Geometric morphometric study of anterior branches of external carotid artery and carotid bifurcation by 3D-CT angiography.

PURPOSE: The aim of our study was to determine the variations of the anterior branches of the external carotid artery (ECA) and investigate the morphometric and geometric features of the anterior branches of the ECA and carotid bifurcation (CB). METHODS: A total of 563 ECAs were included from 288 patients in the study. Classification and exit angles of anterior branches of ECA and determination of vertebral levels of CB and anterior branches were performed. RESULTS: The anterior branch variants of the ECA were observed in 8 different subgroups. The most common variations were type Ia 42.3% (n = 120) on the right and type Ib 40.9% (n = 114) on the left. When looking at the vertebral levels, CB was detected at C4 level in 32.9% of total ECAs (n = 185), STA was at C4 level in 33.4% of total ECAs (n = 188), LA was at C3 level in 50.1% of total ECAs (n = 282), and FA was at C2 level in 37.3% of total ECAs. The mean CB angle in all cases was 59.93° ± 16.04. In the anterior branches of the ECA in cases belonging to the Type I group, the widest angle belonged to FA (R = 116.88 ± 27.04°, L = 110.32° ± 25.94). CONCLUSION: In conclusion, a new classification of the variations of the anterior branches of the ECA was made on the basis of the CTA images to gain more practicality in surgical procedures. This study revealed for the first time the angular and level relationship between CB and ECA anterior branches.

Tribological, biocompatibility, and antibiofilm properties of tungsten-germanium coating using magnetron sputtering.

In this study, borosilicate glass and 316 L stainless steel were coated with germanium (Ge) and tungsten (W) metals using the Magnetron Sputtering System. Surface structural, mechanical, and tribological properties of uncoated and coated samples were examined using SEM, X-ray diffraction (XRD), energy-dispersive spectroscopy, and tribometer. The XRD results showed that WGe2 chemical compound observed in (110) crystalline phase and exhibited a dense structure. According to the tribological analyses, the adhesion strength of the coated deposition on 316 L was obtained 32.8 N, and the mean coefficient of friction was around 0.3. Biocompatibility studies of coated metallic biomaterials were analyzed on fibroblast cell culture (Primary Dermal Fibroblast; Normal, Human, Adult (HDFa)) in vitro. Hoescht 33258 fluorescent staining was performed to investigate the cellular density and chromosomal abnormalities of the HDFa cell line on the borosilicate glasses coated with germanium-tungsten (W-Ge). Cell viabilities of HDFa cell line on each surface (W-Ge coated borosilicate glass, uncoated borosilicate glass, and cell culture plate surface) were analyzed by using (3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) cytotoxicity assay. The antibiofilm activity of W-Ge coated borosilicate glass showed a significant reduction effect on Staphylococcus aureus (ATCC 25923) and Pseudomonas aeruginosa (ATCC 27853) adherence compared to control groups. In the light of findings, tungsten and germanium, which are some of the most common industrial materials, were investigated as biocompatible and antimicrobial surface coatings and recommended as bio-implant materials for the first time.

Left ventricular systolic dysfunction in patients with ankylosing spondylitis without clinically overt cardiovascular disease by speckle tracking echocardiography.

The aim of this study was to evaluate left ventricular systolic and diastolic function using speckle tracking echocardiography (STE) in order to detect subclinical left ventricular dysfunction in patients with ankylosing spondylitis (AS). Twenty-six AS patients (age 43.7 ± 11.8 years, disease duration 11.83 ± 10.98 years) and 26 healthy controls, matched for age, sex, body mass index, and smoking, were enrolled in this cross-sectional study. All patients underwent two-dimensional, Doppler, tissue Doppler, and speckle tracking echocardiography. The mitral early/late diastolic inflow velocity ratio (1.0 ± 0.4 vs. 1.5 ± 0.5; p < 0.001) and the mitral E-wave velocity (8.1 ± 2 vs. 11.1 ± 3; p < 0.001) were lower in the AS patients than in the controls. The ejection fraction did not differ between the patients and controls (64 ± 4.2 vs. 64.8 ± 2.3; p = 0.402). All segments showed a significant decrease in left ventricular diastolic and systolic strain values in the patients with AS when compared with the healthy controls (p < 0.001). Despite no clinical evidence of cardiovascular disease, patients with AS may have impaired left ventricular systolic function as assessed by STE.

