The relationship between hemoglobin A1c levels and thrombus load in patients with type 2 diabetes mellitus and non-ST-segment elevation myocardial infarction.

BACKGROUND: We aimed to investigate the relationship between hemoglobin A1c (HbA1c) and coronary thrombus load in type-2 diabetes mellitus (T2DM) patients with non-ST segment elevation myocardial infarction (NSTEMI). MATERIALS AND METHODS: Ninety diabetic patients with NSTEMI were recruited for the study. They were separated into two groups according to HbA1c levels. Forty-seven patients having HbA1c ≤6.5% formed Group-I (35 male, mean age 58 ± 10.5 years) and the remaining 43 patients with HbA1c >6.5% formed Group-II (23 male, mean age 58 ± 11.1 years). Both the groups were evaluated in terms of thrombolysis in myocardial infarction (TIMI) thrombus score and Syntax score. RESULTS: Baseline patient characteristics were comparable in both the groups. TIMI thrombus score and Syntax score were higher in Group II than in Group I (3.2 ± 1.4 vs. 4.7 ± 0.5 and 20.2 ± 3.4 vs. 26.3 ± 3.0 respectively, P < 0.05). No significant difference was found in other parameters. In stepwise linear regression analysis, prepercutaneous coronary intervention (PCI) and post-PCI TIMI frame number and HbA1c were significantly related to the coronary thrombus scale. However, no significant relationship has been found between thrombus formation and hypertension, previous PCI history, pre-PCI heart rate, pre-PCI cholesterol status, and high-sensitive troponin T. CONCLUSION: In NSTEMI with T2DM, increased HbA1c (HbA1c >6.5%) is related with coronary thrombus in the target vessel. In those patient population, strict anticoagulation should be considered to prevent potential adverse events.

Circulatory Stasis or Thrombus in Left Atrial Appendage, An Easy Diagnostic Solution.

OBJECTIVE: The purpose of this study was to assess the diagnostic performance of prone position cardiac multidetector computed tomography (MDCT) in the detection of left atrial appendage (LAA) thrombi and to make differentiate between thrombus and circulatory stasis using transesophageal echocardiography (TEE) as the criterion-standard imaging modality. METHODS: From December 2014 to April 2016, 53 consecutive patients were admitted to the hospital because of circulatory stasis or/and thrombus. All patients underwent prone-position MDCT and TEE. Prone-position MDCT and TEE sensitivity, specificity, positive predictive value, and negative predictive value were calculated. RESULTS: For the MDCT scan in the prone position, the sensitivity, specificity, positive predictive value, and negative predictive value results were 100%, 100%, 100%, and 100%, respectively. CONCLUSIONS: Multidetector computed tomography scanning in the prone position differentiates circulatory stasis and LAA thrombus, is clinically useful for detecting and ruling out LAA thrombus, and may be an alternative to TEE as a diagnostic tool.

Acute cardiac effects of high dose steroid treatment: A speckle tracking echocardiography study.

PURPOSE: High-dose steroid therapy (HDST) has frequent side-effects that appear at its cessation and depend on its dose. However, there is a lack of studies about the acute effects of HDST on cardiac function in adult patients. METHODS: We included in this study 30 patients who underwent HDST (intravenously at doses ranging from 250 to 1000 mg) and 30 healthy control subjects with similar demographic and clinical characteristics, between September and December 2016. Echocardiographic measurements were made before and during the first 3 hours after the end of treatment, and results were compared between patients and controls. RESULTS: There was no difference in baseline biochemical and echocardiographic characteristics between the patient and control groups. While left ventricular global longitudinal strain (LVGLS) and strain rate E were higher after treatment, no significant change was observed in conventional echocardiographic variables. CONCLUSIONS: LVGLS, but not conventional echocardiographic variables, showed an increase in cardiac systolic function at the acute phase of HDST.

The effect of dialysis type on left atrial functions in patients with end-stage renal failure: A propensity score-matched analysis.

