Evaluation of Left Atrial Functions by 2-dimensional Speckle-Tracking Echocardiography During Healthy Pregnancy.

OBJECTIVES: We aimed to determine the effects of normal pregnancy on left atrial (LA) mechanics using 2-dimensional speckle-tracking echocardiography. METHODS: A total of 47 healthy women with singleton pregnancies were prospectively enrolled in this study. A total of 4 visits, including each trimester and postpartum at 6 months, were planned. Echocardiographic studies were performed with a Vivid 7 device equipped with a 2.5-MHz transducer (GE Vingmed Ultrasound AS, Horten, Norway). RESULTS: Although the LA reservoir phase strain showed a gradual decrease from the first trimester to the third trimester during pregnancy, the measurements in the postpartum period were found to return to initial levels (mean ± SD: first trimester, 40.3% ± 11.7%; second trimester, 37.5% ± 12.9%; third trimester, 33.5% ± 9.0%; postpartum, 42.1% ± 11.1%; P < .001). The LA pump function strain was also parallel to the LA reservoir strain and gradually decreased from the first trimester to the third trimester during pregnancy, and it was observed that rose to the initial level in the postpartum period (first trimester, 16.7% ± 7.4%; second trimester, 14.8% ± 5.5%; third trimester, 12.7% ± 4.3%; postpartum, 15.8% ± 5.5%; P < .001). CONCLUSIONS: We prospectively determined normal reference values for LA deformation parameters using speckle-tracking echocardiography in each trimester and the postpartum period in healthy pregnancy. These reference values may help identify subclinical LA dysfunction in several cardiovascular or systemic conditions. According to this study, these parameters decreased toward the third trimester during pregnancy and recovered in the postpartum period.

Primary cardiac hydatid cyst presenting as noncompaction cardiomyopathy.

We report a case of cyst was initially labeled as left ventricular noncompaction cardiomyopathy. An accurate diagnosis is essential to establish the most effective treatment strategy. In particular, echocardiographic examination assists in identifying the correct diagnosis. In this case, two-dimensional and three-dimensional echocardiography and computed tomography were used for definitive diagnosis of cardiac hydatid cyst.

Role of 2D Strain in the Early Identification of Cardiac Dysfunction and in the Risk Stratification of Arteriogenic Erectile Dysfunction Patients.

BACKGROUND: Vasculogenic erectile dysfunction is a harbinger of vascular disease. Comprehensive cardiac workup is accepted to be beneficial in men with this condition, especially those with otherwise unrecognized cardiovascular disease. We aimed to evaluate the role of two-dimensional speckle-tracking echocardiography (2D-STE) for noninvasive evaluation in patients with documented arteriogenic erectile dysfunction. METHODS: 64 consecutive men with Doppler proven erectile dysfunction of more than 3 months of duration were recruited. Patients divided into 2 groups according to mean peak systolic velocity (PSV). Patients with PSV <20 cm/sn constituted Group 1 and patients with PSV ≥20 cm/sn constituted Group 2. All underwent echocardiography and were compared. According to the 2D-STE analysis for the left atrium (LA); strain during ventricular systole (LARes), during late diastole (LA-Pump), strain rate during ventricular contraction (LA-SRs), during passive ventricular filling (LA-SRe), during active atrial contraction (LASRa) values and for LV; global longitudinal strain (GLS), strain rate in systole (GSRs), strain rate in early diastole (GSRe), and strain rate in late diastole (GSRa) values were obtained. RESULTS: Beside diastolic parameters, LA-Res and LA-Pump were found to be significantly different between groups. GLS and GSR values were lower in Group 1. Moreover, correlation analysis revealed a significant correlation of GLS values with PSV (r = -0.4, P = .001). CONCLUSION: Myocardial deformation parameters by 2D-STE are valuable for detection of subclinical cardiovascular dysfunction in men with arteriogenic erectile dysfunction. This noninvasive method may be used as an emerging prognostic marker for risk stratification.

Left atrial deformation parameters in patients with non-alcoholic fatty liver disease: a 2D speckle tracking imaging study.

