V1r + DIIq is a novel and accurate criterion to predict right vs. left paraseptal accessory pathways.

PURPOSE: The correct estimation of accessory pathway (AP) localization from surface ECG is critical before the procedure. Our study aimed to detect the predictive value of the V1r + DIIq criterion for differentiating right- from left-sided paraseptal APs. METHODS: We retrospectively included 58 patients with (Wolff-Parkinson-White) WPW syndrome and paraseptal APs who underwent successful catheter ablation (37 male, 21 female; mean age 34.4 ± 13.6 years). The V1r + DIIq criterion was calculated using the following formula: V1r + DIIq (mV) = initial r wave amplitude in V1 + q wave amplitude in DII. The combined criterion included V1r + DIIq <2.05 mV and/or no initial r wave in V1. RESULTS: Right-sided paraseptal APs were detected in 36 patients (62.1%), left-sided paraseptal APs were detected in 21 patients (36.2%), and AP from CS was detected in 1 patient (1.7%). The initial r wave amplitude in V1 (mV), q wave amplitude in DII (mV) and V1r + DIIq criterion (mV) were lower in patients with right-sided paraseptal APs (p < 0.001). The percentage of patients with no initial r wave in V1 (36.1% vs. 0%) and those meeting the combined criterion (91.7% vs. 4.5%) were increased in patients with right-sided paraseptal APs. The cutoff value of the V1r + DIIq criterion obtained by ROC curve analysis was 2.05 mV for predicting right-sided paraseptal APs (sensitivity: 86.1%, specificity: 95.5%). The area under the curve (AUC) was 0.943 (95% CI = 0.881-1.000) (p < 0.001). The sensitivity and specificity values were 36.1% and 100%, respectively, for the no initial r wave criterion and 91.7% and 95.5%, respectively, for the combined criterion. CONCLUSION: The V1r + DIIq criterion and the combined criterion represent novel and simple electrocardiographic criteria for accurately differentiating right- from left-sided paraseptal APs. This simple ECG measurement can improve the accuracy of detection of paraseptal AP localization and could be beneficial for decreasing ablation duration and radiation exposure.

The new prognostic factor for pulmonary embolism: The ratio of monocyte count to HDL cholesterol.

PURPOSE: Aim of this study is to investigate effectiveness of the monocyte to HDL cholesterol ratio in patients diagnosed with pulmonary embolism for predicting intra-hospital mortality. METHOD: A total of 269 patients diagnosed with pulmonary embolism in the emergency clinic were included in the study. Study was conducted retrospectively. Pulmonary Embolism Severity Index (PESI), Monocyte count and high density lipoprotein cholesterol (HDL) values were determined. MHR values of the patients were calculated. SPSS 26 package program was used to investigate the effectiveness of MHR in predicting mortality. FINDINGS: Mean age of the patients was 64.51 ± 12.4 years. PESI, Number of monocytes and MHR were significantly higher in the group with mortality than the group without mortality (p < .05). HDL values were significantly lower (p < .05) in mortality group. Sensitivity of MHR 19 cut off value was 89.3%, and its specificity was 82.0%. CONCLUSION: Use of predictors for mortality estimation in patients diagnosed with acute pulmonary embolism is important for faster administration of treatment modalities. We think MHR values can be used as a strong predictor according to the hemogram parameters and biochemical results.

Complement C1q/Tumor Necrosis Factor-Related Protein-3 (CTRP3) is Significantly Decreased in Patients with Heart Failure and Closely Related with Ventricular Tachycardia.

BACKGROUND: The relationship between serum complement C1q/tumor necrosis factor (TNF)-related protein-3 (CTRP3) levels and ventricular tachycardia (VT) in heart failure patients with reduced ejection-fraction (HFrEF) is unclear. The aim of this study was to investigate changes in serum CTRP3 level and the relationship with VT in HFrEF. METHODS: The study included 88 patients with HFrEF with and without VT and 30 age- and sex-matched healthy controls. Serum CTRP3 levels were measured in addition to routine anamnesis, physical, laboratory and echocardiography examinations. The patients were divided into groups with and without HFrEF and HFrEF patients with and without VT. RESULTS: Serum CTRP3 levels were significantly lower in the patients with HFrEF than in the control group (206 ± 16 ng/mL and 427 ± 49 ng/mL, p < 0.001). Similarly, CTRP3 levels were lower in the patients with VT (194 ± 10 ng/mL and 216 ± 15 ng/mL, p < 0.001). Left ventricular (LV) volume and tricuspid regurgitation pressure gradient were significantly higher and LV ejection-fraction was significantly lower in the patients with VT (all p < 0.05). Serum CTRP3 and LV end-systolic volume values independently determined the patients with VT (all p < 0.01). Every 10 ng/mL decrease in CTRP3 level increased the odds ratio of VT by 79%. In the receiver operating characteristic curve (ROC) analysis, the area under the ROC curve for CTRP3 was 0.884 (p < 0.001). A CTRP3 cut-off value of 200 ng/mL could predict VT with 88.1% sensitivity and 80.2% specificity. CONCLUSIONS: Serum CTRP3 levels were significantly decreased in the patients with HFrEF, and decreased CTRP3 levels were very closely related to the presence of VT in these patients.

