Langerhans cell histiocytosis located in the spheno-orbital bone and the pons: illustrative case.

BACKGROUND: This is a case of aggressive Langerhans cell histiocytosis (LCH) with an atypical intracranial location. OBSERVATIONS: In this report, the authors present the diagnosis and treatment of a 12-year-old male patient diagnosed with LCH. The patient was admitted to the emergency department with left-sided facial palsy, and a solid lesion with mass effect in the pons was found. A biopsy was performed via suboccipital craniotomy, and the diagnosis was LCH. A chemotherapy regimen was started since the LCH sample was the resistant type. The patient showed improvement in his neurological deficit following treatment. LESSONS: This rare localized and aggressive case's diagnosis process and treatment choices may apply to future cases.

Anatomically guided self-adapting deep neural network for clinically significant prostate cancer detection on bi-parametric MRI: a multi-center study.

OBJECTIVE: To evaluate the effectiveness of a self-adapting deep network, trained on large-scale bi-parametric MRI data, in detecting clinically significant prostate cancer (csPCa) in external multi-center data from men of diverse demographics; to investigate the advantages of transfer learning. METHODS: We used two samples: (i) Publicly available multi-center and multi-vendor Prostate Imaging: Cancer AI (PI-CAI) training data, consisting of 1500 bi-parametric MRI scans, along with its unseen validation and testing samples; (ii) In-house multi-center testing and transfer learning data, comprising 1036 and 200 bi-parametric MRI scans. We trained a self-adapting 3D nnU-Net model using probabilistic prostate masks on the PI-CAI data and evaluated its performance on the hidden validation and testing samples and the in-house data with and without transfer learning. We used the area under the receiver operating characteristic (AUROC) curve to evaluate patient-level performance in detecting csPCa. RESULTS: The PI-CAI training data had 425 scans with csPCa, while the in-house testing and fine-tuning data had 288 and 50 scans with csPCa, respectively. The nnU-Net model achieved an AUROC of 0.888 and 0.889 on the hidden validation and testing data. The model performed with an AUROC of 0.886 on the in-house testing data, with a slight decrease in performance to 0.870 using transfer learning. CONCLUSIONS: The state-of-the-art deep learning method using prostate masks trained on large-scale bi-parametric MRI data provides high performance in detecting csPCa in internal and external testing data with different characteristics, demonstrating the robustness and generalizability of deep learning within and across datasets. CLINICAL RELEVANCE STATEMENT: A self-adapting deep network, utilizing prostate masks and trained on large-scale bi-parametric MRI data, is effective in accurately detecting clinically significant prostate cancer across diverse datasets, highlighting the potential of deep learning methods for improving prostate cancer detection in clinical practice.

3D-Printed Microrobots: Translational Challenges.

The science of microrobots is accelerating towards the creation of new functionalities for biomedical applications such as targeted delivery of agents, surgical procedures, tracking and imaging, and sensing. Using magnetic properties to control the motion of microrobots for these applications is emerging. Here, 3D printing methods are introduced for the fabrication of microrobots and their future perspectives are discussed to elucidate the path for enabling their clinical translation.

Direct transcatheter aortic valve implantation (TAVI) decreases silent cerebral infarction when compared to routine balloon valvuloplasty.

PURPOSE: Silent cerebral infarctions (SCI), as determined by neuron-specific enolase (NSE) elevations, may develop after the transcatheter aortic valve implantation (TAVI) procedure. Our aim in this study was to compare the SCI rates between patients who underwent routine pre-dilatation balloon aortic valvuloplasty (pre-BAV) and patients who underwent direct TAVI without pre-BAV. METHODS: A total of 139 consecutive patients who underwent TAVI in a single center using the self-expandable Evolut-R valve (Medtronic, Minneapolis, Minnesota, USA) were included in the study. The first 70 patients were included in the pre-BAV group, and the last 69 patients were included in the direct TAVI group. SCI was detected by serum NSE measurements performed at baseline and 12 h after the TAVI. New NSE elevations > 12 ng/mL after the procedure were counted as SCI. In addition, SCI was scanned by MRI (magnetic resonance imaging) in eligible patients. RESULTS: TAVI procedure was successful in all of the study population. Post-dilatation rates were higher in the direct TAVI group. Post-TAVI NSE positivity (SCI) was higher in the routine pre-BAV group (55(78.6%) vs. 43(62.3%) patients, p = 0.036) and NSE levels were also higher in this group (26.8 ± 15.0 vs. 20.5 ± 14.8 ng/ml, p = 0.015). SCI with MRI was found to be significantly higher in the pre-BAV group than direct TAVI group (39(55.1%) vs. 31(44.9%) patients). The presence of atrial fibrillation and diabetes mellitus (DM), total cusp calcification volume, calcification at arcus aorta, routine pre-BAV and failure at first try of the prosthetic valve implantation were significantly higher in SCI (+) group. In the multivariate analysis, presence of DM, total cusp calcification volume, calcification at arcus aorta, routine pre-BAV and failure at first try of the prosthetic valve implantation were significantly associated with new SCI development. CONCLUSIONS: Direct TAVI procedure without pre-dilation seems to be an effective method and avoidance of pre-dilation decreases the risk of SCI development in patients undergoing TAVI with a self-expandable valve.

