The effect of dialysis type on left atrial functions in patients with end-stage renal failure: A propensity score-matched analysis.

INTRODUCTION: Despite the widespread use of both hemodialysis (HD) and peritoneal dialysis (PD), there is no study comparing the effects of these dialysis methods on the left atrial (LA) volume and functions. In this study, we investigated the impact of different dialysis methods on the LA volume and function in the patients exposed to chronic pressure overload and volume overload. METHOD: This study was carried out on the patients who received dialysis treatment at our healthcare center between March, 2015 and January, 2016. Twenty-eight patients receiving hemodialysis (HD) treatment and 24 patients under PD treatment were enrolled into the study. Patients were divided into 2 groups according to the dialysis therapy, and the atrial volumetric and mechanical functions were investigated. RESULTS: As the basal demographical characteristics of patients in the PD and HD groups were significantly different, 44 patients matched on a 1:1 basis were taken for final analysis (22 HD, 22 PD, and the average age of 42.4 ± 4.8; 73% was male). After propensity score matching analysis, it was determined that left atrial volume index (LAVi) was higher in the HD group while peak LA strain and LA contraction strain were higher in the PD group. Additionally, both strain parameters showed a good negative correlation with LAVi. CONCLUSION: We demonstrated that the left atrial structure and functions were better in the PD group suggesting that PD may be a relatively better option for the preservation and maintenance of the left atrial functions as compared to HD.

Comparison of the three conventional methods for the postoperative atrial fibrillation prediction.

INTRODUCTION: Although various risk factors have been defined for the development of postoperative atrial fibrillation (PAF), these parameters have not been adequately verified and validated. We investigated the atrial fibrillation detection capabilities of echocardiographic parameters in PAF developing and the determination of predictive values for clinical use. METHOD: We enrolled 60 consecutive patients with 234 lesions who underwent CABG surgery. All patients underwent preoperative echocardiographic evaluation. Patients were divided into two groups according to PAF development status. RESULTS: The mean age of the patients was 67, and 73% were male and PAF occurred in 19 patients. In univariate analysis, left atrial volume index (LAVi), left ventricular global strain (LVGS) and ejection fraction were associated with PAF development. Parameters which were significant in univariate analysis were included in a logistic regression model to determine the independent predictors of PAF. LAVi was found to be an independent predictor of PAF. CONCLUSION: Although several parameters have been defined for PAF development, LAVi is more advantageous than the other conventional methods in clinical decision making.

Assessment of Left Atrial Mechanics in Patients with Preexcitation Syndrome Scheduled for Catheter Ablation.

OBJECTIVES: We aimed to test the left atrial (LA) mechanics and contraction synchrony by 2D strain imaging, in patients with Wolff-Parkinson-White (WPW) syndrome, before and after radiofrequency catheter ablation (RFCA). METHODS: Study population consisted of 25 patients with WPW scheduled for RFCA and 30 healthy controls. The peak LA strain at the end of the ventricular systole (LAs strain) and the LA strain with LA contraction (LAa Strain) were obtained. To assess LA dyssynchrony, septal versus lateral wall time-to-peak strain measurements were measured. RESULTS: There was no difference between the patients with WPW and control subjects with regard to peak LAs and LAa strain. Patients with WPW demonstrated higher global time-to-peak LAs and LAa strain values compared with the control group. Peak LAs strain and LAa strain values, measured before and after the RF ablation of the accessory pathway, were comparable (34.3 ± 3.92 vs. 34.6 ± 3.2, P = 0.816, 14.7 ± 2.8 vs. 15.3 ± 2.3, P = 0.052, respectively). Global time-to-peak LAs and LAa strain measurements were significantly shorter after the RFCA compared with the values obtained before the RFCA. However, septo-lateral times to peak LA strain differences were found to be comparable in both WPW versus control and pre- versus postablation groups. CONCLUSION: LA mechanical function assessed by 2D strain imaging was comparable between patients with WPW and control subjects. Patients with WPW had more prominent LA dyssynchrony during atrial pump phase as compared with the controls, a condition which could not improve after successful elimination of the accessory pathway by RFCA.