Impaired left ventricular global longitudinal strain improves with radiofrequency catheter ablation in patients with PVC-induced cardiomyopathy.

BACKGROUND: In our study, we aimed to evaluate left ventricular global longitudinal strain (LV-GLS) value in patients with premature ventricular contractions (PVCs) and reduced LV ejection fraction (LVEF) and to determine the effect of radiofrequency catheter ablation (RFA) procedure on LV-GLS. METHODS: In this cross-sectional study, 150 patients who underwent three-dimensional RFA with the diagnosis of PVCs were included. LV-GLS was measured with strain echocardiography in all patients before RFA and in the sixth-month control. Patients included in the study were grouped as LVEF <50% (Group I) and LVEF ≥50% (Group II) according to baseline LVEF, and patients within Group I were grouped as LVEF <50% (Group A) and LVEF ≥50% (Group B) according to the sixth-month LVEF. RESULTS: There were 39 patients (26%) with baseline LVEF <50%. In 14 (36%) of these patients, LVEF <50% was observed to continue during the sixth-month controls. Both the baseline and sixth-month LV-GLS values were significantly lower in Group I patients (<0.01). RFA treatment significantly increased both LVEF and LV-GLS (<0.01). It was found that age, N-terminal pro-brain natriuretic peptide, LV diameters, and baseline LVEF were higher, and baseline LV-GLS level was lower in Group A patients (P < .01). Baseline LVEF and LV-GLS values were found to independently determine the patients in Group A (P < .01). In receiver operator characteristic analysis, when the limit value is accepted as 40% for baseline LVEF and 18% for baseline LV-GLS, it can determine Group A with acceptable sensitivity and specificity. CONCLUSIONS: LV-GLS decreases significantly in patients with reduced LVEF and PVCs. In these patients, RFA treatment significantly increases both LVEF and LV-GLS.

Morning blood pressure surge increases in patients with hypertensive primary hyperparathyroidism and is independently associated with serum calcium level.

Introduction: There is not enough data on the effects of primary hyperparathyroidism (pHPT) on morning blood pressure surge (MBPS) in the literature. We aimed to determine whether there was any change in MBPS value in patients with hypertensive pHPT and to determine the parameters related to MBPS.Method: 80 patients with newly diagnosed pHPT with hypertension (HT) and 80 controls with newly diagnosed hypertension were included. Routine laboratory examinations and ambulatory blood pressure monitoring (ABPM) were performed in all patients.Results: In patients with pHPT, blood urea nitrogen (BUN), triglyceride, hs-CRP, uric acid, serum calcium (Ca), parathormone (PTH), daytime SBP and MBPS levels are higher than others (p < 0.05). Body mass index (BMI) and Ca level were independently associated with MBPS. In patients with MBPS ≥ 25 mmHg, BMI, BUN, creatinine, uric acid, Ca and PTH levels were found to be higher than others. BMI values and Ca levels determine the patients with MBPS ≥ 25 mmHg (p < 0.05) independently. According to this analysis, increase in BMI (for each 1 unit) and Ca level (for each 0.1 mg/dL) was found to increase the probability of MBPS ≥ 25 mmHg by 17.8% and 7.7%, respectively. When the cut-off value for Ca was taken as 10 mg/dL, the patients with MBPS ≥ 25 mmHg were determined with 73.5% sensitivity and 73.1% specificity.Conclusion: MBPS significantly increases in patients with newly diagnosed hypertensive pHPT. This increase in MBPS is closely associated with increased Ca levels. In patients with pHPT, lowering the Ca level below 10 mg/dL may have clinical implications.

Tp-e interval, Tp-e/QT and Tp-e/QTc ratio in hypertensive patients with primary aldosteronism.

