Assessment of right ventricular dysfunction in patients with mitral stenosis: A speckle tracking study.

PURPOSE: Although it is affected at an early stage, there is a lack of studies investigating right ventricular (RV) function in patients with mitral stenosis (MS). We aimed to investigate the correlation between conventional echocardiographic variables and tricuspid annular plane systolic excursion (TAPSE), used as an indicator of RV dysfunction. METHODS: We enrolled 59 consecutive patients with MS and assigned them in group 1 if TAPSE ≤16, or group 2 if: TAPSE >16. RESULTS: The mean age of the patients was 42.2 ± 8 years, and 74.6% were females. In univariate analysis, maximal mitral valve gradient, mean mitral valve gradient, systolic pulmonary arterial pressure, RV strain, and RV strain rates were associated with RV dysfunction. In multivariate analysis, both strain variables were found to be independent predictors of RV dysfunction. Kaplan Maier survival analysis showed that patients with lower RV strain had more rehospitalization rate during the one-year follow-up period. CONCLUSIONS: RV dysfunction is common in patients with MS and is associated with higher rehospitalization rate and morbidity. Evaluation of RV strain and strain rate for early detection of RV dysfunction and prediction of rehospitalization may be an appropriate approach in mitral stenosis.

Assessment of Left Atrial Mechanics in Patients with Preexcitation Syndrome Scheduled for Catheter Ablation.

OBJECTIVES: We aimed to test the left atrial (LA) mechanics and contraction synchrony by 2D strain imaging, in patients with Wolff-Parkinson-White (WPW) syndrome, before and after radiofrequency catheter ablation (RFCA). METHODS: Study population consisted of 25 patients with WPW scheduled for RFCA and 30 healthy controls. The peak LA strain at the end of the ventricular systole (LAs strain) and the LA strain with LA contraction (LAa Strain) were obtained. To assess LA dyssynchrony, septal versus lateral wall time-to-peak strain measurements were measured. RESULTS: There was no difference between the patients with WPW and control subjects with regard to peak LAs and LAa strain. Patients with WPW demonstrated higher global time-to-peak LAs and LAa strain values compared with the control group. Peak LAs strain and LAa strain values, measured before and after the RF ablation of the accessory pathway, were comparable (34.3 ± 3.92 vs. 34.6 ± 3.2, P = 0.816, 14.7 ± 2.8 vs. 15.3 ± 2.3, P = 0.052, respectively). Global time-to-peak LAs and LAa strain measurements were significantly shorter after the RFCA compared with the values obtained before the RFCA. However, septo-lateral times to peak LA strain differences were found to be comparable in both WPW versus control and pre- versus postablation groups. CONCLUSION: LA mechanical function assessed by 2D strain imaging was comparable between patients with WPW and control subjects. Patients with WPW had more prominent LA dyssynchrony during atrial pump phase as compared with the controls, a condition which could not improve after successful elimination of the accessory pathway by RFCA.

Increased Glycated Hemoglobin Level is Associated With SYNTAX Score II in Patients With Type 2 Diabetes Mellitus.

SYNTAX score II (SS II) uses 2 anatomical and 6 clinical variables for the prediction of mortality after coronary artery bypass graft and percutaneous coronary intervention. The aim of this study was to investigate the relationship between glycated hemoglobin (HbA1c), fasting blood glucose (FBG), postprandial glucose (PPG), and SYNTAX Score (SS) and SS II in patients with type 2 diabetes mellitus and coronary artery disease (CAD). We enrolled 215 consecutive diabetic patients with stable angina pectoris who underwent coronary angiography. The SS II was calculated using a nomogram that was based on the findings of a previous study. There was a moderate correlation between HbA1c and SS (r = .396, P < .001), but there was a good correlation between HbA1c and SS II (r = .535, P < .001). There was also a weak correlation between FBG (r = .270, P = .001), PPG (r = .177, P = .027), and SS, but there was a weak-moderate correlation between FBG (r = .341, P < .001), PPG (r = .256, P = .001), and SS II. A better correlation has been detected between HbA1c and SS II compared to the correlation between HbA1c and SS.

