Assessment of the relationship between preprocedural C-reactive protein/albumin ratio and stent restenosis in patients with ST-segment elevation myocardial infarction.

INTRODUCTION: Stent restenosis remains a clinical challenge for patients with ischemic heart disease, since it is associated with repeated coronary interventions as well as higher hospitalization rates and medical costs. Inflammation plays a significant role. Although an association between stent restenosis, increased C-reactive protein (CRP) and decreased albumin levels has been previously reported, no studies have investigated the ability of the CRP/albumin ratio to predict stent restenosis. METHODS: This retrospective study included 448 patients who had previously undergone primary percutaneous coronary intervention and who were referred for subsequent reintervention due to recurrence of anginal symptoms. The study population was divided into two groups based on whether the patient had developed stent restenosis. They were then stratified into three groups according to their CRP/albumin ratio. RESULTS: Out of 448 patients, stent restenosis was observed in 24.5% (n=110), as determined by coronary angiography. Patients with stent restenosis had a higher CRP/albumin ratio, greater platelet distribution width (PDW), higher CRP levels, and lower levels of both high-density lipoprotein (HDL) cholesterol and serum albumin. The CRP/albumin ratio (OR: 2.289, 95% CI: 1.056-4.959; p=0.036), stent diameter, PDW and HDL cholesterol levels were found to be independent predictors of stent restenosis. A ROC curve comparison demonstrated that the CRP/albumin ratio was a better predictor of restenosis than either albumin and CRP individually, but it was not better than PDW and HDL cholesterol. CONCLUSION: As a novel inflammation-based risk score, the CRP/albumin ratio may be an easily accessible marker for assessment of stent restenosis risk.

Echocardiographic assessment of right ventricular functions in healthy subjects who migrated from the sea level to a moderate altitude.

OBJECTIVE: The aim of this study was to evaluate right ventricle (RV) functions using echocardiography in healthy subjects who migrated from the sea level to moderate altitude (1890 m). METHODS: The prospective observational in this study population consisted of 33 healthy subjects (23 men; mean age 20.4±3.2 years) who migrated from the sea level to a moderate altitude (Erzurum city centre, 1890 m above sea level) for long-term stay. Subjects underwent echocardiographic evaluation within the first 48 h of exposure to the moderate altitude and at the sixth month of arrival. Conventional echocardiographic parameters such as RV sizes and areas, systolic, and diastolic functional indices [fractional area change (FAC), tricuspid flow velocities, myocardial performance index (MPI), and tricuspid annular plane systolic excursion (TAPSE)] were obtained. Systolic (S) and diastolic (E', A') velocities were acquired from the apical fourchamber view using tissue Doppler imaging. Kolmogorov-Smirnov test, student's t-test, Wilcoxon test, and chi-square test were used in this study. RESULTS: There were no significant changes in RV size, FAC, MPI, TAPSE, inferior inspiratory vena cava collapse, tricuspid E velocity, and tricuspid annulus E' velocity. Compared with the baseline, there was a significant increase in mean pulmonary artery pressure (p=0.001); RV end systolic area (p=0.014); right atrial end diastolic area (p=0.021); tricuspid A velocity (p=0.013); tricuspid annulus S and A' velocity (p=0.031 and p=0.006, respectively); and RV free wall S, E', and A' velocity (p=0.007, p<0.001, and p=0.007 respectively) at the sixth month. Also, there was a significant decrease in tricuspid E/A ratio (1.61±0.3 vs. 1.45±0.2, p=0.038) and tricuspid annulus E'/A' ratio (1.52±0.5 vs. 1.23±0.4, p=0.002) at the sixth month. CONCLUSION: Our study revealed that right ventricular diastolic function was altered while the systolic function was preserved in healthy subjects who migrated from the sea level to a moderate altitude.

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.

Hemodynamic assessment of mitral stenosis: mitral valve resistance as an echocardiographic index.

BACKGROUND AND AIM OF THE STUDY: Although mitral valve (MV) resistance has been proposed as a new index for the determination of hemodynamic consequence in patients with mitral stenosis (MS), the relationship between this resistance and signs of hemodynamic deterioration, such as the elevation of pulmonary artery pressure and plasma levels of brain natriuretic peptide (BNP), has not yet been investigated. METHODS: The study population comprised 33 consecutive patients (nine males, 24 females; mean age 39 +/- 6 years) with moderate and severe MS (MV area (MVA) <1.5 cm2). The cause of MS in all patients was rheumatic valvular disease. A comprehensive echocardiographic evaluation was performed, with MVA, mean MV pressure gradient (MVPG), systolic pulmonary artery pressure (sPAP) and mitral valve resistance being calculated for all patients, in addition to plasma BNP levels. RESULTS: Both, plasma BNP level and sPAP correlated better with MV resistance (r = 0.75, p < 0.001 and r = 0.52, p = 0.002, respectively) than with MVA by pressure half-time method (MVA-PHT) (r = -0.68, p < 0.001 and r = -0.55, p = 0.001, respectively) and mean MVPG (r = 0.62, p < 0.001 and r = 0.69, p < 0.001, respectively). A comparison of MV resistance and conventional stenotic indices showed that MV resistance correlated best with mean MVPG (r = 0.70, p < 0.001), and correlated least with MVA-PHT (r = -0.45, p = 0.009). Patients with sPAP >50 mmHg and plasma BNP level >150 pg/ml had a significantly higher MV resistance than patients with sPAP < 50 mmHg and plasma BNP level <150 pg/ml. CONCLUSION: MV resistance appeared to be better correlated with elevated sPAP and plasma BNP levels than with conventional stenosis indices.