The presence of the metabolic syndrome is a strong predictor for the presence of NASH (non-alcoholic steatohepatitis) in patients with NAFLD (non-alcoholic fatty liver disease). In the present study, we assessed LA (left atrial) deformation parameters in patients with NAFLD using 2D-STE (speckle tracking echocardiography) and to investigate if any changes exist between subgroups of the NAFLD. A total of 55 NAFLD patients and 21 healthy controls were included in the study. The diagnosis of NAFLD was based on liver biopsy. After patients were categorized into groups according to histopathological analysis (simple steatosis, borderline NASH, definitive NASH), all patients underwent echocardiography with Doppler examination. In the 2D-STE analysis of the left atrium, LA-Res (peak LA strain during ventricular systole), LA-Pump (peak LA strain during atrial systole), LA-SR(S) (peak LA strain rate during ventricular systole), LA-SR(E) (peak LA strain rate during early diastole) and LA-SR(A) (peak LA strain rate during atrial systole) were obtained. LA-Res, LA-Pump and LA-SR(A) were lower in the NAFLD group than in the control group. LA-Res was found to be significantly lower in NAFLD subgroups compared with healthy subjects (43.9±14.2 in healthy controls compared with 31.4±8.3 with simple steatosis, 32.8±12.8 with borderline NASH and 33.8±9.0 with definitive NASH). LA-Pump was significantly lower in the NAFLD group (18.2±3.1 in healthy controls compared with 13.3±4.7 with borderline NASH and 14.4±4.7 with definitive NASH). There were significant differences in LA-SR(A) between healthy controls compared with simple steatosis and borderline NASH (-1.56±0.36 compared with 1.14±0.38 and 1.24±0.32 respectively). Correlation analysis showed significant correlation of LA-Res values with E (early diastolic peak velocity)/E(m) (early diastolic mitral annular velocity) ratio (r=-0.50, P≤0.001), with LAVI (LA volume index; r=-0.45, P≤0.001) and with V(p) (propagation velocity; r=0.39, P≤0.001). 2D-STE-based LA deformation parameters are impaired in patients with NAFLD with normal systolic function. Although LA-Res and pump function parameters might be useful in estimating LV (left ventricular) filling pressure in the NAFLD patient group, it could not be used for differentiating the subgroups.

The impact of metabolic syndrome, recently diagnosed diabetes and hypertension on right ventricular remodeling. Is there difference between risk factors?

The aim of this study was to compare the right ventricular (RV) structure and diastolic function between normotensive and non-diabetic subjects with metabolic syndrome (MS), and new diagnosed diabetic and hypertensive patients. Study included 89 normotensive and non-diabetic subjects with MS which was defined by the presence ≥3 ATP-NCEP-III criteria, 45 diabetic and 117 hypertensive patients, as well as 76 controls with no MS criteria, matched for age and sex. All subjects underwent laboratory blood tests and complete two-dimensional echocardiography including pulsed and tissue Doppler. RV free wall thickness was similar between MS and diabetic patients, but significantly lower than in hypertensive patients (4.6 ± 0.8 versus 4.3 ± 0.7 versus 4.9 ± 0.9 mm; p < 0.01). Tricuspid E/e' ratio was similar between observed groups (5.3 ± 1.2 versus 5.2 ± 1.1 versus 5.7 ± 1.2, p > 0.05). RV systolic function evaluated by tissue Doppler (st) was similar between MS and diabetic participants, but still worse than in hypertensive patients (13.1 ± 2.2 versus 13.5 ± 2.5 versus 12.5 ± 2.4, p < 0.05). Global RV function estimated by Tei index was similar among MS and diabetic patients, and most impaired in hypertensive patients (0.47 ± 0.09 versus 0.45 ± 0.08 versus 0.52 ± 0.1, p < 0.01). Increased fasting glucose level, abdominal obesity and hypertension were independent predictors of biventricular hypertrophy, diastolic dysfunction and global dysfunction in whole population. RV structure and function gradually deteriorated from diabetic patients, across MS subject, to hypertensive patients. Normotensive and non-diabetic subjects with MS had similar level of RV impairment as diabetic patients which emphasize the synergic effects of MS components on cardiac damage.

