Impact of arterial stiffness on echocardiographic myocardial work indices in patients with isolated bicuspid aortic valve.

OBJECTIVE: Data related to the existence of left ventricular (LV) abnormalities in normal functional bicuspid aortic valve (BAV) disease is scarce. In addition, the impact of afterload and the involved mechanisms are unclear. In this work, we study the relationship between LV function assessed with myocardial work index (MWI) and arterial stiffness in a cohort of normal functioning BAV patients. METHODS: In this study, we included a total of 38 consecutive patients with isolated BAV and 44 age- and gender-matched control subjects with tricuspid aortic valve. All participants underwent transthoracic echocardiography to assess conventional parameters and global longitudinal strain (GLS). In addition, MWI was measured by the noninvasive LV pressure-strain cycle method. Aortic pulse wave velocity (PWV) and wave reflection were evaluated by applanation tonometry. RESULTS: The mean aortic PWV was significantly higher in BAV patients (6.4 ± 0.80, 7.02 ± 0.1.2, p = .01, respectively). LV-MWI related parameters such as global work efficiency (GWE) (96.261.69 and 97.051.27, p = .02) and global wasted work (GWW) (78.232.1 and 61.824.4, p = .01) were found significantly different between the BAV and control groups. However, global working index and global constructive working were not different between groups (1969 ± 259 and 2014 ± 278, p = .45; 2299 ± 290 and 2359 ± 345, p = .39, respectively). Multivariable ordinary least squares regression analysis revealed that BAV (ß = 8.4; 95% CI: 1.5-15.3; p = .04) and PVW (ß = 5.6; 95% CI: 0.7-10.5; p = .01) were significant predictors of GWV. CONCLUSION: GWW is increased and GWE is decreased in patients with BAV compared with controls, and these changes are related to arterial stiffness. The relationship between aortic PWV and GWW may help to explain the exact mechanism of subclinical myocardial dysfunction in patients with isolated BAV.

The effect of P wave indices on new onset atrial fibrillation after trans-catheter aortic valve replacement.

OBJECTIVES: Data is scarce regarding the relation between P wave indices and new onset atrial fibrillation (NOAF) after trans-catheter aortic valve replacement (TAVR). AIMS: The present study aimed to find out certain characteristics of P wave that may predict NOAF after TAVR procedure. METHOD: Patients with severe calcific aortic stenosis who had undergone TAVR procedure between 2013 and 2019 in two centers were investigated. P wave abnormalities that have been resumed to reflect impaired atrial conduction; partial and advanced inter atrial block (IAB), P-wave terminal force in lead V1, P wave dispersion, reduced amplitude of P- wave in lead I, P wave peak time in D2 and V1 were evaluated on pre- procedural 12 derivation surface electrocardiography (ECG). The relationship between these parameters and incidence of NOAF during index hospitalization was evaluated. RESULTS: A total of 227 consecutive patients (median age 79 [74-83]; 134 [59%] female) were included in the study. NOAF occurred in 46 (20.3%) patients. P wave duration, P wave dispersion, number of patients with partial and advanced IAB, left atrium diameter, STS score were higher in NOAF patients. Use of general anesthesia and history of prior open heart surgery were also more frequent in NOAF group. In multivariable logistic regression analysis; advanced IAB (OR 6.413 [2.555-16.095] p < 0.01), P wave dispersion (OR 3.544 [1.431-8.780] p = 0.006) and use of general anesthesia (OR 2.736 [1.225-6.109] p = 0.014) were independent predictors of NOAF. CONCLUSION: Among P wave abnormalities evaluated on pre-procedural 12-derivation surface ECG, advanced IAB and P wave dispersion may predict NOAF after TAVR procedure.

Role of the oxidative stress index, myeloperoxidase, catalase activity for cardiac allograft vasculopathy in heart transplant recipients.

