Relationship between left ventricular diastolic function and arterial stiffness in patients with bicuspid aortic valve.

BACKGROUND AND AIM OF THE STUDY: Bicuspid aortic valve (BAV), one of the most common congenital cardiac abnormalities, is the result of abnormal aortic leaflet formation during valvulogenesis. Recent studies have reported BAV to be associated with abnormal aortic stiffness, which has a negative impact on left ventricular (LV) diastolic function. The study aim was to investigate the relationship between LV diastolic function, as measured with two-dimensional speckle tracking echocardiography (2D-STE), and arterial stiffness. METHODS: A total of 38 patients with isolated BAV, and 18 age- and gender-matched healthy controls were enrolled prospectively. Patients with aortic valve velocity > 1.7 m/s, more than mild aortic regurgitation (AR) and ascending aorta diameter > 3.6 cm (indexed diameter > 2.1 cm/m2) were excluded. BAV was classified as either anterior-posterior (AP) orientation or right-left (RL) orientation. The LV diastolic function (E/A and E/Em ratio), left atrial (LA) volume index (LAVI), LA systolic strain and strain rate (SR) was assessed using echocardiography. Strain measurements were reported as longitudinal LA strain during ventricular systole (LA-Res), strain during late diastole (LA-Pump), and also as SR during ventricular contraction (LA-SR(s)), during passive ventricular filling (LA-SR(E)), and during active atrial contraction (LA-SR(A)) from four-chamber views. Arterial stiffness was evaluated by measuring the aortic pulse wave velocity (PWV), wave reflection was assessed by measuring the central systolic blood pressure (cSBP), central pulse pressure (cPP) and augmentation index (AIx) with applanation tonometry. RESULTS: The aortic diameter at the proximal ascending aorta was larger in patients with BAV than in controls. Compared to controls, the E/Em ratio and LAVI were significantly higher in BAV patients. Although PWV was higher in BAV patients than in controls, no differences were found between the groups in terms of cSBP, cPP and AIx. The BAV group was observed to have significant lower LA-Res and LA-Pump strain values compared to controls. Significant correlations were identified between the PWV and echocardiographic parameters of LV diastolic function determinants, such as LA-Res and LA-Pump. However, there were no significant differences between BAV subgroups in terms of LV diastolic parameters and PWV. CONCLUSION: Patients with isolated BAV have early features of subclinical LV diastolic dysfunction, as measured with 2D-STE. In addition, aortic stiffness assessed by PWV was impaired. The LV diastolic parameters were related to aortic stiffness.

Effect of increased severity of mitral regurgitation and preprocedural right ventricular systolic dysfunction on biventricular and left atrial mechanical functions following percutaneous mitral balloon valvuloplasty.

BACKGROUND: Severe mitral stenosis (MS) may impair left atrial (LA) pump function, and increase LA and pulmonary venous pressure resulting in right ventricular (RV) systolic dysfunction. The aim of this study was to evaluate biventricular and LA function after percutaneous mitral balloon valvuloplasty (PMBV) by tissue Doppler (TDI) and speckle tracking echocardiography (STE). METHODS: Twenty-eight consecutive patients with severe symptomatic rheumatic MS (11 men, mean age: 39 ± 7 years) who were referred for PMBV were included in the study. In addition to conventional echocardiography, all patients underwent TDI and two-dimensional (2D) (STE) to assess left ventricular (LV), LA, and RV function before and 3 months after PMBV. Severity of mitral regurgitation (MR) was graded by the ratio of MR jet area to LA area (JA/LAA) method and any postprocedural progression of the JA/LAA ratio was defined as worsening of MR. Peak systolic velocity of tricuspid lateral annulus (RVs) <11.5 cm/sec was accepted as RV dysfunction. RESULTS: Left atrial diameter and area were decreased, while LV dimensions were unchanged following the valvuloplasty. PMBV improved STE-based LV mechanical indices, LA reservoir and conduit function, and RV free wall basal longitudinal strain (LS) and displacement. Increased severity of MR was detected in 6 patients, and PMBV did not improve the STE-based RV or LV function in these patients, while LA reservoir and conduit function were both improved independent of MR worsening. There was significant improvement in RVs and RV basal LS in the 15 patients with preprocedural RV systolic dysfunction, while the improvement in patients with normal preprocedural RV function was not significant. CONCLUSION: Percutaneous mitral balloon valvuloplasty may improve both LA and biventricular function in patients with severe symptomatic MS. Both TDI and STE are useful to determine biventricular and LA function after PMBV. Although the number of patients was insufficient, worsening of MR after PMBV may limit the improvement in RV and LV function, while preprocedural RV dysfunction does not seem to limit the improvement in RV function and pulmonary artery systolic pressure. Large scale follow-up studies are required to see whether the changes observed in cardiac mechanics are persistent.