A diagnostic dilemma: early repolarization syndrome associated with ventricular fibrillation.

An early repolarization (ER) pattern, characterized by J-point elevation, slurring of the terminal part of the QRS and ST-segment elevation, is a common finding on the 12-lead electrocardiogram. It has been suggested that J-point elevation, which was considered benign for many years, may play a critical role in the pathogenesis of idiopathic ventricular fibrillation (VF). Recent studies have shown that an ER pattern in inferior leads or inferolateral leads is associated with increased risk for life-threatening arrhythmias. We report the case of a 52-year-old man with no structural heart disease whose electrocardiogram showed type 2 ER pattern (with evidence of J-point and ST-segment elevation in electrocardiogram leads II, III, and aVF). The patient presented with VF.

Successful Percutaneous Closure of an Aorto-right Ventricular Fistula After Sutureless Aortic Valve Replacement: A Case Report.

Rupture of a sinus of valsalva aneurysm (SVA) and the development of an aorto-right ventricular fistula (ARVF) is a rare condition, associated with high morbidity and mortality rates if left untreated. Opening of the SVA rupture into the right heart chambers may result in various morbidities, such as pulmonary hypertension. We present a case of a patient who developed ARVF following sutureless aortic valve replacement, and was subsequently treated successfully via a percutaneous approach.

Rosuvastatin versus atorvastatin to prevent contrast induced nephropathy in patients undergoing primary percutaneous coronary intervention (ROSA-cIN trial).

AIM: We aimed to compare the incidence of contrast-induced nephropathy (CIN) between atorvastatin versus rosuvastatin in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary coronary angioplasty. METHODS: One hundred ninety-two consecutive patients, who underwent primary percutaneous intervention (p-PCI) with the diagnosis of STEMI, were included in the study. The patients were randomized to take atorvastatin 80 mg (n=98) or rosuvastatin 40 mg (n= 94) before the procedure. Biochemical and complete blood count measurements were done at baseline and at 48 hours following admission. RESULTS: The incidence of CIN was 8.9% (n= 17) in the entire groups. The analysis performed between the statin groups revealed no statistical difference in any of the renal dysfunction indicators [baseline creatinine, baseline estimated glomerular filtration rate (eGFR), creatinine at 48 h, eGFR at 48 h, difference between baseline and 48 h creatinine, the per cent increase in the creatinine at 48 hours relative to basal creatinine]. In STEMI patients undergoing primary PCI, only the amount of the contrast agent administered was determined to be an independent predictor for CIN (OR and 95% CI: 1.08 (1.03- 1.13), P< or = 0.001). Left ventricular ejection fraction exhibited borderline statistical significance (OR and 95% CI: 0.88 (0.77-1.01), P= 0.07). CONCLUSION: Atorvastatin and rosuvastatin had similar efficacy in preventing CIN in patients with STEMI undergoing P-PCI.

Assessment of right ventricular mechanics in patients with mitral stenosis by two-dimensional deformation imaging.

BACKGROUND: It is well known that right ventricular (RV) dysfunction occurs early before clinical systemic congestion in patients with mitral stenosis (MS). Therefore, we aimed to evaluate the role of two-dimensional (2D) strain imaging in the assessment of subclinical RV dysfunction. METHODS: Fifty-nine patients with isolated MS (mild and moderate) and 31 healthy control subjects constituted the study population. RV peak longitudinal strain (RV-LS) and strain rate (RV-LSr) measurements were obtained from apical four-chamber view. RESULTS: There were no significant differences in left ventricular ejection fraction (LV-EF) and RV fractional area change between control and MS groups. RV strain (23.5 ± 7.2 vs. 18.63 ± 6.3, P = 0.001) and RV strain rate (1.72 ± 0.54 vs. 1.37 ± 0.66, P = 0.01) measurements were significantly lower in patients with MS than the control group. However, RV strain and strain rate measurements were comparable between MS subgroups. Correlation analysis revealed that there was poor correlation between RV-LS/LSr and mean-maximum gradients and echoscore but moderate correlation between RV-LS and RV-Sr in systolic pulmonary artery pressure and planimetric mitral valve area. CONCLUSION: We demonstrated that patients with MS had lower RV functions using 2D strain imaging and this is independent from severity of MS. In the detection of subclinical RV dysfunction in patients with MS, 2D strain imaging appears to be useful. (Echocardiography, 2012;00:1-6).

