Novel Echocardiography Techniques for the Diagnosis and Monitoring of Treatment in Cardiovascular Disease

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (30 November 2020) | Viewed by 29113

Special Issue Editor

2nd Cardiology Department, National and Kapodistrian University of Athens, Athens, Greece
Interests: 3D echocardiography; myocardial deformation; stress echocardiography; transesophageal echocardography; transcatherter interventions in valve disease; diabetic heart; systemic inflammatory diseases; cardiomyopathies; heart failure; arterial stiffness; endothelial function

Special Issue Information

Dear Colleagues,

Echocardiography is the most useful tool for cardiologists to diagnose and monitor treatment in patients with cardiovascular disease. Novel echocardiography techniques have upgraded the utility of echocardiography in the early diagnosis of coronary artery disease and cardiomyopathy, in assessment of valve disease and acute thoracic pain syndromes as well as in guiding transcatheter valve implantation and monitoring treatment in acute heart failure and in chronic heart failure with reduced or preserve ejection fraction providing also important information on patient prognosis.

The purpose of this Special Issue is to discuss novel developments of echocardiography in the recent years regarding its utility in the differential diagnosis of coronary artery disease cardiomyopathies athletic heart, valve disease, stroke and acute aortic syndromes and its value in guiding interventional procedures in valve disease and monitoring the effects on pharmacological and nonpharmacological treatment in heart failure or in systemic diseases leading to heart failure.

Assoc. Prof. Ignatios Ikonomidis
Guest Editor

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Keywords

  • Speckle tracking imaging
  • 3D echocardiography
  • Stress echocardiography
  • Transcatheter valve implantation
  • Echocardiography in heart failure
  • Echocardiography in diabetic heart
  • Echocardiography in systemic inflammatory diseases
  • Echocardiography in acute aortic syndrome
  • Echocardiography in stroke and predisposing factors
  • Ultrasound assessment of carotids and endothelium;

Published Papers (12 papers)

