Effect of dobutamine stress echocardiography on serum heart fatty acid binding protein levels.

Objective Heart fatty acid binding protein (HFABP) is a low-molecular-weight free protein that is abundant in the intracytoplasmic space of myocytes. Due to its unique features, serum HFABP levels may increase in myocardial ischaemia. The aim of this study was to evaluate the effect of myocardial ischaemia induced by dobutamine stress echocardiography (DSE) on serum HFABP levels. Methods and results A total of 30 consecutive patients with suspected myocardial ischaemia underwent DSE examination. HFABP levels were measured immediately before and 1 hour after DSE. HFABP rose significantly in individuals in the DSE positive group (1.66 ± 1.18 ng/ml vs 2.65 ± 1.34 ng/ml, P = 0.004), but remained unchanged in the DSE negative group (1.61 ± 0.77 ng/ml vs 1.85 ± 0.76 ng/ml, P = 0.066). Conclusion Serum HFABP levels increased significantly at 1 hour in the presence of ischaemia induced by DSE in patients with stable clinical coronary syndromes. No such increase was evident in the absence of ischaemia.

Fragmented QRS can predict severity of aortic stenosis.

BACKGROUND: Fragmented QRS (fQRS) is an indicator of nonhomogeneous ventricular activity caused by myocardial fibrosis. Aortic stenosis (AS) is known to be a cause of myocardial fibrosis. We aimed to investigate the relationship of fQRS with severity of AS, echocardiographic, and electrocardiographic findings, and development of atrial fibrillation and manifest heart failure in AS patients. METHODS: One hundred four patients with moderate and severe AS were recruited for the study. Patients with mitral or tricuspid stenosis, previous myocardial infarction, segmental wall motion abnormality or left ventricular ejection fraction (LVEF) below 50% and patients with complete-incomplete BBB and pacemaker rhythm were excluded. RESULTS: Mean age of the patients was 69 ± 14.8 and 73.1% had fQRS. Patients with fQRS had lower LVEF, higher mean QRS duration, intrinsic deflection, Cornell voltage, Romhilt-Estes Score, systolic pulmonary artery pressure, mean and peak systolic transaortic gradients and left atrium diameter. Manifest heart failure was more frequent in patients with fQRS. In stepwise multivariate logistic regression analyze, manifest heart failure, peak systolic transaortic gradient, LVEF, intrinsic deflection, strain pattern and Cornell voltage were independently associated with fQRS. Strain pattern and fQRS were found as independent predictors of severe AS. CONCLUSIONS: fQRS is independently associated with the severity of AS while traditional LVH criteria, except strain pattern, are not. fQRS may be better than traditional ECG criteria of LVH and echocardiographic LVH as an indicator of myocardial fibrosis in AS. Thus, fQRS may have a role in determining the severity and prognosis of AS.

Comparison of three diuretic treatment strategies for patients with acute decompensated heart failure.

BACKGROUND: There are few prospective data available for establishing a standard diuretic administration regimen for patients with acute decompensated heart failure (ADHF). We aimed to assess the safety and efficacy of three regimens of furosemide administration in patients with ADHF with regard to diuresis, renal functions, and in-hospital outcomes. METHODS: A total of 43 patients who presented with ADHF were randomized into three groups: (a) continuous infusion (cIV) of 160 mg furosemide for 16 h/day (n = 15); (b) bolus injections (bI) of 80 mg furosemide twice a day (n = 14); (c) and administration of 160 mg furosemide plus hypertonic saline solution (HSS) as an infusion for 30 min once a day (n = 14). All regimens were continued for 48 h. Study endpoints were negative fluid balance assessed by loss of body weight, change in the serum creatinine (baseline to 48 h and baseline to compensated state), and length of hospitalization. RESULTS: There was no significant difference in the mean change in serum creatinine level at the end of 48 h between groups (p = 0.08). There was also no significant difference among groups regarding loss of body weight (p = 0.66). A significantly shorter hospitalization was observed in patients treated with HSS compared with the other groups (cIV group 6.6 ± 3.4 days vs. bI group 7.9 ± 4.1 days vs. HSS group 3.7 ± 1.3 days; p < 0.01). CONCLUSION: All three furosemide regimens have similar renal safety and efficacy measures. However, administration of furosemide plus HSS may be the preferred diuretic strategy because of its shorter hospital stay.