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).

[Assessment of left atrial phasic functions in heart failure patients with preserved or low ejection fractions]. / Ejeksiyon fraksiyonu korunmus veya düsük kalp yetersizligi olgularinda fazik sol atriyal islevlerin degerlendirilmesi.

OBJECTIVES: We aimed to evaluate left atrial (LA) volumes and phasic functions in heart failure patients with preserved or low ejection fractions. STUDY DESIGN: The study consisted of 59 patients (36 men, 23 women; mean age 63.8 years) with heart failure accompanied by low (n=26) or preserved (n=33) ejection fractions. Two-dimensional echocardiographic LA volumes (maximal, minimal and pre-contraction volumes) were obtained and LA phasic functions (reservoir, conduit, and pumping functions) were calculated. The findings were compared with those of age- and sex-matched 30 controls (20 men, 10 women; mean age 60.3 years) without heart failure. RESULTS: All LA volumes were found to be significantly increased in both groups with heart failure compared with controls. Left atrial reservoir and pumping functions were significantly lower in patients with preserved ejection fraction than in those with low ejection fraction (p=0.02 and p=0.009, respectively). Left atrial conduit function was significantly lower in heart failure patients with low ejection fraction than in those with preserved ejection fraction (p=0.005). Compared with controls, heart failure patients with either low or preserved ejection fractions exhibited significantly decreased LA phasic functions (p<0.001). CONCLUSION: Our results demonstrate that, compared to subjects without heart failure, all phasic LA functions are impaired in heart failure patients with either low or preserved ejection fraction. However, impairment in LA reservoir and pumping functions is more prominent in heart failure patients with preserved ejection fraction.

[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.

Assessment of agreement between transthoracic and transesophageal echocardiography techniques for left ventricular longitudinal deformation imaging and conventional Doppler parameters estimation: a cross-sectional study.

OBJECTIVE: Studies investigating the comparison and interchangeability of transthoracic (TTE) and transesophageal echocardiography (TEE) regarding left ventricular (LV) systolic and diastolic function are limited. Therefore, in this study, we aimed to investigate agreement between TTE and TEE in the assessment of LV systolic functions by longitudinal myocardial deformation imaging (strain-S and strain rate-Sr) and LV diastolic functions by conventional Doppler parameters. METHODS: Thirty-five patients underwent a clinically indicated cross-sectional study on agreement between two methods. All the patients underwent TEE right after TTE. From both TTE and TEE Doppler parameters such as early and late diastolic velocities (E, A, E' and A`) deceleration time (DT), averaged mitral annular systolic velocity (Sm), isovolumic relaxation time (IVRT), isovolumic contraction time (IVCT), ejection time (ET), myocardial performance index (MPI) and longitudinal deformation imaging parameters (S, Sr) and systolic velocities were recorded. Agreement between TTE and TEE were evaluated by Bland-Altman analysis. RESULTS: Bland-Altman analysis showed good agreement between TEE and TTE in terms of E, A, DT, E', A', IVRT, IVCT, ET and MPI measurements. However, there was poor agreement in segmental systolic velocities and segmental Sr parameters assessed by TTE and TEE. Besides, septal wall segmental S analysis showed a better agreement than lateral wall segmental analysis between TTE and TEE recordings. CONCLUSION: TTE and TEE conventional Doppler parameters are compatible in the assessment of LV diastolic function; however, agreement was poor in longitudinal deformation parameters that have been used in the quantitative assessment of LV systolic function between two methods and cannot be used interchangeably.

Quantitative assessment of the left atrial myocardial deformation in patients with chronic mitral regurgitation by strain and strain rate imaging: an observational study.

OBJECTIVE: We evaluated regional left atrial (LA) myocardial deformations by strain (S) and strain rate (SR) imaging during LA pump, reservoir, and conduit phases in patients with chronic rheumatic mitral regurgitation (MR). METHODS: This cross-sectional observational study included 42 patients with moderate-to-severe MR who had normal left ventricular (LV) function, and 36 healthy control subjects. Conventional echocardiographic data were used to calculate LV and LA dimensions, volumes and functional indices (LA ejection fraction, LA active and passive emptying fraction). Longitudinal S/SR indices of the mid and superior segments of LA walls were measured during the three LA phases. Student t-test, Mann-Whitney U test, Chi-square test and Bland-Altman analysis were used for statistical analysis. RESULTS: LV systolic functions were similar in the patient and control groups. LV diameters, LA diameters and LA volumes were greater in the patient group compared with the control group (p<0.05, p<0.001, and p<0.001). LA ejection fraction and LA active emptying fraction values were lower in the patient group than in the control group (56 ± 7 vs. 63 ± 5%, 33 ± 9 vs. 40 ± 4%, p<0.05 for both). During the three LA phases, longitudinal S/SR values were significantly lower in all the segments in the patient group compared with the control group (p<0.001 for S, p<0.001 and p<0.05 for SR). CONCLUSION: Regional LA longitudinal myocardial deformations are observed to be impaired during all the mechanical phases in patients with moderate-to-severe MR. Volume overload, remodeling and rheumatic effects may be responsible for the LA myocardial dysfunction in these patients.

