Assessment of subclinical left ventricular systolic dysfunction and structural changes in patients with chronic obstructive pulmonary disease.

BACKGROUND: Patients with chronic obstructive pulmonary disease (COPD) can develop left ventricular (LV) systolic dysfunction and geometric changes due to several reasons. AIM: To investigate subclinical LV systolic dysfunction and structural features in patients with COPD, and its correlation with the severity of airway obstruction, identified by GOLD classification. METHODS: We studied 52 patients with COPD and 29 age and sex-matched controls, without any cardiac disease. In addition to conventional echocardiographic evaluation speckle tracking echocardiography (STE)-based strain imaging were performed to analyse sub-clinical LV systolic dysfunction. Also LV volumes were measured by using three-dimensional real time echocardiography (3DRTE). All patients underwent spirometry. RESULTS: Conventional echocardiographic parameters (LV wall thickness and diameters, LV EF) and LV volume measurements were similar between the groups. LV global longitudinal peak systolic strain (-14.76 ± 2.69% to -20.27 ± 1.41%, P < 0.001) and strain rate (0.75 ± 0.25 1/s to 1.31 ± 0.41 1/s, P < 0.001) were significantly impaired in patients, compared to controls demonstrating sub-clinical ventricular systolic dysfunction. Significant positive correlation was obtained between LV strain/strain rate and spirometry parameters (FEV1, FEV%, FEV1/FVC, PEF%) (r = 0.78/0.68, P < 0.001; r = 0.83/0.70, P < 0.001); r = 0.74/0.55, P < 0.001; r = 0.72/0.65, P < 0.001 respectively). In addition, there was significant negative correlation between LV strain/strain rate and GOLD classification (r = -0.80/ -0.69, P < 0.001 respectively). CONCLUSION: Subclinical LV systolic dysfunction can occur in COPD patients despite normal EF. STE is a technique that provides additional information for detailed evaluation of subtle changes in LV myocardial contractility, significantly associated with the severity of the disease in COPD patients.

Evaluation of carotid intima-media thickness and aortic elasticity in patients with nondipper hypertension.

BACKGROUND: The relationship between cardiovascular diseases and the diurnal blood pressure (BP) rhythm was researched in many studies. It has been demonstrated that the nondipping pattern has been associated with target organ damage and worsened cardiovascular outcomes. The aim of our study was to assess the relationship between aortic elasticity parameters and carotid intima-media thickness (CIMT) and diastolic dysfunction in terms of "dipper" and "nondipper" hypertension subtypes. METHODS: A total of 60 hypertensive patients without known coronary heart disease were recruited to our study. All patients were classified as "dipper" or "nondipper" after ambulatory BP follow-up. Patients' left ventricular (LV) systolic and diastolic functions were assessed with transthoracic echocardiography. Ascending aorta diameters and CIMT were measured by ultrasonography and the elasticity parameters of aorta were calculated by using relevant formula. RESULTS: There were no significant differences between the groups with respect to demographic, biochemical data, and cardiovascular risk factors. Aortic stiffness was significantly increased in nondippers, whereas aortic strain and distensibility were significantly decreased (P = 0.005, P = 0.005, and P = 0.024, respectively). Carotid artery IMT was significantly increased in nondippers compared to dippers (P = 0.013). A significant correlation was noted between CIMT and mean BP. No significant difference was detected between 2 groups in terms of LV hypertrophy and diastolic dysfunction. CONCLUSION: In our study, we showed that impairment of aortic elasticity parameters and increase in CIMT as a predictor of end organ damage were more often in the nondipper hypertensive patients.

Impaired endothelial function in patients with Takayasu's arteritis.