Characterization of echocardiographic measures of cardiac structure and function in healthy octogenarians.

BACKGROUND: Currently, there is not enough echocardiographic information regarding aging-associated changes in the octogenarian population. We aimed to characterize echocardiographic measures of structure and function among a group of healthy octogenarians. METHODS: Approximately 350 octogenarians, residing in nursing homes, were screened in Ankara, Turkey. According to inclusion criteria, 40 octogenarians were enrolled. These subjects underwent conventional and tissue Doppler echocardiography according to the guidelines of the American Society of Echocardiography (ASE). The population was also separated into various groups according to gender, body mass index (BMI, <25 vs. 25-29.9), and blood pressure (<80/120 mmHg vs. 80-89/120-139 mmHg). All measurements were indexed by dividing to body surface area (BSA) for standardization. RESULTS: Left ventricular mass (LVM), posterior wall thickness, right ventricular diameter, tricuspid E/A ratio, and septal e'-wave velocity were significantly higher in men, which lost significance after adjusting for BSA. There was no significant difference between groups formed by BMI and blood pressure. Moreover, mild global left and right ventricular dysfunction including a prominent diastolic counterpart, however, with normal ejection fraction was revealed using conventional and tissue Doppler techniques. Finally, we checked our results with the current reference values of the ASE and observed the following differences: ventricular septum, relative wall thickness, LVM, and mass index values were above ASE reference range, posterior wall measurements were close to upper range. On the contrary, left ventricular diameters and volumes were below ASE reference range. CONCLUSIONS: We described echocardiographic measures of structure and function in a group of healthy octogenarians.

Association of fragmented QRS complex with myocardial reperfusion in acute ST-elevated myocardial infarction.

In this study, we aimed to evaluate the relationship between TIMI myocardial perfusion (TMP) grade, as an indicator of myocardial reperfusion, and fragmented QRS (fQRS) in standard 12-lead electrocardiogram. Also, we evaluate fQRS is an additional indicator of myocardial reperfusion. One hundred patients admitted with first STEMI to Coronary Intensive Care Unit and who were used thrombolytic therapy was included in this retrospective study. Standard 12-lead electrocardiogram records of patients simultaneous with coronary angiography (second day) were assessed and analysed for the presence of fQRS. Also, coronary angiography images were analyzed to identify the infarct related artery, TIMI grade of infarct related artery and TMP grade of infarct related artery. The patients with fQRS demonstrated a significantly lower TMP grade, TIMI grade and ejection fraction compared with the non-fQRS patients (P = 0.004, P = 0.003, P = 0.02 respectively). The patients with inadequate myocardial reperfusion demonstrated a significantly higher fQRS compared with the adequate myocardial reperfusion patients. (56.9% versus 23.5%, P = 0.002 respectively). On correlation analysis, there was a significant negative correlation between fQRS and left ventricular ejection fraction (r = -232, P = 0.02) TMP grade and adequate myocardial reperfusion (TMP 3) showed significant negative correlation with fQRS (r = -0.370, P = 0.000; r = -0.318, P = 0.001 respectively). Presence of fragmented QRS in STEMI patients was associated with inadequate myocardial reperfusion and it can be used as a simple, noninvasive parameter to evaluate myocardial reperfusion.

Atrial electromechanical delay and diastolic dysfunction in primary Sjögren syndrome.

