Search

Background: Screening and accurate diagnosis of chronic thromboembolic pulmonary hypertension(CTEPH) are critical for managing the progression and preventing associated mortality; however, there are no tools for this purpose. We developed and validated an artificial intelligence (AI) algorithm for predicting CTEPH using electrocardiography (ECG). Methods: ECG signals were obtained from 54 regular and 23 CTEPH patients to test the technique. A dataset was created by converting the ECG results to digital. The 12-channel ECG signal received from 77 individuals is 924x1300 in size. The end-point was the diagnosis of CTEPH. By applying the suggested Nigerian motif pattern method to this data set, we obtained a feature matrix of 924x15010. FSCmRMR algorithm determined the most influential 947 characteristics among 15010 features and obtained a matrix of 924x947. We used a decision tree, SVM(Support Vector Machine), and KNN(K-Nearest Neighbour )algorithms to classify the selected most weighted features. Results: We achieved 98.05% success with the decision tree algorithm, 99.89% with the SVM algorithm, and 99.67% with the KNN algorithm. AI algorithm focused on each patient's S-wave, P-wave, and T-wave by QRS complex characteristics. Conclusion: The AI algorithm demonstrated high accuracy for CTEPH prediction using 12-lead and single-lead ECGs.

Objectives: We hypothesized that long-term morbidity and mortality can be identified by the presence of comorbidities in patients with carotid artery stenosis. In our study we aimed to investigate the relationship between clinical characteristics, laboratory findings and long-term prognosis in carotid artery stenosis patients after stenting Patients and Methods: We retrospectively enrolled 212 patients whom underwent carotid artery stenting (CAS) between January 2010 and December 2012 at Kartal-Kosuyolu Training and Research Hospital. CAS was performed in symptomatic patients with >60% stenosis and in asymptomatic patients with >80% stenosis of extracranial carotid artery. Symptoms were defined by an ipsilateral cerebral or ocular minor or major ischemic event within the past 6 months. Results: Mean age of study population was 67.4 ± 7.9 years and 158 patients (74.5%) were male. In the follow-up period 18 patients had MI, 18 patients had major stroke, 23 patients had transient ischemic attack. Twenty-one patients (9.9%) died from cerebral-cardiovascular causes. All MACCE was found in 64 patients (30.2%). Multivariate analysis revealed that age (OR: 1.09, 95% CI: 1.02-1.17, p = 0.05), heart failure (OR: 3.78, 95% CI: 1.48-9.62, p = 0.005), creatinine (OR: 3.54, 95% CI: 1.16-10.82, p=0.026) and neutrophil-lymphocyte ratio (OR: 2.88, 95% CI: 1.90-4.36, p < 0.0001) were independent predictors of the MACCE. Conclusion: Although, the short-term risk of patients undergoing CAS dominated by lesion-related factors, pre-existing comorbidities may be even more important for the long-term event. Age, heart failure, creatinine and neutrophil-lymphocyte ratio were found as the most important risk factors of MACCE.

Purpose: To test the hypothesis of a possible association between platelet reactivity and the severity of diabetic retinopathy using Multiplate whole blood aggregometry in type 2 diabetes mellitus patients. Methods: Of 157 patients were divided to three groups based on the severity of diabetic retinopathy (normal, non-proliferative and proliferative [ordinal among group 1-2-3]). Platelet reactivity was measured using arachidonic acid response to the ASPI and ADP platelet test. The association between DR stage and the degree of platelet reactivity (predictor variable) ASPI, ADP, systolic blood pressure, age, hypertension, body mass index (BMI), HbA1c, creatinine, Microalbumin, platelet, triglyceride/HDL and Hscrp variables were evaluated using ordinal logistic regression models (Model 1). The association between DR presence (outcome variable (group 1 vs group 2 and 3)) and the presence of variables was evaluated using binary logistic regression models (Model 2). Results: A comparison of the laboratory parameters of the three groups revealed that the ASPI, ADP, glucose and HbA1c values were significantly higher in Group-3 than Group-1. ASPI (odds-ratio OR: 1.044[1.021-1.09], p