OBJECTIVES: Takayasu's arteritis (TAK) is a chronic, inflammatory, large-vessel vasculitis. In this study we aimed to evaluate vascular endothelial function by brachial ultrasonography and to evaluate carotid artery intima-media thickness (CIMT) in patients with TAK compared to systemic lupus erythematosus (SLE) and healthy controls. METHODS: The study included 32 patients with TAK, fulfilling the 1990 Classification Criteria of American College of Rheumatology (ACR), 18 patients with systemic lupus erythematosus (SLE) classified according to the 1982 ACR Criteria and 20 age- and sex-matched controls. Brachial artery Doppler ultrasonography and bilateral CIMT measurements were performed. RESULTS: Basal diameter and nitrate-induced dilatation (NID) values of the brachial artery were similar between the three groups. Flow-mediated dilation (FMD) was markedly reduced in patients with TAK compared to controls (P = 0.0001). CIMT was also significantly increased in the TAK group, compared to the controls (P = 0.0001). In the SLE group, a marked impairment in FMD% was also obtained compared to controls (P = 0.0001). CIMT measurement was similar between the patients with SLE and the controls (P = 0.60, P = 0.05). CONCLUSIONS: We detected significantly decreased FMD and increased CIMT in TAK, suggesting a marked endothelial dysfunction. Both chronic systemic inflammation and vasculitis might lead to endothelial dysfunction and increased atherosclerosis in TAK, suggesting that management of cardiovascular risk factors are also important in the management of vasculitis.

Relationship between endothelial dysfunction and cardiovascular risk factors and the extent and severity of coronary artery disease.

OBJECTIVES: Endothelial dysfunction (ED) is associated with coronary artery disease (CAD) and cardiovascular risk factors. The relationship between cardiovascular risk factors, ED and the presence, extent and severity of CAD, was evaluated in patients with and without angiographically defined CAD in our study. STUDY DESIGN: Eighty patients with CAD and 20 subjects with normal coronary arteries were included. Endothelial function was evaluated by endothelium-dependent, flow-mediated dilatation (FMD) and nitroglycerine-mediated dilatation (NMD) measurements, using brachial artery Doppler ultrasonography (USG). Cardiovascular risk factors were identified. The extent and severity of CAD was determined via vessel and modified Gensini scores. RESULTS: FMD% and NMD% were significantly decreased in the CAD(+) group compared with the CAD(-) group (p=0.0001). In the CAD(+) group, the cut-off values of FMD% and NMD% in distinguishing between single-vessel and multi-vessel diseases were 8.5% (sensitivity: 95%, specificity: 62%) and 13.6% (sensitivity: 91%, specificity: 62%), respectively. Additionally, a modified Gensini score was significantly correlated with both FMD and NMD (r=-0.825, r=-0.778, respectively; p=0.0001) in the CAD(+) group. CONCLUSION: ED was more prevalent in the CAD(+) group, and the degree of ED correlated well with the extent and severity of CAD.

Subclinical left and right ventricular systolic dysfunction in Behcet's disease: a combined tissue doppler and velocity vector imaging study.

BACKGROUND: Behcet's disease (BD) is a chronic inflammatory disease characterized by recurrent oral and genital ulcerations and ocular lesions. Subclinical cardiac involvement may develop in BD patients. We aimed to evaluate subclinical left ventricular (LV) and right ventricular (RV) systolic dysfunction in BD patients without any apparent cardiovascular disease. METHODS: We studied 50 BD patients (43.8 ± 9.7 years, 59% men) and 30 healthy controls (45.4 ± 8.2 years, 60% men). Conventional echocardiography, tissue Doppler imaging, and velocity vector imaging-based strain measurements were performed to analyze LV and RV systolic functions. RESULTS: LV isovolumic myocardial acceleration, peak systolic velocity during isovolumic contraction (isovolumic contraction velocity), were significantly lower, while myocardial performance index was increased in BD patients. RV peak systolic velocity, isovolumic myocardial acceleration, and isovolumic contraction velocity were also markedly lower in BD patients. LV and RV longitudinal peak systolic strain and strain rate were significantly lower in patients than in controls, demonstrating subclinical ventricular systolic dysfunction. CONCLUSIONS: Ventricular long-axis functions are important markers of myocardial contractility. Novel echocardiographic techniques may provide additional data for detecting early deterioration in ventricular systolic function in patients with BD.

Association of serum fetuin-A levels with heart valve calcification and other biomarkers of inflammation among persons with acute coronary syndrome.