INTRODUCTION: Despite the widespread use of both hemodialysis (HD) and peritoneal dialysis (PD), there is no study comparing the effects of these dialysis methods on the left atrial (LA) volume and functions. In this study, we investigated the impact of different dialysis methods on the LA volume and function in the patients exposed to chronic pressure overload and volume overload. METHOD: This study was carried out on the patients who received dialysis treatment at our healthcare center between March, 2015 and January, 2016. Twenty-eight patients receiving hemodialysis (HD) treatment and 24 patients under PD treatment were enrolled into the study. Patients were divided into 2 groups according to the dialysis therapy, and the atrial volumetric and mechanical functions were investigated. RESULTS: As the basal demographical characteristics of patients in the PD and HD groups were significantly different, 44 patients matched on a 1:1 basis were taken for final analysis (22 HD, 22 PD, and the average age of 42.4 ± 4.8; 73% was male). After propensity score matching analysis, it was determined that left atrial volume index (LAVi) was higher in the HD group while peak LA strain and LA contraction strain were higher in the PD group. Additionally, both strain parameters showed a good negative correlation with LAVi. CONCLUSION: We demonstrated that the left atrial structure and functions were better in the PD group suggesting that PD may be a relatively better option for the preservation and maintenance of the left atrial functions as compared to HD.

The Feasibility of Dual-Energy Computed Tomography in Cardiac Contusion Imaging for Mildest Blunt Cardiac Injury.

PURPOSE: The purpose of this study was to evaluate the efficiency and feasibility of dual-energy computed tomography (DECT) used in the diagnosis of cardiac contusion with the mildest blunt cardiac injury. MATERIAL AND METHODS: This study was performed between February 2014 and September 2015; a total of 17 consecutive patients (10 men and 7 women; median age, 51 years [range: 20-78]) were enrolled in the study. The DECT was performed within 48 hours of the trauma and a subsequent follow-up DECT was performed a little less than 1 year after the first examination. All examinations were analyzed on iodine map images by 2 experienced radiologists. Interobserver and intraobserver agreement was calculated. The correlation of initial troponin level, age, and sex with number of contusion areas in the left ventricle and complete recovery of contusion were measured. RESULTS: The contusion areas were amorphous, with considerable variation in their size, shape, and density. Contusions were primarily located in the left free wall of the ventricle, the ventricular septum, and the apex, respectively. In 10 patients, contusion areas disappeared on follow-up examination. In 4 patients, the contusion areas decreased but were still present in the follow-up examination. The interobserver agreements were almost perfect with respect to the presence of cardiac contusion, the anatomic location of contusions, and the contusion areas (kappa values of 1.0, 1.0, and 0.9 for intraobserver agreement and 1.0, 1.0, and 1.0 for intraobserver agreement, respectively). Correlations were found between age of patients and complete recovery of contusion (P = 0.01). CONCLUSIONS: Dual-energy computed tomography can show cardiac contusion and could be useful and feasible for the diagnosis and follow-up of blunt cardiac injuries. Dual-energy computed tomography is a new, user-independent, and valuable imaging technique.

Assessment of Left Atrial Mechanics in Patients with Preexcitation Syndrome Scheduled for Catheter Ablation.

OBJECTIVES: We aimed to test the left atrial (LA) mechanics and contraction synchrony by 2D strain imaging, in patients with Wolff-Parkinson-White (WPW) syndrome, before and after radiofrequency catheter ablation (RFCA). METHODS: Study population consisted of 25 patients with WPW scheduled for RFCA and 30 healthy controls. The peak LA strain at the end of the ventricular systole (LAs strain) and the LA strain with LA contraction (LAa Strain) were obtained. To assess LA dyssynchrony, septal versus lateral wall time-to-peak strain measurements were measured. RESULTS: There was no difference between the patients with WPW and control subjects with regard to peak LAs and LAa strain. Patients with WPW demonstrated higher global time-to-peak LAs and LAa strain values compared with the control group. Peak LAs strain and LAa strain values, measured before and after the RF ablation of the accessory pathway, were comparable (34.3 ± 3.92 vs. 34.6 ± 3.2, P = 0.816, 14.7 ± 2.8 vs. 15.3 ± 2.3, P = 0.052, respectively). Global time-to-peak LAs and LAa strain measurements were significantly shorter after the RFCA compared with the values obtained before the RFCA. However, septo-lateral times to peak LA strain differences were found to be comparable in both WPW versus control and pre- versus postablation groups. CONCLUSION: LA mechanical function assessed by 2D strain imaging was comparable between patients with WPW and control subjects. Patients with WPW had more prominent LA dyssynchrony during atrial pump phase as compared with the controls, a condition which could not improve after successful elimination of the accessory pathway by RFCA.

