RESUMEN
Background Obese non-alcoholic fatty liver disease (NAFLD) was found to increase the risk of developing atrial fibrillation (AF) regardless of the metabolic syndrome subgroups that may accompany it. In this study, the effect of NAFLD on the structural and electrical functions of the heart was investigated using tissue Doppler echocardiography (TDE) in non-obese NAFLD patients without any known risk factors for AF.Material and methods The study included 43 female patients (31.3±3.8 years), who had stage 2-3 hepatosteatosis detected by liver ultrasonography and diagnosed as non-obese NAFLD (patient group), and 31 healthy women (control group, 32.5±3.6 years). In addition to standard echocardiographic parameters, inter- and intra-atrial electromechanical delay (EMD) were evaluated by TDE.Results Interatrial EMD (PA lateral - PA tricuspid) and intraatrial EMD (PA septum - PA tricuspid) were significantly longer in patient group (16.1±3.4 vs. 12.5±2.3 ms, p<0.001, and 8.4±1.6 vs. 6.6±1.6 ms, p<0.001, respectively). At the subclinical level. atrial size, left ventricular diastolic function, and left ventricular wall thickness measurements were greater in the patient group.Conclusion Inter-atrial and intra-atrial EMD were detected in young women with non-obese NAFLD. In addition, at the subclinical level, structural and functional impairment was detected However, large-volume prospective studies are required to cobfirm these findings regarding the development of AF in non-obese NAFLD patients.
Asunto(s)
Fibrilación Atrial , Enfermedad del Hígado Graso no Alcohólico , Femenino , Atrios Cardíacos , Humanos , Enfermedad del Hígado Graso no Alcohólico/complicaciones , Obesidad/complicaciones , Estudios ProspectivosRESUMEN
Background/aim: In the literature, there is a paucity of data about the effects of fibromyalgia syndrome (FMS) on myocardial function and electrophysiological properties of atrium and ventricles. In this study, we investigated cardiac functions and noninvasive predictors of arrhythmias in patients with FMS. Materials and methods: The study included 43 female patients diagnosed with FMS and 30 age- and sex-matched healthy subjects. The presence of fragmented QRS (fQRS) morphology, P dispersion, QT dispersion, inter- and intraatrial electromechanical delay was evaluated in the groups with 12-lead ECG and standard and tissue Doppler echocardiography. Results: Among electrocardiographic parameters, P dispersion, QT dispersion, and the ratio of presence of fQRS morphology were found to be significantly higher in the study group as compared to the control group. In lateral and septal, the ratio of the early transmitral flow velocity to the early diastolic tissue velocity (E/Em) was significantly higher in the study group. Additionally, intra- and interatrial electromechanical delay was found significantly prolonged in the study group. Conclusion: FMS is found to be associated with significant cardiac electrical alterations that may indicate the increased risk of atrial and ventricular arrhythmias in this group of patients.
Asunto(s)
Fibromialgia/fisiopatología , Atrios Cardíacos/fisiopatología , Sistema de Conducción Cardíaco/fisiopatología , Ventrículos Cardíacos/fisiopatología , Adulto , Arritmias Cardíacas/fisiopatología , Biomarcadores/análisis , Estudios de Casos y Controles , Estudios Transversales , Ecocardiografía Doppler , Electrocardiografía , Femenino , Pruebas de Función Cardíaca , HumanosRESUMEN
Background and objective: Prevalence of atrial fibrillation is higher in hemodialysis patients as compared to the general population. Atrial electromechanical delay is known as a significant predictor of atrial fibrillation. In this study, we aimed to reveal the relationship between atrial electromechanical delay and attacks of atrial fibrillation. Materials and methods: The study included 77 hemodialysis patients over 18 years of age giving written consent to participate in the study. The patients were divided into two groups based on the results of 24-h Holter Electrocardiogram (Holter ECG) as the ones having attacks of atrial fibrillation and the others without any attack of atrial fibrillation. Standard echocardiographic measurements were taken from all patients. Additionally, atrial conduction times were measured by tissue Doppler technique and atrial electromechanical delays were calculated. Results: Intra- and interatrial electromechanical delay were found as significantly lengthened in the group of patients with attacks of atrial fibrillation (p = 0.03 and p < 0.001 respectively). The optimal cut-off time for interatrial electromechanical delay to predict atrial fibrillation was >21 ms with a specificity of 79.3% and a sensitivity of 73.7% (area under the curve 0.820; 95% confidence interval (CI), 0.716â»0.898). In the multivariate logistic regression model, interatrial electromechanical delay (odds ratio = 1.230; 95% CI, 1.104â»1.370; p < 0.001) and hypertension (odds ratio = 4.525; 95% CI, 1.042â»19.651; p = 0.044) were also associated with atrial fibrillation after adjustment for variables found to be statistically significant in univariate analysis and correlated with interatrial electromechanical delay. Conclusions: Interatrial electromechanical delay is independently related with the attacks of atrial fibrillation detected on Holter ECG records in hemodialysis patients.