PURPOSE: In this study we aimed to investigate myocardial function and atrial electromechanical properties by conventional and tissue doppler echocardiography in patients with primary Sjögren syndrome. METHODS: Forty patients with Sjögren syndrome (SS) and 25 age- and sex-matched healthy volunteers were enrolled in the study. Using transthoracic echocardiography, myocardial performance index and atrial electromechanical properties were measured. RESULTS: Basal characteristics were similar between two groups. Myocardial performance index values were disturbed in patients with Sjögren syndrome (0.41 vs. 0.32, p < 0.01). There was significant intraatrial (16.4±6.4, 5.0±4.5, p < 0.01) and interatrial (30.6±10.1, 15.4±5.9, p < 0.01) electromechanical delay in this patient group. CONCLUSION: Myocardial function is disturbed and there is significant atrial electromechanical delay in patients with primary SS. This study is the first to show altered myocardial function and atrial electromechanical properties in primary SS.

Effect of overweight and obesity on the left ventricular systolic and diastolic functions in patients with acute myocardial infarction.

PURPOSE: The purpose of this study was to evaluate whether a association exits among overweight and obesity and left ventricular systolic and diastolic functions in patients admitted with first ST-elevation myocardial infarction (STEMI). METHODS: The present study was performed on 451 consecutive patients diagnosed with first STEMI (376 men, 75 women; mean age 56.1 ± 10.8 years). The patients were classified into three groups based on their body mass index (BMI) as normal weight (BMI < 25 kg/m2), overweight (BMI: 25-29.9 kg/m2) and obese (BMI > 30 kg/m2). Echocardiographic features were evaluated and compared among the three groups. RESULTS: Mitral annulus E velocities were higher in obese individuals than normal weight group (p < 0.01). In contrast, mitral A velocities were lower (p =0.03); consequently, E\A and E'\A' ratios were lower (both p = 0.01) in the obese group with respect to normal weight group. When the correction of entire variations existing among the groups were performed using multivariate linear regressions analyses, it turned out that BMI was independently associated with E/A (ß = -0.19, p = 0.044) and with E'/A' (ß = -0.016, p = 0.021). Ejection fraction, wall motion score index and myocardial S velocities were comparable among the study groups (p > 0.05). CONCLUSION: These results suggest that while obesity has no adverse effect on the left ventricular systolic function, it has unfavorable consequences on the left ventricular diastolic function in the patients with first STEMI. In contrast, no unfavorable effects of overweight on the left ventricular systolic and diastolic function were detected.

Relationship between plasma asymmetric dimethylarginine level and autonomic dysfunction in diabetic patients.

OBJECTIVES: We aimed to investigate the relationship between plasma asymmetric dimethylarginine (ADMA) levels and heart rate variability (HRV) in diabetic patients. STUDY DESIGN: The study included 100 patients (44 men, 56 women) with type 2 diabetes mellitus. The patients were divided into two groups based on the use of oral antidiabetics (n=67; mean age 54.6±7.8 years) or insulin (n=33; mean age 51.6±8.8 years). Plasma ADMA levels were measured and HRV parameters were calculated from 24-hour Holter EKG recordings. The findings were compared with those of a control group consisting of 42 nondiabetic individuals (mean age 52.8±6.2 years). RESULTS: Compared to the control group, plasma ADMA levels were significantly higher (p=0.007) and all HRV parameters were significantly reduced in both diabetic groups. However, ADMA levels and HRV parameters were similar in the two diabetic groups (p>0.05). Correlation analysis showed no significant relationship between plasma ADMA levels and HRV parameters. CONCLUSION: Our findings show that plasma ADMA levels are increased and HRV is reduced in diabetic patients, indicating that these patients have both endothelial dysfunction and autonomic dysfunction, but plasma ADMA levels cannot be used to evaluate autonomic dysfunction.

Relationship between mean platelet volume and left ventricular systolic function in patients with metabolic syndrome and ST-elevation myocardial infarction.