Introduction: There is no study evaluating the Tp-e/QT and Tp-e/QTc ratios with T wave peak to end interval (Tp-e interval) used for evaluation of cardiac arrhythmia risk and ventricular repolarization changes in patients with primary aldosteronism (PA). We aimed to investigate whether there was a change in Tp-e interval, Tp-e/QT and Tp-e/QTc ratios in patients with PA.Method: Thirty patients with newly diagnosed hypertension (HT) and PA and 30 patients with primary HT were included. Twelve-lead electrocardiography (ECG) was performed in all patients. Tp-e interval, Tp-e/QT and Tp-e/QTc ratios were measured in addition to routine measurements in ECG.Results: Sodium, potassium, and plasma renin activity (PRA) were significantly lower in patients with PA; systolic and diastolic blood pressure, plasma aldosterone, plasma aldosterone/PRA were significantly higher in patients with PA (p < .05 for each one). When ventricular repolarization parameters were examined; while QT and QTc interval were similar between two groups, Tp-e interval, Tp-e/QT and Tp-e/QTc ratio values were significantly higher in patients with PA (p < .05 for each one). Tp-e interval, Tp-e/QT and Tp-e/QTc ratio values were positively correlated with the serum calcium, aldosterone, and aldosterone/PRA levels and negatively correlated with serum sodium, potassium, renin levels (p < .05 for each one). In linear regression analyses, Tp-e interval, Tp-e/QT and Tp-e/QTc ratios were independently associated with the aldosterone/PRA ratio.Conclusion: Tp-e interval, Tp-e/QT and Tp-e/QTc were increased in hypertensive patients with PA and were independently associated with aldosterone/PRA levels. This may be related to the changing neuroendocrine state in patients with PA.

A new approach to radiofrequency catheter ablation of premature ventricular contractions: The diurnal variation index.

BACKGROUND: Radiofrequency catheter ablation (RFA) is a frequently used method in the treatment of premature ventricular contractions (PVCs) resistant to drug therapy. RFA is recommended for patients with PVCs burden >10%. This study was aimed to investigate the presence of other parameters to enhance the indication of ablation in 24-hour rhythm Holter recordings. METHODS: 202 patients with >10% PVCs in 24-hour rhythm Holter recordings were included in the study between January 2015 and August 2019. Patients were divided into two groups. Radiofrequency ablation was performed in 163 patients but not in 39 patients. RESULTS: Laboratory findings were compared between two groups. Total cholesterol (p = 0.018), LDL cholesterol (p = 0.013) and triglyceride (p < 0.001) values were significantly higher in the RFA group, When the 24-hour rhythm Holter findings were compared, the diurnal variation index was significantly higher in the RFA group (p < 0.001). Triglyceride (OR: 1.013, 95% CI: 1.001-1.025, p = 0.032) and diurnal variation index (OR: 3.643, 95% CI: 1.440-9.216, p = 0.006) were determined as independent predictors in binominal logistic regression analysis. In the ROC analysis, when the cut-off value of the diurnal variation index was taken as 1.5, it was found that it could predict patients who undergo effective RFA with 76.7% sensitivity and 60% specificity. CONCLUSION: Diurnal variation index may be a useful parameter for RFA indication with PVC burden in 24-hour rhythm Holter recordings.

S-R difference in V1-V2 is a novel criterion for differentiating the left from right ventricular outflow tract arrhythmias.

AIM: The correct estimation of the VA origin as RVOT or LVOT results in reduced ablation duration reduced radiation exposure and decreased number of vascular access. In our study, we aimed to detect the predictive value of S-R difference in V1-V2 for differentiating the left from right ventricular outflow tract arrhythmias. METHODS: We included 123 patients with symptomatic frequent premature ventricular outflow tract contractions who underwent successful catheter ablation (70 male, 53 female; mean age 46.2 ± 13.9 years, 61 RVOT, 62 LVOT origins). S-R difference in V1-V2 was calculated with this formula on the 12-lead surface ECG: (V1S + V2S) - (V1R + V2R). Conventional ablation was performed in 101 (82.1%) patients, CARTO electroanatomic mapping system was used in 22 (17.9%) patients. RESULTS: V1-2 SRd was found to be significantly lower for LVOT origins than RVOT origins (p < .001). The cutoff value of V1-2 SRd obtained by ROC curve analysis was 1.625 mV for prediction of RVOT origin (sensitivity: 95.1%, specificity: 85.5%, positive predictive value: 86.5%, negative predictive value: 94.5%). The area under the curve (AUC) was 0.929 (p < .001). CONCLUSION: S-R difference in V1-V2 is a novel and simple electrocardiographic criterion for accurately differentiating RVOT from LVOT sites of ventricular arrhythmia origins. The use of this simple ECG measurement could improve the accuracy of OTVA localization, could be beneficial for decreasing ablation duration and radiation exposure. Further studies with larger patient population are needed to verify the results of this study.

Association of P wave duration index with atrial fibrillation recurrence after cryoballoon catheter ablation.

