Right ventricular-pulmonary arterial uncoupling in mild-to-moderate asthma.

OBJECTIVE: Persistent pulmonary hypertension and resulting right ventricular (RV) failure are highly encountered phenomenon in severe pulmonary diseases. However, in this study, we aimed to examine the effects of mild-to-moderate asthma on RV functions, pulmonary arterial stiffness (PAS), and coupling of RV to the pulmonary artery (PA) in the absence of overt pulmonary hypertension. METHODS: We enrolled 53 patients with mild-to-moderate asthma, and 50 healthy control subjects. A comprehensive two dimensional transthoracic echocardiography was performed on each individual. The parameters measuring RV function were all examined. PAS was calculated by dividing maximal frequency shift of pulmonary flow by pulmonary acceleration time. RV-PA coupling was estimated by the tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PASP) ratio (TAPSE/PASP). RESULTS: Baseline demographics, clinical and laboratory parameters of both groups were similar (p > 0.05). Most of conventional echocardiographic parameters measuring RV function were impaired in patients with asthma compared to control subjects. PAS values were significantly higher in the asthma group [24 (21-26) vs. 20 (18-22), p < 0.001], and TAPSE/PASP ratio was significantly lower in the asthma group versus the control group [0.81 ± 0.08 vs. 0.96 ± 0.11, p < 0.001]. Multilinear regression analysis revealed PAS, TAPSE, and PASP as independent predictors of TAPSE/PASP ratio. CONCLUSION: Mild-to-moderate asthma was shown to be associated with both subclinical RV dysfunction and increased PAS values. TAPSE/PASP ratio was also markedly decreased, suggesting RV-PA uncoupling even in the absence of overt pulmonary hypertension. PAS referring RV afterload was shown to be an independent predictor of TAPSE/PASP ratio.

The Relationship of Renal Augmented Velocity Index With Ventricular-Arterial Coupling in Comparison to Renal Resistive Index: Analysis by Means of Arterial and Ventricular Elastances in Hypertensive Patients.

OBJECTIVE: It's a well-known scientific statement that the heart and kidney functions are frequently tied together and the impairment of one directly alters the other. However, there exist knowledge gaps about this intricate pathophysiologic link and the exact unifying mechanism is not established. Herein, we aimed to investigate the presence of cardiorenal interaction at subclinical level while the conventional cardiac and renal clinical parameters are not disrupted yet in patients with hypertension. METHODS: We chose a novel renal Doppler ultrasonographic parameter-augmented velocity index (Avi)-and an echocardiographic measure-ventriculoarterial coupling-which is complex to analyze but increasingly used after its acceptance about being a key determinant of cardiovascular efficiency. We recruited 137 patients without a previous history of antihypertensive medication use (47.4% women; median age, 49 years). Renal Avi, renal resistive index (RI), arterial elastance (Ea ), ventricular elastance (Ees ) and Ea /Ees (ventriculoarterial coupling) parameters were all examined. RESULTS: Renal Avi, Ea , and Ea /Ees values were higher in females. Correlation analysis revealed that renal Avi was correlated with many hemodynamic variables including Ea and Ea /Ees . On multiple linear regression analysis, Ea and Ea /Ees remained as significant independent predictors of renal Avi but not of renal RI after adjustments for co-variables (ß = 0.488, P < .001 for Ea ; ß = 0.380, P < .001 for Ea /Ees ). CONCLUSIONS: In comparison to renal RI, we suggest that renal Avi is a more reliable and promising index that can even measure subclinical changes in the cardiorenal circulation which needs to be elucidated.

Prevalence and characteristics of coronary artery fistula in adults: coronary angiographic analysis of 18,106 patients.