Drospirenone-containing oral contraceptives and risk of adverse outcomes after myocardial infarction.

BACKGROUND: The association between oral contraceptives (OC) and myocardial infarction remains controversial. The new generation contraceptive Yasmin (30 µg ethinyl estradiol and 3 mg drospirenone) has a lower estrogen and newer progestin component. To date, there are no data available for the myocardial infarction risk and outcome for drospirenone. We aimed to investigate the effect of Yasmin use on cardiovascular outcomes in patients with acute ST segment elevation myocardial infarction (STEMI) undergoing primary angioplasty. METHODS: We retrospectively evaluated 1851 patients who underwent primary angioplasty for acute STEMI. Of them, 440 female patients (23.8%) composed the study population and 12 female (2.7%) were taking the oral contraceptive-Yasmin at the time of infarction. Patients were divided into two groups based on their age (≥50 (n = 339) and <50 years old). Patients under 50 years-old (n = 101) were separated into two groups according to use of OC therapy (OC (+) group n = 12; OC (-) group n = 89). RESULTS: Patients who were older than 50-year-old were more likely to have comorbid conditions like diabetes mellitus and hypertension than other groups. Current smoking status was significantly higher in OC (+) group than OC (-) group (P = 0.007). There was a significant difference in favour of OC (+) group when compared with OC (-) group for the increased angiographic thrombus burden according to both TIMI and Yip classification (P = 0.045 and P = 0.029, respectively). The incidence of final TIMI 3 flow and post-procedural complete ST resolution were significantly lower in OC (+) group (P = 0.019, P = 0.002, respectively). In multivariate logistic regression analysis, use of OC was found to be an independent predictor of high grade thrombus burden (OR 5.13, 95% CI 1.07-24.60, P = 0.04). CONCLUSION: This is the first study to evaluate the myocardial infarction risk and its subsequent clinical sequelae in women having a STEMI while taking the OC-Yasmin. Women on the oral contraception Yasmin, who underwent coronary revascularization had a lower post-procedural complete ST resolution and worse left ventricular function. Furthermore, OC use with Yasmin is an independent predictor of a high-grade thrombus burden.

Soluble CD40 ligand release in patients with stable coronary artery disease during elective stent implantation: effect of drug-eluting stent over bare metal stent.

OBJECTIVES: We aimed to determine the effect of drug-eluting stent (DES) implantation on soluble CD40 ligand (sCD40L) levels in patients with stable coronary artery disease undergoing stent replacement. STUDY DESIGN: Eighty-nine consecutive patients (33 women, 56 men; mean age 61±10 years) with stable coronary artery disease undergoing stent replacement were recruited. Pre- and post-procedural blood samples were collected for sCD40L analysis, and differences in plasma levels were calculated and expressed as delta sCD40L. Total size and length of implanted stents and pre- and post-dilatation procedures were recorded for each patient, for possible impact on sCD40L release. Patients were followed for one year following procedures for possible adverse cardiac events such as death, myocardial infarction and revascularization. RESULTS: Forty-nine patients received bare metal stent (BMS) and 40 patients received DES. There were no differences between BMS- and DES-implanted patients in terms of age, stent size and length, and delta sCD40L plasma levels. Delta sCD40L was correlated only with total implanted stent length (r=0.374, p<0.001). Delta sCD40L levels were divided into quartiles for better determination of the procedural parameters that are effective on biomarker release. Total stent length (p=0.008), stent size (p=0.038) and pre-dilatation procedure (p=0.034) were the statistically differing parameters between delta sCD40L quartiles. Although statistically non-significant, all three adverse events were observed in patients with the highest quartile (p=0.179). CONCLUSION: Procedural sCD40L release did not differ between DES- and BMS-implanted stable coronary artery disease patients. Total implanted stent length, stent size and pre-dilatation procedure were the influential parameters on procedural sCD40L release.