AIM: We aimed to investigate the relationship between the recurrence of AF and P wave duration index (PWDI) in patients with nonvalvular PAF. METHODS: We included 114 patients who underwent cryoballoon catheter ablation with the diagnosis of paroxysmal atrial fibrillation (PAF) (55 male, 59 female; mean age 55.5±10,9years). PWDI was calculated by dividing the Pwd by the PR interval in DII lead of 12­lead ECG. Patients had regular follow-up visits with 12-lead ECG, medical history and clinical evaluation. 24h Holter ECG monitoring had been recorded at least 12months after ablation. RESULTS: AF recurrence was detected in 24 patients after 1year. Patients were divided into two groups according to the AF recurrence. All parameters were compared between the two groups. Age, DM, HT frequency, ACEI-ARB use, CHA2DS2VASc and HAS-BLED score, HsCRP, LA diameter, LA volume, LA volume index, Pwd and PWDI were related to AF recurrence. In binary logistic regression analysis, PWDI (OR=1.143, p=0.001) and HT (OR=0.194, p=0.020) were found to be independent parameters for predicting AF recurrence. Every 0,01 unit increase in PWDI was found to be associated with 14.3% increase in the risk of AF recurrence. The cut-off value of PWDI obtained by ROC curve analysis was 59,9 for prediction of AF recurrence (sensitivity: 75.0%, specificity: 69.0%). The area under the curve (AUC) was 0.760 (p<0.001). CONCLUSION: Increased PWDI may help to identify those patients in whom electrical remodeling has already occurred and who will get less benefit from cryoablation.

A new criterion to differentiate atrioventricular nodal reentrant tachycardia from atrioventricular reciprocating tachycardia: Combined AVR criterion.

AIM: A combined aVR criterion is described as the presence of a pseudo r' wave in aVR during tachycardia in patients without r' wave in aVR in sinus rhythm and/or a ≥50% increase in r' wave amplitude compared to sinus rhythm in patients with r' wave in the basal aVR lead. We aimed to investigate the use of combined aVR criterion in differential diagnosis of atrioventricular nodal reentrant tachycardia (AVNRT) and atrioventricular reciprocating tachycardia (AVRT). METHODS: In this prospective study, 480 patients with inducible narrow QRS supraventricular tachycardia (SVT) were included. Twelve-lead electrocardiogram (ECG) was conducted during tachycardia and sinus rhythm. The patients were divided into two groups according to the arrhythmia mechanism that determined via EPS, AVNRT, and AVRT. Criteria of narrow QRS complex tachycardia were compared between the two groups. RESULTS: AVNRT was present in 370 (77%) patients and AVRT in 110 (23%) patients. Combined aVR criterion was found to be more frequent in patients with AVNRT (84.1% and 9.1%, p < 0.001). In logistic regression analysis, combined aVR criterion and classical ECG criterion were found to be the most important predictors of AVNRT (p < 0.001). The sensitivity, specificity, positive predictive value, and negative predictive value of the combined aVR criterion for AVNRT were 84.1%, 90.9%, 96.9%, and 62.9%, respectively. CONCLUSION: In the differential diagnosis of patients with SVT, the combined aVR criterion identifies the presence of AVNRT with an independent and acceptable diagnostic value. In addition to classical ECG criteria for AVNRT, it is necessary to evaluate the combined aVR criterion in daily practice.

Selvester QRS Score is a Predictor of Mortality in Heart Failure with Preserved Ejection Fraction. / O Escore de Selvester QRS é um Preditor de Mortalidade na Insuficiência Cardíaca com Fração de Ejeção Preservada.

BACKGROUND: The Selvester QRS (S-QRS) score on a 12-lead electrocardiogram (ECG) is associated with both the amount of myocardial scar and poor prognosis in myocardial infarction patients. However, its prognostic value in heart failure (HF) with preserved ejection fraction (HFpEF) is unknown. OBJECTIVE: This study aims to investigate the predictive value of the S-QRS score for mortality in HFpEF. METHODS: 359 patients were retrospectively enrolled in this study. Electrocardiographic, echocardiographic, and laboratory features of the patients were recorded. The simplified S-QRS score was measured and recorded. The mean follow-up time of the patients was 38.1±9.5 months. Statistical significance was set at p < 0.05. RESULTS: Of 359 patients, 270 were in the survivor group, and 89 were in the deceased group. Age, Hs-CRP, troponin, pro-BNP, left atrial (LA) diameter, LA volume index, QRS duration, Tpe, and S-QRS score were statistically high in the deceased group. In multivariate logistic regression analysis, age, Hs-CRP, NT-proBNP, LA diameter, LA volume index, Tpe, and S-QRS score were shown to be independent risk factors for mortality. In the receiver-operating characteristic (ROC) analysis, the cut-off value of the S-QRS score was 5.5, the sensitivity was 80.8%, and the specificity was 77.2% (AUC:0.880, p:0.00). In Kaplan-Meier analysis, it was found that mortality was higher in the group with S-QRS score ≥ 5.5 than in the group with S-QRS score < 5.5. (Long-rank, p:0.00). CONCLUSIONS: We think that the S-QRS score can be used as a prognostic indicator of long-term mortality in patients with HFpEF.

