The relationship between echocardiographic parameters and albumin bilirubin (ALBI) score in patients with isolated secundum type atrial septal defect.

BACKGROUND: It has been shown that the increase in volume and pressure in the right heart chambers increases liver stiffness. The Albumin-Bilirubin (ALBI) score is a useful and easy-to-use score for objectively assessing liver function. There is no information in the literature about changes in ALBI score in patients with atrial septal defect (ASD). The aim of our study is to investigate the changes in ALBI score and its clinical impact in patients with ASD. METHODS: Of the 206 analyzed patients, 77 were excluded. The remaining 129 patients with secundum type ASD with left to right shunt were divided into three groups; Group I (16 patients with Qp/Qs < 1.5 and defect diameter < 10 mm), Group II (52 patients with Qp/Qs > 1.5 and defect diameter 10-20 mm) and Group III (61 patients with Qp/Qs > 1.5 and defect diameter > 20 mm). The ALBI score was calculated based on serum albumin and total bilirubin levels using the following formula: ALBI = (log10 bilirubin [umol/L] * .66) + (albumin [g/L] * -.085). RESULTS: ALBI scores as well as total bilirubin levels, transaminases, and functional-structural heart abnormalities (increase in RA and RV dimensions, sPAP, ASD size and decrease in LVEF and TAPSE) showed a significant increasing trend from Group I to Group III (p < .001 for all comparisons). The mean ALBI scores for Group I, Group II, and Group III were -3.71 ± .37, -3.51 ± .25, and -3.27 ± .34, respectively. In multivariate linear regression analysis, ASD size, sPAP, RV-RA diameter were found to be significantly associated with increased ALBI score. CONCLUSION: The ALBI score offers a simple, evidence-based, objective, and discriminatory method of assessing liver function in patients with ASD. ASD size, sPAP, RV and RA diameters were significantly associated with ALBI score.

Plasma apelin-12 levels may predict in-hospital major adverse cardiac events in ST-elevation myocardial infarction and the relationship between apelin-12 and the neutrophil/lymphocyte ratio in patients undergoing primary coronary intervention.

OBJECTIVE: We aimed to investigate the compliance of plasma apelin-12 levels to show angiographic properties and hospital MACE in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). MATERIAL AND METHODS: The association of apelin-12 levels with the N/L ratio on admission was assessed in 170 consecutive patients with primary STEMI undergoing primary PCI. All patient SYNTAX scores and thrombolysis in myocardial infarction (TIMI) flow grades were also assessed. Patients were divided into two groups according to their TIMI flow grade. Patients with a TIMI 0-2 flow and TIMI 3 flow with grade 0/1 myocardial blush grade (MBG) score were defined as the no-reflow group and patients with TIMI grade 3 flow with ⩾2 MBG were considered as the normal flow group. RESULTS: Baseline apelin-12 levels were significantly lower in the no-reflow group than in the normal flow group (3.3±1.81 vs 6.2±1.74, p<0.001). In-hospital events, including death, myocardial infarction (MI) and re-infarction were significantly higher in patients in the no-reflow group than normal flow group (23% vs 7%, p<0.001). Apelin-12 level was negative correlated with the N/L ratio (r= -0.352, p<0.001), Hs-Crp (r=-0.272, p=0.01) and SYNTAX score (r= -0.246, p=0.029). In the multivariate regression analysis, apelin-12, presence of no-reflow and the SYNTAX score were independent predictors of in-hospital MACE (odds ratio [OR] 1.41, 95% confidence interval (CI) [1.27 to 1.67], p=0.001 for apelin-12, OR 1.085, [0.981 to 1.203], p<0.001 for no-reflow and OR 0.201, 95% CI [0.05 to 0.47], p= 0.004 for SYNTAX score). CONCLUSION: We have shown that lower apelin-12 level on admission is associated with higher SYNTAX scores and no-reflow phenomenon and may be used as a prognostic marker for hospital MACE in patients with STEMI.

The Role of Thiol/Disulphide Homeostasis in Anthracycline Associated Cardiac Toxicity.