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Research

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11 pages, 489 KiB  
Article
Left Atrial Strain as a Predictor of Left Ventricular Diastolic Dysfunction in Patients with Arterial Hypertension
by Tatjana Miljković, Aleksandra Ilić, Aleksandra Milovančev, Marija Bjelobrk, Maja Stefanović, Anastazija Stojšić-Milosavljević, Snežana Tadić, Miodrag Golubović, Tanja Popov and Milovan Petrović
Medicina 2022, 58(2), 156; https://doi.org/10.3390/medicina58020156 - 20 Jan 2022
Cited by 5 | Viewed by 2344
Abstract
Background and Objectives: There is emerging evidence of the usefulness of left atrial strain (LAS) in the assessment of diastolic dysfunction (DD). In this study we assess the sensitivity and specificity of LAS, to determine cut-off values and their association to DD with [...] Read more.
Background and Objectives: There is emerging evidence of the usefulness of left atrial strain (LAS) in the assessment of diastolic dysfunction (DD). In this study we assess the sensitivity and specificity of LAS, to determine cut-off values and their association to DD with increased left atrial pressure (LAP) in patients with well-treated arterial hypertension. Materials and Methods: We performed a cross-sectional study on 180 subjects with well-treated arterial hypertension. All patients underwent transthoracic echocardiography. Patients were divided into two groups: a group without increased LAP and/or DD and a group with increased LAP DD. Results: In multivariate logistic regression, LAS proved to be the strongest statistically significant predictor of DD with increased LAP (OR 0.834, p < 0.0005), with AUC 0.885 and a set cut-off value of 24.27% with high sensitivity of 78.9% and specificity of 84.6%. The set cut-off for LAS > 24.27% was significantly highly prevalent in the group of DD with increased LAP 78.9% when compared to the group without increased LAP 15.4%, p < 0.0001. Conclusion: The findings of this study suggest that LAS could be a useful and highly sensitive and specific marker in the evaluation of DD. There is the potential for using LAS in everyday practice as a standard parameter in diastolic function assessment. Full article
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14 pages, 3987 KiB  
Article
Automated Medical Care: Bradycardia Detection and Cardiac Monitoring of Preterm Infants
by Beatrice Arvinti, Emil Radu Iacob, Alexandru Isar, Daniela Iacob and Marius Costache
Medicina 2021, 57(11), 1199; https://doi.org/10.3390/medicina57111199 - 03 Nov 2021
Cited by 1 | Viewed by 1930
Abstract
Background and Objectives: Prematurity of birth occurs before the 37th week of gestation and affects up to 10% of births worldwide. It is correlated with critical outcomes; therefore, constant monitoring in neonatal intensive care units or home environments is required. The aim [...] Read more.
Background and Objectives: Prematurity of birth occurs before the 37th week of gestation and affects up to 10% of births worldwide. It is correlated with critical outcomes; therefore, constant monitoring in neonatal intensive care units or home environments is required. The aim of this work was to develop solutions for remote neonatal intensive supervision systems, which should assist medical diagnosis of premature infants and raise alarm at cardiac abnormalities, such as bradycardia. Additionally, the COVID-19 pandemic has put a worldwide stress upon the medical staff and the management of healthcare units. Materials and Methods: A traditional medical diagnosing scheme was set up, implemented with the aid of powerful mathematical operators. The algorithm was tailored to the infants’ personal ECG characteristics and was tested on real ECG data from the publicly available PhysioNet database “Preterm Infant Cardio-Respiratory Signals Database”. Different processing problems were solved: noise filtering, baseline drift removal, event detection and compression of medical data using the à trous wavelet transform. Results: In all 10 available clinical cases, the bradycardia events annotated by the physicians were correctly detected using the RR intervals. Compressing the ECG signals for remote transmission, we obtained compression ratios (CR) varying from 1.72 to 7.42, with the median CR value around 3. Conclusions: We noticed that a significant amount of noise can