Thrombosis of a mechanical tricuspid valve prosthesis resolved with fibrinolysis.

(Table 2). LV diastolic function estimated by transmitral E/A ratio was significantly impaired in diabetic patients compared with controls (Table 2). associated with all components of 3D LV strain. Our model of stepwise multivariate regression was different, and revealed that 2D LV and LA longitudinal strain, as well as 3D LV area strain, were Twoand 3D LV longitudinal mechanical function was increased in the controls compared with the other 2 groups. Twoand 3D LV circumferential, together with 2D LA longitudinal strain were decreased in the diabetic patients compared with controls. Two-dimensional LV radial strain did not differ between the 3 groups, whereas 3D LV radial strain was lower in diabetic patients than in controls (Table 2). Three-dimensional LV area strain was lower in the prediabetic and diabetic patients than in the controls (Table 2). The multivariate regression analysis demonstrated that 2D LV mass index (b = 0.38; P < .01), 2D LA longitudinal strain (b = -0.3; P = .01) and 3D LV area strain (b = -0.37; P < .01) were independently associated with HbA1c in the whole study population. Our investigation revealed several new findings: a) 3D LV myocardial deformation in all directions is deteriorated in diabetic patients; b) prediabetic patients have decreased 2D LV longitudinal strain, as well as 3D longitudinal and area strain; c) 2D LA longitudinal strain is decreased in diabetic patients; and d) 2D and 3D parameters of left heart mechanics are independently associated with glycemic control, assessed by HbA1c. Recently published studies have shown that 2D LV and LA strain are strong predictors of cardiovascular morbidity and mortality in the general population and in diabetic patients. Ernande et al showed that 2D longitudinal and radial functions of each LV segment are impaired in diabetic participants; Ng et al found that only 2D longitudinal deformation was reduced in diabetic patients, whereas circumferential and radial strain were preserved. Ceyhan et al have published the first report that persons with impaired glucose tolerance have decreased LV systolic strain and strain rate, as well as early diastolic strain rate compared with controls. Our results confirm previous findings and add a new piece of evidence: namely, we found that 2D LV circumferential strain, in addition to longitudinal function, is also deteriorated in diabetic patients. Additionally, 3D speckle tracking revealed that LV mechanical deformation is impaired in all directions, along with area strain, which represents a combination of longitudinal and circumferential strain. Our findings demonstrate that LV systolic function, together with diastolic function, is impaired long before the occurrence of cardiac symptoms. Zhang et al showed that well-controlled diabetic patients have a decreased 3D strain in all directions, which completely confirms our results. The authors also found that HbA1c was independently