The Relationship Between Coronary Collateral Circulation and Serum Adropin Levels.

Objective Coronary collateral circulation (CCC) are vascular structures that limit the infarct area, protect left ventricular function, and reduce the frequency of arrhythmia and mortality during myocardial ischemia and infarction. In this study, we examined the relationship between the development of CCC and serum adropin levels, which has been shown in previous studies to regulate endothelial functions and increase endothelial nitric oxide synthesis, in patients with acute myocardial infarction. Methods This study included 41 patients with insufficient CCC and 43 patients with well-developed CCC who were hospitalized for acute myocardial infarction and underwent coronary angiography. The Cohen-Rentrop classification was used to grade the CCC. The patients were divided into two groups according to Rentrop grades: those with a 0-1 stage were considered as insufficient and those with grades of 2-3 were considered as well-developed CCC. We took blood samples to measure the adropin levels within the first 24 hours of hospitalization. Results The mean age was 59.1±11.9 years and 62 (73.8%) were male. The right coronary artery was the most frequently target vessel (n: 51, 60.7%), and the majority of the patients presented with ST-segment elevation myocardial infarction (STEMI) (n:58, 69%). The median interval between the severe chest pain and the intervention was significantly higher in patients with well-developed CCC (p=0.042). The serum adropin levels in patients with insufficient CCC were significantly lower than in those with well-developed CCC (196.3 [131.5 - 837.0] pg/mL vs. 235.5 [171.9 - 1124.2] pg/mL, p<0.001). Logistic regression analysis revealed that the circumflex artery as the target vessel, NSTEMI (non-STEMI) as the type of myocardial infarction, and serum adropin level were the independent risk factors for the prediction of poor coronary collateral vessel formation (p<0.05). Conclusions In this study, we found that in patients with acute myocardial infarction, those with well-developed CCC had higher adropin levels.

Influence of Intermittent Fasting During Ramadan on Circadian Variation of Symptom-Onset and Prehospital Time Delay in Acute ST-Segment Elevation Myocardial Infarction.

Ramadan interferes with circadian rhythms mainly by disturbing the routine patterns of feeding and smoking. The objective of this study was to investigate the circadian pattern of ST elevation acute myocardial infarction (STEMI) during the month of Ramadan. We studied consecutive STEMI patients 1 month before and after Ramadan (non-Ramadan group-NRG) and during Ramadan (Ramadan group-RG). The RG group was also divided into two groups, based on whether they chose to fast: fasting (FG) and non-fasting group (NFG). The time of STEMI onset was compared. A total of 742 consecutive STEMI patients were classified into 4 groups by 6 h intervals according to time-of-day at symptom onset. No consistent circadian variation in the onset of STEMI was observed both between the RG (P = .938) and NRG (P = .766) or between the FG (P = .232) and NFG (P = .523). When analyzed for subgroups of the study sample, neither smoking nor diabetes showed circadian rhythm. There was a trend towards a delay from symptom onset to hospital presentation, particularly at evening hours in the RG compared with the control group. In conclusion, there was no significant difference in STEMI onset time, but the time from symptom onset to hospital admission was significantly delayed during Ramadan.

A New Insight Into Pathophysiological Mechanism of Abdominal Aortic Aneurysm With Novel Parameters Salusin-ß and Arterial Stiffness.

