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Patients with migraine with aura are at an increased risk of cardiovascular disease. There are limited data on arterial stiffness in migraine patients with aura. The present study evaluated arterial stiffness in these patients using the cardio-ankle vascular index (CAVI). This prospective study included 50 patients with migraine with aura (43 female, mean age 38.9 ± 9.9 years). The patient group was matched for age and gender with 50 healthy individuals with no history of migraine (43 female, mean age 39.3 ± 10.3 years). All patients and control subjects underwent a comprehensive clinical evaluation by an experienced neurologist and were interviewed about their headache histories. There was no significant difference in baseline demographic characteristics and echocardiographic parameters between migraine with aura patients and the control group. Both right and left CAVI values were significantly higher in the patients with migraine with aura (6.5 ± 1.2 vs 6.1 ± 0.7, P = .043 and 6.6 ± 1.2 vs 6.1 ± 0.7, P = .009, respectively). Arterial stiffness is an important mediator of cardiovascular diseases. We found that CAVI, a novel marker of the arterial stiffness, is increased in patients with migraine with aura., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Competing Interests: Funding Support and Author Disclosures The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Background: Hypertension (HT) is a disease associated with endothelial dysfunction which is related to some adipokines and pro- and anti-inflammatory cytokines., Aims: Our aim was to investigate roles of apelin, omentin-1, and vaspin in essential HT and to evaluate their relationships with other pro- and anti-inflammatory cytokines, trace elements, and oxidative stress. We also investigated these parameters to determine asymptomatic target organ damage period and grading essential hypertension., Methods: One hundred fifty-three patients diagnosed with essential hypertension and 45 healthy controls were included in the study. Hypertension was defined as a systolic blood pressure > 140 mmHg and/or a diastolic blood pressure > 90 mm Hg or current use of an antihypertensive medication. The patients who had secondary HT, other chronic metabolic, cardiovascular, cerebrovascular diseases were excluded. History and physical exam including detailed cardiovascular examination were performed in all participants. Adipokines, cytokines, trace elements, lipid peroxidation, and ischemia-modified albumin levels were measured in blood samples by biochemical methods., Results: Vaspin, IL-4, IL-8, IL-10, selenium, and zinc levels were significantly lower in the HT group compared to healthy controls while omentin-1, TNF-α, copper, iron, MDA, SOD, and IMA-C levels were significantly higher in HT patients compared to controls. Multiple ordinal regression revealed that TNF-α, IL-10, and body mass index of patients were statistically significant independent predictors (P = 0.024, P = 0.019, and P = 0.032, respectively) for grading of HT. IL-4 and IL-10 were significantly higher in patients with asymptomatic target organ damage, compared to patients without asymptomatic target organ damage (P = 0.032 and P = 0.015, respectively). Our findings suggest that adipokines apelin, omentin, and vaspin may be involved in hypertension by a complex interaction with the anti- and pro-inflammatory cytokines, trace elements, and oxidative stress pathways.

Objective: Thrombosis of a hemodialysis arteriovenous fistula (AVF) is a serious complication that needs urgent treatment. Most cases are treated surgically, but recently, endovascular strategies have become a viable alternative. This study is an evaluation of the success and patency rate of percutaneous balloon angioplasty of thrombosed hemodialysis fistulas using a drug-coated balloon (DCB) contrasted with a standard balloon (SB)., Methods: The data of 33 patients with a thrombosed native hemodialysis AVF treated percutaneously in a tertiary care center were analyzed retrospectively. Success of the procedure was defined as restoration of flow with less than 30% residual stenosis and resumption of dialysis through the hemodialysis AVF. The success rate of the procedure and the patency rate at 1, 6, and 12 months were evaluated. The effect on patency of a DCB was compared to that of a SB., Results: Twenty-five radiocephalic and 8 brachiocephalic thrombosed hemodialysis AVFs were treated during the study period. Flow was restored in 23 thrombosed fistulas, a success rate of 69.7%. The patency rate of successfully treated fistulas was 95.6% at 1 month, 76.1% at 6 months, and 57.9% at 12 months. Ten of the 23 re-established AVFs were treated with a DCB and the remainder were treated with a SB. The patency of the fistulas treated with a DCB was similar to that of a SB at 1 month (100% vs 92.3%, respectively; p=0.393). The patency rate of a DCB was greater than that of a SB at 6 months (88.9% vs 66.7%, respectively; p=0.258) and 12 months (75% vs 45.4%, respectively; p=0.219)., Conclusion: Percutaneous intervention for thrombosed hemodialysis AVFs is a safe, minimally invasive, and effective procedure. There was a positive trend in the patency rate of patients treated with a DCB at 6 and 12 months compared with a SB.

Objective: This study assessed whether high levels of iodide administered during percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) differentially influenced thyroid function compared to PCI for non-complex coronary lesions., Subjects and Methods: A total of 615 patients were enrolled in the study; 205 underwent elective PCI for CTO lesions (Group I) and 410 underwent elective PCI for non-complex lesions including non-CTO, non-bifurcation, non-calcified, and non-tortuous lesions (Group II). Patients were monitored for development of incidental thyroid dysfunction between 1 and 6 months after PCI., Results: The patients in Group I were administered a median of 255 mL of contrast medium during PCI for CTO; a median of 80 mL was administered to the patients in Group II during non-complex PCI (p =0.001). Ten (5.4%) of the 186 euthyroid patients in Group I and 19 (5%) of the 379 eu-thyroid patients in Group II developed subclinical hyper-thyroidism (p = 0.854). However, 7 (50%) of the 14 subclinical hyperthyroid patients in Group I and only 3 (12%) of the 25 subclinical hyperthyroid patients in Group II developed overt hyperthyroidism (p = 0.019)., Conclusion: In euthyroid patients, PCI for coronary CTO lesions did not increase the risk for subclinical hyperthyroidism when compared to PCI for non-complex coronary lesions. However, in patients with subclinical hyperthyroidism at baseline, PCI for coronary CTO lesions significantly increased the development of overt hyperthyroidism when compared to PCI for non-complex coronary lesions., (© 2019 The Author(s) Published by S. Karger AG, Basel.)

Competing Interests: The authors declare no conflict of interest.