Comparison of transthoracic and transesophageal 2-dimensional speckle tracking echocardiography.

OBJECTIVES: Two-dimensional (2D) strain imaging has been established as a reliable and reproducible technique for the assessment of left and right ventricular function using transthoracic echocardiography (TTE). However, the reproducibility of transesophageal echocardiographic (TEE) 2D strain imaging and the agreement with TTE 2D strain imaging remains unclear. In the present study, the authors studied the reproducibility of TEE 2D strain imaging parameters. DESIGN: A comparative, observational clinical study. SETTING: The echocardiography laboratory of the tertiary referral center. PARTICIPANTS: Healthy individuals with a suspected patent foramen ovale. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Thirty-four patients were included in the study. None of the patients had any structural cardiovascular disease. TTE and TEE images of the subjects were recorded and analyzed offline (EchoPAC 6.1; GE Vingmed Ultrasound AS, Horten, Norway). Longitudinal strain and strain rate measurements of the 4 chambers, the apical long axis, 2 chambers, and the right ventricle were obtained for each record of TTE and TEE. The mean age of the patients in this study was 36 ± 9.2 years. Bland-Altman analysis showed that there were generally good agreements between strain and strain rate measurements on TEE and TTE. The inter- and intraobserver agreement for TEE parameters was good. CONCLUSIONS: Transesophageal 2D strain imaging is a reproducible method to measure ventricular function and has a good agreement with TTE 2D strain imaging.

[Assessment of multivariate logistic regression analysis in articles published in Turkish cardiology journals]. / Türk kardiyoloji dergilerinde yayimlanan çalismalarda çokdegiskenli lojistik regresyon analiz yönteminin degerlendirilmesi.

OBJECTIVES: We aimed to assess the use and reporting-quality of multivariate logistic regression analysis (MVLRA) in articles published in two Turkish cardiology journals. STUDY DESIGN: We reviewed all original articles published in two Turkish cardiology journals (The Anatolian Journal of Cardiology and Archives of the Turkish Society of Cardiology) between January 2010 and August 2011. The articles that used MVLRA were analyzed comprehensively based on 10 predefined criteria. RESULTS: A total of 212 articles were reviewed, of which MVLRA was used in 33 (15.6%). Twenty-nine articles (87.9%) properly included the main components of the MVRLA, namely, odds ratios, 95% confidence intervals, and p values. However, none of the articles reported MVRLA-related data such as the modeling type, validation, goodness-fit, multicollinearity and interaction tests. There were severe reporting flaws and faults as to the ratio of the total number of events or sample size to the number of independent variables included into the MVLRA model, the use of fitness procedures, and how the independent variables were selected. CONCLUSION: Our results indicate that MVLRA has become a standard statistical method in the Turkish cardiology literature. However, overall reporting of MVLRA data still has seriously inadequate and inaccurate aspects.

Reproducibility of syntax score: from core lab to real world.

AIMS: Syntax score is a significant tool in the management of complex coronary artery disease (CAD). This score is based on visual assessment of coronary lesions via coronary angiograms. It has some limitations due to its visual assessment. Therefore, interobserver and intraobserver agreement should be tested. METHODS: One hundred twenty-two coronary angiograms were examined, and 76 in whom critical lesions were detected in the coronary arteries were included the study. Coronary angiograms were assessed by 2 independent interventional cardiologists. After 8 weeks, the same interventional cardiologists reassessed coronary angiograms by randomly choosing 30 patients from the first analysis. RESULTS: For numeric Syntax score value, both interobserver and intraobserver variability shows perfect agreement but interobserver variability shows high mean difference. Syntax score was analyzed in terms of tertiles (≤22, >22 -≤32, >32), it has moderate agreement for interobserver variability (weighted kappa value of 0.56) and substantial agreement for intraobserver variability (weighted kappa value of 0.69). CONCLUSION: The Syntax score reproducibility is within acceptable limits in real world clinical practice and it may become a significant tool in complex CAD management. (J Interven Cardiol 2011;24:302-306).

