Four-dimensional speckle tracking echocardiography and fragmented QRS in detection of early left ventricular systolic dysfunction in patients with subclinical hyperthyroidism.

BACKGROUND: Thyroid disorders are associated with many cardiovascular risk factors. The importance of thyroid hormones in the pathophysiology of heart failure is underlined by the European guidelines of the European Society of Cardiology. However, the role of subclinical hyperthyroidism (SCH) in subclinical left ventricular (LV) systolic dysfunction is not entirely clear. METHODS: This cross-sectional study included 56 SCH patients and 40 healthy volunteers. The 56 SCH group was divided into two subgroups depending on the presence of fragmented QRS (fQRS). In both groups, left ventricular global area strain (LV-GAS), global radial strain (GRS), global longitudinal strain (GLS), and global circumferential strain (GCS) were obtained with four-dimensional (4D) echocardiography. RESULTS: GAS, GRS, GLS, and GCS values were significantly different in SCH patients and in healthy volunteers. GLS and GAS values were lower in the fQRS+ than in the fQRS- group (-17.06 ± 1.00 vs. -19.08 ± 1.71, p < .001, and -26.61 ± 2.38 vs. -30.61 ± 2.57, p < .001, respectively). ProBNP was positively correlated with LV-GLS (r = 0.278, p = .006) and LV-GAS (r = 0.357, p < .001). Multiple linear regression analysis showed that fQRS was an independent predictor of LV-GAS. CONCLUSIONS: 4D strain echocardiography may be helpful for the prediction of early cardiac dysfunction in patients with SCH. The presence of fQRS may be an indicator of subclinical LV dysfunction in SCH.

The importance of pulmonary pulse transit time in indicating right ventricular dysfunction and pulmonary arterial stiffness in rheumatoid arthritis.

SUBJECT: Rheumatoid arthritis patients are at risk of developing cardiovascular disease such as right heart failure and pulmonary hypertension (PH). Arterial stiffness can be used to assess pulmonary hemodynamics. Noninvasive approaches can also be used to assess pulmonary hemodynamics. Recently, there have been reports that pulmonary pulse transit time (PPTT) may also be a useful measure. This study aims to examine the effects of pulmonary hemodynamic alterations on PPTT in RA patients. METHODS: Forty RA patients and 40 healthy controls were included in the study. Sociodemographic characteristics, laboratory data, and echocardiographic examinations were performed in both groups. Conventional echocardiographic examination included left and right ventricular systolic and diastolic diameters, right ventricular myocardial performance index (RVMPI), right ventricular diastolic function, estimated pulmonary artery systolic pressure (sPAP), tricuspid annular plane systolic excursion (TAPSE), pulmonary artery stiffness (PAS), and PPTT. Right ventricular diastolic and systolic volumes, right ventricular ejection fraction (RVEF), and right ventricular fractional area change (RVFAC) were determined by four-dimensional echocardiography (4DE). RESULTS: There was no difference between the sPAP values of the patients. RVMPI and PAS were increased in RA patients compared with controls. The PPTT was shortened in RA patients and correlated with RVEF, RVFAC, RVMPI, TAPSE/sPAP, disease duration, and C-reactive protein (CRP). In univariate linear regression analysis, PPTT (p < .001) was thought to be an independent predictor of PAS. RVFAC, disease duration, and PAS were also independent predictors of PPTT. CONCLUSION: In RA patients, PPTT may be the first evidence of early abnormalities in pulmonary vascular hemodynamics. PPTT and PAS are the values that may predict each other in RA patients. Due to its more practical application, PPTT can be used instead of PAS to assess pulmonary hemodynamics.

Fragmented QRS complexes are associated with subclinical left ventricular dysfunction in patients with Behcet's disease: Four-dimensional speckle tracking echocardiography.