be added to a signal while monitoring using standard clinical sensors. We tried to offer solutions for these technical problems. Recent studies have shown that persons infected with the COVID-19 disease are frequently reported to develop cardiovascular symptoms and cardiac arrhythmias. An automatic surveillance system (both for neonates and adults) has a practical medical application. The proposed algorithm is personalized, no fixed reference value being applied, and the algorithm follows the neonate’s cardiac rhythm changes. The performance depends on the characteristics of the input ECG. The signal-to-noise ratio of the processed ECG was improved, with a value of up to 10 dB. Full article
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7 pages, 274 KiB  
Article
Left Ventricular Diastolic and Systolic Functions in Patients with Hypothyroidism
by Rina Tafarshiku, Michael Y. Henein, Venera Berisha-Muharremi, Ibadete Bytyçi, Pranvera Ibrahimi, Afrim Poniku, Shpend Elezi and Gani Bajraktari
Medicina 2020, 56(10), 524; https://doi.org/10.3390/medicina56100524 - 07 Oct 2020
Cited by 3 | Viewed by 2184
Abstract
Background and objectives: Long standing hypothyroidism may impair myocardial relaxation, but its effect on systolic myocardial function is still controversial. The aim of this study was to investigate left ventricular (LV) systolic and diastolic function in patients with hypothyroidism. Materials and Methods [...] Read more.
Background and objectives: Long standing hypothyroidism may impair myocardial relaxation, but its effect on systolic myocardial function is still controversial. The aim of this study was to investigate left ventricular (LV) systolic and diastolic function in patients with hypothyroidism. Materials and Methods: This study included 81 (age 42 ± 13 years, 92% female) patients with hypothyroidism, and 22 age and gender matched controls. All subjects underwent a detailed clinical examination followed by a complete biochemical blood analysis including thyroid function assessment and anthropometric parameters measurements. LV function was assessed by 2-dimensional, M-mode and Tissue-Doppler Doppler echocardiographic examination performed in the same day. Results: Patients had lower waist/hip ratio (p< 0.001), higher urea level (p = 0.002), and lower white blood cells (p = 0.011), compared with controls. All other clinical, biochemical, and anthropometric data did not differ between the two groups. Patients had impaired LV diastolic function (lower E wave [p< 0.001], higher A wave [p = 0.028], lower E/A ratio [p< 0.001], longer E wave deceleration time [p = 0.01], and higher E/e’ ratio [p< 0.001]), compared with controls. Although LV global systolic function did not differ between groups, LV longitudinal systolic function was compromised in patients (lateral mitral annular plane systolic excursion—MAPSE [p = 0.005], as were lateral and septal s’ [p< 0.001 for both]). Conclusions: In patients with hypothyroidism, in addition to compromised LV diastolic function, LV longitudinal systolic function is also impaired compared to healthy subjects of the same age and gender. These findings suggest significant subendocardial function impairment, reflecting potentially micro-circulation disease that requires optimum management. Full article
10 pages, 1084 KiB  
Article
Comparison of Intracardiac Echocardiography and Transesophageal Echocardiography for Image Guidance in Percutaneous Patent Foramen Ovale Closure
by Jeonggeun Moon, Yeonjeong Park, Su Jung Park, Pyung Chun Oh, Albert Youngwoo Jang, Wook-Jin Chung and Woong Chol Kang
Medicina 2020, 56(8), 401; https://doi.org/10.3390/medicina56080401 - 09 Aug 2020
Cited by 7 | Viewed by 2424
Abstract
Background and Objectives: Transesophageal echocardiography (TEE) guidance is the current gold standard for catheter-based procedures in the treatment of structural heart diseases. Intracardiac echocardiography (ICE), which can be performed under local anesthesia, has been recently introduced and is becoming more widely used. We [...] Read more.