BACKGROUND: The aim of this study was to explore the role of oxidative stress index (OSI), myeloperoxidase (MPO), and catalase (CAT) activity in cardiac allograft vasculopathy (CAV) in heart transplant recipients (HTRs). METHODS: The study enrolled a median age of 41 ± 9 years 47 recipients. The HTx patients were divided into two groups based on the presence CAV as follows: CAV(+) and CAV(-) group. Also, CAV(+) group were divided into two groups as mild/moderate to severe CAV. The OSI, MPO, and CAT activity were analyzed in both groups. RESULTS: The mean total antioxidant capacity (0.79 ± 0.46 vs 1.03 ± 0.33 µmol H2 O2 equiv/L) P = .043 was significantly lower and OSI, MPO, CAT activity were significantly higher in CAV(+) group (63 ± 38 vs 20 ± 16 arbitrary unit, P = .001; 398 ± 242 vs 139  ± 112 µg/L, P = .001; 51 ± 42 vs 26 ± 23 pmol/mg protein, P = .013, respectively). Also, mean OSI (38 ± 41 vs 93 ± 75, P = .05) were significantly higher in severe CAV(+) group. Recipient age, male gender, and low density lipoprotein-cholesterol were significantly higher in CAV(+) group. There was a moderate correlation between the CAV grade and OSI, MPO, and CAT levels in univariate analysis (r = .560, P = .002; r = .643, P = .007; r = .681, P = .001, respectively). CONCLUSION: An increase in the serum level of OSI, MPO, and CAT was associated with CAV in HTRs.

Effects of Obstructive Carotid Artery Disease on Ocular Circulation and the Safety of Carotid Artery Stenting.

BACKGROUND: The aims of this study were to examine the ophthalmic artery flow changes in patients with obstructive carotid artery disease, evaluate the orbital blood flow changes after carotid artery stenting and assess the safety of carotid stenting procedure by using transorbital colour and spectral Doppler sonography. METHODS: Thirty-one consecutive patients scheduled for carotid stenting with severe internal carotid artery stenosis (>60%; the study group) and 30 control subjects were included. Ophthalmic artery (OA) Doppler sonography was performed in the control group and study group before and after stenting. Peak systolic velocity (PSV), end-diastolic velocity (EDV), pulsatility index (PI), and resistive index (RI) and systolic/diastolic ratio (S/D) in the ophthalmic artery were recorded. Statistical comparisons were made between controls and study group before stenting and before and after stenting in the study group. RESULTS: Comparison between control and study group before stenting revealed a statistically significant decrease in OA PSV (51.5±14.5 vs. 39.7±19cm/sec, p= 0.008) and EDV (15.2±4.5 vs. 11.3±5.7cm/sec, p=0.004) in the study group. Differences in PI (1.3±0.14 vs. 1.36±0.4, p=0.47), RI (0.7±0.04 vs. 0.75±0.21, p=0.19), and S/D (3.5±0.6 vs. 3.6±1, p= 0.5) ratio were not statistically significant between groups. Peak systolic velocity (39.7±18.9 vs. 51.3±22.2cm/sec, p <0.001), RI (0.75±0.21 vs. 0.81±0.13, p=0.16) and S/D ratio (3.6±1 vs. 4.6±1.5, p= 0.001) were found to be significantly increased in the study group after stenting compared to baseline. There were no statistically significant differences in EDV and RI EDV(11.3±5.7 vs. 11.7±5.7cm/sec, p=0.66), PI (1.36±0.4 vs. 1.6±0.6, p =0.047) after stenting. CONCLUSIONS: Ophthalmic artery flow parameters were significantly lower in patients with severe carotid artery stenosis compared to control, indicating compromised ocular blood flow in severe carotid stenosis. Flow indicators significantly improved after stent implantation suggesting the importance of revascularisation in restoring ocular blood flow and safety of carotid stenting.

Comparison of Right Ventricle Systolic Function between Long-Term Anabolic-Androgenic Steroid User and Nonuser Bodybuilder Athletes: A Study of Two-Dimensional Speckle Tracking Echocardiography.