Assessment of P-wave dispersion in patients with isolated bicuspid aortic valve and its relationship with aortic elasticity.

OBJECTIVES: We evaluated P-wave duration and P-wave dispersion (PWD) in patients with isolated bicuspid aortic valve (BAV) without significant valve dysfunction and investigated the relationship between P-wave measurements and aortic elasticity. STUDY DESIGN: This prospective study consisted of 39 patients with isolated BAV with normal ejection fraction and 29 age- and gender-matched healthy subjects. P-wave duration and P-wave dispersion were calculated on 12-lead electrocardiograms. Echocardiographic examination was performed and aortic elasticity parameters were calculated including aortic strain, aortic stiffness index, aortic distensibility, and aortic elastic modulus. RESULTS: Patients with BAV had significantly greater Pmax and PWD compared to controls (128±11 vs. 115±11 msec, p=0.006; 70±10 vs. 66±13 msec, p=0.02, respectively), whereas Pmin was similar. Aortic strain and distensibility were significantly lower and aortic stiffness index and aortic elastic modulus were significantly greater in patients with BAV (for all, p=0.0001). In correlation analysis, Pmax was significantly correlated with aortic strain (r=-0.30, p=0.01), aortic distensibility (r=-0.27, p=0.02), aortic stiffness index (r=0.36, p=0.004), and aortic elastic modulus (r=0.38, p=0.003), while PWD was correlated with aortic strain (r=-0.23, p=0.05) and aortic elastic modulus (r=0.25, p=0.05). CONCLUSION: Our data showed that isolated BAV without valve dysfunction was associated with prolonged P-wave duration and increased PWD, both of which were related to aortic elasticity parameters.

[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 risk of false results in the assessment of platelet function in the absence of antiplatelet medication: comparison of the PFA-100, multiplate electrical impedance aggregometry and verify now assays.

OBJECTIVES: Evaluation of aspirin (ASA) responsiveness with platelet function tests varies by the choice of blood mixture and functional test and cut off values for defining the the treatment used. Addition to that we also aimed to determine agreement between three tests and to research whether there is any necessity to measure baseline platelet activity. METHODS: The study group comprised of 52 patients with multiple risk factors receiving primary prophylaxis of ASA (100 mg/day). For each patient inhibition of platelet aggregation with aspirin was determined using three different whole blood tests: Multiplate electrical impedance aggregometry, Verify Now Aspirin, and collagen-epinephrine closure time PFA-100. Platelet aggregation was assessed with multiplate electrical impedance aggregometry,and was defined as the area under curve (AUC,AUxmin). Maximal 6,4 microM collagen-induced AUC were used to quantify platelet aggregation due to ASA. The ASA response was defined as >30 % reduction in basal platelet aggregation with multiplate electrical impedance aggregometry. Collagen induced platelet aggregation at the Verify Now Aspirin assay quantitated the ASA-induced platelet inhibition as aspirin reaction units (ARU). According to manufacturer insert ARU>550 indicates aspirin resistance. ASA platelet function studies were assessed twice at baseline (pre-aspirin), and after 7 day(post-aspirin) were performed. RESULTS: After ASA intake none of the patients was found aspirin resistant with PFA-100. (CEPI-CT (129+/-36 vs 289+/-18 ). None of the patients was found aspirin resistant with PFA-100. As>30 % reduction in basal platelet aggregation with multiplate electrical impedance aggregometry is selected all of the patients have been stratified as responders.(COL TEST 688+/-230 vs 169+/-131 AU) None of the patients with Verify Now Aspirin found resistance to ASA(594+/-62 vs 446+/-43).Prior to ASA intake 15 of all patients with VN(501+/-16) and 2 of all patients with multiplate electrical impedance aggregometry (223+/-40 AUC )aggregation levels below the cut off label before ingestion of ASA.None of the patients was above the cut off label with PFA -100 (129+/-36). CONCLUSIONS: Verify Now ASA assay, multiplate electrical impedance aggregometry and PFA-100 seem to be reliable tests in reflecting ASA effect on platelets. Cut off labels for the defining the responsiveness given by manufacturer may show significant interindividual variability with Verify Now ASA assay and multiplate electrical impedance aggregometry, and these test may show platelet inhibition despite the absence of ASA intake. Consideration of the pretreatment values may eliminate the risk of overestimation in the assessment of platelet inhibition by ASA.