Background and Objectives: Transesophageal echocardiography (TEE) guidance is the current gold standard for catheter-based procedures in the treatment of structural heart diseases. Intracardiac echocardiography (ICE), which can be performed under local anesthesia, has been recently introduced and is becoming more widely used. We aimed to compare the efficacy and safety of ICE and TEE in patent foramen ovale (PFO) device closure. Materials and Methods: All 74 patients with a history of cryptogenic stroke undergoing PFO closure for secondary prophylaxis were selected from our registry. Intraprocedural TEE was performed by echocardiographer-cardiologists with the patient under general anesthesia. Conversely, ICE was performed with the patient under local anesthesia. Baseline characteristics, procedural details, and immediate outcomes were compared between the TEE and ICE groups (n = 49 and n = 25, respectively). Results: Although patients in the ICE group were older (47 ± 10 vs. 57 ± 7 years, p < 0.001), sex and comorbidity variables were similar between the two groups. The degree of inducible right-to-left shunt via the PFO, assessed using preprocedural TEE, was also comparable. Notably, fluoroscopy time (22 ± 18 vs. 16 ± 7 min, p = 0.030), radiation dose (498 ± 880 vs. 196 ± 111 mGy, p = 0.022), and total procedural time in the catheter laboratory (99 ± 30 vs. 67 ± 12 min, p < 0.001) were significantly lower in the ICE group than those in the TEE group. The entire hospital stay was similar between groups (3.8 ± 2.2 vs. 3.4 ± 1.3 days, p = 0.433). No procedural complications, such as device embolization, pericardial hemorrhage, major bleeding, mortality, or access-related vascular injury were reported in either group. Conclusions: ICE-guided PFO device closure is quicker and less hazardous in terms of radiation exposure than the TEE-guided procedure, with similar procedural outcomes and duration of hospital stay. Full article
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9 pages, 792 KiB  
Article
Global Longitudinal Strain of the Systemic Ventricle Is Correlated with Plasma Galectin-3 and Predicts Major Cardiovascular Events in Adult Patients with Congenital Heart Disease
by Alexandra A. Frogoudaki, Ioannis Pantelakis, Vasiliki Bistola, Christos Kroupis, Dionysia Birba, Ignatios Ikonomidis, Dimitrios Alexopoulos, Gerasimos Filippatos and John Parissis
Medicina 2020, 56(6), 305; https://doi.org/10.3390/medicina56060305 - 22 Jun 2020
Cited by 6 | Viewed by 1805
Abstract
Backround and Objective: We sought to assess in adult congenital heart disease (ACHD) patients the prognostic value of plasma galectin-3 (Gal-3) levels and systemic ventricular global longitudinal strain (SV GLS) as well as their association with NTproBNP and arrhythmogenesis. Materials and Methods [...] Read more.
Backround and Objective: We sought to assess in adult congenital heart disease (ACHD) patients the prognostic value of plasma galectin-3 (Gal-3) levels and systemic ventricular global longitudinal strain (SV GLS) as well as their association with NTproBNP and arrhythmogenesis. Materials and Methods: We studied 58 patients (26 men, mean age 37 ± 16.8 years) with various congenital heart diseases. Patients underwent echocardiogram, 24 h ambulatory ECG monitoring, while NTproBNP and Gal-3 were measured. They were followed up (median of 790.5 days -IQR 350.3 days) and major cardiovascular events (MACE) were recorded. Results. Mean Gal-3 levels were 17.07 ± 6.38 ng/m. Plasma Gal-3 was correlated with LogNTproBNP (r = 0.456, p = 0.001).Gal-3 levels associated with supraventricular tachycardia (SVT) (p < 0.001) and ventricular tachycardia (VT) (p < 0.001), but was not associated with MACE (HR 1.018, 95% CI 0.944–1.098, p = 0.641).Mean SVGLS in patients with systemic left ventricle was −15.91% ± 4.09%, which was significantly lower compared to patients with systemic right ventricle and patients with single ventricle (−11.42% ± 3.37% and −11.9% ± 5.06%, respectively, p = 0.021).SV GLS correlated with plasma Gal-3 (r = 0.313, p = 0.027) and logNTproBNP (r = 0.479, p < 0.001). SVGLS correlated with VT arrhythmias (p = 0.004). NTproBNP predicted MACE (AUC 0.750, p = 0.03). SVGLS also predicted MACE (AUC 0.745, p = 0.03. In multivariate analysis, SVGLS and logNTproBNP maintained their predictive value (p = 0.004 and p = 0.009, respectively) Conclusion: In ACHD patients, SV GLS was found to predict MACE independently from NTproBNP and correlated with VT. Gal-3 correlated with NTproBNP and SVGLS as well as SVT and VT, but has not been shown to bear significant prognostic potential. Full article
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Review

