Acute sleep deprivation: impairment of biventricular function assesed by speckle tracking echocardiography in healthy subjects.

OBJECTIVES: Sleep deprivation (SD) has been found to be associated with an increased incidence of adverse cardiovascular disease (CVD) events. The aim of this study was to investigate whether or not acute SD has a pathological effect on the geometry and the systolic and diastolic functions of the right and left heart chambers by standard transthoracic echocardiography (TTE) and speckle tracking echocardiography (STE) in healthy individuals with acute SD. METHODS: Nurses with no history of acute or chronic diseases underwent TTE and STE after working a night shift, a sleepless period of 24 h and 7 days of normal sleep after the night shift. Measurements of TTE and STE taken in the rested state were compared with those taken after 24 h of sleep deprivation. RESULTS: The study included 52 nurses (38 women, 73%). The mean age of the study population was 27.9 ± 7.4 years and mean BMI was 24.1 ± 4.8. Left atrial reservoir (51.5 ± 13.5 vs. 45.4 ± 10; p = 0.004), conduit (- 37.3 ± 11.3 vs. - 33.6 ± 7.9; p = 0.01), left ventricular global longitudinal strain (LVGLS, - 22.6 ± 2.4 vs. - 21.3 ± 2.4; p = 0.001), right ventricular global longitudinal strain (RVGLS, - 25.3 ± 3.7 vs. - 23.5 ± 3.9; p = 0.005) and right ventricular free wall longitudinal strain (RVFWSL, - 29.1 ± 4.2 vs. - 27 ± 4.5; p = 0.001) were impaired significantly after SD. CONCLUSION: This study is the first to investigate the negative effects of acute sleep deprivation on LV and RV strain in healthy adults using echocardiography. The findings showed that acute sleep deprivation leads to deterioration in function of both ventricles and left atrium. Speckle tracking echocardiography demonstrated subclinical diminished heart function.

High seroprevalence of SARS-CoV-2 among high-density communities in Saudi Arabia.

BACKGROUND: The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection had been investigated utilizing serology. MATERIALS AND METHODS: This community-based sero-survey was carried out in the neighborhoods of three cities in Saudi Arabia. RESULTS: Of 5629 participants, 2766 (49.1%) were women; and 2148 (38.1%) were 18-34 years of age, and 3645 (64.7%) were from South East Asia. Positive serology was seen in 2825 (50.2% (95% CI: 48.8-51.5%) for SARS-CoV-2 anti-S1 IgG antibodies by ECLIA. Being in the age category of 18-34 years and being from Eastern Mediterranean Region (country A) were associated with higher COVID-19 seropositivity with estimated odds ratio of 1.3 [95% CI 1.1-1.8] and 2.5 [95% CI 1.1.5-4.2] respectively. Gender, social status, education, nationality, symptoms, presence of comorbidities and activity style were positively associated with increased seropositivity. Factors associated negatively with the rate of seropositivity were higher education and having outdoor activity with estimated OR of 0.92 [95% CI 0.46-0.95] and 0.59 [95% CI 0.47-0.74], respectively. CONCLUSION: The study showed high seroprevalence of SARS-CoV-2 among high density population. Health education campaigns should target middle-aged, those with low education, those living in lower standards and indoor workers.

Primary pituitary abscess mimicking meningitis in a pediatric patient.

INTRODUCTION: Pituitary abscess is a rare lesion of the pituitary gland that can cause morbidity and mortality in the absence of appropriate treatment. They are classified as primary and secondary pituitary abscesses. Primary pituitary abscesses occur in patients with no previous pituitary pathology. Secondary pituitary abscesses are detected in patients with existing pituitary pathologies. CASE PRESENTATION: We report a 16-year-old female patient with primary pituitary abscess who was misdiagnosed initially and treated as meningitis. Following the visual disturbances, pituitary abscess was diagnosed, and she underwent abscess drainage via endoscopic endonasal transsphenoidal surgery and antibiotic treatment. CONCLUSION: Primary pituitary abscess can be clinically confused with other pathologies affecting the central nervous system. In order to avoid permanent sequelae in such patients, it should be kept in mind by physicians in similar cases. Satisfying results are obtained in these patients after appropriate treatment and dramatic improvement is achieved.