FUNDAMENTO: O escore Selvester QRS (S-QRS) em um eletrocardiograma (ECG) de 12 derivações está associado tanto à quantidade de cicatriz miocárdica quanto ao mau prognóstico em pacientes com infarto do miocárdio. Entretanto, seu valor prognóstico na insuficiência cardíaca (IC) com fração de ejeção preservada (ICFEp) é desconhecido. OBJETIVO: Este estudo tem como objetivo investigar o valor preditivo do escore S-QRS para mortalidade na ICFEp. MÉTODOS: 359 pacientes foram incluídos retrospectivamente neste estudo. As características eletrocardiográficas, ecocardiográficas e laboratoriais dos pacientes foram registradas. O escore S-QRS simplificado foi medido e registrado. O tempo médio de seguimento dos pacientes foi de 38,1±9,5 meses. A significância estatística foi estabelecida em p < 0,05. RESULTADOS: Dos 359 pacientes, 270 estavam no grupo sobrevivente e 89 no grupo falecido. Idade, PCR-us, troponina, pro-BNP, diâmetro do átrio esquerdo (AE), índice de volume do AE, duração do QRS, Tpe e escore do S-QRS foram estatisticamente altos no grupo falecido. Na análise de regressão logística multivariada, idade, PCR-us, NT-proBNP, diâmetro do AE, índice de volume do AE, Tpe e escore S-QRS mostraram-se fatores de risco independentes para mortalidade. Na análise da característica operacional do receptor (ROC), o valor de corte do escore S-QRS foi de 5,5, a sensibilidade foi de 80,8% e a especificidade foi de 77,2% (AUC: 0,880, p:0,00). Na análise de Kaplan-Meier, verificou-se que a mortalidade foi maior no grupo com escore S-QRS ≥ 5,5 do que no grupo com escore S-QRS < 5,5. (Long-rank, p:0,00). CONCLUSÃO: Acreditamos que o escore S-QRS pode ser usado como um indicador prognóstico de mortalidade a longo prazo em pacientes com ICFEp.

Tinnitus Frequency is Higher in Patients with Chronic Heart Failure with Reduced Ejection Fraction and is Closely Related to NT-proBNP Level.

There is not enough information about tinnitus and related parameters in patients with heart failure with reduced ejection fraction (HFrEF). In our study, we aimed to investigate the frequency of tinnitus in HFrEF patients and the clinical parameters associated with this condition. This study included 100 patients with HFrEF and whose medical treatment was arranged according to their disease stage, and 100 control patients without HFrEF with similar age, gender and cardiovascular risk factors. Routine history, physical examinations, echocardiography and laboratory examinations were performed. In addition, a detailed ear examination and tinnitus evaluation were performed in all patients. First of all, the frequency of tinnitus in patients with and without HFrEF was determined. Afterwards, all individuals included in the study were divided into two groups as individuals with and without tinnitus. It was determined that the frequency of tinnitus was higher in patients with HFrEF compared to individuals without HFrEF. (25% and 13%, p = 0.023). It was determined that hypertension and hyperlipidemia were more common in the patient group with tinnitus, the patients were older, and the frequency of use of beta blocker, diuretic or spironolactone treatment was higher (p < 0.05 for each). Serum uric acid and NT-proBNP levels were found to be higher in patients with tinnitus (p < 0.05 for each). Logistic regression analysis was performed with the parameters which were found to be significantly different in patients with tinnitus, and in this analysis, age and NT-proBNP levels were found to be independently associated with the presence of tinnitus (p < 0.001 and p = 0.005). According to this analysis, it was determined that every one year increase of age and every 20 pg/mL increase of NTproBNP increased the frequency of tinnitus by 12% and 6.1%, respectively. The frequency of tinnitus increases in patients with HFrEF. Although the increased frequency of tinnitus in these patients is associated with diuretic therapy, increasing age and high NT-proBNP levels are independently associated with the presence of tinnitus in these patients. NT-proBNP may be a follow-up parameter for tinnitus in patients with HFrEF. However, our study needs to be supported by other studies and studies involving more patients.

Native thiol decreases in patients with asymptomatic primary hyperparathyroidism, especially in the presence of surgery indication.

