Effect of Exercise on Left Atrium Mechanics in Mild Mitral Stenosis.

OBJECTIVE: A significant number of individuals with mild mitral stenosis (MS) experience exertional symptoms that are disproportionate to the hemodynamic severity of their condition. This study aims to determine whether exercise-induced left atrial (LA) dysfunction occurs in these patients and whether it is related to the development of symptoms. METHODS: In this observational study, we recruited 46 patients with mild MS. Echocardiographic measurements were initially taken at rest, followed by a maximal exercise stress test. Patients were then returned to the echocardiography laboratory for post-exercise measurements. RESULTS: Our study cohort exhibited considerably higher left atrial volume index (LAVI) values (mean: 40.52 ± 18.27) compared to those of a healthy population. Furthermore, the LA reservoir strain (mean: 17.1 ± 8.33) was reduced relative to reference values. Following exercise, there was no change in the LA reservoir strain. However, trans-mitral pressure gradients and systolic pulmonary artery pressures increased. The post-exercise mean trans-mitral gradient was identified as the sole predictor of symptom development in patients with mild MS. CONCLUSION: The LA reservoir strain is already reduced in individuals with mild MS, and exercise does not lead to further decline in LA reservoir function in these cases. To our knowledge, this study is the first to explore the effects of exercise on LA mechanics in MS.

Evaluation of the Relationship Between Vitamin D Deficiency and Subclinical Cardiac Dysfunction Using 2D/3D Strain Echocardiography in Healthy People.

AIM: Vitamin D deficiency has a high prevalence in the population and is highly associated with cardiovascular diseases. The aim of this study was to evaluate subclinical left ventricular (LV) function using strain analysis in healthy individuals with vitamin D deficiency. MATERIAL AND METHODS: 113 healthy volunteers were enrolled in the study (age, 44.1±7 yrs, 34 male). All volunteers underwent two-dimensional (2D) and three-dimensional (3D) speckle tracking echocardiography after conventional echocardiographic evaluation. The subjects were divided into two groups according to their vitamin D concentrations. 61 subjects with vitamin D less than 20 ng / ml were included in the vitamin D deficiency group. The baseline clinical characteristics, laboratory measurements, echocardiographic data, including 2D and 3D global longitudinal strain (GLS) values, were compared between the groups. RESULTS: The 2D GLS values of the subjects with vitamin D deficiency were lower (mathematically less negative) than subjects with normal vitamin D (-16.1±3.4 vs -19.3±4.2, p<0.001). Similarly, the 3D GLS results were lower in subjects with vitamin D deficiency (-18.3±5.2 vs -24.1±6.9, p<0.001). A significant correlation was detected between the vitamin D concentrations and the 2D and 3D GLS measurements. (r=0.765 and r=0.628, respectively, p<0.001). Vitamin D was found to be an independent predictor of impaired 2D and 3D LV GLS (p=0.031, p=0.023, respectively). CONCLUSION: Subclinical LV dysfunction in healthy individuals with vitamin D deficiency was demonstrated by 3D and 2D strain analysis. Due to potential negative effects of vitamin D deficiency on cardiac function, more attention should be paid to healthy individuals with vitamin D deficiency.

The Frequency of Fabry Disease in Patients with Cardiac Hypertrophy of Various Phenotypes Including Prominent Papillary Muscle: The TUCARFAB Study in Turkey.

BACKGROUND: The present study aimed to identify the frequency of Fabry disease in patients with cardiac hypertrophy of unknown etiology and to evaluate demographic and clinical characteristics, enzyme activity levels, and genetic mutations at the time of diagnosis. METHODS: This national, multicenter, cross-sectional, single-arm, observational registry study was conducted in adult patients with a clinical echocardiographic diagnosis of left ventricular hypertrophy and/or the presence of prominent papillary muscle. In both genders, genetic analysis was performed by DNA Sanger sequence analysis. RESULTS: A total of 406 patients with left ventricular hypertrophy of unknown origin were included. Of the patients, 19.5% had decreased enzyme activity (≤2.5 nmol/mL/h). Although genetic analysis revealed GLA (galactosidase alpha) gene mutation in only 2  patients (0.5%), these patients were considered to have probable but not 'definite Fabry disease' due to normal lyso Gb3 levels and gene mutations categorized as variants of unknown significance. CONCLUSION: The prevalence of Fabry disease varies according to the characteristics of the population screened and the definition of the disease used in these trials. From cardiology perspective, left ventricular hypertrophy is the major reason to consider screening for Fabry disease. Enzyme testing, genetic analysis, substrate analysis, histopathological examination, and family screening should be performed, when necessary, for a definite diagnosis of Fabry disease. The results of this study underline the importance of the comprehensive use of these diagnostic tools to reach a definite diagnosis. The diagnosis and management of Fabry disease should not be based solely on the results of the screening tests.