BACKGROUND: Abdominal aortic aneurysm (AAA) has risk factors similar to those of atherosclerosis. Salusin-ß and arterial stiffness are novel parameters that have been shown to predict atherosclerosis and related cardiovascular disorders. However, their predictive value for detecting AAA remains unclear. METHODS: Forty-eight patients with AAA and 47 age- and sex-matched participants without AAA were enrolled in the study. Arterial stiffness parameters were obtained via an oscillometric Mobil-O-Graph PWA Monitor device (IEM GmbH) with integrated ARCSolver software (Australian Institute of Technology). Plasma salusin-ß levels were analyzed using an enzyme-linked immunosorbent assay reagent kit (Abbkine, Inc). The measured salusin-ß levels and arterial stiffness parameters of the AAA and control groups were compared. RESULTS: Salusin-ß levels were significantly lower in patients with AAA (P = .014). There was a significant negative correlation between salusin-ß levels and abdominal aorta diameter. No significant difference was detected between AAA and control groups in terms of arterial stiffness parameters (P > .05). In backward multiple regression analysis, the presence of AAA, platelet count, and augmentation index were found to be independent predictors of salusin-ß levels (P = .006 and P = .023, respectively). CONCLUSION: Arterial stiffness parameters were not found to be associated with AAA. Contrary to previous results regarding atherosclerosis and related cardiovascular disorders, salusin-ß levels were found to be lower in patients with AAA. Although AAA is thought to have similar risk factors as atherosclerosis, the exact pathophysiologic mechanism remains unclear.

Well-Developed Coronary Collateral Circulation Is Associated With Higher Thrombus Burden in the Setting of ST-Segment Elevation Myocardial Infarction.

BACKGROUND: This study investigated the relationship between coronary collateral circulation (CCC) and intracoronary thrombus burden in patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction (STEMI). CCC and thrombus burden are predictive of clinical outcomes in patients with STEMI. METHODS: Patients with STEMI undergoing primary percutaneous coronary intervention were enrolled (n = 172). CCC was graded according to the Cohen-Rentrop classification. Patients were classified as insufficient (grade 0 or 1, n = 134) or well-developed (grade 2 or 3; n = 38) CCC. The Thrombolysis in Myocardial Infarction scale was used to evaluate intra-coronary thrombus burden. The low-thrombus-burden group comprised those with grades 0 to 2, and the high-thrombus-burden group comprised those with grades 3 or 4. RESULTS: Right coronary artery infarcts had a 13.830-fold higher chance of having well-developed CCC than did left anterior descending artery infarcts (P < .001). Circumflex artery infarcts had a 7.904-fold higher chance of well-developed CCC than did left anterior descending artery infarcts (P = .016). High thrombus burden was associated with a 4.393-fold higher chance for well-developed CCC than was low thrombus burden (P = .030). Low albumin levels were related to a greater chance of having well-developed CCC (P = .046). CONCLUSION: Patients with well-developed CCC have higher thrombus burden than do those with insufficient CCC. Because well-developed CCC is an indicator of more severe underlying lesions, we speculate that patients with severe lesions are more prone to experience more complicated STEMI with high thrombus burden.

Machine Learning-Enabled Prediction of 3D-Printed Microneedle Features.

Microneedles (MNs) introduced a novel injection alternative to conventional needles, offering a decreased administration pain and phobia along with more efficient transdermal and intradermal drug delivery/sample collecting. 3D printing methods have emerged in the field of MNs for their time- and cost-efficient manufacturing. Tuning 3D printing parameters with artificial intelligence (AI), including machine learning (ML) and deep learning (DL), is an emerging multidisciplinary field for optimization of manufacturing biomedical devices. Herein, we presented an AI framework to assess and predict 3D-printed MN features. Biodegradable MNs were fabricated using fused deposition modeling (FDM) 3D printing technology followed by chemical etching to enhance their geometrical precision. DL was used for quality control and anomaly detection in the fabricated MNAs. Ten different MN designs and various etching exposure doses were used create a data library to train ML models for extraction of similarity metrics in order to predict new fabrication outcomes when the mentioned parameters were adjusted. The integration of AI-enabled prediction with 3D printed MNs will facilitate the development of new healthcare systems and advancement of MNs' biomedical applications.

Acute epiglottitis is a rare clinical presentation of coronavirus disease 2019: a case report.

