Assessment of biventricular function with speckle tracking echocardiography in newly-diagnosed adult-onset asthma.

OBJECTIVE: There is limited number of studies on the effect of asthma disease on cardiac functions. The aim of this study was to investigate if there was any association between adult onset asthma and cardiac dysfunction. METHODS: Total of 83 nonsmoking adult onset asthma patients aged between 18 and 65, and 83 control subjects with comparable age and sex distribution were included in the study.None of the subjects had any chronic cardiovascular or systemic diseases.Two-dimensional, M-mode and tissue Doppler examinations were performed. STE analysis was obtained using the QLAB software. Complete blood count and high-sensitive C-reactive protein (hsCRP) levels were measured. RESULTS: There was no difference between two groups in terms of standard echocardiography and Doppler parameters. While tricuspid annular plane systolic excursion (TAPSE) was observed to be lower in asthmatics (24.9 ± 2.0 vs. 25.5 ± 2.1, p = 0.043), right ventricular myocardial performance index (RV MPI) was higher (0.36 ± 0.07 vs 0.32 ± 0.06, p˂0.001). There was no significant difference between the groups in terms of left ventricular STE parameters. Measurements of right ventricular global longitudinal strain (RVGLS) and right ventricular free wall strain (RVfree) were observed to be lower in the asthma group (-20.3 ± 2.9 vs -21.5 ± 2.9, p = 0.007; -24.0 ± 3.0 vs 25.1 ± 2.9, p = 0.009, respectively). CONCLUSION: -We demonstrated that while adult onset mild-stage asthma patients have normal parameters in standard echocardiography, they have reduced right ventricular functions by STE.

Treatment delays and in-hospital outcomes in acute myocardial infarction during the COVID-19 pandemic: A nationwide study.

OBJECTIVE: Delayed admission of myocardial infarction (MI) patients is an important prognostic factor. In the present nationwide registry (TURKMI-2), we evaluated the treatment delays and outcomes of patients with acute MI during the Covid-19 pandemic and compaired with a recentpre-pandemic registry (TURKMI-1). METHODS: The pandemic and pre-pandemic studies were conducted prospectively as 15-day snapshot registries in the same 48 centers. The inclusion criteria for both registries were aged ≥18 years and a final diagnosis of acute MI (AMI) with positive troponin levels. The only difference between the 2 registries was that the pre-pandemic (TURKMI-1) registry (n=1872) included only patients presenting within the first 48 hours after symptom-onset. TURKMI-2 enrolled all consecutive patients (n=1113) presenting with AMI during the pandemic period. RESULTS: A comparison of the patients with acute MI presenting within the 48-hour of symptom-onset in the pre-pandemic and pandemic registries revealed an overall 47.1% decrease in acute MI admissions during the pandemic. Median time from symptom-onset to hospital-arrival increased from 150 min to 185 min in patients with ST elevation MI (STEMI) and 295 min to 419 min in patients presenting with non-STEMI (NSTEMI) (p-values <0.001). Door-to-balloon time was similar in the two periods (37 vs. 40 min, p=0.448). In the pandemic period, percutaneous coronary intervention (PCI) decreased, especially in the NSTEMI group (60.3% vs. 47.4% in NSTEMI, p<0.001; 94.8% vs. 91.1% in STEMI, p=0.013) but the decrease was not significant in STEMI patients admitted within 12 hours of symptom-onset (94.9% vs. 92.1%; p=0.075). In-hospital major adverse cardiac events (MACE) were significantly increased during the pandemic period [4.8% vs. 8.9%; p<0.001; age- and sex-adjusted Odds ratio (95% CI) 1.96 (1.20-3.22) for NSTEMI, p=0.007; and 2.08 (1.38-3.13) for STEMI, p<0.001]. CONCLUSION: The present comparison of 2 nationwide registries showed a significant delay in treatment of patients presenting with acute MI during the COVID-19 pandemic. Although PCI was performed in a timely fashion, an increase in treatment delay might be responsible for the increased risk of MACE. Public education and establishing COVID-free hospitals are necessary to overcome patients' fear of using healthcare services and mitigate the potential complications of AMI during the pandemic. (Anatol J Cardiol 2020; 24: 334-42).

Practical Method for Salt Intake Follow-Up in Hypertensive Patients.