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8 pages, 772 KiB  
Review
It’s Not All about Echocardiography. Open the Lung Window for the Cardiac Emergencies
by Eftihia Polyzogopoulou, Antonios Boultadakis, Ignatios Ikonomidis and John Parissis
Medicina 2021, 57(1), 69; https://doi.org/10.3390/medicina57010069 - 14 Jan 2021
Cited by 2 | Viewed by 2028
Abstract
In the acute cardiac care setting, undifferentiated clinical presentations such as dyspnea, chest pain, shock, and cardiac arrest are common diagnostic challenges for the clinician. Lung ultrasonography is a well-established diagnostic tool which can be integrated in simplified decision making algorithms during the [...] Read more.
In the acute cardiac care setting, undifferentiated clinical presentations such as dyspnea, chest pain, shock, and cardiac arrest are common diagnostic challenges for the clinician. Lung ultrasonography is a well-established diagnostic tool which can be integrated in simplified decision making algorithms during the initial approach of the patient, in order to differentiate accurately cardiac from non-cardiac causes and improve the management of time-sensitive cardiovascular emergencies. Full article
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17 pages, 1901 KiB  
Review
Ultrasound Assessment of Extracranial Carotids and Vertebral Arteries in Acute Cerebral Ischemia
by Klearchos Psychogios, Georgios Magoufis, Odysseas Kargiotis, Apostolos Safouris, Eleni Bakola, Maria Chondrogianni, Panagiotis Zis, Elefterios Stamboulis and Georgios Tsivgoulis
Medicina 2020, 56(12), 711; https://doi.org/10.3390/medicina56120711 - 18 Dec 2020
Cited by 9 | Viewed by 4449
Abstract
Assessing ischemic etiology and mechanism during the acute phase of an ischemic stroke is crucial in order to tailor and monitor appropriate treatment and determine prognosis. Cervical Duplex Ultrasound (CDU) has evolved since many years as an excellent screening tool for the evaluation [...] Read more.
Assessing ischemic etiology and mechanism during the acute phase of an ischemic stroke is crucial in order to tailor and monitor appropriate treatment and determine prognosis. Cervical Duplex Ultrasound (CDU) has evolved since many years as an excellent screening tool for the evaluation of extracranial vasculature. CDU has the advantages of a low cost, easily applicable, bed side examination with high temporal and spatial resolution and without exposing the patients to any significant complications. It represents an easily repeatable test that can be performed in the emergency room as a first-line examination of cervical artery pathology. CDU provides well validated estimates of the type of the atherosclerotic plaque, the degree of stenosis, as well as structural and hemodynamic information directly about extracranial vessels (e.g., subclavian steal syndrome) and indirectly about intracranial circulation. CDU may also aid the diagnosis of non-atherosclerotic lesions of vessel walls including dissections, arteritis, carotid-jugular fistulas and fibromuscular dysplasias. The present narrative review outlines all potential applications of CDU in acute stroke management and also highlights its potential therapeutic implications. Full article
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19 pages, 337 KiB  
Review
Echocardiography, an Indispensable Tool for the Management of Diabetics, with or without Coronary Artery Disease, in Clinical Practice
by Konstantinos Katogiannis, Dimitrios Vlastos, Foteini Kousathana, John Thymis, Aikaterini Kountouri, Emmanouil Korakas, Panagiotis Plotas, Konstantinos Papadopoulos, Ignatios Ikonomidis and Vaia Lambadiari
Medicina 2020, 56(12), 709; https://doi.org/10.3390/medicina56120709 - 18 Dec 2020
Cited by 4 | Viewed by 2013
Abstract
Diabetes mellitus is a major factor contributing to the development of cardiovascular disease. As morbidity and mortality rates rise dramatically, when target organ damage develops pre-symptomatic assessment is critical for the management of diabetic patients. Echocardiography is a noninvasive and reproducible method that [...] Read more.
Diabetes mellitus is a major factor contributing to the development of cardiovascular disease. As morbidity and mortality rates rise dramatically, when target organ damage develops pre-symptomatic assessment is critical for the management of diabetic patients. Echocardiography is a noninvasive and reproducible method that may aid in risk stratification and in evaluation of treatment effects. The aim of this review is to analyze the echocardiographic techniques which can detect early alteration in cardiac function in patients with diabetes. Full article
9 pages, 2089 KiB  
Review
Real-Time Remote Tele-Mentored Echocardiography: A Systematic Review
by Alexis Salerno, Diane Kuhn, Rayan El Sibai, Andrea R. Levine and Michael T. McCurdy
Medicina 2020, 56(12), 668; https://doi.org/10.3390/medicina56120668 - 02 Dec 2020
Cited by 8 | Viewed by 2291
Abstract
Background and Objectives: Real-time remote tele-mentored echocardiography (RTMUS echo) involves the transmission of clinical ultrasound (CU) cardiac images with direct feedback from a CU expert at a different location. In this review, we summarize the current uses of RTMUS to diagnose and [...] Read more.
Background and Objectives: Real-time remote tele-mentored echocardiography (RTMUS echo) involves the transmission of clinical ultrasound (CU) cardiac images with direct feedback from a CU expert at a different location. In this review, we summarize the current uses of RTMUS to diagnose and manage cardiovascular dysfunction and discuss expanded and future uses. Materials and Methods: We performed a literature search (PubMed and EMBase) to access articles related to RTMUS echo. We reviewed articles for selection using Covidence, a web-based tool for managing systematic reviews and data were extracted using a separate standardized collection form. Results: Our search yielded 15 articles. Twelve of these articles demonstrated the feasibility of having a novice sonographer mentored by a tele-expert in obtaining a variety of cardiac ultrasound views. The articles discussed different technological specifications for the RTMUS system, but all showed that adequate images were able to be obtained. Overall, RTMUS echo was found to be a positive intervention that contributed to patient care. Conclusion: RTMUS echo allows for rapid access to diagnostic imaging in various clinical settings. RTMUS echo can help in assessing patients that may require a higher level of isolation precautions or in other resource-constrained environments. In the future, identifying the least expensive way to utilize RTMUS echo will be important. Full article
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14 pages, 1181 KiB  
Review
Echocardiography in Autoimmune Rheumatic Diseases for Diagnosis and Prognosis of Cardiovascular Complications
by George Makavos, Maria Varoudi, Konstantina Papangelopoulou, Eirini Kapniari, Panagiotis Plotas, Ignatios Ikonomidis and Evangelia Papadavid
Medicina 2020, 56(9), 445; https://doi.org/10.3390/medicina56090445 - 01 Sep 2020
Cited by 6 | Viewed by 2670
Abstract
Autoimmune rheumatic diseases are systemic diseases frequently affecting the heart and vessels. The main cardiovascular complications are pericarditis, myocarditis, valvular disease, obstructive coronary artery disease and coronary microcirculatory dysfunction, cardiac failure and pulmonary hypertension. Echocardiography, including transthoracic two and three-dimensional echocardiography, Doppler imaging, [...] Read more.
Autoimmune rheumatic diseases are systemic diseases frequently affecting the heart and vessels. The main cardiovascular complications are pericarditis, myocarditis, valvular disease, obstructive coronary artery disease and coronary microcirculatory dysfunction, cardiac failure and pulmonary hypertension. Echocardiography, including transthoracic two and three-dimensional echocardiography, Doppler imaging, myocardial deformation and transesophageal echo, is an established and widely available imaging technique for the identification of cardiovascular manifestations that are crucial for prognosis in rheumatic diseases. Echocardiography is also important for monitoring the impact of drug treatment on cardiac function, coronary microcirculatory function, valvular function and pulmonary artery pressures. In this article we summarize established and evolving knowledge on the role of echocardiography for diagnosis and prognosis of cardiovascular abnormalities in rheumatic diseases. Full article
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Other

