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Purpose: To determine the effect of inspiratory muscle training (IMT) on respiratory and peripheral muscle strength, functional exercise capacity, health-related quality of life (HRQoL), fatigue, depression, and cardiac functions in patients with stable angina. Methods: A randomized, controlled, single-blinded study. Twenty patients (59.95 ± 7.35 y, LVEF - 58.77 ± 7.49) with stable angina received IMT at the lowest load (10 cmH2O), and 20 patients (55.85 ± 7.60 y, LVEF - 62.26 ± 7.75) received training at 30% of maximal inspiratory pressure (MIP) seven days/8 weeks. Respiratory muscle strength (MIP; maximal expiratory pressure, MEP), peripheral muscle strength, pulmonary functions, functional exercise capacity (6-min walking test; exercise test), fatigue, HRQoL, depression, and cardiac functions were evaluated before and after. Results: A statistical difference was found between groups in terms of respiratory and peripheral muscle strength, pulmonary functions, functional exercise capacity (p<0.05). The results of fatigue, depression, HRQoL, and cardiac functions were similar between the groups (p>0.05). Conclusions: This study is the first to demonstrate the positive effects of IMT in patients with stable angina. IMT is a safe and effective method and is recommended to be added to cardiopulmonary rehabilitation programs and guidelines, as it results in increased peripheral muscle strength and functional exercise capacity in stable angina patients. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to investigate the association between the platelet/lymphocyte ratio (PLR) and the neutrophil/lymphocyte ratio (NLR) and postoperative atrial fibrillation (POAF) after lung resection. Methods: After the implementation of the exclusion criteria, 170 patients were retrospectively analyzed. PLR and NLR were obtained from fasting complete blood counts before surgery. POAF was diagnosed using standard clinical criteria. The associations between different variables and POAF, NLR, and PLR were calculated using univariate and multivariate analyses. The receiver operating characteristics (ROC) curve was used to determine the sensitivity and specificity of PLR and NLR. Results: Of the 170 patients, 32 with POAF (mean age =71.28±7.27 y, 28 males and 4 females) and 138 patients without POAF (mean age =64.69±10.31 y, 125 males and 13 females) were identified, and the difference in the mean age was statistically significant (P=0.001). It was found that PLR (157.67±65.04 vs 127.52±56.80; P=0.005) and NLR (3.90±1.79 vs 2.04±0.88; P=0.001) were statistically significantly higher in the POAF group. In the multivariate regression analysis, age, lung resection size, chronic obstructive pulmonary disease, NLR, PLR, and pulmonary arterial pressure were independent risk factors. In the ROC analysis, PLR had a sensitivity of 100% and a specificity of 33% (AUC, 0.66; P<0.001), and NLR had a sensitivity of 71.9% and a specificity of 87.7% (AUC, 0.87; P<0.001). A comparison of AUC between PLR and NLR showed that NLR was statistically more significant (P<0.001). Conclusion: This study showed that NLR was a stronger independent risk factor than PLR for the development of POAF after lung resection. [ABSTRACT FROM AUTHOR]

Objective To investigate whether obstructive sleep apnea syndrome (OSAS) has any effect on pulmonary artery stiffness (PAS) derived from echocardiographic calculation. Methods Fifty-two patients with newly diagnosed OSAS and forty-two subjects without OSAS matched by age and sex were enrolled in the study. OSAS was categorized according to apnea hypopnea index (AHI, event/h) as follows: normal (AHI<5), mild OSAS (AHI 5-15), moderate and severe OSAS (AHI>15). All participants were evaluated by echocardiography to determine PAS and right ventricle functions. PAS was calculated throughout pulmonary artery flow by the formula; PAS (kHz/sec) = maximal frequency shift/acceleration time. Results Demographic and clinical parameters were similar in both groups. PAS significantly increased in OSAS compared with the control group (26.9 ± 6.1 vs. 18.0 ± 3.5, P < 0.001). Additionally, PAS in severe and moderate OSAS was considerably high compared with that in mild OSAS and control group (P < 0.001). Right ventricular myocardial performance index (MPI) and mean pulmonary artery pressures (mPAP) were considerably higher in OSAS group than control group (P < 0.001). Tricuspid E/A, right ventricle tissue Doppler E'/A', and right ventricular ejection time (RVET) decreased in OSAS group compared with control group (P < 0.001). There was a significantly positive correlation between PAS and AHI, mPAP, and MPI (P < 0.001), and a significantly negative correlation between PAS and tricuspid E/A, E'/A', and RVET (P < 0.001). Linear regression analyses showed that PAS was an independent factor for mPAP (ß = 0.595, P = 0.034). Conclusion Elastic properties of pulmonary artery deteriorate with severity of OSAS and may be responsible for right ventricular dysfunctions in OSAS. [ABSTRACT FROM AUTHOR]