Introduction Periprocedural myocardial necrosis, which can range from a low level elevation of cardiac biomarkers to a large myocardial infarction (MI), is a common complication after percutaneous coronary intervention (PCI). Aim We hypothesized that insulin-like growth factor-1 (IGF-1) levels may play a protective role in myocardial injury after coronary stent placement and aimed to investigate the relationship between IGF-1 levels and plaque characteristics assessed by optical coherence tomography (OCT). Material and methods Between May 2015 and December 2015 we prospectively enrolled 74 patients with stable angina pectoris in whom single de novo coronary artery stenosis was present. PCI was performed according to standard methods. OCT was applied to all patients. TnT was analyzed at admission, before PCI and at 6, 12, 24 and 48 h after PCI. Serum IGF-1 was measured prior to PCI. Results A total of 25 (33.7%) patients had periprocedural myocardial injury or type 4a myocardial infarction, and 49 (66.2%) patients had no events. IGF-1 level and reference intimal thickness, medial thickness, and plaque fibrous cap thickness in OCT had strong correlations (r = 0.88, 0.80 and 0.88 respectively, p < 0.001). IGF-1 was an independent predictor of periprocedural myocardial injury or type 4a MI in univariate (OR = 0.929, 95% CI: 0.895-0.964, p < 0.001) and multivariate regression analysis (OR = 0.757, 95% CI: 0.575-0.998, p = 0.04). Based on ROC analysis, the best cut-off value of IGF-1 for predicting periprocedural myocardial injury or type 4a myocardial infarction was 144.5 ng/ml, with a maximum sensitivity of 88% and specificity of 77.6% (AUC = 0.80, 95% CI: 0.69-0.88, p < 0.0001). Conclusions The results from this study indicate that low IGF-1 levels are associated with plaque instability assessed by OCT. Low IGF-1 levels may identify patients who are at increased risk for periprocedural myocardial injury/infarction.

Introduction:Thepurpose of this study was to evaluate left ventricular myocardial mechanicsusing 2-dimensional speckle tracking echocardiography (2D-STE) during normal,uncomplicated pregancy and postpartum term.Patientsand Methods: In this prospective, longitudinal study, 86 healthypregnant women who underwent serial 2 dimensional echocardiographic evaluationduring each trimester (trimester one 8-12 weeks; trimester two 20-24 weeks,trimester three 32-36 weeks, and postpartum 10-14 weeks). Two-dimensional STEwas performed to measure global left ventricular longitudinal, circumferential,and radial strain (GLS, GCS, and GRS, respectively).Results: GLS showeda decrease during pregnancy (for first trimester 21.0 ± 2.1%; for secondtrimester 19.9 ± 1.8%; for third trimester 18.2 ± 2.1; for postpartum 19.1 ±1.4, p< 0.001). GCS was significantly reduced during pregnancy (p= 0.033)and peaked as the same value in the first trimester. GRS remained unchangedthroughout the pregnancy and labor (p= 0.033).Conclusion: This study gives normalranges of 2D indices in pregnancy. 2D STE demonstrated that LV longitudinal andcircumferantial strain are significantly reduced, whereas radial strainremained unchanged., Giriş: Bu çalışmanın amacı sağlıklı gebelerde, gebelik süresince ve sonrasında solventrikül fonksiyonlarındaki değişimi “iki boyutlu speckle trackingekokardiyografi (STE)” yöntemi ile araştırmaktır.Hastalar veYöntem: Çalışmaya 86 sağlıklı gebe dahil edilmiş ve gebeliğinbirinci trimester 8-12 hafta, ikinci trimester 20-24 hafta, üçüncü trimester32-36 hafta ve postpartum 10-14. haftada 2 boyutlu ekokardiyografi ilekayıtları alınmıştır. Sol ventrikül global longitüdinal strain (SV-GLS), solventrikül global radiyal strain (SV-GRS), sol ventrikül global sirkumferansiyelstrain (SV-GCS) değerleri not edilmiştir. Bulgular: SV-GLS birinci trimester için -%21.0 ± 2.1; ikinci. trimester için -%19.9 ±1.8; üçüncü trimester için -%18.2 ± 2.1; postpartum -%19.1 ± 1.4, p< 0.001).SV-GCS gebelik boyunca anlamlı olarak azalırken (p= 0.033), post partum dönemde1.ci trimesterde bulunan değerlerine yükseldi. SV-GRS değerlerinde gebelikboyunca değişiklikler istatistiksel olarak anlamlı bulunmadı (p= 0.103).Sonuç: Bu çalışmada STE iledeğerlendirilen, SV-GLS ve SV-GCS ile mekanik fonksiyonlarının anlamlı birşekilde değiştiğini ve SV-GRS’de bir değişim olmadığını saptadık.