BACKGROUND: In humans, coronavirus disease 2019 (COVID-19) has a variable presentation ranging from mild self-limiting respiratory tract infections to severe acute respiratory distress syndrome. Methods: We present the case of a patient who developed acute epiglottitis after surgery for an intracranial tumour and was subsequently diagnosed with COVID-19. RESULTS: A 58-year-old female patient developed acute-onset respiratory distress on day 6 after intracranial surgery. Neck computed tomography revealed near-total airway obstruction due to severe edoema of the epiglottis and periepiglottis. The patient's SARS-CoV-2 polymerase chain reaction test was positive. Viral respiratory tract panel and sputum and blood cultures were negative. She completed the antiviral and antibacterial treatment regimens recommended by the chest disease department. CONCLUSIONS: We conclude that epiglottitis can be an unusual manifestation of COVID-19.

The relationship between severe acute respiratory syndrome coronavirus 2 (SARS - COV - 2) pandemic and fragmented QRS.

OBJECTIVE: The aim of the study is to determine the frequency of fragmented QRS (FQRS) in patients with SARS - COV - 2. METHODS: A total of 125 consecutive patients over 20 years of age who were hospitalized for SARS - COV - 2 between 20th March 2020 and 18th May 2020 were included in the study. The data of the patients in the inpatient ward and in the intensive care unit were recorded separately. The duration of QRS and presence of FQRS were evaluated by two experienced cardiologists. The patients were divided into two groups as FQRS positive and FQRS negative considering presence of FQRS. Moreover, the frequency of FQRS in the patients in the inpatient ward and in the intensive care unit were compared with each other. RESULTS: FQRS was found in 24% of the patients who had SARS-COV-2. There was no difference between FQRS positive and negative groups in terms of age and gender. Heart rate was higher in FQRS positive group. C-reactive protein (7.25 ±â€¯6.65 mg/dl vs. 4.80 ±â€¯4.48 mg/dl; p = .02) levels were also significantly higher in the FQRS positive group. In patients with SARS-COV-2, intensive care unit requirement increased with increasing levels of troponin (p < .000). A positive correlation was detected between serum CRP levels and FQRS (r = 0.204, p = .024). CONCLUSIONS: The frequency of FQRS is high in patients with SARS - COV - 2. Serum CRP levels increase with increasing frequency of FQRS in patients with SARS - COV - 2 indicating that patients with FQRS are exposed to more inflammation. Presence of FQRS in SARS - COV - 2 patients may be useful in predicting cardiovascular outcomes.

The relationship between the severity of erectile dysfunction and aortic stiffness.

Aortic stiffness increases in patients with erectile dysfunction (ED) but it is not known whether aortic stiffness affects the degree of ED. In the present study, we aimed to determine whether there is any relationship between aortic stiffness and the severity of ED. Patients with ED were divided into 3 groups according to the International Index of Erectile Function (IIEF) scores. Mild ED was named as group 1, moderate ED as group 2 and severe ED as group 3. The values of fasting blood glucose (FBG), serum lipid values, total testosterone (T. tes), and free testosterone (F tes) were recorded. Aortic stiffness was determined by pulse wave velocity (PWV) and augmentation index (AIX) measurements. The mean or median values of the laboratory parameters among the groups were similar (p > .05). No statistical difference was found between the groups in terms of AIX value (p = .386). Mean PWV values were calculated as 7.26, 8.30 and 8.78 in group 1, group 2 and group 3 respectively. PWV values were significantly different between groups (p < .0001). PWV values were found to be increased with increasing severity of erectile dysfunction.

Devastating Consequences of a Jailed Knuckled Wire in CTO PCI of an Anomalous RCA.

A knuckled tip of a jailed guidewire may lead to distortion of the main branch stent when pulled back after balloon dilatation of the side branch ostium. The distorted stent can be crushed to the side of the vessel as a bail-out intervention. (Level of Difficulty: Advanced.).

Triphasic mitral flow pattern may indicate subclinical left ventricular systolic dysfunction.