Objective: It is still debatable whether diagnostic coronary angiography (CA) or percutaneous coronary interventions (PCIs) increase radiation exposure when performed via radial approach as compared to femoral approach. This question was investigated in this study by comparison of dose-area product (DAP), reference air kerma (RAK), and fluoroscopy time (FT) among radial and femoral approaches., Methods: All coronary procedures between November 2015 and November 2017 were assessed; and 4215 coronary procedures were enrolled in the study. Patients with bifurcation, chronic total occlusion, cardiogenic shock, or prior coronary artery bypass surgery were excluded. These 4215 procedures were evaluated for three different categories: diagnostic CA (Group I), PCI in patients with stable angina (Group II), and PCI in patients with ACS (Group III)., Results: Age was significantly higher in the femoral arm of all groups. Among patients in the radial arm of Groups I and II, males were over-represented. Therefore, a multiple linear regression analysis with stepwise method was performed. After adjusting these clinical confounders, there was no significant difference with regard to DAP, RAK, and FT between femoral and radial access in Group I. In contrast, PCI via radial access was significantly associated with increased DAP, RAK, and FT in Groups II and III., Conclusion: In spite of an increased experience with trans-radial approach, PCI of coronary lesions via radial route was associated with a relatively small but significant radiation exposure in our study. Compared to femoral access, diagnostic CA via radial access was not related to an increased radiation exposure.

Objective: Identification of the asymptomatic target organ damage (AOD) helps to stratify the overall risk of cardiovascular (CV) diseases and guides a treatment decision in hypertensive patients without a symptomatic CV or renal disease. The endothelial-cell-specific molecule 1 (endocan) is regarded as a novel marker of endothelial dysfunction. Its release is increased in hypertensive patients, especially those with symptomatic CV and renal disease. In the present study, we aimed to evaluate the endocan levels in asymptomatic hypertensive patients with or without AOD., Methods: The study included 132 asymptomatic hypertensive patients, and 101 of who had at least one AOD., Results: Serum endocan levels did not differ between patients with and without AOD (3.81±0.78 vs. 3.83±0.63 ng/mL, p=0.88). An analysis according to the presence of any specific AOD did not show any difference between groups. No significant correlation was found between serum endocan levels and any of the continuous variables related to AOD, such as the pulse pressure, carotid intimae-media thickness, cardio-ankle vascular index, ankle-brachial index, left ventricular mass index, Sokolow-Lyon index, Cornell voltage-duration product, and estimated glomerular filtration rate., Conclusion: Endocan may not serve as a useful biomarker at asymptomatic vascular stages of hypertension, despite its role in indicating disease severity and inflammatory activation in advanced symptomatic CV and renal disease.

Aim: Transradial access (TRA) for coronary intervention is increasingly used in current clinical practice. The aim of the present study was to evaluate the hypothesis that cutaneous analgesia before TRA for coronary intervention at a puncture site 30 minutes before puncture can reduce patient discomfort and the incidence of radial artery spasm (RAS)., Methods: Patients (n=104) undergoing planned coronary interventions using TRA were prospectively randomized to receive either 1 mL of 1% lidocaine subcutaneously (n=52) (control group) or subcutaneous lidocaine plus 5% lidocaine cream (n=52) cutaneously 30 minutes before puncture (treatment group). The primary endpoint was angiographically or clinically confirmed RAS. Secondary endpoints were the occurrence of patient discomfort in the forearm during the procedure and access-site crossover to the femoral artery. Patient discomfort was quantified with a visual analogue scale (VAS) score., Results: Fifty-two patients in the treatment group (60.5±9.4 years of age and 16 female) and 52 patients in the control group (60.4±9.7 years of age and 16 female) were included in the final analysis. Radial artery spasm occurrence decreased in the treatment group compared to the control group (26.9% vs 9.6%; p=0.04) accompanied by a VAS score of 3.7±1.8 in the treatment group and 4.9±2.0 in the control group; p=0.02. The access site crossover rate did not differ between the groups (7.6% vs 21.1%; p=0.09)., Conclusion: Cutaneous analgesia before TRA for coronary interventions is associated with a substantial reduction in the RAS and the procedure-related level of patient discomfort.

Background: Xanthelasma palpebrarum (XP) is associated with increased risk of ischemic heart disease and myocardial infarction independent of other well-known cardiovascular risk factors. Cardio-ankle vascular index (CAVI) is a novel index of arterial stiffness and important marker of subclinical atherosclerosis. The purpose of this study was to investigate the association between XP and CAVI in asymptomatic subjects., Methods: Consecutive 50 subjects with XP and age-gender matched 50 control subjects were enrolled. Patients with known atherosclerotic vascular disease were excluded. Arterial stiffness was assessed by CAVI and defined as abnormal if CAVI is ≥ 8., Results: Subjects with XP had higher mean CAVI than control subjects (8.05 ± 1.72 vs. 6.76 ± 1.18, p < 0.001). Frequency of abnormal CAVI was higher in subjects with XP (n = 27) compared to those without XP (n = 9, 54 vs. 18 %, p < 0.001). There was a significant correlation between XP and CAVI (r = 0.42, p < 0.001). Conditional logistic regression analysis showed that XP (odds ratio OR 8.80, 95 % confidence interval CI 2.63-29.49, p < 0.001) and age (OR 1.17, 95 % CI 1.08-1.26, p < 0.001) were independent predictors for abnormal CAVI., Conclusion: The study suggests that XP is associated with increased arterial stiffness in asymptomatic subjects.

Background: The main aim of the current study was to investigate the association between presystolic wave (PSW) and subclinical left ventricular (LV) dysfunction., Patients and Methods: A total of 139 patients admitted to the cardiology outpatient clinic with hypertension were consecutively enrolled. The patient population included 79 men and 60 women. The presence of a PSW on the left ventricular outflow tract flow was evaluated in all patients. Subclinical LV dysfunction was defined as the presence of a tissue Doppler-derived myocardial performance index (MPI) of at least 0.5 in the absence of impaired left ventricular ejection fraction (<50%) as evaluated by transthoracic echocardiography., Results: The mean age of the patients was 52±10. Patients with PSW had higher MPI (0.44±0.13 vs. 0.37±0.09, P<0.001), left ventricular mass (LVM) (176±45 vs.142±33, P<0.001), and LVM index values (92±23 vs. 76±17, P<0.001) compared with those without PSW. Patients with PSW had a higher prevalence of subclinical LV dysfunction (29 vs. 3.4%, P: 0.008) and LV hypertrophy (22 vs. 2%, P: 0.011). There was a significant correlation with PSW velocity and age (r=0.22, P: 0.04), LVM (r=0.24, P: 0.021), late diastolic mitral annular velocity (r=0.25, P: 0.018), and an inverse correlation with the Em : Am ratio (r=-0.34, P: 0.001). Binary logistic regression analysis indicated the presence of PSW (95% confidence interval 1.3-8.031, odds ratio 3.2, P: 0.012) as an independent determinant of abnormal MPI., Conclusion: Assessment of presystolic wave on echocardiography was an independent predictor of subclinical LV dysfunction in patients with hypertension. Attention to the PSW on echocardiography examination might help to identify hypertension patients who could be at risk for developing overt heart failure that has a prognostic impact.