Asunto(s)
Fibrilación Atrial/diagnóstico , Fibrilación Atrial/fisiopatología , Diálisis Renal/efectos adversos , Fibrilación Atrial/etiología , Estudios Transversales , Electrocardiografía Ambulatoria/métodos , Femenino , Atrios Cardíacos/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Prospectivos , Sensibilidad y EspecificidadRESUMEN
OBJECTIVES: Stiffness index beta (SIB), aortic strain (AS) and distensibility (AD) are the parameters used to assess elasticity of the aorta, and can be measured by non-invasive method such as echocardiography. In this study, we aimed to analyse the effects of Maras powder and smoking on aortic stiffness by comparing young individuals. STUDY DESIGN: The study included 90 male subjects aged 18-40 years. 30 subjects were Maras powder users (mean age; 32±2), 30 were smokers (mean age: 28±2) and 30 were healthy volunteers (mean age: 29±2). After detailed physical examination, all subjects underwent transthoracic echocardiography. Systolic and diastolic diameters of the aorta were measured from the ascending aorta at modified parasternal long axis views by M-mode echocardiography. AS, AD, and SIB were calculated using standard formulae. Group parameters were then compared to each other. RESULTS: There was no significant difference between the groups in terms of demographic and clinical features, including blood pressures, lipid profile and serum creatinine (p>0.05). Although AS and AD were lower, and SIB was higher in the Maras powder and smoking groups compared to the control group, the difference between groups was not statistically significant (for AS: 17.61±2.22, 17.75±1.93, 18.48±2.02 respectively, for AD: 9.03±1.12, 9.14±0.96, 9.9±1.12, respectively, for SIB: 2.72±1.07, 2.59±0.88, 2.37±0.71 respectively, for all p>0.05). CONCLUSION: Our study revealed that smoking and Maras powder did not lead to a significant change in elasticity of the aorta in individuals under the age of 40.
Asunto(s)
Aorta/fisiopatología , Fumar/efectos adversos , Adolescente , Adulto , Enfermedades Cardiovasculares/sangre , Enfermedades Cardiovasculares/etiología , Enfermedades Cardiovasculares/fisiopatología , Estudios de Casos y Controles , Endotelio Vascular/fisiopatología , Humanos , Masculino , Tabaco sin Humo/efectos adversos , TurquíaRESUMEN
AIM: Hyperthyroidism is a well-known cause of atrial fibrillation (AF) which is associated with increased morbidity and mortality. Atrial electromechanical delay (EMD) is a significant predictor of AF. The aim of this study was to assess the atrial EMD and diastolic functions in subclinical and overt hyperthyroidism by using tissue Doppler imaging (TDI). METHODS AND RESULTS: The study population consisted of 3 groups: group I (30 healthy subjects), group II (38 patients with subclinical hyperthyroidism), and group III (25 patients with overt hyperthyroidism). Atrial electromechanical coupling was measured with TDI. Standard echocardiographic measurements and parameters of diastolic function were obtained by conventional echocardiography and TDI. Intra- and inter-atrial EMD were significantly prolonged in subclinical and overt hyperthyroidism compared with control group (P = 0.03 and P < 0.001 for intra-atrial EMD; P < 0.001 for inter-atrial EMD). In groups II and III, mitral A velocity (P = 0.005 and P = 0.001) and mitral E-wave deceleration time (P < 0.001 and P = 0.02) were significantly increased, and mitral E/A ratio (P = 0.005 and P = 0.001) was significantly decreased compared with the control group. The lateral mitral Em /Am ratio in group II and group III was significantly lower than controls (P = 0.001). Mitral Em /Am ratio (ß = -0.32, P = 0.002) and thyroid stimulating hormone (TSH) level (ß = -0.27, P = 0.009) were negatively and independently correlated with inter-atrial EMD. CONCLUSION: This study showed that intra- and inter-atrial electromechanical intervals were prolonged and diastolic function was impaired in both overt and subclinical hyperthyroidism. TSH level and mitral Em /Am ratio were found as independent predictors of atrial EMD.