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8 pages, 2986 KiB  
Case Report
Superior Sinus Venosus Atrial Septal Defect with Partial Anomalous Pulmonary Venous Drainage—Minimally Invasive Approach—Case Report
by Horațiu Moldovan, Andra-Mădălina Sibișan, Robert Țigănașu, Bogdan-Ștefan Popescu, Gabriel Vasile, Daniela Gheorghiță, Ondin Zaharia, Victor Sebastian Costache, Andrada Guță and Adrian Molnar
Medicina 2021, 57(9), 984; https://doi.org/10.3390/medicina57090984 - 18 Sep 2021
Cited by 2 | Viewed by 2154
Abstract
The atrial septal defect is, after bicuspid aortic valve disease, the most common congenital cardiac disease present in the adult population. The most common atrial septal defects are the ostium secundum type (75–80%), followed by the ostium primum type (15%). The sinus venosus [...] Read more.
The atrial septal defect is, after bicuspid aortic valve disease, the most common congenital cardiac disease present in the adult population. The most common atrial septal defects are the ostium secundum type (75–80%), followed by the ostium primum type (15%). The sinus venosus atrial septal defects (SV-ASD), defined as a communication in the posterior part of the interatrial septum, account for about 5 to 10% of atrial septal defects. Approximately 90% of SV-ASDs are associated with partial anomalous pulmonary venous drainage (PAPVD). The minimally invasive approach has gained ground in the treatment of ASDs, especially those of the ostium secundum type. The sinus venosus type is a relatively uncommon form of ASD, which, when associated with a PAPVD, is considered a complex cardiac malformation, and is usually treated in a classical manner, through median sternotomy. We describe the case of a 45-year-old woman diagnosed in adolescence with SV-ASD with PAPVD, who successfully underwent minimally invasive repair with fresh autologous pericardial patch reconstruction through an anterolateral mini-thoracotomy incision. The patient presented with shortness of breath and fatigue after heavy exertions, episodes of paroxysmal nocturnal dyspnea, palpitations during effort and at rest, and had a history of syncope dating from 17 years previously. Echocardiography revealed an SV-ASD with PAPVD in the right atrium and the intraoperative examination discovered that both right pulmonary veins were draining into the superior vena cava. Full article
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4 pages, 559 KiB  
Case Report
May We Use Non-Invasive Indices of Aortic Stiffness and Endothelial Glycocalyx as Biomarkers for Idiopathic Pulmonary Artery Hypertension Follow-Up?
by Helen Triantafyllidi, Dionysia Birmpa, Dimitrios Benas, Ignatios Ikonomidis, Antonis Schoinas, Paraskevi Trivilou, Frantzeska Frantzeskaki and Stylianos E. Orfanos
Medicina 2021, 57(6), 558; https://doi.org/10.3390/medicina57060558 - 01 Jun 2021
Viewed by 1936
Abstract
Idiopathic pulmonary arterial hypertension (IPAH) initial evaluation and follow-up, a rare and incurable disease if left untreated, is based on a multiparametric approach (functional status of the patient, biomarkers, hemodynamic parameters and imaging evaluation of right heart impairment). Arterial stiffness (AS) and endothelial [...] Read more.
Idiopathic pulmonary arterial hypertension (IPAH) initial evaluation and follow-up, a rare and incurable disease if left untreated, is based on a multiparametric approach (functional status of the patient, biomarkers, hemodynamic parameters and imaging evaluation of right heart impairment). Arterial stiffness (AS) and endothelial glycocalyx are indices of systemic circulation. We present the 3-years follow-up of a female IPAH patient. We propose aortic stiffness and endothelial glycocalyx indices as non-invasive markers of either improvement or deterioration of IPAH disease. Full article
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