Effect of remote ischemic postconditioning on left ventricular mechanics.

BACKGROUND: Remote ischemic postconditioning (RIPC) decreases infarct size and prevents left ventricular (LV) remodeling in patients with myocardial infarction. However, there is no study that evaluates the effect of RIPC on LV mechanics assessed by speckle tracking echocardiography. Therefore, we aimed to test the effects of RIPC on LV deformation parameters such as strain, strain rate, rotation, and twist in healthy subjects. METHODS: The study group consisted of 22 healthy subjects. To test the effects of RIPC, 3 cycles of reperfusion followed by ischemia (each lasting 10 or 30 seconds) were applied immediately after 20 minutes of nondominant arm ischemia. Transthoracic echocardiography (TTE) was obtained at baseline and repeated 30 minutes after the completion of these cycles. In TTE images, apical 4-3-2 chamber longitudinal strain (LS)/strain rate, basal and apical circumferential strain/strain rate, and rotational parameters, such as basal rotation, apical rotation, and LV twist, were recorded. RESULTS: Apical 4-3-2 chamber LS and apical circumferential strain/strain rate measurements were comparable before and after RIPC, whereas basal circumferential strain was significantly decreased after RIPC (-23 ± 3.4 vs. -18.9 ± 6.9, P = 0.017). After RIPC, apical rotation was significantly increased (11.6 ± 3.7 vs. 16.7 ± 4.0, P < 0.001) and basal rotation was significantly decreased (-6.1 ± 2.1 vs. -4.7 ± 2.4, P = 0.03).Consequently, net LV twist was significantly increased (17.4 ± 4.5 vs. 21.7 ± 4.7). CONCLUSIONS: We proposed that RIPC affects the rotational mechanics of the heart rather than longitudinal mechanics. These results might give new insights into understanding the favorable effects of the post- conditioning.

Relation of uric acid and contrast-induced nephropathy in patients undergoing primary percutaneous coronary intervention in the ED.

OBJECTIVES: To investigate the predictive role of serum uric acid (SUA) levels measured in the emergency department (ED) to monitor contrast-induced nephropathy (CIN) and correlation with severity of nephropathy in patients undergoing primary percutaneous coronary intervention (PCI). METHOD: The patients who were admitted to our ED and underwent primary PCI were enrolled retrospectively. Their baseline characteristics including SUA and creatinine levels in the ED and their creatinine levels 48 hours after PCI were noted. Nephropathy was graded as follows: grade 0, ΔCr ≤25% and ≤0.5 mg/dL; grade 1, ΔCr >25% but ≤0.5 mg/dL; and grade 2, ΔCr >0.5 mg/dL. A multiple logistic regression analysis was used to define the independent predictors of CIN. RESULTS: Of a total of 744 patients, CIN was observed in 12.5% (n = 93). Serum uric acid levels were significantly higher in the CIN (+) group compared with the CIN (-) group (6.09 ± 2.01 mg/dL vs 4.89 ± 1.32 mg/dL, respectively; P < .001). Patients with grade 0 CIN had significantly lower SUA levels than did those with grades 1 and 2 (4.89 ± 1.32 mg/dL vs 5.88 ± 1.99 and 6.41 ± 2.02 mg/dL, respectively; P < .001), but there was no significant difference between grade 1 and grade 2 CIN cases in terms of SUA levels (5.88 ± 1.99 mg/dL vs 6.41 ± 2.02 mg/dL, P = .10). The cutoff value for SUA was 5.05 mg/dL for the prediction of CIN (area under the curve, 0.685; P < .001; sensitivity, 66%; specificity, 60%) in the population. CONCLUSIONS: The SUA level is a simple independent early predictor of CIN in patients who underwent primary PCI, and early detection may help prevent the progression of CIN.

Hypertension and Occupational Health: A General Overview and Expert Consensus Suggestions.