Learning electrocardiogram on YouTube: how useful is it?

BACKGROUND: YouTube has become a useful resource for knowledge and is widely used by medical students as an e-learning source. The purpose of this study was to assess the videos relating electrocardiogram (ECG) on YouTube. METHODS: YouTube was searched on May 28, 2013 for the search terms "AF ecg" for atrial fibrillation, "AVNRT" for atrioventricular nodal reentrant tachycardia, "AVRT" for atrioventricular reentrant tachycardia, "AV block or heart block" for atrioventricular block, "LBBB, RBBB" for bundle branch block, "left anterior fascicular block or left posterior fascicular block" for fascicular blocks, "VT ecg" for ventricular tachycardia, "long QT" and "Brugada ecg". Non-English language, unrelated and non-educational videos were excluded. Remaining videos were assessed for usefulness, source and characteristics. Usefulness was assessed with using a checklist developed by the authors. RESULTS: One hundred nineteen videos were included in the analysis. Sources of the videos were as follows: individuals n=70, 58.8%, universities/hospitals n=10, 8.4% and medical organizations n=3, 2.5%, health ads n=10 8.4%, health websites n=26, 21.8%. Fifty-six (47.1%) videos were classified as very useful and 16 (13.4%) videos were misleading. 90% of the videos uploaded by universities/hospitals were grouped as very useful videos, the same ratio was 45% for the individual uploads. There were statistically significant differences in ECG diagnosis among the groups (for very useful, useful and misleading, p<0.001, 0.02 and 0.008, respectively). The ratio of the misleading information in ventricular tachycardia videos was found to be 42.9%. CONCLUSIONS: YouTube has a substantial amount of videos on ECG with a wide diversity from useful to misleading content. The lack of quality content relating to ECG on YouTube necessitates that videos should be selected with utmost care.

Assessment of the influence of radiofrequency catheter ablation of the slow pathway of the atrioventricular node on cardiac function in patients with atrioventricular nodal reentrant tachycardia: a speckle tracking echocardiography study.

OBJECTIVES: Typical atrioventricular nodal reentrant tachycardia (AVNRT) can be cured with slow pathway ablation. This study was designed to assess the alterations in atrial and ventricular functioning using speckle tracking echocardiography in consecutive patients with typical AVNRT who underwent slow pathway radiofrequency (RF) ablation. STUDY DESIGN: Included in this study were 23 consecutive patients with symptomatic drug-resistant typical (slow-fast) AVNRT, all of whom underwent an invasive electrophysiology study and RF ablation. Patients underwent transthoracic echocardiographic evaluation 24 hours before and 24 hours after the ablation procedure. RESULTS: AVNRT was induced during the electrophysiological study, and RF ablation successfully eliminated tachyarrhythmia in 23 (100%) patients. The atrial-His (A-H) interval was decreased in the post-ablation period compared to the pre-ablation period without the occurrence of immediate conduction disturbances. Peak left atrial longitudinal strain during the reservoir phase was increased in the post-ablation period compared to the pre-ablation period (48.24±16.45 vs. 38.07±15.72, p<0.001). The left atrial septal electromechanical coupling time was significantly decreased after the procedure (48.90±12.26 vs. 38.92±7.14 ms, p=0.036). CONCLUSION: In addition to treatment of arrhythmia, RF catheter ablation of AVNRT may also restore left atrial function as early as 24 hours after the procedure.

Drospirenone-containing oral contraceptives and risk of adverse outcomes after myocardial infarction.

