Left atrium enlargement is a pathophysiological response to volume and pressure overload associated with a wide range of cardiovascular disorders leading to left ventricle systolic and diastolic dysfunction. Physiological factors contribute to significant differences in left atrium size in normal individuals. Moreover, left atrium enlargement was shown to have a significant prognostic value for cardiovascular events such as heart failure, atrial fibrillation or stroke, and increased cardiovascular and all-cause mortality rates. Current imaging techniques such as two-and three dimensional echocardiography, cardiac magnetic resonance imaging and multi-detector computed tomography allow a detailed assessment of the left atrium. The current paper aims to offer an overview of two-dimensional echocardiography parameters which provide data concerning left atrium dimensions and phasic functions and may lead to a better understanding of left atrium physiology and pathology.Keywords Left atrium (LA) structure and function assessment by echocardiography has gained interest lately and several quite recent studies were focused particularly on the LA and the changes it is submitted to in a wide range of pathologies. LA impairment has already been shown to emerge with advancing age [1,2], heart failure [3,4] and other cardiovascular disorders such as hypertension [5], atrial fibrillation [6], or hypertrophic cardiomyopathy [7]. Moreover, LA enlargement was proved to be associated with an increased risk of developing chronic atrial fibrillation [8] and stroke [9], as well as with higher cardiovascular and all cause mortality rates, particularly in men and in the presence of associated cardiovascular risk factors (high body mass index, smoking, advanced age or diabetes mellitus) [10,11]. Left atrium anatomy and physiologyThe LA has a complex morphology, which may render echocardiographic assessment difficult, due to the oblique position of the interatrial septum and the long and narrow LA appendage [12]; current echocardiographic techniques, which allow surface and volume assessment, assume spherical, cube or ellipsoid models for the LA that are not entirely accurate and may lead to error [13]. Moreover, the four pulmonary veins enter the LA via the posterior wall and are frequently inaccessible for venous flow evaluation by Doppler [12].LA performance is based on four basic mechanical functions: the reservoir function; the conduit function; the active contractile pump function; and the suction force [14]. The latter is not described by most authors, as it is considered the early stage of the reservoir phase.As a reservoir, the LA receives blood from the pulmonary veins during ventricular systole; the mitral annulus and valve descend as a consequence of longitudinal shortening during ventricular contraction, leading to an increase in LA volume and a decrease in pressure due

In this prospective pilot study, we aimed to evaluate the ability of cardiac magnetic resonance imaging (CMR) parameters of right ventricular function and pulmonary artery stiffness to identify pulmonary hypertension (PH), predict major adverse cardiovascular events (MACEs) in patients with secondary PH due to chronic obstructive pulmonary disease (COPD), and to estimate a prospective sample size necessary for a reliable power of the study. Thirty consecutive patients with COPD and suspected secondary PH were assessed by clinical examination, the six minute walk test, echocardiography, right heart catheterization and CMR, and followed–up for a mean period of 16 months to identify MACEs (cardiac death, ventricular tachyarrhythmia, and heart failure). Among CMR parameters of pulmonary artery stiffness, pulse wave velocity (PWV) yielded the best sensitivity (93.5%) and specificity (92.8%) for identifying PH, as diagnosed by cardiac catheterization. Moreover, PWV proved to be a valuable predictor of MACEs (HR = 4.75, 95% CI 1.00 to 22.59, p = 0.03). In conclusion, PWV by phase-contrast CMR can accurately identify PH in patients with COPD and may help stratify prognosis.

The current study reveals correlations between sST2 levels and echocardiographic parameters of RV dysfunction, suggesting that use of sST2 and NT-proBNP may improve diagnosis and risk stratification in patients with secondary pulmonary hypertension owing to chronic obstructive pulmonary disease.

We report the case of a 69-year-old female patient in which echocardiography and cardiac magnetic resonance imaging were used to diagnose a patient presenting with heart failure with preserved ejection fraction (HFpEF) due to Loeffler endocarditis. Loeffler endocarditis is an uncommon cause of heart failure with preserved ejection fraction, triggered by eosinophil and lymphocyte infiltration of the endomyocardium, followed by the formation of thrombus in the afflicted area, and eventually fibrosis. This condition is due to an increased number of eosinophils associated with allergies, infections, systemic conditions, as well as malignancies and hypereosinophilic syndrome. Loeffler endocarditis can lead to serious complications, such as progressive heart failure, systemic thromboembolic events, or arrhythmias (including sudden cardiac death).

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