PURPOSE: In this study, the presence and severity of left ventricular (LV) systolic dysfunction were investigated by speckle tracking echocardiography (STE) technique in patients with mitral triphasic mitral flow pattern (TMFP). The aim of the study was to evaluate the possible role of TMFP in the ethiopathogenesis of congestive heart failure. METHODS AND RESULTS: A total of 45 patients who were diagnosed with TMFP and 30 age- and gender-matched healthy volunteers were included in the study. The mean age in the study and control groups was 64 ± 12 and 62 ± 11 (P = .642), respectively. When echocardiographic parameters were evaluated, LV ejection fraction was found to be 63% ± 14 and 64 ± 12 (P = .745), in the study and control groups, respectively. LV end-diastolic and systolic diameters and LV mass index were also similar (P < .05). When LV diastolic parameters were compared, diastolic dysfunction was detected in 38 (84.4%) patients in the study population and 13 patients (43.3%) in the control group (P < .001). When STE findings were evaluated, both global longitidunal strain and global circumferential strain were significantly lower in the TMFP group when compared to controls (18.3 ± 1.7 vs 21.5 ± 1.5, P < .001 and 17.9 ± 1.6 vs 21.3 ± 2.1, P < .001, respectively). CONCLUSION: TMFP results in LV systolic dysfunction. Therefore, these patients may develop congestive heart failure in the long term. It will be rational that the patients with TMFP should be followed up more closely in terms of preventing manifest heart failure symptoms.

Association between Fragmented QRS and Left Ventricular Systolic Function in Patients with Erectile Dysfunction.

PURPOSE: The aim of this study was to investigate the association between fragmented QRS and left ventricular (LV) systolic function in patients with erectile dysfunction (ED). METHODS: A total of 106 patients with ED and without a history of coronary artery disease (CAD) were compared with 54 age- and gender-matched healthy controls. LV systolic function was evaluated using speckle tracking echocardiography via global longitudinal strain (GLS) and global circumferential strain (GCS). The patients with ED were compared with healthy controls. The study group was further subdivided into fQRS (+) and fQRS (-) groups and compared with each other. RESULTS: The frequency of fQRS was significantly higher in the patients with ED (p = 0.01). The frequency of fQRS was higher in the patients with mild and moderate ED, and significantly higher in those with severe ED (p < 0.001). LV-GLS (%) was 17.46 ± 1.37 and 20.05 ± 1.42 in the fQRS (+) and fQRS (-) groups, respectively (p ≤ 0.001). LV-GCS (%) was 17.33 ± 0.81 and 18.55 ± 0.92 in the fQRS (+) and fQRS (-) groups, respectively (p ≤ 0.001). fQRS and age were independent predictors of LV-GLS. CONCLUSIONS: The frequency of fQRS was higher in the patients with ED even in the absence of overt CAD. In the patients with ED, the fQRS (+) group had significantly lower values of LV-GLS and LV-GCS. These results indicate that presence of fQRS is associated with subclinical LV dysfunction in patients with ED.

The effects of treatment in patients with childhood asthma on the elastic properties of the aorta.

INTRODUCTION: The study aimed to investigate the effects of treatment in patients with childhood asthma on the elastic properties of the aorta and cardiovascular risk. METHODS: The study was performed in 66 paediatric patients diagnosed with bronchial asthma (BA). All patients were administered the ß2 agonist, salbutamol, for seven days, followed by one month of montelukast and six months of inhaled steroid treatment. All patients underwent conventional transthoracic echocardiographic imaging before and after treatment. Aortic elasticity parameters were considered to be the markers of aortic function. RESULTS: Aortic elasticity parameters, including aortic strain (15.2 ± 4.8 and 18.8 ± 9.5%, p = 0.043), aortic distensibility (7.26 ± 4.71 and 9.53 ± 3.50 cm2/dyn, p = 0.010) and aortic stiffness index (3.2 ± 0.6 and 2.8 ± 0.5, p = 0.045 showed significant post-treatment improvement when compared to pre-treatment values. Tricuspid annular plane systolic excursion (TAPSE) was also observed to improve after treatment (1.81 ± 0.38 and 1.98 ± 0.43, p = 0.049). CONCLUSION: The study demonstrated that when provided at appropriate doses, medications used in BA may result in an improvement in aortic stiffness.

Distinction of hypertriglyceridemic waist phenotype from simple abdominal obesity: interaction with sex hormone-binding globulin levels to confer high coronary risk.