BACKGROUND: Behcet's disease (BD) is a chronic systemic inflammatory disease in which early detection of cardiac involvement is essential. The aim of this study was to assess the left ventricular (LV) functions in BD patients using four-dimensional (4D) speckle tracking echocardiography (STE) and to test the correlation between LV dysfunction and the presence of QRS fragmentation. METHODS: This cross-sectional study included 64 Behcet's patients and 48 healthy volunteers. The BD group was divided into two subgroups depending on the presence (fQRS+) or absence (fQRS-) of fragmented QRS (fQRS). In both groups, left ventricular global area strain (LV-GAS), global radial strain (GRS), global longitudinal strain (GLS), and global circumferential strain (GCS) were obtained with 4D echocardiography. RESULTS: GAS, GRS, GLS, and GCS values were significantly different in Behcet's patients and in healthy volunteers. GLS and GAS values were lower in the fQRS+ than in the fQRS- group (-15.8 ± 1.8 and -17.9 ± 1.6, P = .001 vs -25.0 ± 3.1 and -29.2 ± 4.2, P < .001, respectively). The duration of disease was longer in fQRS+ than in fQRS- patients (120.8 ± 67.4 vs 71.0 ± 40.5, P < .001). Multiple linear regression analysis showed that fQRS and disease duration were independent predictors of LV-GAS. CONCLUSIONS: Four-dimensional STE may be helpful for the prediction of early cardiac dysfunction in patients with BD. The presence of fQRS may be an indicator of subclinical LV dysfunction.

Effects of Septoplasty on Tp-e Interval and Tp-e/QT Ratio in Patients With Nasal Septal Deviation.

OBJECTIVES: There are multiple nasal airway pathologies leading to upper airway obstruction, and one of the most common ones is nasal septum deviation (NSD). Our study aimed to evaluate the effect of nasal septal surgery in patients with NSD on ventricular arrhythmogenesis using the novel electrocardiographic parameters, Tp-e interval, and Tp-e/QT ratio. METHODS: This retrospective cross-sectional study included 102 consecutive patients diagnosed with NSD. All participants completed a validated outcomes instrument (the NOSE scale), echocardiographic and electrocardiographic evaluation before and 3 months after septoplasty. The degree of nasal septal deviation was evaluated with the Dreher classification. RESULTS: All of the electrocardiography parameters (except heart rate and QTmin) were significantly decreased with the septoplasty operation. Electrocardiographic parameters have significantly decreased especially in marked NSD patients. (Δ = difference between the preoperative and postoperative values) ΔNOSE was positively correlated both ΔcTp-e (r = 0.348, P < .001) and ΔcTp-e/QT values (r = 0.536, P < .001). CONCLUSION: Consequently, marked NSD was associated with increased risk of arrhythmogenesis, which were too much improved after septoplasty. So, treatment of especially marked NSD not only reduces otolaryngological complaints, but also leads to improvement of ventricular repolarization parameters.

Association between fragmented QRS complexes and left ventricular dysfunction in healthy smokers.

OBJECTIVE: Smoking is a known risk factor for cardiovascular diseases and may cause myocardial damage independently of coronary artery disease. Fragmented QRS (fQRS) is an important marker of myocardial fibrosis, while speckle-tracking echocardiography is a method used to show subclinical left ventricle dysfunction. METHODS: Our study included 230 healthy individuals aged 18-40 years. The patients included were separated into two groups: those smokers (n = 130) and non-smokers (n = 100). After that healthy smokers group were divided into two groups: those with fQRS (n = 24) and those without (n = 106). In both groups, the arithmetic mean of three images was used to obtain the left ventricle global longitudinal strain (LV-GLS). The E/SRe ratio was also calculated and analyzed. RESULTS: There were significant differences between the smokers and non-smokers in terms of, E/SRe (55.7 ± 17.9 vs 50.3 ± 14.8; P = 0.015), LV-GLS (23.1 ± 1.9 vs 24.0 ± 1.7; P = 0.001), and fQRS (18.5% vs 6%; P = 0.005). As a result of subgroup analysis, pack-year history was higher in the fQRS positive group (16.7 ± 3.7 vs 11.2 ± 3.7, P < 0.001). While a negative correlation was observed between pack-year history and LV-GLS (r = -0.678, P < 0.001), there was a positive correlation between pack-year history and E/SRe (r = 0.730, P < 0.001). CONCLUSION: In conclusion, our study demonstrated that fQRS is a parameter that can be used to determine left ventricle subclinical systolic and diastolic dysfunction in smokers, and that left ventricle dysfunction is related to the duration and intensity of smoking.