Effect of remote ischemic postconditioning on left ventricular mechanics.

BACKGROUND: Remote ischemic postconditioning (RIPC) decreases infarct size and prevents left ventricular (LV) remodeling in patients with myocardial infarction. However, there is no study that evaluates the effect of RIPC on LV mechanics assessed by speckle tracking echocardiography. Therefore, we aimed to test the effects of RIPC on LV deformation parameters such as strain, strain rate, rotation, and twist in healthy subjects. METHODS: The study group consisted of 22 healthy subjects. To test the effects of RIPC, 3 cycles of reperfusion followed by ischemia (each lasting 10 or 30 seconds) were applied immediately after 20 minutes of nondominant arm ischemia. Transthoracic echocardiography (TTE) was obtained at baseline and repeated 30 minutes after the completion of these cycles. In TTE images, apical 4-3-2 chamber longitudinal strain (LS)/strain rate, basal and apical circumferential strain/strain rate, and rotational parameters, such as basal rotation, apical rotation, and LV twist, were recorded. RESULTS: Apical 4-3-2 chamber LS and apical circumferential strain/strain rate measurements were comparable before and after RIPC, whereas basal circumferential strain was significantly decreased after RIPC (-23 ± 3.4 vs. -18.9 ± 6.9, P = 0.017). After RIPC, apical rotation was significantly increased (11.6 ± 3.7 vs. 16.7 ± 4.0, P < 0.001) and basal rotation was significantly decreased (-6.1 ± 2.1 vs. -4.7 ± 2.4, P = 0.03).Consequently, net LV twist was significantly increased (17.4 ± 4.5 vs. 21.7 ± 4.7). CONCLUSIONS: We proposed that RIPC affects the rotational mechanics of the heart rather than longitudinal mechanics. These results might give new insights into understanding the favorable effects of the post- conditioning.

The relationship between coronary collateral circulation and neutrophil/lymphocyte ratio in patients with coronary chronic total occlusion.

OBJECTIVES: To investigate the relationship between neutrophil/lymphocyte ratio (NLR) and coronary collateral circulation (CCC) in patients with coronary chronic total occlusion. SUBJECTS AND METHODS: Our study population consisted of 275 consecutive patients with chronic total occlusion. One hundred and thirty-eight patients with chronic total occlusion were included in the study. They were classified into 2 groups as follows: impaired CCC (group 1: Rentrop grades 0-1) and good CCC (group 2: Rentrop grades 2-3). The NLR was calculated from the complete blood count. RESULTS: The NLR values of the patients with impaired CCC (4.5 ± 0.7) were significantly higher than of those with good CCC (2.7 ± 0.6, p < 0.001). In the multivariate logistic regression test, NLR (OR 33.36, 95% CI 8.189-135.7, p < 0.001), high-sensitivity C-reactive protein (hs-CRP; OR 2.152, 95% CI 1.226-3.777, p = 0.008), estimated glomerular filtration rate (OR 1.167, 95% CI 1.049-1.298, p = 0.004) and systolic blood pressure (OR 1.068, 95% CI 1.009-1.1310, p = 0.025) were independent predictors of impaired CCC. The NLR value >3.55 yielded an area under the curve value of 0.957 (95% CI 0.921-0.992, p < 0.001) and demonstrated a sensitivity of 95% and a specificity of 90% for the prediction of CCC. A moderate correlation between NLR and hs-CRP was observed (r = 0.443; p < 0.001). CONCLUSION: Our findings reveal that NLR correlates with the impaired development of coronary collaterals.