Asunto(s)
Fibrilación Atrial/diagnóstico por imagen , Diástole , Atrios Cardíacos/diagnóstico por imagen , Hipertiroidismo/complicaciones , Adulto , Fibrilación Atrial/etiología , Ecocardiografía , Electrocardiografía , Femenino , Ventrículos Cardíacos/diagnóstico por imagen , Humanos , MasculinoRESUMEN
OBJECTIVES: There is increasing evidence linking inflammation and oxidative stress to atrial fibrillation (AF). In this study, we tested the hypothesis that C-reactive protein (CRP) and oxidative stress markers can predict the recurrence of persistent AF after successful pharmacological cardioversion. A possible relationship with AF occurrence was also investigated. STUDY DESIGN: Using a case-control study design, CRP, catalase, superoxide dismutase (SOD), and malondialdehyde (MDA) levels of 42 patients (23 female, 19 male; mean age 58.4±13.6 years) with documented persistent AF episodes were compared with 21 controls (9 female; 12 male; mean age 58.1±6.9 years). RESULTS: Overall AF patients were followed for 6 months, and 17 showed recurrence. Then, they were divided into two groups (recurrence and no recurrence) and compared with each other. CRP, SOD, and MDA levels were significantly higher in AF patients compared with controls. However, only CRP levels were significantly higher in patients with AF recurrence compared to those without recurrence. CONCLUSION: Increased markers of inflammation and oxidative stress are found in patients with persistent AF, suggesting that inflammation and oxidative stress may be associated with the presence of arrhythmia.
Asunto(s)
Fibrilación Atrial , Cardioversión Eléctrica , Fibrilación Atrial/epidemiología , Biomarcadores , Proteína C-Reactiva/metabolismo , Estudios de Casos y Controles , HumanosRESUMEN
BACKGROUND: Preeclampsia increases the risk of cardiovascular mortality and morbidity both during pregnancy and long term after the labor by causing cardiac changes that may lead to atrial and ventricular arrhythmias. OBJECTIVE: We aimed to investigate noninvasive predictors of atrial and ventricular arrhythmias and cardiac structural changes in preeclampsia. METHODS: The study included 34 preeclampsia patients as the study group and 33 healthy pregnant women as the control group. The presence of fragmented QRS morphology, P dispersion, QT dispersion, Tp-e/QTc ratio, inter- and intra-atrial electromechanical delay, left ventricular mass index was evaluated in the groups by 12 lead- ECG and standard and tissue Doppler echocardiography. RESULTS: Left ventricular mass index and relative wall thickness, and E/Em ratio was significantly higher in preeclampsia. Inter- and intra-atrial electromechanical delay and Tp-e were prolonged, and P dispersion, QT dispersion, and Tp-e/QTc ratio were increased significantly in patients with preeclampsia. In addition, fragmented QRS morphology was seen in 76.5% of patients with preeclampsia while it was present in only 27.3% of the control group (p < .001). CONCLUSION: Preeclampsia causes significant cardiac structural and electrocardiographic alterations that may increase the risk of atrial and/or ventricular arrhythmias. A more thorough and earlier cardiac assessment and closer follow-up of these patients would be useful to avoid further complications.
Asunto(s)
Preeclampsia , Arritmias Cardíacas/etiología , Ecocardiografía Doppler , Electrocardiografía , Femenino , Atrios Cardíacos , Humanos , EmbarazoRESUMEN
OBJECTIVES: Hypertension is an important cardiovascular risk factor for the development of atrial fibrillation (AF). Increased atrial electromechanical coupling time interval measured by tissue Doppler is accepted as an important factor for prediction of AF development in hypertensive patients. The aim of this study was to compare the effects of valsartan, an angiotensin receptor blocker, and nebivolol, a beta-blocker, on atrial electromechanical coupling in newly diagnosed stage 1 hypertensive patients. STUDY DESIGN: The study included 60 newly diagnosed stage 1 hypertensive patients with no other systemic disease. The patients were randomized to receive nebivolol 5 mg (30 patients; 21 women, 9 men; mean age 48.4 ± 11.4 years) and valsartan 160 mg (30 patients; 21 women, 9 men; mean age 49.8 ± 11.3 years). All the patients underwent tissue Doppler echocardiographic examination before and three months after treatment to compare the effects of the two drugs on atrial electromechanical coupling. RESULTS: Baseline blood pressures, electrocardiographic and echocardiographic findings, and atrial electromechanical coupling were similar in both groups (p>0.05). Both drugs significantly reduced blood pressure after treatment, with similar efficacy (p>0.05). Atrial electromechanical coupling time intervals showed significant decreases in both groups. CONCLUSION: Prolonged interatrial electromechanical time intervals in hypertensives are improved with antihypertensive treatment.