Ascending aorta mycotic aneurysm in a child secondary to subacute infective endocarditis on the basis of congenital aortic stenosis demonstrated by cardiac computerized tomography.

Infective endocarditis (IE) is rarely seen in children, and it can cause significant morbidity and mortality. Congenital heart disease is a predisposing cardiac condition for IE and has an increasing prevalence. A mycotic aortic aneurysm is a rare disease due to infection and it has been reported that it may be a result of IE. We present a 10-year-old boy who was referred to our cardiovascular surgery department due to severe aortic stenosis (AS). Transthoracic echocardiography revealed calcific severe AS and computerized tomography (CT) angiography was performed to better evaluate the ascending aorta. CT angiography demonstrated a saccular aneurysm of the ascending aorta. The underlying pathology was considered as chronic IE on top of congenital AS with an unknown number of cusps. Histologic findings supported our diagnosis and accompanied by a saccular aneurysm. The patient underwent a successful aortic root enlargement, mechanical aortic valve replacement, and ascending aorta repair surgery.

Spine Metastasis of Thymic Carcinoma in a Pediatric Patient: A Case Report and Comprehensive Literature Review.

INTRODUCTION: Thymic carcinoma metastases of the spinal column are very rare, especially in pediatric patients. To our knowledge, this is the first such pediatric case in the literature. CASE PRESENTATION: We report the case of a 14-year-old male patient with T12 and L1 metastases of thymic carcinoma. He had history of thymectomy and intrathoracic tumor resection 7 months previously. The patient's neurological condition deteriorated; therefore, tumor resection and decompression of the spinal canal were performed. He underwent instrumentation and fusion procedures to prevent spinal instability. CONCLUSION: The main purpose of the treatment is gross total resection of the thymic carcinoma. However, adjuvant methods such as radiotherapy and chemotherapy should be added to the treatment protocol in patients who have higher stage diseases or those in whom total tumor resection cannot be achieved.

Short and Long Term Mortality Predictors in Octogenarians with Acute Coronary Syndromes.

PURPOSE: Octogenarians with acute coronary syndromes have higher mortality and morbidity due to higher prevalence of comorbidities and frailty. The aim of this study was to explore the predictors of short and long term mortality in octogenarians with ACS. METHODS: Ninety-eight consecutive octogenarians presenting with acute coronary syndrome (mean age:84±3 years, 56 male) were included. All patients underwent coronary angiography and were given optimal medical treatment. The primary end point was cardiovascular mortality in hospital and at one year. RESULTS: Fifteen patients died during hospitalization and 20 patients died after discharge within the first year. ST-segment-elevation myocardial infarction and hypotension were significantly more prevalent in the in-hospital mortality group while atrial fibrillation and hyponatremia were more prevalent in the long-term mortality group. All deceased patients had significantly lower left ventricular ejection fraction and glomerular filtration rate. Cox analysis revealed ST-segment-elevation myocardial infarction, hypotension and left ventricular ejection fraction as independent predictors of in-hospital mortality while hyponatremia, atrial fibrillation and renal dysfunction as independent predictors of long term mortality. CONCLUSION: It would be reasonable to pay further attention to octogenarians with acute coronary syndrome if they are presenting with ST-segment-elevation myocardial infarction, and have hypotension, impaired left ventricular function, hyponatremia, atrial fibrillation or renal dysfunction, which are associated with increased mortality.

Renal functions in obstructive sleep apnea patients.