Optimal timing of valve replacement in asymptomatic severe aortic stenosis.

Patients with asymptomatic severe aortic stenosis (AS) constitute a heterogeneous group which includes not only certain cases who are at high risk of sudden death and valve-related heart failure, but also those at low risk for these events. Degenerative AS, which includes a majority of patients with AS, is characterized by stricture of the valve, increased arterial stiffness, and diverse left ventricular response to the valvular plus arterial vascular load. In addition to using traditional primary parameters, the severity of AS and the total left ventricular load should be assessed using new measures such as energy loss index and valvulo-arterial impedance. Natriuretic peptide levels and global longitudinal strain imaging may also be used as secondary parameters to obtain information about left ventricular systolic function, although these parameters do not correlate with the severity of AS. Exercise stress testing and exercise echocardiography are also beneficial when assessing the patient if they are symptomatic, and for determining valvular and left ventricular contractile reserves. The aim of this review was to emphasize the importance of risk stratifications in asymptomatic severe AS cases, and to assess the severity of AS using not only conventional methods but also new methods on which much emphasis has been placed during recent years.

Menopausal cardiomyopathy: does it really exist? A case-control deformation imaging study.

AIM: We aimed to evaluate and compare the left ventricular (LV) functions of pre- and postmenopausal women at similar ages with none of the known cardiovascular risk factors, by both conventional and advanced echocardiographic methods such as 2-D strain imaging via speckle tracking echocardiography. METHODS: The study population consisted of 40 healthy postmenopausal women aged 45-50 years and 40 healthy premenopausal women of the same age group. None of the subjects had any cardiovascular risk factors and were on hormone replacement therapy. LV strain and strain rate parameters were measured by 2-D strain imaging. The main outcome measure was effect of menopause on LV function. RESULTS: There were no significant differences between the pre- and postmenopausal groups with regard to conventional echocardiographic parameters. LV longitudinal strain and LV early diastolic strain rate values were significantly lower in the postmenopausal group when compared to the premenopausal group. Also, there was a significant negative correlation between LV global strain and serum follicle-stimulating hormone (r = -0.349, P = 0.002). CONCLUSION: Our study results demonstrated that healthy postmenopausal women had lower LV longitudinal strain values when compared to the healthy premenopausal women of the same age group by speckle tracking echocardiography.

Mitral valve resistance correlates more closely with left atrial deformation than with conventional indices of rheumatic mitral stenosis.

BACKGROUND AND AIM OF THE STUDY: The relationship between mitral valve (MV) resistance and left atrial (LA) mechanical function is unknown. Hence, the study aim was to investigate the relationship between LA mechanics and MV resistance, compared to conventional indices such as mitral valve area (MVA) and transmitral gradient, in patients with rheumatic mitral stenosis (MS). METHODS: The study population consisted of 73 patients with MS and 30 age- and gender-matched controls. MV resistance was calculated and LA strain parameters were assessed from the apical four-chamber view by speckle tracking echocardiography (LA reservoir strain, LA pump strain, LA strain rate (SR)) in all subjects. RESULTS: The MS group has a markedly higher MV resistance (94 +/- 46 versus 67 +/- 22 dynes x s x cm(-5), p = 0.003) and lower LA reservoir strain (24.5 +/- 7.4% versus 36.6 +/- 3.8%, p < 0.001), LA pump strain (12.0 +/- 5.0% versus 17.1 +/- 3.4%, p < 0.001) and SR (1.23 +/- 0.33 versus 1.4 +/- 0.29, p = 0.017) values compared to controls. Moreover, both LA reservoir strain and LA pump strain correlated with MV resistance more closely than did MVA and transmitral gradients. Multiple linear regression analysis revealed only MV resistance to be an independent predictor of LA reservoir strain, while MV resistance, indexed left atrial volume and mean gradient were independent predictors of LA pump strain. CONCLUSION: It can be concluded that, in patients with MS, mitral valve resistance was more closely related to LA mechanics measurements than were conventional indices of MS.