Introduction: The aim of this study was to use speckle-tracking echocardiography (STE) for identifying subclinical global systolic function abnormalities in chronic asymptomatic alcoholic patients with a normal ejection fraction. Patients and Methods: We included 30 healthy subjects (age 34.8 ± 5.8 years) and 75 asymptomatic alcoholic patients (age 39.8 ± 6.5 years) and divided them into two groups according to their total lifetime dose of ethanol (TLDE): group I (TLDE < 15 kg ethanol/kg body weight) and group II (TLDE ≥ 15 kg ethanol/kg body weight). In the two-dimensional (2D)-STE analysis, the left ventricular (LV) global longitudinal strain (G-LS), longitudinal global strain rate in systole (G-SRsys), longitudinal global strain rate in early diastole (G-SRearly) and longitudinal global strain rate in late diastole (G-SRlate) values were obtained. Results: Alcoholic patients had larger end-systolic and end-diastolic dimensions, thicker interventricular septal and posterior wall and higher LV mass index. However, there were no differences in the end-systolic and end-diastolic dimensions and LV mass index among them. The ejection fraction did not differ between the groups. The G-LS values were lower in alcoholic patients (p< 0.001). G-LS was found to be significantly lower among alcoholic patients, although the LV mass index and LV dimensions remained unchanged. Although G-SRsys was lower in alcoholic patients compared with that in controls (p= 0.03), there were no differences in the G-SRearly and G-SRlate values. There was a significant correlation between G-LS values and TLDE (r= 0.49, p< 0.001). Conclusion: To the best of our knowledge, this is the first study demonstrating the presence of early functional abnormalities of longitudinal systolic function by 2D-STE in chronic alcoholic patients. These functional mechanics have a parallel impairment with the increase in alcohol consumption.

OBJECTIVES We aimed to determine the effects of normal pregnancy on left atrial (LA) mechanics using 2-dimensional speckle-tracking echocardiography. METHODS A total of 47 healthy women with singleton pregnancies were prospectively enrolled in this study. A total of 4 visits, including each trimester and postpartum at 6 months, were planned. Echocardiographic studies were performed with a Vivid 7 device equipped with a 2.5-MHz transducer (GE Vingmed Ultrasound AS, Horten, Norway). RESULTS Although the LA reservoir phase strain showed a gradual decrease from the first trimester to the third trimester during pregnancy, the measurements in the postpartum period were found to return to initial levels (mean ± SD: first trimester, 40.3% ± 11.7%; second trimester, 37.5% ± 12.9%; third trimester, 33.5% ± 9.0%; postpartum, 42.1% ± 11.1%; P < .001). The LA pump function strain was also parallel to the LA reservoir strain and gradually decreased from the first trimester to the third trimester during pregnancy, and it was observed that rose to the initial level in the postpartum period (first trimester, 16.7% ± 7.4%; second trimester, 14.8% ± 5.5%; third trimester, 12.7% ± 4.3%; postpartum, 15.8% ± 5.5%; P < .001). CONCLUSIONS We prospectively determined normal reference values for LA deformation parameters using speckle-tracking echocardiography in each trimester and the postpartum period in healthy pregnancy. These reference values may help identify subclinical LA dysfunction in several cardiovascular or systemic conditions. According to this study, these parameters decreased toward the third trimester during pregnancy and recovered in the postpartum period.

Hepatit Cvirüsü (HCV) tedavisinde peginterferon (Peg-IFN)2b ve ribavirin tedavisi konvansiyonel interferon veribavirin tedavisinden daha etkilidir. Peg-IFN ve ribavirin tedavisinin önemlietkilerinin yanında ateş, halsizlik, heyecan, huzursuzluk, nötropeni ve trombositopenigibi bir çok yan etki görülebilir. Ayrıca kardiyak aritmiler ve senkop gibinadir olaylar da Peg-IFNtedavisine bağlı gelişebilir. Bizler bu çalışmada Peg-IFN ve ribavirin tedavisi sırasında presenkop atağı vereenteran taşikardilerin en sık formu olan atriyoventriküler nodal reenterantaşikardi gelişen bir yoğun bakım hastasını sunuyoruz., Thetreatment of hepatitis C virus (HCV) with peginterferon (Peg-IFN) α2b andribavirin is more effective than with conventional interferon and ribavirin.Despite the important effects of Peg-IFN and ribavirin therapy, many sideeffects, such as fever, fatigue, anxiety, irritability, neutropenia andthrombocytopenia, may be observed. In addition, cardiac arrhythmias and syncopeare rare consequences of Peg-IFN therapy. In this study, we report an intensivecare unit patient who developed atrioventricular nodal reentrant tachycardia(AVNRT), which is the most common type of reentrant supraventriculartachycardia, and presyncopal attack during Peg-IFN and ribavirin therapy.

