In the realm of preventive medicine, reinforcement of a zero-tolerance stance on cigarette smoking is imperative. The use of heat-not-burn (HnB) technology by individuals who are unable to quit smoking has prompted strong discussions in both the public health and clinical domains. This raises the question of whether exposure to cigarettes or HnB products has a different effect on blood pressure (BP) values and whether this effect depends on the concentration of heavy metals. A total of 33 participants were divided into four exposure groups: passive HnB exposure (n=7), active HnB users (n=4), passive cigarette smokers (n=11), and active cigarette smokers (n=9). Blood concentrations of cadmium (Cd) and lead (Pb) were determined by atomic absorption spectroscopy (AAS) using a Graphite Furnace Atomic Absorption Spectrometer, Agilent 240Z AA (Agilent Technologies, Santa Clara, CA, USA). Samples were prepared by wet digestion with nitric acid solution. After centrifugation, the supernatant was transferred into vials for AAS analysis. Concentrations of Cd and Pb were measured before and after exposure, and changes were analyzed using generalized linear models (GLM) adjusted for sex, age, and body mass index (BMI). All participants were smokers who had stopped smoking five days prior to the experiment. None of the participants had any chronic diseases. After a five-day abstinence (washout period), they were exposed to active and passive consumption of HnB or traditional cigarettes. BP was measured before and after exposure to tobacco smoke. Average Cd levels were similar across all groups (p = 0.55): passive HnB 1.59 µg/L, active HnB 1.29 µg/L, passive cigarette smokers 1.65 µg/L, and active cigarette smokers 1.64 µg/L. Pb levels varied significantly by exposure type (p = 0.006), as follows: 35.95 µg/L with passive HnB exposure, 26.98 µg/L with active HnB exposure, 52.45 µg/L and 36.50 µg/L in passive and active cigarette smokers, respectively. Upon monitoring, an elevation in Cd levels was significantly associated with a rise in systolic pressure (p = 0.026) and a decrease in diastolic pressure (p = 0.006), indicating an increase in pulse pressure and potential arterial stiffness. Pb concentration showed no direct effect on hemodynamic parameters. These findings suggest that Cd and Pb levels vary based on type of exposure. There was a significant difference between traditional cigarettes and HNB products, with the latter exhibiting lower concentrations, as well as between active and passive exposure. Changes in BP tend to be more closely linked to Cd, as higher levels correlate with increased systolic and decreased diastolic pressures, indicating its role in arterial stiffness and early vascular dysfunction.

Acute coronary syndrome (ACS) is increasingly prevalent among young patients. The prevalence of ACS among young women has also increased. It is well known that coronary artery disease (CAD) follows a different pattern in women and men. In order to provide timely and appropriate treatment, it is necessary to understand the gender differences in the risk factors, clinical profile, and early outcome in the young ACS patient population. Understanding and addressing the risk factors linked to the early onset of the disease is therefore essential to lowering the burden of premature CAD (PCAD). This study aimed to analyse the gender differences in the presence of major coronary risk factors, clinical presentation, diagnosis and immediate outcomes in patients with PCAD. We evaluated 218 consecutive patients who were hospitalised in the ICCU of cardiology department with diagnosis of PCAD between November 2023 and May 2025, after satisfying the inclusion criteria. All included patients were 45 years of age or younger, were admitted for their first acute coronary syndrome and underwent primary PCI with optimal revascularization results. The study included 72 female and 146 male patients. The mean age of females was 42.5 ± 2.22 years and males was 39.6 ± 3.85 years (p<0.001). Young women had significantly more risk burden of hypertension (70.2% vs 36.5% p<0.001) diabetes (38.9% vs 28.7%, p<0.001) and dyslipidaemia (61.4% vs. 38.4%, p<0.001) compared to young men. Among young males, smoking was significantly higher (76.5% vs. 25.2%, p<0.001). NSTEMI was more common presentation among females (22.5% vs 8.4%, p<0.001) with more prevalent non obstructive CAD (13.1% vs. 8.2%, p=0.15). Young male patients showed angiographically more severe CAD and greater frequency of multivessel CAD (22.8% vs 17.9%, p=0.58). Young female patients had significantly better mean ejection fraction (EF) (48.1±7.9% vs 39.2±9.8%, p=0.13). Young women had more often acute heart failure (Kilip class ≥ 2) and longer length of stay in the intensive care unit (12.4% vs.6.29%, P=0.04; 5.5 vs 2.7 days, p <0.001 respectively). Mortality rate in the first 48 hours of admission was higher in man than in woman (1.65% vs.1.13%, p=0.65). A distinct gender difference in the risk factor profile for PCAD supports an early, comprehensive, but gender-specific approach to prevention. Young patients with premature CAD may benefit from these findings in terms of risk factor modification and gender-based management approach.