Purpose There are different clinical cardiac applications of dual source computed tomography ( DSCT). Here, we aimed to compare the DSCT with the transthoracic echocardiography ( TTE) for evaluating the Wilkins score and planimetric mitral valve area ( MVA) of a rheumatic stenotic mitral valve. Materials and Methods We prospectively evaluated mitral valvular structure and function in 31 patients with known mitral stenosis undergoing electrocardiogram-gated, second-generation DSCT, in our heart center for different indications. Mitral valve was evaluated using Wilkins score, and also, the planimetric MVA was assessed. Results We found a significant difference between MVAs determined by DSCT (average 1.42 ± 0.44 cm2) and MVAs determined by TTE (average 1.35 ± 0.43 cm2; difference 0.07 ± 0.16 cm2; P = 0.018). Linear regression analysis revealed a good correlation between the two techniques (r = 0.934; P < 0.0001). The limits of agreement for DSCT and TTE in the Bland-Altman analysis were ±0.31 cm2. DSCT using TTE as the reference enabled good discrimination between mild and moderate-to-severe stenosis and had an area under the ROC curve of 0.967 ( CI 0.912-1.023; P < 0.0001). Wilkins scores obtained by DSCT (7.51 ± 1.17, range 5-10) and TTE (8.16 ± 1.27, range 6-10) had a moderate correlation (r = 0.686; P < 0.0001). Conclusion We found that planimetric MVA measurements assessed by DSCT were closely correlated with MVA calculations by TTE. The moderate correlation was observed for the Wilkins score. [ABSTRACT FROM AUTHOR]

Objective This study aims to investigate the effects of antenatalmagnesium sulfate on intestinal blood flow in preterm neonates. Study Design In this prospective case–match study, 25 preterm neonates exposed to magnesium sulfate antenatally were included (study group). Overall, 25 gestational age–matched neonates who had no exposure to magnesium constituted the control group. Serial daily Doppler flow measurements of superior mesenteric artery (SMA) were performed. The time to reach full feeds, first meconium passage were assessed. Presence of feeding intolerance or necrotizing enterocolitis was recorded. Results Blood flow velocities of SMA were not different between the groups during the first five postnatal days. However, SMA blood flow showed an increasing trend in the control group unlike the study group (control group, p < 0.001; study group, p ¼ 0.29). There was no significant difference between the two groups regarding the time to reach full feeds or first meconium passage and presence of feeding intolerance. No case of necrotizing enterocolitis was seen. Conclusion Antenatal magnesium does not significantly affect intestinal blood flow, but it seems to attenuate the increasing trend of the intestinal blood flow in the early postnatal days. However, this study failed to show any impact of this finding on clinical outcomes. [ABSTRACT FROM AUTHOR]