PURPOSE: Mean platelet volume (MPV) is an indicator of platelet activation, which is a central process in the pathophysiology of coronary heart disease. Metabolic syndrome (MS) may lead to worsened left ventricular systolic function by causing recurrent thrombotic events and by aggravating systemic inflammation in the course of acute myocardial infarction. The present study was designed to investigate the relationship between MPV and left ventricular systolic function in patients with metabolic syndrome who had first ST-elevation myocardial infarction. METHODS: MPV was measured on admission in 33 patients who had preserved left ventricle systolic function (mean age, 56.9±10.2 years) and in 48 patients who had depressed left ventricle systolic function (mean age, 57.9±10.5 years) with metabolic syndrome and first ST elevation myocardial infarction. Depressed left ventricle systolic function was defined as ≤50% ejection fraction value. MPV levels were compared in the two groups. RESULTS: MPV was significantly higher in patients with depressed left ventricle systolic function in comparison with patients showing preserved left ventricle systolic function (p=0.02). Logistic regression analysis showed an independent relationship between MPV and deteriorated left ventricular systolic function, even after adjustment for potential confounders (1.08 (1.04-1.20), CI: 95%, p=0.02). CONCLUSIONS: Increased MPV on admission can be associated with degree of left ventricle systolic depression in patients with metabolic syndrome with first ST-elevation myocardial infarction. MPV may prove to be useful as a prognostic marker in patients with metabolic syndrome and ST elevation MI.

Plasma osteopontin levels in prediction of prognosis in acute myocardial infarction.

OBJECTIVE: We sought to explain the clinical importance of the osteopontin (OPN) in the setting of acute ST-elevation myocardial infarction (STEMI). METHODS: Eighty consecutive patients (55 = 11 years, 12 women and 68 men) and sixty healthy control subjects were included in the study. In all patients, plasma OPN levels were assessed on admission and on the third day (peak value). Creatinine kinase (CK)/CK-myocardial band (MB), troponin I and N-terminal pro-brain natriuretic factor levels and echocardiographic findings were also recorded. Patients were classified into high and low OPN groups according to the median OPN value, and monitored for the occurrence of major adverse cardiovascular events (MACE). RESULTS: Patients with STEMI had higher OPN levels (23.8 [16.7-41.3] ng/ml) on admission than the control subjects (18.0 [11.3-31.5] ng/ml, P = 0.004).The third day value of OPN was significantly higher (39.2 [27.2-56.0] ng/ml) than the OPN level on admission (23.8 [16.7-41.3] ng/ml, P < 0.001). Admission and peak OPN levels were not correlated with CK/CK-MB, white blood cell counts, troponin I and the N-terminal pro-brain natriuretic factor. The plasma OPN levels were not correlated with left ventricular wall motion score index either. In the subgroups of infarct localization and reperfusion strategy, plasma OPN levels were similar. When the patients were compared according to the median OPN values, there were no differences in the occurrence of MACE between the high and low OPN groups. CONCLUSION: This study suggests, for the first time, that the plasma OPN level increases in the first hours of the acute STEMI; however, it could not be used as a prognostic biomarker of STEMI.

Coronary heart disease is associated with mean platelet volume in type 2 diabetic patients.

BACKGROUND: Mean platelet volume (MPV) is an indicator of platelet activation which is a central process in the pathophysiology of coronary heart disease (CHD). The aim of the study was twofold; first to determine whether MPV values is increased in patients with DM, and secondly to evaluate the relation between diabetic complications and MPV. METHODS: The study population included 258 patients divided into two groups. Group A composed of 158 type 2 diabetic patients with coexistent coronary artery disease (stenotic lesions of 50%) (78 women, 80 men; mean age 53.9_10.8; mean diabetes duration 13.1_6.0). One hundred subjects (48 women, 52 men; mean age 53.9_11) without type 2 diabetes with normal coronary angiographies were taken as the control group (group B). To evaluate the extension of CHD, Gensini scoring system was used. RESULTS: The MPV was significantly different in the patient group compared to the controls (9.79 +/- 1.5 fl vs 8.3 +/- 0.9 fl, P<0.001). The existence of CHD was associated with MPV with odds ratio (95% CI) of 2.31 (1.55-4.42, p50.001). CONCLUSION: We have found that diabetic patients with coronary heart disease have significantly higher MPV values compared to control subjects without diabetes and with angiographically normal coronary arteries.