The aim of the present study was to evaluate whether the baseline thiol/disulfide state can predict the occurrence of anthracycline induced cardiac toxicity. A total of 186 cancer patients receiving anthracycline (doxorubicin)-based chemotherapy were enrolled. All patients underwent 2-dimensional (2D) speckle tracking echocardiography (STE) to determine their left ventricular ejection fraction (LVEF) and blood samples for measuring thiol forms were obtained before treatment and 4 weeks after completion of the chemotherapy. The mean dose of doxorubicin exposure was 255 ± 39.2 mg/m2. Baseline native thiol was found to be lower whereas baseline disulfide and the disulfide/total thiol ratio were found to be higher in patients who had a decrease in LVEF after anthracycline therapy. Also, the amount of decrease in LVEF was well correlated with the delta value of the thiol forms. Logistic regression analysis revealed that changes in BNP and global longitudinal strain (GLS), baseline level of native thiol, disulfide, and the disulfide/total thiol ratio were strong predictors for a decrease in LVEF.The thiol/disulfide pathway may be a factor for predicting chemotherapy-induced cardiac toxicity as one of the oxidative stress mechanisms.

T-peak to T-end Interval Predicts Appropriate Shocks in Patients with Heart Failure Undergoing Implantable Cardioverter Defibrillator Implantation for Primary Prophylaxis.

BACKGROUND: T-wave peak to T-wave end interval (Tp-e) correlates with dispersion of ventricular repolarization. The purpose of this study was to assess the ability of Tp-e to predict appropriate implantable cardioverter defibrillator (ICD) shocks and all-cause mortality in patients who underwent ICD implantation for primary prophylaxis. METHODS: Two hundred twenty-eight patients with left ventricular ejection fraction ≤35% and an ICD implanted were followed-up prospectively. Patients divided into two subgroups according to presence of appropriate ICD shocks (Group 1: 112 patients with ICD shocks, Group 2: 116 patients without shocks). End points were appropriate ICD therapy due to ventricular tachycardia (VT)/ventricular fibrillation (VF), death, and a combined end point of VT/VF or death. RESULTS: During a mean follow-up of 22.3 ± 7.7 months, appropriate ICD shocks were observed in 112 of 228 patients (49.1%). The mean duration of the Tp-e Group 1 was significantly longer than Group 2 (115.3 ± 22.2 vs 104.7 ± 20.2 ms, P < 0.001). Ischemic etiology and Tp-e duration were found to be independent predictors of ICD therapy. When the patients were divided into two groups based on Tp-e interval, there was no significant difference regarding the mortality between groups (21.2% vs 21.8%, P: 0.186). However, appropriate ICD shocks due to VT/VF (37.5% vs 58.8%, P < 0.001) and combined end point (39.4% vs 64.5%, P: 0.002) were significantly higher in patients with longer Tp-e group. CONCLUSIONS: Tp-e interval independently predicts appropriate ICD shocks in patients with systolic dysfunction and ICDs implanted for primary prevention.

The prognostic importance of thiol/disulfide homeostasis in patients with acute pulmonary thromboembolism.

OBJECTIVE: The aim of this study was to evaluate the role of thiol/disulfide homeostasis in acute pulmonary embolism (APE) and investigate its compliance to show hospital mortality of patients with APE. MATERIAL AND METHODS: A total of 173 participants including 113 patients with APE, and 60 healthy individuals were included in the study. APE group was categorized into two subgroups according to Pulmonary Embolism Severity Index (PESI) clinic risk score (PESI low group [n=71, class 1-3] and PESI high group [n=42, class 4-5]). RESULTS: Mean level of native thiol was lower and disulfide level and disulfide/total thiol ratio were higher in APE group than control group. In APE group, 14 patients died during hospitalization. Native thiol and disulfide level, presence of shock, heart rate, oxygen saturation, right ventricular dysfunction, N-terminal pro-brain natriuretic peptide, and creatinine levels were found to have prognostic significance in univariate analysis. On multilvariable logistic regression analysis, native thiol and disulfide level (odds ratio [OR], 1.16(0.87-1.36); P=.010 and OR, 1.49; P=.015, respectively), presence of shock (OR, 1.04; P=.012) and N-terminal pro-brain natriuretic peptide (OR, 1.67; P=.002) were strong predictors for APE-related hospital mortality after the adjustment of other potential confounders. CONCLUSION: We have shown that thiol/disulfide homeostasis can be altered during APE and associated with worse hemodynamic parameters, and may be used as a prognostic marker for hospital mortality.

Effect of Spironolactone on Plasma Apelin-12 Levels in Patients with Chronic Systolic Heart Failure.

