Quantitative assessment of left atrial functions by speckle tracking echocardiography in hypertensive patients with and without retinopathy.

PURPOSE: The association between hypertensive retinopathy and left atrial (LA) impairment is unknown. Accordingly, it was aimed to investigate the possible relationship between hypertensive retinopathy and LA phasic functions by means of two-dimensional speckle-tracking echocardiography (2D-STE). METHODS: A total of 124 hypertensive patients and 27 control subjects were included in the study. LA reservoir strain (LAS-S ), LA conduit strain (LAS-E ), and LA booster strain (LAS-A ) parameters were used to evaluate LA myocardial functions. RESULTS: Hypertensive patients (with and without retinopathy) displayed an obvious reduction in the LA reservoir strain (LAS-S ), and LA conduit strain (LAS-E ). Moreover, further impairment in LA reservoir and conduit strain was found in patients with hypertensive retinopathy than in the isolated hypertensive patients. There were no significant differences in LA booster strain (LAS-A ) among the three groups. Impaired LAS-S (OR: 0.764, CI: 0.657-0.888, and p < 0.001), LAS-E (OR: 0.754, CI: 0.634-0.897, and p = 0.001), and hypertension (HT) duration (OR: 2.345, CI: 1.568-3.507, and p < 0.001) were shown to be independent predictors of hypertensive retinopathy. CONCLUSION: Impaired LA reservoir and conduit strain may be used to predict hypertensive patients at higher risk of developing hypertensive retinopathy, and to determine which patients should be followed more closely for hypertensive retinopathy.

Assessment of fragmented QRS formation and its relationship with left ventricular hypertrophy in nonhypertensive acromegaly patients

Background/aim: It is known that the presence of fragmented QRS (fQRS) on electrocardiography (ECG) is associated with cardiovascular events. The aim of this study was the evaluation of fQRS formation and its relationship with the left ventricular hypertrophy (LVH) parameters in acromegaly patients. Materials and methods: In total, 47 previously diagnosed with non-hypertensive acromegaly patients and 48 control subjects were included in the study. ECG and transthoracic echocardiography (TTE) were performed for each participant. Acromegaly patients were divided into two groups according to the fQRS formation on the ECG. Left ventricular wall thicknesses, and left atrial diameter (LAD), left ventricular mass (LVM), left ventricular mass index (LVMi), and relative wall thickness (RWT) were obtained. Results: In control group 5 (10.4%) and in acromegaly group 17 (36.2%) patients had fQRS on ECG (p = 0.003). LAD [36.0 (34.0­38.0) vs. 38.0 (35.0­41.0) mm, p < 0.001], LVM [155.27 ± 27.00 vs. 173.0 (153.0­235.0) g, p < 0.001], LVMi [83.12 ± 13.19 vs. 92.0 (83.0­118.0) g/m², p < 0.001] and RWT [0.39 ± 0.03 vs. 0.43 (0.41­0.45), p = 0.001] were significantly higher in patients with acromegaly. Disease duration was significantly higher (11.59 ± 1.3 vs. 8.2 ± 1.8 years, p < 0.001) in the fQRS (+) group. LAD [41.0 (39.0­42.5) vs. 37.0 (34.7­38.0) mm, p < 0.001], LVM [219.0 (160.5­254.5) vs. 164.0 (153.0­188.0) g, p = 0.017], LVMi [117.0 (92.5­128.5) vs. 86.0 (82.0­100.2) g/m², p = 0.013] and RWT [0.44 (0.42­0.49) vs. 0.43 (0.40­0.44), p = 0.037] were significantly higher in fQSR (+) acromegaly patients. In multivariate logistic regression analysis, disease duration (odds ratio: 10.05, 95% CI: 1.099­92.012, p = 0.041) and LAD (odds ratio: 2.19, 95% CI: 1.030­4.660, p = 0.042) were found to be the independent predictors of fQRS formation. Conclusion: The results of our study revealed that fQRS (+) acromegaly patients had increased LVH parameters compared to fQRS (-) patients.

Assessment of arterial stiffness and epicardial adipose tissue thickness in predicting the subclinical atherosclerosis in patients with ankylosing spondylitis.

OBJECTIVE: Atherosclerosis is a chronic, progressive, inflammatory disease. Recognition of subclinical atherosclerotic vascular changes before clinical manifestation in an asymptomatic population is important for risk stratification and optimal management, which finally leads to the prevention of cardiovascular disease. We aimed to determine the risk of premature subclinical atherosclerosis by evaluating epicardial adipose tissue thickness (EATT) and arterial stiffness parameters in patients with ankylosing spondylitis (AS). METHODS: We performed a prospective study of 60 consecutive patients meeting modified New York criteria for AS compared to 60 controls matched for age and sex. Patients with traditional cardiovascular risk factors were excluded. Arterial stiffness parameters and EATT (examined via echocardiography) values of all patients and control groups were measured. RESULTS: There was no difference between basal characteristic and echocardiographic parameters in patients with AS and in the control group. EATT and pulse wave velocity (PWV) were higher in the AS patients compared to the control group. EATT was 5.74 ± 1.22 mm and 4.91 ± 1.21 mm (p < .001) and PWV was 9.90 ± 0.98 m/s and 6.46 ± 0.83 m/s (p = .009) in the AS and control groups, respectively. Also, PWV was significantly correlated with EATT, age, and central blood pressure in patients with AS. CONCLUSIONS: EATT and PWV, markers of atherosclerosis and cardiovascular disease, were significantly higher in patients with AS than the control group. In addition, in this study, it has been shown that there is a significant relationship between PWV and EATT in patients with AS.