PURPOSE: The aim of this study is to investigate possible factors influencing glomerular filtration rate (GFR) in obstructive sleep apnea (OSA). METHODS: Data of OSA patients admitted to Gaziantep University sleep clinic from January 2005 to January 2010 were retrospectively evaluated. GFR is calculated with the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Patients younger than 18 years old were excluded. RESULTS: The mean age of OSA (n = 634) and control group (n = 62) were 51.13 ± 11.61 and 50.69 ± 13.88 years, respectively (p = 0.81). The mean estimated GFR (eGFR) was 90.73 ± 19.59 ml/min/1.73 m(2) in OSA patients and 94.14 ± 18.81 ml/min/1.73 m(2) in control subjects (p = 0.19). GFR was 84.25 ± 20.87 ml/min/1.73 m(2) in patients with left ventricular hypertrophy (LVH) while it was 93.94 ± 18.44 ml/min/1.73 m(2) in patients without LVH (p = 0.00). GFR of male subjects was 92.1 ± 19.23 in OSA and 95.84 ± 20.08 ml/min/1.73 m(2) in controls (p = 0.33). GFR of female and male patients in the OSA were 87.45 ± 20.10 and 92.91 ± 18.02 ml/min/1.73 m(2), respectively (p = 0.13). Serum creatinine was higher in OSA patients compared to controls (p = 0.01). GFR was 92.30 ± 19.27 in male and 88.33 ± 19.84 ml/min/1.73 m(2) in female subjects (p = 0.01). GFR was 84.86 ± 19.95 in hypertensive patients while it was 95.11 ± 18.20 ml/min/1.73 m(2) in normotensive subjects (p = 0.00). GFR was 89.30 ± 19.96 in patients with metabolic syndrome (MetS) and it was 93.46 ± 18.68 ml/min/1.73 m(2) in patients without MetS (p = 0.00). CONCLUSIONS: GFR values were lower in sleep apneic patients with MetS as well as in patients with hypertension and LVH.

Effect of acute sleep deprivation on left atrial mechanics assessed by three-dimensional echocardiography.

BACKGROUND: Although sleep deprivation (SD) affects cardiovascular system in many ways, physio-pathological changes in cardiac chamber volume and function have not been described well. The aim of the present study was to investigate the effect of SD on left atrial (LA) and ventricular function with three-dimensional (3D) echocardiography. METHODS: Thirty-two healthy individuals (12 females, mean age 33.25 ± 8.18) were evaluated. Echocardiographic examination was performed once after a night of regular sleep and a night of sleep debt. Beside conventional parameters, 3D phasic volumes and function were measured using a commercially available 3D echocardiography system and offline analysis software. RESULTS: Mean sleep duration of the study group was 8.15 ± 2.19 h in the day of regular sleep and 2.56 ± 2.25 h in the day of sleep deprivation. There was a significant prolongation in deceleration time (180.83 ± 15.34 vs. 166.44 ± 26.12; p = 0.044) and increase in E/e' (6.95 ± 1.26 vs. 6.38 ± 0.85; p = 0.005). Among 3D measurements, the difference in left ventricular ejection fraction (EF), LA EF, LA reservoir function and LA active EF were not significant. Mean LA passive EF of the individuals was significantly lower after night shift (24.10 ± 7.66 vs. 31.49 ± 7.75; p = 0.006). CONCLUSION: Acute SD is associated with a reduction in LA passive emptying function in healthy adults. 3D-derived indices were sufficient to show subclinical diastolic dysfunction according to impairment in passive phase of LA ejection. Prospective large-scale studies are needed to enlighten this issue.

Increased arterial stiffness parameters in panic disorder patients in long term treatment period.

BACKGROUND: The relationship between mental stress and cardiovascular disease has been shown in several studies. Panic disorder (PD) is also associated with cardiovascular disease due to increased risk of myocardial infarction. The aim of this study is to evaluate the association between arterial stiffness parameters and depression/anxiety scores in patients with PD. METHODS: The study population consisted of 25 patients with PD and 25 age-sex-matched healthy controls. Depression and anxiety levels were evaluated by Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI), respectively. Determination of arterial stiffness parameters was conducted using a Mobil-O-Graph arteriograph system that detected signals from the brachial artery. RESULTS: While baseline characteristics were similar between two groups, BDI and BAI scores were significantly higher in patients with PD (p < 0.005). The pulse wave velocity (PWV) and Augmentation Index (AIx) were also significantly higher in patients with PD (p = 0.001, p = 0.006). There was a moderate correlation between PWV and AIx with BAI scores (r = 0.442, p = 0.001, r = 0.441, p = 0.001). AIx was also positively correlated with BDI scores (r = 0.415, p = 0.03). CONCLUSION: We demonstrated a significant relationship between arterial stiffness parameters and anxiety/depression scores in patients with PD who receive antidepressant treatment.

Postoperative Atrial Fibrillation after Coronary Artery Bypass Grafting Surgery: A Two-dimensional Speckle Tracking Echocardiography Study.

