Comparison of left ventricular subclinical systolic dysfunction between hemodialysis patients and renal transplant recipients using real time three-dimensional echocardiography.

AIMS: The relationship between chronic kidney disease and development of heart failure is a well-known clinical entity. Systolic dyssynchrony index (SDI_16) is a new diagnostic tool for detection of subclinical left ventricular (LV) systolic dysfunction by using three-dimensional echocardiography (3DE). We aimed to investigate this parameter in patients with end-stage renal disease who were receiving hemodialysis and patients with renal transplant compared to healthy control subjects. MATERIAL AND METHODS: Forty-five hemodialysis patients, 45 patients with renal transplant and 45 age-sex matched healthy control subjects included in the study. All participants were evaluated with 3DE in the interdialytic phase for measurement of LV volumes, ejection fraction and SDI_16 parameter. RESULTS: Both LV diastolic and systolic volumes were significantly higher in hemodialysis group compared to renal transplant group and healthy controls, but this finding did not translate to a statistically significant difference for LVEF measurements between groups (58.71 ± 3.53 vs. 57.17 ± 2.97 vs. 59.23 ± 3.26, p = .16 for renal transplant and hemodialysis and healthy control groups, respectively). Mean value of SDI_16 parameters was significantly higher in hemodialysis group compared to renal transplant group (7.93 ± 2.50 vs. 3.72 ± 1.71, p < .001) and healthy controls (7.93 ± 2.50 vs. 3.00 ± .99, p < .001); whereas, it was similar between renal transplant group and control subjects (3.72 ± 1.71 vs. 3.00 ± .99, p = .10). CONCLUSION: SDI_16 was significantly higher in hemodialysis patients compared to patients with renal transplant and healthy controls.

Left ventricular systolic dyssynchrony index and endothelial dysfunction parameters as subclinical predictors of cardiovascular involvement in patients with beta-thalassemia major.

OBJECTIVE: Cardiovascular iron load is the leading cause of morbidity and mortality in beta-thalassemia major (ß-TM). However, many patients remain asymptomatic until the late stage. In this cross-sectional study, we investigated the role of three-dimensional (3D) echocardiography and endothelial dysfunction parameters in asymptomatic ß-TM patients, and the relationship between these parameters and cardiac magnetic resonance imaging (MRI) T2* value. METHODS: A total of 51 asymptomatic ß-TM patients receiving regular blood transfusions were divided into two groups based on cardiac MRI-T2* values (MRI-T2*<20 ms and ≥20 ms), which MRI-T2*<20 ms determines myocardial iron load and evaluated by two-dimensional (2D) and 3D-echocardiography including endothelial dysfunction parameters. The relationships between ferritin levels, 2D and 3D-echocardiography measurements, endothelial dysfunction parameters, and cardiac MRI-T2* values were investigated. RESULTS: All left ventricle ejection fraction (LVEF) obtained by 2D-echocardiography were normal (≥50%). LVEF-3D (53.25 ± 2.33 vs. 58.81 + 1.02), SDI12 (6.53 ± 0.56 vs. 2.85 + 0.48), and SDI16 (7.65 ± 0.75 vs. 3.26 + 0.49) were significantly different and negatively correlated between groups with MRI-T2*<20 ms and ≥20 ms, respectively. Flow-mediated dilatation (FMD) (6.08% ± 0.34% vs. 14.46% ± 1.12), aortic strain (7.79% ± 2.19% vs. 12.76% ± 4.19), ferritin levels were significantly different and negatively correlated between groups with MRI-T2*<20 ms and ≥20 ms, respectively. Higher ferritin, SDI12/16 were significant independent predictors of MR-T2* < 20 ms. SDI16 > 5.5, SDI12 > 4.3 predicted MRI-T2*<20ms with a sensitivity of 92%, specificity of 81% (AUC 0.85, P < .001), and sensitivity of 92%, specificity of 78% (AUC 0.83, P < .001), respectively. CONCLUSION: SDI12/16 calculated by 3D-echocardiography may be a promising predictors of cardiovascular iron load and, decreased LVEF-3D, FMD, and aortic strain might be good indicators of subclinical cardiovascular involvement of ß-TM.