Intracoronary bolus-only compared with intravenous bolus plus infusion of tirofiban application in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention.

OBJECTIVES: The aim of this pilot study was to compare intracoronary bolus-only with standard intravenous bolus plus maintenance infusion of tirofiban with respect to improvement in myocardial reperfusion after primary percutaneous coronary intervention (p-PCI). BACKGROUND: Changes in clinical practice may obviate the need for a maintenance infusion of small molecule glycoprotein IIb/IIIa inhibitors in current practice. METHODS: Forty-nine patients undergoing p-PCI were randomized to either intracoronary bolus-only (n = 25) or intravenous bolus plus infusion (n = 24) of tirofiban. The primary end point was coronary hemodynamic indices of microvascular perfusion measured 4-5 days after p-PCI. The secondary end points were ST segment resolution at 90 min, the corrected TIMI frame count and myocardial blush grade. At 6 months, echocardiography and technetium-99m single-photon-emission computed tomography were performed. RESULTS: Microvascular perfusion did not differ significantly between the two treatment groups: index of microvascular resistance (27 ± 13 vs. 35 ± 15 U, P = 0.08) and coronary flow reserve (2.2 ± 0.7 vs. 1.9 ± 0.6, P = 0.25). The corrected TIMI frame counts assessed in the first (P = 0.13) and the second (P = 0.09) catheterization or the myocardial blush grades evaluated immediately (P = 0.23) and 4-5 days after MI (P = 1.00) were not significantly different between the two groups. At 6 months, there was no difference between the two groups in infarct size, left ventricular volumes, or ejection fraction. CONCLUSIONS: The standard intravenous bolus plus maintenance infusion of tirofiban in p-PCI is not superior to intracoronary bolus-only administration with respect to microvascular perfusion. Further, adequately powered randomized trials are warranted to evaluate the clinical outcomes associated with this strategy.

Serum levels of angiopoietin-1 in patients with pulmonary hypertension due to mitral stenosis.

The molecular basis and pathophysiology of pulmonary hypertension (PH) are rapidly evolving areas. Recently discovered angiopoietins (Ang) constitute a family of growth factors, and whether they play a causal or protective role in pulmonary hypertension has not been fully elucidated. Since left heart disease probably represents the most frequent cause of PH, we sought to determine whether there was a relationship between serum Ang-1 levels and pulmonary hypertension caused by mitral stenosis (MS). The study population was composed of 49 patients with isolated MS. These patients were then divided into group 1 [31 patients with severe MS: mitral valve area (MVA) ≤1.1 cm(2)] and group 2 (18 patients with mild-moderate MS: MVA 1.2-2.0 cm(2)). Twenty-one healthy volunteers comprised the control group (group 3). All of the subjects underwent complete transthoracic echocardiography with determination of systolic pulmonary artery pressure (PAPs). Ang-1 levels were determined in serum. Serum levels of Ang-1 were significantly higher in the control group compared to patients with severe (group 1) and mild-moderate (group 2) MS (p < 0.001). Ang-1 levels were found to have moderate inverse correlation with PAPs and left atrial (LA) diameter (r: -0.620, p < 0.001 and r: -0.489, p < 0.001, respectively). The AUC for the ROC curve for predicting PAPs <50 mmHg by serum Ang-1 level was 0.824 (95% CI 0.722-0.926, p < 0.001). A serum level of Ang-1 above 34,656 pg/ml has 74% sensitivity and 80% specificity for predicting that PH is not severe (PAPs <50 mmHg). In conclusion, the findings of this study are distinctive in the sense that they clearly demonstrate a negative correlation between serum Ang-1 levels and the degree of PH.

Primary angioplasty in a high-volume tertiary center in Turkey: in-hospital clinical outcomes of 1625 patients.