Aim    Coronary artery fistula (CAF) is a rarely encountered anomaly that is characterized by an abnormal connection between a coronary artery and a cardiac chamber or a great thoracic vessel. Its incidence has not been precisely established due to the large number of undiagnosed cases and it shows heterogeneity in its anatomic configuration and clinical consequences. We aimed to assess the frequency, imaging findings, and clinical features of CAF among patients in our tertiary medical center.Material and methods    The angiographic data of 18,106 consecutive adult patients who underwent coronary angiography between January 2011 and June 2013 were retrospectively analyzed.Results    CAF was detected in 22 patients (0.14 %). Of these, 5 patients had bilateral fistulas (23 %). 65 % of the fistulas originated from the left anterior descending coronary artery,and 53 % drained into the pulmonary artery. The left ventricle and left atrium were the only drainage sites for left-sided coronary artery fistulas. One patient with a CAF presented with non-ST elevated myocardial infarction in the absence of an evident thrombosis.Conclusion    Unlike previous reports, bilateral CAFs were more commonly encountered in this study. Contrary to most of the data in the literature, more than half of the CAFs originated from the left anterior descending coronary artery and most drained into the pulmonary artery. Rare anatomic types of CAFs were also detected.

Can Asthma Cause Pericardial Effusion? Insights Into an Intriguing Association.

BACKGROUND: Pericardial effusion (PE) is a commonly encountered condition in clinical practice, but its etiology can be difficult to identify, with many cases remaining classified as idiopathic. This study aimed to investigate whether an association exists between asthma and idiopathic PE (IPE). METHODS: Patients who had been diagnosed with PE in the authors' outpatient cardiology clinics between March 2015 and November 2018 were retrospectively analyzed. The study population was divided into 2 groups-non-IPE (NIPE) and IPE-based on whether a cause had been identified. Demographic, laboratory, and clinical data for the 2 groups were examined statistically. RESULTS: A total of 714 patients were enrolled in the study after exclusion of 40 cases. Of these 714 patients, 558 were allocated to the NIPE group and 156 to the IPE group (NIPE group median [IQR] age, 50 [41-58] years vs IPE group median [IQR] age, 47 [39-56] years; P = .03). Asthma was significantly more prevalent among patients in the IPE group than among those in the NIPE group (n = 54 [34.6%] vs n = 82 [14.7%]; P < .001). In multivariate logistic regression analysis, asthma (odds ratio, 2.67 [95% CI, 1.53-4.67]; P = .001) was found to be an independent predictor of IPE. In the IPE group, patients with asthma had either mild or moderate PE, with the right atrium being the most common location in these patients. CONCLUSION: Asthma was an independent predictor of mild to moderate IPE. The right atrium was the most frequently encountered location for PE in patients with asthma.

Impaired aortic elasticity in patients with psoriasis.

BACKGROUND: Psoriasis vulgaris is a chronic inflammatory disease involving 1-3% of the human population worldwide. Many systemic diseases including cardiovascular disturbances have been described in psoriatic patients. The effect of psoriasis on aortic elasticity parameters has not been well-defined previously. The aim of this study was to determine whether there was any change in aortic elasticity in psoriasis. METHODS: Twenty-seven psoriatic patients without cardiovascular involvement and 22 healthy subjects were enrolled into the study. The severity of the disease was evaluated by the "Psoriasis Area and Severity Index (PASI)". Aortic strain, distensibility and stiffness index were calculated from aortic diameters measured by echocardiography and blood pressures simultaneously measured by sphygmomanometry. RESULTS: The aortic strain and distensibility in the psoriasis group were significantly lower than those in the control group. The aortic stiffness index in the psoriasis group was higher than that in the control group. There was a positive correlation between aortic stiffness index and PASI and longevity of psoriasis disease, whereas a negative correlation between aortic strain and PASI and longevity of psoriasis disease was found. CONCLUSION: We found that in psoriatic patients without cardiac involvement, aortic elasticity was decreased and this decrease was correlated with the duration and the severity of the disease.

Primary valvular lipomatous hamartoma: a case report and a collective review of the literature.

Cardiac valvular tumors are very infrequent lesions constituting about 10% of the primary cardiac neoplasms. Among the valvular tumors, lipomatous hamartoma represents a very rare and distinct pathological entity. Retrieval of the literature reveals only eight reported cases, and there is lack of information regarding their clinical features. Herein, we describe a patient with a mass on the tricuspid valve detected incidentally and diagnosed to be a "lipomatous hamartoma." To obtain a better understanding of the nature of these unusual lesions, we reviewed the literature and presented their clinicoanatomical characteristics together with diagnostic and therapeutic approaches.