FIB-4 liver fibrosis index correlates with aortic valve sclerosis in non-alcoholic population.

AIM: Hepatic fibrosis, a progressive scarring of liver tissue, is commonly caused by non-alcoholic fatty liver disease (NAFLD), which increases the risk of cardiovascular disease. The Fibrosis-4 (FIB-4) index is a non-invasive tool used to assess liver fibrosis in patients with NAFLD. Aortic valve sclerosis (AVS), a degenerative disorder characterized by thickening and calcification of valve leaflets, is prevalent in the elderly and associated with increased cardiovascular morbidity and mortality. Recent studies have suggested that AVS may also be linked to other systemic diseases such as liver fibrosis. This study aimed to investigate the relationship between the FIB-4 index and AVS in a non-alcoholic population, with the hypothesis that the FIB-4 index could serve as a potential marker for AVS. METHOD: A total of 92 patients were included in this study. AVS was detected using transthoracic echocardiography, and patients were divided into groups according to the presence of AVS. The FIB-4 index was calculated for all patients and compared between the groups. RESULTS: A total of 17 (18.4%) patients were diagnosed AVS. Patients with AVS had higher rates of diabetes mellitus, older age, hypertension, angiotensin-converting enzyme inhibitor use, higher systolic blood pressure (BP) and diastolic BP in the office, coronary artery disease prevalence, left atrial volume index (LAVI), left ventricular mass index (LVMI), and late diastolic peak flow velocity (A) compared to those without AVS. Moreover, AVS patients had significantly higher creatinine levels and lower estimated glomerular filtration rate. Remarkably, the FIB-4 index was significantly higher in patients with AVS. In univariate and multivariate analyses, higher systolic BP in the office (OR, 1.044; 95% CI 1.002-1.080, p = .024) and higher FIB-4 index (1.46 ± .6 vs. .91 ± .46, p < .001) were independently associated with AVS. CONCLUSION: Our findings suggest that the FIB-4 index is associated with AVS in non-alcoholic individuals. Our results highlight the potential utility of the FIB-4 index as a non-invasive tool for identifying individuals at an increased risk of developing AVS.

Presystolic wave as a predictor of interatrial block in patients with supraventricular tachycardia.

The identification of interatrial block (IAB) through electrocardiography (ECG) has been correlated with an elevated likelihood of developing atrial fibrillation (AF) and stroke. IAB is diagnosed by evaluating P-wave prolongation on a surface ECG. The presystolic wave (PSW) is an echocardiographic marker determined by pulse-wave examination of the aortic root during late diastole. As IAB and PSW share similar pathophysiological mechanisms, we speculated that PSW, as a component of the P wave, might be useful in predicting IAB. In the present study, we aimed to determine the relationship between PSW and IAB. Patients with pre-diagnosis of supraventricular tachycardia (SVT) on electrocardiography or rhythm Holter monitoring between January 2021 and December 2022 were included in the study. Surface 12-lead ECG and transthoracic echocardiography (TTE) were performed for the diagnosis of IAB and PSW. Patients were divided into two groups based on the presence of IAB, and PSW was compared between the groups. In total, 104 patients were enrolled in this study. IAB was diagnosed in 16 patients (15.3%) and PSW was detected in 33 patients (31.7%). The PSW was higher in the IAB ( +) group than in the IAB ( -) group (10 patients (71.4%) vs. 23 patients (32.4%), p = 0.008). PSW may be a useful tool for predicting IAB in patients with SVT. Further studies are needed to determine the clinical utility of PSW in the diagnosis and management of IAB.

The relationship between ascending aortic diameter with left atrial functions and left ventricular mass index in a population with normal left ventricular systolic function.