BACKGROUND: Postoperative atrial fibrillation (POAF) may develop after coronary artery bypass grafting (CABG). The aim of the study was to explore the relationship between preoperative left atrial function and atrial fibrosis and POAF after CABG. METHODS: Forty-eight consecutive patients undergoing CABG (mean age: 61.6±8.9 years, 39 male) were included. All patients were in sinus rhythm during surgery. Patients were followed by continuous electrocardiography monitoring and daily electrocardiogram. Left atrial function was assessed by both conventional and speckle tracking echocardiography. Atrial fibrosis was determined by samples taken from right atrium. RESULTS: Postoperative atrial fibrillation was detected in 13 patients. Female sex and number of bypassed vessels were significantly higher and cardiopulmonary bypass time was significantly longer in patients with POAF. Left atrial volume index (LAVI) was significantly higher while left atrial reservoir strain was significantly lower in POAF patients. The percentage of patients with severe fibrosis was higher in the POAF group. Regression analysis revealed fibrosis and LAVI as independent predictors of POAF. Left atrial volume index ≥36mL/m(2) predicted POAF with a sensitivity of 84.6% and specificity of 68.6% in our cohort. CONCLUSION: Patients who developed POAF after CABG had more fibrosis, increased LAVI and lower left atrial reservoir strain. Preoperative echocardiography might be helpful in discriminating these patients.

A Case of Iatrogenic Chordal Rupture after Transcatheter Aortic Valve Implantation Procedure Requiring a Second Valve.

Transcatheter aortic valve implantation (TAVI) has emerged as a therapeutic option for high-risk aortic stenosis. Malposition of the prosthesis and severe residual aortic regurgitation are known complications of the procedure, which might require a second valve implantation. Although the implantation of a second valve seems to be an effective method, very few data are available describing this technique. Herein is reported a case of iatrogenic chordal rupture in a TAVI procedure which required a second valve implantation due to dislodgment of the first prosthesis.

Assessment of arterial stiffness and cardiovascular hemodynamics by oscillometric method in psoriasis patients with normal cardiac functions.

Arterial stiffness is associated with increased cardiovascular risk. Pulse wave velocity (PWV) and augmentation index (AIx) are non-invasive markers for assessment of arterial stiffness. Increased arterial stiffness is associated with atherosclerosis in patients with psoriasis. Previous studies have shown that high neutrophil-to-lymphocyte ratio (NLR) predicts poor cardiovascular outcome. The aim of this study was to evaluate arterial stiffness and cardiovascular hemodynamics by oscillometric method in psoriasis patients with normal cardiac functions. Fifty consecutive patients with the diagnosis of psoriasis and 50 controls were included in the study. NLR was calculated as the ratio of neutrophil count to lymphocyte count. All patients underwent echocardiographic examination. Measurements of arterial stiffness were carried out using a Mobil-O-Graph arteriograph system. Fifty patients with psoriasis (26 male, mean age 43.3 ± 13.2 years) and 50 controls (33 male, mean age 45.0 ± 6.1 years) were included into the study. The distribution of cardiovascular risk factors was similar between the two groups, and NLR was significantly higher in patients with psoriasis (2.74 ± 1.78 versus 1.82 ± 0.52, p = 0.002). There was a weak correlation between NLR and PASI score without reaching statistical significance (r = 0.300, p = 0.060). While echocardiographic and hemodynamic parameters were comparable between psoriasis and control groups, heart rate was significantly higher in psoriasis group (81.5 ± 15.1 and 75.2 ± 11.8 beats/min, p = 0.021). Psoriasis patients had significantly higher AIx and PWV values as compared to controls (25.8 ± 13.1 versus 17.4 ± 12.3%, p = 0.001 and 6.78 ± 1.42 versus 6.18 ± 0.80 m/s, p = 0.011, respectively). AI and PWV were significantly associated with psoriasis when adjusted by heart rate (p = 0.005, odds ratio 1.04, 95% confidence interval 1.01-1.08 and p = 0.035, odds ratio 1.52, 95 % confidence interval 1.02-2.26, respectively). PWV significantly correlated with blood pressure, lipid levels, and several echocardiographic indices. AIx only correlated with left atrial diameter (r = 291, p = 0.040). Linear regression analysis was performed to find predictors of PWV. Central systolic blood pressure, left atrial diameter, and total cholesterol were independent predictors of PWV. PWV and AIx were significantly higher in patients with psoriasis. Assessment of arterial stiffness parameters may be useful for early detection of cardiovascular deterioration in psoriasis patients with normal cardiac functions. Novel inflammatory biomarkers such as NLR may elucidate the mechanism of vascular dysfunction in such patients.