PURPOSE: Fetuin-A is a multifunctional hepatic secretory protein that inhibits dystrophic vascular and valvular calcification. Our aim was to evaluate the relationship among fetuin-A levels, heart valve calcification and other biomarkers of inflammation in patients with acute coronary syndrome (ACS). METHODS: The associations among serum fetuin-A concentrations, mitral annular (MAC) and aortic valve calcification and other biomarkers of inflammation (hs-CRP, ferritin, fibrinogen, white blood cell count (WBC), erythrocyte sedimentation rate (ESR), albumin levels) were evaluated in ACS patients and healthy controls. The study included 95 patients (mean age 61.8 ± 12.10 years) and 81 healthy controls (mean age 48.33 ± 9.19 years). RESULTS: Fetuin-A levels were significantly lower in patients with ACS than in healthy controls (0.76 ± 0.23 and 1.10 ± 0.45 g/L, respectively; p < 0.001). Fetuin-A was lower in patients with mitral annular calcification (p = 0.007) and aortic (p = 0.001) valve calcification. In patients with ACS, there was a negative correlation among serum urea (r = -0.377; p < 0.001) and creatinine (r = -0.232; p = 0.024) levels and fetuin-A, and a negative correlation among WBC (r = -0.156; p = 0,132), ESR (r = -0.214; p = 0.037), hs-CRP (r = -0.220; p = 0.032) levels and fetuin-A. A positive correlation was seen between albumin and fetuin-A (r = 0.362; p < 0.001). Multivariate logistic regression analysis revealed that fetuin-A was the variable that had a significant effect on ACS (p = 0.020 OR = .015; (95% CI)(0.000-0.520). CONCLUSION: Fetuin-A levels decrease in patients with acute coronary syndromes, independent of heart valve calcification. Fetuin-A may therefore act as a negative acute phase protein after myocardial infarction.

Assessment of right ventricular endocardial dysfunction in mild-to-moderate mitral stenosis patients using velocity vector imaging.

PURPOSE: Right ventricular (RV) function plays an important role in the development of clinical symptoms, exercise capacity, prognosis, and survival in patients with mitral stenosis (MS). The purpose of this study was to evaluate global and regional RV systolic functions using a novel technique, VVI, in mild-to-moderate MS patients without clinical symptoms of heart failure. METHODS: The study population consisted of 60 patients (mean age 51.7 ± 11.6 years; 85% female) with isolated rheumatic mitral valve stenosis and 40 age- and sex-matched control subjects (mean age 49.1 ± 10.5 years; 76.7% female). Conventional echocardiography, tissue Doppler imaging (TDI), strain (S), and strain rate (SRs) analysis were performed in all patients. RESULTS: Transmitral mean pressure gradient was 6.1 ± 3.0 mmHg and mean mitral valve area was 1.41 ± 0.31 cm(2) in patients with MS. TDI systolic velocity was significantly lower in MS patients compared to control subjects (0.13 ± 0.03 m/sec vs. 0.17 ± 0.03 m/sec; P < 0.0001). RV-isovolumic acceleration was reduced in MS patients (3.75 ± 1.09 m/sec(2) vs. 4.62 ± 1.0 m/sec(2) ; P = 0.006). RV-myocardial performance index was significantly increased in patients with MS (0.75 ± 0.05 in MS and 0.29 ± 0.04 in controls; P < 0.0001) revealing impaired RV systolic and diastolic function. The mean longitudinal peak systolic S and SR were significantly reduced in patients with MS (P < 0.0001). CONCLUSION: Our data revealed that RV systolic performance is reduced in patients with mild-to-moderate MS.

Evaluation of endothelial functions in patients with Behcet's disease without overt vascular involvement.

