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Spontaneous echocardiographic contrast (SEC) is the presence of smoke-like echoes with a characteristic swirling motion of blood in echocardiography. Previous clinical studies have demonstrated that SEC is a risk factor for left atrial thrombus formation and an important indicator of potential systemic embolism originated from heart. An established relation exists between the inflammatory status and the prothrombotic state. Therefore, we investigated the role of inflammatory status on SEC in patients with mitral stenosis (MS). A total of 62 consecutive patients with MS who undergoing mitral balloon valvuloplasty were enrolled in the present study. The patients were divided into 2 groups according to the formation of SEC in the left atrium. Of the 62 patients, 32 (mean age 45 ± 12 years; 75% women) were in the SEC-negative group and 30 patients (mean age 45 ± 11 years; 63% women) were in the SEC-positive group. The high-sensitive C-reactive protein levels were significantly greater in the SEC-positive group than in the SEC-negative group (3.9 ± 2.2 vs 10.6 ± 6.3, p = 0.024). The neutrophil levels (64.6 ± 9.4 vs 72.6 ± 8.6) were significantly greater in the SEC-positive group, and the lymphocyte levels (24.4 ± 6.9 vs 18.3 ± 6.0) were significantly greater in the SEC-negative group (p = 0.001 for each). The neutrophil/lymphocyte (N/L) ratio was also significantly greater in the SEC-positive group (3.0 ± 1.8 vs 4.5 ± 1.8, p = 0.003). In the receiver operating characteristics curve analysis, a N/L ratio > 3.1 mg/dl had a 80% sensitivity and 72% specificity in predicting SEC in patients with MS. On multivariate analysis, high-sensitive C-reactive protein (odds ratio [OR] 1.235, 95% confidence interval [CI] 1.040 to 1.466; p = 0.016), N/L ratio (OR 1.461, 95% CI 0.977 to 2.184; p = 0.02), left atrial volume (OR 3.012, 95% CI 1.501 to 5.611; p = 0.001), and mitral valve area (OR 0.135, 95% CI 0.020 to 0.503; p = 0.017) were independent risk factors of SEC in patients with MS. In conclusion, the high-sensitive C-reactive protein and N/L ratio were independently associated with SEC in patients with MS., (Crown Copyright © 2012. Published by Elsevier Inc. All rights reserved.)

Red cell distribution width (RDW) was found to be a prognostic marker in heart failure patients. The aim of the study was to investigate the relationship between RDW and echocardiographic parameters in diastolic heart failure (DHF). Seventy-one consecutive DHF patients (26 men) and 50 controls (21 men) were included in the study. All of the study population underwent echocardiographic evaluation, and blood samples were obtained. RDW and N-terminal pro-B-type natriuretic peptide (NT-proBNP) values were significantly higher, whereas there was an increasing trend for high-sensitivity C-reactive protein levels in DHF patients than those in controls (p<0.001, p<0.001, and p=0.064, respectively). All of the echocardiographic parameters evaluating diastolic function were more deteriorated in the DHF group. Patients who had an RDW value greater than the cutoff point also had higher NT-proBNP levels, an elevated ratio of mitral peak velocity of early diastolic filling to early diastolic mitral annular velocity, and increased estimated pulmonary capillary wedge pressures by tissue Doppler parameters, but lower creatinine clearance (p<0.05 for all). According to the cutoff values calculated using receiver operating characteristic analysis, RDW>13.6% and NT-proBNP>125pg/mL have high diagnostic accuracy for predicting DHF. RDW values were increased in the DHF population. Our results suggest that the high RDW levels in patients with DHF may be related to increased neurohormonal activity, impaired renal functions, and elevated filling pressure, but not to increased inflammation., (Copyright © 2012. Published by Elsevier B.V.)