BACKGROUND: Right ventricular (RV) effects of long-term use of anabolic-androgenic steroids (AAS) are not clearly known. The aim of this study was to assess RV systolic functions by two-dimensional speckle tracking echocardiography (2DSTE) in AAS user and nonuser bodybuilders. METHODS: A total of 33 competitive male bodybuilders (15 AAS users, 18 AAS nonusers) were assessed. To assess RV systolic functions, all participants underwent standard two-dimensional and Doppler echocardiography, and 2DSTE. RESULTS: Interventricular septal thickness, left ventricle posterior wall thickness, relative wall thickness, and left ventricle mass index were significantly higher in AAS users than nonusers. While standard diastolic parameters were not statistically different between the groups, tissue Doppler parameters including RV E' and E'/A' were lower in AAS users than nonusers (10.1 ± 2.0 vs. 12.7 ± 2.1; P = 0.001, 1.1 ± 0.1 vs. 1.5 ± 0.4; P = 0.009, respectively). Tricuspid annular plane systolic excursion, RV fractional area change, and RV S' were in normal ranges. However, RV S' was found to be lower in users than nonusers (12.2 ± 2.2 vs. 14.6 ± 2.8, P = 0.011). RV free wall longitudinal strain and strain rate were decreased in AAS users in comparison with nonusers (-20.2 ± 3.1 vs. -23.3 ± 3.5; P = 0.012, -3.2 ± 0.1 vs. -3.4 ± 0.1; P = 0.022, respectively). In addition, there were good correlations between 2DSTE parameters and RV S', E', and E'/A'. CONCLUSION: Despite normal standard systolic echo parameters, peak systolic RV free wall strain and strain rate were reduced in AAS user bodybuilders in comparison with nonusers. Strain and strain rate by 2DSTE may be useful for early determination of subclinical RV dysfunction in AAS user bodybuilders.

Relation of epicardial fat thickness to the severity of heart failure in patients with nonischemic dilated cardiomyopathy.

BACKGROUND: The aim of this study was to assess whether epicardial fat thickness (EFT) is associated with the severity of heart failure in patients with nonischemic dilated cardiomyopathy (NICMP). METHODS: The study group was composed of 93 patients with NICMP and38 age- and sex-matched healty individuals as the control group. The EFT was identified during end-systole at the point on the free wall of the right ventricle. RESULTS: Patients with NICMP had significantly lower mean EFT than those in the control group (4.1 ± 0.8 vs. 6.1 ± 1.8 mm, P < 0.001). EFT was thinnest in patients with New York Heart Association (NYHA) functional class III or IV (3.5 ± 0.5, P < 0.001). There was a significant correlation between EFT, left ventricle EF (r = 0.540 P < 0.001), and B-type natriuretic peptide (BNP) (r = -0.695, P < 0.001) values in patients with NICMP. In addition, when EFT was corrected for BMI, EFT/BMI was lower in patients with NYHA functional class III-IV than patients with NYHA class I-II and control group (0.13 ± 0.01, 0.16 ± 0.02, 0.23 ± 0.04, respectively; P < 0.001). There was a significant correlation between EFT/BMI, left ventricle EF (r = 0.489, P < 0.001), and BNP (r = -0.549, P < 0.001) in patients with NICMP. In multivariate regression analysis, EFT (P = 0.009), BNP (P = 0.039), and left atrium volume index (P = 0.039) were independently associated with impaired functional status. CONCLUSION: Echocardiographic EFT is an inexpensive, simple, and readily available marker that may be used to asses the severity of chronic heart failure in patients with NICMP.

Neutrophil/lymphocyte ratio is related to the severity of idiopathic dilated cardiomyopathy.

OBJECTIVES: The aim of this study was to assess whether NLR levels are associated with echocardiographic parameters, New York Heart Association (NYHA) functional class, or B- type natriuretic peptide (BNP) levels in patients with idiopathic dilated cardiomyopathy (DCM). DESIGN: Eighty-seven patients with idiopathic DCM were included prospectively from 2009 to 2014. Patients with acute decompensated heart failure and conditions that alter the total or differential white blood cell counts were excluded. Blood samples were collected before echocardiographic investigation on admission. RESULTS: There was a statistically significant correlation between neutrophil/lymphocyte ratio (NLR) and NYHA functional class (r = 0.68, p < 0.001), BNP levels (r = 0.61, p < 0.001) and various echocardiographic parameters. NLR was significantly higher in patients in NYHA functional class III or IV (n = 39) than among those categorized as NYHA class I or II (n = 48), (3.3 ± 1.0 vs 2.1 ± 0.6; p < 0.001). The NLR cutoff value predicting severe chronic HF was 2.25 with 82% sensitivity and 65% specificity (p < 0.001). On multivariate linear regression analysis NLR (p = 0.025), left ventricular end-diastolic volume (p = 0.041) and left atrial volume index (LAVI) (p = 0.001) were found to be independent positive predictors of BNP levels. CONCLUSION: Neutrophil/Lymphocyte ratio is associated with the severity of chronic heart failure in patients with idiopathic DCM.