OBJECTIVES: We evaluated in-hospital results of primary percutaneous coronary intervention (PCI) in a high-volume tertiary center. STUDY DESIGN: We retrospectively evaluated 1625 patients (1323 males, 302 females; mean age 56.0 ± 11.6 years) who underwent primary PCI for acute ST-elevation myocardial infarction between January 2006 and April 2008. All coronary angiography procedures were performed using the femoral artery route. In-hospital clinical and angiographic results were recorded. RESULTS: On admission, 23% of the patients had diabetes mellitus, 49.6% had anterior myocardial infarction, and 4.9% had cardiogenic shock. The mean duration of pain was 171.2 ± 121.2 minutes, and the mean door-to-balloon time was 31.6 ± 7.2 minutes. Infarct-related artery was the left anterior descending artery in 49.7%, multivessel disease was present in 40.9%, TIMI 2/3 flow was present in 23.6%, and high-grade thrombus was observed in 66.8%. Primary PCI involved balloon dilatation (5.7%) and stent implantation (94.3%). The incidence of angiographic no-reflow was 11.9%. The mean hospital stay was 5.2 ± 3.3 days. All-cause mortality occurred in 71 patients (4.4%). Other in-hospital events were reinfarction (1.4%), target vessel revascularization (1.9%), hemorrhagic/ischemic stroke (0.6%), stent thrombosis (1.2%), major bleeding (3.8%), blood transfusion (4.8%), heart failure (10.5%), atrial fibrillation (4%), and ventricular tachycardia (3.9%). CONCLUSION: Primary PCI is an effective method in achieving complete revascularization of the infarct-related artery. Successful in-hospital results not only depend on the experience and equipment of the center, but also on how rapidly reperfusion is achieved.

In-hospital prognostic value of admission plasma B-type natriuretic peptide levels in patients undergoing primary angioplasty for acute ST-elevation myocardial infarction.

OBJECTIVES: We assessed in-hospital prognostic value of admission plasma B-type natriuretic peptide (BNP) levels in patients undergoing primary percutaneous coronary intervention (p-PCI) for acute ST-elevation myocardial infarction (STEMI). STUDY DESIGN: In a retrospective design, we evaluated 992 patients (801 males, 191 females; mean age 56 ± 12 years) treated with p-PCI for STEMI. The patients were divided into two groups according to the admission BNP levels, taking the cut-off value of BNP as 100 pg/ml; i.e, ≥ 100 pg/ml (n=334, 33.7%) and <100 pg/ml (n=658, 66.3%). Postprocedural angiographic and clinical in-hospital results were recorded. RESULTS: No-reflow (24% vs. 9%), heart failure (32.3% vs. 5.5%) and death (15.6% vs. 1.7%) were significantly more common in patients with BNP ≥ 100 pg/ml (p<0.001). In multivariate analysis, elevated baseline BNP level was identified as an independent predictor of no-reflow (OR=1.83; 95% CI 1.22-2.74, p=0.003), acute heart failure (OR=2.67; 95% CI 1.55-4.58, p<0.001), and in-hospital mortality (OR=3.28; 95% CI 1.51-7.14, p=0.003). In receiver operating characteristic curve analysis, the area under the curve and sensitivity/specificity of the cut-off value of BNP (100 pg/ml) for prediction of clinical endpoints were 0.741 and 58.6%/70.3% for no-reflow, 0.822 and 75%/73.3% for heart failure, and 0.833 and 82.5%/69.4% for death, respectively (p<0.001 for all). CONCLUSION: Elevated admission BNP level is an independent predictor of angiographic no-reflow, acute heart failure, and mortality in STEMI patients during in-hospital period, suggesting that it might be incorporated into traditional risk scoring systems to improve early risk stratification.

Prognostic value of N-terminal pro-B-type natriuretic peptide in patients with active infective endocarditis.

Our aim was to determine whether N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) and cardiac troponin I (cTnI) levels are valuable for predicting prognosis in patients with infective endocarditis (IE). We analyzed measured plasma NT-pro-BNP levels at admission in 45 patients with definite IE. The primary end point was early surgery or in-hospital death. The other data recorded were baseline clinical, echocardiographic, and laboratory parameters. Thirty patients underwent early surgery, and 9 died in hospital. Univariate analysis revealed that log NT-pro-BNP, cTnI > or =0.03 ng/ml, New York Heart Association functional class III to IV symptoms, left atrial diameter, left ventricular end-diastolic diameter, left ventricular end-systolic diameter, and severe valvular regurgitation were associated with increased risk of reaching the primary end point. Cox proportional hazard regression analysis identified log NT-pro-BNP (hazard ratio 1.5; 95% confidence interval 1.2 to 1.9, p <0.001) as the only independent predictor of the primary end point. The log NT-pro-BNP cut-off value with the highest sensitivity (97%) and specificity (92%) for predicting primary end point was 7.2 (1,500 pg/ml). Patients with NT-pro-BNP level > or =1,500 pg/ml had significantly lower event-free survival than others. In conclusion, admission NT-pro-BNP is of prognostic value in patients with IE. The combination of admission NT-pro-BNP and cTnI levels appears to have even greater value for risk stratification in this patient group.