AIM: Ascending aortic dilatation is a common clinical issue. In the present study, we aimed to evaluate the relationship between ascending aortic diameter with left ventricular (LV) and left atrial (LA) functions, and LV mass index (LVMI) in a population with normal LV systolic function. METHODS: A total of 127 healthy participants with normal LV systolic function took part in the study. Echocardiographic measurements were obtained from each subject. RESULTS: The mean age of the participants was 43 ± 14.1 years and 76 (59.8%) were female. The mean aortic diameter of the participants was 32.2 ± 4.7 mm. A negative correlation was found between aortic diameter and LV systolic function (LVEF r = -.516, p < .001; Gls r = -.370). In addition, there was a strong positive correlation between aortic diameter with LV wall thicknesses, LVMI (r = .745, p < .001), and systolic and diastolic diameters. The relationship between aortic diameter and diastolic parameters was evaluated, a negative correlation with Mitral E, Em, E/A ratio, and a positive correlation with MPI, Mitral A, Am, E/Em ratio were found. CONCLUSION: A strong correlation between ascending aortic diameter with LV and LA functions, and LVMI in individuals with normal LV systolic function.

Serum apelin levels and cardiovascular diseases.

Apelin is a G protein-linked receptor endogenous ligand, synthesized as a 77-amino acid pre-propeptide. Increased expression of apelin is present in many cardiovascular (CV) tissues, including cardiomyocytes. It is a peripheral vasodilator and one of the most potent stimulants of ventricular contraction. Apelin may be a valuable therapeutic for both blood pressure regulation and myocardial performance. More information is needed for the CV pathophysiology of apelin. We will discuss the importance of apelin level in CV diseases in this review.

Effect of Coronavirus Disease-2019 Infection on Left Atrial Functions.

Objective: Left atrial (LA) dysfunction is a crucial risk factor for cardiovascular events, and various pathologies may affect LA function. Coronavirus disease-2019 (COVID-19) is an ongoing global pandemic causing morbidity and mortality. In the present study, we aimed to evaluate LA functions in patients who recovered from COVID-19. Methods: Sixty consecutive patients recovered from COVID-19 and 60 healthy individuals as a control group were included in the study. Blood samples and echocardiography measurements were obtained from each subject. The two groups were compared in terms of demographic and echocardiographic characteristics. Results: In the COVID-19 group, LA maximum volume (LAVmax) (P = 0.040), LA pre-A volume (LAVpre-A) (P = 0.014), and LA active emptying fraction (P = 0.027) were higher, while LA passive emptying fraction (P = 0.035) was lower. In addition, left ventricular ejection fraction (P = 0.006) and isovolumetric relaxation time (P = 0.008) were decreased in this group. Although LA volume index was higher in the COVID-19 group, it does not reach statistical significance. Conclusion: LA functions may be impaired in patients recovered from COVID-19 infection.

Role of myocardial strain and rotation for predicting prosthetic aortic valve stenosis.

Pressure overload due to aortic stenosis leads to subclinical left ventricular (LV) dysfunction and global longitudinal strain (GLS) impairment even if ejection fraction is preserved. However, little is known about LV mechanics in aortic prosthetic valve (APV) stenosis. The study aimed to determine the role of myocardial strain and rotation in predicting prosthetic valve stenosis in mechanical APV patients. 60 patients with mechanical APV and 30 healthy individuals were evaluated. APV patients were analyzed in two groups; aortic valve mean gradient < 20 mmHg (27 normal gradient patients) and ≥ 20 mmHg (33 high gradient patients). Strain, rotation, and twist values were assessed using the speckle tracking method, and brain natriuretic peptide (BNP) levels were measured. Four-chamber (p < 0.001) and two-chamber (p = 0.008) longitudinal strain (LS) were higher in the control group. GLS was lower in the high gradient group than control and normal gradient groups (p < 0.001, p = 0.022). LS of lateral wall's basal and mid segments were lower in normal and high gradient groups than the control group (p = 0.003, p = 0.008). While basal rotation was lower in the high gradient group than the control group (p = 0.048), there was no difference between the groups in terms of apical rotation, and twist. BNP levels were significantly different between the groups (p = 0.048). No correlation was found between aortic valve mean gradient and GLS, basal rotation, and BNP. In conclusions, LV GLS and basal rotation are depressed in high APV gradient patients; however, these parameters are not independent predictors of gradient increment.