Acute sleep deprivation in healthy adults is associated with a reduction in left atrial early diastolic strain rate.

BACKGROUND: Sleep deprivation (SD) is known to be associated with adverse cardiovascular events. Strain and strain rate measure the local deformation of the myocardium and have been used to evaluate atrial phasic function in various disease states. The aim of the study was to investigate whether strain rate imaging enables the identification of left atrial dysfunction in otherwise healthy young adults with acute SD which has not been studied previously. METHODS: Adequate echocardiographic images of 27 healthy volunteers were obtained both after a night with regular sleep and after a night with SD. Tissue Doppler-derived strain and strain rate were measured from the apical four- and two-chamber views of the left atrium, and global values were calculated as the mean of all segments. Measurements included peak systolic strain, systolic strain rate (S-Sr), early diastolic (E-Sr) and late diastolic (A-Sr) strain rate. Phasic left atrial (LA) volumes and fractions were also calculated. RESULTS: There was no significant difference in the traditional parameters of atrial function and LA volumes. Subjects had similar S-Sr, A-Sr and global atrial strain values after the night of sleep debt when compared after regular sleep, whereas they had significantly reduced E-Sr values (mean (SD) 3.2 (0.7) s(-1) vs 3.7 (0.6) s(-1), p < 0.001). Moreover, global E-Sr showed a significant correlation with sleep time (r = 0.554, p < 0.001). CONCLUSION: Acute SD in healthy adults is associated with a reduction in LA early diastolic strain rate in the absence of geometric alterations or functional impairment of the left atrium, raising the possibility that chronic SD may more profoundly affect LA function and thereby promote the occurrence of atrial fibrillation.

Acute sleep deprivation is associated with increased atrial electromechanical delay in healthy young adults.

BACKGROUND: Sleep deprivation (SD) is known to be associated with an increased incidence of adverse cardiovascular outcome. Atrial electromechanical delay (AEMD) calculated from tissue Doppler imaging has been shown to detect atrial impairment in paroxysmal atrial fibrillation. The aim of the study was to investigate whether AEMD would increase in otherwise healthy young adults with acute SD. METHODS: Twenty-seven healthy volunteers were included into the study (mean age: 26 ± 3 years). The participants underwent an echocardiographic examination after a night with SD. AEMD defined as the interval from the onset of P wave to the onset of late diastolic Am wave (PA) was calculated from the lateral and septal mitral annulus, and lateral tricuspid annulus (PA lateral, PA septum, and PA tricuspid, respectively). RESULTS: Subjects had similar values of PA tricuspid duration in milliseconds after the night of sleep debt when compared after regular sleep, whereas they had significantly higher values of PA lateral and PA septal durations (69.05 ± 10.64 ms vs 51.31 ± 11.32 ms, P < 0.001 and 51.75 ± 7.15 ms vs 41.37 ± 8.52 ms, P < 0.001; respectively). Moreover, participants had higher inter-AEMD and intra-AEMD values after the night of sleep debt when compared after regular sleep [30.19 ± 9.84 ms vs 14.72 ± 6.81 ms, P < 0.001 and 12.82 ± 7.09 ms vs 4.41 ± 3.60 ms, P < 0.001; respectively]. Pearson's correlation analyses suggest that inter-AEMD and intra-AEMD were inversely correlated with sleep time (r =-0.628, r =-0.499, r =-0.696, and r =-0.572, respectively [all P < 0.001]). CONCLUSION: In conclusion, in this cross-sectional study, we clearly found that even one night of SD is associated with higher values of inter-AEMD and intra-AEMD in healthy young adults.