Resumen Introduccion y objetivos La ecocardiografia con speckle tracking bidimensional es un nuevo instrumento para evaluar la funcion del miocardio. El objetivo de este estudio fue evaluar los parametros de rotacion y strain del ventriculo izquierdo mediante la ecocardiografia con speckle tracking bidimensional en un gran grupo de adultos sanos de una amplia gama de edades, con objeto de establecer los valores de referencia de dichos parametros y determinar la influencia de la edad, el sexo y los factores hemodinamicos. Metodos Se realizaron ecocardiografias transtoracicas a 247 voluntarios sanos (139 mujeres; media de edad, 44 ± 16 [intervalo, 18-80] anos). Efectuamos determinaciones de los valores de strain sistolico maximo longitudinal, circunferencial y radial, asi como de la rotacion y el giro del ventriculo izquierdo. Resultados Los valores medios de strain total longitudinal, radial y circunferencial fueron –21,5% ± 2,0%, 40,1 ± 11,8% y –22,2 ± 3,4%, respectivamente. El strain longitudinal fue significativamente mas negativo en las mujeres, mientras que el strain radial y el circunferencial y los parametros rotacionales fueron similares en ambos sexos. En consecuencia, los limites inferiores de la normalidad para los componentes del strain fueron –16,9% en los varones y –18,5% en las mujeres para el strain longitudinal, –15,4% para el strain circunferencial y 24,6% para el strain radial, con independencia del sexo. Los valores de strain longitudinal fueron mas negativos en la base que en los segmentos apicales. Los valores medios de la rotacion fueron–6,9 ± 3,5 ° en la base, 13,0 ± 6,5° para la rotacion apical y 20,0 ± 7,3° para el giro neto. Conclusiones Presentamos una evaluacion detallada de la deformacion normal del miocardio y la mecanica rotacional en una cohorte amplia de voluntarios sanos. Observamos que las mujeres presentan un strain longitudinal mas negativo, lo cual explica su mayor fraccion de eyeccion del ventriculo izquierdo. La disponibilidad de valores de referencia de esos parametros puede facilitar su aplicacion en la practica clinica habitual.

Introduction and objectives Two-dimensional speckle-tracking echocardiography is a novel tool to assess myocardial function. The purpose of this study was to evaluate left ventricular myocardial strain and rotation parameters by two-dimensional speckle-tracking echocardiography in a large group of healthy adults across a wide age range to establish their reference values and to assess the influence of age, sex, and hemodynamic factors. Methods Transthoracic echocardiograms were acquired in 247 healthy volunteers (139 women, 44 years [standard deviation, 16 years old] (range, 18-80 years). We measured longitudinal, circumferential, and radial peak systolic strain values, and left ventricular rotation and twist. Results Average values of global longitudinal, radial, and circumferential strain were -21.5% (standard deviation, 2.0%), 40.1% (standard deviation, 11.8%) and -22.2% (standard deviation, 3.4%), respectively. Longitudinal strain was significantly more negative in women, whereas radial and circumferential strain and rotational parameters were similar in both sexes. Accordingly, lower limits of normality for the strain components were -16.9% in men and -18.5% in women for longitudinal strain, and -15.4% for circumferential and 24.6% for radial strain, irrespective of sex. Longitudinal strain values were more negative at the base than at apical segments. Mean rotational values were -6.9 ° (standard deviation, 3.5 °) for the base, 13.0 ° (standard deviation, 6.5 °) for apical rotation, and 20.0 ° (standard deviation, 7.3 °) for net twist. Conclusions We report the comprehensive assessment of normal myocardial deformation and rotational mechanics in a large cohort of healthy volunteers. We found that women have more negative longitudinal strain, accounting for their higher left ventricular ejection fraction. Availability of reference values for these parameters may foster their implementation in the clinical routine. Full English text available from: www.revespcardiol.org/en. © 2013 Sociedad Española de Cardiología. Published by Elsevier España, S.L. All rights reserved.

Polycystic ovary syndrome (PCOS) is closely related to increased cardiovascular risk in women of reproductive age. Atrial conduction abnormalities in these patients have not been investigated in terms of atrial electromechanical delay measured by tissue Doppler imaging (TDI) as an early predictor of atrial fibrillation development. The aim of this study was to evaluate whether TDI-derived atrial conduction time is prolonged in PCOS. The study included 51 patients with PCOS and 48 age-matched healthy controls. P-wave dispersion (PWD) was calculated on the 12-lead surface electrocardiogram. Systolic and diastolic left ventricular (LV) functions, atrial electromechanical coupling, intraatrial and interatrial electromechanical delays were measured with conventional echocardiography and TDI. PWD was higher in PCOS women (50.45 ± 3.7 vs 34.73 ± 6.7 ms, p = 0.008). Interatrial and intraatrial electromechanical delay were found longer in patients with PCOS compared to controls (41.9 ± 9.0 vs 22.2 ± 6.6 ms, p