Pheochromocytoma: An overlooked reversible cause of heart failure with reduced ejection fraction.

Pheochromocytoma is a rare, benign tumor of adrenal medulla, and its clinical symptoms are related to catecholamine production. Clinical presentation may vary in a broad spectrum. Dilated or hypertrophied cardiomyopathies are the possible clinical outcomes of pheochromocytoma. Pheochromocytoma should be kept in mind in the differential diagnosis where resistant hypertension, palpitations, headache, and sweating accompany cardiomyopathy. Excessive adrenergic stimulation causing catecholamine discharge can trigger hypertension crisis, pulmonary edema, and myocardial necrosis. Here in this report, we aimed to present the case of a patient with pheochromocytoma related cardiomyopathy who was totally recovered after surgical excision of the tumor.

Epicardial fat thickness is associated with retinopathy in patients with newly diagnosed hypertension.

OBJECTIVE: Hypertensive retinopathy develops based on endothelial dysfunction, inflammation, and atherosclerosis. Epicardial fat secretes various cytokines associated with endothelial dysfunction, oxidative stress, inflammation, and atherosclerosis. We aimed to evaluate whether epicardial adipose tissue (EAT) thickness is a marker for retinopathy in newly diagnosed hypertensive patients. METHODS: A total of 73 newly diagnosed hypertension (HT) patients were included in the study. Transthoracic echocardiography (TTE) was used to measure EAT thickness. To evaluate the presence of retinopathy in HT patients, hypertensive retinopathy staging was performed by ophthalmologists, according to Scheie classification. RESULTS: Retinopathy was detected in 27 (37.0%) of 73 patients. EAT thickness in HT patients with retinopathy was higher than the group without retinopathy (5.07±1.45 mm vs. 4.19±1.20 mm, p=0.007). Low-density lipoprotein cholesterol (LDL-C) levels in HT patients with retinopathy were higher than the group without retinopathy (162.4±41.2 mg/dl vs. 138.1±35.6 mg/dl, p=0.010). As a result of the regression analysis, LDL-C (OR=1.016, 95% CI 1.001-1.031, p=0.043) and EAT thickness (OR=1.674, 95% CI 1.069-2.626, p=0.043) were the independent predictors of retinopathy. CONCLUSION: Increased EAT thickness is associated with the presence of retinopathy in hypertensive patients.

Myocardial injury in COVID-19 patients is associated with the thickness of epicardial adipose tissue.

Aim    High sensitive troponin (hs-TnI) levels may increase secondary to Coronavirus disease-2019 (COVID-19), and this increase is associated with cardiovascular mortality in COVID-19 patients. Epicardial adipose tissue (EAT) is associated with myocardial injury directly as a reservoir tissue for coronavirus, and indirectly through mediators it secretes as an apocrine gland. We aimed to evaluate the relationship between myocardial injury secondary to COVID-19 infection and EAT thickness.Material and methods    Thoracic computed tomography (CT) was performed in 73 consecutive patients diagnosed with COVID-19. EAT thickness and volume were calculated by two radiologists blind to the study data. We formed two groups according to hs-TnI concentrations, patients with myocardial damage (hs-TnI ≥11.6 ng / l) and without myocardial damage (hs-TnI<11.6 ng / dl).Results    A total of 46 patients were women (63.0 %). The mean age was 66.4±12.3 yrs in the myocardial injury group and 55.9±9.7 yrs in the group without myocardial injury (p<0.001). There were 20 hypertensive patients (68.9 %) in the injury group, while there were 12 hypertensive patients (27.3 %) in the group without injury (p=0.001). Glucose, C-reactive protein, D-dimer, white blood cell count, neutrophil, and neutrophil / lymphocyte ratio were higher in the injury group (p<0.05, for all variables). The mean EAT thickness was 5.6±1.6 mm in the injury group, whereas it was 4.8±1.8 mm in the group without injury (p=0.031). EAT thickness of 4.85 mm and above was associated with the myocardial injury with 65 % sensitivity and 39 % specificity (AUC=0.65, 95 % CI: 0.52-078, p=0.031).Conclusion    In patients with COVID-19 infection, higher rates of myocardial injury were observed as the EAT thickness increased. Epicardial adipose tissue, contributes to cytokine-mediated myocardial injury either directly or indirectly by acting as a reservoir for coronavirus. Increased EAT thickness is associated with myocardial injury in COVID-19 patients.