Purpose Transesophageal echocardiography ( TEE) has a pivotal role in invasive cardiology practice in terms of guiding a variety of procedures. It is challenging to perform TEE examination with sedated patients due to difficulties in cooperation and positioning the patient properly, therefore the risk of complications is escalated. We aimed to assess the impact of pediatric TEE probe utilization on procedural success and complication rates; in comparison with conventional adult TEE probe. Methods Fifty-eight patients undergoing atrial fibrillation ( AF) ablation with TEE guidance were enrolled and patients were grouped based on probe size: Group 1 (n = 35) included patients undergoing the procedure with adult TEE probe guidance and Group 2 (n = 23) included patients with pediatric TEE probe guidance. Procedural success, postprocedural odynophagia and periprocedural intra-oral bleeding frequency, number of intubation attempts, TEE imaging time, and midazolam doses for both groups were compared. Results Odynophagia frequency was significantly higher in Group 1 (25.7% [n = 9] vs. 0%, P = 0.008) besides oral mucosal bleeding was also higher in Group 1, although the difference did not reach statistical significance (5.7% [n = 2] vs. 0%, P = 0.513). Number of repeated attempts was lower in Group 2 (median, 1; range [3-1] vs. 1, [1-1], P = 0.038). Image resolutions and septal puncture success rates were similar for both groups. Total imaging time with TEE was significantly shorter in Group 2 (6.4 ± 1.8 min vs. 3.6 ± 0.9 min, P < 0.001). Midazolam dose was lower in Group 2 (7.0 ± 1.7 vs. 6.2 ± 1.7, P = 0.065). Conclusion Using TEE probes with smaller size for guiding invasive percutaneous procedures performed in cardiac catheterization laboratory decreased TEE-associated complication rates and enhanced patient comfort without any negative effect on procedural success. [ABSTRACT FROM AUTHOR]

Objectives: Children with Turner syndrome (TS) are at increased risk of cardiovascular disease (CVD), but associations with subclinical CVD are not well-characterized. The purpose of this study was to assess myocardial function using strain imaging (SI) by echocardiography in children with TS and without known CVD. Methods: The study included 48 children with TS aged 4-16 years and 20 healthy control children. Children with TS were excluded if they had a cardiac malformation, a decreased left ventricular (LV) systolic function, or any chronic disease. Each child had an echocardiographic examination with conventional echocardiography and one-dimensional longitudinal strain (1DST) echocardiography. Results: Septal and lateral systolic strain (S) and strain rate (SR) values, which are indicative of longitudinal myocardial function, were significantly decreased in TS patients. However, LV ejection fraction (LVEF) and LV fractional shortening (LVFS) was not significantly different between groups. LV mass index (LVMi), interventricular septum (IVS) thickness, LV posterior wall (LVPW) thickness, and left atrial (LA) diameter index were significantly higher in TS children compared to controls. Peak transmitral flow velocity in late diastole (peak A) was significantly higher, whereas peak transmitral flow velocity in early diastole (peak E), deceleration time (DT), and the ratio of early to late diastolic filling were significantly lower, in TS patients. Conclusion: Reduced LV systolic S and SR in children with TS may indicate early myocardial dysfunction before any detectable change in LVEF. [ABSTRACT FROM AUTHOR]

Objective: Total atrial conduction time (TACT) is the most important parameter in predicting the development of newonset atrial fibrillation. We investigated the effect of cilostazol therapy on TACT in patients with peripheral artery disease. Methods: Thirty patients with peripheral artery disease were treated with cilostazol (200 mg/day) for 6 months. The baseline echocardiographic total atrial conduction time parameter was compared with the 6-month follow-up. Results: The TACT duration was decreased in all patients compared with the baseline after therapy (121.8 ± 19.3 vs. 109.1 ± 15.9 milliseconds, p<0.001). However, left atrial (LA) diameter was not changed with the therapy. The reduction of TACT duration was correlated with the increase in mitral E wave velocity/mitral A wave velocity ratio (r=-0.48, p<0.003). Conclusion: Our results showed that 200 mg cilostazol treatment decreased TACT duration in patients with peripheral artery disease, which may also prevent the development and/or recurrence of atrial fibrillation (AF). [ABSTRACT FROM AUTHOR]