Evaluation of Cardiac Function in Uncomplicated COVID-19 Survivors by 2-Dimensional Speckle Tracking Imaging.

BACKGROUND: COVID-19 is a multi-systemic infectious disease. Nearly 20%-30% of hospitalized patients have evidence of acute myocardial involvement, portending a poorer prognosis. However, information about the long-term effects of the disease on cardiac functions is sparse. As a result, there is a growing concern about the cardiac sequelae of COVID-19 among survivors. This study aimed to investigate the effects of prior mild-moderate COVID-19 infection on cardiac functions, using speckle tracking echocardiography. METHODS: Patients who have been diagnosed with COVID-19 within the previous 6 months and age-, sex-, and risk factor-matched healthy adults were included. All patients underwent a comprehensive echocardiographic examination. Both conventional and 2-dimensional speckle tracking echocardiographic measurements were performed. Serum cardiac biomarkers were also obtained on the day of the echocardiographic study. RESULTS: Compared with healthy controls, COVID-19 survivors had similar left and right ventricular longitudinal strain values at 6 months. Also, left and right atrial peak systolic strain values did not differ between the groups. CONCLUSION: Our study is valuable in putting forth the unaffected ventricular and atrial functions on long term in uncomplicated COVID-19 cases and may decrease the survivors' anxiety and the number of unnecessary applications to cardiology clinics.

Comparison of Biochemical Markers and Echocardiographic Parameters in the Diagnosis of Prosthetic Valve and Intracardiac Device Endocarditis.

BACKGROUND: The use of prosthetic valves and intracardiac devices has steadily increased in recent years. In this group of patients with prosthetic valves or intracardiac devices, infective endocarditis could not be easily diagnosed, and in general, infective endocar- ditis can be missed in many patients. The purpose of this study was to evaluate the diag- nostic performance of clinical, laboratory, and imaging parameters in a group of patients with pre-diagnosis of infective endocarditis. METHODS: Ninety-four patients diagnosed with prosthetic valve or intracardiac device endocarditis during 2008-2019 were included in the study. The patients' data were evalu-ated according to modified Duke criteria, and the data of the patients who were diag- nosed with and without a definitive infective endocarditis were compared accordingly. RESULTS: Values of procalcitonin (P < .001), leukocytes (P=.004), C-reactive protein (P < .001), sedimentation (P < .001), and maximal vegetation size (P = .012) were found to be significant in the diagnosis of IE. Criteria to determine definitive IE included a C-reactive protein level of 105 mg/dL or higher, 77% sensitivity, 75% specificity, 60% positive predic- tive value, and 87% negative predictive value. In particular, a C-reactive protein level of ≥105 mg/dL was found to positively indicate the diagnosis of definitive infective endocar- ditis by 10 times (odds ratio = 10; 95% CI: 3.6-27.8, P < .001). In a multiple logistic regression analysis, the C-reactive protein level was found to be the best independent predictor of definitive infective endocarditis in this population. CONCLUSION: In cases of prosthetic valve and intracardiac devices endocarditis where pre- diagnosis is difficult to confirm, measuring C-reactive protein levels is a reliable, strong, and simple parameter for definitive infective endocarditis diagnosis.

Agreement between visually estimated left ventricular ejection fraction on echocardiography and quantitative measurements using cardiac magnetic resonance.