The Effect of Marked Nasal Septal Deviation on Left Ventricular Function and Blood Markers.

OBJECTIVES: This study aimed to assess the effect of nasal septoplasty in patients with marked nasal septal deviation (MNSD) on subjective perception of nasal patency, echocardiography, and hematologic parameters. METHODS: Seventy-nine consecutive patients (mean age, 29.9 ±â€Š9.7 years; 57 men and 22 women) at least 18 years old were diagnosed as MNSD consistent with presenting symptom of chronic nasal obstruction lasting at least 3 months. Complete blood count measurement to assess mean platelet volume (MPV) and neutrophil to lymphocyte ratio (NLR), the Nasal Obstruction Symptom Evaluation (NOSE) questionnaire, and echocardiography were performed for all patients just before and at postoperative third month of septoplasty. RESULTS: The MPV (0.021), NLR (<0.001), and NOSE (<0.001) were all significantly decreased, and global longitudinal strain (GLS) value (<0.001) were also significantly increased at postoperative third month. Correlation analysis also indicated that ΔNLR was positively correlated with ΔGLS (r = 0.385, P < 0.001), and ΔNOSE (r = 0.436, P < 0.001), and correlated negatively with the ΔMPV (r = -0.302, P = 0.024). ΔGLS was also positively correlated with the ΔNOSE (r = 0.769, P < 0.001). CONCLUSION: Septoplasty for MNSD could provide not only alleviation of otorhinolaryngologic symptoms but also improvement in subclinical left ventricular systolic dysfunction and decline in MPV and NLR levels.

Prediction of no-reflow and major adverse cardiovascular events with a new scoring system in STEMI patients.

BACKGROUND: No-reflow is associated with a poor prognosis in STEMI patients. There are many factors and mechanisms that contribute to the development of no-reflow, including age, reperfusion time, a high thrombus burden, Killip class, long stent use, ejection fraction ≤40, and a high Syntax score. In this study, we aimed to evaluate the parameters associated with no-reflow prediction by creating a new scoring system. METHODS: The study included 515 consecutive STEMI patients who underwent PCI; 632 STEMI patients who had undergone PCI in another center were included in the external validation of the scoring system. The correlations between 1-year major adverse cardiac events and low/high risk score were assessed. RESULTS: In this study, seven independent variables were used to build a risk score for predicting no-reflow. The predictors of no-reflow are age, EF ≤40, SS ≥22, stent length ≥20, thrombus grade ≥4, Killip class ≥3, and pain-balloon time ≥4 h. In the derivation group, the optimal threshold score for predicting no-reflow was >10, with a 75% sensitivity and 77.7% specificity (Area under the curve (AUC) = 0.809, 95%CI: 0.772-0.842, P < 0.001). In the validation group, AUC was 0.793 (95%CI: 0.760-0.824, P < 0.001). CONCLUSION: This new score, which can be calculated in STEMI patients before PCI and used to predict no-reflow in STEMI patients, may help physicians to estimate the development of no-reflow in the pre-PCI period.

Left ventricular myocardial performance index in prediabetic patients without coronary artery disease.

INTRODUCTION: Prediabetes is a high-risk condition for diabetes mellitus type 2, which is an important public health issue. The myocardial performance index (MPI) is a noninvasive Doppler measurement of global ventricular function. We evaluated the MPI and left ventricular (LV) function in prediabetic patients who did not have coronary artery disease. METHODS: In total, 80 prediabetics (34 females and 46 males) and an equal number of sex-matched healthy volunteers (35 females and 45 males) were enrolled prospectively. All subjects underwent laboratory analyses and echocardiographic examinations, including MPI measurements. RESULTS: There was a moderate increase in MPI between healthy controls and prediabetics (P < .001). Prediabetes was strongly associated with MPI (r = .553, P < .001). We found that MPI was associated with prediabetes on multivariate logistic regression analysis (Odds Ratio (OR) = 1.967, 95% confidence interval [CI] = 1.574-2.459, P < .001). CONCLUSIONS: The results of this study show that systolic functions and LV diastolic parameters were adversely affected in prediabetic patients. Prediabetes is closely associated with subclinical LV systolic and diastolic dysfunction as assessed by MPI.