Hypertension is a common public health issue, and its incidene increases parallel to age. It is inevitable that certain occupational conditions may pose risks for high blood pressure or cause difficulties in managing blood pressure. Working under specific circumstances may compromise the safety of individuals with hypertension and potentially others. Therefore, it is crucial to implement activities that enhance awareness of hypertension, to ensure regular periodic examinations, and to establish necessary precautions in the workplace for the health of employees and the public. Given the limited resources offering guidance on hypertension in the context of occupational health, the authors of this paper, who hail from different disciplines, have prepared a set of consensus-based suggestions.

Mitral valve resistance correlates more closely with left atrial deformation than with conventional indices of rheumatic mitral stenosis.

BACKGROUND AND AIM OF THE STUDY: The relationship between mitral valve (MV) resistance and left atrial (LA) mechanical function is unknown. Hence, the study aim was to investigate the relationship between LA mechanics and MV resistance, compared to conventional indices such as mitral valve area (MVA) and transmitral gradient, in patients with rheumatic mitral stenosis (MS). METHODS: The study population consisted of 73 patients with MS and 30 age- and gender-matched controls. MV resistance was calculated and LA strain parameters were assessed from the apical four-chamber view by speckle tracking echocardiography (LA reservoir strain, LA pump strain, LA strain rate (SR)) in all subjects. RESULTS: The MS group has a markedly higher MV resistance (94 +/- 46 versus 67 +/- 22 dynes x s x cm(-5), p = 0.003) and lower LA reservoir strain (24.5 +/- 7.4% versus 36.6 +/- 3.8%, p < 0.001), LA pump strain (12.0 +/- 5.0% versus 17.1 +/- 3.4%, p < 0.001) and SR (1.23 +/- 0.33 versus 1.4 +/- 0.29, p = 0.017) values compared to controls. Moreover, both LA reservoir strain and LA pump strain correlated with MV resistance more closely than did MVA and transmitral gradients. Multiple linear regression analysis revealed only MV resistance to be an independent predictor of LA reservoir strain, while MV resistance, indexed left atrial volume and mean gradient were independent predictors of LA pump strain. CONCLUSION: It can be concluded that, in patients with MS, mitral valve resistance was more closely related to LA mechanics measurements than were conventional indices of MS.

Rosuvastatin versus atorvastatin to prevent contrast induced nephropathy in patients undergoing primary percutaneous coronary intervention (ROSA-cIN trial).

AIM: We aimed to compare the incidence of contrast-induced nephropathy (CIN) between atorvastatin versus rosuvastatin in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary coronary angioplasty. METHODS: One hundred ninety-two consecutive patients, who underwent primary percutaneous intervention (p-PCI) with the diagnosis of STEMI, were included in the study. The patients were randomized to take atorvastatin 80 mg (n=98) or rosuvastatin 40 mg (n= 94) before the procedure. Biochemical and complete blood count measurements were done at baseline and at 48 hours following admission. RESULTS: The incidence of CIN was 8.9% (n= 17) in the entire groups. The analysis performed between the statin groups revealed no statistical difference in any of the renal dysfunction indicators [baseline creatinine, baseline estimated glomerular filtration rate (eGFR), creatinine at 48 h, eGFR at 48 h, difference between baseline and 48 h creatinine, the per cent increase in the creatinine at 48 hours relative to basal creatinine]. In STEMI patients undergoing primary PCI, only the amount of the contrast agent administered was determined to be an independent predictor for CIN (OR and 95% CI: 1.08 (1.03- 1.13), P< or = 0.001). Left ventricular ejection fraction exhibited borderline statistical significance (OR and 95% CI: 0.88 (0.77-1.01), P= 0.07). CONCLUSION: Atorvastatin and rosuvastatin had similar efficacy in preventing CIN in patients with STEMI undergoing P-PCI.

[Subgroup analysis results of platelet inhibition trial in acute coronary syndrome patients (PLATO) who underwent intervention or medical treatment]. / Akut koroner sendromlu hastalarda trombosit inhibisyonu PLATO çalismasinin girisimsel tedavi planlanan veya medikal tedavi alan hastalardaki alt grup çaIisma sonuçlari.