Asunto(s)
Antihipertensivos , Fibrilación Atrial/tratamiento farmacológico , Benzopiranos/uso terapéutico , Etanolaminas/uso terapéutico , Hipertensión/tratamiento farmacológico , Tetrazoles/uso terapéutico , Valina/análogos & derivados , Fibrilación Atrial/complicaciones , Fibrilación Atrial/diagnóstico por imagen , Ecocardiografía Doppler , Femenino , Humanos , Hipertensión/complicaciones , Masculino , Persona de Mediana Edad , Nebivolol , Resultado del Tratamiento , Valina/uso terapéutico , ValsartánRESUMEN
OBJECTIVES: Imbalance between oxidative stress and antioxidant defense has been demonstrated in patients with slow coronary flow (SCF). The aim of this study was to investigate the effect of nebivolol treatment on oxidative stress parameters in SCF patients. STUDY DESIGN: The study included 32 patients (10 females, 22 males; mean age 53.3 ± 5.2 years) with SCF and 32 control subjects (14 females, 18 males; mean age 50.6 ± 5.2 years) with normal coronary arteries on angiography. Coronary slow flow was determined by the TIMI frame count method. Patients with SCF received nebivolol treatment (5 mg/day) for six months. Blood samples were analyzed for malondialdehyde (MDA) and serum nitric oxide (NO) levels, and erythrocyte catalase (CAT) and erythrocyte superoxide dismutase (SOD) activities in the control group and, in SCF patients, at baseline and after six months of nebivolol treatment. RESULTS: The two groups were similar with respect to age, body mass index, blood pressure, heart rate, and lipid profile. Smoking was more frequent in the SCF group compared to the controls. TIMI frame counts measured from the left anterior descending, circumflex, and right coronary arteries were significantly higher in the SCF group (p < 0.0001). Baseline MDA and NO levels, and SOD and CAT activities were significantly different between the two groups, with significantly increased MDA (p < 0.0001), and significantly decreased SOD (p < 0.0001), CAT (p < 0.001), and NO (p < 0.001) in the SCF group. After six months of nebivolol treatment, all oxidative stress parameters showed significant improvements compared to the baseline values (p < 0.0001 for MDA, SOD, CAT, and NO) and approximated to the values of the control group. CONCLUSION: Our results show that nebivolol treatment may be beneficial to improve oxidative stress parameters in patients with SCF, which are considered to be an early stage of atherosclerosis.
Asunto(s)
Antagonistas de Receptores Adrenérgicos beta 1/uso terapéutico , Benzopiranos/uso terapéutico , Etanolaminas/uso terapéutico , Fenómeno de no Reflujo/tratamiento farmacológico , Estrés Oxidativo/efectos de los fármacos , Vasodilatadores/uso terapéutico , Antagonistas de Receptores Adrenérgicos beta 1/farmacología , Benzopiranos/farmacología , Velocidad del Flujo Sanguíneo/efectos de los fármacos , Estudios de Casos y Controles , Catalasa/sangre , Circulación Coronaria/efectos de los fármacos , Eritrocitos/enzimología , Etanolaminas/farmacología , Femenino , Humanos , Peroxidación de Lípido/efectos de los fármacos , Masculino , Malondialdehído/sangre , Persona de Mediana Edad , Nebivolol , Óxido Nítrico/sangre , Fenómeno de no Reflujo/metabolismo , Fenómeno de no Reflujo/fisiopatología , Superóxido Dismutasa/sangre , Vasodilatadores/farmacologíaRESUMEN
OBJECTIVES: The aim of this study was to determine the prevalence of atrial fibrillation in long-term hemodialysis patients and to identify clinical and echocardiographic risk factors. STUDY DESIGN: The study included 183 patients (93 males, 90 females; mean age 52+/-17 years) who had been on long-term hemodialysis treatment (mean 41.6+/-39.8 months) and had preserved systolic function. Atrial fibrillation was determined electrocardiographically and the patients were divided into two groups depending on the presence or absence of atrial fibrillation. Conventional and tissue Doppler echocardiographic examinations were performed on interdialytic days. Clinical, laboratory, and echocardiographic parameters were compared. RESULTS: Twenty-four patients (13.1%) had atrial fibrillation. Patients with atrial fibrillation significantly differed in terms of higher age (64.9+/-9.8 vs. 49.9+/-16.6 years; p<0.001), higher frequency of coronary artery disease (37.5% vs. 10.7%; p=0.008), and lower serum albumin level (3.6+/-0.4 vs. 3.9+/-0.5 mg/dl; p=0.015). Echocardiographic examination showed significantly increased left and right atrial diameters (p<0.05), higher incidence of mitral and/or aortic calcification (p=0.033), increased systolic pulmonary artery pressure (38.1+/-6.1 vs. 28.5+/-5.5 mmHg, p<0.001) and E/E' ratio (11.8+/-3.8 vs. 8.8+/-4.7, p=0.008) in patients with atrial fibrillation. In multivariate logistic regression analysis, age (OR 1.09; 95% CI 1.00-1.17; p=0.036) and right atrial diameter (OR 1.19; 95% CI 1.05-1.35; p=0.008) were independent risk factors for the development of atrial fibrillation. CONCLUSION: Our findings highlight age and right atrial diameter as independent predictors of atrial fibrillation in hemodialysis patients. In addition, the E/E' ratio and pulmonary artery pressure may be considered new risk factors of atrial fibrillation in this population.