OBJECTIVE: Visual estimation of left ventricular ejection fraction (LVEF) is still used in routine clinical practice. However, most of the studies evaluating the agreement between the visually estimated LVEF (ve-LVEF) and quantitatively measured LVEF (qm-LVEF) either have not used appropriate statistical methods or gold standard imaging modality. In this study, we aimed to assess the agreement between the ve-LVEF and qm-LVEF using contemporary statistical methods and cardiac magnetic resonance imaging (CMRI). METHODS: In 54 subjects who underwent 1.5-T CMRI, echocardiographic images were recorded after the CMRI procedure on the same day. Two independent observers estimated ve-LVEFs on echocardiographic records in a random and blinded fashion, and qm-LVEF was obtained by CMRI. Agreement between the ve-LVEF and qm-LVEF values and intra/interobserver ve-LVEF estimations were assessed using intraclass correlation coefficient (ICC), Bland-Altman analysis, and kappa statistics. RESULTS: There was a high agreement between the ve-LVEF and qm-LVEF (ICC 0.93, 95% confidence interval 0.88-0.96). Bland-Altman analysis also demonstrated a good agreement between ve-LVEF and qm-LVEF with ve-LVEF, on average, being 0.6% lower than that obtained by CMRI (mean -0.6, limits of agreement -10.5 and +9.3). A good agreement was also observed for LVEF categories ≤35%, 36%-54%, and ≥55% (unweighted kappa 0.71, linearly weighted kappa 0.76); and LVEF of <55% and ≥55% (kappa 0.80). Intra/inter observer agreement was good for ve-LVEFs (ICC value 0.96 and 0.91, respectively). CONCLUSION: Visual approach for LVEF assessment may be used for rapid assessment of left ventricular systolic function in clinical practice, particularly in patients with good image quality.

Acute effects of consumption of low-caffeine energy drinks on endothelial functions in healthy volunteers.

OBJECTIVE: Energy drink consumption is increasing among the population, especially adolescents and young adults. The health effects of energy drinks are unknown. In this study, we investigate the effects of low caffeine energy drinks on endothelial functions assessed by flow-mediated dilation (FMD) of the brachial artery. METHODS: Thirty healthy volunteers (15 men, 15 women) aged 19 to 46 years participated in the study. Flow-mediated dilation measurements of the brachial artery were performed and recorded per protocol. The volunteers were asked to drink 355 mL of energy drink containing 53.25 mg of caffeine after baseline measurements, and all measurements were repeated 60 minutes later. Baseline and post-energy drink values were compared. RESULTS: Systolic blood pressure (p=0.592), diastolic blood pressure (p=0.714), and heart rate values (p=0.056) were similar before and after the consumption of energy drinks. Preocclusion arterial diameters (p=0.236) and blood velocities (p=0.447) did not change after energy drink consumption. FMD levels were 9.2%±4.6% and 8.1%±4.7%, respectively, before and after energy drink consumption (p=0.176). Women had a 3% increase in preocclusion arterial diameters after energy drink consumption, whereas men had a 2.6% decrease (p=0.026) Conclusion: Low caffeine energy drinks containing 53.25 mg of caffeine/355 mL can did not have any influence on blood pressure, heart rate, or endothelial functions in healthy volunteers.

Invasive validation of the left ventricular global longitudinal strain for estimating left ventricular filling pressure.

PURPOSE: An elevated left ventricular (LV) filling pressure is the main finding in heart failure patients with preserved ejection fraction, which is estimated with an algorithm using echocardiographic parameters recommended by the recent American Society of Echocardiography (ASE)/European Association of Cardiovascular Imaging (EACVI) guidelines. In this study, we sought to determine the efficacy of the LV global longitudinal strain (GLS) in predicting an elevated LV filling pressure. METHODS AND RESULTS: A total of 73 prospectively selected patients undergoing LV catheterization (mean age 63.19 ± 9.64, 69% male) participated in this study. Using the algorithm, the LV filling pressure was estimated using the echocardiographic parameters obtained within 24 hours before catheterization. The LV GLS was measured using an automated functional imaging system (GE, Vivid E9 USA). Invasive LV pre-A pressure corresponding to the mean left atrial pressure (LAP) was used as a reference, and a LAP of >12 mm Hg was defined as elevated. Invasive LV filling pressure was elevated in 43 patients (59%) and normal in 30 patients (41%). Nine of 73 (12%) patients were defined as indeterminate based on the 2016 algorithm. Using the ROC method, -18.1% of LV GLS determined the elevated LAP (AUC =0.79; specificity, 73%; sensitivity, 84%) with better sensitivity compared to that by the algorithm (AUC =0.76; specificity, 77%; sensitivity, 72%). CONCLUSIONS: We demonstrated that LV GLS was an independent predictor of elevated LAP as the E/e' ratio and TR jet velocity and may be used as a major criterion for the diagnosis of HFpEF.