Effect of acute sleep deprivation on heart rate recovery in healthy young adults.

BACKGROUND: Sleep deprivation (SD) is known to be associated with increased incidence of adverse cardiovascular events, but underlying pathophysiological mechanism has not been clearly demonstrated. Autonomic nervous system plays an important role in the regulation of cardiovascular function, and impairment in this system is associated with increased cardiovascular mortality. The aim of the current study was to investigate the effect of acute SD on autonomic regulation of cardiac function by determining heart rate recovery (HRR). METHODS: Twenty-one healthy security officers and nine nurses (mean age 33.25 ± 8.18) were evaluated. Treadmill exercise test was applied once after a night with regular sleep and once after a night shift in hospital. The HRR was calculated as the reduction in heart rate from peak exercise to the 30th second (HRR30), 1st minute (HRR1), 2nd minute (HRR2), 3rd minute (HRR3), and 5th minute (HRR5). The change in blood pressure (BP) measurements was also determined. RESULTS: Exercise capacity of individuals with SD was significantly lower (10.96 ± 1.01 vs. 11.71 ± 1.30 metabolic equivalent task (MET)s; p = 0.002), and peak systolic BP was significantly higher (173.8 ± 16.3 vs. 166.2 ± 9.9; p = 0.019). There was a signicant difference in HRR30 (12.74 ± 6.19 vs. 17.66 ± 5.46; p = 0.003) and HRR1 (31 ± 6.49 vs. 36.10 ± 7.78; p = 0.004). The ratio of these indices to peak HR was also significantly lower with SD (HRR%30 8.04 ± 4.26 vs. 10.19 ± 3.21; p = 0.025 and HRR%1: 18.66 ± 4.43 vs. 20.98 ± 4.72; p = 0.013). The difference in other indices of HRR was not significant. CONCLUSION: Our findings suggest that SD blunts cardiovascular autonomic response, and consequences of this relation might be more pronounced in subjects who are exposed to sleeplessness regularly or in subjects with baseline cardiovascular disease.

Giant Purulent Pericarditis with Cardiac Tamponade Due to Streptococcus intermedius Rapidly Progressing to Constriction.

Purulent pericardial effusion, although rare, is a life-threatening condition usually produced by the extension of a nearby bacterial infection locus or by blood dissemination in the immune-suppressed subjects or in the course of cardiothoracic surgery. Because clinical features of purulent pericardial effusion are often nonspecific, it can cause delay in diagnosis. Therefore, a high index of suspicion is required for timely diagnosis and management. Herein, we describe a case of giant purulent pericardial effusion due to Streptococcus intermedius with the history of bronchiectasis and pneumonia, which was successfully treated with pericardiocentesis via parasternal approach, appropriate antibiotics, and pericardiectomy.

Neutrophil-to-lymphocyte ratio as a prognostic marker in infective endocarditis: in-hospital and long-term clinical results.

BACKGROUND AND AIM OF THE STUDY: The neutrophil-to-lymphocyte ratio (NLR) is an independent predictor of poor prognosis in different clinical conditions such as infectious and cardiovascular diseases. It was hypothesized that a patient's admission NLR would be predictive of an adverse clinical outcome in cases of infective endocarditis (IE). METHODS: A total of 171 patients with IE was enrolled retrospectively, and allocated to two tertiles based on admission NLR values. The high-NLR group (n = 76) was defined as having an NLR value in the third tertile (> 5.46), and the low-NLR group (n = 95) as having a value in the lower two tertiles (≤ 5.46). RESULTS: Patients in the high-NLR group had a significantly higher incidence of in-hospital mortality than the low-NLR group (39.4% versus 18.9%, p = 0.003). A high NLR was found to be an independent predictor of in-hospital mortality (odds ratio 2.53, 95% confidence interval 1.19-5.3; p = 0.01). The mean follow up was 25.5 months, and long-term follow up mortality was similar in both groups (12.9% versus 19.5%; p = 0.33). CONCLUSION: A high NLR at admission is associated with increased in-hospital mortality in patients with IE. During the long-term follow up, NLR showed no predictive indication of mortality.

Evaluation of cardiac function by two-dimensional speckle tracking echocardiography in ulcerative colitis patients.