Predictors and clinical significance of angiographically detected distal embolization after primary percutaneous coronary interventions.

OBJECTIVES: The aim of this study was to investigate clinical, angiographic and procedural predictors of distal embolization (DE) on angiography after primary percutaneous coronary intervention (PCI). The impact of DE on outcome in the first 30 days was also assessed. METHODS: Between January 2004 and April 2006, primary PCI was performed in 212 consecutive patients with acute myocardial infarction (AMI) of < or = 12-h duration. RESULTS: Distal embolization was present in 27 patients (12.7%) and more often observed in female sex (27.5 vs. 10.4%, P=0.01), in patients with right coronary artery involvement (52 vs. 28%, P=0.02), prerevascularization thrombolysis in myocardial infarction flow < or = 1 (89 vs. 69%, P=0.03), in the presence of high thrombus burden (92.6 vs. 39.5%, P=0.0009), and a long target lesion in the infarct-related artery (>14.5 mm, 74 vs. 29%, P<0.0001). By multiple stepwise logistic regression analysis, only the presence of high thrombus burden before the PCI procedure [odds ratio (OR)=5.2, 95% confidence interval (CI)=1.09-24.97, P=0.03)] and target lesion length (>14.5 mm, OR=3.9, 95% CI=1.45-10.60, P=0.007) were found independent predictors of DE. Patients with DE had an increased risk of target vessel revascularization (26 vs. 5%, P=0.001) and short-term mortality (29.6 vs. 7.5%, P=0.002) when compared with patients without angiographic signs of embolization. CONCLUSIONS: In patients who undergo primary PCI, high thrombus burden on angiography before PCI and/or a long target lesion in the infarct-related artery increase the risk of DE and subsequent short-term mortality.

Closure of mitral paravalvular defects without performing an arteriovenous loop: a case series of fourteen patients.

INTRODUCTION: The arteriovenous (AV) loop is recommended when further support is needed during paravalvular leak (PVL) closure. AIM: We report the feasibility and safety of mitral PVL closure without constructing an AV loop, based on a single-centre experience. MATERIAL AND METHODS: Fourteen patients with mitral valve replacement (MVR) who had New York Heart Association (NYHA) class III-IV dyspnoea or NYHA class II symptoms with significant haemolytic anaemia caused by severe or moderate-to-severe paravalvular regurgitation and who underwent transcatheter PVL closure (TPVLC) between May 2014 and February 2017 were enrolled. RESULTS: In total, 15 PVL procedures and 19 device deployments were performed. The patients had one (n = 10), three (n = 1) or four (n = 1) devices for closure at the time of the procedure; one patient had two devices from two procedures at different times with different access ways. Nineteen devices (10 (66.6%) via transseptal access; 4 (26.6%), transapical access; and 1 (6.6%), retrograde access) were deployed successfully without making an AV loop. CONCLUSIONS: The TPVLC is a less invasive and effective alternative to surgery in symptomatic patients with significant PVLs and high operational risks. The success rates are satisfactory, with improving techniques and devices. Procedural success without using an AV loop can be achieved with reduced costs, fluoroscopic times and complications.

Increased urinary albumin excretion rates can be a marker of coexisting coronary artery disease in patients with peripheral arterial disease.