Assessment of left ventricular dyssynchrony in dipper and non-dipper hypertension.

BACKGROUND: Ventricular dyssynchrony is an co-determinant of progression and exacerbation of heart failure (HF). The co-existence of ventricular dyssynchrony with hypertension (HT) and HF were shown, however there is no data regarding the effect of circadian rhythm of blood pressure (BP) on ventricular synchrony. Therefore, we aimed to study the left ventricular synchrony in dipper and non-dipper normotensive and hypertensive participants. METHODS: Participants (n = 142) were categorized into four groups as "Normotensive-Dipper" (NT-D) (n = 40), "Normotensive-Non-dipper" (NT-ND) (n = 30), "Hypertensive-Dipper" (HT-D) (n = 38) and "Hypertensive-Non-dipper" (HT-ND) (n = 34). Left ventricular dyssynchrony was investigated by color-coded tissue Doppler imaging. RESULTS: Non-dippers had higher 24-h and night-time BP both in normotensives and hypertensives. The incidence of ventricular dyssynchrony (a Ts-SD-12 > 34.4 ms) was higher in the hypertensive group (47.2% vs 24.3%, p = 0.005). The frequency of ventricular dyssynchrony was higher in the HT-ND group than the HT-D group (58.8% vs 36.8%, p = 0.05); however, the frequency of ventricular dyssynchrony was similar among the normotensives (26.7% vs 22.5%, p = 0.45). Ts-SD-12 and Ts-12 were higher in NT-ND group than the NT-D group. CONCLUSIONS: Non-dipping BP pattern was associated with impaired left ventricular contraction synchrony in both normotensive and hypertensive participants, which may be related with short- and long-term effects of HT on myocardium.

Left ventricular dyssynchrony is an early manifestation of heart involvement in sickle cell anemia.

BACKGROUND: Sickle cell anemia (SCA) is the most common inherited anemia. Although heart involvement in SCA is well-established, there is no data about changes of contraction synchrony in SCA. Therefore, we aimed to study the left ventricular contraction synchrony in SCA patients with narrow QRS and normal ejection fraction (EF). METHODS: Thirty-six patients with SCA and 37 age- and gender-matched control subjects were included in the study. Left ventricular dyssynchrony was investigated by color-coded tissue Doppler imaging. RESULTS: The SCA patients had lower hemoglobin (Hb) and higher ferritin, left ventricular end-diastolic diameter, left ventricular end-systolic diameter, left ventricular mass index (LVMI), and pulmonary artery pressure. Peak A velocity, Dt, and E/E' values were higher in the SCA group however, E/A ratio and average Em were higher in the control group. LV systolic dyssynchrony parameters including Ts-SD-12, Ts-12, Ts-SD-6, and Ts-6 were found to be higher in SCA group when compared with controls. In addition to that, the patients with ventricular dyssynchrony (a Ts-SD-12 > 34.4 msec) were higher in the SCA group than the control group (55.6% vs. 8.1%, P < 0.001). In the correlation analysis, systolic dyssynchrony parameters were found to be correlated with Hb, ferritin, LVMI, E/A, Dt, Em. CONCLUSION: Our results revealed that in SCA patients with normal EF and narrow QRS, left ventricular systolic dyssynchrony was an early manifestation of heart involvement and might be coexisted with or preceding diastolic dysfunction.

Rosuvastatin versus atorvastatin to prevent contrast induced nephropathy in patients undergoing primary percutaneous coronary intervention (ROSA-cIN trial).