PURPOSE: Although ulcerative colitis (UC) shows obvious similarities with other autoimmune diseases, cardiac consequences have not adequately introduced. The aim of our study was to evaluate left ventricular (LV) function in UC patients by using novel echocardiographic parameters. RESULTS: Forty-five UC patients (mean age 37, 18 female) and 90 age- and sex-matched healthy volunteers (mean age 40, 38 female) included in the study. The mean disease activity score according to partial Mayo score was 2.16 ± 2.13. Mean global longitudinal strain (GLS) and global longitudinal strain rate (GLSR) measurements were significantly lower (-21.16 ± 2.71 vs. -23.36 ± 3.34; p < 0.001 and -1.33 ± 0.24 vs. -1.43 ± 0.24; p = 0.037, respectively), whereas global circumferential (-22.67 ± 3.66 vs. -23.37 ± 3.99; p = 0.140) and global radial strain (43.07 ± 8.58 vs. 44.12 ± 9.32; p = 0.545) measurements of the LV were similar in patients with UC compared with controls. The correlation coefficient (r) between GLS and partial Mayo score was -0.578 (p < 0.001). CONCLUSION: Our study suggests that systolic cardiac deformation values are impaired in UC patients. Reduced GLS and GLSR might be an early indicator of cardiac involvement in this population.

Acute sleep deprivation is associated with increased arterial stiffness in healthy young adults.

BACKGROUND: Arterial stiffness and its hemodynamic consequences are known to be associated with increased cardiovascular morbidity and mortality. Pulse wave velocity (PWV) and augmentation index (AIx) are noninvasive indicators of the arterial stiffness and wave reflection. Sleep deprivation (SD) is known to be associated with increased incidence of adverse cardiovascular events. The aim of this study was to investigate whether there is an association between acute SD and arterial stiffness parameters in healthy adults, which has not been studied previously. METHODS: The study population consisted of 42 healthy volunteers (18 males, mean age 30.0 ± 4.5 years). Measurements of arterial stiffness were carried out by using a Mobil-O-Graph arteriograph system. Arterial stiffness measurements were obtained both after a night with regular sleep (RS) and after a night with SD. RESULTS: Mean sleep time was significantly lower after the night of SD when compared after RS (0.73 ± 1.39 versus 7.33 ± 0.52 h, p<0.001). Peripheral systolic blood pressure, peripheral pulse pressure, and cardiac output were significantly higher after SD when compared after RS (p=0.032, 0.007, and 0.003, respectively). PWV was significantly higher (5.33 ± 0.46 versus 5.15 ± 0.26 m/s, p=0.001), and AIx was significantly lower (20.5 ± 11.9 versus 26.0 ± 8.4 %, p=0.008) after the night of SD when compared after the RS. While PWV was significantly higher (p=0.008), and AIx was significantly lower (p=0.039) in male subjects, only PWV was significantly higher (p=0.009) in female subjects. Sleep time correlated with AIx (p=0.034; r=0.233) and inversely correlated with PWV (p=0.044; r=-0.222). CONCLUSION: In the present study, we demonstrated that even one night of SD is associated with increased arterial stiffness in healthy adults. The present findings suggest that adverse effects of SD on cardiovascular system might be at least in part due to increased arterial stiffness which needs to be tested with large-scale studies and in the chronic SD setting.

Acute proximal left anterior descending artery occlusion with de Winter sign.

Prompt recognition of electrocardiographic signs of acute coronary occlusion is essential for timely restoration of flow. ST-segment elevation or new onset left bundle-branch block are the most common electrocardiographic changes seen in acute phase of coronary occlusion. However, some patients may present with atypical electrocardiographic signs, and early diagnosis of these patients may constitute a clinical challenge. Here, we report a 41-year-old man presenting with an atypical electrocardiographic manifestation despite angiographically confirmed acute thrombotic occlusion of proximal left anterior descending artery.

Left ventricular and atrial functions in hypertrophic cardiomyopathy patients with very high LVOT gradient: a speckle tracking echocardiographic study.