Asunto(s)
Fibrilación Atrial/epidemiología , Diálisis Renal/efectos adversos , Adulto , Anciano , Fibrilación Atrial/diagnóstico por imagen , Fibrilación Atrial/fisiopatología , Enfermedad Coronaria/complicaciones , Complicaciones de la Diabetes/clasificación , Ecocardiografía , Femenino , Atrios Cardíacos/diagnóstico por imagen , Atrios Cardíacos/fisiopatología , Humanos , Hipertensión/complicaciones , Masculino , Persona de Mediana Edad , PrevalenciaRESUMEN
BACKGROUND: Increased inflammatory activity is known to be a pathophysiologic characteristic of atrial fibrillation. Familial Mediterranean fever (FMF) is a disease characterized by recurrent and sustained increased inflammatory activity. Atrial conduction abnormalities in these patients have not been investigated in terms of P-wave duration, P-wave dispersion (Pd), and atrial electromechanical delay measured by tissue Doppler echocardiography (TDE). We aimed to assess atrial conduction time in patients with FMF. METHODS: A total of 33 patients with FMF (13 males/20 females, 28.4 +/- 12.5 years), and 33 controls (13 males/20 females, 28.5 +/- 12.1 years) were included. Atrial electromechanical coupling (PA) and intra- and interatrial electromechanical delay were measured with TDE. From the 12-lead electrocardiogram Pd was calculated. RESULTS: Atrial electromechanical coupling at the left lateral mitral annulus (PA lateral) was significantly higher in FMF patients (58.0 +/- 9.0 vs 51.0 +/- 5.8, P < 0.001). Interatrial (PA lateral-PA tricuspid) and intraatrial electromechanical delay (PA septum-PA tricuspid) were significantly longer in FMF patients (21.3 +/- 7.4 vs 12.9 +/- 4.6, P < 0.001 and 4.7 +/- 5.5 vs 2.1 +/- 1.7, P = 0.01, respectively). Also, Pd and maximum P-wave duration were significantly higher in FMF patients (42.8 +/- 7.9 vs 35.3 +/- 6.1, P < 0.001 and 98.6 +/- 9.0 vs 93.1 +/- 8.5, P = 0.01, respectively). A positive correlation was detected between interatrial electromechanical delay and Pd (r = 0.622, P < 0.001). Plasma level of C-reactive protein (CRP) correlated with interatrial electromechanical delay and Pd (r = 0.733, P < 0.001; and r = 0.427, P < 0.001, respectively). CONCLUSION: This study shows that atrial electromechanical delay and Pd are prolonged in FMF patients. Atrial electromechanical delay is closely associated with Pd and plasma level of CRP.
Asunto(s)
Fibrilación Atrial/diagnóstico , Fibrilación Atrial/etiología , Técnicas Electrofisiológicas Cardíacas/métodos , Fiebre Mediterránea Familiar/complicaciones , Fiebre Mediterránea Familiar/diagnóstico , Adulto , Femenino , Humanos , Masculino , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
OBJECTIVE: The aim of this study was to evaluate atrial conduction abnormalities obtained by Doppler tissue imaging (DTI) and electrocardiogram analysis in ankylosing spondylitis (AS) patients. METHODS: A total of 40 patients with AS (22 males /18 females, 37.82 +/- 10.22 years), and 42 controls (22 males/20 females, 35.74 +/- 9.98 years) were included. Systolic and diastolic left ventricular (LV) functions were measured by using conventional echocardiography and DTI. Interatrial and intraatrial electromechanical coupling (PA) intervals were measured with DTI. P-wave dispersion (PD) was calculated from the 12-lead electrocardiogram. RESULTS: Atrial electromechanical coupling at the left lateral mitral annulus (PA lateral) was significantly delayed in AS patients (61.65 +/- 7.81 vs 53.69 +/- 6.75 ms, P < 0.0001). Interatrial (PA lateral - PA tricuspid), intraatrial electromechanical coupling intervals (PA septum - PA tricuspid), maximum P-wave (Pmax) duration, and PD were significantly longer in AS patients (23.50 +/- 7.08 vs 14.76 +/- 5.69 ms, P < 0.0001; 5.08 +/- 5.24 vs 2.12 +/- 2.09 ms, P = 0.001; 103.85 +/- 6.10 vs 97.52 +/- 6.79 ms, P < 0.0001; and 48.65 +/- 6.17 vs 40.98 +/- 5.37 ms, P < 0.0001, respectively). Reflecting LV diastolic function mitral A-wave and E/A, mitral E-wave deceleration time (DT), Am and Em/Am were significantly different between the groups (P < 0.05). We found a significant correlation between interatrial electromechanical coupling interval with PD (r = 0.536, P < 0.01). Interatrial electromechanical coupling interval was positively correlated with DT (r = 0.422, P < 0.01) and inversely correlated with E/A (r =-0.263, P < 0.05) and Em/Am (r =-0.263, P < 0.05). CONCLUSION: This study shows that atrial electromechanical coupling intervals and PD are delayed, and LV diastolic functions are impaired in AS patients.
