[Increased myocardial energy expenditure in cardiac syndrome X: More work, more pain]. / Kardiyak sendrom X'li hastalarda artmis miyokart enerji tüketimi: Çok is, çok agri.

OBJECTIVE: The aim of this study was to assess the myocardial energy expenditure (MEE) in patients with cardiac syndrome X (CSX) and to examine its association with exercise electrocardiogram (ECG) parameters. METHODS: A total of 99 patients who underwent coronary angiography and who were diagnosed as having normal coronary arteries were included. The patients were divided into 2 groups based on symptoms and exercise ECG parameters: 56 CSX patients and 43 control patients with a negative stress test. MEE was calculated using transthoracic echocardiography-derived parameters: circumferential end-systolic stress, left ventricular ejection time, and stroke volume. RESULTS: In patients with CSX, the MEE at rest was 28% higher in than the control group (89.2±36.3 vs. 69.8±17.2 cal/minute). Correlation analysis revealed a moderately negative correlation between MEE and the Duke treadmill score (DTS) (ß:-0.456; p<0.001). Receiver operating characteristic analysis with a cut-off value of 74.6 cal/minute for MEE had a sensitivity of 78.1% and a specificity of 75.3% for the prediction of CSX (area under the curve: 0.872; p<0.001). An extra 1 calorie spent per minute at rest increased the likelihood of CSX by about 86% (odds ratio: 1.863). CONCLUSION: This study demonstrated that MEE was greater in CSX patients compared with a control group. Increased MEE was determined to be an independent predictor of CSX. DTS was inversely correlated with MEE. Increased MEE may have a crucial role in CSX pathophysiology.

Prognostic significance of myocardial energy expenditure and myocardial efficiency in patients with heart failure with reduced ejection fraction.

In heart failure with reduced ejection fraction (HFrEF) patients, myocardial blood flow (MBF), myocardial energy expenditure (MEE), myocardial efficiency has been poorly evaluated because of the necessity of invasive procedures in the determination of these parameters. Transthoracic echocardiography (TTE) can provide reliable data for MEE, MBF (via coronary sinus (CS) flows). Also, myocardial efficiency can be evaluated by the MEE to MBF ratio. We aim to assess MBF, MEE and energy efficiency and the prognostic value of these parameters in HFrEF. In this prospective study, a total of 80 patients with HFrEF due to either ischemic or non-ischemic etiology and 20 healthy control subjects were included. Median follow-up duration was 901 (27-1004) days. MBF was calculated via coronary sinus blood flow. MEE was measured from circumferential end-systolic stress, stroke volume and left ventricular ejection time. MEE to MBF ratio was determined as MEf. Primary composite end-point (CEP) was cardiovascular mortality, heart transplantation or mechanical circulatory support. MEE and MEf were lower and MBF per minute was higher in HF group compared to control subjects whereas MBF per 100 g left ventricular mass was not different. MEE and MEf have significantly negative correlation with troponin I, BNP, uric acid and positive correlation with epicardial fat thickness. In Cox regression analysis, per one calorie decrease of MEE was associated 4.3 times increased risk [HR 4.396 (95% CI 1.230-15.716)] and per one percent decrease of MEf was associated 3.3 times increased risk of CEP [HR 3.343 (95% CI 1.025-10.905)]. Our study demonstrated that while MEE and MEf diminished in HFrEF, MBF preserved with the symptomatic progression of HF. MEE and MEf were found to be associated with important prognostic markers and independent predictors of CEP in HFrEF. Evaluation of MEE, MBF and MEf with echocardiography may provide an additional data regarding prognostic assessment of HFrEF population.

Assessment of the atrial electromechanical properties of patients with human immunodeficiency virus.

The relationship between atrial fibrillation and human immunodeficiency virus (HIV) infection was evaluated. Electro-echocardiographic methods can be used to predict the development of atrial fibrillation (AF). In this study, we aimed to investigate the atrial electromechanical delay (AEMD) parameters of HIV (+) patients. Forty-two HIV (+) patients and 40 HIV (-) healthy volunteers were prospectively enrolled in this study. The electromechanical properties of the subjects' atria were evaluated with tissue Doppler imaging. The left-AEMD, right-AEMD and inter-AEMD were increased in the HIV (+) patients relative to the controls (p=0.003, p<0.001, and p<0.001, respectively). The CD4 count was inversely correlated with the inter-AEMD (r=-0.428, p<0.001). The CD4 count was an independent predictor of the inter-AEMD (ß=0.523, p=0.007). Our study demonstrated that both the inter- and intra-atrial electromechanical delays were prolonged in the patients with HIV. This non-invasive and simple technique may provide significant contributions to the assessment of the risk of atrial arrhythmia in patients with HIV.

Cost of heart failure management in Turkey: results of a Delphi Panel.