Assessment of Tumor Sequencing as a Replacement for Lynch Syndrome Screening and Current Molecular Tests for Patients With Colorectal Cancer.

Importance: Universal tumor screening for Lynch syndrome (LS) in colorectal cancer (CRC) is recommended and involves up to 6 sequential tests. Somatic gene testing is performed on stage IV CRCs for treatment determination. The diagnostic workup for patients with CRC could be simplified and improved using a single up-front tumor next-generation sequencing test if it has higher sensitivity and specificity than the current screening protocol. Objective: To determine whether up-front tumor sequencing (TS) could replace the current multiple sequential test approach for universal tumor screening for LS. Design, Setting, and Participants: Tumor DNA from 419 consecutive CRC cases undergoing standard universal tumor screening and germline genetic testing when indicated as part of the multicenter, population-based Ohio Colorectal Cancer Prevention Initiative from October 2015 through February 2016 (the prospective cohort) and 46 patients with CRC known to have LS due to a germline mutation in a mismatch repair gene from January 2013 through September 2015 (the validation cohort) underwent blinded TS. Main Outcomes and Measures: Sensitivity of TS compared with microsatellite instability (MSI) testing and immunohistochemical (IHC) staining for the detection of LS. Results: In the 465 patients, mean age at diagnosis was 59.9 years (range, 20-96 years), and 241 (51.8%) were female. Tumor sequencing identified all 46 known LS cases from the validation cohort and an additional 12 LS cases from the 419-member prospective cohort. Testing with MSI or IHC, followed by BRAF p.V600E testing missed 5 and 6 cases of LS, respectively. Tumor sequencing alone had better sensitivity (100%; 95% CI, 93.8%-100%) than IHC plus BRAF (89.7%; 95% CI, 78.8%-96.1%; P = .04) and MSI plus BRAF (91.4%; 95% CI, 81.0%-97.1%; P = .07). Tumor sequencing had equal specificity (95.3%; 95% CI, 92.6%-97.2%) to IHC plus BRAF (94.6%; 95% CI, 91.9%-96.6%; P > .99) and MSI plus BRAF (94.8%; 95% CI, 92.2%-96.8%; P = .88). Tumor sequencing identified 284 cases with KRAS, NRAS, or BRAF mutations that could affect therapy for stage IV CRC, avoiding another test. Finally, TS identified 8 patients with germline DPYD mutations that confer toxicity to fluorouracil chemotherapy, which could also be useful for treatment selection. Conclusions and Relevance: Up-front TS in CRC is simpler and has superior sensitivity to current multitest approaches to LS screening, while simultaneously providing critical information for treatment selection.

Assessment of atrial electromechanical delay and P-wave dispersion in patients with type 2 diabetes mellitus.

OBJECTIVES: Diabetes mellitus is an independent and strong risk factor for development of atrial fibrillation (AF). Electrophysiologic and electromechanical abnormalities are associated with a higher risk of AF. In this study we aimed to determine the correlation of atrial conduction abnormalities between the surface electrocardiographic and tissue Doppler echocardiographic measurements in type 2 diabetes mellitus (T2DM) patients. METHODS: A total of 88 consecutive T2DM patients and 49 age-, gender-, and body mass index-matched healthy volunteers were included in the present study. Baseline characteristics were recorded and 24-hour ambulatory blood pressure monitoring, transthoracic echocardiography, and 12-lead surface electrocardiography were performed for all study participants. Atrial electromechanical delay (EMD) intervals were measured. RESULTS: Maximum P-wave duration and P-wave dispersion (Pd) were significantly higher in patients with T2DM (105.7±10.2ms vs. 102.2±7.5ms, p=0.02; 40.6±7.6ms vs. 33.6±5.9ms, p<0.001, respectively). Interatrial, intraatrial, and intraleft atrial EMD were significantly higher in the T2DM patients when compared with the controls (16.5±7.8ms vs.11.2±4.4ms, p<0.001; 9.0±7.3ms vs. 6.0±3.8ms, p=0.002, and 7.4±5.2ms vs. 5.1±3.2ms, p=0.002 respectively). Correlation analysis showed a positive correlation between interatrial EMD and Pd (r=0.429, p<0.001) and left atrial volume (r=0.428, p<0.001). CONCLUSIONS: In this study, there was significant EMD and Pd in patients with T2DM as compared with healthy volunteers. Additionally, interatrial EMD was correlated with Pd and left atrial volume index.

Assessment of inhomogeneities of repolarization in patients with systemic lupus erythematosus.