Asunto(s)
Fibrilación Atrial/diagnóstico , Fibrilación Atrial/fisiopatología , Sistema de Conducción Cardíaco/fisiopatología , Espondilitis Anquilosante/diagnóstico , Espondilitis Anquilosante/fisiopatología , Disfunción Ventricular Izquierda/diagnóstico , Disfunción Ventricular Izquierda/fisiopatología , Adulto , Fibrilación Atrial/etiología , Femenino , Humanos , Masculino , Contracción Miocárdica , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Disfunción Ventricular Izquierda/etiologíaRESUMEN
AIM: Slow coronary flow (SCF) is characterized by angiographically normal coronary arteries with delayed opacification of the distal vasculature. The purpose of this study was to evaluate atrial electromechanical couplings and P-wave dispersion (Pd) reflecting intraatrial and interatrial conduction delays in SCF patients and the relationship between these parameters and Thrombolysis in Myocardial Infarction (TIMI) frame count. METHODS: Thirty-four patients with SCF and 40 controls were enrolled. From 12-lead surface electrocardiograms, Pd was calculated. Atrial electromechanical coupling (PA), intraatrial, and interatrial electromechanical delay were measured with tissue Doppler imaging. RESULTS: Maximum P-wave duration (Pmax) and Pd were higher in SCF patients than those of controls (109.2 +/- 9.3 vs 92.3 +/- 13.5 milliseconds; P < .0001 and 50.4 +/- 9.4 vs 34.4 +/- 8.9 milliseconds; P < .0001). Atrial electromechanical coupling at the left lateral mitral annulus (lateral PA), septal mitral annulus (septal PA), and right ventricular tricuspid annulus (RV PA) were significantly higher in SCF patients than controls (68.1 +/- 8.1 vs 52.6 +/- 7.3 milliseconds; P < .0001; 49.3 +/- 9.8 vs 38.2 +/- 5.3 milliseconds; P < .0001; 47.5 +/- 9.0 vs 37.6 +/- 4.6 milliseconds, P < .0001, respectively). Interatrial electromechanical delay (lateral PA - RV PA) was significantly longer in SCF patients (20.6 +/- 9.1 vs 15.0 +/- 6.0 milliseconds; P = .0002). A positive correlation was detected between circumflex coronary artery TIMI frame count and interatrial electromechanical delay (r = 0.45; P < .01). CONCLUSIONS: Prolongation of interatrial electromechanical delay, Pmax, and Pd suggest that SCF might contribute to development of adverse functional and electrophysiologic atrial characteristics in these patients.
Asunto(s)
Velocidad del Flujo Sanguíneo , Circulación Coronaria , Estenosis Coronaria/fisiopatología , Vasos Coronarios/fisiopatología , Sistema de Conducción Cardíaco/fisiopatología , Frecuencia Cardíaca , Contracción Miocárdica , Estenosis Coronaria/diagnóstico por imagen , Vasos Coronarios/diagnóstico por imagen , Femenino , Humanos , Masculino , Persona de Mediana Edad , UltrasonografíaRESUMEN
BACKGROUND: Insulin resistance was an independent predictor of cardiovascular mortality in uremic patients without diabetes. Rosiglitazone (ROS) improves insulin sensitivity in the liver, muscle, and adipose tissue. We prospectively investigated the effects of ROS on cardiac functions by standard (SDE) and tissue Doppler echocardiography (TDI) in continuous ambulatory peritoneal dialysis (CAPD) patients. METHODS: A total of 24 CAPD patients (13 males, 11 females; mean age 42.2 +/- 14.8 years) were included. Routine blood samples were examined. Left and right ventricular functions were assessed, and myocardial performance index (MPI) was calculated by SDE and TDI at baseline and after 12-month ROS therapy. Left and right atrial volumes were measured and indexed to body surface area. RESULTS: When compared with baseline, after 12 months of ROS treatment, it was shown that early (E) and late (A) diastolic velocities of atrioventricular valves, E/A ratio, mitral E-wave deceleration time (DT), isovolumetric relaxation time (IVRT), and MPI were similar (p > 0.05). Also, no significant changes were detected in LV dimensions, LV mass index, LVEF, LA volume index, or RA volume index measured by SDE before and after ROS therapy (p > 0.05). Left and right ventricular function parameters measured by TDI including Sm, Em, Am, Em/Am ratio, E/Em ratio, and MPI were similar. CONCLUSION: It was found that there was no negative effect of long-term ROS therapy on cardiac functions measured by SDE and TDI in CAPD patients.
