Background Dipyridamole stress echocardiography (DSE) represents a fundamental test in patients with suspected coronary artery disease (CAD). The diagnosis of microvascular disease is still challenging. We aimed to determine the diagnostic value of left ventricular (LV) layer‐specific longitudinal (LS) and circumferential strain (CS) by Speckle Tracking in detecting CAD during DSE and to study if they can help in discriminate between a negative echo and a suspected microvascular angina. Methods and results We enrolled 66 patients with known or suspected CAD. All underwent standard DSE. We identified 3 groups according to the result of DSE (36 negative DSE, 19 positive DSE, 11 indicatives for microvascular disease). Wall motion score index, global LV LS and CS (global longitudinal strain [GLS] and global circumferential strain [GCS]), and layer‐specific LV LS and CS were measured at rest and peak stress. The Delta between rest and peak stress values was calculated. GLS increased after injection in negative DSE and microvascular disease while reducing in positive DSE. Endocardial GCS and transmural GCS values were stable in microvascular disease while increasing significantly in negative DSE, helping in the diagnosis. The specific analysis of endocardial LS showed the most powerful difference between healthy and macrovascular CAD patients, both for LS and CS. Conclusions Global circumferential strain can be a new valuable added tool in the echocardiographic diagnosis of microvascular disease. Endocardial GLS is the best indicator of an altered wall deformation in the presence of macrovascular ischemia.

Background: The function of the left atrium (LA) is reduced in many cardiac diseases even with normal size. The assessment of its compliance could represent an added value in an echocardiographic report in case the gold standard technique (speckle-tracking echocardiography [STE]) is not available. We sought to test a simple and quick method as surrogate of STE: the dynamic measurement of the LA anteroposterior diameter (APD) that we called LA fractional shortening (LAFS). Materials and Methods: A total of 153 consecutive patients underwent a transthoracic echocardiography in our echo laboratory between January and June 2017. The only inclusion criteria were the presence of an acoustic window and the informed consent. We chose to not apply exclusion criteria to assess LAFS feasibility. The LAFS was calculated as (maxAPD−minAPD)/(maxAPD) × 100 in parasternal long-axis view. We evaluated the correlation of its value with the peak atrial longitudinal strain (PALS) and the LA emptying fraction (EF). Results: Mean execution time was 32.1 ± 5 s for LAFS, 2.3 ± 0.7 min for LAEF, and 2 ± 1 min for PALS. LAFS, with a feasibility of about 97%, was moderately correlated with PALS and LAEF (R between 0.20 and 0.30, P < 0.05). LAFS fractional shortening also emerged as surrogate for PALS via the relationship PALS = 21.07 + 0.364x (LAFS). Conclusions: LAFS demonstrated a correlation with PALS, a short execution time, a high feasibility, and the possibility to be used as a surrogate of PALS, applying a specific formula.

Ischemic heart disease (IHD) is one of the leading causes of death and morbidity in the world. The role of primary prevention is particularly relevant since IHD can be for a long time asymptomatic until the occurrence of a condition that could lead to plaque instabilization or increased oxygen demand. Secondary prevention is also essential to improve patients' prognosis and quality of life. The aim of this review is to provide a detailed and updated description of the role of sport and physical activity both in primary prevention and secondary prevention. In primary prevention, sport and physical activity are effective through the control of the main cardiovascular risk factors, such as hypertension and dyslipidemia. In secondary prevention, sport and physical activity can lead to a reduction in subsequent coronary events. Every effort must be made to encourage the performance of physical and sports activity both in asymptomatic subjects at risk and those with a history of IHD.

echocardiography. It has been suggested that a pattern of reduced LV longitudinal strain with "apical sparing" may accurately identify cardiac AMI. Purpose: To analyze patients with both physiologic and pathologic primary and secondary LVH in order to select echocardiographic anatomic and functional variables that could accurately identify cardiac AMI. Methods: We examined 192 patients with LVH (hypertension, n=60; aortic stenosis, n=45, HCM, n=28; athlete's heart, n=40; non-compaction, n=4; amyloidosis, n=15; other restrictive, n=6), compared to 60 age matched normal subjects, using echographic GE Vivid 7 and systems. We measured: m-mode LV hypertrophy index (LV wall thickness/radius ratio) and mass index; biplane LV volumes and ejection fraction (EFb); Tei index (MPI, isovolumic intervals/ejection time ratio); mean systolic (s', cm/s) and early diastolic (e') tissue Doppler velocities of the mitral annulus (lateral and septal); LV filling pressures (Ep/e'); maximum and minimum left atrial (LA) volumes and the LA compliance index (LAres, ml)= (maximum -minimum volume); LV global peak systolic longitudinal strain (GLPSS, %), the mean longitudinal peak systolic strain of apical (ALPSS) and basal (BLPSS) segments, and their ratio (A/BLPSS); peak systolic (SRs, s -1 ) and early diastolic (SRd, s -1 ) global strain rate.Results: Compared to all other groups, only the hypertrophy index was significantly higher in AMI patients (0.88±0.117, da p<0.01 a p<0.001); the increase in mass index -prevalently in AMI and HCM -was not significant because of high variability. In contrast with LV volumes, systolic and diastolic LV function indices, and maximum LA volume, only LAres was significantly reduced in AMI patients compared to all other groups (15±8, p<0.001). Strain analysis showed the greatest reduction of GLPSS in AMI (-8±3%, p<0.001), secondary to marked reduction of BLPSS (-4±3%, p<0.001 vs all groups), whereas A/BLPSS, SRs and SRd were similar between study groups. Finally, decisional tree analysis identified 2 nodes using LAres (cutoff= 25 ml) and GLPSS (cutoff= -13%), correctly identifying AMI patients with 96.3% accuracy (93,3% sensitivity and 96.6% specificity). Conclusions: An algorithm combining LV longitudinal systolic strain and LA compliance provides accurate differential diagnosis of cardiac AMI. Apparent "apical sparing" is secondary to marked longitudinal dysfunction of the LV basal segments, and hence of global longitudinal function. Impairment of LA compliance may be secondary to both increased LV stiffness and amyloid deposits in the LA wall. Background: Changes in Global Longitudinal Strain (GLS) are often the first signs of functional impairment during cardiovascular disease development. As an explanation for this observation, the reflection of subendocardial function by GLS assessment is widely assumed, since the subendocardium has a unique vulnerability against cardiac injury and determines longitudinal mechanics of the left ventricle. However, there is a lack of studies correlating directly assess...

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