AIM: We aimed to compare the incidence of contrast-induced nephropathy (CIN) between atorvastatin versus rosuvastatin in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary coronary angioplasty. METHODS: One hundred ninety-two consecutive patients, who underwent primary percutaneous intervention (p-PCI) with the diagnosis of STEMI, were included in the study. The patients were randomized to take atorvastatin 80 mg (n=98) or rosuvastatin 40 mg (n= 94) before the procedure. Biochemical and complete blood count measurements were done at baseline and at 48 hours following admission. RESULTS: The incidence of CIN was 8.9% (n= 17) in the entire groups. The analysis performed between the statin groups revealed no statistical difference in any of the renal dysfunction indicators [baseline creatinine, baseline estimated glomerular filtration rate (eGFR), creatinine at 48 h, eGFR at 48 h, difference between baseline and 48 h creatinine, the per cent increase in the creatinine at 48 hours relative to basal creatinine]. In STEMI patients undergoing primary PCI, only the amount of the contrast agent administered was determined to be an independent predictor for CIN (OR and 95% CI: 1.08 (1.03- 1.13), P< or = 0.001). Left ventricular ejection fraction exhibited borderline statistical significance (OR and 95% CI: 0.88 (0.77-1.01), P= 0.07). CONCLUSION: Atorvastatin and rosuvastatin had similar efficacy in preventing CIN in patients with STEMI undergoing P-PCI.

Serum pentraxin-3 levels are associated with the severity of metabolic syndrome.

OBJECTIVES: The aim of the present study was to assess the association between the level of pentraxin-3 (PTX-3) and the severity of metabolic syndrome (MS). SUBJECTS AND METHOD: One hundred and two patients with MS and 101 consecutive age- and sex-matched control subjects were included in the study. The MS patients were classified into three groups based on the number of MS criteria, i.e. group 1: patients with 3 MS criteria, group 2: patients with 4 MS criteria, and group 3: patients with 5 MS criteria. Serum PTX-3 and high-sensitivity C-reactive protein (hs-CRP) levels were measured. RESULTS: Group 1 had higher PTX-3 levels compared to the control group (0.58 ± 0.11 ng/ml vs. 0.36 ± 0.15 ng/ml, p < 0.001). PTX-3 levels were higher in group 3 than in both group 1 (0.90 ± 0.06 ng/ml vs. 0.58 ± 0.11 ng/ml, p < 0.001) and group 2 (0.90 ± 0.06 ng/ml vs. 0.63 ± 0.12 ng/ml, p < 0.001). Group 3, however, had higher hs-CRP levels than both group 1 (1.89 ± 0.45 mg/dl vs. 1.40 ± 0.44 mg/dl, p = 0.007) and group 2 (1.89 ± 0.45 mg/dl vs. 1.47 ± 0.58 mg/dl, p = 0.01). The control group had lower hs-CRP levels than group 1 (0.81 ± 0.47 mg/dl vs. 1.40 ± 0.44 mg/dl, p < 0.001) and group 2 (0.81 ± 0.47 mg/dl vs. 1.47 ± 0.58 mg/dl, p < 0.001). Serum PTX-3 levels correlated with serum hs-CRP levels (r = 0.49, p < 0.001). CONCLUSIONS: PTX-3, a novel inflammatory marker, was found to be associated with the severity of MS.

Clinical and morphological evaluation of coronary bifurcation lesions.

OBJECTIVES: We aimed to investigate the anatomical and morphological characterization of coronary bifurcation lesions. STUDY DESIGN: The study population consisted of 542 stable patients who underwent coronary angiography. Bifurcation lesions were defined as a lesion >=50% diameter stenosis involving a main branch and/or contiguous side branch with a diameter of >=2.5 mm. Using these criteria, the presence and number of bifurcation lesions, bifurcation lesion location, lesion classification according to Medina classification and the angle of the bifurcation lesion were determined. RESULTS: According to the bifurcation definition 19.3% (n=105) of our patients had bifurcation lesions. In 77% of all bifurcation lesions, the bifurcation angle was <70°. About 37% of all lesions were concordant with the Medina 1.1.1 classification. Approximately 56% of bifurcation lesions were in the LAD region, 25.4% in the Cx region, and 12.5% in the RCA region. Medina 1.1.1 was the most frequently observed in the LAD and RCA regions, while it was least common in the Cx and LMCA regions. Diabetes was observed to be significantly higher in those with bifurcation lesions than in those without. CONCLUSION: Bifurcation lesions are frequently observed in coronary angiography practice. Angiographic characteristics and the relationship of these lesions with clinical conditions may be a crucial factor in choosing the appropriate interventional procedure.