Background: Obese and hypertensive (HT) patients should restrict salt intake. In excessive salt intake, ouabain-like compounds inhibit Na/K-ATPase (Na+ pump), which increases intracellular Na+ and Ca2+. Ca2+ has a vasotonic effect on arteries and an inotropic effect on the heart and may cause cortical opacities in the lens. To our knowledge, there is still no practical method for salt intake follow-up. This study tested whether salt intake follow-up can be performed with the help of opacity tracking. Methods: In total, 400 HT patients (age 30-69 years) with cortical lens opacities were included in the study. Changes in opacities based on biomicroscopic examination at baseline and after 3 months were recorded digitally with the help of imaging software. Salt intake at 1 and 3 months was evaluated with a 24-hr urine Na assay. Changes in opacities were compared among group 1 (∼50% salt reduction), group 2 (∼10% salt reduction), and group 3 (∼15% salt increase). Results: Age and changes in small opacity diameter (SOD) and large opacity diameter (LOD) were the most important determinants of the 50% salt reduction in the third month. For changes in LOD, the sensitivity was 88.5% [confidence interval (95% CI) 85.2-91.7] and specificity was 95.5% (95% CI 93.1-98.7) for predicting a 50% salt restriction during the 3-month period. For SOD, the values were 85% (95% CI 82.5-87) and 95% (95% CI 92.3-97.5), respectively. Conclusions: Opacity changes are a practical method for predicting a 50% reduction in salt intake over a 3-month period in 30- to 59-year-old HT patients.

Heart aging when near vision difficulty begins.

OBJECTIVES: Heart, lens, and neuronal cells change significantly with age, and they are older than cells from renewable tissues. Near vision deterioration during aging results from a decrease in accommodation amplitude (AA). Cardiac aging is an independent risk factor for cardiovascular disease. We investigated the association between cardiac aging and AA. METHODS: The subjects (500 mean 50-year-old subjects, with equal males and females) were divided into two groups according to AA measured with a Raf ruler. Biomicroscopy was used to capture images of the lens nucleus in the unaccommodated and accommodated state. The nucleus diameter change at 1 D accommodation was measured using ImageJ. Cardiac conduction system differences were evaluated using electrocardiography, and cardiac autonomic aging was assessed based on heart rate variability. Myocardial aging was assessed based on diastolic dysfunction. RESULTS: For near distance vision, compared to subjects who could see clearly from 24 to 28 cm, subjects who could see clearly from 29 to 33 cm had a 2.104-fold higher risk of a lateral e' velocity <10 cm/s [95%CI: 1.312-3.374], 2.603-fold higher risk of diastolic dysfunction [95%CI: 1.453-4.662], 1.54-fold higher risk of a low/high frequency ratio >3.1 [95%CI: 1.085-2.197]. CONCLUSIONS: As a simple screening test, subjective AA measurement can predict important heart aging parameters, including diastolic dysfunction. CLINICALTRIALS.GOV REGISTRY NO: NCT04362215.

Oxidant-Antioxidant balance in patients with coronary slow flow.

OBJECTIVE: Recent studies have focused on the probable role of oxidative stress in cardiovascular diseases. We aimed to assess the oxidant/antioxidant biomarkers in coronary slow flow (CSF). METHODS: The study included 51 subjects with CSF and age and sex matched 32 controls. Detailed anamnesis of the patients in the study was taken and routine physical examinations were performed. Routine biochemical blood tests were analyzed. Total oxidative status (TOS), oxidative stress index (OSI) and lipid hydroxyperoxide (LOOH) levels as oxidant biomarkers; paraoxonase (PON1), ceruloplasmin (CP), free sulphydryl (SH) groups, and total antioxidant capacity (TAS) levels as antioxidant biomarkers were studied. RESULTS: Baseline demographic characteristics of the study population did not differ significantly between groups.TOS, OSI and LOOH concentrations were higher in study group than in control group. However, there was no significant difference detected in levels of TAS, PON1, SH and CP. Multivariate logistic regression analysis revealed that TOS, hsCRP and smoking were indepedent risk factors of CSF. CONCLUSIONS: Although there was not any significant difference in antioxidant biomarkers (TAS, PON1, SH and CP) in CSF patients, we detected increased TOS, OSI and LOOH levels which have oxidant properties. These data supported the possible involvement of oxidative stress in pathogenesis of CSF as previous studies reported.

Evaluation of pulmonary artery stiffness in newly diagnosed adult patients with asthma.

BACKGROUND: There are limited studies on the effects of asthma on cardiac function. Right ventricular dysfunction and pulmonary hypertension are cardiovascular complications that may be seen in advanced stages of the disease. Pulmonary artery stiffness (PAS), is a promising, relatively new echocardiographic index that has been reported to increase in right ventricular failure, providing information about pulmonary vascular bed. AIM: In this study, we aimed to evaluate PAS, a marker of pulmonary artery elasticity, in adult-onset asthma. METHODS: Ninety-nine nonsmokers who had a new asthma diagnosis between the ages of 18 and 65 years and 97 healthy controls with similar age and sex distribution were included in the study. PAS was calculated by dividing the maximal frequency shift of pulmonary flow (MFS) in pulmonary acceleration time (PAT). RESULTS: Clinical and demographic characteristics of both groups were similar (P Ëƒ 0.05). PAS values were higher in the asthma group than in the control group (25.2 ± 4.5 vs 22.4 ± 4.1, P ˂0.001). TAPSE was lower in the case group (24.9 ± 2.0 vs 25.5 ± 2.1, P = 0.043), while RV MPI was higher (0.36 ± 0.07 vs 0.32 ± 0.06, P ˂0.001). In the multivariate linear regression analysis, RV MPI, RV Em, and TAPSE variables were independent predictors of PAS. CONCLUSION: In our study, PAS values were higher in patients with newly diagnosed adult asthma and we found a significant weak correlation between PAS values and subclinical right ventricular dysfunction.