OBJECTIVES: Systemic lupus erythematosus (SLE) is a chronic disease that affects many organ systems and manifests a broad spectrum of laboratory and clinical features. SLE patients have an increased risk of developing cardiovascular disease. The aim of this study was to evaluate inhomogeneities of repolarization by using Tpeak -Tend (Tp-e) interval and Tp-e/QT ratio were measured from the 12-lead surface electrocardiogram (ECG) in patients with SLE. MATERIAL AND METHOD: This study included 69 SLE patients (69 females; mean age 35.8 ± 10.2) and 57 control subjects (57 females; mean age 34.5 ± 8.9). Transthoracic echocardiographic examination was done in all participants. QT parameters, Tp-e intervals and Tp-e/QT ratio were measured from the 12-lead ECG. These parameters were compared between groups. RESULTS: No statistically significant difference was found between two groups in terms of basic characteristics. Diastolic function parameters were similar between the two groups (P > 0.05). In electrocardiographic parameters analysis, QT dispersion (QTd) and corrected QT dispersion (cQTd) were significantly increased in SLE patients compared the control group (49.5 ± 16.4 ms vs. 32.8±11.7 ms and 56.7 ± 19.5 ms vs. 36.4 ± 13.1 ms, all P value < 0.001). Tp-e interval and Tp-e/QT ratio were also significantly higher in SLE patients (82.8 ± 18.9 vs. 72.4 ± 17.6 and 0.22 ± 0.05 vs. 0.19 ± 0.05, P = 0.002 and P = 0.001, respectively). Tp-e interval and Tp-e/QT were positively correlated with disease duration (r = 0.29, P = 0.01 and r = 0.24, P = 0.04, respectively). CONCLUSION: Our study revealed that QTd, cQTd, Tp-e interval and Tp-e/QT ratio increased in patients with SLE. Also, Tp-e interval and Tp-e/QT were positively correlated with disease duration.

Is the assessment of dental age by the Nolla method valid for eastern Turkish children?

The aim of this study was to investigate whether or not the Nolla method is appropriate for Turkish children for the determination of the dental age (DA). A group of 719 children between the ages of 6 and 18 years were included in the study. DAs from orthopantograms by the Nolla method were estimated. The results obtained were compared with chronologic age (CA). Paired t and the Wilcoxon tests were performed. Both genders were underestimated in dental maturity when compared with the reference samples in total (-0.3 years) (p<0.01). The differences in girls were statistically significant in total and in all groups except for 7-7.9. The differences in boys between the CAs and DAs were not statistically significant in total and in all groups except for 7-7.9 and 8-8.9. Although the accuracy of this method was suitable for boys, according to our findings, it was not suitable for girls.

Psychometric properties of the Rivermead Motor Assessment: its utility in stroke.

OBJECTIVE: To investigate the psychometric properties of the Rivermead Motor Assessment by Rasch analysis and conventional statistics to improve its clinical utility. METHODS: A total of 107 patients after stroke were evaluated using the Rivermead Motor Assessment and Functional Independence Measure (FIM). Scaling properties were assessed using Mokken scaling, internal construct validity using Rasch analysis, reliability using Cronbach's alpha and intra-class correlation coefficients, external construct validity through convergent validity with FIM, and responsiveness using the effect size and standardized response mean. RESULTS: Cronbach's alpha and intra-class correlation coefficients for 3 sections of the Rivermead Motor Assessment were between 0.88 and 0.95. Mokken scaling showed appropriate Guttman patterns, but the hierarchical ordering of the items differed from that of the original. After removing 4 items of gross function, 1 of leg-trunk, and 4 of arm, all sections met Rasch model expectations. External construct validity was confirmed. Mean values of effect size and standardized response were 0.38-0.51 and 0.60-0.89, respectively. CONCLUSION: The Rivermead Motor Assessment has been shown to be reliable and responsive. Guttman scaling is apparent, but not as originally defined. After removing some items, the scale satisfies the most stringent Rasch measurement criteria and can produce interval scaling for the assessment of motor function in stroke.

Clinical assessment of 324 breast cancer cases in two centers between the years of 1992 and 2002.

The records of the 324 patients with breast cancer; diagnosed and followed in two different University Hospital between years of January 1992 and January 2002 were reviewed retrospectively. The median age of the patients was 49.0+/-12.5 years, with the range of 18 and 90 years. The most frequently seen age interval of the patients was 40 and 49 years. The most frequently seen symptom and physical examination finding of the patients were breast mass. Breast cancer was diagnosed in 324 women, 173 in the left breast and 151 in the right breast. At the hospital admission percentages of the patients' disease stages were as follows: I (2.8%), IIA (30.0%), IIB (24.0%), IIIA (19.8%), IIIB (11.4) and IV (12.0%). The most frequently seen histopathological diagnosis was infiltrative ductal carcinoma (84.4%). Axillary lymph node metastasis was found in 61.7% of the patients. Primary therapeutic options and percentages were surgical therapy (78.5%), systemic chemotherapy (17.5%) and radiotherapy (4%). Systemic chemotherapy was given to 81.2% of the patients. From the files, estrogen receptor status was known in 311 and positive in 128 (41.2%) of them. Tamoxifen was given patients who had positive estrogen receptor. The five-year survival rate of the patients was calculated as 75.9%.