BACKGROUND: The association between oral contraceptives (OC) and myocardial infarction remains controversial. The new generation contraceptive Yasmin (30 µg ethinyl estradiol and 3 mg drospirenone) has a lower estrogen and newer progestin component. To date, there are no data available for the myocardial infarction risk and outcome for drospirenone. We aimed to investigate the effect of Yasmin use on cardiovascular outcomes in patients with acute ST segment elevation myocardial infarction (STEMI) undergoing primary angioplasty. METHODS: We retrospectively evaluated 1851 patients who underwent primary angioplasty for acute STEMI. Of them, 440 female patients (23.8%) composed the study population and 12 female (2.7%) were taking the oral contraceptive-Yasmin at the time of infarction. Patients were divided into two groups based on their age (≥50 (n = 339) and <50 years old). Patients under 50 years-old (n = 101) were separated into two groups according to use of OC therapy (OC (+) group n = 12; OC (-) group n = 89). RESULTS: Patients who were older than 50-year-old were more likely to have comorbid conditions like diabetes mellitus and hypertension than other groups. Current smoking status was significantly higher in OC (+) group than OC (-) group (P = 0.007). There was a significant difference in favour of OC (+) group when compared with OC (-) group for the increased angiographic thrombus burden according to both TIMI and Yip classification (P = 0.045 and P = 0.029, respectively). The incidence of final TIMI 3 flow and post-procedural complete ST resolution were significantly lower in OC (+) group (P = 0.019, P = 0.002, respectively). In multivariate logistic regression analysis, use of OC was found to be an independent predictor of high grade thrombus burden (OR 5.13, 95% CI 1.07-24.60, P = 0.04). CONCLUSION: This is the first study to evaluate the myocardial infarction risk and its subsequent clinical sequelae in women having a STEMI while taking the OC-Yasmin. Women on the oral contraception Yasmin, who underwent coronary revascularization had a lower post-procedural complete ST resolution and worse left ventricular function. Furthermore, OC use with Yasmin is an independent predictor of a high-grade thrombus burden.

Varenicline-induced coronary thrombosis.

Varenicline (Champix, Chantix) has been available for use in smoking cessation since 2006. This drug has been associated with adverse cardiovascular events. Potential mechanisms for this association include modulation of parasymphathetic output from the brainstem to the heart, release of catecholamines and prothrombotic effect. We report the case of a 30-year-old man with no known cardiac disease, who developed thrombotic occlusion of left anterior descending artery and presented with acute coronary syndrome secondary to treatment with varenicline. The Naranjo probability scale indicates that varenicline was the probable cause of the myocardial infarction.

Effect of altitude on ticagrelor-induced dyspnea in patients with acute coronary syndrome.

OBJECTIVE: This study aimed to define the association between altitude and ticagrelor-associated dyspnea in patients with acute coronary syndrome (ACS). METHODS: We studied consecutive patients with de novo ACS who were admitted to two centers at a low altitude (18 and 25 m, n = 65) and two centers at a high altitude (1313 and 1041 m, n = 136). We managed them with ticagrelor between May 2017 and September 2017. Patients with ACS underwent an interventional procedure within <90 minutes in those with ST elevation and within <3 hours in those without ST elevation. We recorded the incidence of dyspnea in patients with ACS receiving ticagrelor therapy. RESULTS: The mean age was 59.5 ± 10 years, and the mean ejection fraction was 43% ± 18%. A total of 110 (56.7%) patients had ST elevation and 84 (43.3%) did not. There were no significant differences in cardiac risk factors, concurrent medications, or procedural variables between the two groups. Dyspnea developed during hospitalization in 53 (38%) patients from high-altitude centers and in 13 (20%) patients from low-altitude centers (66 patients represented 32% of the total ACS cohort). CONCLUSIONS: Dyspnea is a common multifactorial symptom in patients following development of ACS. Ticagrelor-induced dyspnea appears to be associated with altitude.

Myocardial infarction secondary to contrast agent. Contrast effect or type II Kounis syndrome?

The diagnostic administration of contrast agents has been increased recently in various fields, including coronary angiography, but reports of coronary artery spasm caused by contrast agents are rare. However, myocardial infarction following administration of nonionic contrast agents has not been reported, as far as we are aware. Herein, we described a case of acute anterior myocardial infarction induced by the contrast agent iopromide (Ultravist). We also discussed the possible reasons for this situation.

Acute inferior myocardial infarction with nephrotic syndrome.