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.

Long-term exposure to biomass fuel and its relation to systolic and diastolic biventricular performance in addition to obstructive and restrictive lung diseases.

BACKGROUND: Previous studies have demonstrated an increased risk for cardiovascular events and pulmonary disease in patients with biomass fuel exposure (BFE). However, biventricular heart function has yet to be investigated in these patients. Left ventricular (LV) myocardial performance index (LVMPI), which is an index of global ventricular function, incorporates ejection, isovolumic relaxation, and contraction times. In this study, pulmonary function and biventricular heart function were investigated in nonsmoking female patients with BFE. METHODS: Our study population consisted of 46 female patients with BFE (group 1) and 31 control subjects (group 2). Pulmonary function tests and transthoracic echocardiographic examination were performed. Right ventricular myocardial performance index (RVMPI) and LVMPI were obtained by tissue Doppler imaging echocardiography (TDI). RESULTS: BFE caused obstructive and restrictive spirometric impairments. RVMPI was higher in group 1 (0.55 ± 0.07) than group 2 (0.46 ± 0.06) (P = 0.042) and LVMPI was higher in group 1 (0.54 ± 0.08) than group 2 (0.47 ± 0.05) (P = 0.032). Also, pulmonary artery systolic pressure was higher in group 1 than group 2 (P = 0.02). CONCLUSIONS: BFE causes both obstructive and/or restrictive lung disease and systolic and diastolic biventricular dysfunction. Nonetheless, long-term studies are needed to understand on BFE-related ventricular dysfunctions and to document subsequent cardiovascular events.

Impaired cerebral circulation in patients with slow coronary flow.

Slow coronary flow (SCF) is characterized by delayed opacification of coronary arteries during coronary angiography and is associated with myocardial perfusion abnormalities, ischemia or myocardial infarction. We hypothesized that SCF could be a part of systemic circulatory abnormalities. Therefore, the present study was conducted to investigate whether cerebral blood flow velocity is altered in patients with SCF. The study included 16 patients suffering from chest pain with angiographically proven SCF and 16 subjects suffering from atypical chest pain with angiographically normal coronary flow. All study subjects were selected among those who undergone routine cardiac catheterization. SCF was defined based on thrombolysis in myocardial infarction frame count that reflects coronary artery flow. Thrombolysis in myocardial infarction frame count was significantly higher in patients with SCF than those with normal coronary flow. The average peak systolic, end diastolic and mean flow velocities of the middle cerebral artery were measured and recorded in both groups by transcranial Doppler ultrasonography. Baseline demographic properties were similar in both groups. Echocardiographic parameters were also similar in patients with SCF and those with normal coronary flow. In contrast, both right and left middle cerebral artery peak systolic, end diastolic and mean flow velocities were significantly lower in patients with SCF than those with normal coronary flow. We conclude that cerebral blood flow velocity is significantly lower in patients with SCF. SCF phenomenon may reflect a part of impaired systemic circulation.

Assessment of atrial conduction time in patients with essential hypertension.