BACKGROUND: Oxidative stress increases in many systemic and endocrine diseases. The effect of increased parathyroid hormone levels (PTH) and the effects of this hormone on oxidative stress in patients with primary hyperparathyroidism (pHPT) is unknown. We aimed to investigate the change of Thiol-disulfide (SH-SS), one of the oxidative stress parameters, in patients diagnosed with pHPT and the usability of this parameter in patients with pHPT. METHODS: Forty-six patients who recently diagnosed with asymptomatic pHPT and 40 healthy controls were included in this prospective study. In addition to routine examinations for pHPT, serum SH-SS measurements were recorded. The pHPT patients included in the study were divided into two groups as patients with and without surgical treatment indication. RESULTS: It was observed that the pHPT group had lower total SH and native SH values and higher SS values compared to the control group (P<0.05 for each). Native SH values were found to be lower in pHPT patients who were indicated for surgical treatment compared to those who did not (P<0.05). An independent relationship was found between Native SH and serum calcium, urine calcium and T scores in DEXA level in asymptomatic pHPT patients with surgical treatment indication (P<0.05). CONCLUSIONS: In our study, native SH level decreases in patients with pHPT, especially in patients with surgical treatment indication for pHPT. The decrease in SH levels, which is a natural antioxidant that protects the body against oxidative stress, and the increase in SS levels in pHPT patients may be another metabolic effect of this disease. Native SH may be helpful in determining the indication for surgical treatment in asymptomatic pHPT patients.

Evaluation of Liver Stiffness After Atrial Septal Defect Closure.

ABSTRACT: In this study, we aimed to evaluate the liver stiffness (LS) values and the right ventricle (RV) functions after atrial septal defect (ASD) closure treatment. Sixty-six patients were included (38 female, 28 male) in the study. Patients were grouped into 3 subgroups (group I = 21 patients without ASD closure, group II = 38 patients who underwent ASD closure, and group III = 11 patients with ASD and Eisenmenger syndrome). After 1-year follow-up of the patients who underwent ASD closure, LS was assessed using the liver elastography technique. Echocardiographic changes and LS changes over time were compared. Absolute Δ-LS and Δ-liver size were found to be significantly decreased in group II compared with the other groups. While liver size, LS levels, RV and left ventricle (LV) dimensions, and tricuspid regurgitation pressure gradient were found to be significantly decreased; the tricuspid annular plane systolic excursion and the LV ejection fraction were significantly increased in group II. In addition, Δ-LV and Δ-RV dimensions and Δ-tricuspid regurgitation pressure gradient values were statistically significant and Δ-tricuspid annular plane systolic excursion and LV ejection fraction values were statistically higher in group II compared with the other groups. In conclusion, our study demonstrates that the LS is another parameter, which significantly decreases in patients treated with ASD occluder devices and can be used as an objective follow-up parameter in addition to classic echocardiographic measurements.

Subclinical Left Atrial and Ventricular Dysfunction in Acromegaly Patients: A Speckle Tracking Echocardiography Study. / Disfunção Ventricular e do Átrio Esquerdo Subclínica em Pacientes com Acromegalia: Um Estudo de Ecocardiograma de Rastreamento de Manchas.

BACKGROUND: Although it is known that the left ventricular (LV) ejection fraction (EF) measured by echocardiography is preserved in patients with acromegaly, there is not enough information about the LV and left atrial strain (LV-GLS and LAS). OBJECTIVE: This study aimed to evaluate the left ventricular (LV) and left atrial (LA) functions with strain echocardiography (SE) in patients with acromegaly. METHODS: This study included 50 acromegaly patients with active disease and 50 healthy controls with similar age, gender, and body surface area. In addition to routine echocardiography examinations, LV-GLS and LAS measurements were performed with SE. RESULTS: LAS and LV-GLS values were significantly lower in patients with acromegaly (p<0.05 for all). In bivariate analysis, systolic blood pressure, N-terminal prohormone of brain natriuretic peptide, Insulin-like growth factor-1, LA diastolic diameter, and LVMI levels were found to be positively correlated with both LAS and LV-GLS (p <0.05). IGF-1 level was strongly correlated with LAS and LV-GLS (p<0.001 and ß=0.5 vs. p<0.001 and ß=0.626, respectively); 48% of patients with acromegaly have reduced LV-GLS (<20%). Left ventricular mass-index (LVMI) independently determines the presence of reduced LV-GLS and each 1g/m2increase in LVMI level increases the likelihood of reduced LV-GLS by 6%. CONCLUSION: Although LV ejection fraction is normal in patients with acromegaly, LAS and LV-GLS values were significantly reduced. Apart from LVMI increase, another finding of cardiac involvement may be LAS and LV-GLS decrease. Therefore, in addition to routine echocardiography, LAS and LV-GLS may be useful to evaluate early signs of cardiac involvement before the occurrence of irreversible cardiac changes.