Although thrombotic complications in the venous system are common in patients with nephrotic syndrome, arterial thromboses associated with nephrotic syndrome are much less common. However, coronary thromboses are extremely rarely observed. Whereas venous thromboses predominate in adults, thromboembolic complications of the arterial system are mainly seen in children. We presented a case of acute inferior myocardial infarction secondary to a thrombotic occlusion of the right proximal coronary artery in a 21-year-old man with nephrotic syndrome due to renal amyloidosis. It is interesting that the duration between nephrotic syndrome findings and onset of myocardial infarction was found only 7 days in this case.

Aluminium-induced ventricular tachycardia.

Aluminium (Al) is the most widely distributed metal in the environment. It is commonly used in daily life, which provides easy exposure to human. The exposure to this toxic metal occurs through air, food, and water. The clinical spectrum of poisoning varies depending on the dosage and duration of consumption. Acute exposure to Al is highly toxic to lungs, heart, and blood vessels causing pulmonary edema, shock, and arrhythmias. Chronic exposure to aluminium is associated with behavioral, neurologic, and hematologic changes. Some epidemiologic studies have shown poor performance in cognitive tests and a higher prevalence rate of neurologic symptoms for workers occupationally exposed to aluminium. Although there are several reports about ventricular tachycardia in case of acute poisoning, there is no report about chronic poisoning. In this report, we presented a 20-year-old man who had recurrent ventricular tachycardia.

A hyperparathyroid case with pulmonary edema: can hypercalcemia trigger pulmonary edema?

Most cases of pulmonary edema presenting with hypercalcemia are associated with malignant hypercalcemia and related with metastatic calcification. Most patients have predisposing factors such as hematological and solid organ malignancies and chronic renal failure. Pulmonary edema, induced by moderate hypercalcemia, which is associated with primary hyperparathyroidism, has not been reported previously. A 72-year-old female patient was admitted to the emergency service with pulmonary edema and moderate hypercalcemia because of primary hyperparathyroidism. In this presented case, we have discussed the 72-year-old female patient admitted with acute pulmonary edema who had primary hyperparathyroidism.

[Carotid endarterectomy versus stenting: where do we stand today?]. / Karotis arter endarterektomisine karsi karotis artere stent: Bugün nerede duruyoruz?

Carotid artery stenosis is the major cause of the stroke associated with ischemic origin and carries increased mortality and morbidity. Since carotid artery endarterectomy (CEA) was first performed in 1950, in conjunction with the advanced technology and increased experience under the guidance of randomized controlled trials, balloon angioplasty and carotid artery stenting, which have similar mortality and morbidity, have become comparable with CEA. Determining the optimal treatment option for each patient is the most important issue in carotid artery stenosis. Today, there have been improvements in technology and recent advances in the cardiovascular sciences. Moreover, there is increased experience, increased attention to patient selection, and a team approach to find the most suitable treatment for the patient. In this review, we briefly discuss the current treatment approaches for carotid artery stenosis under the guidance of the modern studies.

Iopromide-induced encephalopathy following coronary angioplasty.

Non-ionic agents have pharmacological side effects, such as seizure, alteration of cerebral function, confusion, short-term memory loss, mental aberrations and ophthalmoplegia. In this report, we present two cases that developed contrast-induced encephalopathy following coronary angioplasty by the non-ionic contrast agent, iopromide (Ultravist(®)). As a result, we concluded that iopromide-induced encephalopathy may occur during angioplasty in patients with no particular predispositions. In addition to that, contrast-induced encephalopathy should be considered as a new-onset neurological disorder.

The importance of the conus artery in patients with obstructive coronary artery disease.

It is well-known that collateral circulation is important in preserving ventricular functions, especially in coronary artery disease with total occlusion. The conus branch is distinct in having notable capacity of angiogenesis and arteriogenesis. We intend to emphasize the clinical importance of the conus branch by presenting two cases in which it supplied the distal regions of total occlusion.

Are inflammatory and malnutrition markers associated with metabolic syndrome in patients with sarcoidosis?