Antiplatelet agents are among the most important drug classes in reducing mortality in patients with acute coronary syndromes (ACS). Ticagrelor is the first reversible and direct acting P2Y(12) receptor inhibitor with an earlier onset of action compared to clopidogrel. The PLATO study (Platelet Inhibition and Patient Outcomes) with ticagrelor was conducted with a design providing consistency with the current clinical practice, including all forms of ACS and a wide spectrum of treatment options in 18624 patients from 862 centers in 43 countries. Of these patients, 13408 underwent interventional procedures (ticagrelor/clopidogrel; 6732/6676) (PLATO-INVASIVE). As reported by the investigator, non-invasive treatment strategy was planned for 5216 patients (ticagrelor/clopidogrel; 2601/2615). However, 2040 patients in this group received interventional treatment during the follow-up (PLATO-NON-INVASIVE/MEDICAL TREATMENT). 1261 patients requiring surgical treatment underwent coronary artery bypass grafting (CABG) within 7 days after the discontinuation of study treatment (ticagrelor/clopidogrel; 632/629) (PLATO-CABG). The results of these three subgroups were consistent with the main PLATO study results, demonstrating that ticagrelor reduced the primary (cardiovascular death, myocardial Infarction and stroke) and secondary composite endpoints without increasing bleeding compared with clopidogrel. Ticagrelor fulfills an important unmet need regarding antiplatelet effectiveness in patients with ACS. This review evaluates the INVASIVE and MEDICAL subgroup studies of the PLATO study.

Clinical and morphological evaluation of coronary bifurcation lesions.

OBJECTIVES: We aimed to investigate the anatomical and morphological characterization of coronary bifurcation lesions. STUDY DESIGN: The study population consisted of 542 stable patients who underwent coronary angiography. Bifurcation lesions were defined as a lesion >=50% diameter stenosis involving a main branch and/or contiguous side branch with a diameter of >=2.5 mm. Using these criteria, the presence and number of bifurcation lesions, bifurcation lesion location, lesion classification according to Medina classification and the angle of the bifurcation lesion were determined. RESULTS: According to the bifurcation definition 19.3% (n=105) of our patients had bifurcation lesions. In 77% of all bifurcation lesions, the bifurcation angle was <70°. About 37% of all lesions were concordant with the Medina 1.1.1 classification. Approximately 56% of bifurcation lesions were in the LAD region, 25.4% in the Cx region, and 12.5% in the RCA region. Medina 1.1.1 was the most frequently observed in the LAD and RCA regions, while it was least common in the Cx and LMCA regions. Diabetes was observed to be significantly higher in those with bifurcation lesions than in those without. CONCLUSION: Bifurcation lesions are frequently observed in coronary angiography practice. Angiographic characteristics and the relationship of these lesions with clinical conditions may be a crucial factor in choosing the appropriate interventional procedure.

Can left atrial strain and strain rate imaging be used to assess left atrial appendage function?

BACKGROUND: The aim of this study was to evaluate the efficiency of left atrial strain (S) and strain rate (SR) imaging in assessing left atrial appendage (LAA) function. METHODS: We studied 78 consecutive patients (35 females and 43 males; mean age 38 ± 15 years) referred for transesophageal echocardiography (TEE). LAA late emptying velocity (LAA-EV) was calculated. Real-time color Doppler myocardial velocity imaging (MVI) data were recorded from the LAA by TEE and the lateral wall of the left atrium (LA) by transthoracic echocardiography. Longitudinal S and SR were measured in the mid portion of the lateral LA wall and lateral LAA wall during the contractile period. LAA late systolic velocity (LSV) and LA-LSV were obtained from Doppler analysis. RESULTS: A significant positive correlation was detected between LAA-EV and MVI parameters (for LAA-S, r = 0.88, p < 0.001; for LAA-SR, r = 0.84, p < 0.001; for LAA-LSV, r = 0.83, p < 0.001; for LA-S, r = 0.84, p < 0.001; for LA-SR, r = 0.79, p < 0.001, and for LA-LSV, r = 0.70, p < 0.001). In addition, a significant positive correlation was detected between LAA-S and LA-S (r = 0.85, p < 0.001). CONCLUSION: We suggest that LA-S and LA-SR imaging is a beneficial method to evaluate LAA functions noninvasively.

Hemodynamic assessment of mitral stenosis: mitral valve resistance as an echocardiographic index.