Asunto(s)
Ecocardiografía Doppler de Pulso/métodos , Diálisis Peritoneal Ambulatoria Continua/métodos , Tiazolidinedionas/administración & dosificación , Vasodilatadores/administración & dosificación , Disfunción Ventricular Izquierda/tratamiento farmacológico , Disfunción Ventricular Derecha/tratamiento farmacológico , Adulto , Velocidad del Flujo Sanguíneo , Estudios de Cohortes , Femenino , Pruebas de Función Cardíaca , Humanos , Fallo Renal Crónico/diagnóstico , Fallo Renal Crónico/mortalidad , Fallo Renal Crónico/terapia , Masculino , Persona de Mediana Edad , Diálisis Peritoneal Ambulatoria Continua/efectos adversos , Probabilidad , Pronóstico , Estudios Prospectivos , Valores de Referencia , Medición de Riesgo , Rosiglitazona , Análisis de Supervivencia , Resultado del Tratamiento , Disfunción Ventricular Izquierda/diagnóstico por imagen , Disfunción Ventricular Izquierda/mortalidad , Disfunción Ventricular Derecha/diagnóstico por imagen , Disfunción Ventricular Derecha/mortalidadRESUMEN
Stenosis of the subclavian artery, before the left internal mammary artery branch, is an important problem for patients who have undergone coronary artery bypass grafting, with an incidence rate of 0.5-1.1%. In this paper, a case of left subclavian artery stenosis, which developed after coronary artery bypass surgery and led to recurrent anginal attacks in the patient, is presented.
Asunto(s)
Angina de Pecho/etiología , Puente de Arteria Coronaria/efectos adversos , Síndrome del Robo de la Subclavia/etiología , Angiografía , Femenino , Humanos , Persona de Mediana Edad , Pulso Arterial , Recurrencia , Síndrome del Robo de la Subclavia/diagnóstico por imagenRESUMEN
Familial Mediterranean fever (FMF) is a disease characterized by sporadic, paroxysmal attacks of fever and serosal inflammation. QT dispersion (QTd) and transmural dispersion of repolarization (TDR), simple noninvasive arrhythmogenic markers, that can be used to assess homogeneity of cardiac repolarization, have not been studied in FMF patients before. The aim of our study was to evaluate the QTd and TDR in FMF patients without overt cardiac involvement. A total of 50 patients with FMF (30 men, 20 women, 29.4 +/- 11.8 years) and 50 controls (30 men, 20 women; mean age 31.3 +/- 11.9 years) were included. QTd, corrected QTd (cQTd), maximum QT (QTmax), maximum corrected QT (cQTmax), minimum QT (QTmin), and minimum corrected QT intervals (cQTmin) and TDR were measured from standard 12-lead electrocardiography (ECG). We found that QTd, QTmax, and TDR were greater in FMF patients than in the control group (36.0 +/- 11.4 vs. 20 +/- 11.2, P < 0.001 and 354.8 +/- 30.9 vs. 342.8 +/- 18.0, P = 0.02; 62.0 +/- 16.0 vs. 49.0 +/- 9.5 P < 0.001, respectively), as were cQTd and cQTmax (40.4 +/- 13.5 vs. 21.9 +/- 12.4, P < 0.001 and 397.7 +/- 40.2 vs. 375.5 +/- 25.4 P = 0.001). A modest positive correlation was found between cQTd and C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) (r = 0.30, P < 0.001; r = 0.40, P < 0.001; respectively). QTd, which is an index of inhomogeneity of ventricular repolarization and an important predictor of cardiovascular mortality, and TDR, which is a better marker of cardiac repolarization, increased in FMF patients similarly as in other rheumatologic diseases.
Asunto(s)
Fiebre Mediterránea Familiar/fisiopatología , Sistema de Conducción Cardíaco/fisiopatología , Contracción Miocárdica/fisiología , Adulto , Sedimentación Sanguínea , Proteína C-Reactiva/metabolismo , Ecocardiografía , Electrocardiografía , Femenino , Humanos , MasculinoRESUMEN
Free-floating right heart thrombus can be seen in 4% to 18% of patients presenting with acute pulmonary embolism. A 76-year-old man was admitted to the intensive coronary care unit due to resting dyspnea and pleuritic pain of sudden onset, raising a high suspicion of acute pulmonary embolism. A recent coronary angiogram showed a 50% stenosis in the proximal left anterior descending coronary artery. He had diabetes and hypertension for more than 10 years, but no history of venous thromboembolism. Bed-side transthoracic echocardiography revealed dilated right heart chambers, and a huge (78x12 mm) mobile mass in the inferior vena cava. We witnessed the migration of the thrombus from the inferior vena cava to the right atrium. The thrombus then totally lodged in the right atrial cavity and protruded into the right ventricle. Surgical removal of the thrombus was decided. However, during induction of anesthesia, cardiac arrest developed. All resuscitation efforts including open heart massage were unsuccessful. The thrombotic material removed from the right atrium was 150 mm in length. Pathological examination showed the mass to be a thrombus.