FEV1 is independently related with impaired left atrial strain in chronic obstructive pulmonary disease patients: A speckle tracking study.

BACKGROUND: Atrial fibrillation (AF) is common in chronic obstructive pulmonary disease (COPD) patients. It is known that impaired forced expiratory volume in 1 s (FEV1) is one of the risk factors of cardiovascular disease. Two-dimensional speckle tracking echocardiography (2D-STE) can detect deterioration of left atrial mechanical functions in the subclinical stage. We hypothesized that reduced lung functions, measured by FEV1 in COPD patients, may be associated with impaired left atrial (LA) mechanical functions. OBJECTIVES: Present study included 127 consecutive COPD patients. We divided study population into two groups: patients with normal LA strain (n = 20) or with impaired LA strain (n = 107). RESULTS: In univariate logistic regression analysis, age (p: 0.001), FEV1% (p < 0.001), FEV1 (p < 0.001), FEV1/forced vital capacity (FVC) (p: 0.014), white blood cell (p: 0.012), LA Max vol (p: 0.026), C-reactive protein (p :0.001), arterial oxygen pressure (PaO2 ) (p: 0.019), arterial oxygen saturation (SO2 ) (p: 0.021), left ventricle ejection fraction (LVEF) (p: 0.042), and mitral A-wave velocity (p: 0.017) were associated with impaired LA-strain. In multivariate logistic regression analysis, age (p: 0.043), FEV1 (p < 0.001), LA Max vol (p: 0.004), and LVEF (p: 0.004) were independently associated with impaired LA strain. CONCLUSION: FEV1 is associated with impaired left atrial strain independently of arterial blood gas and left ventricular diastolic dysfunction parameters in COPD patients with preserved left ventricular systolic function.

Paradoxical association between lipoprotein cholesterol levels and left atrial function in hypertensive diabetic patients: A speckle tracking study.

BACKGROUND: Studies have shown that subclinical left atrial (LA) dysfunction can be diagnosed with two-dimensional speckle tracking echocardiography (2D-STE). Although low-density lipoprotein cholesterol (LDL-C) is a risk factor for cardiovascular diseases, recent studies have reported a paradoxical relationship between LDL-C level and atrial fibrillation. In this study, we investigated the relationship between LDL-C levels and LA function. METHODS: In 168 patients with the diagnosis of hypertension and diabetes, transthoracic echocardiography with LA 2D-STE was performed. The patients were then divided into two groups: normal LA-strain (n = 94) or impaired LA-strain (n = 74). The relationship between LDL-C and LA function was analyzed. RESULTS: Patients with impaired LA-strain had higher body mass index (BMI) (p = 0.029), higher statin usage (p = 0.003), and lower LDL-C levels (p = 0.001) than patients with normal LA-strain. They also had lower left ventricle ejection fraction (LVEF) (p = 0.047) and higher E-wave velocity (mitral e, m/s) (p = 0.020). Multivariate logistic regression analysis showed that lower LDL-C (p = 0.034), higher BMI (p = 0.004), lower LVEF (p = 0.004), and higher E-wave velocity (p = 0.003) values were independently associated with impaired LA-strain. The area under the receiver operating curve of LDL-C in predicting impaired LA-strain was 0.645 (0.564-0.730, p < 0.05). LDL-C ≤ 112.5 mg/dl was found to be the optimal cut-off value with 74.5% sensitivity and 51.2% specificity in predicting impaired LA strain. CONCLUSION: In patients with hypertension and diabetes, LDC-C levels are moderately but independently and paradoxically associated with impaired LA function assessed by 2D-STE.

Is Adiponectin Elevation Associated with Left Atrial Remodeling and Impaired Mechanical Functions? (a Speckle Tracking Study).