An extensive caseous calcification of the mitral annulus complicated with severe mitral regurgitation.

Caseous calcification of the mitral annulus (CCMA) is considered a rare variant of mitral annular calcification (MAC) due to caseous transformation of the inner material and prevalence of CCMA, about 0.63% of all MAC cases and 0.06%-0.07% of the population. The precise pathophysiology of CCMA is still unknown. It is a chronic degenerative disorder common in the elderly, particularly in women. Caseous calcification of the mitral annulus (CCMA) is a soft peri-annular extensive calcification, resembling cardiac tumors, abscesses, vegetation, or calcified thrombus, which is composed of an admixture of calcium, fatty acids, and cholesterol with a toothpaste-like texture. In the characteristic appearance on echocardiography, the calcification is a round, large, soft mass with a central echo dense area, typically located at the basal area of the posterior mitral valve. It usually carries a benign prognosis but rarely may be complicated with mitral valve dysfunction (valve stenosis/mitral regurgitation) or systemic embolization. The current data suggest conservative medical therapy and clinical follow-up for management of CCMA unless there is a need of cardiac surgery for severe mitral stenosis and/or regurgitation. We present a case, complicated with severe mitral regurgitation, and need surgical resection of the CCMA because of the CCMA-induced symptomatic severe mitral regurgitation despite optimal medical therapy. Macroscopic and microscopic examination of caseous material also demonstrated the characteristic appearance of CCMA.

Comparison of the Predictive Roles of Risk Scores of In-Hospital Major Adverse Cardiovascular Events in Patients with Non-ST Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention.

OBJECTIVE: We evaluated the relationship between various risk scores (SYNTAX score [SS], SYNTAX score-II [SS-II], thrombolysis in myocardial infarction [TIMI] risk scores, and Global Registry of Acute Coronary Events [GRACE] risk scores) and major adverse cardiovascular events (MACE) in non-ST elevation myocardial infarction (NSTEMI) patients undergoing percutaneous coronary intervention (PCI). SUBJECTS AND METHODS: The study population were selected from among 589 patients who underwent coronary angiography with a diagnosis of NSTEMI. TIMI and GRACE risk scores were calculated. SS and SS-II were calculated in all patients, and points were added according to the predefined algorithm, taking into account the other 6 clinical variables being monitored (age, sex, left ventricular ejection fraction, creatinine clearance, chronic obstructive pulmonary disease, and peripheral artery disease). Patients were classified into tertile 1 (SS < 22), tertile 2 (SS 23-32), and tertile 3 (SS > 32). RESULTS: The group with high SS-II for PCI values in the risk scores were observed from tertile 1 to tertile 3 (from 25.0 ± 7.7 to 31.6 ± 9.4, p < 0.001, respectively). The SS-II score in patients with PCI was an independent predictor of MACE, in-hospital mortality, nonfatal myocardial infarction, and stent thrombosis (OR 1.082, 95% CI 1.036-1.131, p < 0.001). The overall MACE, in-hospital mortality, and nonfatal myocardial infarction rates were significantly higher in the high SS-II for PCI group (p < 0.001). CONCLUSION: TIMI and GRACE risk scores were able to predict MACE. In addition to these, SS-II was also able to predict in-hospital mortality, nonfatal myocardial infarction, and stent thrombosis.

Association between metabolic syndrome and fragmented QRS complexes: Speckle tracking echocardiography study.