OBJECTIVE: The study aimed to investigate the use of Neutrophil/lymphocyte ratio, C-reactive protein/albumin ratio, controlling nutritional status, and prognostic nutritional index immune, inflammatory, and malnutrition markers Metabolic syndrome+ in sarcoidosis patients, as an early-stage marker. METHOD: This is a single-center and cross-sectional study that determines the association of Metabolic syndrome in patients with sarcoidosis. Patients were evaluated based on the National Cholesterol Education Program's Adult Treatment Panel III criteria. Neutrophil/lymphocyte ratio, C-reactive protein/albumin ratio, controlling nutritional status, and prognostic nutritional index values were simultaneously determined through blood test. RESULTS: A total of 253 patients diagnosed with sarcoidosis were included in this study. Metabolic syndrome- was detected in 37.2% of patients. The prevalence was significantly higher in females (p<0.001). Any degree of malnutrition assessed by controlling nutritional status had higher Metabolic syndrome (p=0.035). The Neutrophil/lymphocyte ratio cutoff value was 2.24, sensitivity was 70.53, specificity was 60.13, and Area Under the Curve value was 0.663 for predicting Metabolic syndrome in sarcoidosis patients. CONCLUSION: Neutrophil/lymphocyte ratio and controlling nutritional status are associated with the Metabolic syndrome+ in sarcoidosis patients. Thus, close monitoring of Neutrophil/lymphocyte ratio and controlling nutritional status increase in terms of Metabolic syndrome and immune malnutrition may be important in sarcoidosis patients.

Relation Between Platelet Reactivity Levels and Diabetic Retinopathy Stage in Patient with Type 2 Diabetes Mellitus by Using Multiplate Whole Blood Aggregometry.

Purpose: To test the hypothesis of a possible association between platelet reactivity and the severity of diabetic retinopathy using Multiplate whole blood aggregometry in type 2 diabetes mellitus patients. Methods: Of 157 patients were divided to three groups based on the severity of diabetic retinopathy (normal, non-proliferative and proliferative [ordinal among group 1-2-3]). Platelet reactivity was measured using arachidonic acid response to the ASPI and ADP platelet test. The association between DR stage and the degree of platelet reactivity (predictor variable) ASPI, ADP, systolic blood pressure, age, hypertension, body mass index (BMI), HbA1c, creatinine, Microalbumin, platelet, triglyceride/HDL and Hscrp variables were evaluated using ordinal logistic regression models (Model 1). The association between DR presence (outcome variable (group 1 vs group 2 and 3)) and the presence of variables was evaluated using binary logistic regression models (Model 2). Results: A comparison of the laboratory parameters of the three groups revealed that the ASPI, ADP, glucose and HbA1c values were significantly higher in Group-3 than Group-1. ASPI (odds-ratio OR: 1.044[1.021-1.09], p < .001], ADP (OR: 1.033[1.010-1.10], p: 0.002] and HbA1c (OR: 2.42(1.22, 4.94), p < .001) were demonstrated to be associated with stage of DR while the other variables were not. In binary logistic regression (model-2) analysis; ASPI (OR: 1.061[1.031-1.1], p < .001], ADP (OR: 1.03(1.01, 1.06), p: 0.045] and HbA1c (OR: 4.37 (1.67, 11.36)], p: 0.002) were associated with DR while the other variables were not. Conclusion: Herewith, we demonstrated that higher platelet reactivity measured by multiplate ASPI and ADP was significantly associated with stages of DR. Therefore, these measurements may be useful to predict the severity of DR in the clinical practice of physicians.

Mitral regurgitation due to papillary muscle dyssynchrony during trastuzumab treatment.

Trastuzumab is a monoclonal antibody used for the treatment of metastatic breast carcinoma in women whose tumors overexpress the human epidermal growth factor receptor-2. Although trastuzumab is generally well tolerated, cardiac toxicity has occurred as a rare but potentially serious complication that limits its use in some patients. In this study, we detected new-onset mitral regurgitation in trastuzumab-treated patients. To our knowledge, there is no report or survey on new-onset mitral regurgitation during this treatment. We discussed the possible reasons for this newly described side effect of the drug in the light of left ventricular longitudinal global strain and papillary muscle dyssynchrony of the patient by detecting two-dimensional speckle tracking echocardiography.