OBJECTIVES: Behcet's disease (BD) is a chronic inflammatory disease characterized by recurrent oral and genital ulcerations and ocular lesions. This multisystemic disorder primarily affects the vascular system. In the present study, we aimed to evaluate vascular endothelial function in patients with Behcet' s disease without vascular involvement. STUDY DESIGN: We studied 40 patients with BD (44.9±5.4 years) and 20 healthy controls (45.4±8.2 years). Brachial artery Doppler ultrasonography (USG) and bilateral carotid artery intima-media thickness measurements were performed. RESULTS: Basal diameter of the brachial artery were similar between the two groups. However, flow-mediated dilation was markedly impaired in patients with Behcet' s disease (p=0.03). Nitrate-induced dilation values were similar between the two groups (p=0.16). Carotid artery intima-media thickness was slightly increased in the patient group compared to the control group, but the difference did not reach statistical significance (0.69±0.15 to 0.59±0.09 respectively; p=0.06). CONCLUSION: Vascular endothelial function is impaired in BD. Brachial artery Doppler USG is a reliable and reproducible method to establish changes in vascular functions.

Subclinical left ventricular dysfunction in asymptomatic chronic mitral regurgitation patients with normal ejection fraction: a combined tissue Doppler and velocity vector imaging-based study.

BACKGROUND: The optimal timing of the surgery in asymptomatic severe mitral regurgitation (MR) remains a challenge. The aim of the study is to evaluate the subclinical changes in LV longitudinal functions by using a novel strain imaging technique; velocity vector imaging (VVI); in patients with chronic MR. METHODS AND RESULTS: We studied 54 patients with asymptomatic, nonischemic, chronic MR (56.8 ± 9 years and 56% male) and 30 healthy controls (55 ± 6.5 years and 55% male) with normal ejection fraction. Patients with MR were analyzed in tertiles according to their regurgitant volumes (RV) and regurgitant fractions (RF): mild MR (RV < 30 mL, RF < 30% n = 7), moderate MR (RV: 30-59 mL, RF = 30-50%; n = 29), and severe MR (RV > 60 mL, RF ≥ 50%; n = 18). Conventional echocardiography and VVI-based strain imaging were performed to analyze LV functions. LV longitudinal peak systolic strain and strain rate (SRs) were significantly impaired in moderate and severe MR patients. Changes in LV longitudinal deformation were more significant in patients with severe MR. All deformation parameters showed a marked negative correlation with RV (LV Strain r =-0.583, P = 0.0001; LV SR r =-0.408, P = 0.002, respectively). CONCLUSIONS: LV long-axis functions are important markers of LV contractility in MR patients. Novel echocardiographic techniques may provide additional data on subclinical changes in the LV and give way to the optimal timing for the surgery in severe MR patients.

Progressive subclinical left ventricular systolic dysfunction in severe aortic regurgitation patients with normal ejection fraction: a 24 months follow-up velocity vector imaging study.

OBJECTIVES: We aimed to evaluate long-term changes in left ventricular (LV) longitudinal systolic functions in patients with asymptomatic, severe aortic regurgitation (AR) by using novel 2D strain imaging. METHODS AND RESULTS: Thirty severe AR patients with normal ejection fraction (EF) and 30 healthy controls were evaluated by both conventional echocardiography and velocity vector maging (VVI) based strain imaging at baseline and 24 months follow-up. To evaluate LV longitudinal systolic function, segmental peak systolic strain and strain rate (SRs) data were acquired from apical four-chamber, two-chamber and long-axis views. Longitudinal peak systolic strain and SRs of the LV were decreased in patients with severe AR compared to controls at baseline (P = 0.0001). The impairment was more significant in 24 months follow-up (P = 0.0001 for strain, P = 0.01 for SRs). Longitudinal peak systolic strain was significantly correlated with left ventricular end-diastolic (LVEDD; r =-0.42, P = 0.0001) and left ventricular end-systolic diameter (LVESD) (r =-0.41, P = 0.0001) There was also a strong negative correlation between LV SRs and LVEDD (r =-0.50, P = 0.0001), and LVESD (r =-0.39, P = 0.0001). CONCLUSIONS: VVI-derived strain and SRs may be used as adjunctive, noninvasive parameters in the assessment of subclinical LV dysfunction and its progress during clinical follow-up, in patients with severe AR.