BACKGROUND AND AIM OF THE STUDY: Although mitral valve (MV) resistance has been proposed as a new index for the determination of hemodynamic consequence in patients with mitral stenosis (MS), the relationship between this resistance and signs of hemodynamic deterioration, such as the elevation of pulmonary artery pressure and plasma levels of brain natriuretic peptide (BNP), has not yet been investigated. METHODS: The study population comprised 33 consecutive patients (nine males, 24 females; mean age 39 +/- 6 years) with moderate and severe MS (MV area (MVA) <1.5 cm2). The cause of MS in all patients was rheumatic valvular disease. A comprehensive echocardiographic evaluation was performed, with MVA, mean MV pressure gradient (MVPG), systolic pulmonary artery pressure (sPAP) and mitral valve resistance being calculated for all patients, in addition to plasma BNP levels. RESULTS: Both, plasma BNP level and sPAP correlated better with MV resistance (r = 0.75, p < 0.001 and r = 0.52, p = 0.002, respectively) than with MVA by pressure half-time method (MVA-PHT) (r = -0.68, p < 0.001 and r = -0.55, p = 0.001, respectively) and mean MVPG (r = 0.62, p < 0.001 and r = 0.69, p < 0.001, respectively). A comparison of MV resistance and conventional stenotic indices showed that MV resistance correlated best with mean MVPG (r = 0.70, p < 0.001), and correlated least with MVA-PHT (r = -0.45, p = 0.009). Patients with sPAP >50 mmHg and plasma BNP level >150 pg/ml had a significantly higher MV resistance than patients with sPAP < 50 mmHg and plasma BNP level <150 pg/ml. CONCLUSION: MV resistance appeared to be better correlated with elevated sPAP and plasma BNP levels than with conventional stenosis indices.

Complete atrioventricular block due to overdose of pregabalin.

Pregabalin, a synthetic derivate of the inhibitory neurotransmitter γ-aminobutyric acid, shows antiepileptic, analgesic, anticonvulsant, anxiolytic, and sleep-modulating activities. The major advantage of pregabalin is its relative reliability, easy use, high tolerance, and lack of negative interaction with other drugs. A 65-year-old woman with medical histories of diabetes mellitus, lumbar spondylosis, diabetic nephropathy, chronic renal failure, and anemia of chronic disease was admitted with the complaint of dizziness and syncope. She had been taking pregabalin 300 mg daily for 8 months. Electrocardiogram revealed complete atrioventricular (AV) block and right bundle-brunch block with a heart rate of 39 per minute. Her creatinine was 1.8 mg/dL, and creatinine clearance was 50 mL/min. Pregabalin treatment was discontinued. Four days later, the complete AV block resolved spontaneously to Mobitz type II block and to sinus rhythm with right bundle-brunch block on the seventh day. To our knowledge, this is the first case of complete AV block associated with pregabalin. We believe that AV block occurred as a result of pregabalin's effect on L-type Ca++ channels in the heart. Pregabalin's different effects on electrocardiogram and on the heart in different individuals may have an association with the patterns of distribution of the L-type calcium channels in myocardium.

Two questions for Kounis syndrome: can we use magnetic resonance imaging in the diagnosis and does ST elevation correlates with troponin levels?

Kounis syndrome (KS) is an acute coronary vasospasm after exposure to an allergen due to mast cell degranulation and existing mediators. Various drugs, conditions, and environmental exposures can cause KS. We presented 2 cases, 1 of whom had taken an antiflu drug (containing paracetamol, pseudoephedrine, and dextromethorphan). His electrocardiogram (ECG) showed inferior ST elevations (2 mm) with normal cardiac biomarkers. His cardiac magnetic resonance imaging showed hypokinesis and myocardial hibernation on apical septum and on the left ventricle. The second patient took a pill of naproxen sodium. The ECG showed 1-mm ST elevation in leads DII, V5, and V6. His troponin was markedly elevated. These cases showed that there seems to be no correlation with ECG and troponin levels in KS. In addition, for patients in whom KS type 1 is expected without troponin elevation, noninvasive cardiac magnetic resonance imaging study seems to be appropriate for the diagnosis of KS.

Assessment of right ventricular mechanics in patients with mitral stenosis by two-dimensional deformation imaging.