Comparison of the effects of metoprolol or carvedilol on serum gamma-glutamyltransferase and uric acid levels among patients with acute coronary syndrome without ST segment elevation.

OBJECTIVE: Serum gamma-glutamyltransferase (GGT) and uric acid levels measured in patients with acute coronary syndrome without ST segment elevation (NSTEMI) are important in diagnosis and in predicting the prognosis of the disease. There is a limited number of clinical studies investigating the effects of beta-blockers on GGT and uric acid levels in these patients. In our study, we aimed to investigate the effects of beta-blocker therapy on GGT and uric acid levels. METHODS: We conducted a randomized, prospective clinical study. Hundred patients with NSTEMI were included in this study, and they were divided into two groups. Fifty patients were administered metoprolol succinate treatment (1 x 50 mg), whereas the remaining 50 patients were administered carvedilol treatment (2 x 12.5 mg). Thereafter, all of the patients underwent coronary angiography. Blood samples were taken at the time of admission, at the 1st month, and 3rd month to detect GGT and uric acid levels. RESULTS: There was no statistically significant difference among the metoprolol or carvedilol groups in terms of the GGT levels measured at the baseline, 1st month, and 3rd month (p=0.904 and p=0.573, respectively). In addition, there was no statistically significant difference among the metoprolol or carvedilol groups in terms of uric acid levels measured at the baseline, 1st month, and 3rd month (p=0.601 and p=0.601, respectively). CONCLUSION: We found that GGT and uric acid levels did not show any change compared to the baseline values, with metoprolol and carvedilol treatment initiated in the early period in patients with NSTEMI.

A diagnostic dilemma: early repolarization syndrome associated with ventricular fibrillation.

An early repolarization (ER) pattern, characterized by J-point elevation, slurring of the terminal part of the QRS and ST-segment elevation, is a common finding on the 12-lead electrocardiogram. It has been suggested that J-point elevation, which was considered benign for many years, may play a critical role in the pathogenesis of idiopathic ventricular fibrillation (VF). Recent studies have shown that an ER pattern in inferior leads or inferolateral leads is associated with increased risk for life-threatening arrhythmias. We report the case of a 52-year-old man with no structural heart disease whose electrocardiogram showed type 2 ER pattern (with evidence of J-point and ST-segment elevation in electrocardiogram leads II, III, and aVF). The patient presented with VF.

Effects of tirofiban maintenance duration on myocardial perfusion defect severity in anterior myocardial infarction.

INTRODUCTION: Percutaneous coronary intervention (PCI) does not often produce optimal results, despite restoration of coronary blood flow at myocardial recovery, because of impaired microvascular perfusion. This study aimed to investigate and evaluate with (99m)Tc-sestamibi scan whether the results of PCI can be changed by maintenance infusion of tirofiban for 24 or 48 h in patients presenting with anterior ST-elevation myocardial infarction (STEMI). METHODS: The study included 84 patients with anterior STEMI who were candidates for primary PCI and whose occlusion was in the proximal or mid-left anterior descending artery. Patients were given 25 µg/kg/3 min tirofiban and randomized to receive maintenance infusion at 0.15 µg/kg/min for 24 or 48 h. A resting (99m)Tc sestamibi scan was performed on the 5th day post-procedure before discharge. The primary efficacy endpoint was a patient's score on a 5-point scoring system for perfusion defect severity. Major adverse cardiac events (MACE) were defined as death from any cause, re-infarction, and clinically driven target-vessel revascularization within the first 6 months. RESULTS: Baseline characteristics of the patients were similar in the two infusion groups (n = 42 per group). There was no significant difference in the symptom onset-to-presentation time or door-to-balloon time between the two groups. With the exception of basal anteroseptal and basal anterior segments, significant reductions were obtained on the 5-point scoring system for perfusion defect severity in segments and in the summed rest scores. No significant differences were observed between the two groups in the incidence of MACE at 6 months. The safety profile did not differ between 24 and 48 h infusions of tirofiban. CONCLUSION: The use of tirofiban, when administered at a high bolus dose and maintained for 48 h, was safe and significantly reduced perfusion defect severity in patients with anterior STEMI presenting early after symptom onset and undergoing primary PCI.