Objective: In the present study, we aimed to compare the amount of epicardial adipose tissue in subjects with and without xanthelasma., Subjects and Methods: Fifty-two subjects with xanthelasma and 52 age- and gender-matched control subjects were enrolled in this study. Epicardial adipose tissue was assessed by measuring epicardial fat thickness (EFT) with echocardiography. Participants were dichotomized according to median EFT, which was 4 mm. The group with EFT >4 mm was defined as the supramedian group. Body mass index (BMI) was calculated by weight (kilograms) divided by height (meters) squared. Conditional logistic regression analysis was performed to find independent factors associated with supramedian EFT (>4 mm)., Results: Subjects with xanthelasma had higher BMI (31.2 ± 5.6 vs. 28.6 ± 5.7, p = 0.01) and higher levels of total cholesterol (216 ± 54 vs. 181 ± 42 mg/dl, p < 0.001), LDL cholesterol (142 ± 45 vs. 115 ± 36 mg/dl, p = 0.003) and triglycerides (median, 154 vs. 101 mg/dl, p = 0.01) than control subjects. EFT was significantly higher in subjects with xanthelasma than in controls (5.04 ± 2.02 vs. 3.81 ± 2.03 mm, p = 0.002). In the conditional logistic regression analysis, the presence of xanthelasma (OR, 3.55; 95% CI, 1.43-8.78, p = 0.006) and lower HDL cholesterol level (OR, 0.96; 95% CI, 0.92-0.99, p = 0.023) were independently associated with supramedian EFT., Conclusion: The amount of epicardial adipose tissue found in subjects with xanthelasma was higher than in subjects without xanthelasma. In addition, the presence of xanthelasma was independently associated with supramedian EFT., (© 2015 S. Karger AG, Basel.)

Objective: The aim of this study was to evaluate the left (LV) and right (RV) ventricular function in euthyroid Hashimoto's thyroiditis (eHT) patients., Subjects and Methods: Forty-five patients diagnosed with eHT and 45 age- and gender-matched control subjects were enrolled in this study. Echocardiographic parameters reflecting RV and LV functions such as chamber dimensions, ejection fraction, fractional shortening, conventional and tissue Doppler-derived early and late filling velocities (E, A, E', A'), isovolumic relaxation (IVRT) and contraction (IVCT) times, ejection time (ET), deceleration time (DT), Tei index, pulmonary acceleration time (PAcT) and tricuspid annular plane systolic excursion (TAPSE) of patients with eHT were compared to those of control subjects using the paired-samples t test or Wilcoxon signed-rank test., Results: Regarding the LV function, compared to the controls patients with eHT had a higher LV-Tei index (0.6 ± 0.2 vs. 0.4 ± 0.1, p < 0.001), higher DT (p < 0.001) and IVRT (p < 0.001) values, and higher E/E' ratios (p = 0.04). In contrast, the peak E wave velocity (p = 0.02), E/A ratio (p = 0.01) and ET (p = 0.02) were significantly lower in the eHT group than amongst the controls. The RV, Tei index (0.40 ± 0.11 vs. 0.28 ± 0.07, p < 0.001), TAPSE (2.0 ± 0.3 vs. 2.2 ± 0.2 mm, p < 0.001), PAcT (124.3 ± 22.6 vs. 149.4 ± 18.3 ms, p < 0.001), A' (p = 0.007) and IVCT (p = 0.001) were significantly higher in patients with eHT than the controls. However, the tricuspid E/A ratio (p = 0.01), E' (p = 0.03) and E'/A' ratio (p = 0.001) were significantly lower in the eHT patients than the control group., Conclusions: This study demonstrated that both RV and LV functions were impaired in patients with eHT., (© 2015 S. Karger AG, Basel.)

Background: CHA2DS2-VASc score is the most widely preferred method for prediction of stroke risk in patients with atrial fibrillation. We hypothesized that CHA2DS2-VASc score may represent atrial remodeling status, and therefore echocardiographic evaluation of left atrial electromechanical remodeling can be used to identify patients with high risk., Methods: A total of 65 patients who had documented diagnosis of paroxysmal atrial fibrillation (PAF) were divided into three risk groups according to the CHA2DS2-VASc score: patients with low risk (score=0, group 1), with moderate risk (score=1, group 2), and with high risk score (score ≥2, group 3). We compared groups according to atrial electromechanical intervals and left atrium mechanical functions., Results: Atrial electromechanical intervals including inter-atrial and intra-atrial electromechanical delay were not different between groups. However, parameters reflecting atrial mechanical functions including LA phasic volumes (Vmax, Vmin and Vp) were significantly higher in groups 2 and 3 compared with group 1. Likewise, LA passive emptying volume (LATEV) in the groups 2 and 3 was significantly higher than low-risk group (14.12±8.13ml/m(2), 22.36±8.78ml/m(2), 22.89±7.23ml/m(2), p: 0.031). Univariate analysis demonstrated that Vmax, Vmin and Vp were significantly correlated with CHA2DS2-VASc score (r=0.428, r=0.456, r=0.451 and p<0.001). Also, LATEV (r=0.397, p=0.016) and LA active emptying volume (LAAEV) (r=0.281, p=0.023) were positively correlated with CHA2DS2-VASc score. In the ROC analysis, Vmin≥11ml/m(2) has the highest predictive value for CHA2DS2-VASc score ≥2 (88% sensitivity and 89% specificity; ROC area 0.88, p<0.001, CI [0.76-0.99])., Conclusion: Echocardiographic evaluation of left atrial electromechanical function might represent a useful method to identify patients with high risk., (Copyright © 2015 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.)