Salt, Hypertension, and the Lens.

BACKGROUND: Salt is important in the pathogenesis of hypertension (HT). Salt-sensitive hypertension (SSH) accounts for about half of all HT cases. In SSH, sodium/potassium adenosine triphosphatase (Na+/K+-ATPase) activity is impaired. Impaired Na+/K+-ATPase activity in the lens epithelium results in cortical opacities in the peripheral equator of the lens. We investigated the sensitivity of cortical lens opacities in detecting SSH. METHODS: The study included 191 SSH and 159 non-SSH, salt-resistant HT (SRH) patients (350 HT patients total), aged 40-80 years. One hundred twenty-four sex- and age-matched patients without a HT diagnosis made up the control group. Daily salt intake of all groups was calculated from 24-hr urinary Na excretion. SSH was diagnosed when the difference in mean arterial blood pressure values obtained during high- and low-Na diets was ≥10%. Non-SSH, SRH was diagnosed when the difference was <10%.Two researchers examined the presence of cortical lens opacities biomicroscopically using the diffuse, direct, Scheimpflug, and retroillumination from fundus methods. RESULTS: Total lens opacity was predictive of SSH among all cases (P < 0.001), with a sensitivity and specificity of 75.4% [95% confidence interval (CI): 68.6-81.3] and 83.6% (95% CI: 77.0-89.0), respectively. Its positive and negative predictive values were 84.7% (95% CI: 79.4-88.8) and 73.9% (95% CI: 68.6-78.5), respectively. CONCLUSIONS: Lens opacities can be used as a finding that can be easily observed in the detection of SSH and excess salt intake.

Treatment-associated change in apelin concentration in patients with hypertension and its relationship with left ventricular diastolic function.

OBJECTIVE: We examined the change in apelin concentration and its relationship with left ventricular diastolic function in patients treated for hypertension. METHODS: Ninety treatment-naive patients with newly diagnosed hypertension and 33 age- and sex-matched control subjects were prospectively enrolled. Patients with hypertension were randomized to treatment either with telmisartan 80 mg or amlodipine 10 mg. Apelin concentration was measured and echocardiography was performed at baseline and after 1 month of treatment. RESULTS: The data of 77 patients and 33 controls were analyzed. Mean age, gender, baseline blood pressure, apelin levels, and echocardiographic measurements were similar between the treatment groups (p>0.05 for all). Apelin concentration was significantly lower in patients with hypertension than in controls. There was a significant increase in apelin level after 1 month of treatment in both groups (0.32±0.17 vs. 0.38±0.17 ng/dL in telmisartan group, p=0.009, and 0.27±0.13 vs. 0.34±0.18 ng/dL in amlodipine group, p=0.013). Diastolic function improved significantly in both groups (p<0.05) but was not significantly associated with change in apelin concentration. CONCLUSION: Apelin concentration increased significantly after 1 month of effective treatment with telmisartan or amlodipine to a similar extent. Change in apelin concentration was not associated with improvement in diastolic function.

Usefulness of the epicardial fat tissue thickness as a diagnostic criterion for geriatric patients with metabolic syndrome.

OBJECTIVE: To evaluate the epicardial fat tissue thickness (EFTT) as a diagnostic criterion for geriatric patients with metabolic syndrome (MetS). METHODS: Sixty geriatric patients over 65 years of age were recruited for the study. Patients were divided into two groups: Group 1 (n = 30) consisted of patients with MetS; Group 2 (n = 30) consisted of patients without MetS. Echocardiography was used to measure EFTT in all patients, and blood samples were analyzed for biochemical parameters. RESULTS: Compared to Group 2, EFTT levels of Group 1 were statistically higher (P < 0.05). In a binary logistic regression analysis, EFTT levels served as the independent factor for metabolic syndrome (B = 17.35, SE = 4.93, Wald = 12.36, P < 0.001). Receivers operating characteristic Curve (ROC-curve) analysis revealed that EFTT predicted MetS with 96.7% sensitivity and 86.7% specificity above the level of 7.3 mm [area under the curve = 0.969; 95% confidence interval (CI): 0.928-1.00]. CONCLUSIONS: The present study demonstrated that serum EFTT levels were higher in geriatric patients with MetS and can therefore be used as a diagnostic criterion for MetS.