BACKGROUND: Metabolic syndrome (MetS) is an endocrinological disease with both metabolic and physiological components. Previous studies have shown a relationship between MetS and left ventricular (LV) dysfunction. A fragmented QRS (fQRS) is a reliable electrocardiogram (ECG) finding with the importance of an indicator of myocardial fibrosis and scarring. In this study, we examined the utility of speckle tracking echocardiography (STE) in assessing LV function in MetS patients with fQRS. METHODS: The 164 consecutive MetS patients included in the study. They were separated into two groups; those with (n=33) and those without (n=131) fQRS. The two groups were compared by obtaining LV strain values with STE. RESULTS: Statistically significant differences between the fQRS (-) and fQRS (+) groups were identified for LV global longitudinal strain (LV-GLS) (p<0.001), maximum left atrial volume index (maxLAVI) (p≤0.001), strain rate during isovolumic relaxation period (SRivr) (p<0.001), and the E/SRivr ratio (p<0.001). In the multiple linear regression analysis, fQRS (ß=-1.456, p=0.003), diabetes mellitus (ß=-0.973, p=0.015), hypertension (ß=-0.820, p=0.015) and MaxLAVI (ß=-0.142, p=0.018) were independent predictors of LV-GLS. However, fQRS (ß=21.995, p<0.001), MaxLAVI (ß=3.090, p<0.001), and E/Em ratio (ß=3.326, p<0.001) were also independent predictors of E/SRivr. CONCLUSIONS: The results of this study showed that LV dysfunction was more common in MetS patients with fQRS. MetS patients, and especially those who are fQRS (+), should thus be closely monitored for subclinical LV systolic and diastolic dysfunction.

Is Nebivolol Really Effective in Preventing Contrast Induced Nephropathy?

BACKGROUND/AIMS: Contrast induced nephropathy (CIN) has multifactorial etiopatogenesis including oxidative stress and vasoconstriction. Nebivolol is an antioxidant and has vasodilatatory effect via NO release and may prevent CIN development. We have noticed that a few number of studies that have evaluated the effectiveness of nebivolol for the prevention of CIN used serum creatinine (sCr) levels for CIN detection. However, sCr is an insensitive marker for renal damage. Therefore in this study we used serum neutrophil-gelatinase associated lipocalin (NGAL), a more sensitive marker of renal damage, to evaluate preventive role of nebivolol in CIN. METHODS: 159 patients undergoing coronary angiography (CAG) who had at least one risk factor for CIN were divided into nebivolol (+) and (-) groups. CIN was defined as a rise in sCr of 0.5mg/dl or a 25% increase from the baseline value. Serum Cr, glomerular filtration rate (eGFR) and NGAL levels were assessed before and 48 h after CAG. Mehran risk scores were calculated for both groups. RESULTS: Both groups were similar in terms of baseline characteristics, Mehran risk scores, and current medications. Clinically, CIN developed at similar rates in both groups. Serum Cr, eGFR and NGAL values were similar in both groups before and after CAG. Serum Cr and NGAL levels increased and eGFR decreased significantly compared to the levels before CAG. Patients who developed CIN were significantly older (p=0.003), and were more likely to have DM (p=0.012), a higher mean contrast agent volume (p<0.001), and a higher Mehran score (p <0.001). We did not observe any favorable effect of Nebivolol in the prevention of CIN in patients undergoing CAG. CONCLUSION: According to the results of our study Nebivolol does not seem to prevent CIN in patients undergoing CAG. However, further randomised controlled trials with more sensitive renal damage markers are obviously needed to understand the actual effect of nebivolol on CIN especially through oxidative pathways and in high risk patients.

Effects of the coronary collateral circulation on the Tp-e interval and Tp-e/QT ratio in patients with stable coronary artery disease.

BACKGROUND: The clinical utility of the Tp-e interval and Tp-e/QT ratio in the risk stratification of ventricular arrhythmic events is controversial. Therefore, we investigated the impact of CCC on these electrocardiographic indexes in the course of stable CAD. METHODS: Two hundred three consecutive patients with stable CAD who underwent coronary angiography and had documented total occlusion of one of the major coronary arteries were enrolled in this prospective cross-sectional study. The Tp-e interval and Tp-e/QT ratio were measured by 12-lead electrocardiogram. RESULTS: The Tp-e interval, cTp-e interval, Tp-e/QT ratio, and cTp-e/QT ratio were lower in the grade 3 CCC group compared with the others in all leads. Multivariate linear regression analyses was performed to identify the clinical factors affecting the cTp-e interval and was indicated that age (ß = 0.261, P < 0.001), male sex (ß = 0.334, P < 0.001), poor Rentrop grade (ß = -0.228, P < 0.001), and NLR (ß = 0.137, P = 0.027) were independent predictors of a prolonged cTp-e interval. CONCLUSION: It could be concluded that the decreased dispersion of ventricular repolarization might contribute to the lower incidence of ventricular arrhythmias and SCD in CAD patients with a good CCC.