Objective: Oxidative stress plays a major role in the development of atherosclerosis. However, the relationship between oxidative stress and complexity and intensity of coronary artery disease is less clear. The aim of this study is to assess the relationship between oxidative stress markers and the complexity and intensity of coronary artery disease in patients with acute coronary syndrome (ACS)., Methods: Sixty-seven consecutive patients with an early phase of ACS (<3 h) were included in this single-centre, cross-sectional, prospective study. Syntax and Gensini scores were calculated based on angiographic findings. Patients were divided into two CAD complexity groups according to their Syntax scores: low SYNTAX score (<22) and moderate to high SYNTAX score (>=22). Likewise patients were divided into two CAD severity groups according to the median Gensini score of 64: less intensive CAD with Gensini score (<64) and intensive CAD with Gensini score >=64. Blood samples were taken in 1 hour within administration in order to measure total oxidative status (TOS) and total antioxidant capacity (TAC) levels determined by Erel method. Oxidative stress index (OSI) was calculated by TOS /TAC., Results: There was no significant difference between the two SYNTAX groups for oxidative stress markers. Median TOS and OSI values were significantly high in the intensive CAD group (p=0.005, p=0.04, respectively). The Gensini score was positively correlated with TOS and OSI (p=0.003, p=0.02, respectively)., Conclusion: Oxidative stress markers may be considered supportive laboratory parameters related to CAD intensity but not complexity in ACS patients.

Objective: The"no-reflow" phenomenon is associated with a worse prognosis at follow-up for patients with acute ST-segment elevation myocardial infarction (STEMI). Predicting and preventing no-reflow is therefore a crucial step in improving the prognosis of STEMI patients. The purpose of this study was to investigate the association between aortic valve sclerosis (AVS) and myocardial no-reflow in patients with STEMI., Patients and Methods: Patients with a first-time diagnosis of STEMI were enrolled consecutively. No-reflow was defined as a final TIMI 3 flow with a myocardial blush of grade < 2, temporary epicardial coronary no-reflow, and distal coronary occlusion. AVS was defined by echocardiography as thickening and calcification of the normal trileaflet aortic valve without obstruction to the left ventricular outflow., Results: No-reflow developed in 41 patients. In univariate analysis, age, male gender, smoking, culprit lesion Syntax score (SX score), and hypertension were significantly associated with no-reflow. Multivariate binary logistic regression analyses demonstrated age [95 % confidence interval (CI), 1.024-1.096; p=0.001), AVS (95 % CI, 1.002-1.100; p=0.039], culprit lesion SX score (95 % CI, 1.08-1.021 p=0.008), and symptom-to-balloon time (95 % CI, 1.020-1.097; p=0.002) as independent determinants of myocardial no-reflow., Conclusion: AVS was significantly and independently associated with myocardial no-reflow in STEMI patients.

Objective: The aim of the present study was to investigate the association between nitrate-induced headache (NIH) and the complexity of coronary artery lesions in patients with stable coronary artery disease (CAD)., Subjects and Methods: Two hundred and seventy-five patients with anginal chest pain who underwent coronary angiography were enrolled in the present study. NIH was defined as the presence of headache due to nitrate treatment (isosorbide mononitrate 40 mg) after excluding confounding factors. Coronary artery lesion complexity was assessed by the SYNTAX score (SXscore) using a dedicated computer software system., Results: The mean SXscore was lower in the patients with NIH than in patients without NIH (7.3 ± 5.2 vs. 14.4 ± 8.5, respectively; p < 0.001). Additionally, patients with NIH had a lower rate of multivessel disease compared with those without NIH (the mean number of diseased vessels was 1.5 ± 0.7 and 2.0 ± 07, respectively; p < 0.001). In multivariate analysis, increasing age (p = 0.02) and headache (p = 0.001) were found to be independent determinants of SXscore., Conclusion: The present study demonstrated an independent inverse association between NIH and SXscore. The NIH could provide important predictive information about coronary artery lesion complexity in patients with stable CAD., (© 2015 S. Karger AG, Basel.)

Objective: The purpose of the present study was to investigate the relation between aortic valve sclerosis (AVS) and coronary artery lesion complexity as assessed using the SYNTAX score (SxScore) in acute coronary syndrome (ACS) patients., Patients and Methods: A total of 164 patients with a first time diagnosis of acute coronary syndrome were consecutively enrolled. AVS was defined by echocardiography as thickening and calcification of the normal trileaflet aortic valve without obstruction to the left ventricular outflow. The SxScore was calculated using dedicated computer software., Results: There were significantly higher SxScores in subjects with AVS than those without AVS (18 ± 6 vs 12 ± 5, p = 0.02). In the univariate analysis, age (p = 0.03) and presence of AVS (p = 0.007) were significantly associated with higher SxScores. Logistic regression analysis demonstrated AVS [95 % confidence interval (CI) 0.17-0.86, p = 0.017] and age (95 % CI 1.01-1.21, p = 0.028) as independent determinants of higher SxScores., Conclusion: Aortic valve sclerosis was significantly and independently associated with a high SxScore in acute coronary syndrome patients.

Background: QT dispersion (QTd) is a predictor of ventricular arrhythmia. Ventricular arrhythmia is an important factor influencing morbidity and mortality in patients with aortic stenosis. Surgical aortic valve replacement reduced the QTd in this patients group. However, the effect of transcatheter aortic valve implantation (TAVI) on QTd in patients with aortic stenosis is unknown. The aim of this study was to investigate the effect of TAVI on QTd in patients with aortic stenosis., Methods: Patients with severe aortic stenosis, who were not candidates for surgical aortic valve replacement due to contraindications or high surgical risk, were included in the study. All patients underwent electrocardiographic and echocardiographic evaluation before, and at the 6(th) month after TAVI, computed QTd and left ventricular mass index (LVMI)., Results: A total 30 patients were admitted to the study (mean age 83.2 ± 1.0 years, female 21 and male 9, mean valve area 0.7 ± 3 mm(2)). Edwards SAPIEN heart valves, 23 mm (21 patients) and 26 mm (9 patients), by the transfemoral approach were used in the TAVI procedures. All TAVI procedures were successful. Both QTd and LVMI at the 6(th) month after TAVI were significantly reduced compared with baseline values of QTd and LVMI before TAVI (73.8 ± 4 ms vs. 68 ± 2 ms, P = 0.001 and 198 ± 51 g/m(2) vs. 184 ± 40 g/m(2), P = 0.04, respectively). There was a significant correlation between QTd and LVMI (r = 0.646, P < 0.001)., Conclusions: QTd, which malign ventricular arrhythmia marker, and LVMI were significantly reduced after TAVI procedure. TAVI may decrease the possibility of ventricular arrhythmia in patients with aortic stenosis.