Background Although a treadmill exercise stress testing (EST) is often the first-line screening procedure for subjects with an intermediate probability of coronary artery disease (CAD), one limitation of this test is the high rate of inconclusive tests that result from borderline exercise-induced ST changes. The carotid intima media thickness (CIMT) correlates well with atherosclerosis. The purpose of this study was to evaluate the clinical usefulness of performing CIMT measurements in patients with an inconclusive EST. Methods Symptomatic patients without history of vascular disease and with inconclusive EST result were included. Inconclusive results were defined as the presence of horizontal or downsloping ST-segment depression between 0.5 and 0.9 mm or 1.0 and 1.4 mm upsloping ST-segment depression. After inconclusive EST regarding electrocardiographic changes, the measurements of the CIMT and myocardial perfusion imaging study (MPS) were performed in all patients. The CIMT was measured at the posterior wall of the common carotid artery. The diagnosis of CAD was based on the presence of reversible perfusion defects on exercise MPS. Results A total of 87 patients (57 men) with a mean age of 58.9 ± 7.2 years were enrolled. The MPS was positive in 18 patients. The CIMT in patients with positive MPS was significantly greater than in patients with negative MPS. The CIMT was 0.82 ± 0.33 mm in patients with positive MPS and 0.63 ± 0.21 mm in patients with negative MPS (p = 0.004). Receiver operating characteristic curve analyses revealed that the greatest specificity was obtained when the cut-off value of CIMT was set at 0.66 mm (sensitivity 39%; specificity 72.5%; positive predictive value 27%; negative predictive value 82%). Conclusion In patients with inconclusive electrocardiographic changes during EST, CIMT was a useful measurement to prevent alternative more expensive and invasive tests. Additionally, mean CIMT is useful for screening patients with an inconclusive EST result to exclude CAD.

Nonalcoholic fatty liver disease (NAFLD) encompasses a disease spectrum ranging from simple steatosis to nonalcoholic steatohepatitis (NASH). We aimed to evaluate left ventricular (LV) systolic function using two-dimensional speckle-tracking echocardiography (2D-STE) in patients with NAFLD and to investigate whether any changes exist among the subgroups of NAFLD.We included 55 NAFLD patients and 21 healthy controls. The diagnosis of NAFLD was made on the basis of liver biopsy. After the patients were categorized into groups according to their histopathological analysis (simple steatosis, borderline NASH, and definitive NASH), all patients underwent echocardiography. In the 2D-STE analysis of the LV global longitudinal strain (G-LS), strain rate in systole (G-SRsys), strain rate in early diastole (G-SRearly), and strain rate in late diastole (G-SRlate) values were obtained.G-LS and G-SRsys values were lower in the NAFLD group. Although there was a significant difference in the G-LS between controls and simple steatosis, borderline NASH, and definitive NASH, no significant differences were found between NAFLD groups. To investigate whether impaired LV systolic dysfunction, determined using 2D-STE, is the consequence of NAFLD components, we included a subgroup. A total of 11 patients with NAFLD who were normotensive, nondiabetic, nonobese, and had a normal lipid profile and low homeostasis model assessment of insulin resistance (HOMA-IR) values were included. Echocardiographic abnormalities in systolic function were not different between this subgroup of NAFLD and healthy individuals.Patients with NAFLD and its subgroups have evidence of subclinical myocardial dysfunction in relation to the presence of insulin resistance. 2D-STE could not be used for differentiation of the NAFLD subgroups.

Objectives: The SYNTAX score (SXscore) has emerged as a reproducible angiographic tool to quantify the extent of coronary artery disease based on the location and complexity of each lesion. The aim of this study was to evaluate whether the SXscore is an independent predictor of long-term cardiovascular outcomes in patients treated with primary percutaneous coronary intervention (PCI) for acute ST-segment elevation myocardial infarction (STEMI). Methods: A total of 2993 patients with acute STEMI who underwent primary PCI were stratified into the 4 groups according to the SXscore quartiles; quartile 1(Q1, SXscore ≤ 9, n = 819), Q2 (9 < SXscore < 16, n = 715), Q3 (16 ≤ SXscore < 20, n = 710), and Q4 (SXscore ≥ 20, n = 749). Results: There were significant differences among the quartiles with respect to age, basal creatinine and glucose levels, and the incidences of diabetes mellitus, Killip ≥2, and anemia. From Q1 to Q4, there were increasing rates of culprit left anterior descending lesion ( P < .001), multivessel disease ( P < .001), chronic total occlusion ( P < .001), and proximal lesion localization ( P < .001). At long-term follow-up, all-cause mortality, nonfatal myocardial infarction, stroke, rehospitalization due to heart failure, and the need of revascularization were significantly more frequent among the patients in the highest SXscore quartile. In multivariate analysis, after including the SXscore as a numerical variable into the model, every point of increase was determined as an independent predictor for long-term mortality (hazard ratio [HR] 1.03, 95% confidence interval [CI] 1.01-1.05, P = .008) and for overall major adverse cardiac events (MACEs; HR 1.02, 95% CI 1.01-1.04, P < .001). Conclusion: The SXscore is an independent predictor of both in-hospital and long-term mortality and MACE in patients with acute STEMI undergoing primary PCI.