Background Pulmonary hypertension ( PH) is an important complication in the natural history of chronic obstructive pulmonary disease ( COPD) and is caused by the remodeling of pulmonary arteries impairing the distensibility and stiffness of the major pulmonary arteries. Objectives To evaluate the pulmonary artery distensibility by transthoracic echocardiography in patients with COPD. Method We prospectively investigated COPD male patients and compared with healthy controls. In addition to right ventricle ( RV) conventional echocardiographic parameters, right pulmonary artery fractional shortening( RPA- FS) and new pulmonary artery stiffness ( PAS) parameters were compared. Results Fifty-four COPD patients participated in the study and compared with a control group consisting of 24, all men, healthy, nonsmoking subjects. Six patients were excluded from study due to poor quality of echocardiographic recordings. The distensibility of PA evaluated by the RPA- FS parameter was found to be significantly lower in patients with COPD than it was in normal subjects (13.3 ± 8.1 vs. 27.6 ± 4.9,P :< 0.001) and correlated positively with tricuspid annular systolic excursion ( TAPSE) (r = 0.566, P < 0.001) and pulmonary acceleration time (r = 0.607, P < 0.001) and correlated inversely with pulmonary artery systolic pressure (r = −0.587, P < 0.001), PAS(r = −0.479, P < 0.001) and functional capacity (r = −0.586, P < 0.001). Similar to this, PAS found to be impaired in COPD patients (29.5 ± 13.6 vs. 15.7 ± 4.1, P < 0.001) and correlated inversely RPA- FS (r = −0.479, P < 0.001). There were statistically significant difference for pulmonary artery distensibility ( RPA- FS) and PAS parameters among the COPD subgroups with regard to NYHA functional capacity (P < 0.001). Conclusion In this study, we found that PAS and distensibility were worsened in COPD patients and correlated with decreased functional capacity. [ABSTRACT FROM AUTHOR]

Rationale: Carbon monoxide (CO) poisoning is associated with direct cardiovascular toxicity. In mild CO poisoning in which cardiovascular life support is not required, the effects of CO on left and right ventricular functions are unknown in patients without cardiac failure. Objectives: Echocardiography was used to determine whether or not mild CO poisoning impairs ventricular function. Twenty otherwise healthy patients with CO poisoning and 20 age- and gender-matched controls were studied. Echocardiographic examinations were performed at the time of admission and 1 week after poisoning. Results: The impairment observed in the left and right ventricular diastolic function at the time of admission was greater than the impairment 1 week after poisoning. Mild CO poisoning did not have a significant effect on systolic function. Carboxyhemoglobin levels were positively correlated with left ventricular diastolic dysfunction, whereas the levels were not correlated with right ventricular diastolic function. Conclusions: In CO intoxication, the development of left and right ventricular diastolic dysfunction precedes systolic abnormality. Patients with mild CO poisoning do not manifest cardiovascular symptoms; however, it should be borne in mind that most of these patients have myocardial involvemen [ABSTRACT FROM AUTHOR]

Background: Quantitative assessment of the right ventricular ( RV) function in atrial septal defect ( ASD) patients before and after closure remains difficult. The aim of this study was to assess the regional RV function in ASD patients, to evaluate the extent and time course of RV remodeling following ASD closure, and to investigate whether any regional difference exists in RV remodeling. Methods: Twenty patients with ASD and 20 age-matched controls were included. All underwent standard echocardiography and two-dimensional strain ( S) and strain rate ( SR) imaging by speckle tracking before, and 24 hours and 1 month after the defect closure. Results: Right ventricular S was higher in ASD patients except apical lateral segment S, which was lower when compared with controls. There was no difference in RV SR between ASD patients and controls. RV septal S and SR, and lateral SR decreased in 24 hours after the procedure and remained the same at 1 month. RV lateral basal and mid S decreased and apical S increased in 24 hours after the closure. All 3 segments showed some more increase at 1 month. RV apical S showed strong correlations with systolic pulmonary artery pressure and global RV systolic function indices. Conclusions: Chronic volume overload in ASD patients causes alterations in RV deformation. Percutaneous closure results in rapid remodeling and normalization of RV deformation. The major geometrical and deformational changes are completed in 24 hours. Lateral wall S seems to reflect the RV deformational changes due to volume loading and unloading better than SR in ASD patients. [ABSTRACT FROM AUTHOR]