Relationship between elevated platelet volume and saphenous vein graft disease.

BACKGROUND: Saphenous vein graft (SVG) disease is the major determinant of long term graft viability in patients undergoing coronary artery bypass graft (CABG) surgery. Although, platelets play a major role in this pathogenetic process the nature of this interaction has not been yet been clarified. Mean platelet volume (MPV) reflects platelet production rate and stimulation. This study was designed to investigate MPV in patients with late stage SVG disease. METHODS: The study population composed of 188 patients who underwent elective coronary angiography more than one year after coronary artery bypass surgery. The study population was divided in to two groups according to SVG patency. The first group consisted of 90 patients (75 men, 15 women; mean age, 63.4 +/- 9.2 years) with patent SVG's (no-stenosis group). The second group consisted of 98 patients (80 men, 18 women; mean age, 62.1 +/- 10.1 years) with SVG stenosis based on the results of coronary angiography (stenosis group). Greater than 50% stenosis within the SVG was accepted as hemodynamically significant. RESULTS: MPV were significantly higher in patients with SVG disease in comparison with the patients without graft disease group (9.3 +/- 1.19 vs. 8.3 +/- 1.10 fl, respectively, p < 0.001). In a multiple regression model, SVG disease was independently associated with MPV (beta=0.837, p=0.05) along with LDL-cholesterol (beta=0.159, p=0.008) and time interval after bypass surgery (beta=-0.092, p=0.05). CONCLUSION: Platelet volume, and therefore platelet activation, appears to play a causal role in late SVG disease graft disease; hence, MPV may be useful as a post-operative marker of graft success.

The relationship between admission hemoglobin level and left ventricular systolic functions in patients with first ST-segment elevated myocardial infarction.

OBJECTIVES: The goal of this study was to evaluate the relationship between admission hemoglobin levels and left ventricular systolic functions in patients admitted with first ST-segment elevated myocardial infarction (STEMI). STUDY DESIGN: The study was conducted prospectively in three centers in 483 consecutive patients (402 men, 81 women; mean age 56.5 ± 11.2 years; range 24 to 74 years) with first STEMI. All patients were evaluated by echocardiography after a mean of 2.4 days of admission. Evaluation of left ventricular systolic functions included measurements of ejection fraction (EF), wall motion score index (WMSI), and tissue Doppler S wave velocities at four different localizations (anterior, inferior, lateral, posterior septum). Hemoglobin levels were measured within one hour of admission. Anemia was defined according to the World Health Organization criteria (hemoglobin < 13.0 g/dl in men and < 12.0 g/dl in women). Echocardiographic characteristics of the patients with and without anemia were compared. RESULTS: Anemia was detected in 67 patients (13.9%). There were no significant differences between patients with and without anemia with respect to left ventricular end-systolic and end-diastolic diameters, wall thickness, WMSI, and EF. The mean EF in the anemic group (47.5%) was lower than that of the patients without anemia (48.5%), but this difference was not significant. All Sm velocities were lower in the anemic group, but only septal mitral annular Sm velocity reached statistical significance (p = 0.048). There was no correlation between hemoglobin levels and EF (r = 0.027, p = 0.55). CONCLUSION: Our findings suggest that mild to moderate anemia has no deleterious effect on systolic function in patients with first STEMI.

[Endomyocardial fibrosis causing right intraventricular gradient and obliteration]. / Sag ventrikül içi basinç gradiyentine ve obliterasyona neden olan endomiyokardiyal fibrozis.