Objectives: Typical atrioventricular nodal reentrant tachycardia (AVNRT) can be cured with slow pathway ablation. This study was designed to assess the alterations in atrial and ventricular functioning using speckle tracking echocardiography in consecutive patients with typical AVNRT who underwent slow pathway radiofrequency (RF) ablation. Study design: Included in this study were 23 consecutive patients with symptomatic drug-resistant typical (slow-fast) AVNRT, all of whom underwent an invasive electrophysiology study and RF ablation. Patients underwent transthoracic echocardiographic evaluation 24 hours before and 24 hours after the ablation procedure. Results: AVNRT was induced during the electrophysiological study, and RF ablation successfully eliminated tachyarrhythmia in 23 (100%) patients. The atrial-His (A-H) interval was decreased in the post-ablation period compared to the pre-ablation period without the occurrence of immediate conduction disturbances. Peak left atrial longitudinal strain during the reservoir phase was increased in the post-ablation period compared to the pre-ablation period (48.24+-16.45 vs. 38.07+-15.72, p

Background: During coronary artery bypass grafting (CABG), one of the most important complications related to the internal mammary artery (IMA) is perioperative spasm. Nebivolol causes endothelium-dependent vascular relaxation by increasing nitric oxide (NO) release and prevents endothelial dysfunction in long-term use. In our study, we measured the effect of a third generation beta blocker, nebivolol, on the flow dynamics of IMA grafts. Methods: We recruited 90 hypertensive patients undergoing isolated CABG operation, who were divided into three groups and each group included 30 patients: Group 1 patients were under antihypertensive treatment other than beta-blockers (angiontensin-converting enzyme [ACE] inhibitors, calcium channel blockers or diuretics; monotherapy or combination therapy), Group 2 received metoprolol (50 mg/day) and Group 3 received nebivolol (5 mg/day). These antihypertensive therapies were given for at least one week before the operation and continued thereafter. IMA blood flow volume was measured for one minute just before cardiopulmonary bypass (measurement A) and before left internal mammary artery (LIMA)-left anterior descending (LAD) artery anastomosis (measurement B) in the three groups. Cardiac output measurements were also achieved simultaneously. Results: The measurement A results were 56.3 ± 36.2, 54.6 ± 28.1 and 66.8 ± 34.2 mL/min in Groups 1, 2 and 3, respectively (p0.05). While the cardiac outputs were similar within the three groups, the IMA free flow volume was higher in the nebivolol group after local papaverine use. Conclusion: Nebivolol might represent a good choice in hypertensive patients undergoing cardiac surgery by preventing perioperative myocardial hypoperfusion which increases early morbidity and mortality.

AIMS: Reference ranges of ascending aorta diameters (AAoD) for two-dimensional echocardiography (2DE) using inner edge (IE) convention are lacking, preventing the comparison of AAoD measurements by 2DE with those obtained by other imaging modalities. METHODS AND RESULTS: We used harmonic imaging 2DE to prospectively study 218 healthy volunteers (56% women, 42 ± 15 years, 18-80 years). Measurements were performed at the level of aortic root (AoR), sinotubular junction (STJ), and proximal tubular portion (TAo, 1 cm from the STJ) using both leading edge (LE) and IE conventions at end-diastole and end-systole. Feasibility of AAoD measurements between end-diastole and end-systole was similar at AoR and STJ levels, but it was significantly different at TAo level (82 vs. 96%, respectively, P < 0.0001). Ascending aorta diameters indexed to height were larger in men than in women (P < 0.0001). After adjusting for the effect of gender, only age and body surface area (BSA) were independent predictors of AAoD at multivariable analysis. Average end-diastolic AoR, STJ, and TAo diameters measured using IE convention were similar between genders (17 ± 2, 15 ± 2, and 15 ± 2 mm/m(2), respectively). Corresponding AAoD measured using the LE convention were 18 ± 2, 16 ± 2, and 17 ± 4 mm/m(2), respectively. On average, the end-systolic AAoD measured using LE were 2 mm larger than those performed using IE or at end-diastole. Mean aortic wall thickness was 2.4 ± 0.8 mm. CONCLUSION: End-diastolic AAoD measured using IE were significantly smaller than those obtained either using LE convention or at end-systole. Gender-specific reference values for AAoD indexed for BSA should be used to identify ascending aorta pathology.