BACKGROUND: It is well known that right ventricular (RV) dysfunction occurs early before clinical systemic congestion in patients with mitral stenosis (MS). Therefore, we aimed to evaluate the role of two-dimensional (2D) strain imaging in the assessment of subclinical RV dysfunction. METHODS: Fifty-nine patients with isolated MS (mild and moderate) and 31 healthy control subjects constituted the study population. RV peak longitudinal strain (RV-LS) and strain rate (RV-LSr) measurements were obtained from apical four-chamber view. RESULTS: There were no significant differences in left ventricular ejection fraction (LV-EF) and RV fractional area change between control and MS groups. RV strain (23.5 ± 7.2 vs. 18.63 ± 6.3, P = 0.001) and RV strain rate (1.72 ± 0.54 vs. 1.37 ± 0.66, P = 0.01) measurements were significantly lower in patients with MS than the control group. However, RV strain and strain rate measurements were comparable between MS subgroups. Correlation analysis revealed that there was poor correlation between RV-LS/LSr and mean-maximum gradients and echoscore but moderate correlation between RV-LS and RV-Sr in systolic pulmonary artery pressure and planimetric mitral valve area. CONCLUSION: We demonstrated that patients with MS had lower RV functions using 2D strain imaging and this is independent from severity of MS. In the detection of subclinical RV dysfunction in patients with MS, 2D strain imaging appears to be useful. (Echocardiography, 2012;00:1-6).

Comparison of transthoracic and transesophageal 2-dimensional speckle tracking echocardiography.

OBJECTIVES: Two-dimensional (2D) strain imaging has been established as a reliable and reproducible technique for the assessment of left and right ventricular function using transthoracic echocardiography (TTE). However, the reproducibility of transesophageal echocardiographic (TEE) 2D strain imaging and the agreement with TTE 2D strain imaging remains unclear. In the present study, the authors studied the reproducibility of TEE 2D strain imaging parameters. DESIGN: A comparative, observational clinical study. SETTING: The echocardiography laboratory of the tertiary referral center. PARTICIPANTS: Healthy individuals with a suspected patent foramen ovale. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Thirty-four patients were included in the study. None of the patients had any structural cardiovascular disease. TTE and TEE images of the subjects were recorded and analyzed offline (EchoPAC 6.1; GE Vingmed Ultrasound AS, Horten, Norway). Longitudinal strain and strain rate measurements of the 4 chambers, the apical long axis, 2 chambers, and the right ventricle were obtained for each record of TTE and TEE. The mean age of the patients in this study was 36 ± 9.2 years. Bland-Altman analysis showed that there were generally good agreements between strain and strain rate measurements on TEE and TTE. The inter- and intraobserver agreement for TEE parameters was good. CONCLUSIONS: Transesophageal 2D strain imaging is a reproducible method to measure ventricular function and has a good agreement with TTE 2D strain imaging.

[Assessment of multivariate logistic regression analysis in articles published in Turkish cardiology journals]. / Türk kardiyoloji dergilerinde yayimlanan çalismalarda çokdegiskenli lojistik regresyon analiz yönteminin degerlendirilmesi.

OBJECTIVES: We aimed to assess the use and reporting-quality of multivariate logistic regression analysis (MVLRA) in articles published in two Turkish cardiology journals. STUDY DESIGN: We reviewed all original articles published in two Turkish cardiology journals (The Anatolian Journal of Cardiology and Archives of the Turkish Society of Cardiology) between January 2010 and August 2011. The articles that used MVLRA were analyzed comprehensively based on 10 predefined criteria. RESULTS: A total of 212 articles were reviewed, of which MVLRA was used in 33 (15.6%). Twenty-nine articles (87.9%) properly included the main components of the MVRLA, namely, odds ratios, 95% confidence intervals, and p values. However, none of the articles reported MVRLA-related data such as the modeling type, validation, goodness-fit, multicollinearity and interaction tests. There were severe reporting flaws and faults as to the ratio of the total number of events or sample size to the number of independent variables included into the MVLRA model, the use of fitness procedures, and how the independent variables were selected. CONCLUSION: Our results indicate that MVLRA has become a standard statistical method in the Turkish cardiology literature. However, overall reporting of MVLRA data still has seriously inadequate and inaccurate aspects.