OBJECTIVE: To analyze health-related cost of heart failure (HF) and to evaluate health-related source utilization aiming to provide data on the economic burden of HF in actual clinical practice in Turkey. METHODS: The study used the Delphi process of seeking expert consensus of opinion including 11 cardiologists who are experienced in HF. The standardized questionnaire comprised items to reflect the opinion of the expert panelists on the distribution of the HF patients in terms of demographic and clinical characteristics and background disease states. Costs related to out-patient follow-up, in-patient follow-up, medications, and other therapies were also evaluated. RESULTS: 34.1% of the HF patients were in the age range of 60-69 years, and 62.3% were males. Coronary heart disease was the leading cause of HF (59.6%); 63.6% of the HF patients had reduced ejection fraction (rEF) and 42.3% were in New York Heart Association (NYHA)-II class. Approximately 75 % of the patients were followed up by a cardiology unit. The total annual visit number was estimated as 3.41. Approximately 32% of HF patients were hospitalized 1.64 times a year, for an average of 6.77 days each time. The total annual costs of all HF patients and HF-rEF patients were estimated as 1.537 TL and as 2.141 TL, respectively. CONCLUSION: The analysis demonstrating the magnitude of the economic impact of HF management on Turkey's healthcare system may help facilitate health and social policy interventions to improve the prevention and treatment of HF.

Assessment of global left ventricular systolic function with multidetector CT and 2D echocardiography: a comparison between reconstructions of 1-mm and 2-mm slice thickness at multidetector CT.

PURPOSE: To compare multidetector computed tomography (MDCT) and two-dimensional transthoracic echocardiography (2DE) for left ventricular ejection fraction (EF); and to make comparison between reconstructions of 1-mm and 2-mm slice thickness at MDCT in left ventricular analysis by using a semiautomated segmentation algorithm. MATERIALS AND METHODS: In 43 patients global left ventricular systolic function was assessed by using both MDCT and 2DE. Functional MDCT data sets were reconstructed in 20 cardiac phases (0-95%) with both 1-mm and 2-mm slice thickness.With semi-automatic left ventricle segmentation, end-diastolic volume (EDV), endsystolic volume (ESV) and EF were calculated seperately for both 1-mm and 2-mm reconstructions. RESULTS: On MDCT with 1-mm slice thickness, mean EF was 66.8 +/- 5.6 %, mean EDV was 133.7 +/- 38.9 mL, and mean ESV was 45.1 +/- 17.9 mL, these values for 2-mm slice thickness were 66.2 +/- 5.6 %, 133.5 +/- 39.6 mL, and 45.9 +/- 18.3 mL, respectively. On 2DE, mean EF was 66.7 +/- 5.7 %, mean EDV was 98.7 +/- 42.1 mL, and mean ESV was 33.6 +/- 18.7 mL. There was no difference between EF values calculated with 1-mm and 2-mm reconstructions and 2DE (P = 0.83 and P = 0.3705, respectively). However, EDV and ESV values calculated by MDCT were significantly higher than those obtained by 2DE (P < 0.0001). CONCLUSION: There was a good correlation between MDCT and 2DE in the evaluation of left ventricular EF. At MDCT left ventricular ESV was statistically smaller, EF was statistically greater by using 1-mm rather than 2-mm slice thickness. However, these differences are not clinically relevant.

The comparison of the effects of standard 20 mg atorvastatin daily and 20 mg atorvastatin every other day on serum LDL-cholesterol and high sensitive C-reactive protein levels.

OBJECTIVE: In this study, we aimed at comparing the effects of standard once daily 20 mg atorvastatin treatment with that of atorvastatin 20 mg administered every other day on serum lipids and high sensitive C-reactive protein (hs-CRP) levels. METHODS: Sixty-one patients with serum total cholesterol levels of above 200 mg/dl and low density lipoprotein (LDL)--cholesterol levels of above 130 mg/dl were included in this prospective, randomized study. The patients were randomized into daily treatment of 20 mg atorvastatin (standard treatment) and 20 mg atorvastatin every other day (every other day treatment) groups. Before the treatment and at each visit, serum lipids and hs-CRP levels of all the patients were measured. Statistical analyses were performed Chi-square, unpaired t and two-way repeated measurements ANOVA tests. RESULTS: In the every other day treatment group, there was a 36.1% reduction in LDL-cholesterol levels by the end of first month (p<0.01). At the end of three months there was further decrease of 10.2% in LDL-cholesterol levels when compared to 1 month levels (p>0.05). The LDL cholesterol levels of the group receiving 20 mg atorvastatin every day was reduced by %41 by the end of 1 month (p<0.01). At the end of three months, the difference between the changes in the all lipid parameters of the two groups was not found to be of statistical significance. In the group receiving the medication every other day, there was a 21% decrease in hs-CRP levels compared to the basal measurements at the end of first month (p<0.05). In the group, receiving the medication every day the decrease in hs-CRP levels at the end of one month was more striking (37%, p<0.05). However, the effects of both treatment arms on hs-CRP levels, did not differ significantly (p>0.05). CONCLUSIONS: Alternate-day dosing of atorvastatin causes a significant lipid-lowering and antiinflammatory effects similar to that of daily administration and yet may provide some cost savings.