[Evaluation of subclinical atherosclerosis in chronic sinusitis patients]. / Kronik sinüzitli hastalarda subklinik aterosklerozun degerlendirilmesi.

OBJECTIVE: This study aimed to assess the impact of chronic sinusitis (CS) on carotid-intima-media thickness (CIMT), a marker of early atherosclerotic changes in the arterial bed. METHODS: The study included 50 patients with CS (25 male, 25 female, mean age 26.6 ± 5.34 years), and 50 healthy subjects (25 male, 25 female, mean age 25.8 ± 4.76 years), aged 18 to 35 years without atherosclerotic risk factors, normal body mass index and normal metabolic parameters. CIMT was measured in all patients by ultrasonography. CS was confirmed by medical history and computed tomography scan of the paranasal cavities. RESULTS: No significant difference existed between the groups in terms of age, sex, body mass index (BMI), waist circumference, plasma creatinine, glucose, low-density lipoprotein (LDL), high-density lipoprotein (HDL) cholesterol values (p>0.05). However, mean values of CIMT (mm) were significantly greater in CS patients than in healthy subjects (0.51 ± 0.09 vs. 0.40 ± 0.07, p<0.001). Duration of CS disease was 6.0 (3.0-13.0) years. Significant correlation was found between CIMT mean values and age, BMI, waist circumference, HDL and LDL-cholesterol values and duration of CS (r=0.413; p<0.001, r=0.353; p<0.001, r=0.355; p<0.001, r=-0.266; p=0.007, r=0.327; p<0.001 and r=0.425; p=0.002 respectively). Multiple linear regression analysis revealed that waist circumference, HDL and LDL-cholesterol and duration disease of CS were independent predictors of CIMT (ß=0.523; p=0.001, ß=-0.176; p=0.045, ß=0.297; p=0.002, and ß=0.436; p<0.001, respectively). CONCLUSION: Our cross-sectional study revealed the presence of a negative effect of CS on the atherosclerotic process. Therefore, it is believed that effective treatment of CS may be beneficial in slowing the process of atherosclerosis.

The relationship between high-sensitive troponin T, neutrophil lymphocyte ratio and SYNTAX Score.

AIM: Cardiac troponins are the most preferred biomarkers in the evaluation of acute coronary syndromes (ACS). The aim of our study was to examine the association between high sensitive troponin T (hs-TnT), and neutrophil to lymphocyte ratio (NLR) and the complexity of ACS assessed by SYNTAX Score. METHODS AND RESULTS: 287 patients who underwent coronary angiography were studied (215 male, mean age 62.0 ± 12.7 years). 133 patients were ST elevation myocardial infarction (STEMI), 154 patients were non-ST elevation (NSTE) ACS . The patients are divided to tertiles according to SYNTAX Score; SYNTAX Score ≤ 22 (n = 122) 22 < SYNTAX Score ≤ 32 (n = 120), and SYNTAX Score > 32 (n = 45). NLR was significantly correlated with SYNTAX Score in both STEMI and NSTE-ACS groups (r = 0.254, p = 0.003, r = 0.419 p < 0.001). Multiple linear regression analysis showed NLR predicted the angiographic severity of ACS assessed by SYNTAX Score in two groups (ß = 0.231, p = 0.004; ß = 0.232, p = 0.003). Hs-TnT was significantly correlated with SYNTAX Score in two groups (r = 0.327, p < 0.001; r = 0.430, p < 0.001). Multiple linear regression analysis showed hs-TnT was independent predictor of SYNTAX Score in STEMI and NSTE-ACS patients (ß = 0.292, p < 0.001; ß = 0.317, p < 0.001). CONCLUSION: Hs-TnT and NLR were significantly correlated with angiographic severity of ACS assessed by SYNTAX Score.

