BACKGROUND: Increased systolic pulmonary artery pressure (sPAP) could lead to mechanical dysfunction and myocardial fibrosis of right heart chambers. Echocardiographic strain analysis has not been adequately studied in patients living with pulmonary hypertension (PH). METHODS AND RESULTS: A cross-sectional cohort of patients with suspected PH and echocardiographic strain evaluation was recruited. Cut-off values of peak tricuspid regurgitation velocity with low probability of PH (≤ 2.8 m/s), intermediate probability (2.9-3.4 m/s, without other echo PH signs) and high probability of PH (2.9-3.4 m/s with other echo PH signs and >3.4 m/s) categories were studied by right ventricular and right atrial strain analysis in a sample of 236 patients, 58 (56.9%) had low, 15 (14.7%) intermediate, and 29 (28.4%) high probability of PH. We observed a negative association between right ventricular free wall strain and atrial global strain with sPAP. As PH severity increased, right atrial reservoir, conduit, and contraction (booster) strain values decreased. Identified cut-off values of strain parameters had an adequate ability to detect PH severity categories In addition, post-mortem biopsies of right heart chambers from subjects with known severe pulmonary hypertension were analyzed to quantify myocardial fibrosis. Our sample of right heart biopsies (n=12) demonstrated an association between increased sPAP before death and right ventricular and right atrial fibrosis. CONCLUSIONS: Mechanical dysfunction and fibrosis in right chambers is associated with increased sPAP. Right ventricular and atrial strain could provide enhancement in the diagnosis and categorization of subjects with suspected PH.

Background and objectives: Inadequate adherence has been recognized as a constant determinant in the overall burden of ischemic heart disease, particularly in countries with higher income-health inequalities, such as Mexico. The overall impression is that the lack of population-based epidemiological data and low public awareness may account for this problem. This study aimed to determine the level of adherence to secondary cardiovascular prevention therapy in a tertiary hospital in Mexico City and identify the barriers contributing to medication nonadherence. Methods: A cross-sectional study was conducted in the cardiology outpatient department between August 2018 and February 2020. Participants were asked about socio-demographic data, the MMAS-4, and an interview regarding reasons for nonadherence. Results: A total of 991 patients were included, with a median age of 65 (58,72) years old. Inadequate adherence to treatment was reported by 70.3%, with forgetfulness as the most frequent cause (55.4%). Patients on combined pharmacological therapy with PCI or CABG were more adherent than those on optimal medical therapy alone. A higher proportion of patients in the inadequate group were in NYHA classes II and III. Low educational level and the use of optimal medical treatment alone were predictors for poor adherence. Conclusion: These findings provide an initial framework of the current situation of adherence to secondary prevention therapy in Mexico, highlighting the value of promoting national consensus on medication adherence to move towards a population-based strategy to reduce cardiovascular disease burden.