Objectives    Recent studies demonstrated that elevated adiponectin levels predicted an increased risk of atrial fibrillation (AF) and stroke; however, a causal relationship is yet to be unknown. Reduced left atrium (LA) functions detected by two-dimensional echocardiographic speckle tracking (2D-STE) can predict AF development. We aimed to investigate the relationship between adiponectin level and LA functions in hypertensive and diabetic patients at high risk for incident AF.Material and methods    The study consisted of 80 hypertensive diabetic patients. All patients underwent echocardiography, and venous blood samples were taken. The relationship between adiponectin levels and LA functions was analyzed.Results    We divided patients into two groups according to the mean adiponectin level (13.63 ng / ml). In the high adiponectin group, the mean age (p=0.001) and high-density lipoprotein (HDL) cholesterol (p=0.015) were higher, whereas estimated glomerular filtration rate (eGFR) (p=0.036) and hemoglobin (p=0.014) levels were lower. Although LA maximum volume, LA minimum volume, and LA pre-A volume were higher in the group with high adiponectin levels, they did not reach a statistical significance. Peak early diastolic LA strain (S-LAe) (p=0.048) and strain rate (SR-LAe) (p=0.017) were lower in this group. Multivariate logistic regression analysis demonstrated that age (p=0.003) and hemoglobin (p=0.006) were predictors of elevated adiponectin levels. On the contrary, S-LAe, HDL cholesterol, and eGFR lost their statistical significance.Conclusion    In patients with HT and DM, elevated adiponectin level is associated with impaired LA mechanical functions. Increased age and hemoglobin level are independent predictors of elevated adiponectin levels.

Blood urea nitrogen is associated with long-term all-cause mortality in stable angina pectoris patients: 8-year follow-up results.

Background    Elevation of blood urea nitrogen (BUN) indicates renal dysfunction and is associated with increased mortality in cardiovascular diseases. We investigated the relationship between the BUN concentration measured at hospital admission and the long-term all-cause mortality in patients with stable angina pectoris (SAP).Methods    The mortality rate of 344 patients who underwent coronary angiography (CAG) in our clinic due to SAP was analyzed during a mean follow-up period of 8 yrs.Results    Age (p<0.001), male gender (p=0.020), waist circumference (p=0.007), body-mass index (p=0.002), fasting glucose (p=0.004), BUN (p<0.001), serum creatinine (Cr) (p<0.001), hemoglobin (p=0.015), triglyceride concentrations (p=0.033), and the Gensini score (p<0.001) were related to all-cause mortality as shown by univariate Cox regression analysis. Age (OR 1.056, 95 % CI 1.015-1.100, p=0.008), fasting glucose (OR 1.006, 95 % CI 1.001-1.011, p=0.018), BUN, (OR 1.077, 95 % CI 1.026-1.130, p=0.003), and the Gensini score (OR 2.269, 95 % CI 1.233-4.174, p=0.008) were significantly related with mortality as shown by multivariate Cox regression analysis. According to receiver operating characteristic analysis ofthe sensitivity and specificity of BUN and Cr for predicting mortality, the area under the curve values of BUN and Cr were 0.789 (p<0.001) and 0.652 (p=0.001), respectively. BUN had a stronger relationship with mortality than Cr. A concentration of BUN above 16.1 mg / dl had 90.1 % sensitivity and 60 % specificity for predicting mortality (OR=2.23).Conclusion    In patients who underwent CAG due to SAP, the BUN concentration was associated with all-cause mortality during a mean follow-up period of 8 yrs.

Evaluation of left ventricular global functions with speckle tracking echocardiography in patients recovered from COVID-19.