Coexisting coronary artery disease (CAD) is an important cause of morbidity and mortality in patients with peripheral arterial disease (PAD). Clinical evaluation and noninvasive tests have some important limitations for the detection of CAD in patients with PAD. The purpose of this study was to investigate whether urinary albumin excretion (UAE) was a sign of atherosclerotic involvement of coronary arteries in patients with PAD. Our study consisted of 65 consecutive patients (56 men, 9 women, mean age; 59.7+/-7.9 years) with PAD who underwent coronary angiography. Urinary albumin excretion was measured in 24-hour urine samples by immunoprecipitation technique. PAD was defined as the presence of > or =50% stenotic lesions in at least 1 of the iliac, femoral, popliteal, tibialis anterior, tibialis posterior, or peroneal arteries. CAD was defined as > or =25% diameter stenosis in at least 1 coronary artery. Patients without any coronary lesions were accepted as having normal coronaries. Age, sex, distributions of coronary risk factors, and UAE rates were compared between patients with and without CAD. Mean UAE was 17.9+/-15.6 mg/day in the total population. Thirty-seven percent of patients had CAD, and 63% had no coronary lesion. UAE rates were 22.33+/-18.74 and 15.32+/-13.01 mg/day in patients with CAD and those with normal coronary arteries, respectively (p = 0.021). Microalbuminuria was detected in 25% in patients with CAD and 12% in those without coronary artery lesions (p = 0.184). The difference was not statistically significant. The distributions of other risk factors and sex were not different between the 2 groups. These data suggest that in patients with PAD, urinary albumin excretion rates may be used to determine those with a high probability of CAD. Further studies are required to decide whether this noninvasive testing is appropriate in detecting high-risk patients.

Correlation between the tissue Doppler, strain rate, strain imaging during the dobutamine infusion and coronary fractional flow reserve during catheterization: a comparative study.

UNLABELLED: Coronary fractional flow reserve (FFR) as an invasive, and dobutamine stress echocardiography (DSE) as a noninvasive technique were used to detect critical coronary stenosis. This study was undertaken to assess correlation between these two techniques by using tissue Doppler, strain rate (SR), and strain imaging (S). METHODS: In 17 patients (aged 54.9+/-12.6, 4 F), a total of 22 vessels were studied. On dobutamine stress echocardiography, baseline and peak systolic (Sm), early (Em) and late (Am) diastolic myocardial velocities, SR and S were recorded from parasternal view (mid-posterior segment) for radial and apical view (mid-septum) for longitudinal deformation. Then coronary FFR was performed by using intracoronary adenosine infusion, and the value of < or = 0.75 was accepted as critical coronary stenosis. RESULTS: FFR was found to be significant in 10 vessels (FFR critical). Baseline Sm, Em/Am, SR, S values, and peak Em/Am, SR, S values were similar between critical or noncritical FFR groups. Baseline Sm and Em, and change between baseline and peak Sm and S were significantly higher in noncritical FFR group (p < 0.01, < 0.05, < 0.001, < 0.001, respectively). In all vessels, FFR after adenosine infusion showed a poor correlation with WMSI, Em, Am, Em/Am values, and the change in SR values (r = -0.22, 0.16, -0.14, 0.21, 18, respectively) showed a good correlation with the change in S (r = 0.51; p = 0.014), and a very good correlation with the change in Sm values (r = 0.77; p < 0.001) during DSE. When FFR values at left coronary system were analyzed for longitudinal SR and S values, it had a mild correlation with SR (r = 0.47, p = 0.044) and a good correlation with S (r = 0.66, p = 0.002). CONCLUSION: The quantification of regional myocardial deformation by using DSE rather than the motion would be more appropriate in detecting the ischemic dysfunctional segment supplied by the critical coronary stenosis. Strain measurement during the dobutamine infusion may provide an information on the FFR results of the culprit vessel.

Left atrial function by speckle-tracking echocardiography in chronic asymptomatic alcoholic patients.

Although the effects of chronic alcoholism on left ventricular (LV) systolic function are well established, diastolic impairment has been evaluated partially. In addition, there are scarce data available about the relation of LV diastolic function to either or both duration and quantity of drinking among alcoholics. The aim of the study was to evaluate the left atrial (LA) function in chronic asymptomatic alcoholic patients by using two-dimensional speckle-tracking echocardiography (2D-STE). We enrolled 30 healthy subjects (age 34.8 ± 5.8 years) and 75 asymptomatic male alcoholics (age 39.8 ± 6.5 years) divided into two groups, according to total lifetime dose of ethanol: group I, <15 kg/kg and group II, ≥15 kg/kg. In the 2D-STE analysis of the LA, strain during ventricular systole (LA-Res), during late diastole (LA-Pump) and strain rate during ventricular contraction (LA-SRs), during passive ventricular filling (LA-SRe), during active atrial contraction (LA-SRa) were obtained. Deceleration time was longer, E/A and V(p) were smaller, and E/E(m) was higher in alcoholics. Although parameters of diastolic dysfunction were comparable in alcoholic groups, LA-Res and LA-Pump were found significantly different among the alcoholics. However, there were no differences in LA-SRs and LA-SRe between the controls and alcoholic groups. LA function is reduced in chronic alcohol abuse, and heavy alcohol consumption may play an important role in LA function impairment.