BACKGROUND: The aim of this study was to determine whether spironolactone therapy has an effect on serum apelin-12 levels in heart failure with reduced ejection fraction (HFrEF) patients. METHODS: Eighty outpatients previously diagnosed with HFrEF were enrolled in the current study. Included patients were taking only standard heart failure therapy (ST) (angiotensin converting enzyme or angiotensin receptor blocker, beta-blockers, loop diuretics and anticoagulant or antiagregan agents) without a mineralocorticoid receptor antagonists (MRA) because of its side effects, and were designated the non-MRA group; those patients taking 25 mg/daily spironolactone in addition to the ST were deemed the MRA group. Patient blood samples were collected to measure serum apelin-12 levels. RESULTS: After adjustment for all clinical and demographic factors, plasma apelin-12 levels were significantly higher and NT pro-BNP levels were significantly lower in the MRA group compared to the non-MRA group (p < 0.001, p < 0.001; respectively). In multiple linear regression analyses, there was no association between baseline apelin-12 level and clinical parameters. MRA using initial apelin-12 levels were lower and NT pro-BNP levels were higher in patients with stricken event than in event-free patients (p = 0.042, p < 0.001, and p < 0.001; respectively). CONCLUSIONS: Blocking the aldosterone receptors by spironolactone, in addition to maximal standard therapy, may increase serum apelin-12 levels among patients with HFrEF.

Epicardial adipose tissue is related to coronary collateral vessel formation in patients with acute coronary syndrome.

OBJECTIVES: Epicardial adipose tissue (EAT) is the ectopic fat surrounding the heart, and it may contribute to coronary collateral vessel (CCV) formation. We aimed to evaluate the association of EAT with the presence of CCV in patients with acute coronary syndrome (ACS). DESIGN: A total of 230 patients with ACS were included. The CCVs were graded according to the Rentrop scoring system, and a Rentrop grade 0-1 was accepted as low-grade CCV group, Rentrop grade 2-3 was accepted as high-grade CCV group. RESULTS: According to angiography, 70 (30%) patients constituted the high-grade CCV group and 160 (70%) constituted the low-grade CCV group. The high-grade CCV group had thicker EAT than the low-grade CCV group (6.1 ± 1.4 vs. 5.3 ± 1.4 mm; p = 0.001). Multivariate logistic regression analysis showed that presence of CCV was independently associated with EAT thickness, ejection fraction, presenting with ST-segment elevation myocardial infarction, and presence of angina on admission. EAT thickness of > 5.7 mm can independently predict high-grade CCV with 73% sensitivity and 69% specificity (area under the curve or AUC: 0.65; 95% confidence interval or CI: 0.57-0.72). CONCLUSIONS: EAT thickness on admission was associated with the presence of CCVs in patients with ACS.

Gamma glutamyl transferase activity is independently associated with oxidative stress rather than SYNTAX score.

BACKGROUND: Gamma glutamyl transferase (GGT) is involved in the pathophysiologic process of coronary atherosclerosis. GGT activity plays a role in the catabolism of glutathione which is known as one of the major antioxidants. However, there is a lack of research on direct examination of relevance between serum GGT activity with systemic oxidative stress. OBJECTIVES: We aimed to investigate the relationship between GGT activity with systemic oxidative stress markers and the extent and complexity of coronary artery disease (CAD) assessed with SYNTAX score in stable CAD. METHODS: Measurements were obtained from 359 patients with stable CAD (Mean age = 57.7 ± 10.1 years). The patients were divided into two groups according to the median GGT level (GGT < median group < 22 and GGT > median group ≥ 22). Angiography was performed and SYNTAX score was calculated in all patients. Oxidative stress markers (total oxidant status [TOS], total antioxidant capacity [TAC] and oxidative stress index [OSI]) were measured in all patients. RESULTS: While SYNTAX score and oxidative stress markers such as TOS and OSI have been increased, TAC was decreased in GGT > median group compared with GGT < median group (p < 0.05, for all). GGT activity was independently associated with diabetes (ß = 0.106, p = 0.015) and OSI (ß = 0.556, p < 0.001) in multiple linear regression analysis. However, the independent association between GGT activity and SYNTAX score was not found in present study (ß = 0.063, p = 0.238). CONCLUSION: In stable CAD, increased GGT activity within the normal range is associated with increased oxidative stress rather than increased extent and complexity of CAD.

Coronary flow velocity reserve in patients with ascending aorta aneurysm.