Asunto(s)
Cardiopatías/diagnóstico por imagen , Embolia Pulmonar/diagnóstico por imagen , Trombosis/diagnóstico por imagen , Vena Cava Inferior , Anciano , Ecocardiografía , Resultado Fatal , Paro Cardíaco/etiología , Atrios Cardíacos/diagnóstico por imagen , Cardiopatías/complicaciones , Cardiopatías/patología , Humanos , Masculino , Embolia Pulmonar/etiología , Trombosis/complicaciones , Trombosis/patología , Vena Cava Inferior/diagnóstico por imagenRESUMEN
OBJECTIVES: The aim of this study was to evaluate atrial electromechanical delay measured by tissue Doppler imaging (TDI) and left atrial (LA) mechanical functions in patients with rheumatoid arthritis (RA). STUDY DESIGN: The study included 68 patients (53 females, 15 males; mean age 43.7 years) with RA. Using TDI, atrial electromechanical coupling (PA) was measured from the lateral mitral annulus (PA lateral), septal mitral annulus (PA septum), and right ventricular tricuspid annulus (PA tricuspid). Left atrial volumes (maximal, minimal, and pre-systolic) were measured by the method of discs in the apical four-chamber view and were indexed to body surface area. Mechanical function parameters of the LA were calculated. The results were compared with those of 41 age- and gender-matched healthy volunteers (32 females, 9 males; mean age 41.9 years). RESULTS: Patients with RA had significantly prolonged PA lateral, PA septum, and intra- (PA septum-PA tricuspid) and interatrial (PA lateral-PA tricuspid) electromechanical delays compared to controls (p<0.0001, p=0.05, p<0.0001, and p<0.0001, respectively). Left atrial volumes were similar in the two groups (p>0.05). Left atrial passive emptying fraction was significantly decreased, LA active emptying volume and active emptying fraction were increased in RA patients (p=0.05, p=0.01, and p<0.0001; respectively). Interatrial electromechanical delay was correlated with systolic blood pressure (r=0.20, p=0.04), left ventricular mass index (r=0.22, p=0.02), C-reactive protein (CRP) (r=0.27, p=0.005), and LA active emptying fraction (r=0.29, p=0.002). In linear regression analysis, LA active emptying fraction and CRP were independent variables of interatrial electromechanical delay (beta=0.28, p=0.002 and beta=0.25, p=0.006, respectively). CONCLUSION: Prolonged electromechanical delays and impaired LA mechanical functions may be an early manifestation of subclinical cardiac involvement in RA patients.
Asunto(s)
Artritis Reumatoide/fisiopatología , Función del Atrio Izquierdo/fisiología , Atrios Cardíacos/fisiopatología , Adulto , Artritis Reumatoide/diagnóstico por imagen , Proteína C-Reactiva/metabolismo , Femenino , Atrios Cardíacos/diagnóstico por imagen , Frecuencia Cardíaca , Humanos , Masculino , Persona de Mediana Edad , Volumen Sistólico , Ultrasonografía DopplerRESUMEN
BACKGROUND: Majority of the incidentally discovered adrenal masses, called adrenal incidentaloma (AI), are nonfunctioning adrenal adenomas. The appropriate management of AI is still a matter debate, so it is necessary to investigate their associated morbidity. However, data regarding morphological and functional cardiac alterations are limited in this group. OBJECTIVE: In this study, we aimed to assess cardiac structural and functional characteristics and atrial conduction properties in patients with nonfunctioning AI. METHODS: Thirty patients with nonfunctioning AI and 46 properly matched control subjects were included in the study. After hormonal and biochemical analysis, all participants underwent transthoracic echocardiography to obtain systolic and diastolic parameters of both ventricles, in addition to atrial conduction times by tissue Doppler echocardiography. Data were analyzed with Statistical Package for the Social Sciences (SPSS, Chicago, IL, United States) statistics, version 17.0 for Windows. P < 0.05 was considered statistically significant. RESULTS: Left ventricular (LV) mass index and LV myocardial performance index were significantly increased in AI group. Among atrial conduction times, both intra- and interatrial electromechanical delays were significantly prolonged in patients with nonfunctioning AI. Other laboratory and echocardiographic findings were similar between groups. CONCLUSION: Our study revealed that intra- and inter-atrial conduction times were prolonged, and LV mass index was increased in patients with nonfunctioning AI. These findings may be markers of subclinical cardiac involvement and tendency to cardiovascular complications. Close follow-up is necessary for individuals with nonfunctioning AI for their increased cardiovascular risk.