Highly sensitive troponin (hs-TnI) levels are frequently elevated in COVID-19 patients and are associated with increased cardiovascular mortality during hospitalization. However, no data exists on cardiac involvement in patients recovered from COVID-19 infection. We aimed to evaluate by global longitudinal strain (LV-GLS) whether there is subclinical myocardial deformation after COVID-19 infection. Two-dimensional speckle tracking echocardiography (2D-STE) was performed within 29.5 ± 4.5 days after COVID-19 treatment. The standard GLS limit was identified at < -18%. The patients were divided into two groups according to their hs-TnI levels during hospitalization as with (> 11.6 ng/dl) and without (< 11.6 ng/dl) myocardial injury. Patients' (n = 74) mean age was 59.9 years, and women were in the majority (60.8%). Of the patients, 43.2% of them were hypertensive, and 10.9% were diabetic. Abnormal LV-GLS values (> -18) were measured in 28 patients (37.8%). While 16 (57.1%) of these patients were in the group with myocardial injury, 12 (26.1%) of them were in the group without myocardial injury (p = 0.014). D-dimer, C reactive protein, white blood cell levels were higher in the group with myocardial injury (All p values < 0.05). Electrocardiographically, 9 (12.2%) patients had T wave inversion, while two patients had a bundle branch block. Subclinical left ventricular dysfunction was observed in approximately one-third of the patients at the one-month follow-up after COVID-19 infection. This rate was higher in those who develop myocardial injury during hospitalization. This result suggests that patients recovered from COVID-19 infection should be evaluated and followed in terms of cardiac involvement.

Serum osteoprotegerin level is independently related to subclinical left atrial mechanical function in patients with hypertension and diabetes.

OBJECTIVES: Previous studies showed that subclinical abnormal left atrial (LA) function could be diagnosed with LA speckle tracking evaluation long before chamber enlargement. Osteoprotegerin (OPG) is a member of the tumor necrosis factor (TNF) receptor superfamily and was recently found to be an indicator for adverse cardiovascular outcomes and a risk factor for new onset atrial fibrillation. The authors hypothesized that OPG values could predict LA mechanical dysfunction and LA remodeling assessed by two-dimensional speckle tracking echocardiography (2D-STE) in patients with hypertension (HT) and diabetes mellitus (DM). METHODS: A single center study was conducted including consecutive patients presenting to the authors' outpatient clinic. Enrolled patients needed to have been treated for HT and DM for at least 1 year. RESULTS: The study included 80 patients (mean age, 57.5 ± 8.3 years). Patients in the impaired LA strain group were older (p = 0.035), had lower low density lipoprotein (LDL) cholesterol (mg/dl) (p = 0.021), and higher OPG (pmol/l) (p = 0.004) values than patients in the normal LA strain group. Univariate logistic regression analysis demonstrated that age (p = 0.039), LDL cholesterol (mg/dl) (p = 0.025), and OPG (pmol/l) (p = 0.008) values were associated with impaired LA strain. Backward multivariate logistic regression analysis showed that LDL cholesterol (mg/dl) (OR: 0.982, CI 95% 0.964-0.999, p = 0.049) and OPG (pmol/l) (OR: 1.438, CI 95% 1.043-1.983, p = 0.027) were independently associated with impaired LA strain. CONCLUSION: In hypertensive and diabetic patients, higher OPG values were associated with impaired LA function assessed by 2D-STE. In this high-risk patient group, serum OPG can be used as a risk predictor for LA mechanical dysfunction.

Epicardial adipose tissue is associated with increased systolic pulmonary artery pressure in patients with chronic obstructive pulmonary disease.

OBJECTIVES: Pulmonary hypertension (PHT) is one of the essential predictors of mortality in chronic obstructive pulmonary disease (COPD). It is thought that PHT is due to vasoconstriction secondary to hypoxia caused by airway obstruction in COPD patients; however, loss of capillary bed with emphysema, inflammation, and endothelial dysfunction may also play a role in the development of PHT. Epicardial adipose tissue (EAT) has a role as a metabolically active endocrine organ and secretes various proinflammatory cytokines. We hypothesized that EAT thickness in COPD patients might be associated with the systolic pulmonary arterial pressure (PAPs) level, and we aimed to test it. METHODS: The present study included 129 consecutive patients with the diagnosis of COPD. All patients underwent transthoracic echocardiographic evaluation. The relationship between PAPs and EAT thickness was evaluated. RESULTS: Positive correlations with PAPs were reported with age, EAT, white blood cell (WBC) and GOLD grade score (range 0.197-0.275, P values 0.026 to 0.002), negative correlations with body-mass index (BMI), hyperlipidemia, FEV1 (% predicted) and pO2 (range -0.216 to -0.340, P values .014 to <.001). In stepwise linear regression analysis, BMI (P = .003), EAT (P = .002), WBC (P = .001), and FEV1 (% predicted) (P = .010), were independently associated with PAPs. CONCLUSION: EAT thickness in COPD patients with preserved left ventricular systolic function is associated with increased PAPs, and this association is independent of the parameters indicating the severity of COPD.