Epicardial adipose tissue thickness in hemodialysis patients.

AIM: Hemodialysis (HD) patients had higher cardiovascular mortality and it is related to atherosclerosis. Epicardial adipose tissue (EAT) thickness is a marker of atherosclerosis and independent predictor of coronary artery disease. The aim of our study was to evaluate the relationship between EAT and carotid intima-media thickness (CIMT) predictors of early atherosclerosis in HD patients. METHODS: The study included 62 HD patients and 40 healthy controls. EAT thickness and CIMT were measured by echocardiography in all subjects. RESULTS: Epicardial adipose tissue thickness and CIMT were higher (6.98 ± 1.67 vs. 3.84 ± 0.73 mm, P < 0.001, 0.94 ± 0.17 vs. 0.63 ± 0.11 mm, P < 0.001, respectively) in HD patients than in control subjects. EAT thickness were correlated with CIMT, HD duration, age, and calcium. In addition, HD duration, CIMT, and age were independent predictors of EAT thickness on HD patients in regression analysis. CONCLUSION: Epicardial adipose tissue thickness may be a useful indicator of early atherosclerosis in HD patients.

Evaluation of vertebral artery involvement by Doppler sonography in patients with Behçet disease.

OBJECTIVES: Neurologic lesions in Behçet disease are most frequently observed in areas supplied by the vertebrobasilar system. We aimed to evaluate possible vertebral artery involvement by Doppler sonography in patients with Behçet disease. METHODS: Forty-five patients with Behçet disease and 29 healthy volunteers had Doppler sonography of the vertebral arteries. Patients were grouped according to neurologic examination and magnetic resonance imaging findings as follows: group 1, Behçet disease without neurologic involvement; group 2, neuro-Behçet disease; and group 3, control. Results were assessed with a 95% confidence interval. RESULTS: The main findings of our study were as follows: (1) total vertebral artery volume flow was significantly lower in the patient groups than the control group (P< .05); (2) total volume flow was lower in group 2 than group 1, although the difference was not statistically significant; (3) peak systolic and end-diastolic velocity values were significantly lower in the patient groups than the control group; (4) right and left mean volume values were lower in group 2; and (5) resistive and pulsatility index values for the left vertebral artery were significantly higher in group 2, but no statistically significant differences were found in the resistive and pulsatility index values for the right vertebral artery. CONCLUSIONS: Doppler sonography of the vertebral arteries in Behçet disease shows alterations that may aid in the diagnosis and treatment of this condition.

Increased epicardial adipose tissue thickness on transthoracic echocardiography in patients with Behçet disease.

OBJECTIVES: Owing to the fact that the potential frequency of endothelial dysfunction and early atherosclerosis might be higher in Behçet disease, characterized by acute and chronic inflammatory attacks, it may lead to impairment in flow-mediated dilatation and an increase in epicardial adipose tissue thickness. Therefore, we aimed to evaluate whether epicardial adipose tissue thickness and brachial artery flow-mediated dilatation as markers of early atherosclerosis and endothelial dysfunction were associated with Behçet disease. METHODS: Thirty-five patients with Behçet disease and 35 healthy volunteers were included in this study. Epicardial adipose tissue was identified as an anechoic space between epicardial layers on 2-dimensional images, and its thickness was measured on the free wall of the right ventricle. Right brachial artery flow-mediated dilatation was assessed according to recent guidelines. RESULTS: Serum γ-glutamyl transferase (GGT) levels and epicardial adipose tissue thickness were significantly higher (P = .001; P < .001 respectively), whereas flow-mediated, endothelium-dependent dilatation was significantly lower in the Behçet disease group than controls (P < .001). There was a significant negative association between epicardial adipose tissue thickness and flow-mediated dilatation (P < .001). Epicardial adipose tissue thickness was also positively correlated with Behçet disease activity (P< .001), Behçet disease duration (P< .001), and waist circumference (P< .001). Flow-mediated dilatation was negatively correlated with GGT (P< .001), Behçet disease activity (P< .001), and age (P< .001). There was also a significant association between GGT and Behçet disease activity (P < .001). CONCLUSIONS: We found that epicardial adipose tissue thickness was significantly higher and flow-mediated dilatation was significantly lower in patients with Behçet disease than in controls. We suggest that identification of increased epicardial adipose tissue might aid in the diagnosis and treatment of possible coronary artery disease in patients with Behçet disease.