Real-time three-dimensional echocardiography for detection of cardiac sarcoidosis in the early stage: a cross-sectional single-centre study.

BACKGROUND: Sarcoidosis with cardiac involvement has a relatively high morbidity and mortality, and early diagnose of cardiac sarcoidosis is a critical issue. Systolic dyssynchrony index (SDI) measured by three-dimensional echocardiography was used in our study for detection of subclinical left ventricular (LV) systolic dysfunction in patients with sarcoidosis and normal LV function on two-dimensional echocardiography. METHODS: Forty-four patients diagnosed with sarcoidosis (without clinically apparent cardiac involvement) and 44 healthy control subjects were included in this study. Two-dimensional echocardiographic parameters, also LV volumes and SDI measured by 3D echocardiography were analyzed in all participants. RESULTS: While two-dimensional echocardiographic results of both study groups were similar; SDI_16 (SDI for 16 segments of LV) results were significantly higher in sarcoidosis group compared to healthy controls (6.99 ±5.02 vs 2.89 ± 1.32, p < 0.0001). CONCLUSION: SDI_16 was higher in patients with sarcoidosis compared to healthy controls probably due to patchy infiltration characteristic of the disease. This parameter could be used as a marker to identify patients with cardiac involvement of sarcoidosis in the early phase.

Association of cardiac adaptations with NT-proBNP levels after percutaneous closure of atrial septal defect.

OBJECTIVE: The aim of this study was to evaluate the early effects of transcatheter closure of secundum atrial septal defect (ASD) on atrial and ventricular diameters and functions evaluated by transthoracic echocardiography, and to assess the relation of morphological changes to N-terminal pro-brain natriuretic peptide (NT-proBNP) levels. METHODS: Twenty-two patients with secundum-type ASD referred for percutaneous closure were included in the study as well as 22 healthy individuals who served as a control group. TTE and concurrent blood sampling were performed prior to and 24 hours and 30 days after the closure procedure. RESULTS: At follow-up 24 hours and 30 days after the closure, the right atrial (RA) area, right ventricular (RV) area, RV end-diastolic volume (EDV), and RV end-systolic volume (ESV) decreased, while left ventricle (LV) EDV (LVEDV), LVESV, and LV stroke volume (LVSV) increased. Global RV systolic and diastolic function indices, such as the tricuspid annular plane systolic excursion, the tricuspid E/A and E/e' ratio decreased immediately after the closure. The NT-proBNP value increased in the 24 hours following closure, and after 30 days, it was still higher than the measurement recorded before the transcatheter closure. The LV structural and functional parameters were significantly correlated with the NT-proBNP value (LVEDV: r=0.37, p=0.02; LVESV: r=0.38, p=0.01; left atrium area: r=0.46, p=0.002; mitral E/e': r=0.28, p=0.04). CONCLUSION: Percutaneous ASD closure can lead to both early and sustained changes in cardiac anatomy and function involving both sides of the heart. The NT-proBNP level had increased at 24 hours post procedure, and was also notably increased 30 days after the percutaneous ASD closure, which is associated with increased LV diameter and volume.

Resveratrol did not alter blood pressure in rats with nitric oxide synthase-inhibited hypertension.