Cystic subaortic discrete membrane in an elderly woman.

A discrete subaortic membrane is an uncommon cause of left ventricular outflow tract (LVOT) obstruction in patients of advanced age. Here, a significant LVOT obstruction caused by a discrete membrane is reported in a 64-year-old woman. On echocardiographic examination the membrane had a cystic appearance. To the present authors' knowledge, this is the first reported case of a cystic subaortic membrane.

Extensive aortic surgery in Marfan syndrome: 16-year experience.

The aim of this study was to evaluate the clinical outcome of surgical treatment in patients with Marfan syndrome. Between 1985 and November 2001, 33 patients with Marfan syndrome were operated for chronic aneurysm of the aortic root with involvement of the ascending aorta in 20 patients and type A dissection in 13 patients. The patients comprised 24 males and 9 females with a mean age of 31.9 +/- 9.7 years (range, 18 to 54 years). The mean diameter of the ascending aorta was 6.6 +/- 1.6 cm and that of the aortic root was 5.4 +/- 1.2 cm. Hemodynamic instability was observed in 11 patients. The aortic arch was replaced in 7 patients. There was no hospital mortality. Late mortality was 6%, involving 2 patients who had aortic valve replacement. Actuarial freedom from death was 92.3% +/- 7.4% at 12 years and from late aortic complications was 86.4% +/- 9.4% at 13 years. Aortic aneurysm was a significant univariate adverse factor for late aortic complications. Aortic surgery can be performed in Marfan patients with low morbidity and mortality. Aggressive surgical intervention does not impair surgical outcome while it decreases reoperation risk.

Does radial artery harvesting cause any changes in the forehand circulation during the postoperative period? An angiographic study.

OBJECTIVE: The aim of this study was to evaluate angiographic changes in the ulnar and interosseous arteries, and the collateral circulation of forehand after harvesting radial artery. METHODS: Forty patients were studied between June 1998 and June 2001. Study group consisted of 30 patients who received radial artery as a conduit for coronary artery bypass operation, and control group consisted of 10 patients who did not undergo any cardiac or vascular operation before. Preoperative risk factors were similar between the two groups. All patients underwent angiographic evaluation to detect coronary artery and left forehand arterial circulation. RESULTS: Angiographic evaluation was performed 25.5 +/- 2.0 months after the initial operation in the study group. Mean diameter of ulnar artery was 2.9 +/- 0.59 mm (range 2.1 - 4.8) in the study group and 3.2 +/- 0.8 mm (range 1.5 t- 4.7) in the control group (p >0.05). Mean diameter of interosseous artery was significantly higher in the study group than in control one: 2.06 +/- 0.57 mm (range 1.2 t- 4.2) versus 1.46 +/- 0.79 mm (range 0.8 t- 3.6); (p = 0.003). CONCLUSION: Although angiography was performed in a limited number of patients, interosseous artery rather than ulnar artery enlarged to compensate blood supply of forehand 25 months after harvesting the radial artery for coronary artery bypass grafting.

[Distribution of risk factors according to socioeconomic status in male and female cases with coronary artery disease]. / Koroner arter hastaligi bulunan olgularda risk faktörlerinin erkek ve kadinlarda sosyoekonomik duruma göre dagilimi.