The main aim of the present study was to investigate the association between epicardial adipose tissue (EAT) and arterial function in patients with asymptomatic hypertension. Patients with hypertension (n = 155) were enrolled consecutively. Patients with decreased arterial compliance (AC) and increased cardioankle vascular index (CAVI) had higher EAT values compared with those with normal AC and CAVI (6.23 ± 1.67 vs 4.91 ± 1.40, P < .001 and 6.02 ± 1.61 vs 4.96 ± 1.46, P = .01, respectively). Analysis using the receiver-operating characteristics curve demonstrated that EAT 5.5 mm constitutes the cutoff value for the presence of increased CAVI with 67% sensitivity and 62% specificity (area under the curve [AUC]: 0.702, 95% confidence interval [CI] 0.590-0.814) and decreased AC with 77% sensitivity and 65% specificity (AUC: 0.756, 95% CI 0.645-0.867). Assessment of EAT during echocardiography examination may provide information on arterial function in patients with asymptomatic hypertension. The link between EAT and arterial stiffness deserves further investigation., (© The Author(s) 2013.)

Objective: The main purpose of present study was to investigate the impact of percutaneous closure of atrial septal defect (ASD) on right ventricular (RV) systolic function assessed by tricuspid annular isovolumic myocardial acceleration (IVA) that is independent of preload and afterload changes., Methods: A prospective cohort study was designed involving twenty five patients with secundum type ASD whom were successfully closed percutaneously between 2009 and 2011. Standard transthoracic echocardiography and tissue Doppler imaging were performed in all patients 12 to 24 hours before and one month after closure. Paired t test was performed to determine the statistical significance of variables before and after closure., Results: Significant decreases were observed in RV end-diastolic diameter, RV/left ventricular (LV) end-diastolic diameter ratio, right ventricular systolic myocardial velocity (Sm), right ventricular early myocardial velocity (Em) and right ventricular late myocardial velocity (Am) in the control echocardiography in the first month when compared with pre-procedure values. While significant increase was observed after procedure in right ventricular IVA (3.4 ± 1.3 m/sec2 vs. 4.2 ± 1.8 m/sec2, p=0.001), no significant change was observed in right ventricular global performance index, in right ventricular Em/Am ratio and left ventricular ejection fraction., Conclusion: Percutaneous closure of ASD resulted in recovery of right ventricular function as early as 1 month after closure.

Objectives: The major determinant of final infarct size for a given coronary occlusion is the size of the myocardial area-at-risk. We propose herein a new index 'Relative Importance Index (RII)' to predict area-at-risk in patients with anterior myocardial infarction (MI). The aim of the study was to assess the predictive value of RII in left ventricle (LV) systolic function reduction and its relation to adverse clinical outcome., Study Design: One hundred twenty-three acute anterior MI patients with their first acute coronary syndrome incident were consecutively and prospectively enrolled in to the study. RII was calculated by dividing the culprit segment diameter by the sum of diameters of the left anterior descending, circumflex, and right coronary arteries at their proximal segments. We evaluated the one-month follow-up rates of major clinical endpoints, which were defined as death, non-fatal MI, stroke, and new congestive heart failure (CHF)., Results: RII was significantly and negatively correlated with left ventricular ejection fraction (LVEF) (r=-0.65, p<0.001). Likewise, RII was significantly correlated with 72 hour troponin I (TnI) (r=0.48, p<0.001). Patients were dichotomized according to the median value of RII (median RII: 0.30). Supra-median RII was associated with lower EF (32.8±8.6 vs. 42.8±9.4, p<0.001) and higher incidence of composite major adverse cardiac events (33.9% vs. 13.1%, p=0.01). The mortality, non-fatal MI and new CHF rates in the supra-median RII group trended higher but they did not reach statistical significance. An RII >0.30 had an 88% sensitivity and 60% specificity (ROC area: 0.82, p<0.001, CI: 0.73-0.90) for predicting severe LV dysfunction (LVEF<30%)., Conclusion: A simple index derived from coronary angiography at the time of primary percutaneous coronary intervention can predict LV systolic function loss and adverse clinical outcome in patients with acute anterior MI.

The diagonal earlobe crease (ELC) has been regarded as a simple marker of atherosclerosis. There is no knowledge concerning the relation of ELC to the presence, extent, and severity of peripheral arterial disease (PAD). Patients (n = 253) without known atherosclerotic vascular disease and symptoms were enrolled consecutively. Ankle brachial index (ABI) was measured. Patients with ELC had lower ABI compared to those with no ELC (1.02 ± 0.12 vs 1.11 ± 0.08, P < .001). Multivariate analysis demonstrated ELC (95% confidence interval [CI]: 3.3-21.9; P: .001) and age (95% CI: 0.87-0.99; P = .02) as independent determinants of abnormal ABI. There was incremental increased frequency of ELC from normal ABI to significant PAD. We have shown for the first time a significant and independent association between presence of ELC and increased prevalence, extent, and severity of PAD in patients without overt atherosclerotic vascular disease.

Objective: Increased arterial stiffness is a predictor of cardiovascular events. The cardio-ankle vascular index (CAVI) is a measure of arterial stiffness. The stroke volume (SV) to pulse pressure (PP) ratio is an estimate of arterial compliance (AC). The main purpose of this study was to investigate the association between echocardiography-derived AC and arterial stiffness., Methods: One hundred and forty asymptomatic hypertensive patients were enrolled consecutively. AC was calculated as SV/PP and adjusted to body surface area to calculate the SV/PP index (SV/PPi). Arterial stiffness was assessed by a VaSera-1000 CAVI instrument., Results: There was statistically significant negative correlation between SV/PPi and CAVI (r=-0.402; P<0.001). Multivariate binary logistic regression analysis demonstrated SV/PPi as an independent predictor of increased CAVI (CAVI≥9) (95% confidence interval: 0.001-0.147; P<0.001). There were lower SV/PPi values in abnormal CAVI groups (CAVI≥9) than normal and borderline CAVI (CAVI<9) (0.68±0.23 vs. 0.93±0.27; P<0.001). Analysis using the receiver operating characteristic curve has demonstrated that SV/PPi of 0.61 ml/m/mmHg constitutes the cut-off value for the presence of abnormal CAVI with 89% sensitivity and 53% specificity (area under the curve: 0.771, 95% confidence interval 0.674-0.868)., Conclusion: Assessment of AC during echocardiography examination may provide predictive information of increased arterial stiffness in asymptomatic hypertensive patients.