For patients presenting with non-ST-elevation acute coronary syndrome (NSTE-ACS) who are not considered to be at very high mortality risk at the time of admission, current clinical guidelines advocate for coronary angiography (CAG) to be performed during hospitalization. Therefore, in these patients, introduction of novel non-invasive methods for prediction of severity of coronary artery disease is needed in order to identify patients who could benefit from CAG earlier during their hospital stay. The aim of this study was to evaluate the association between severity of CAD and echocardiographically assessed global longitudinal strain (GLS) and post-systolic shortening (PSS) of left ventricular myocardium in patients with NSTE-ACS. This prospective cross-sectional study included patients admitted to the cardiology clinic with the diagnosis of NSTE-ACS. Inclusion criteria were: preserved left ventricular ejection fraction (>50%), absence of regional wall motion abnormalities and indication for CAG set by interventional cardiologist and performed during the hospital stay. Patients who were estimated to be at very high mortality risk were excluded from the study. In addition to conventional echocardiography parameters, post-systolic shortening index (PSI), LAD specific PSI (PSI-LAD) and GLS were measured. PSI was calculated as the average PSS across all 17 myocardial segments, generated from strain curves, while PSI-LAD was calculated as the average PSS across 10 myocardial segments vascularized by LAD. The severity of CAD was assessed using the SYNTAX score. Significant coronary artery stenosis was defined as ≥90% narrowing in one of the three main epicardial arteries. Among the 70 enrolled patients, 45.7% (n=32) were diagnosed with unstable angina, while 54.3% (n=38) were diagnosed with NSTEMI. There was a significant positive correlation between SYNTAX score and both GLS (rho=0.504; p<0.001) and PSI (rho=0.249; p=0.035). Patients with significant LAD stenosis had higher GLS values (-14.88±2.53% vs. -17.02±3.23%, p=0.001) and higher PSI-LAD values (10.65 [3.13–18.53] vs. 4.2 [2.53–8.3], p=0.015) compared to those without significant LAD stenosis. GLS emerged as an independent predictor of significant stenosis on one of three main epicardial arteries (p=0.001; OR 1.43; 95% CI: 1.16–1.76). Both PSI-LAD and GLS demonstrated significant predictive value for LAD stenosis, with AUCs of 0.672 (p=0.020) and 0.675 (p=0.019), respectively. In addition to other known clinical factors, GLS and PSI may serve as feasible non-invasive echocardiographic parameters for additional risk stratification in NSTE-ACS patients who are not at very high risk. These measures could help identify individuals who might benefit from earlier CAG during hospitalization. Further research is warranted to develop precise risk assessment models incorporating these parameters.