Impaired left atrial mechanical functions as indicators for increased aortic root diameter in hypertensive and diabetic patients.

OBJECTIVES: Previous studies have demonstrated that increased aortic root diameter (ARD) is frequently associated with increased cardiovascular (CV) events and is a predictor of stroke. Two-dimensional speckle tracking echocardiography (2D-STE) provides a better evaluation of left atrial (LA) functions. Left atrial mechanical dispersion is a useful predictor of new-onset atrial fibrillation (AF) independent of LA enlargement and dysfunction. We aimed to investigate the relationship between ARD and LA mechanical functions. METHODS: The present study included 93 consecutive patients with hypertension and diabetes. The relationships between ARD and LA functions was evaluated. RESULTS: Study population was divided into two groups according to the mean ARD values: group 1 (ARD ≤30.03 mm, n = 53) and group 2 (ARD >30.03 mm, n = 40). In group 2, age, LA max volume (vol), LA pre A vol, LA min vol, LA emptying fraction, LA active ejection fraction (EF), and LA expansion index were significantly higher compared to group 1. S­LAs and SR-LAs (peak LA strain and strain rate, respectively, during ventricular systole) and S­LAe and SR-LAe (peak early diastolic LA strain and strain rate, respectively) were significantly lower in group 2 compared to group 1. Age, LA max vol, LA pre A vol, LA min vol, LA emptying fraction, LA active EF, LA expansion index, S­LAs, S­LAe, SR-LAs, and SR-LAe were significantly associated with increased ARD. In multivariate logistic regression analysis, age, LA expansion index, and SR-LAe were independent predictors for ARD. CONCLUSION: Impaired LA mechanical functions determined by speckle tracking methods are related with increased ARD independent of LV diastolic dysfunction.

A New Scoring System Detecting the Supraventricular Tachycardia Inducibility and Radiofrequency Ablation With High Specificity in Electrophysiological Study.

AIM: The relationship between arrhythmia induction and ablation with palpitation characteristics has been demonstrated in electrophysiological study (EPS) patients. However, there is insufficient data on palpitation characteristics and their sensitivity and specificity. We aimed to identify the relationship between scoring composed of palpitation characteristics with the supraventricular tachycardia (SVT) induction and the success rate of the procedure. METHOD: A total of 119 patients, diagnosed as paroxysmal supraventricular tachycardia (PSVT) by electrocardiography, rhythm Holter or symptoms, and underwent EPS, were enrolled in the study. A psychiatrist administered the Hospital Anxiety and Depression Score (HADS) questionnaire. RESULTS: In SVT induced group, palpitation duration (p = 0.048), palpitation spread to neck (p 0.004), responsiveness to medication (p = 0.008), induction with stress (p = 0.007), admission to emergency (p = 0.021) and documented PSVT (p = 0.017) were more common. Atropine administration (p = 0.001) was higher, and the Wenckebach cycle length (p < 0.001) was longer in the non-induced arrhythmia group. The presence of dual AV pathways was higher in SVT induced group (p = 0.002). There were no differences between groups in terms of anxiety score (p = 0.192), depression score (p = 0.730), and total psychiatric results (p = 0.280) in the HADS questionnaire. In scoring designed by the palpitation characteristics, the score of four and over predicted SVT induction with 63.6% sensitivity and 92.5% specificity. Radio-frequency ablation (RFA) was performed succesfully in 82.1% of patients with a score of ≥4. CONCLUSION: Supraventricular tachycardia induction score obtained from the palpitations characteristics and arrhythmia documentation can be useful in predicting the induction of SVT and the success of RFA.