BACKGROUND: We aimed to assess atrial conduction time in patients with essential hypertension. METHODS: A total of 80 patients with hypertension (51 males/29 females, 53 ± 12.5 years) and 80 controls (50 males/30 females, 50 ± 12 years) were included. Atrial electromechanical coupling (time interval from the onset of P wave on surface electrocardiogram [ECG] to the beginning of A wave interval with tissue Doppler echocardiography [PA]), intraatrial and interatrial electromechanical delay (intra and inter atrial electromechanical delay [AEMD]), and P-wave dispersion (Pd) were measured (Appelton, C.P., Hatle, L., Popp, R.L., Relation of transmitral flow velocity patterns to left ventricular diastolic function: new insights from combined hemodynamic and Doppler echocardiographic study. J Am Coll Cardiol. 1988; 12: 426-440). RESULTS: Atrial electromechanical coupling at the left lateral mitral annulus (PA lateral) and septal mitral annulus were longer in patients with hypertension (63.0 ± 8.0 vs 50.2 ± 4.3, P < .001, and 53.3 ± 6.2 vs 40.1 ± 5.5, P < .001). Interatrial (PA lateral-PA tricuspid) and intraatrial electromechanical delay (PA septum-PA tricuspid) were longer in patients with hypertension (24.8 ± 7.2 vs 12.4 ± 4.3, P < .001, and 14.1 ± 4.5 vs 2.3 ± 1.6, P < .001, respectively). Maximum P-wave duration and Pd were higher in patients with hypertension compared with controls (95.6 ± 8.0 vs 90.1 ± 9.5, P = .01, and 41.3 ± 7.1 vs 33.5 ± 6.1 P < .001, respectively). In correlation analysis, a positive correlation was detected between interatrial electromechanical delay and Pd (r = 0.72, P < .001). There was a moderate correlation between left ventricular mass index and PA lateral (r = 0.48, P < .001). CONCLUSION: Our results revealed that interatrial electromechanical delay and Pd were prolonged in patients with hypertension. Our results also showed a correlation between interatrial electromechanical delay and Pd. Prolonged electromechanical delay and Pd found in hypertensive patients could be related with increased incidence of atrial fibrillation in these patients. Prospective studies are needed to document the association between intraatrial and interatrial electromechanical delays and the development of atrial fibrillation.

A hammock in the left atrium.

Shone's anomaly describes a complex involving multiple left sided cardiac obstructions, namely, parachute deformity of the mitral valve, supravalvular ring of the left atrium, subaortic stenosis and aortic coarctation. We are reporting a case of Shone's anomaly characterised by aortic recoarctation, mitral supravalvular membrane, bicuspid aortic valve, complicated complete atrioventricular block and bradycardia-induced nonsustained polymorphic ventricular tachycardia. We revealed mitral supravalvular membrane by 3D transoesophageal echocardiography.

The relationship between echocardiographic parameters and brain natriuretic peptide levels in acute and chronic mitral regurgitation.

OBJECTIVES: Plasma brain natriuretic peptide (BNP) level increases with symptoms and severity of mitral regurgitation (MR). We aimed to determine the relationship between plasma BNP levels and echocardiographic parameters in patients with acute and chronic MR. STUDY DESIGN: The study included 55 patients (31 males, 24 females) with isolated moderate-to-severe MR. Of these, 31 patients had acute MR, and 24 patients had chronic MR. All the patients were assessed by transthoracic, transesophageal and Doppler echocardiography and plasma BNP levels were determined. RESULTS: Clinical characteristics and functional capacity were similar in the two groups. Patients with acute MR had significantly higher left ventricular (LV) ejection fraction (EF) (p=0.001), and significantly lower LV end-systolic diameter (p=0.016), end-systolic volume (p=0.027), end-diastolic diameter (p=0.011), left atrial volume (LAV) (p=0.003), and plasma BNP levels (p=0.036). Effective regurgitation orifice area was also significantly higher in patients with acute MR (p=0.038). In multiple linear regression analysis, the natural logarithm of BNP was significantly correlated with E/Ea ratio (ß=0.50, p=0.002) and LAV (ß=0.38, p=0.015) in patients with acute MR, and with systolic pulmonary artery pressure (ß=0.60, p=0.002) and EF (ß=-0.36, p=0.039) in patients with chronic MR. CONCLUSION: Although the echocardiographic degree of MR was more pronounced in patients with acute MR, serum BNP levels tended to be lower in this group. Correlation of serum BNP with E/Ea and LAV in this group may be an important finding.

The prognostic value of combined fractional flow reserve and TIMI frame count measurements in patients with stable angina pectoris and acute coronary syndrome.