Although very high gradient levels were measured during the evaluation of ventricular septal defect (VSD) in daily practice, these measurements are generally interpreted as erroneous and thus neglected. Our aim was to assess the features of VSD’s having erroneous interventricular pressure gradients by echocardiography. A 46 patients were enrolled in the study. The patients with higher Doppler-derived interventricular gradient than brachial systolic blood pressure were compared with patients with lower gradient (group 1, n = 26; group 2, n = 20, respectively) in terms of echocardiographic characteristics of VSD. No significant relations were observed in systolic and diastolic blood pressure and interventricular synchronicity between two groups (117.1 ± 6.7 vs 110.2 ± 6.3 mmHg, p = 0.145; 74.7 ± 4.3 vs 73.2 ± 4.9 mmHg, p = 0.32; 31.2 ± 5.5 vs 33.2 ± 4.9 msn, p = 0.29, respectively). Left ventricular end-diastolic and end-systolic diameters were greater in group 2 (46.6 ± 3.5 vs 49.5 ± 4.5, p = 0.022; 30.3 ± 2.5 vs 32.9 ± 3.2, p = 0.004, respectively). Doppler-derived interventricular pressure gradients were significantly higher in group 1 (144.4 ± 13.6 vs 75.7 ± 5.1 mmHg, p

Primary percutaneous coronary intervention (P-PCI) is the gold standard treatment for acute coronary syndromes. Plasma levels of catecholamines and other vasopressors are elevated during acute myocardial infarction (AMI) and coronary vasoconstriction is frequent. We aimed to compare the reference vessel diameter (RVD) of the infarct-related artery (IRA) during primary PCI and after an average of 3 days.Coronary angiography (CAG) was performed on 58 patients with acute ST-segment elevation myocardial infarction (STEMI) and TIMI 3 flow after P-PCI (43 men, 15 women; mean age, 55.5 ± 10 years). TIMI 3 flow was achieved either by simple balloon dilatation and/or thrombus aspiration. Lesion length, RVD, minimal lumen diameter (MLD), mean vessel diameter (meanD), and area of stenosis were compared during P-PCI and follow-up CAG.RVD, MLD, and meanD values were significantly higher during the follow-up CAG than after P-PCI (RVD 2.7 ± 0.7 mm vs. 2.9 ± 0.7 mm, p = 0.001; MLD 1.5 ± 0.5 mm vs. 1.7 ± 0.4 mm, p = 0.002; meanD 2.2 ± 0.5 mm vs. 2.4 ± 0.5 mm, p = 0.001). Area of stenosis values were significantly lower during the follow-up CAG than after primary PCI (69.5 ± 16.5 % vs. 62.1 ± 15 %, p = 0.001). Lesion lengths were not statistically significant during the follow-up CAG and primary PCI (lesion length 24.0 ± 10.8 mm vs. 22.1 ± 8.8 mm, p 0.05).This study showed that RVD was higher at the follow-up CAG a few days after AMI in patients who had TIMI 3 flow after P-PCI with simple balloon dilatation and/or thrombus aspiration. A delay of a few days for stent implantation in P-PCI allows for larger-diameter stent use and may help to reduce stent thrombosis and restenosis rates.

Background The association between oral contraceptives (OC) and myocardial infarction remains controversial. The new generation contraceptive Yasmin (30 µg ethinyl estradiol and 3 mg drospirenone) has a lower estrogen and newer progestin component. To date, there are no data available for the myocardial infarction risk and outcome for drospirenone. We aimed to investigate the effect of Yasmin use on cardiovascular outcomes in patients with acute ST segment elevation myocardial infarction (STEMI) undergoing primary angioplasty. Methods We retrospectively evaluated 1851 patients who underwent primary angioplasty for acute STEMI. Of them, 440 female patients (23.8%) composed the study population and 12 female (2.7%) were taking the oral contraceptive-Yasmin at the time of infarction. Patients were divided into two groups based on their age (≥50 (n = 339) and

We report a case of cyst was initially labeled as left ventricular noncompaction cardiomyopathy. An accurate diagnosis is essential to establish the most effective treatment strategy. In particular, echocardiographic examination assists in identifying the correct diagnosis. In this case, two-dimensional and three-dimensional echocardiography and computed tomography were used for definitive diagnosis of cardiac hydatid cyst.

NO ABSTRACT AVAILABLE

Carotid artery stenosis is the major cause of the stroke associated with ischemic origin and carries increased mortality and morbidity. Since carotid artery endarterectomy (CEA) was first performed in 1950, in conjunction with the advanced technology and increased experience under the guidance of randomized controlled trials, balloon angioplasty and carotid artery stenting, which have similar mortality and morbidity, have become comparable with CEA. Determining the optimal treatment option for each patient is the most important issue in carotid artery stenosis. Today, there have been improvements in technology and recent advances in the cardiovascular sciences. Moreover, there is increased experience, increased attention to patient selection, and a team approach to find the most suitable treatment for the patient. In this review, we briefly discuss the current treatment approaches for carotid artery stenosis under the guidance of the modern studies.

