Changes in Aortic Pulse Wave Velocity and the Predictors of Improvement in Arterial Stiffness Following Aortic Valve Replacement.

BACKGROUND: The interaction between valvular aortic stenosis (AS) and arterial stiffness, as well as the impact of aortic valve replacement (AVR) on arterial stiffness, remains unclear. In this study, we aimed to evaluate the degree of AS severity on non-invasive pulse wave velocity (PWV) measurements. We also searched whether the AVR procedure favorably affects PWV. METHODS: In all, 38 patients undergoing AVR for chronic AS were included. The degree of aortic stiffness was measured with PWV at both baseline and 6 months after AVR. Improvement in aortic stiffness was defined as the absolute decrease in PWV at 6 months compared to the baseline value. RESULTS: The study population had a mean age of 59 ± 16 years, mean aortic gradient of 47.1 ± 6.4 mmHg, and mean aortic valve area (AVA) index of 0.45 ± 0.11 cm² /m² . Baseline PWV values correlated positively with the mean aortic gradient (r = 0.350, p = 0.031) and negatively with the AVA index (r = -0.512, p = 0.001). The mean PWV improved in 20 patients (53%) and worsened in 18 patients (47%). The baseline New York Heart Association (NYHA) class (odds ratio [OR] = 1.023, 95% confidence interval [CI] = 1.005-1.041, p = 0.041) and AVA index (OR = 1.040, 96% CI = 1.023-1.057, p = 0.028) emerged as the independent predictors of improvement in PWV following AVR. CONCLUSION: The severity of AS was significantly associated with baseline PWV. In general, the mean PWV did not change with AVR. Baseline NYHA class and the AVA index independently predicted PWV improvement following AVR. Since the change in PWV after AVR was polarized based on the patients' characteristics, such as preoperative NYHA functional class or AVA index, further studies are needed to confirm clinical significance of PWV change following AVR in severe AS patients.

Prediction of infarct size using two-dimensional speckle tracking echocardiography in acute myocardial infarction.

BACKGROUND: This study aimed to determine the myocardial damage (infarct size provided by cardiac single-photon emission tomography) in early stages of the infarction using longitudinal strain and rotational parameters of the left ventricle. METHODS: The study included 66 patients with anterior myocardial infarction (AMI) and 62 patients with inferior myocardial infarction (IMI) who underwent primary percutaneous intervention as well as a control group consisting of 50 healthy subjects. LV rotational parameters based on parasternal short-axis views in basal and apical planes and global longitudinal strain were measured with apical four-chamber, apical two-chamber, and apical long-axis views. RESULTS: There was a significant positive correlation between infarct size and GLPSavg (r=-.55 <.001), GTOR angle (r=-.52, P<.001), apical rotation angle (r=-.40 <.001, and EF (r=-.43, <.001). While cutoff values were GLPSavg: 11.9 (AUC=0.78), GTOR angle: 11.4° (AUC=0.77), apical rotation angle: 7.1° (AUC=0.76) for patients with an infarct size greater than 20%, the cutoff values were GLPSavg: 10.7 (AUC=0.75), GTOR angle: 8.7° (AUC=0.86), apical rotation angle: 4.35° (AUC=0.87) for those with an infarct size greater than 40%. CONCLUSION: GLPSavg, GTOR angle, and apical rotation angle values may be used to determine the extent of infarction in early post-MI period, thereby allowing precautions to be taken for remodeling in early stages.

Percutaneous Retrieval of an Embolized Catheter Tip With the Balloon Dilatation Technique.

INTRODUCTION: Increasing numbers of complex percutaneous coronary interventions have been accompanied by various intra-procedural complications. The fracture and embolization of devices or their fragments are potentially life-threatening situations, depending on the site of embolization. Different non-surgical methods to handle embolic complications have been proposed for different clinical situations. CASE PRESENTATION: We present a case of a distally embolized catheter fragment that was percutaneously retrieved. The catheter fragment was tightly held by the inflated balloon, moved together with the system, and successfully retrieved out of the circulation via the femoral sheath. Considerable distal embolization of the foreign body and retrieval with the balloon dilatation technique are the unique features of this case. CONCLUSIONS: The present case appears to offer a safe and relatively simple method of balloon dilatation inside the lumen of the embolized fragment when the foreign body is too distal to retrieve with conventional snare systems.

