The patient achieved euthyroid status and had a normalization of the left ventricular ejection fraction and left ventricular size. This indicates that there is a possible relationship between the hypothyroidism and the development of the left ventricular dysfunction in the current case. Moreover, our case indicates that myocardial

function in DCM secondary to hypothyroidism can be reversed with restoration of normal thyroid function and the management of heart failure. In conclusion, our case highlights that clinicians should consider the possibility of DCM secondary to hypothyroidism in patients with congestive heart failure.
The tissue Doppler imaging (TDI) derived pattern of the Inhibitors,research,lifescience,medical left ventricular (LV) longitudinal motion is characterized by a distinct velocity pattern during Inhibitors,research,lifescience,medical the time interval between the end of the systolic velocity wave and the onset of the early diastolic velocity wave. Negative and S3I-201 mouse positive velocity waves are commonly distinguished.1),2),3) The origin of these longitudinal myocardial velocities has not been fully resolved. We suggest considering the nadir of the negative velocity wave as being the onset of a notch leading to an interruption of the ongoing basally Inhibitors,research,lifescience,medical directed velocity of the myocardium. We have

labeled this phenomenon as the post-systolic velocity notch (PSN) (Fig. 1). Remme et al.4) demonstrated that the presence of the aortic valve is necessary for a PSN to occur. Inhibitors,research,lifescience,medical Stenting of the aortic valve led to the disappearance of the PSN in an animal model. The downstroke of the velocity curve between the end of the systolic wave and the onset of the PSN represented the protodiastolic myocardial

lengthening. However, the exact origin of the upstroke Inhibitors,research,lifescience,medical of the PSN, which frequently reaches positive values, was not clarified. Fig. 1 Schematic presentation of the post-systolic velocity notch (PSN). On the left the current designation of the post-systolic negative (red) and positive (blue) velocity waves. On the right the proposed view of the PSN (green). The arrow indicates the onset … For the current study, it was hypothesized that the energy released at the instant of the sudden cessation of the closing motion of the aortic valve is responsible for the Oxalosuccinic acid upstroke of the PSN. In order to evaluate this assumption the timing of the onset, the amplitude and the duration of the PSN were measured at different cardiac segments along the longitudinal axis in healthy subjects. Methods Study subjects Patients referred for a standard transthoracic echocardiogram were included in the study if they met the following inclusion criteria: no history of known cardiovascular disease, no abnormalities on physical examination, electrocardiogram and echocardiogram. Ultrasound acquisition For the purpose of the study, color TDI images of the apical longitudinal axis of the left ventricle were obtained.