BACKGROUND: Ascending aorta aneurysms (AAA) are one of the leading causes of morbidity and mortality. Impairment in coronary flow may contribute to cardiovascular consequences in AAA patients. Coronary flow velocity reserve (CFVR) has been considered an important diagnostic index of the functional capacity of coronary arteries noninvasively. The aim of this study was to evaluate, by noninvasive CVFR, whether patients with AAA demonstrate significant coronary microvascular dysfunction in the absence of coronary artery disease (CAD). METHODS: We prospectively included 44 patients with thoracic AAA in the absence of concomitant CAD (30 men, 14 women; mean age 57.5 ± 8.4 years). A total of 36 patients without aortic dilatation (mean age 55.2 ± 9.9 years) were selected as the control group. Coronary flow velocities in the distal left anterior descending (LAD) artery were measured using transthoracic echocardiography. CFVR was calculated as the hyperemic to resting coronary diastolic peak velocities ratio. RESULTS: Compared with controls, patients with AAA had higher baseline LAD peak diastolic coronary flow velocities (28.3 ± 5.8 vs. 25.2 ± 4.5 cm/sec, P = 0.01), lower hyperemic LAD flow velocities (54.0 ± 10.3 vs. 57.2 ± 12.7 cm/sec, P = 0.220), and consequently lower CFVR (1.9 ± 0.3 vs. 2.3 ± 0.5, P < 0.001). Multivariate linear regression analysis showed that CFVR was independently associated only with aortic systolic diameter (AoSD) (ß = -0.679, P = <0.001). CONCLUSIONS: Our study demonstrates that noninvasive CFVR is significantly reduced in patients with AAA and AoSD is the most important determinant of impaired CFVR.

Assessment of insulin-like growth factor-1 (IGF-I) level in patients with rheumatic mitral stenosis.

OBJECTIVES: Insulin-like growth factor-1 may serve some regulatory function in the immune system. Rheumatic mitral stenosis is related to autoimmune heart valve damage after streptococcal infection. The aim of this study was to assess the level of insulin-like growth factor-1 and its correlation with the Wilkins score in patients with rheumatic mitral stenosis. METHODS: A total of 65 patients with rheumatic mitral stenosis and 62 age- and sex-matched control subjects were enrolled in this study. All subjects underwent transthoracic echocardiography. The mitral valve area and Wilkins score were evaluated for all patients. Biochemical parameters and serum insulin-like growth factor-1 levels were measured. RESULTS: Demographic data were similar in the rheumatic mitral stenosis and control groups. The mean mitral valve area was 1.6±0.4 cm2 in the rheumatic mitral stenosis group. The level of insulin-like growth factor-1 was significantly higher in the rheumatic mitral stenosis group than in the control group (104 (55.6-267) versus 79.1 (23.0-244.0) ng/ml; p=0.039). There was a significant moderate positive correlation between insulin-like growth factor-1 and thickening of leaflets score of Wilkins (r=0.541, p<0.001). CONCLUSIONS: The present study demonstrated that serum insulin-like growth factor-1 levels were significantly higher in the rheumatic mitral stenosis group compared with control subjects and that insulin-like growth factor-1 level was also correlated with the Wilkins score. It can be suggested that there may be a link between insulin-like growth factor-1 level and immune pathogenesis of rheumatic mitral stenosis.

Coil embolization of a traumatic arteriovenous fistula of the lower extremity.

Arteriovenous fistulas (AVFs) are unusual connections between the arterial and venous system that bypass the normal anatomic capillary beds. This case report presents an arteriovenous fistula of the lower extremity caused by a penetrating injury. The patient was diagnosed by Duplex ultrasonography. Diagnostic catheterization of the affected limb showed a high-flow AVF between the left profunda femoris artery and left femoral vein with a deep femoral vein aneurysm measuring 9x4 cm. The AVF was successfully treated with coil embolization.

Left ventricle geometry affects coronary flow reserve in diabetic patients.