FUNDAMENTO: Embora se saiba que a fração de ejeção (FE) do ventrículo esquerdo (VE) medida por eletrocardiograma seja preservada em pacientes com acromegalia, não há informação suficiente sobre deformação longitudinal global e deformação do átrio esquerdo (SLG-VE e SAE). OBJETIVO: O objetivo deste estudo foi avaliar as funções do ventrículo esquerdo (VE) e do átrio esquerdo (AE) por ecocardiograma strain (ES) em pacientes com acromegalia. MÉTODOS: Este estudo incluiu 50 pacientes com acromegalia na forma ativa da doença e 50 controles saudáveis com idade, sexo e área de superfície corporal similares. Além dos ecocardiogramas de rotina, medições de SLG-VE e SAE foram realizadas com o ES. RESULTADOS: Os valores dos SAE e SLG-VE foram significativamente mais baixos em pacientes com acromegalia (p<0,05 para todos). Na análise bivariada, a pressão arterial sistólica, o pró-hormônio N-terminal do peptídeo natriurético cerebral, o fator de crescimento semelhante à insulina tipo 1, e detectou-se que os níveis de IMVE tinham correlação positiva com SAE e SLG-VE (p<0,05). O nível de IGF-1 tinha forte correlação com SAE e SLG-VE (p<0,001 e ß=0,5 vs. p<0,001 e ß=0,626, respectivamente); 48% dos pacientes com acromegalia têm SLG-VE reduzido (<20%). O índice de massa do ventrículo esquerdo (IMVE) determina independentemente a presença de SLG-VE reduzido, e cada 1g/m2 de aumento no nível de IMVE aumenta a probabilidade de redução de SLG-VE em 6%. CONCLUSÃO: Embora a fração de ejeção de VE seja normal em pacientes com acromegalia, os valores de SAE e SLG-VE são significativamente mais baixos. Além do aumento em IMVE, outro achado do envolvimento cardíaco pode ser a redução de SAE e SLG-VE. Portanto, além do ecocardiograma de rotina, SAE e SLG-VE podem ser úteis para avaliar os sinais iniciais de envolvimento cardíaco antes da ocorrência de alterações cardíacas irreversíveis.

Frequency of postoperative atrial fibrillation and related parameters in patients who underwent sleeve gastrectomy for obesity.

BACKGROUND: In this study, we planned to determine the frequency of postoperative AF and its related parameters in morbidly obese patients who underwent bariatric surgery. METHODS: The study included 300 patients with morbidly obese who had no history of AF and underwent successful bariatric surgery. Routine anamnesis, physical examination and laboratory parameters of the patients were recorded. Patients with postoperative AF were detected. The participants were grouped as patients with and without AF. RESULTS: Postoperative AF occurred in 19 (6.3%) patients. Age, BMI and LAd diameter parameters independently determined the presence of AF. When the ROC curve was performed to identify patients with AF, the area under the ROC curve was found to be 0.841, 0.785 and 0.902 for age, BMI and LAd diameter, respectively. According to this analysis, 50 years for age, 43 kg/m2 for BMI and 40 mm for LAd were used to determine patients with AF with acceptable sensitivity and specificity (>70% each). CONCLUSIONS: The most important determinants of postoperative AF are age, LAd and basal BMI. Therefore, morbidly obese patients with LAd >40 mm, BMI >43 kg/m2 and >50 years of age should be followed up more closely for postoperative AF development and preoperative precautions should be taken to prevent AF development.

Modified Lung Ultrasound Score in Evaluating the Severity of Covid-19 Pneumonia.

Severe acute respiratory syndrome coronavirus 2 causes coronavirus disease 2019 (Covid-19), which has been declared as a pandemic by the World Health Organization. The aim of the study described here was to determine the severity of pneumonia and the clinical parameters related to a modified lung ultrasound score (mLUS) in patients with COVID-19 pneumonia. The study included 44 patients with proven COVID-19 pneumonia. Patients were divided into three groups on the basis of pneumonia severity: mild/moderate pneumonia (group I), severe pneumonia (group II) and critically ill patients (group III). It was determined that mLUS values in groups I-III were 6.51 ± 4.12, 23.5 ± 5.9 and 24.7 ± 3.9, respectively. mLUS values were significantly higher in group II and III patients than in group I patients. There was a positive relationship between mLUS and age and N-terminal pro-brain natriuretic peptide level and a negative relationship with PaO2/FiO2 (p = 0.032, ß = 0.275 vs. p = 0.012, ß = 0.315 vs. p = 0.001, ß = -0.520, respectively). In patients with COVID-19 pneumonia, mLUS increases significantly with the severity of the disease.