ObjectiveTo evaluate the predictive value of LA strain parameters and LASI for AF recurrence following electrical CV, and to compare them to conventional echocardiographic, biochemical, and clinical markers.MethodsIn this prospective, observational pilot study, 31 patients with persistent AF underwent electrical CV and were followed for six months. Echocardiographic evaluation included LA reservoir, conduit, and contractile strain, left atrial stiffness index, left atrial volume index (LAVI), left atrial appendage (LAA) morphology, left ventricular ejection fraction (LVEF), right atrial (RA) area, and right ventricular systolic pressure (RVSP). AF recurrence was assessed at three and six months.ResultsAt three months post-CV, LA reservoir, conduit, and contractile strain values were significantly negatively associated with AF recurrence (p < 0.001), while LASI and E/E' ratios were positively associated (p < 0.001). At six months, only contractile strain retained prognostic significance (p = 0.008). LVEF showed a positive correlation with recurrence at six months (p = 0.003), potentially reflecting the role of diastolic dysfunction.ConclusionLA strain parameters and LASI are valuable tools for predicting AF recurrence after CV, particularly in the early post-procedural period. Contractile strain may serve as a more reliable long-term predictor, emphasizing the importance of longitudinal atrial function assessment in rhythm outcome prediction. However, given the small sample size and single-center design, these results should be considered hypothesis-generating, requiring validation in larger studies.

Iron deficiency (ID) is a major problem in heart failure (HF) patients. Iron deficiency is often pressent in patients with rheumatoid arthritis (RA), can be a cause of fatigue and linked with reduced functional capacity. The relationship between ID and right ventricular (RV) systolic function in patients with RA is still not well understood. The aim of this study was to analyze the relationship between ID and RV systolic function. A forty six female patients with seropositive RA were included in our study. Primary goal was to determine association between iron deficiency and echocardiography parameters such as Tricuspid annular plane systolic excursion TAPSE, RV fractional area change (RV FAC), TDI-Derived tricuspid lateral annular systolic velocity (RV TDI S’), Pulmonary artery systolic pressure (PASP); RV free wall global longitudinal strain (RVfwGLS), RV global longitudinal strain (RV GLS) and Right ventriculoarterial coupling (RVAC). The RVAC was determined with the RVfwGLS/PASP ratio. RA was diagnosed according to the ACR/EULAR 2010 classification criteria, without other significant comorbidity. ID was defined as ferritin levels lower than 100 ng/mL and iron levels lower than 10 µmol/L. The mean age of stady population was 57±8 years. Iron deficiency was found in 48% of analysed RA patients. On transthoracic echocardiography the median TAPSE was 18.3 mm, the mean FAC % 38.4±.6.3, the mean RV GLS %-17.2±7.5, the mean RVfwGLS % -20.6±3.8, the mean RV TDI S’ was 10.6±3.9 cm/s, the mean PASP was 29,2±8.7mmHg, the mean RVAC was 0.76. There was no notable difference in demographics or in TAPSE, RV FAC, RV TDI S’, and PASP between patients with iron deficiency and those without. The RVfwGLS (-16.7% vs -21.2%, p = 0.005) was lower in patients with ID. RV GLS (-14.3% vs -18.6%, p=0.005) was lower in patients with ID. Additionally, RVAC (0.65 vs 0.91, p=0.005) was lower in patients with ID. A significant correlation exists between iron deficiency and subclinical RV dysfunction, defined as reduced RV GLS, RVfwGLS and RVAC prior to the decline of parameters commonly used on echocardiography to measure right ventricle systolic function (TAPSE, RV FAC, PASP and RV TDI S'). Screening for iron deficiency in RA patients facilitates early detection and treatment of iron deficiency which may prevent RV dysfunction.

.

Given the undeniable clinical and prognostic value, the function of the left atrium (LA) plays a leading role in the contemporary evaluation of cardiac diseases and is considered an essential morphological substrate for the development of cardiovascular diseases. It is sensitive to nervous, endocrine, and immunological stimuli. New evidence from the literature highlights the importance of fibrotic, electrical, and autonomic remodeling of the LA, introducing the concept of atrial cardiomyopathy, which is closely associated with atrial fibrillation and stroke. In the past, the diameter of the LA was the most important parameter for assessing its characteristics, but new information about the various roles of the LA has created the need for parameters that more precisely or thoroughly evaluate LA function. The function of the LA is complex, consisting of three phases: the reservoir phase (ventricular systole), the conduit phase (early diastole), and the pump phase (late diastole). The introduction of myocardial deformation analysis, or strain of the LA via speckle tracking, has achieved significant progress in detecting even subtle functional abnormalities before an increase in LA size. This method improves the diagnostic capabilities of standard echocardiographic examinations, and its diagnostic and prognostic value is sometimes comparable to more advanced and less accessible techniques such as cardiac magnetic resonance imaging and computed tomography.