Endomyocardial fibrosis is a cause of restrictive cardiomyopathy and it generally occurs in tropical regions more commonly affecting children and young adults. A 19-year-old male patient presented with edema in the lower extremities and fatigue. Transthoracic echocardiography showed dilated right heart chambers, restrictive physiology in the left ventricle, and increased tissue growth in the right ventricle that caused a 60-mmHg gradient and obliteration. Magnetic resonance imaging confirmed the presence of increased tissue formation in the right ventricular inflow region. Surgical resection was not considered taking into account the functional capacity of the patient (class II), disappearance of symptoms following medical treatment, and the high risk for operative mortality. The presented case may arouse interest in that increased tissue growth in the right ventricle inflow region caused a gradient in the right ventricle, leading to an incorrect diagnosis, at another center, as idiopathic pulmonary hypertension.

Comparison of serum adiponectin and tumor necrosis factor-alpha levels between patients with and without obstructive sleep apnea syndrome.

BACKGROUND: The obstructive sleep apnea syndrome (OSAS) is closely associated with cardiovascular and metabolic disorders. OBJECTIVES: The aim of this study was to evaluate the influence of OSAS on plasma adiponectin levels independent of obesity in our study group. We also investigated the association between plasma adiponectin, plasma tumor necrosis factor-alpha (TNF-alpha), obesity, cardiovascular disease (CVD) and OSAS. METHODS: The patients were classified into controls or OSAS patients according to the apnea-hypopnea index (AHI): patients with an AHI <5 constituted the control group (n = 32) and patients with an AHI > or =5 constituted the OSAS group (n = 106). Plasma TNF-alpha and adiponectin levels were measured in both groups. RESULTS: Plasma adiponectin levels were negatively correlated with AHI, body mass index (BMI) and SpO(2) <90% and positively correlated with minimum oxygen saturation. The plasma levels of TNF-alpha were positively correlated with SpO(2) <90%, BMI and fasting plasma glucose levels. In addition, there was a significant negative correlation between plasma TNF-alpha and adiponectin levels in theOSAS group. Compared with thenon-obese OSAS group, subjects with obesity and OSAS had lower adiponectin levels and SpO(2) <90%, and higher TNF-alpha levels. Obese OSAS patients had higher rates of CVD with lower plasma adiponectin levels when compared with obese control subjects. CONCLUSION: Serum adiponectin is significantly lower in patients with OSAS and it is independent of obesity. This might explain the high incidence of CVD and metabolic syndrome in patients with OSAS.

Assessment of left ventricular systolic and diastolic function by tissue Doppler analysis in patients with hypertension with or without hyperuricemia.

OBJECTIVE: Hyperuricemia (HU) is a well-recognized risk factor for cardiovascular diseases. The independence of this association from other confounding factors has remained controversial. The possible contributory effect of HU to myocardial impairment produced by hypertension (HT), however, has not been clarified yet. The study was designed to assess the left ventricular (LV) systolic and diastolic function in patients with HT with or without HU. Tissue Doppler imaging (TDI) was used for detailed analysis as this method was superior to other conventional echocardiographic techniques. METHODS: The study participants consisted of 27 patients (men 56%, mean age+/-SD; 55+/-10 years) with HT without HU, and 27 patients with HT with HU (men 62%, mean age+/-SD; 56+/-9 years), and 27 age-matched healthy control participants (men 57%, mean age+/-SD; 53+/-11 years). Cardiac functions were determined using echocardiography, comprising standard two-dimensional and conventional Doppler and TDI. Peak systolic myocardial velocity at mitral annulus (Sm), mitral inflow velocities and early diastolic mitral annular velocity (Em), late diastolic mitral annular velocity (Am), peak systolic mitral annular velocity, Em/Am, and myocardial performance index were calculated by TDI. RESULTS: Mitral inflow velocities and tissue Doppler-derived mitral annular diastolic velocities were significantly different in the patient groups (HT without HU and HT with HU) compared with the control cases. Tissue Doppler-derived myocardial performance index (LV-MPI) was significantly impaired in the patient groups compared with those of the control's (0.48+/-0.09, 0.53+/-0.07, and 0.39+/-0.07, respectively, P<0.001). Significant differences were also observed between the patients who had HT without HU and the patients who had HT with HU regarding LV-MPI. Significant correlations were observed between the serum uric acid levels and LV function parameters.