Objective: To investigate the presence of myocardial fibrosis determined by fragmented QRS in patients with severe aortic valve stenosis., Subjects and Methods: Eighty-seven consecutive patients with severe aortic valve stenosis and 83 age- and gender-matched control subjects were enrolled into this study. Severe aortic valve stenosis was defined as an aortic valve area <1 cm(2), a Vmax >4 m/s, or a mean gradient ≥40 mm Hg. Fragmented QRS was assessed using a 12-lead electrocardiogram., Results: Fragmented QRS was detected in 40 (46%) patients in the aortic valve stenosis group and in 15 (18%) control subjects (p < 0.001). In multivariate binary logistic regression analysis, the presence of aortic valve stenosis was the only independent factor associated with fragmented QRS (OR = 3.69; 95% CI 1.81-7.55, p < 0.001)., Conclusion: A higher frequency of fragmented QRS was detected in patients with severe aortic valve stenosis compared to controls., (© 2013 S. Karger AG, Basel.)

Transcatheter aortic valve implantation (TAVI) is now considered a viable alternative therapy to surgery in patients with severe symptomatic aortic stenosis, considered to have a high risk for surgery. Herein, we present a case of severe aortic stenosis treated with transfemoral aortic valve implantation and complicated by complete atrioventrciular block and left main coronary artery obstruction that was successfully managed with permanent pacemaker implantation and left main coronary artery stenting. Although less invasive, TAVI can be associated with major complications. Therefore, extra care is required when performing TAVI in patients with borderline valve to coronary ostia distance., (Copyright © 2013 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.)

Purpose: Coronary artery calcification (CAC) is an indicator of coronary atherosclerosis and is associated with future adverse cardiac events. Isolated coronary artery ectasia (CAE) is defined as localized or diffuse dilation of the coronary arteries without coronary stenosis. The aim of this study was to assess the relationship between CAC and isolated CAE., Methods: Thirty-four patients with isolated CAE and 50 controls subjects, with normal coronary arteries, were enrolled in the study. Baseline demographic features and atherosclerosis risk factors were similar in both groups., Results: Patients with CAE had higher total CAC than control subjects (84±111 vs. 33.5±103.5; p<0.001). There was also a significant correlation between per-segment CAC and ectatic segment length (r=0.32; p=0.01) but no correlation with diameter (r=0.09; p=0.5)., Conclusion: Patients with isolated CAE had higher CAC than control subjects, suggesting that atherosclerosis may be involved in the pathogenesis of isolated CAE. Patients with isolated CAE may have increased cardiovascular risk and should receive appropriate risk stratification and relevant medical treatment.

Objective: Although aortic valve sclerosis (AVS) and atherosclerosis may share same atherosclerotic process, there is still a controversy whether AVS may be related to atherosclerotic and nonatherosclerotic processes. The purpose of present study was to investigate this relation., Methods: In this cross-sectional and observational study, we enrolled 60 patients diagnosed with AVS and risk factor matched 76 subjects without AVS. Applanation tonometry was applied to assess the augmentation index and aortic pulse-wave velocity (PWV). Control and AVS group were examined by B-mode ultrasound to measure the intima-media thickness (IMT). Continuous variables were compared using unpaired t-test and Mann-Whitney U test. Logistic regression analysis was performed in order to find independent predictors of AVS., Results: PWV and augmentation index did not differ between control and AVS groups (11.2±3.6 vs 12±3.2, p=0.18 and 26±7.6 vs 27±9.8, p=0.2 respectively). But IMT was significantly higher in AVS group than in control one (0.76 mm±0.17 vs 0.6 mm±0.16; p<0.001). There was a significant positive bivariate correlation between the presence of AVS, IMT (r=0.43, p<0.001), male gender(r=0.31, p<0.001), augmentation index (r=0.17, p:0,04), and age (r=0.36, p<0.001). Logistic regression analysis demonstrated that only IMT (OR: 1.46, 95% CI: 1.1-1.9, p=0.009) and age (OR: 1.1, 95% CI: 1.01-1.16, p=0.013) were independent predictors of AVS., Conclusion: Increased IMT but not PWV in subjects with AVS compared to control group may suggest that, AVS is probably a multifactorial disease, related to the both atherosclerotic and nonatherosclerotic processes.

Most patients with peripheral arterial disease (PAD) are asymptomatic and have similar vascular morbidity and mortality with patients with symptomatic PAD. Despite being a very highly prevalent disease, physicians underdiagnose and undertreat PAD. A total of 100 participants with aortic valve sclerosis (AVS) and 100 participants without AVS and age-, gender-, and cardiovascular risk factor-matched participants were enrolled. Ankle-brachial index (ABI) and AVS were evaluated by handheld Doppler device and echocardiography, respectively. There was significantly lower ABI in participants with AVS compared with those without AVS (1.04 ± 0.14 v 1.11 ± 0.07, P = .001). There was a negative correlation between ABI and AVS (r = -.29, P < .001). Linear regression analysis demonstrated an independent association between ABI and AVS (95% confidence interval [CI]: -0.91 to -0.27, P < .001) and β-blocker use (95% CI: -0.96 to -0.02, P: .04). Our findings confirm an association between AVS and PAD that may be attributed to shared vascular risk factors.

Objective: To investigate whether or not patients with subclinical hypothyroidism (SH) have increased epicardial adipose tissue (EAT)., Subjects and Methods: Sixty-one patients with newly diagnosed SH and without any known cardiovascular disease were enrolled. Twenty-four subjects matched for age, gender and body mass index without any thyroid dysfunctions were included as a control group. The EAT was measured by echocardiography and thyroid functions were assessed by routine blood examination., Results: Patients with SH had higher EAT values than control subjects (3.6 ± 0.9 vs. 2.8 ± 1.4, p = 0.005). Also, SH patients with thyroid-stimulating hormone (TSH) ≥10 mU/l had higher EAT than those with SH with TSH <10 mU/l and control subjects (p = 0.013). In addition, while there was significant correlation between EAT and TSH (r = 0.31, p = 0.014) in patients with SH, there was no significant relation between EAT and TSH in normal subjects (r = 0.09, p = 0.64)., Conclusions: There was a higher level of EAT in patients with SH compared with normal subjects and a significant correlation between EAT and TSH was found., (Copyright © 2012 S. Karger AG, Basel.)