Background: The prevalence of obesity is increasing in the developed and developing world. It is an independent risk factor for heart failure. Left ventricular (LV) diastolic dysfunction has been demonstrated to be a strong predictor of heart failure. In the present study we aimed to assess the impact of body weight on LV diastolic function. Methods: The study was conducted on 2,228 participants (1,424 women, 804 men with a mean age of 49). Traditional and tissue Doppler echocardiographic examination were performed in all of the participants. The demographic and echocardiographic data were compared. Multivariate logistic regression analysis was used to assess the independent predictors of association of LV diastolic function. The study sample was divided into four groups: group 1 (body mass index [BMI] < 25.0 kg/m2), group 2 (BMI 25.0-29.9 kg/m2), group 3 (BMI ≥ 30-39.9 kg/m2), and group 4 (BMI ≥ 40 kg/m2). Results: Septal E was significantly lower in groups 2 and 3 compared to group 1 (P = 0.003). Septal A and septal A' were significantly higher whereas septal E' and lateral E' were significantly lower in the groups 2, 3, and 4 compared to the normal weight group (P < 0.001). Lateral A', deceleration time, and ejection time were significantly higher in obese when compared to the normal weight (P = 0.025, P < 0.001, and P = 0.009, respectively). The E/E' ratio was significantly higher in groups 2, 3, and 4 compared to the group 1 (P < 0.001). Logistic regression analysis revealed that age, BMI (OR = 1.060 [95% CI = 1.040 and 1.080]; P < 0.001), hypertension, and diabetes mellitus were independent predictors of LV diastolic dysfunction. Conclusion: BMI is an independent predictor of LV diastolic dysfunction along with age, hypertension, and diabetes mellitus. (Echocardiography 2012;29:647-651) [ABSTRACT FROM AUTHOR]

Background: P-wave dispersion (P dispersion), defined as the difference between the maximum and the minimum P-wave duration (P minimum), and maximum P-wave duration (P maximum) have been used to evaluate the discontinuous propagation of sinus impulse and the prolongation of atrial conduction time respectively. The aim of this study was to investigate whether early assessment of P dispersion predicts paroxysmal atrial fibrillation (AF) in patients with acute anterior wall myocardial infarction (MI).Methods: We prospectively evaluated 147 consecutive patients (45 women, 102 men; aged 55 +/- 9 years) with a first acute anterior wall MI. All patients were evaluated by echocardiography to measure the left atrial diameter and left ventricular ejection fraction (LVEF). Electrocardiography was recorded from all patients on admission and every day during hospitalization.Results: AF occurred in 25 patients. In 122 patients, AF did not occur. P maximum was found to be significantly higher in patients with AF than in patients without AF (115 +/- 17.3 ms vs 101 +/- 14.7 ms, P = 0.001). P dispersion also was significantly higher in patients with AF than in patients without AF (50 +/- 12.5 ms vs 43 +/- 10.1 ms, P = 0.01). There was no significant difference between the two groups in P minimum (64 +/- 12.5 ms vs 59 +/- 11.7 ms, P = 0.057). The echocardiographically left atrial diameters were not significantly higher in the patients with AF than those without (25 +/- 3.38 mm and 23 +/- 3.36 mm, respectively, P = 0.76). LVEF was found to be significantly different in the patients who developed AF and in those who did not (37.96 +/- 6.18% vs 47.70 +/- 6.01%, P = 0.0001).Conclusions: Although P maximum and P dispersion are significant predictive factors of AF in patients with acute anterior wall MI in the univariate analysis, on the basis of multivariate analysis, only age and LVEF were independent predictive parameters for AF. [ABSTRACT FROM AUTHOR]