Liver stiffness increases in patients with severe pericardial effusion, especially in the presence of cardiac tamponade.

AIMS: Liver stiffness (LS) is associated with central venous pressure and pericardial effusion (PE) may be associated with these increased pressures. The aim of this study was to investigate the change in LS obtained by liver elastography (LE) in patients with severe PE and its usefulness for the diagnosis of cardiac tamponade. MATERIALS AND METHODS: Forty-patients with severe-PE were included in this study. All patients underwent LE examination in addition to echocardiography. Patients were divided into 2 groups: with and without cardiac tamponade. RESULTS: In patients with cardiac tamponade, LS values, inspiratory-expiratory vena cava inferior (VCI) diameters and presence of <50% inspiratory-VCI collapse was significantly higher. LS value and inspiratory-VCI diameter before pericardiocentesis independently determined the risk of cardiac tamponade. Each 1kPa increase in LS value and 1mm increase in inspiratory-VCI diameter increased the risk of cardiac tamponade by 4.9-times and 40.8%, respectively. When the cut-off value of 10kPa for LS was analyzed, it determined the presence of cardiac tamponade with ≥90% sensitivity and specificity. The higher LS before pericardiocentesis and the decrease in LS after pericardiocentesis (Δ-Liver stiffness of 5.91±1.79 kPa in first group and 2.31±1.25 kPa in the second group) was interpreted to be directly related to the pathophysiology of systemic congestion due to PE. CONCLUSION: In all patients with severe PE, and especially in patients with cardiac tamponade, the LS is significantly increased and this modification can be explained by the systemic congestion. However, this being the first study to evaluate LS in patients with severe PE and cardiac tamponade, the data should be confirmed by multicenter prospective studies.

Residual SYNTAX Score Is Associated With Contrast-Induced Nephropathy in Patients With Non-ST Segment Elevation Myocardial Infarction With Preserved LVEF.

The purpose of this study is to investigate the relation between residual SYNTAX score (rSS) and contrast-induced nephropathy (CIN) development in patients with non-ST segment elevation myocardial infarction (NSTEMI) with normal or near-to-normal left ventricular ejection fraction (LVEF) who underwent percutaneous coronary intervention (PCI). A total of 306 patients who underwent PCI with NSTEMI were included in our study. SYNTAX scores were calculated for the periods before and after PCI. Patients were divided into 2 groups as developed CIN following PCI (CIN +) and patients did not (CIN -). Fifty-four (17.6%) of patients who were included in the study developed CIN. Age (P = .001) and rSS (P = .002) were significantly higher and LVEF was lower (P = .034) in the CIN (+) group. Age (P = .031, odds ratio [OR]: 1.031, 95% CI, 1.003-1.059) and rSS (P = .04, OR: 1.036, 95% CI, 1.002-1.071) were independent predictors for CIN. In receiver operating characteristic analyses, when the cutoff value of rSS was taken as 3.5, it determined CIN with 79% sensitivity and 65% specificity. Contrast-induced nephropathy may develop more frequently in patients with increased rSS value. The rSS may be useful to follow-up these patients for CIN development.

Impaired self-reported sleep quality improves with radiofrequency catheter ablation in patients with premature ventricular complexes.

BACKGROUND: The frequency of premature ventricular contractions (PVCs) increases in patients with poor sleep quality (PSQ). AIMS: The aim of this study was to evaluate PSQ in patients referred for radiofrequency catheter ablation (RFA) due to PVCs and to determine the effect of RFA on PSQ. METHODS: A total of 207 patients who were diagnosed with the PVC burden greater than 10% and underwent 3-dimensional RFA in our center were included in this cross -sectional study. Self -reported sleep quality was assessed in all patients in addition to a 24-hour Holter electrocardiogram before ablation and at 3-month follow -up. The effect of RFA on self -reported sleep quality in patients with PVCs was evaluated. RESULTS: Before RFA, 87% of the study patients had PSQ. In those with PVCs, subjective sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbances, daytime dysfunction, and the global Pittsburgh Sleep Quality Index (PSQI) improved after RFA (P <0.001). Positive correlations were found between the PSQI and the total number of PVCs, PVC burden, PVC burden in the morning, PVC burden at midday, PVC burden in the evening, and PVC burden at nighttime (P <0.01). In linear regression analysis, only the nighttime PVC burden was found to be related to the PSQI (P = 0.002, ß = 0.397). CONCLUSION: Poor sleep quality is common in patients with PVCs and it improves significantly after the RFA procedure. Poor sleep quality in patients with PVCs is closely related to the PVC burden at nighttime. Our study showed that, while evaluating PVCs, we also should suspect PSQ, especially due to PVCs.