BACKGROUND: The aim of this study was to evaluate the prognostic value of different fractional flow reserve (FFR) cutoff values and corrected thrombolysis in myocardial infarction frame (TIMI) count (CTFC) measurements in a series of consecutive patients with moderate coronary lesions, including patients with unstable angina, myocardial infarction, and/or positive noninvasive functional test findings. METHODS: We included 162 consecutive coronary patients in whom revascularization of a moderate coronary lesion was deferred based on a FFR value ≥0.75. Patients were divided according to the results of the intracoronary pressure and flow measurements into four groups: group A: 0.75 ≤ FFR ≤ 0.85 and CTFC > 28 (n=22), group B: 0.75 ≤ FFR ≤ 0.85 and CTFC ≤ 28 (n = 55), group C: 0.85 < FFR and CTFC > 28 (n = 19), and group D: 0.85 < FFR and CTFC ≤ 28 (n = 66). Adverse cardiac events and the presence of angina were evaluated at follow-up. RESULTS: At a mean follow-up of 18 ± 10 months, cardiac event rate in patients with 0.75 ≤ FFR ≤ 0.85 and FFR > 0.85 were 22% and 9%, respectively (P = 0.026) and also, a trend was observed toward a higher cardiac event rate in case of an abnormal CTFC (CTFC > 28) compared to a normal CTFC (24% vs 12%, P = 0.066). Furthermore, a significantly higher cardiac event rate was observed when group A was compared to group D (31.8% vs 7.6%, respectively, P = 0.004). CONCLUSION: Patients with potential microvascular dysfunction and borderline FFR values should be interpreted with caution, and management strategies should be guided not only by pressure measurement, but also by possibly supplementary clinical risk stratification and noninvasive tests.

BNP levels in patients with long-term exposure to biomass fuel and its relation to right ventricular function.

UNLABELLED: Previous studies have demonstrated a consistent increased risk for cardiovascular events and pulmonary disease in patients with biomass fuel exposure (BFE). However right ventricular (RV) function have not been investigated yet in these patients. In this study, pulmonary function, right ventricular function and their relations with Brain Natriuretic Peptide (BNP) were investigated in non-smoking female patients with BFE. METHODS: Our study population consisted of 39 female patients with BFE (group 1) and, 31 control subjects (group 2). Pulmonary function tests and transthoracic echocardiographic examination were performed. Right ventricular volumes, diameters and tissue velocities were obtained by tissue Doppler echocardiography. BNP levels were measured and correlated to right ventricular measurements and pulmonary artery pressure. RESULTS: In BFE group, obstructive and restrictive spirometric findings were found. RV diameters, volumes and pulmonary artery pressure were higher in group 1 than group 2. BNP levels were well correlated with right ventricular end diastolic diameter and pulmonary artery pressure. A suspicion is also arised that toxic chemicals in biomass fuel may play a role in RV dysfunction. CONCLUSION: Biomass fuel exposure not only cause obstructive and/or restrictive lung disease but also leads to systolic and diastolic right ventricular dysfunction. BNP levels may be used to monitor pulmonary artery pressure and right ventricular enlargement in these patients.

Heart rate recovery and chronotropic incompetence in patients with subclinical hypothyroidism.

BACKGROUND: Heart rate recovery (HRR) and chronotropic incompetence (CI) in patients with subclinical hypothyroidism (SCH) has not been explored previously. The aim of the present study was to evaluate the HRR and CI in patients with SCH. METHODS: Twenty-five patients (11 men, 14 women with a mean age of 36 + or - 10 years) who were diagnosed SCH determined by an increased serum thyrothrophine (TSH) concentration (>4.0 ng/mL) and the normal free triiodothyronine (fT3) and free thyroxin (fT4) levels, were included in the study. The control group of healthy individuals with normal TSH (12 males, 15 females) with a mean age of 36 + or - 3 years was also included. Two groups were well matched for age, sex, and body mass index. Medical history, physical examination, electrocardiogram, treadmill exercise testing, and chest radiogram were performed for all participants. RESULTS: The characteristics of SCH patients and control cases were similar with regard to age, sex, and BMI except for TSH levels. Serum TSH levels were significantly higher in SCH patients than the controls (P < 0.001). No significant differences were observed in the changes of heart rate (HR), exercise tolerance (metabolic equivalents), or systolic and diastolic blood pressures at rest or during exercise between the groups, whereas HRR and CI were significantly lower during exercise testing in the SCH patients compared to controls (P < 0.003; P < 0.03, respectively). CONCLUSION: The results of the present study demonstrated that SCH can cause impaired cardiovascular autonomic function and attenuated HR response to exercise. (PACE 2010; 2-5).