OBJECTIVE: Socioeconomic status (SES) is associated with coronary artery disease (CAD) risk factors, coronary morbidity and mortality. In industrialized countries several studies showed that the lowest SES groups have higher coronary morbidity and mortality rates and higher coronary risk factors profile. The aim of our study was to investigate the distribution of risk factors in cases with CAD in different socioeconomic groups. METHODS: Our study group consists of 550 consecutive cases with > or = 50% lesions in at least one coronary artery. Educational level and income were taken into consideration for the determination of the SES. In both sexes the distribution of eight risk factors such as, smoking, family history, diabetes mellitus, hypertension, high low-density lipoprotein cholesterol (LDL-C), low high-density lipoprotein cholesterol (HDL-C), body mass index, central obesity was compared in three different groups determined according to the education and income levels. RESULTS: In men, the distribution of risk factors did not differ according to education levels. In women, central obesity was found to be higher in the group with low education level. In men, the prevalence of low HDL-C, high LDL-C and obesity increased with increasing levels of economical status. In women, central obesity was found to be inversely related with the economic status. CONCLUSION: Our data show a higher risk factor profile in men with higher income level, while in women central obesity was inversely related to the income and educational level. These data should be considered in secondary prevention efforts.

[Traumatic vascular complications due to intraaortic balloon pump support]. / Intraaortik balon pompasi destegine bagli vasküler travmalar.

BACKGROUND: The use of an intraaortic balloon pump (IABP) catheter was retrospectively evaluated in terms of risk factors, insertion techniques, and complications in patients with low cardiac output. METHODS: A total of 1036 patients (804 males, 232 females; mean age 53.4 years; range 16 to 75 years) received IABP support from 1985 to March 2002. Of these, 789 patients (76.1%) underwent open heart surgery, 247 patients (23.8%) developed low cardiac output during medical treatment. Insertion of IABP was performed via the femoral artery either percutaneously by the Seldinger technique in 897 patients (86.6%), or by direct surgical exposure in 88 patients (8.5%). Open surgical IABP insertion was performed through an 8 mm Dacron graft placed with an end-to-side anastomosis to the common femoral artery (88 patients) or to the ascending aorta (23 patients). RESULTS: The overall mortality rate was 35.1% (364 patients). Vascular complications were associated with IABP in 104 patients (10%), of which 57 patients (5.5%) required surgical treatment. Major complications were aortic arch dissection in two patients and paraplegia in two patients. Vascular complications tended to increase with female gender, older age, diabetes, and peripheral vascular disease. The mean duration of IABP support in the presence of vascular complications was 7.8 days (range 5 hours to 77 days). CONCLUSION: Application of unsheathed IABP and proper evaluation of peripheral circulation seem to decrease the incidence of vascular complications.

Clinical and echocardiographic evaluation of mitral valve aneurysms: a retrospective, single center study.

Mitral valve aneurysms (MVAs) are rarely encountered in echocardiography laboratories. Although they are commonly associated with endocarditis of the aortic valve, various mechanisms have been suggested for the etiopathogenesis of MVAs associated with non-infectious conditions. 5,887 patients who underwent transesophageal echocardiography (TEE) between 2007 and 2012 were evaluated retrospectively for MVA. Mitral valve aneurysm is defined as a localized saccular bulging of the mitral leaflet towards the left atrium with systolic expansion and diastolic collapse. The color flow Doppler image of a perforation was described as a high-velocity turbulent jet traversing a valve leaflet in systole. We found that 12 of 5,887 patients (0.204 %) had MVA in TEE examinations. The mean age of patients with MVA was 53 years (range 21-80 years), including four females and eight males. Nine patients presented with symptoms of endocarditis. On TEE, aneurysms were located in the anterior mitral leaflet in 11 patients, and in the posterior mitral leaflet in one patient. Eight patients had severe, three had moderate, and one had trace mitral regurgitation. Of the nine patients with perforated leaflets, eight patients had severe and one patient had moderate mitral regurgitation. Aortic regurgitation was present in nine patients, being severe in three, moderate in two, mild in two, and trace in two patients. Two patients without severe mitral regurgitation were followed-up conservatively, while nine patients underwent surgery. Two patients died from septic shock, one in the postoperative period and the other one prior to surgery. Although MVAs occur during the course of aortic valve endocarditis and, in particular, due to aortic regurgitation jet, it should be borne in mind that they may develop as an isolated valvular pathology and may be misdiagnosed as chordal rupture, other cardiac masses, or vegetation. Thus, MVAs may not be so infrequent as they are thought; they may justify to be considered in the differential diagnosis of masses seen on the mitral valve on echocardiographic examination.