Objective: The aim of the study was to investigate the effect of intragastric balloon therapy on left ventricular function and left ventricular mass in a cohort of morbidly obese patients. Subjects and Methods: A prospective trial was performed in a cohort of 17 class II and class III morbidly obese individuals. The intragastric balloon was retained in the stomach for an average of 6 months. Conventional and tissue Doppler echocardiography were performed in all patients before and after the procedure. Results: The mean age of the study participants was 36 ± 10 years (range: 18-55). The mean body mass index was significantly decreased following the intragastric balloon insertion procedure (44 ± 8 vs. 38 ± 5, p < 0.001). The left ventricular mass index and left atrial volume index were significantly decreased following the procedure (112 ± 21 vs. 93 ± 17, p = 0.001 and 20 ± 6 vs. 14 ± 5, p = 0.02, respectfully). In addition, the ratio of mitral peak early diastolic velocity to tissue Doppler-derived peak diastolic velocity and tissue Doppler echocardiography-derived left ventricular myocardial performance index were decreased significantly following the procedure (9.5 ± 1.9 vs. 7.7 ± 1.5, p = 0.002 and 0.57 ± 0.11 vs. 0.46 ± 0.06, p = 0.001, respectively). Conclusions: Intragastric balloon therapy resulted in significant weight reduction in morbidly obese patients. This weight reduction was associated with improved left ventricular function. © 2015 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Objectives We aimed to investigate whether coronary sinus ( CS) dilatation develops in patients with mitral stenosis ( MS) and to demonstrate its relationship with the global myocardial performance of the right ventricle ( RV). Methods We enrolled 34 patients with MS who underwent echocardiography after exhibiting typical symptoms (31 female; mean age 41 ± 12 years) and 20 age- and sex-matched controls without MS who underwent echocardiography (16 female; mean age 38 ± 13 years). The RV myocardial performance index ( MPI) was detected using tissue Doppler echocardiography ( TDE), and maximum CS diameter was measured from the posterior atrioventricular groove in the apical four-chamber view during the ventricular systole. Results The RV MPI was significantly higher in the MS group compared to the control group (0.60 ± 0.11 vs. 0.41 ± 0.08, P < 0.001). Moreover, the maximum CS dimension was higher in the MS group compared to the control group (8.5 ± 1.1 mm vs. 6.5 ± 1.4 mm, P < 0.001). The maximum CS dilatation was positively correlated with the RV MPI (r = 0.691; P < 0.001). Conclusion The RV MPI, which represents both systolic and diastolic functions, is increased in patients with MS and correlates with CS dilatation. [ABSTRACT FROM AUTHOR]

Aims The aim of this study was to investigate the effects of spironolactone on left ventricular ( LV) remodeling in patients with preserved LV function following acute myocardial infarction ( AMI). Methods and Results Successfully revascularized patients (n = 186) with acute ST elevation MI ( STEMI) were included in the study. Patients were randomly divided into three groups, each of which was administered a different dose of spironolactone (12.5, 25 mg, or none). Echocardiography was performed within the first 3 days and at 6 months after MI. Echocardiography control was performed on 160 patients at a 6-month follow-up. The median left ventricular ejection fraction ( LVEF) increased significantly in all groups, but no significant difference was observed between groups ( P = 0.13). At the end of the sixth month, the myocardial performance index ( MPI) had improved in each of the three groups, but no significant difference was found between groups (F = 2.00, P = 0.15). The mean LV peak systolic velocities (Sm) increased only in the control group during the follow-up period, but there is no significant difference between groups (F = 1.79, P = 0.18). The left ventricular end-systolic volume index ( LVESVI) and the left ventricular end-diastolic volume index ( LVEDVI) did not change significantly compared with the basal values between groups (F = 0.05, P = 0.81 and F = 1.03, P = 0.31, respectively). Conclusion In conclusion, spironolactone dosages of up to 25 mg do not augment optimal medical treatment for LV remodeling in patients with preserved cardiac functions after AMI. [ABSTRACT FROM AUTHOR]