The serum pentraxin-3 is elevated in patients with cardiac syndrome X.

OBJECTIVES: Cardiac syndrome X (CSX) is a clinical entity that is defined as normal coronary arteries with angina pectoris and objective sins of ischemia. The correlation between CSX and inflammatory markers such as high-sensitivity C-reactive protein (hs-CRP) is well established, however an association with pentraxin-3 (PTX-3) has not been examined. The aim of this study was to investigate the association between PTX-3 and CSX. STUDY DESIGN: A total of 122 patients (58 female, 64 male, mean age 49.6±5.8 years) with suspected of coronary artery disease (CAD) were included in the study. Those with evidence of ischemia (50 patients with positive treadmill tests, 32 patients with positive myocardial perfusion scintography) underwent coronary angiography (82 patients). Patients with a normal angiogram were considered the CSX group (n=41) and patients with coronary lesions were referred to as the CAD group (n=41). Patients without signs of ischemia served as the control group. Serum PTX-3 and hs-CRP levels were measured in all patients. RESULTS: The CSX group had significantly increased PTX-3 levels relative to the control group (0.46±0.16 vs. 0.23±0.09 ng/ml, p<0.001). However there were no differences in levels of PTX-3 and hs-CRP between the CSX and the CAD groups (PTX-3: 0.46±0.16 vs. 0.51±0.13 ng/ml, p=0.21; hs-CRP: 1.04±0.45 vs. 1.16±0.64 mg/dl, p=0.62). The control group had significantly lower hs-CRP levels (0.73±0.51 mg/dl) when compared to the both CSX and CAD groups (p=0.03 and p=0.002, respectively). Serum PTX-3 levels were weakly correlated with hs-CRP levels (r=0.30, p=0.001). CONCLUSION: PTX-3, a novel inflammatory marker, is elevated in patients with CSX, similar to the well known inflammatory marker hs-CRP, and may be a promising biomarker reflecting inflammatory status in these patients.

Association of neutrophil to lymphocyte ratio with presence of isolated coronary artery ectasia.

OBJECTIVES: Coronary artery ectasia (CAE) has been defined as a dilated artery luminal diameter that is at least 50% greater than the diameter of the normal portion of the artery. Isolated CAE is defined as CAE without significant coronary artery stenosis and isolated CAE has more pronounced inflammatory symptoms. Neutrophil to lymphocyte ratio (NLR) is widely used as a marker of inflammation and an indicator of cardiovascular outcomes in patients with coronary artery disease. We examined a possible association between NLR and the presence of isolated CAE. STUDY DESIGN: In this study, 2345 patients who underwent coronary angiography for suspected or known ischemic heart disease were evaluated retrospectively. Following the application of exclusion criteria, our study population consisted of 81 CAE patients and 85 age- and gender-matched subjects who proved to have normal coronary angiograms. Baseline neutrophil, lymphocyte and other hematologic indices were measured routinely prior to the coronary angiography. RESULTS: Patients with angiographic isolated CAE had significantly elevated NLR when compared to the patients with normal coronary artery pathology (3.39 ± 1.36 vs. 2.25 ± 0.58, p<0.001). A NLR level >= 2.37 measured on admission had a 77% sensitivity and 63% specificity in predicting isolated CAE at ROC curve analysis. In the multivariate analysis, hypercholesterolemia (OR=2.63, 95% CI 1.22-5.65, p=0.01), obesity (OR=3.76, 95% CI 1.43-9.87, p=0.007) and increased NLR (OR=6.03, 95% CI 2.61-13.94, p<0.001) were independent predictors for the presence of isolated CAE. CONCLUSION: Neutrophil to lymphocyte ratio is a readily available clinical laboratory value that is associated with the presence of isolated CAE.