A broken, O-shaped catheter during coronary angiography: Percutaneous retrieval via femoral approach using a wire-balloon technique.

Entrapment of equipment during coronary angiography is an uncommon but serious complication of invasive coronary procedures. Percutaneous extraction of trapped material is the accepted method of treatment. This case report is a description of the extraction of a diagnostic catheter retained as a result of collapsing into an O-shape in the right common iliac artery while trying to engage the tip of the catheter with the right coronary ostium. This rationale and unique wire-balloon method, requiring no specifically designed device, can be simply and safely performed in similar cases.

D-Dimer is a strong predictor of in-hospital mortality in patients with infective endocarditis.

OBJECTIVE: Infective endocarditis (IE) is a rare disease with a high mortality. Therefore, prognostic markers can play an important role in the follow-up. In this study, we investigated the relationship between the D-dimer (DD) level and in-hospital mortality and complications in patients with IE, because DD indicates both the fibrin turnover in vegetation and the autoimmune inflammatory response in patients with IE. METHODS: Seventy-nine patients with IE were included in the study. In-hospital death for any reason was considered to be the primary endpoint. Secondary endpoints were embolism and in-hospital death or embolism. RESULTS: In-hospital mortality occurred in 31 (39%) patients. The DD level was significantly higher in the group with in-hospital mortality [median (interquartile range) values 3048.0 (4911.0) vs. 556.0 (1100.2) ng/mL, p<0.001]. When the DD level was 795 ng/mL or higher, the sensitivity was 83.5%, specificity was 66.7%, the positive predictive value was 66.4%, and the negative predictive value was 94.1%, to determine in-hospital mortality. Categorically, the DD level of 795 ng/mL or higher was found to increase the risk of in-hospital mortality by 29 times (odds ratio=29; 95% confidence interval=6.13-137.11; p<0.001). In a multiple logistic regression analysis, the DD level was found to be the best independent predictor of in-hospital mortality (the AUC value only for DD was 0.86, and for the multiple logistic regression model, it was 0.89, p=0.48). A significant correlation was found between the DD level and in-hospital death or embolization [1863.0 (4914, 0) vs. 376 (607, 0) ng/mL, p<0.001]. In the multiple logistic regression analysis, DD was found to be the best independent parameter showing in-hospital mortality or embolization (the AUC value was 0.83 for DD, and 0.84 for the multiple logistic regression analysis, p=0.69). CONCLUSION: These findings support that a high DD is a strong parameter predicting in-hospital mortality, and in-hospital mortality or embolic events in patients with IE.

Evaluation of the effect of non-ergot dopamine agonists on left ventricular systolic function with speckle tracking echocardiography.

OBJECTIVE: Parkinson's disease (PD) is a neurological disorder, and ergot dopamine agonists (DAs) are no longer usually preferred in the treatment due to the increased risk of valvular heart disease. Some recent studies have shown that commonly used non-ergot DA also increases the risk of heart failure. On the other hand, there are studies showing conflicting data about this relationship. The aim of the present study was to investigate the cardiac effects of non-ergot DAs in patients with PD using echocardiography. METHODS: Conventional echocardiography and two-dimensional (2D) speckle tracking strain echocardiography were performed to determine the possible systolic dysfunction prior to the development of apparent systolic heart failure. Ninety-one (55 male, 64±10 years) patients with PD were included in the study. Furthermore, 25 subjects with newly diagnosed PD and using no drug were enrolled as the control group. All patients were divided into groups according to their medication. Patients using levodopa were classified as Group 1 (36), levodopa+pramipexole as Group 2 (27), and levodopa+ropinirole as Group 3 (28). RESULTS: Left ventricle dysfunction with non-ergot DA use in patients with PD was not established with conventional echocardiographic evaluation. For 2D strain analysis, global longitudinal strain values were obtained as -18.5%, -18.5%, and -18.9% in the groups, respectively. Strain and strain rate values of the left ventricle were not different between the groups (p=0.816 and p=0.881, respectively). CONCLUSION: There was no significant relationship between left ventricular dysfunction and use of non-ergot DA in patients with PD. Similar results were obtained in strain analysis showing left ventricular subclinical dysfunction. Our study appears to confirm the safety of non-ergot DA in the point of heart failure risk. To our knowledge, this is the first study to evaluate the effect of this group of drugs on subclinical left ventricular systolic function.