Introduction: Peripheral artery disease (PAD) is a marker of systemic atherosclerosis and most patients with PAD also have concomitant coronary artery disease (CAD)., Aim: There are no published data investigating the relationship between PAD and CAD complexity assessed by a well-accepted classification system such as the SYNTAX score (SS) or Trans-Atlantic Inter-Society Consensus II (TASC II)., Material and Methods: The study population consisted of 72 patients who underwent coronary angiography for the assessment of CAD. At the same session, peripheral angiography was performed in cases of suspected PAD. A coronary lesion was defined as significant if it caused a 50% reduction of the luminal diameter by visual estimation in vessels ≥ 1.5 mm. The SYNTAX score was computed by dedicated software., Results: Patients with peripheral artery disease were divided into four groups according to the Trans-Atlantic Inter-Society Consensus II classification. Numbers of patients with peripheral artery disease classified as A, B, C, and D by the Trans-Atlantic Inter-Society Consensus II classification were 27, 16, 18 and 11, respectively. SYNTAX scores for each group from A to D were 10 ±9, 11 ±10, 24 ±13 and 27 ±12, respectively; p for trend < 0.001., Conclusions: Higher Trans-Atlantic Inter-Society Consensus II classification is associated with higher SYNTAX score in patients who underwent coronary and peripheral diagnostic angiography. It may suggest that arterial atherosclerotic disease complexity is a systemic panvascular phenomenon.

Background: Classic risk scores may under estimate the risk of cardiovascular (CV) events in specific risk groups requiring appropriate medical and interventional treatment. Arterialstiffness has been known as a sign of CV risk and has a predictive value for CV events beyond classic CV risk factors. The purpose of this study was to investigate the relation between thecardio-ankle vascular index (CAVI) that has been recently reported as a new surrogate marker of arterial stiffness and aortic valve sclerosis (AVS)., Methods: Eighty patients with AVS and 80 control subjects were enrolled to the study. Arterial stiffness was evaluated by VaSera-1000 CAVI instrument and AVS was defined by echocardiography as thickening and calcification of the normal trileaflet aortic valve without obstruction to the left ventricular outflow., Results: CAVI was significantly higher in patients with AVS compared to the control subjects (10.5 ± 2.7 vs. 8.6 ± 1.4, p < 0.001). Higher frequency of AVS was detected in patients with abnormal than borderline and normal CAVI values (69% vs. 27% and 20%, respectively, p < 0.001). In univariate analysis, there was a significant association between AVS and CAVI (95% confidence interval [CI] 1.44-2.48, p < 0.001]. Multivariate analysis demonstrated CAVI (95% CI 1.39-2.44, p < 0.001) as an independent determinant of AVS., Conclusions: Detection of increased arterial stiffness could prevent patients from being mistakenly classified as at low or moderate risk, when they actually are at high risk. Assessment of aortic valve during echocardiography examination may offer the opportunity to identify these subjects.

Objective: The aim of this study was to investigate the association between earlobe crease (ELC) and cardio-ankle vascular index (CAVI) in asymptomatic hypertensive subjects., Materials and Methods: A total of 75 subjects with ELC and 75 age- and gender-matched patients without ELC were prospectively selected from subjects admitted to the Outpatient Cardiology Clinic. ELC was assigned to a person with a crease stretching obliquely from the outer ear canal towards the border of the earlobe of at least one ear. CAVI was assessed by a VaSera VS-1000 instrument., Results: There were statistically significant higher CAVI values in ELC subjects (9.8 ± 2.1 vs. 8.6 ± 1.6, p < 0.001). There was a significant and positive association between CAVI and age (r = 0.42, p < 0.001), ELC (r = 0.31, p < 0.001), BMI (0.20, p < 0.001) and male gender (r = 0.21, p = 0.04). Linear regression analysis demonstrated ELC (95% confidence interval, CI, 0.61-1.74, p = 0.009), age (95% CI 0.03-0.09, p < 0.001) and male gender (95% CI 0.48-1.55, p = 0.03) as independent determinants of CAVI. Also, there was a higher prevalence of ELC in subjects with subclinical atherosclerosis (CAVI ≥9) than in normal subjects (CAVI <9)., Conclusion: Patients with ELC had higher CAVI than normal subjects. This observation of ELC is simple, adds no cost and can be easily made by most physicians, and it may provide important predictive information of arterial stiffness and subclinical atherosclerosis in asymptomatic hypertensive subjects. © 2013 S. Karger AG, Basel.

We investigated the relationship between peripheral artery disease (PAD) and coronary artery disease (CAD) complexity in patients with acute coronary syndromes (ACS). Consecutive patients with first time diagnosis of ACS (n = 150) were enrolled. SYNTAX score (SS), a marker of CAD complexity, was assessed by dedicated computer software and diagnosis of PAD was established by ankle-brachial index (ABI) value. SYNTAX score was higher in patients with overt and borderline PAD (ABI ≤ 0.99) than normal participants (ABI 1-1.29; 16.7 ± 8.2 vs 10.1 ± 5.5; P < .001). In addition, there was a strong negative correlation between ABI and SS (r = -.46; P < .001).We have demonstrated increased CAD complexity in patients with ACS and PAD and strong correlation between degree of PAD and coronary lesion complexity.

Objectives: Coronary artery lesion complexity is important for risk stratification of acute coronary syndrome (ACS) patients undergoing cardiac catheterization. SYNTAX score is a pure angiographic measure of anatomic coronary complexity. Chest radiography is a routine examination for evaluating patients with chest pain. There have been no studies to date exploring the relation between aortic knob calcification (AKC) and coronary lesion complexity assessed by SYNTAX score., Study Design: 135 consecutive patients with first time diagnosis of non-ST segment elevation ACS were enrolled. SYNTAX score was calculated by dedicated computer software. Aortic calcification was assessed visually., Results: Patients with AKC had higher SYNTAX score compared to those without AKC (16±6 vs. 11±7, p=0.019). Also, patients with AKC had higher TIMI risk score and were more elderly. Linear regression analysis demonstrated AKC (95% confidence interval [CI] 1.7-6.9, p=0.002), diabetes (95% CI, 1.1-5.7, p=0.005), and smoking (95% CI, 1.2-13.5, p=0.004) as independent determinants of SYNTAX score., Conclusion: Aortic calcification detected on chest X-ray is an independent predictor of complex coronary artery lesions in patients with ACS.

Although rare in adults, coarctation of the aorta can present as an occult cause of cardiomyopathy. In this case report, we describe a 55-year-old man who presented to our clinic with new-onset symptoms of heart failure. Transthoracic echocardiography showed a dilated left ventricle with severely depressed systolic function. Cardiac catheterisation showed no critical coronary artery disease but a severe aortic coarctation just distal to the origin of the left subclavian artery, with a peak-to-peak systolic pressure gradient of 40 mmHg. We successfully implanted a balloon-expandable stent with good angiographic results. The procedure resulted in immediate clinical improvement. Six-months after stent implantation, the patient was free of symptoms and an echocardiographic examination showed completely normalised cardiac size and systolic function.