The detailed assessment of left and right ventricular functions by tissue Doppler imaging in patients with familial Mediterranean fever.

In the contrary to other rheumatologic disorders, there have been limited numbers of studies investigating the cardiac involvement in patients with familial Mediterranean fever (FMF), although the disease may carry a potential for cardiovascular disorders because of sustained inflammation during its course. In the present study, we used high usefulness tissue Doppler echocardiography for detailed analysis of cardiac changes in FMF patients. The study population included 30 patients with FMF (11 men, 19 women; mean age, 35 +/- 7 years, mean disease duration, 15.4 +/- 7.6 years) and 30 healthy subjects as controls (12 men, 18 women; mean age, 33 +/- 7 years). The diagnosis of FMF was established according to the Tell-Hashomer criteria. Left and right ventricular functions were measured using echocardiography comprising standard two-dimensional, M-mode, and conventional Doppler as well as tissue Doppler imaging. The conventional echocardiographic paratemeters were similar apart from left ventricular relaxation time was longer (107 +/- 25 vs 85 +/- 10 ms, p < 0.001, respectively) in patients with FMF. According to the tissue Doppler measurements, while systolic velocities of both ventricles were not different, diastolic filling velocities of left ventricle including E'(m) (12.6 +/- 3.4 vs 14.7 +/- 3.3 cm/s, p = 0.04), A'(m) (10.1 +/- 2.6 vs 8.6 +/- 2.0 cm/s, p = 0.015), and E'(m)/ A'(m) (1.24 +/- 0.4 vs 1.71 +/- 0.5 cm/s, p = 0.012) values were statistically different between the groups. Left ventricular myocardial performance indices and right ventricular diastolic functions were found similar between two groups. In addition, there were no significant correlations between the disease duration, clinical features, and echocardiographic parameters. In conclusion, we have demonstrated that although systolic functions were comparable in the patients and controls, left ventricular diastolic function indices were impaired in FMF patients by using tissue Doppler analysis.

The assessment of cardiac functions by tissue Doppler-derived myocardial performance index in patients with Behcet's disease.

Vascular involvement is one of the major characteristics of Behcet's disease (BD). However, there are controversial findings regarding cardiac involvement in BD. Although early reports demonstrated that there is diastolic dysfunction in BD, conflicting results were found in the following trials. Hence, a new method for more objectively estimating the cardiac functions is needed. For this aim, we used high-usefulness tissue Doppler echocardiography for detailed analysis of cardiac changes in BD patients because this method was superior to other conventional echocardiographic techniques. The study population included 42 patients with BD (19 men, 23 women; mean age, 35 +/- 10 years, mean disease duration, 2.7 +/- 1.6 years) and 30 healthy subjects (14 men, 16 women; mean age, 38 +/- 7 years). Cardiac functions were determined using echocardiography, comprising standard two-dimensional and conventional Doppler and tissue Doppler imaging (TDI). Peak systolic myocardial velocity at mitral annulus, early diastolic mitral annular velocity (Em), late diastolic mitral annular velocity (Am), Em/Am, and myocardial performance index (MPI) were calculated by TDI. The conventional echocardiographic parameters and tissue Doppler measurements were similar between the groups. Tissue Doppler derived mitral relaxation time was longer (75 +/- 13 vs 63 +/- 16 msn, p = 0.021) in patients with BD. There was statistically significant difference between the two groups regarding left ventricular MPI (0.458 +/- 0.072 vs 0.416 +/- 0.068%, p = 0.016), which were calculated from tissue Doppler systolic time intervals. There was also significant correlation between the disease duration and MPI (r = 0.38, p = 0.017). We have demonstrated that tissue Doppler-derived myocardial left ventricular relaxation time and MPI were impaired in BD patients, although systolic and diastolic function parameters were comparable in the patients and controls.