BACKGROUND: Left atrial (LA) strain analysis has emerged as a noninvasive technique for assessing LA function and early detection of myocardial deformation. Recently, its application has also shown promise in the pediatric population, spanning diverse cardiac conditions that demand accurate and sensitive diagnostic measures. OBJECTIVE: This research article endeavors to explore the role of LA strain parameters and contribute to the growing body of knowledge in pediatric cardiology, paving the way for more effective and tailored approaches to patient care. METHODS: A comprehensive literature review was conducted to gather evidence from studies using echocardiographic strain imaging techniques across pediatric populations. RESULTS: LA strain parameters exhibited greater sensitivity than conventional atrial function indicators, with early detection of diastolic dysfunction and LA remodeling in pediatric cardiomyopathy, children with multisystem inflammatory syndrome, rheumatic heart disease, as well as childhood renal insufficiency and obesity offering prognostic relevance as potential markers in these pediatric subpopulations. However, there remains a paucity of evidence concerning pediatric mitral valve pathology, justifying further exploration. CONCLUSION: LA strain analysis carries crucial clinical and prognostic implications in pediatric cardiac conditions, with reliable accuracy and sensitivity to early functional changes.

Abstract Funding Acknowledgements Type of funding sources: None. Introduction The fibrosis of the LA, which is characteristic of AF, causes mechanical dysfunction of the LA and may also be present in patients without LA enlargement. LA strain represents a surrogate marker of this mechanical dysfunction. Early detection of LA dysfunction may be crucial in identifying patients who are more likely to experience AF recurrence following cardioversion and ablation. Before cardioversion and ablation, the probability of AF recurrence might be predicted, which could lead to better patient selection, an individualized therapeutic strategy with reduced risk and focused follow-up. Purpose The aim of this study was to evaluate the additional predictive value of LA function assessed by using strain echocardiography for early AF recurrence after cardioversion and ablation. Methods 94 patients diagnosed with symptomatic persistent atrial fibrillation (EHRA symptom score ≥3 (mean age 59.4 ± 12.2 years, 58% male, 42%female), preserved LV ejection fraction were prospectively analyzed. In 39 (41,5%) patients pharmacological cardioversion was done after saturation with antiarhythmic drugs,in 27 (28,7%) patients planed electrical cardioversion was done after medical saturation with antiarrhythmic drugs and failure of pharmacological cardioversion, and in 28 (29,8%) patients planed RF ablation was performed. Complete echocardiography evaluation including strain and volume index LA was performed before cardioversion and ablation. The rhythm evaluation was done in the first month after cardioversion and RF ablation (35±5 days). The primary endpoint was persistent AF recurrence. Results 29 (30,8%) patients had AF recurrence in the overall study population, independently of duration of AF or method of rhythm control. Peak atrial longitudinal strain (PALS) ≤15% had the highest incremental predictive value for AF recurrence (HR =8.42, 95% CI: 3.17–25.12, p < 0.001). In patients with non-dilated LA, PALS≤15% remained an independent predictor of AF recurrence (HR = 5.32, 95% CI: 1.77–17.42, p = 0.005). Conclusion This study shown that, in addition to LA dilatation, LA function as determined by PALS can provide a prognostic value for early AF recurrence after cardioversion or ablation. PALS also predicted AF recurrence in patients with nondilated LA. These findings highlight the additional prognostic usefulness of LA strain and recommend its implementation in the systematic assessment of AF patients prior to the choice of rhythm/rate control.