Severity of mitral stenosis and left ventricular mechanics: a speckle tracking study.

BACKGROUND: It has been shown that mitral stenosis (MS) impairs left ventricular (LV) systolic function; however, this issue has not been studied comprehensively. We aimed to evaluate the role of 2D strain in the assessment of subclinical LV systolic dysfunction in patients with MS. METHODS: Seventy-two patients with isolated MS (mild, moderate and severe) and 31 healthy control subjects constituted the study population. 2D echocardiography images were obtained from LV apical 4-chamber (4C), long axis (LAX), and 2-chamber (2C) views. Peak longitudinal strain and strain rate (Sr) were obtained from 4C, LAX, and 2C views. Global strain and Sr were calculated by averaging the three apical views. RESULTS: There were no significant differences in LV ejection fraction and LV systolic or diastolic dimensions between the groups. Patients with MS had significantly lower LV longitudinal strain and Sr measurements than the control group. In addition, there were no significant differences in MS subgroups with respect to LV strain and Sr measurements. CONCLUSION: We demonstrated that patients with MS had lower LV functions using 2D strain imaging, and this is independent of the hemodynamic severity of MS. In the detection of subclinical LV dysfunction in patients with MS, 2D strain imaging appears to be useful.

[Assessment of left ventricular functions with strain and strain rate echocardiography and tissue Doppler imaging in patients with cardiac tamponade]. / Kardiyak tamponatli hastalarda sol ventrikül fonksiyonlarinin gerilim (strain) ve gerilim hizi (strain rate) ekokardiyografi ve doku Doppler görüntüleme ile degerlendirilmesi.

OBJECTIVES: We evaluated left ventricular (LV) myocardial functions with strain (S) and strain rate (Sr) echocardiography and tissue Doppler imaging (TDI) before and after pericardiocentesis in patients with cardiac tamponade. STUDY DESIGN: The study included 27 patients (19 men, 8 women; mean age 51.4 ± 16.3 years) who underwent pericardiocentesis following clinical and echocardiographic diagnosis of cardiac tamponade. Besides echocardiographic parameters of LV functions, S/Sr parameters and TDI velocities were measured before and five days after pericardiocentesis, including peak systolic S, peak systolic Sr (Sr-s), peak early diastolic Sr (Sr-e), peak late diastolic Sr (Sr-a), peak lateral and septal mitral annular systolic (Sm), early diastolic (E'), and late diastolic (A') velocities. RESULTS: Pericardiocentesis was successful in all the patients, resulting in significant patient comfort and symptomatic improvement. In segmental analysis, there were no significant differences in peak systolic S and Sr values obtained before and after pericardiocentesis (p>0.05), except for basal lateral segment S and apical anterior segment Sr-s values (p<0.05). After pericardiocentesis, Sr-e and Sr-a values measured in all the walls and segments, and TDI-derived lateral and septal mitral E' and A' velocities showed significant decreases (p<0.05). All these changes demonstrated by S and Sr echocardiography corresponded well to those obtained by TDI. CONCLUSION: We concluded that S and Sr echocardiography was not superior to TDI in the assessment of LV functions in patients with cardiac tamponade.

[The association of coronary slow flow with time to peak systolic strain]. / Koroner yavas akimin zirve sistolik gerilim (strain) süresi ile iliskisi.