[Relationship between human platelet antigen-1 gene polymorphism and clopidogrel resistance in patients with coronary artery disease]. / Koroner arter hastalarinda insan trombosit antijen-1 gen polimorfizmi ile klopidogrel direnci iliskisi.

OBJECTIVES: It has been proposed that human platelet antigen-1 (HPA-1) gene polymorphism is associated with coronary artery disease (CAD) and affects platelet function. We aimed to investigate the distribution of HPA gene polymorphism between angiographic CAD and a control group and the relation between HPA gene polymorphism and platelet aggregation. STUDY DESIGN: The study population consisted of 94 patients with angiographic CAD and 115 patients without angiographic CAD. Platelet aggregation was measured with impedance aggregometry on the fifth day of percutaneous coronary intervention (PCI). Platelet aggregation >480 AU*min was defined as the clopidogrel resistance group. Blood samples were obtained from all participants at discharge for investigating HPA-1 gene polymorphism. RESULTS: There was no significant difference in the distribution of HPA-1 gene polymorphism between the control and CAD groups (78.7% vs. 78.1% for A allele and 21.3% vs. 21.9% for B allele, p=NS). The analysis between groups with and without clopidogrel resistance revealed no significant difference in the distribution of HPA-1A and HPA-1B alleles between the groups (A allele 78.7% vs. 78.9% and B allele 21.3% vs. 21.1%, p=NS). In the CAD group, there were no significant differences in platelet aggregation between HPA-1A and HPA-1B alleles (294±240 vs. 259±261 AU*min, p=NS). CONCLUSION: The distribution of HPA-1 gene polymorphism was not different in CAD patients compared to the control group. HPA-1 gene polymorphism was not associated with platelet aggregation or clopidogrel resistance assessed by impedance aggregometry in the CAD group.

Abnormal left ventricular mechanics in isolated bicuspid aortic valve disease may be independent of aortic distensibility: 2D strain imaging study.

BACKGROUND AIM OF THE STUDY: In this study, we hypothesized that subclinical impairment of left ventricular (LV) mechanical function in bicuspid aortic valve (BAV) patients is independent of valvular hemodynamics represented by valvuloarterial impedance and aortic elastic characteristics. Therefore, we aimed to test left ventricular mechanics in cases of isolated non-stenotic BAV with non-dilated aorta. METHODS: Thirty-three patients with isolated BAV exhibiting non-dilated aorta, and 25 age-and gender-matched healthy subjects were included in the study. Patients with aortic valve velocity > 1.5 m/s and mild-to-moderate aortic regurgitation or ascending aorta diameter > 3.5 cm were excluded from the study. Aortic elasticity parameters and valvulo-arterial impedance were calculated. Strain measurements were reported as the peak longitudinal strain (LS) for four chamber (4C), long axis (LAX) and two chamber (2C) views. Strain rate (Sr) measurements were reported as the peak systolic strain rate (Sr-sm), early diastolic strain rate (Sr-em) and late diastolic strain rate (Sr-am) for 4C, LAX and 2C views. RESULTS: Systolic and diastolic diameters of the ascending aorta, aortic elastic properties (aortic strain, aortic distensibility, aortic stiffness and aortic elastic modulus), and valvulo-arterial impedances were found to be comparable between the BAV and control groups. BAV group was observed to have statistically significantly lower 4C (18.9 +/- 1.7 vs. 17.8 +/- 1.5, p = 0.02), LAX (19.7 +/- 1.7 vs. 17.7 +/- 1.3, p = 0.001) and 2C (20.1 +/- 1.8 vs. 17.7 +/- 1.2, p < 0.001) peak longitudinal strain values compared with the control group. Moreover, LV-GS values were found to be significantly lower in the BAV group than in the control group (19.6 +/- 1.1 vs. 17.7 +/- 0.9, p < 0.001). However, there was no statistically significant difference between the groups in terms of Sr-sm, Sr-em ve Sr-am values in the 4C, LAX, and 2C views. CONCLUSION: BAV might affect LV systolic functions, assessed by 2D strain imaging, in a fashion independent from the valvular dynamics and aortic elasticity. This might show that BAV is not only a valvular disease, but possibly a ventricular disease as well.