OBJECTIVES: The aim of this study was to investigate the association between coronary flow reserve (CFR) and left ventricle (LV) geometric patterns in patients with newly-diagnosed diabetes mellitus (DM). STUDY DESIGN: We studied 116 patients with newly-diagnosed DM and 31 healthy control subjects. Echocardiographic examination was performed on all subjects. Four different geometric patterns were identified in diabetic patients, according to LV mass index (LVMI) and relative wall thickness (RWT) [NG: Normal geometry; CR: Concentric remodeling; EH: Eccentric hypertrophy; CH: Concentric hypertrophy]. CFR was calculated as the hyperemic to resting coronary diastolic peak velocities ratio. RESULTS: Compared with controls, CFR was decreased in diabetic patients (p<0.05). The lowest CFR values were observed in the CH group compared with control and other groups (p<0.05, for all). Also, CFR values of the CR and EH groups were lower than NG and the control group (p<0.05, for all). CFR was associated with LV geometry (r=-0.449, p=0.001), LVMI (r=-0.401, p<0.001), RWT (r=-0.247, p=0.008), HbA1c (r=-0.576, p<0.001) and mitral valve E/A ratio (r=0.239, p=0.01) in bivariate analysis. CFR was independently associated with LV geometry (ß=-0.449, p<0.001), LVMI (ß=-0.192, p=0.016), and HbA1c (ß=-0.576, p<0.001) in multivariate analysis. CONCLUSION: CFR was impaired in newly-diagnosed DM. The degree of this deformation increases from normal geometry towards to concentric hypertrophy. This condition suggests that myocardial structural remodeling due to diabetes might be effective on CFR.

Latitude or altitude as the future refugium? A case for the future of forests in Asia Minor and its surroundings.

At the current juncture with climate change, centennial projections of species distributions in biodiversity hotspots, using dynamic vegetation models may provide vital insight into conservation efforts. This study aims to answer: (1) if climate change progresses under a business-as-usual scenario of anthropogenic emissions for this century, how may the forest ranges be affected? (2) will there be potential regional extinctions of the taxa simulated? (3) may any site emerge as a potential refugium? STUDY AREA: Anatolian Peninsula and its surroundings, longitudes 24-50° E, latitudes 33-46° N. Time Period: 1961-2100. Major Taxa Studied: 25 woody species and a C3 grass-type. METHOD: Keeping a spatial window large enough to track potential changes in the vegetation range and composition especially in the mountain ranges within the study area, we parameterized a process-based regional-to-global dynamic vegetation model (LPJ-GUESS v 4.1), forced it with ERA5-Land reanalysis for the historical period, and five different bias-corrected centennial global circulation model (GCM) datasets under SSP5-8.5, and simulated the dynamic responses of key forest species. Bivariate spatio-temporal maps from the simulation results were constructed for final analysis. RESULTS: A significant increase in woody taxa biomass for the majority of our study area, towards the end of the century was simulated, where temperate taxa with high tolerance for drought and a wider range of temperatures took dominance. The mountain ranges in our study area stood out as critical potential refugia for cold favoring species. There were no regional extinctions of taxa, however, important changes in areal dominance and potential future forest composition were simulated. MAIN CONCLUSIONS: Our simulation results suggest a high potential for future forest cover in our study region by the end of the century under a high emissions scenario, sans human presence, with important changes in vegetation composition, including encroachment of grasslands ecosystems by woody taxa.

Assessment of transabdominal fat volumes as a predictor of prognosis in patients undergoing transcatheter aortic valve replacement.

Transcatheter aortic valve replacement (TAVR) has emerged as a well-established treatment option for eligible patients with severe aortic stenosis. This study aimed to investigate the correlation between abdominal fat tissue volumes, measured using computed tomography (CT), and all-cause mortality in patients undergoing TAVR. The study included 258 consecutive patients who underwent TAVR at a single center between September 2017 and November 2020. During the preoperative preparation, CT scans were used to perform a semi-quantitative measurement of abdominal fat components. Body mass index (BMI) for each participant was calculated. The relationship between fat parameters and overall survival was determined using multivariable Cox proportional hazards models. Participants had a mean age of 76.8 ± 7.8 years, of whom 32.9% were male. The median follow-up period was 12 months, during which 38 patients (14.7%) died. Both the survivor and non-survivor groups showed comparable risk factors. Regarding transabdominal fat volume parameters, deceased individuals exhibited significantly lower values. However, no significant differences were observed in BMI and transabdominal area measurements. Among transabdominal fat parameters, only subcutaneous fat volume [adjusted Hazard Ratio (aHR) = 0.83, p = 0.045] and total fat volume (TFV) [aHR = 0.82, p = 0.007] were identified as significant predictors of reduced all-cause mortality. Furthermore, TFV demonstrated the highest discriminative performance with a threshold of ≤ 9.1 L (AUC = 0.751, p < 0.001, sensitivity 71.1%, specificity 70.9%). Preoperative CT-based abdominal fat volume parameters, particularly TFV, can serve as potential predictors of survival in patients undergoing TAVR.