BACKGROUND: Inhibition of nitric oxide synthase (NOS) is a well-known experimental model of hypertension (HT). It was shown that oxidative stress contributes to the pathogenesis of HT. Resveratrol is a potent anti-oxidant that is found in red grapes, peanuts and red wine. It improves the NO response and increases endothelial NOS expression, which causes endothelium-dependent vasorelaxation as well as renal vasodilation. We aimed to explore the effects of resveratrol on blood pressure, the water-salt balance and sodium excretion as a reflection of renal function in NOS-inhibited rat models. METHODS: Thirty-five male Sprague-Dawley rats (200-250 g) were used in this study. In order to obtain hypertension models, an NOS inhibitor, N-nitro-L-arginin (L-NNA) was used. The rats were randomly divided into five groups: controls (given water and 0.8% salty diet) and four groups [given L-NNA, resveratrol (RSV) eluent, RSV, and L-NNA + RSV]. Blood pressures were measured indirectly by the tailcuff method on the first, seventh and 10th days. At the end of the study protocol (10th day), fluid balance, glomerular filtration rate, fractional sodium excretion, and blood and urine sodium and creatinine levels were measured. RESULTS: At the end of the study protocol, blood pressures were higher in only the L-NNA group (117.8 ± 3.5 vs 149.5 ± 2.1 mmHg; p < 0.05), as expected. Additional applications of RSV with L-NNA could not prevent the increase in blood pressure (122.8 ± 7.3 vs 155.4 ± 4.4 mmHg; p < 0.05). There were no remarkable changes in water-salt balance and renal function with the application of resveratrol. CONCLUSION: Resveratrol was unable to prevent or reverse blood pressure increase in NOS-inhibited rats.

Is there a relationship between slow coronary flow and normal to mildly impaired renal function?

OBJECTIVE: The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation is more effective at estimating glomerular filtration rate (GFR) than the Modification of Diet in Renal Disease (MDRD) equation, particularly in patients with mildly impaired renal function. Recent studies have demonstrated, using the Cockroft-Gault and MDRD formulas, a significant correlation between slow coronary flow (SCF) and normal to mildly impaired renal function. However, these studies had some limitations. The aim of the present study was to investigate the relationship between SCF and normal to mildly impaired renal function using the CKD-EPI equation. METHODS: A total of 370 patients were included, 172 with normal coronary flow (NCF) and 198 with SCF. All participants had normal to mildly impaired renal function. Both the CKD-EPI and MDRD formulas were used to calculated estimated glomerular filtration rate (eGFR), which was compared between groups. RESULTS: No significant difference in mean values of eGFR was found between the NCF and SCF groups (CKD-EPI: 92.9±14.7 vs 92.7±14.2, p=0.72; MDRD: 89.5±19.5 vs 88.2±17.0, p=0.70, respectively). Among patients with eGFR(MDRD) ≥90 mL/min/1.73 m2, mean eGFR levels were lower among patients with SCF (107.0±12.7 vs 102.7±10.0, p=0.02). CONCLUSION: No correlation was found between SCF and normal to mildly impaired renal function.

Aortic valve sclerosis is associated with lower serum adiponectin levels.

AIMS: The sclerotic lesions of the aortic valve share common features with atherosclerosis. An anti-inflammatory protein, adiponectin, seems to have a protective effect on the cardiovascular system. The goal of our study is to determine adiponectin levels in patients with aortic sclerosis and to compare these values with the control group with similar age and cardiovascular risk profile. METHODS: Sixty-eight patients with aortic sclerosis and 40 controls were included. Serum adiponectin levels were measured by solid-phase enzyme-linked immunosorbent assay. RESULTS: There were no significant differences regarding age, sex and other cardiovascular risk factors between groups. Also, mean body mass index values were similar. The rate of mitral annular calcification and left ventricular hypertrophy were significantly higher in patients with aortic sclerosis. Among laboratory variables, high-sensitive C-reactive protein (hsCRP) levels were significantly higher in patients with aortic sclerosis than in those without (4.0 ±â€Š2.9 vs. 2.9 ±â€Š2.3 mg/dl, P = 0.04). Adiponectin levels were found to be significantly lower in aortic sclerosis group than in controls (9.7 ±â€Š4.4 vs. 11.7 ±â€Š4.9 µg/ml, P = 0.034). In the whole group, adiponectin levels were significantly correlated with BMI (r = -0.22, P = 0.02), white blood cell count (r = -0.2, P = 0.03), hsCRP (r = -0.25, P = 0.008), total cholesterol (r = -0.18, P = 0.05), high-density lipoprotein (HDL) cholesterol (r = 0.31, P = 0.001) and triglyceride (r = -0.36, P < 0.001). CONCLUSION: In patients with aortic sclerosis, serum adiponectin levels were significantly lower compared with those with normal aortic valves. Our findings suggested that adiponectin might play a role in the progression of degenerative aortic valve disease.