OBJECTIVES: Tissue deformation time is an important factor in regional myocardial contractile functions. The aim of this study was to evaluate the association of coronary slow flow (CSF) with time to peak systolic strain. STUDY DESIGN: The study included 25 patients (23 men, 2 women; mean age 48.4±11.9 years) who were found to have CSF on coronary angiography and 20 healthy controls (16 men, 4 women; mean age 51±11.3 years) with normal coronary angiograms. Coronary slow flow was determined using the TIMI frame count (TFC) method. Echocardiographic recordings were obtained from standard apical and parasternal views. Color Doppler myocardial images were acquired at 160-200/sec frame rates. Time to peak systolic strain was measured from the basal, mid, and apical segments of all left ventricular walls. RESULTS: There were no significant differences between the patients and controls with respect to left ventricular systolic functions (ejection fraction 67±5% vs. 66±4%). TIMI frame counts were greater in the CSF group compared to the controls (left anterior descending artery 42.8±7.7 vs. 17.9±3.5; circumflex artery 37.7±6.5 vs. 16.6±2.9; right coronary artery 41.2±6.4 vs. 17.3±2.7, respectively; p<0.001). All peak systolic strain values measured at 18 segments of the left ventricle walls on color Doppler myocardial images were significantly higher in the CSF group compared to the controls (p<0.001). In both groups, the mean peak systolic strain values obtained in the same walls were shorter in the mid segments compared with basal segments (p<0.05), but mid and apical segments did not differ significantly in this respect (p>0.05). CONCLUSION: Our study is the first to demonstrate prolonged peak systolic strain times in CSF. This prolongation might be used as a predictor for the deterioration of regional myocardial contractile functions in CSF patients.

[Assessment of regional left ventricular functions by strain and strain rate echocardiography in type II diabetes mellitus patients without microvascular complications]. / Mikrovasküler komplikasyonu olmayan tip II diabetes mellituslu hastalarda bölgesel sol ventrikül fonksiyonlarinin gerilim (strain) ve gerilim hizi (strain rate) ekokardiyografi ile degerlendirilmesi.

OBJECTIVES: We evaluated regional left ventricular myocardial functions by strain (S) and strain rate (Sr) echocardiography in patients with type II diabetes mellitus (DM) without microvascular complications. STUDY DESIGN: The study included 40 DM patients (20 women, 20 men; mean age 52.4 ± 7.9 years) without microvascular complications, and 40 healthy controls (20 women, 20 men; mean age 52.8 ± 10.1 years). Left ventricular functions were evaluated by conventional Doppler, tissue Doppler, and S-Sr echocardiography. Longitudinal peak systolic S and Sr were measured from the basal, mid and apical segments of the left ventricle walls. Patients with DM duration of >3 years (n=24) and receiving medical therapy for DM (n=30) were also evaluated. RESULTS: Conventional Doppler findings were similar in the patient and control groups. Among tissue Doppler variables, only early diastolic mitral annular velocity (Em) was significantly decreased (10 ± 2.9 vs. 11.4 ± 3.2 cm/sec, p<0.05), and accordingly, mitral inflow E/Em ratio was significantly increased (7.3 ± 2.5 vs. 6.3 ± 2, p<0.05) in patients with DM. The two groups were similar with respect to systolic S and Sr values, except for apical-lateral S, mid-anterior S, basal-anteroseptal S, apical-anterior Sr, and mid-anteroseptal Sr (p<0.05, for all). Patients with DM duration of >3 years and receiving medical therapy showed similar changes as the overall patient group. CONCLUSION: The frequency of left ventricular diastolic dysfunction was higher in patients with DM. Irregular distribution of systolic S and Sr indices in the left ventricular segments may indicate that DM leads to heterogeneous myocardial involvement also in the early period.

Ventricular double rupture case of long-term survival without surgical repair.

A 78-year-old asymptomatic male with a history of coronary artery disease was admitted for preoperative cardiovascular evaluation before noncardiac surgery. Auscultation revealed a Grade 3 holosystolic murmur at the left parasternal area. Transthoracic echocardiography documented ventricular double rupture (VDR), consisting of ventricular septal rupture, and rupture of the apical part of the left ventricular free wall with pseudoaneurysm formation. Hospital records revealed that VDR had been noticed 7 years ago during hospitalization due to anterior myocardial infarction. However, recommended surgical repair could not be performed because of the patient's refusal.

Effects of high altitude and sea level on mean platelet volume and platelet count in patients with acute coronary syndrome.