QRS prolongation after cardiac resynchronization therapy is a predictor of persistent mechanical dyssynchrony.

PURPOSE: Prolonged QRS duration is the main selection criterion for cardiac resynchronization therapy (CRT) which ameliorates left ventricular mechanical dyssynchrony (MD). However, consequences of post-CRT QRS prolongation and residual MD have been poorly evaluated. We aimed to define the predictors of persistent MD and hypothesized that CRT-induced QRS change (ΔQRS) might have an impact on residual MD after CRT. METHODS: A total of 80 patients receiving CRT were included in the study. ΔQRS was calculated as the difference between the baseline and paced QRS intervals. Residual MD was assessed early after device implantation with a longitudinal dyssynchrony index (Yu index). Significant MD was defined as a Yu index ≥ 33 msec. Two groups were created based on residual MD and compared according to clinical, electrocardiographic and echocardiographic features. RESULTS: Patients with persistent MD had longer paced QRS durations (182.5 ± 16.2 vs. 165.4 ± 22.5 msec, p = 0.03) and were less likely to have left ventricular (LV) leads located in the posterolateral vein (53 % vs. 85 %, p = 0.002). The linear correlation between the ΔQRS and the Yu index values was modest (Spearman's rho = -0.341, p = 0.002); additionally, a prolonged QRS was strongly associated with MD after CRT (p = 0.00008). Both LV lead localization and CRT-induced QRS prolongation emerged as the significant predictors of persistent MD. A biventricularly paced QRS more than 10 msec longer than the pre-paced QRS width was predictive of persistent MD after CRT (sensitivity = 80 %, specificity = 62 %). CONCLUSIONS: ΔQRS was found to be associated with residual MD after CRT. Ten milliseconds of QRS prolongation predicted persistent MD after CRT.

Tako-tsubo cardiomyopathy following catheter ablation of atrial fibrillation.

Tako-tsubo cardiomyopathy is characterized by reversible left ventricular dysfunction following emotional or surgical stress. Unlike the well-known complications of catheter ablation (CA) of atrial fibrillation (AF), Tako-tsubo cardiomyopathy has been rarely reported so far. We report a case of acute reversible left heart failure following successful CA of paroxysmal AF in a patient with a history of panic disorder.

Atrial longitudinal strain parameters predict left atrial reverse remodeling after mitral valve surgery: a speckle tracking echocardiography study.

Volume overload in chronic severe mitral regurgitation (MR) causes left atrial (LA) remodeling. Volume overload generally diminishes after mitral valve surgery and LA size and shape are expected to recover. The recovery of LA functions named as reverse remodeling is said to be related with prognosis and mortality. A few clinical and echocardiographic parameters have been reported to be associated with LA reverse remodeling. In this study, we investigated the relationship between LA peak longitudinal strain (reservoir strain) assessed with 2-dimensional speckle tracking echocardiography (2D STE) and LA reverse remodeling. 53 patients (24 females and 29 males, mean age: 45.7 ± 13.5 years) with severe MR and preserved left ventricular systolic function were included in the study. All patients had normal sinus rhythm. The etiology of MR was mitral valve prolapse (MVP) in 37 patients and rheumatic valvular disease in 16 patients. Mitral valve repair was performed in 30 patients while 23 underwent mitral valve replacement. Echocardiography was performed before the surgery and 6 months later. LA peak atrial longitudinal strain (PALS) was assessed with speckle tracking imaging. LA reverse remodeling was defined as a percent of decrease in LA volume index (LAVI). Left atrial volume index significantly decreased after surgery (58.2 ± 16.6 vs. 43.9 ± 17.2 ml/m2, p ≤ 0.001). Mean LAVI reduction was 22.5 ± 27.2%. There was no significant difference in LAVI reduction between mitral repair and replacement groups (22.1 ± 22.6 vs. 23.1 ± 32.8 %, p = 0.9). Although the decrease in LAVI was higher in MVP group than rheumatic group, it was not statistically significant (24.4 ± 26.8 vs. 18.2 ± 28.9%, p = 0.4). Correlates of LAVI reduction were preoperative LAVI (r 0.28, p = 0.039), PALS (r 0.36, p = 0.001) and age (r -0.36, p = 0.007). Furthermore, in multivariate linear regression analysis (entering models), preoperative LAVI, age and PALS were all significant predictors of LA reverse remodeling (p ≤ 0.001, p = 0.04, p = 0.001 respectively). Left atrial peak longitudinal strain measured by 2D STE, in conjunction with preoperative LAVI and age is a predictor of LA reverse remodeling in patients undergoing surgery for severe MR. We suggest that in this patient population, PALS may also be used as a preoperative prognostic marker.

