Twist deformation for predicting postoperative left ventricular function in patients with mitral regurgitation: A speckle tracking echocardiography study.

PURPOSE: Postoperative LV dysfunction is associated with poor prognosis and increased mortality in patient with mitral regurgitation undergoing surgery. With this study, we aimed to investigate the predictive value of classic and speckle tracking echocardiographic (STE) LV deformational parameters for estimating postoperative LV dysfunction. METHODS: Fifty-nine asymptomatic patients with severe mitral regurgitation (MR) due to mitral valve prolapse, who had sinus rhythm and LV ejection fraction (EF) ≥50%, were included. Patients underwent comprehensive and speckle tracking echocardiographic examination before and 6 months after the surgical procedure. Patients were divided into two groups according to postoperative LV function: group A postoperative LV EF≥50% and group B postoperative LV EF<50%. RESULTS: Patients in group A were found to have higher LV twist (19.7±6.8° vs 11.9±4.2°; P<.001), LV global longitudinal peak strain (GLPS) (-21.7±4 vs -16.5±3.4%; P<.001), and circumferential strain (-19.5±5.2 vs -14.4±5.1%; P=.004) values but lower end-systolic diameter (ESD) (3.2±0.6 vs 4.1±0.9 cm; P<.001) when compared to group B. Multivariate logistic regression analysis revealed that GLPS, ESD, and twist were independent predictors of postoperative LV functions. In the ROC analysis, GLPS ≥18.4% and twist>14.4° predicted postoperative LVEF ≥50%. CONCLUSION: GLPS and twist measured by 2DSTE are predictors of LV preservation after surgery in severe MR. These parameters may also be used as prognostic predictors and optimal timing of operation in this patient population.

[Relationship between D-dimer and systemic embolism in patients with infective endocarditis]. / Enfektif endokarditli hastalarda D-dimer düzeyinin sistemik emboliyle iliskisi.

OBJECTIVES: The aim of this study was to investigate the value of plasma D-dimer (DD) levels for predicting systemic embolism in patients with infective endocarditis (IE). STUDY DESIGN: A total of 42 patients (mean age: 46±16 years; 78% males) with IE were included. Clinical, laboratory and echocardiographic findings of the patients were evaluated. RESULTS: Increased plasma DD levels were determined in 13 patients with systemic embolism (p=0.016). Moreover, when patients were divided in two groups as DD >500 ng/dl and DD <500 ng/dl, systemic embolism was increased in the DD >500 ng/dl group (p=0.036). Receiver operating characteristics (ROC) curve analysis was performed to detect the best cut-off value of DD in the prediction of systemic embolism. DD >425 ng/dl yielded an area under the curve (AUC) value of 0.735 (95% CI 0.560-0.909, p=0.016). DD >425 ng/dl demonstrated a sensitivity of 77% and specificity of 62% for the prediction of clinical embolism. Hematocrit (r=-0.31, p=0.045), platelet count (r=-0.40, p=0.009), albumin (r=-0.37, p=0.026), and globulin (r=0.38, p=0.028) levels were correlated with DD levels. CONCLUSION: Plasma DD levels are increased in patients with IE who suffered from clinically significant systemic embolism. Further studies are needed to determine the predictive value of DD levels for clinically silent systemic embolism.

Multimodality imaging of a giant caseous calcification of the mitral annulus.

We present an unusual case of giant caseous calcification of the mitral annulus in a 58-year-old female patient. The mass was detected during echocardiography and was defined as a big, round echodense lesion attached to the posterior mitral ring annulus. The patient was further evaluated with a full spectrum of cardiac noninvasive imaging modalities and the diagnosis was confirmed. Caseous calcification of the mitral annulus is a rare entity usually diagnosed by transthoracic echocardiography. Since it is very important to differentiate it from cardiac tumors, complimentary imaging modalities could be used for this purpose if a doubt exists about the diagnosis.