A relationship exists between exposure to high altitude and increased coagulability. Mean platelet volume is a parameter of platelet functions and may be a marker for increased platelet aggregability. The aim of this study was to compare the mean platelet volumes and platelet counts in patients who experienced an acute coronary event at moderately high altitude and at sea altitude. Four hundred and one patients who experienced an acute coronary event were enrolled, of them 211 were born and had been living at the sea level, while 190 were born and had been living at high altitude (at least 2,000 m above the sea level). Patients were compared regarding the mean platelet volumes and platelet counts. The mean platelet volumes were significantly higher in patients living in high altitude (P = 0.001). No statistically significant differences were found among the groups regarding the platelet counts. As a result, this increased MPV values in highlanders who experienced an acute coronary event may reflect increased platelet aggregability.

Three-dimensional imaging of a comma-shaped right ventricular hydatid cyst.

We report herein a hydatid cyst of the right ventricle and its two- and three-dimensional echocardiographic appearance.

Relation of multicenter automatic defibrillator implantation trial implantable cardioverter-defibrillator score with long-term cardiovascular events in patients with implantable cardioverter-defibrillator.

OBJECTIVE: To test the hypothesis that multicenter automatic defibrillator implantation trial (MADIT) - implantable cardioverter-defibrillator (ICD) scores predict replacement requirement and appropriate shock in a mixed population including both primary and secondary prevention and long-term adverse cardiovascular events. METHODS: The study has a retrospective design. Patients who were implanted with ICD in the cardiology clinic of Atatürk University Faculty of Medicine between 2000 and 2013 were included in the study. For this purpose, 1394 patients who were implanted with a device in our clinic were reviewed. Then, those who were implanted with permanent pacemaker (n=1005), cardiac resynchronization treatment (CRT) (n=45) and CRT-ICD (n=198) were excluded. RESULTS: A total of 146 patients (98 males, 67.1%) with a mean age of 61.1 (±14.8) years were recruited. The median follow-up time was 21.5 months (mean 30.6±25.9 months; minimum 4 months, and maximum 120 months). The median MADIT-ICD scores in the patients were 2. MADIT-ICD scores were categorized as low in 15.1%, intermediate in 57.5%, and high score in 27.4% of patients. Accordingly, MADIT-ICD scores (1.29 [1.00-1.68], p=0.050), hemoglobin (0.86 [0.75-0.99], p=0.047), and left ventricular ejection fraction (EF) (0.97 [0.94-0.99], p=0.023) were determined as independent predictors of major adverse cardiovascular events in the long-term follow-up of ICD-implanted population. CONCLUSION: In this study, we showed that there was an independent association of long-term adverse cardiovascular events with MADIT-ICD score, hemoglobin, and EF in patients implanted with ICD.

Comparison of serum levels of inflammatory markers and allelic variant of interleukin-6 in patients with acute coronary syndrome and stable angina pectoris.

OBJECTIVES: Although the relationship between atherosclerosis and inflammatory cells has been recognized in recent years, the effect of interleukin-6 (IL-6) genetic variants associated with atherosclerosis is still controversial. Therefore, we investigated the association between IL-6 polymorphism and levels of IL-6 in patients with coronary artery disease (CAD). METHODS: We conducted a case-control study on 294 unrelated participants who were referred to the cardiology department of the university hospital for coronary angiography because of suspected ischemic heart disease. Group I comprised patients with clinically acute coronary syndrome, and group II comprised patients (individuals matched for age and sex) with clinically stable angina pectoris; both groups were categorized, based on their angiographic findings, as either having angiographically documented less extensive CAD (1 vessel narrowed) or extensive CAD (> or =2 vessels narrowed). They were studied to examine effect of the IL-6 gene variants in CAD. Genotyping was determined by polymerase chain reaction. RESULTS: The IL-6 G/C-174 polymorphism was found in 19 of 106 (18%) in group I and in four of 188 (2%) in group II (P<0.001). Median IL-6 levels were significantly higher in group I (6.7+/-13.6 pg/ml) than in group II (4.1+/-3.8 pg/ml) (P<0.05). In addition, high sensitivity C-reactive protein levels were significantly higher in group I (8.2+/-6.2 mg/dl) than in group II (4.6+/-3.4 mg/dl) (P<0.001). CONCLUSION: These results demonstrated that the presence of the IL-6 G/C-174 polymorphism and increased IL-6 and high sensitivity C-reactive protein levels are strongly associated with the inflammatory system and the course of clinical and hemodynamically significant CAD.