[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.

Left atrial longitudinal strain parameters predict postoperative persistent atrial fibrillation following mitral valve surgery: a speckle tracking echocardiography study.

Postoperative atrial fibrillation (POAF) is common after cardiac surgery and is associated with increased morbidity, mortality, and prolonged hospital stay. Speckle tracking echocardiography (STE) has been applied recently for evaluation of LA function. The purpose of this study was to examine whether left atrial longitudinal strain measured by STE is a predictor for the development of POAF following mitral valve surgery for severe mitral regurgitation. We studied 53 patients undergoing mitral valve surgery in sinus rhythm at the time of surgery. Echocardiography with evaluation of LA strain by STE was performed. Detection of POAF was based on documentation of AF episodes by continuous telemetry throughout hospitalization. Patients who did not develop POAF were taken as group 1 and those who had POAF constituted group 2. The echocardiographic and clinical predictors of POAF were investigated. POAF occurred in 28.3% of subjects. Mean age, LAVi and BNP were found higher in group 2 while peak atrial longitudinal strain (PALS) (13.9 ± 3.8% vs. 24.8 ± 7.3%; P < 0.001), peak atrial contraction strain (PACS) (7.6 ± 1.95% vs. 11.3 ± 3.5%; P < 0.001) were significantly lower. By multivariate logistic regression analysis, PALS and LAVi were independent predictor of POAF development. LA longitudinal strain was found to predict POAF in patients undergoing mitral valve surgery. It could be used to better identify patients at greater risk of developing POAF, and thus to guide in risk stratification and to take appropriate intensive prophylactic therapy.

Assessment of ST-elevation myocardial infarction-related diastolic dysfunction with compensatory rise in left atrial ejection force.

BACKGROUND: It is well known that patients with ST-elevation myocardial infarction (STEMI) show both systolic and diastolic left ventricular dysfunction. The aim of this study was to assess post-myocardial infarction diastolic dysfunction using left atrial ejection force (LAEF) in patients treated with primary percutaneous coronary intervention (PCI). METHODS AND RESULTS: We enrolled 58 patients presenting with STEMI who were treated with primary PCI and 23 healthy subjects as a control group. A detailed transthoracic echocardiogram, including mitral flow velocities, tissue Doppler mitral annular velocities, and left atrial (LA) phasic volumes, was performed in both groups. We also measured the level of B-type natriuretic peptide (BNP). LAEF was calculated using the formula: 0.5 × P × Mitral orifice area × (Peak A velocity)(2) . Correlations between variables were studied using "Pearson and Spearman's rho" test. In the test group, we found that the level of BNP in the plasma, E/E' ratio, and the LA volume measurements were higher than that of the control group, and those differences were statistically significant. LAEF was increased in patients with myocardial infarction (MI); moderately correlated to BNP (r = 0.383 and P = 0.001) and E/E' (r = 0.473 and P = 0.001), and strongly correlated to A-wave velocity (r = 0.731 and P = 0.001). LAEF was also negatively correlated to E/A ratio (r = -0.419 and P = 0.001) and LVEF (r = -0.339 and P = 0.003). CONCLUSION: Impaired diastolic function in STEMI affects LA and increased LAEF is one of its manifestations. LAEF may also have diagnostic importance in diastolic dysfunction, but these findings should be confirmed by further studies.