BACKGROUND: Determination of myocardial deformation (strain) by two-dimensional (2D) speckle tracking echocardiography (STE) is a new method for evaluating left ventricular (LV) regional function in patients with hypertrophic cardiomyopathy (HCM). The aim of this study was to assess LV and left atrial (LA) functions with 2DSTE in HCM patients and to investigate relation between strain analysis and LV outflow tract (LVOT) gradient. METHODS: Forty consecutive HCM patients (26 male, mean age: 47.7 ± 15.2 years), and 40 healthy volunteers (22 male, mean age: 46.6 ± 11.2 years) were included in the study. All subjects underwent a transthoracic echocardiography for evaluation of LV and LA functions with 2DSTE. The HCM patients were divided into 2 groups according to the presence of resting LVOT gradient >100 mmHg. RESULTS: Left ventricular global longitudinal strain (GLS), global radial strain (GRS), and global circumferential strain (GCS) were significantly lower in patients with HCM compared with controls (-20.3 ± 3.6% vs. -24.1 ± 3.4% P < 0.001, 38.1 ± 12.8% vs. 44.8 ± 10.2% P = 0.012, and -22.0 ± 4.4% vs. -23.9 ± 4.0% P = 0.045, respectively). Although basal and apical rotation were similar between the groups, mid-rotation was significantly clockwise in HCM patients (-1.53 ± 2.06° vs. 0.05 ± 1.7° P < 0.001). Both LA reservoir functions and LA conduit functions were significantly lower in HCM patients (21.6 ± 9.1% vs. 39.4 ± 10.6% P < 0.001, and 10.5 ± 4.3% vs. 15.7 ± 5.3%, P < 0.001). Fifteen patients had a resting LVOT gradient of >100 mmHg and they had significantly decreased GLS, twist and untwist compared to the HCM patients with lower resting LVOT gradient (-18.7 ± 2.3% vs. -21.2 ± 3.9% P = 0.016, 19.4 ± 4.3° vs. 23.5 ± 7.4° P = 0.038 and -94.0 ± 29.1°/sec vs. -134.9 ± 55.8°/sec, 0.005, respectively). Although basal and apical rotation were similar between the 2 groups, mid-rotation was significantly clockwise in HCM patients with higher LVOT gradient (-2.52 ± 1.76° vs. -0.96 ± 2.03°, P = 0.018). Correlation analysis revealed that LVOT peak velocity was associated with GLS (r = -0.358, P = 0.023), LV mid-rotation (r = -0.366, P = 0.024), and LV untwist (r = -0.401, P = 0.013). CONCLUSIONS: Left ventricular and LA functions are impaired in patients with HCM. 2DSTE is useful in determining patients with impaired myocardial mechanics. High LVOT gradient may be one of the responsible factors that trigger deterioration of LV longitudinal strain and twist mechanics in patients with HCM. Further studies are required to clarify the preliminary results of this study.

Neutrophil to lymphocyte and platelet to lymphocyte ratio in patients with dipper versus non-dipper hypertension.

BACKGROUND: Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are associated with worse outcome in various diseases. Non-dipping blood pressure pattern is associated with higher cardiovascular mortality. The aim of this study was to explore the association between NLR and PLR in patients with dipper versus non-dipper hypertension. METHODS: The study included 166 patients with hypertension. Eighty-three patients (40 male, mean age: 49.1 ± 10.5 years) had dipper hypertension, while 83 patients (41 male, mean age: 52.3 ± 12.7 years) had non-dipper hypertension. RESULTS: Baseline demographic characteristics were similar in both groups. Patients with non-dipper hypertension had significantly higher NLR compared to dipper hypertension (2.3 ± 0.9 versus 1.8 ± 0.5, p < 0.001). Patients with non-dipper hypertension had significantly higher PLR compared to dipper hypertension (117.7 ± 35.2 versus 100.9 ± 30.5, p = 0.001). In univariate analysis, hyperlipidemia, smoking, presence of diabetes, PLR more than 107 and NLR more than 1.89 were among predictors of dipper and non-dipper status. In logistic regression analyses, only hyperlipidemia (odds ratio: 2.96, CI: 1.22-7.13) and PLR more than 107 (odds ratio: 2.62, CI: 1.13-6.06) were independent predictors of dipper and non-dipper status. A PLR of 107 or higher predicted non-dipper status with a sensitivity of 66.3% and specificity of 68.7%. CONCLUSION: We demonstrated that patients with non-dipper hypertension had significantly higher NLR and PLR compared to dipper hypertension, which has not been reported previously. Moreover PLR more than 107 but not NLR was independent predictor of non-dipper status.