Aortic elastic properties and left ventricular diastolic function in patients with isolated bicuspid aortic valve.

BACKGROUND AND AIM OF THE STUDY: Bicuspid aortic valve (BAV) is one of the most common congenital heart defects. BAV disease is not only a disorder of valvulogenesis, but also represents a genetic disorder of aorta and cardiac development. Recent studies have shown that BAV is associated with abnormal aortic elasticity, and that a reduced distensibility of the aortic root may have a negative impact on left ventricular function. Hence, the study aim was to investigate left ventricular diastolic function and its relationship to aortic elasticity in this patient group. METHODS: Thirty-nine patients with isolated BAV with a normal left ventricular ejection fraction, and 29 age- and gender-matched healthy (control) subjects, were studied prospectively. In none of the patients with BAV was the aortic velocity >2m/s, and no aortic regurgitation (other than mild) was present. Parameters of aortic elasticity (aortic strain, distensibility index, stiffness index and elastic modulus), left ventricular diastolic parameters (E, A, E/a, deceleration time, E', ratio of E/E', left atrial volume index) and valvulo-arterial impedance were calculated in all patients. RESULTS: Aortic strain and distensibility were lower, and aortic stiffness index and aortic modulus higher, in patients with BAV than in controls. Compared to controls, the E/E' ratio and left atrial volume index were significantly higher in BAV patients (E/E' ratio 8.26 +/- 2.56 versus 6.85 +/- 1.45, p = 0.01; left atrium volume index 24.23 +/- 5.78 versus 21.68 +/- 4.11 ml/m2, p = 0.04). However, no significant correlations were identified between the aortic elasticity parameters, valvulo-arterial impedance, and left ventricular diastolic parameters. CONCLUSION: These findings indicated that BAV is associated with an increased left atrial volume and a decreased E/E' ratio. In addition, these parameters did not correlate with any parameters of aortic elasticity, nor valvulo-arterial impedance. These data suggest that BAV disease might have subclinical cardiac dysfunction, and further studies are required to confirm these findings and any causal relationship.

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.

The relation of fragmented QRS with tissue Doppler derived parameters in patients with b-thalassaemia major.

PURPOSE: The most important complication encountered in patients with b-thalassaemia major is degenerative fibrosis developing as a result of iron accumulation in myocardial tissue. Dysfunction pursues this accumulation. Recently, presence of fragmented QRS (fQRS) in ECG has been regarded as a predictor of myocardial fibrosis. We aimed in our study to investigate the frequency with which fQRS develops in patients with b-thalassaemia major and to disclose the correlation between fQRS frequency and Doppler-derived indices. METHODS: The patients with b-thalassaemia major (n=66; mean age: 23±6 years) and healthy controls (n=30; mean age: 23±4 years) were included. fQRS pattern was described as presence of RSR' manifested as existence of additional R wave and notching in either R or S waves in ECG recordings. 2D, M-mode, conventional Doppler, tissue Doppler echocardiography parameters were assessed. Mean serum ferritin levels over past 5 years were also calculated. RESULTS: When compared to those in control group, fQRS was more frequent in b-thalassaemia major group, indicating statistical significance (p = 0.001). While E/Em and ferritin level exhibited statistically significant increase in thalassaemia patients with fQRS (p < 0.05), the mean Em and Sm values were found to be significantly low (p < 0.05). CONCLUSIONS: fQRS was frequently observed in the patients with b-thalassaemia major, which was of statistical significance. Tissue Doppler-derived diastolic and systolic indices in thalassaemia cases with fQRS showed statistically significant impairment compared to those without fQRS. In conclusion, fQRS may represent a novel noninvasive marker for cardiac involvement in patients with b-thalassaemia major.