Prolonged QRS independently predicts long-term all-cause mortality in patients with narrow QRS complex undergoing coronary artery bypass grafting surgery (9-year follow-up results).

AIM: We investigated the association of intermediate QRS prolongation with the long-term all-cause mortality in coronary artery bypass grafting (CABG) surgery patients with a narrow QRS complex in the preoperative electrocardiography (ECG). MATERIAL AND METHODS: A total of 221 consecutive patients with narrow QRS (< 120 ms) sinus rhythm who underwent CABG surgery were included in the study. The patients were followed up for 9.2 years postoperatively in terms of mortality outcomes. RESULTS: Follow-up data were obtained from 211 (173 men, 38 women) of 221 patients. Death occurred in 57 of them. We examined patients in the two groups according to survival outcomes. In multivariate COX regression analysis EuroSCORE (OR = 1.342, 95% CI: 1.167-1.544, p < 0.001), extent of coronary artery disease (OR = 1.768, 95% CI: 1.034-3.020, p = 0.037), QRS duration (OR = 1.029, 95% CI: 1.002-1.058, p = 0.035) and fasting glucose levels (OR = 0.992, 95% CI: 0.984-0.999, p = 0.029) were independent predictors of all-cause mortality. QRS duration > 89.5 ms determined all-cause mortality with a sensitivity of 73.7% and a specificity of 52% (OR = 2.07) due to ROC analysis. All-cause mortality was significantly higher in patients with preop QRS duration > 90 ms from the first year (c2 = 6.724, p = 0.010). CONCLUSIONS: In CABG patients with a narrow QRS complex, preoperative intermediate prolonged QRS is an independent predictor of all-cause mortality in long-term follow-up.

A Prospective Noninterventional, Observational Study to Describe the Effectiveness and Safety of Trandolapril and Verapamil Single-Pill Combination in the Management of Patients with Hypertension and Type 2 Diabetes Mellitus: A Harvest TR Study.

Maintaining regular blood pressure control usually requires multidrug regimens rather than monotherapy. The objective of this study was to describe the effectiveness and safety of an angiotensin-converting enzyme inhibitor and a nondihydropyridine calcium channel blocker in a single-tablet combination in patients with hypertension, a heart rate higher than 70 beats/min, and type 2 diabetes mellitus (T2DM). This study was conducted in Turkey as a prospective, noninterventional, observational study. At 22 clinical sites, the data of 200 patients with hypertension were used for efficacy analysis; however, 262 patients received at least one dose of trandolapril/verapamil fixed-dose combination at two dose strengths. Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate, PR interval, glycated haemoglobin (HbA1c), and albumin/creatinine ratios were recorded during 8 weeks of treatment. With treatment, the mean (±SD) SBP that was recorded as 162.8 (±14.642) mm Hg at baseline was reduced to 131.7 ± 11.1 mm Hg at week 8 (p < 0.05). Similarly, the mean DBP was reduced from 93.76 ± 9.16 mm Hg to 77.6 ± 7.6 mm Hg (p < 0.001). Following 8 weeks of treatment, SBP and DBP values were reduced below 140 mm Hg and 90 mm Hg in most patients (81.5%), respectively. The mean heart rate as evaluated using electrocardiography measurements was reduced to 78.25 beats/min at week 8 as compared with baseline during trandolapril/verapamil single-pill combination treatment (p < 0.001). Treatment with trandolapril and verapamil was well tolerated over 8 weeks with no unexpected safety signals. In conclusion, the single-pill combination of trandolapril and verapamil was considered effective in reducing and controlling blood pressure in patients with hypertension and T2DM. There was a significant improvement in HbA1c and ACR levels in a smaller subgroup of the patient cohort. The trandolapril/verapamil combination was evaluated as being safe and well-tolerated following a treatment period of 8 weeks. This trial was registered with NCT02298556.