Evaluation of correlation between aortic elastic parameters and atrial electromechanical abnormalities in hypertensive patients.

OBJECTIVES: Arterial hypertension leads to instability and heterogeneity in atrial conduction by these hemodynamic and morphological changes in heart and aorta. These changes can be evaluated by transthoracic echocardiography. The aim of this study was to evaluate the correlation of aortic elastic parameters and atrial electromechanical delay (AEMD) parameters in patients with hypertension. METHODS: Eighty-one hypertensive patients and 55 control subjects were included in the study. All subjects underwent transthoracic echocardiography for detecting aortic elastic parameters and AEMD parameters. RESULTS: There was no difference between HT and control groups regarding age and gender. Aortic strain (8.1 ± 4.3% vs. 10.3 ± 5.1%, P = 0.008) and aortic distensibility (0.35 ± 0.18 cm(2) /dyn vs. 0.45 ± 0.23 cm(2) /dyn, P = 0.003) were decreased in hypertensive patients than in controls. Intra-left AEMD (25.5 ± 7.3 vs. 21.8 ± 9.2 P < 0.009) was significantly higher in hypertensive patients compared to control subjects. No statistically significant difference was found in intra-right AEMD and inter-AEMD between the groups. There was a positive significant moderate correlation between aortic strain and intra-left AEMD (r = 0.501, P < 0.001). CONCLUSIONS: This study demonstrated that intra-left AEMD was increased in hypertensive patients and aortic elastic parameters was correlated with intra-left AEMD. These findings may be related to similar structural and functional changes in heart and aorta in hypertension.

Real-Life Performance and Clinical Outcomes of Portico Transcatheter Aortic Valve with FlexNav Delivery System: One-Year Data from a Single-Center Experience.

Significant progress has been made in both valves and delivery systems (DSs) for transcatheter aortic valve replacement (TAVR) procedures. We aimed to present one-year real-life data regarding TAVR procedures using Portico transcatheter heart valves (THVs) with new-generation, low-profile FlexNav DSs. This retrospective, single-center study enrolled 169 consecutive patients (mean age: 75.8 years, 68% females) with severe aortic stenosis undergoing TAVR with Portico THVs and FlexNav DSs between 2020 and 2021. We evaluated safety and efficacy outcomes, following the VARC-3 consensus, periprocedurally and at 30 days and 1 year. Procedural success was observed in 95.9% of cases, and no procedural mortality occurred. At 30 days, the rates of all-cause mortality, cardiovascular mortality, and neurological events were 4.7%, 3.6%, and 3.0%, respectively. Additionally, major vascular complications, acute kidney injury, and bleeding were recorded at rates of 11.2%, 14.8%, and 7.7%, respectively. The 1-year data showed all-cause mortality, cardiovascular mortality, and neurological event rates of 10.7%, 8.3%, and 7.7%, respectively. The moderate paravalvular leak and permanent pacemaker rates at 1 year were 2.6% and 12.2%, respectively. This real-life data provided evidence of positive outcomes and high technical success with Portico THVs and FlexNav DSs. Furthermore, we found low rates of mortality and neurological events, with satisfactory hemodynamic and functional results.

Serum 25-hydroxyvitamin D levels are correlated with mitral valve calcification score in patients with rheumatic mitral stenosis.

BACKGROUND AND AIM OF THE STUDY: Rheumatic mitral stenosis (RMS) is a chronic disease related to autoimmune heart valve damage after streptococcal infection. Epidemiological evidence supports an association between vitamin D and the susceptibility and severity of autoimmune disorders. The study aim was to assess the serum levels of 25-hydroxyvitamin D and their correlation with Wilkins calcification score in patients with RMS. METHODS: Thirty-four patients with RMS and 29 healthy age- and gender-matched controls were enrolled in the study. All subjects underwent transthoracic echocardiography after a complete medical evaluation and laboratory examination. The planimetric mitral valve area and Wilkins score were evaluated for all patients, and biochemical parameters and serum levels of 25-hydroxyvitamin D and calcitriol were determined. RESULTS: The mean patient age was similar in the RMS and control groups (50 +/- 10 versus 52 +/- 10 years; p = NS). The serum level of 25-hydroxyvitamin D was significantly lower in RMS patients than in controls (8.6 ng/ml; range: 4.9-26.3 ng/ml versus 12.3 ng/ml; range: 4-158 ng/ml; p = 0.031). A significantly moderate inverse correlation was identified between the serum 25-hydroxyvitamin D level and the Wilkins score (r = -0.567, p < 0.001), but no correlation was identified between 25-hydroxyvitamin D levels and other echocardiographic parameters of mitral stenosis. The serum level of calcitriol was also significantly lower in RMS patients than in controls (19.8 pg/ml; range: 16.0-54.6 pg/ml versus 26.1 pg/ml; range: 13.2-47.0 pg/ml; p = 0.013). CONCLUSION: The study results showed that serum levels of 25-hydroxyvitamin D were significantly lower in RMS patients than in controls, and also correlated with the Wilkins calcification score. Thus, a link may exist between 25-hydroxyvitamin D and the calcification process in RMS.