OBJECTIVE: The associations of total testosterone (TT) and sex hormone-binding globulin (SHBG) with the hypertriglyceridemic waist (HtgW) phenotype and coronary heart disease (CHD) risk have scarcely been examined. We explored such cardiometabolic risk mediations in middle-aged adults. METHODS: Participants (n = 1924) in a population-based study were studied by forming categories consisting of abdominal obesity, hypertriglyceridemia, both (HtgW), or none ('healthy'). Cardiometabolic risk was prospectively analyzed (mean follow-up 5.7 years). RESULTS: With reference to the healthy group, SHBG values in HtgW were significantly lower, alike serum HDL-cholesterol. ApolipoproteinB-containing lipoproteins, fasting glucose and complement C3 levels, inverse to lipoprotein[Lp](a) especially in female participants with HtgW phenotype compared with those in the 'healthy' category, suggested the operation of aggregation to Lp(a). Multivariable Cox regression analysis in a model comprising age, waist circumference and systolic blood pressure showed significant protection by SHBG against incident diabetes which tended to be so with TT in men. Sex hormones were not associated with risk of incident CHD or MetS. In another multivariable model, compared to the 'healthy' and the hypertriglyceridemia categories, dichotomized high and, in females, low SHBG values within the HtgW category, positively predicted CHD at significant over 2-fold relative risks. CONCLUSION: HtgW phenotype distinguishes itself from the (virtually neutral) simple abdominal obesity in independently conferring high CHD risk when elevated or reduced SHBG levels interact. Underlying operation of Lp(a) aggregation is suggested.

Cardioprotective effects of Viscum album L. ssp. album (Loranthaceae) on isoproterenol-induced heart failure via regulation of the nitric oxide pathway in rats.

OBJECTIVE: Viscum album L. has favorable cardiovascular effects including antihypertensive and vasorelaxant activity, and the nitric oxide (NO) pathway upregulation has been proposed to be the underlying mechanism. NO also plays an important role in the pathophysiology of heart failure. However, its effects on cardiac systolic function are unclear. METHODS: A total of 30 male Wistar albino rats at 12 weeks of age were randomly divided into three groups: control, isoproterenol-induced heart failure group (ISO), and isoproterenol-induced heart failure + V. album treatment group (VA) groups (n=10 in each group). V. album was orally given at a dose of 250 mg/kg/day by gavage. Parameters of heart failure were compared among the groups. Tamhane's T2 test, paired sample t-test, and Bonferroni methods were used for statistical analysis. RESULTS: V. album resulted in an improvement in all parameters of heart failure including left ventricular diameters (6.34±0.23 mm, 6.98±0.35 mm, and 6.71±0.10 mm for left ventricular end-diastolic diameter in control, ISO, and VA groups, respectively, p<0.05), ejection fraction (73.3±3.1%, 56.7±2.6%, and 65.2±1.5% for control, ISO, and VA groups, respectively, p<0.05), serum NT-proBNP levels, and histopathological changes. V. album treatment resulted in a statistically significant attenuation of increased levels of NO and iNOS (p<0.0001). The levels of hs-CRP were also found to be lower in the VA group compared with the controls and ISO groups (p<0.01). CONCLUSION: V. album exerted favorable effects on left ventricular function in isoproterenol-induced heart failure rats. Upregulation of the NO pathway seems to be the possible pathophysiological mechanism. Favorable vascular outcomes can also be speculated considering the reduction in serum hs-CRP levels.

Effects of levodopa therapy on global left ventricular systolic function in patients with Parkinson disease.

OBJECTIVES: Since levodopa was identified as an efficient therapeutic option in Parkinson disease (PD), great success has been achieved in the course and treatment of the disease. However, L­dopa-related side effects limit the therapeutic use in some patients. The aim of this study was to evaluate the effects of L­dopa therapy on left ventricular global systolic function via speckle tracking method. METHODS: In this study, 55 patients with PD under L­dopa/dopa decarboxylase inhibitor therapy were compared with 30 age- and sex-matched control subjects. Conventional transthoracic echocardiography was performed in the left lateral position by two experienced operators in accordance with generally accepted guidelines. Left ventricular systolic function was analyzed by speckle tracking method using global longitudinal strain (GLS) and global circumferential strain (GCS) imaging. RESULTS: Adequate echocardiographic imaging for the evaluation of global longitudinal strain and global circumferential strain could be achieved in 55 of the patients. LVEF (left ventricular ejection fraction), GLS and GCS values were found to be similar between the patients with PD under L­dopa therapy and the control group (62 ± 3.5 % vs 61 ± 4 %, p < 0.05; -19.46 ± 2.3 vs -19.4 ± 3.2, p < 0.05; and -18.60 ± 3.5 vs -18.22 ± 3.2, p < 0.05 respectively.) CONCLUSION: Levodopa therapy has no unfavorable effect on left ventricular systolic function in patients with PD.