Anterior mitral valve length is associated with ventricular tachycardia in patients with classical mitral valve prolapse.

BACKGROUND: The aim of this study was to investigate the electrocardiographic and echocardiographic predictors of ventricular tachycardia (VT) in patients with classical mitral valve prolapse (MVP). METHODS: Thirty patients (nine men and 21 women; mean age, 41.5 ± 15 years) in sinus rhythm with mitral valve prolapse who had VT in 24-hour Holter analysis and 30 patients with MVP without VT (eight men and 22 women; mean age, 43 ± 16 years) were included in this study. Transthoracic echocardiography, QT analyses from 12-lead electrocardiography, and 24-hour Holter electrocardiogram recordings were performed. RESULTS: Mitral posterior leaflet thickness (0.48 ± 0.03 cm vs 0.43 ± 0,08 cm, P = 0.025), mitral anterior leaflet length (3.2 ± 0.24 cm vs 2.9 ± 0.36, P < 0.001), mitral posterior leaflet length (2.2 ± 0.3 cm vs 1.9 ± 0.35 cm, P = 0.01), left atrium anteroposterior diameter (4.2 ± 0.8 cm vs 3.5 ± 0.5 cm, P = 0.001), and mitral annulus circumference (15.7 ± 1.3 cm vs 14.6 ± 1.6 cm, P = 0.004) were increased significantly in MVP cases with VT. No significant difference was found between the cases with and without VT in terms of frequency- and time-domain analysis. QT dispersion (72 ± 18 ms vs 55 ± 15 ms, P = 0.0002) and corrected QT dispersion (QTcD) (76 ± 18 ms vs 55 ± 15 ms, P = 0.0002) were significantly increased in cases with VT compared with those without VT. Based on logistic regression analysis for MVP cases, in the case of VT, an enhancement in QTcD (P = 0.01) and the mitral anterior leaflet length (P = 0.003) were the independent predictors of VT. CONCLUSION: Mitral anterior leaflet length and enhanced QTcD are closely related with VT in patients with classical MVP.

Relationship between the tissue Doppler-derived Tei index and plasma brain natriuretic peptide levels in patients with mitral regurgitation.

BACKGROUND AND AIM OF THE STUDY: The Tei index, obtained from tissue Doppler echocardiography (TDE-Tei index), has emerged as a new parameter that incorporates both systolic and diastolic time intervals to express global ventricular performance. The study aim was to evaluate whether the TDE-Tei index also correlates with left ventricular (LV) systolic and diastolic function and plasma brain natriuretic peptide (BNP) levels and echocardiographic parameters in patients with symptoms of mitral regurgitation (MR). METHODS: Thirty-three patients (17 males, 16 females; mean age 57 +/- 17 years) with isolated organic MR underwent transthoracic echocardiography and tissue Doppler echocardiography, and were also assessed for symptoms. Plasma BNP levels were also monitored. The patients were allocated to two groups, based on a TDE-Tei index cut-off level of 0.51. RESULTS: Correlations were identified between the TDE-Tei index and LV ejection fraction (LVEF) (r = -0.54), plasma BNP level (r = 0.5), MR index (r = 0.48), MR jet area (r = 0.38), MR effective regurgitant orifice area (r = 0.37), LV end-systolic diameter (r = 0.43), E/Ea (r = 0.41) and NYHA functional class (r = 0.38). However, no correlations were identified with the left atrial area, MR vena contracta width, MR regurgitant volume, MR regurgitant fraction, systolic pulmonary artery pressure, LV end-diastolic dimensions and LV diastolic dysfunction. The mean values of the TDE-Tei index were 0.40 +/- 11, 0.44 +/- 11 and 0.53 +/- 16 in MR patients in NYHA classes I, II and III, respectively. CONCLUSION: In patients with isolated organic MR, the TDE Tei index was found to correlate well with LVEF and plasma BNP levels, and thus may be considered as a new echocardiographic parameter for the assessment of global ventricular function during patient follow up.