Simulating land-cover change in Montane mainland southeast Asia.

We used the conversion of land use and its effects (CLUE-s) model to simulate scenarios of land-cover change in Montane mainland southeast Asia (MMSEA), a region in the midst of transformation due to rapid intensification of agriculture and expansion of regional trade markets. Simulated changes affected approximately 10 % of the MMSEA landscape between 2001 and 2025 and 16 % between 2001 and 2050. Roughly 9 % of the current vegetation, which consists of native species of trees, shrubs, and grasses, is projected to be replaced by tree plantations, tea, and other evergreen shrubs during the 50 years period. Importantly, 4 % of this transition is expected to be due to the expansion of rubber (Hevea brasiliensis), a tree plantation crop that may have important implications for local-to-regional scale hydrology because of its potentially high water consumption in the dry season.

Elevation of B-type natriuretic peptide level in asymptomatic hepatitis B virus-positive patients is not associated with abnormalities of cardiac function.

OBJECTIVES: To compare B-type natriuretic peptide (BNP) and echocardiographic parameters in patients with hepatitis B virus (HBV) and healthy control subjects. SUBJECTS AND METHODS: 52 consecutive patients with HBV and 47 healthy controls were examined. All subjects underwent transthoracic echocardiography after a complete medical history and laboratory examination including BNP, C-reactive protein (CRP) and high-sensitivity CRP (hsCRP). RESULTS: Demographic characteristics were similar in patients with HBV and the control group. No significant difference was found in conventional Doppler and tissue Doppler parameters between the two groups. BNP levels were significantly higher in patients with HBV [6.5 ng/l (range 0.5-85.2)] than controls [4.3 ng/l (range 0.5-18.3)], p = 0.039. hsCRP [3.25 mg/l (0.02-40.2) vs. 0.5 mg/l (0.02-8.0)] levels were significantly higher in patients with HBV than control subjects (p < 0.001). CONCLUSION: Patients with HBV had higher BNP, CRP, and hsCRP levels than controls. Echocardiographic findings were similar in both groups. This slight BNP elevation in HBV patients may be related to chronic inflammation due to HBV.

The effect of different atrioventricular delays on left atrium and left atrial appendage function in patients with DDD pacemaker.

BACKGROUND: Although it has been known that optimization of atrioventricular delay (AVD) has favorable effect on the left ventricular functions in patients with DDD pacemaker, the effect of different AVDs on left atrium (LA) and left atrial appendage (LAA) functions has not been exactly evaluated. The aim of the present study was to assess the effect of different AVDs on LA and LAA functions in DDD pacemaker implanted patients with atrioventricular block. METHODS: Forty-eight patients with DDD pacemaker were enrolled into the study. Patients were divided into two groups according to the echocardiographic diastolic function: Group I (normal diastolic function) and Group II (diastolic dysfunction). LAA emptying velocity on pulsed wave Doppler and LAA late systolic wave velocity by using tissue Doppler were recorded. Patients were paced for five successive continuous pacing periods of 10 minutes duration using five selective AVDs (80-250 ms). RESULTS: Significant effect on LA and LAA functions has not been observed by the setting of AVD in Group I. However, when the AVD was gradually shortened form 150 ms to 80 ms, LA and LAA functions gradually decreased in Group II patients. When AVD increased to 200 ms, LA and LAA functions were improved. Further increase in AVD resulted in decreased LA and LAA functions. CONCLUSION: Setting of AVD has not significant effect on the LA and LAA functions in patients with normal diastolic function, but moderate prolongation of AVD in physiological limits improved LA and LAA functions in DDD pacemaker implanted patients with diastolic dysfunction.