Objective: Carotid-femoral pulse wave velocity (PWV), the current "gold-standard" measure of arterial stiffness, has emerged as an important independent predictor of cardiovascular events. The increased PWV is recognized as an indicator of atherosclerosis. The relationship between isolated coronary artery ectasia (CAE) and carotid-femoral PWV has not been well-described. The aim of our study was to assess this relation., Methods: Thirty-four patients with isolated CAE without any visible coronary stenosis and 24 control subjects with angiographically normal coronary arteries were enrolled to this cross-sectional observational study. Applanation tonometry was applied to assess the carotid-femoral PWV. Statistical analyses were performed by Mann-Whitney U and Chi-square tests. Multiple linear regression analysis was used for the evaluation of the relations of parameters., Results: The baseline clinical and laboratory parameters of the both groups were similar. Patients with isolated CAE had significantly higher carotid-femoral PWV compared to control subjects (10.5±2.4 vs 9.2±1.7 m/s, p=0.02). In multiple regression analysis, age (beta=0.23, 95% CI=0.001-0.094, p=0.04), number of ectatic vessels (beta=0.24, 95% CI=0.044-1.07, p=0.03), and systolic blood pressure (beta=0.52, 95% CI=0.028-0.1, p=0.001) were found independently related to PWV., Conclusion: We have shown an association between increased carotid-femoral PWV and isolated CAE, suggesting that atherosclerosis may be involved in the pathogenesis of isolated CAE without any coronary stenosis in the adult population.

Objectives: Several studies have demonstrated that inflammation plays a major role in the development of atherosclerosis and that the inflammatory process might also be involved in coronary artery calcification (CAC). The main purpose of this study was to investigate the relation between leucocyte count and CAC and to determine whether a higher leucocyte count could indicate subclinical atherosclerosis in patients without overt cardiovascular disease., Study Design: A total of 284 consecutive patients (156 men, 128 women) without established cardiovascular disease were enrolled. CAC was measured using cardiac computed tomography. Leucocyte count was measured via routine blood examination., Results: Patients with CAC had higher leucocyte counts compared to those without calcification (7.87±1.85 vs. 6.01±1.84; p<0.001). Logistic regression analysis identified the following as independent predictors of CAC: leucocyte count (odds ratio [OR]: 1.7, 95% confidence interval [CI]: 1.3-2.1), smoking (OR: 2.4, 95% CI: 1.2-4.6) and age (OR: 1.2, 95% CI: 1.1-2.3). There was also a significant correlation between CAC and leucocyte count (r=0.57, p<0.001)., Conclusion: We demonstrated that leucocytes may play an important role in the evolution of CAC and may be used in the detection of subclinical atherosclerosis in asymptomatic subjects.

Objective: The aim of our study was to determine the usefulness of the aortic knob width (AKW) in the assessment of subclinical atherosclerosis in hypertensive patients., Methods: In this study on diagnostic accuracy, 374 consecutive hypertensive patients with at least one cardiovascular risk factor were enrolled. AKW was measured on chest X-ray. Cardio-ankle vascular index (CAVI) was measured by VaSera-1000 CAVI instrument. The diagnostic value of AKW was assessed using ROC analysis., Results: There was a significant correlation between aortic knob width and CAVI (r=0.45, p<0.001), age (0.39, p<0.001), systolic (r=0.17, p<0.001), diastolic (r=0.23, p<0.001) and mean (r=0.2, p<0.001) blood pressures. In linear regression analysis CAVI (β=0.3, 95% CI 0.33-0.98, p<0.001), age (β=0.3, 95% CI 0.09 - 0.21, p<0.001) and diastolic blood pressure β=0.2, 95% CI 0.08-1.9, p<0.001) were independently associated with AKW. It was significantly higher in patients with subclinical atherosclerosis (CAVI ≥9) than borderline (8 ≤CAVI <9) (41.4±5.5 versus 36.7±5.3 mm, p<0.001) and healthy (CAVI <8) subjects (41.4±5.5 versus 35.5±4.3 mm, p<0.001). Analysis using the ROC curve has demonstrated that aortic knob of 41 mm constitutes the cut-off value for the presence of subclinical atherosclerosis with 71% sensitivity and 77% specificity (AUC-0.67, 95% CI 0.51-0.82)., Conclusion: Observation of aortic knob on chest X-ray in hypertensive patients may provide important predictive information of subclinical atherosclerosis.

Aims: There is limited data on alterations in novel right ventricular (RV) function indices like tricuspid annular plane systolic excursion (TAPSE) and tricuspid annular systolic velocity (TASV) after transcatheter atrial septal defect (ASD) closure. We aimed to evaluate RV function by echocardiography (ECG) with these novel indices in early period in patients with secundum-type ASD that was closed percutaneously., Methods: Patients were enrolled to study if they had secundum-type ASD that was suitable for percutaneous closure. Patient population consisted of 4 men and 16 women. Echocardiography was performed before and 1 month after closure., Results: Mean age was 37 ± 16. Mean diameter of ASD and total atrial septum length measured by ECG were 19 ± 6 mm and 49 ± 7 mm, respectively. Mean diameter of defect in transesophageal echocardiography was 20 ± 6 mm. Stretched mean diameter in catheterization was 23 ± 6 mm. One month after closure, there were statistically significant decreases in RV end-diastolic diameters (43.3 ± 10.7 mm vs. 34.9 ± 5.5 mm; P < 0.001), RV/left ventricular (LV) end-diastolic diameter ratio (1.1 ± 0.3 vs. 0.87 ± 0.1; P < 0.001), TASV (16.9 ± 3.2 cm/sec vs. 14.3 ± 3.3 cm/sec; P < 0.05), early diastolic tricuspid annular velocity (15.3 ± 3.1 cm/sec vs. 13.4 ± 2.4 cm/sec P <0.05), late diastolic tricuspid annular velocity (16.2 ± 5.4 cm/sec vs. 14.3 ± 6.3 cm/sec; P < 0.05), and TAPSE (29.9 ± 6.2 mm vs. 22.4 ± 7.4 mm; P < 0.001). LV end-diastolic diameter (38.0 ± 6.9 mm and 40.0 ± 4.5 P < 0.05) was increased, whereas there was no change in LV ejection fraction., Conclusion: Closure of ASD by using Amplatzer devices led to decrease in right heart chamber size, tissue Doppler-derived tricuspid annular velocities and TAPSE in early period., (© 2011, Wiley Periodicals, Inc.)