Assessment of atrial electromechanical delay in patients with polycystic ovary syndrome in both lean and obese subjects.

AIM: Even though polycystic ovary syndrome (PCOS) is characterized by increased inflammatory activity and insulin resistance, there is no clinical data about whether risk of atrial fibrillation are increased in these patients. We aimed to evaluate atrial conduction parameters predicting atrial involvement in this patient group. METHODS: The study population comprised 50 women 18-40 years of age who had been diagnosed with PCOS. The patients were divided into two groups: lean women (L-PCOS) with a body mass index (BMI) under 25 kg/m² and obese women (O-PCOS) with a BMI greater than 30 kg/m². Twenty-five age-matched lean healthy women were enrolled voluntarily as the control group. Difference between maximum and minimum P-wave duration was calculated and was defined as P-wave dispersion (Pd). Inter- and intra-atrial electromechanical delays (inter-AED, intra-AED, respectively) were measured with tissue Doppler imaging. RESULTS: Inter- and intra-AED parameters were higher in the L-PCOS group when compared with control subjects (anova, P=0.004 and P=0.013, respectively), and were also significantly higher in the O-PCOS group compared with other groups (anova, P<0.001 for both). The regression analyses indicated that Homeostasis Model of Assessment - Insulin Resistance (HOMA-IR) (ß=0.603, P<0.001) and BMI (ß=0.379, P<0.001) were the independent predictors of inter-AED, HOMA-IR (ß=0.835, P<0.001) was an independent predictor of intra-AED, and BMI (ß=0.457, P=0.006) and the left atrial diameter (ß=0.350, P<0.034) were independent predictors of Pd. CONCLUSION: Consequently, our findings provide data regarding prolonged atrial conduction parameters in PCOS patients, especially when accompanied by obesity.

Effect of smoking on Tp-e interval, Tp-e/QT and Tp-e/QTc ratios as indices of ventricular arrhythmogenesis.

BACKGROUND: Smoking may lead to ventricular arrhythmias and sudden cardiac death via altering ventricular recovery time dispersion indices such as QT interval and QT dispersion (QTd). The Tp-e/QT and Tp-e/QTc ratios are also known as predictors of ventricular arrhythmogenesis. The aim of this study was to evaluate the relationship between cigarette smoking and ventricular repolarisation dispersion using these novel electrocardiographic parameters. METHODS: One hundred and twenty-one chronic smokers and 70 age- and sex-matched non-smoker controls were included in our study. The Tp-e interval and Tp-e/QT ratio were measured by 12-lead electrocardiogram, and corrected for heart rate. RESULTS: QTd (34.2 ± 8.4, 27.2 ± 10.4, P<0.001) and corrected QTd (37.3 ± 8.9, 29.8 ± 11.2, P<0.001) were significantly increased in the smokers compared to the non-smoker control group. The Tp-e interval (76.5 ± 6.3, 70.3 ± 6.8, P<0.001), cTp-e interval (83.5 ± 8.0, 77.1 ± 8.7, P<0.001), Tp-e/QT (0.20 ± 0.03, 0.19 ± 0.02, P<0.001) and Tp-e/QTc ratios (0.19 ± 0.02, 0.17 ± 0.02, P<0.001) were increased in the patient group when compared to the controls. Significant positive correlations were also found between the level of smoking with the cTp-e interval (r=0.836, P<0.001), and Tp-e/QT (r=0.714, P<0.001) and Tp-e/QTc ratios (r=0.448, P<0.001). CONCLUSION: We found in our study that cTp-e interval, Tp-e/QT and Tp-e/QTc ratios were increased in smokers and significantly correlated to the amount of smoking.