, while a decrease to 100 ms in the septal-to-posterior wall motion delay was limited to the basal septum (Fig. 2B). Similarly, the result of a speckle tracking analysis in short-axial view during CRT showed normal LV anterior, lateral, posterior, and inferior wall motions, as well as dyssynchronous, anteroseptal, and septal motions at the point of attachment of the false tendon, which was characterized by dyssynchronous motion during mid and late systolic phases after a small synchronous motion during an early systolic phase (Fig. 3B). The shape and length of the false tendon remained fixed during the entire cardiac cycle, regardless of the presence or absence of CRT. However, a dyssynchronous apical motion was not nor...