Objectives: To determine both ventricular functions and tissue Doppler echocardiography (TDE)-derived myocardial performance index (MPI) in patients with coronary artery ectasia (CAE). Subjects and Methods: Twenty-five patients with CAE (13 men; mean age 57 ± 9 years) and 25 age- and sex-matched controls without CAE (8 men; mean age 54 ± 10 years) were enrolled in the study. Left and right ventricular functions were detected using conventional echocardiography and TDE. Results: Left ventricle-lateral wall (0.61 ± 0.17; 0.50 ± 0.10, p = 0.02), interventricular septum (0.66 ± 0.17; 0.52 ± 0.10, p = 0.007) and mean MPI (0.63 ± 0.15; 0.51 ± 0.09, p = 0.004) were increased in the CAE group compared to the control group. Right ventricular MPI was similar in both the CAE and control groups (0.58 ± 0.18; 0.52 ± 0.19, p > 0.05). Conclusion: The findings show that left ventricular MPI is different in CAE patients without obstructive coronary artery disease compared to the normal control group. Also in these patients, right ventricular MPI was similar to the control group. Copyright © 2011 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: We aimed to investigate the circadian rhythm on left ventricular (LV) function and infarct size, according to the onset of ST elevation myocardial infarction (STEMI), with echocardiography in patients with first STEMI successfully revascularised with primary percutaneous coronary intervention (PCI).Methods: We conducted a retrospective analysis of 252 STEMI patients. Patients were divided into the four, six-hour periods of the day. Conventional and tissue Doppler imaging (TDI) echocardiography were performed within 48hours after onset of chest pain. The average of peak systolic myocardial velocities (Sm) in each of the four myocardial segments and LV ejection fraction (LVEF) were calculated.Results: A negative linear correlation was shown between CK-MB levels and Sm (r= -0.209, p=0.001). There was an oscillation between time of day and average of Sm. The lowest Sm and largest infarct size were in the period of 06:00-noon compared with period of noon-18:00 and 18:00-midnight (p=0.029 and p=0.031, respectively). A secondary analysis showed that both LVEF and Sm were lower in the midnight-noon group compared with the noon-midnight group (44.9±7.3% versus 47.3±7.9%, p=0.018, and 7.6±1.4cm/s versus 8.2±1.6cm/s, p=0.003, respectively).Conclusions: This study has shown that there was a circadian rhythm of infarct size and LV function evaluated by echocardiography according to time of STEMI onset. The largest infarct size and poor LV function occurred in the midnight-noon period, in particular in the 06:00-noon period. [ABSTRACT FROM AUTHOR]

Purpose. A case of complete atrioventricular block associated with rivastigmine use is presented. Summary. A 67-year-old Turkish woman with Alzheimer's disease was admitted to the hospital because of dizziness and syncope. Her medical history included diagnoses of hypertension (treated with amlodipine 5 mg daily) and diabetes mellitus (treated with nateglinide 120 mg daily). She had been taking both drugs for over five years. She had also been taking rivastigmine 6 mg p.o. daily for five months for the treatment of Alzheimer's disease. She had experienced dizziness since the onset of rivastigmine therapy but had not reported it to any health care provider. On admission, she had a blood pressure measurement of 90/60 mm Hg and a pulse rate of 34 beats/min. A 12-lead electrocardiogram revealed complete atrioventricular block. Echocardiography results, blood electrolyte levels, and cardiac biochemical markers were normal. After initial evaluation, a temporary transvenous pacemaker was implanted via the right femoral vein. Amlodipine and rivastigmine were discontinued. On the first day of hospitalization, a coronary angiogram revealed normal coronary anatomy. Two days later, the complete atrioventricular block resolved spontaneously to sinus rhythm. Rivastigmine 6 mg p.o. daily was reinitiated, and complete atrioventricular block recurred on the fourth day of therapy. A VVI permanent pacemaker was implanted on the fifth day of hospitalization. Amlodipine and rivastigmine were reinitiated. The patient continued rivastigmine 6 mg p.o. daily after permanent pacemaker implantation. A three-month follow-up appointment revealed that no further syncope episodes or dizziness had occurred. Conclusion. A 67-year-old woman developed complete atrioventricular block after receiving rivastigmine for the treatment of Alzheimer's disease. [ABSTRACT FROM AUTHOR]