WOS: 000384729500007, PubMed ID: 27319275, Background: Vasculogenic erectile dysfunction is a harbinger of vascular disease. Comprehensive cardiac workup is accepted to be beneficial in men with this condition, especially those with otherwise unrecognized cardiovascular disease. We aimed to evaluate the role of two-dimensional speckle-tracking echocardiography (2D-STE) for noninvasive evaluation in patients with documented arteriogenic erectile dysfunction. Methods: 64 consecutive men with Doppler proven erectile dysfunction of more than 3 months of duration were recruited. Patients divided into 2 groups according to mean peak systolic velocity (PSV). Patients with PSV < 20 cm/sn constituted Group 1 and patients with PSV >= 20 cm/sn constituted Group 2. All underwent echocardiography and were compared. According to the 2D-STE analysis for the left atrium (LA); strain during ventricular systole (LARes), during late diastole (LA-Pump), strain rate during ventricular contraction (LA-SRs), during passive ventricular filling (LA-SRe), during active atrial contraction (LASRa) values and for LV; global longitudinal strain (GLS), strain rate in systole (GSRs), strain rate in early diastole (GSRe), and strain rate in late diastole (GSRa) values were obtained. Results: Beside diastolic parameters, LA-Res and LA-Pump were found to be significantly different between groups. GLS and GSR values were lower in Group 1. Moreover, correlation analysis revealed a significant correlation of GLS values with PSV (r = -0.4, P = .001). Conclusion: Myocardial deformation parameters by 2D-STE are valuable for detection of subclinical cardiovascular dysfunction in men with arteriogenic erectile dysfunction. This noninvasive method may be used as an emerging prognostic marker for risk stratification. Copyright (C) 2016, International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

Objective: To evaluate whether a complete analysis of electrocardiograms (ECGs) taken before hip fracture surgery could provide prognostic data regarding in-hospital perioperative cardiovascular complications (PCVCs). Methods: Elderly patients who underwent surgery using a proximal femoral nail due to peritrochanteric fracture between 2009 and 2013 were retrospectively evaluated. Patients’ 12-lead preoperative ECGs were analyzed and corrected QT intervals (QTcs) were calculated. Following analysis, ECGs with atrial fibrillation, left or right bundle branch block, ventricular premature beats, Q-waves, ventricular strain, sinus bradycardia or tachycardia were designated as abnormal. The relationship between observed ECG abnormalities and calculated QTc interval, and the development of in-hospital PCVC was evaluated. Results: In total, 190 male and 232 female patients were included in the study. Two hundred nineteen (51.9%) patients had a fractured right hip and 203 (48.1%) had a fractured left hip. ECGs of 133 patients were abnormal. Seventeen patients (4.02%) died and 62 patients (14.6%) developed PCVCs. There was a statistically significant increase (P=0.0183) in PCVC as perioperative cardiac risk factors increased. Of the abnormal ECG changes, only atrial fibrillation, paced rhythm and ventricular strain were found to be related to PCVCs (P

Varenicline (Champix, Chantix) has been available for use in smoking cessation since 2006. This drug has been associated with adverse cardiovascular events. Potential mechanisms for this association include modulation of parasymphathetic output from the brainstem to the heart, release of catecholamines and prothrombotic effect. We report the case of a 30-year-old man with no known cardiac disease, who developed thrombotic occlusion of left anterior descending artery and presented with acute coronary syndrome secondary to treatment with varenicline. The Naranjo probability scale indicates that varenicline was the probable cause of the myocardial infarction.

This letter to the editor reports on a case of third-generation oral contraceptive pill use associated with spontaneous coronary dissection of the left coronary artery and proximal thrombotic occlusion of the right coronary artery (RCA).

Although the effects of chronic alcoholism on left ventricular (LV) systolic function are well established, diastolic impairment has been evaluated partially. In addition, there are scarce data available about the relation of LV diastolic function to either or both duration and quantity of drinking among alcoholics. The aim of the study was to evaluate the left atrial (LA) function in chronic asymptomatic alcoholic patients by using two-dimensional speckle-tracking echocardiography (2D-STE). We enrolled 30 healthy subjects (age 34.8 ± 5.8 years) and 75 asymptomatic male alcoholics (age 39.8 ± 6.5 years) divided into two groups, according to total lifetime dose of ethanol: group I

Peripartum cardiomyopathy (PPCM) is a rare form of dilated cardiomyopathy that is associated with high maternal morbidity and mortality. Onset is usually between the last month of pregnancy and up to the fifth month postpartum. PPCM usually presents with signs and symptoms of heart failure and rarely with thromboembolic complications. The true incidence of thromboemboli in PPCM is unknown. Herein we report an unusual case of PPCM in a previously healthy woman who presented with recurrent transient ischemic attacks due to thrombus in the left ventricle. Resumo: A miocardiopatia periparto (MPP) é uma forma rara de miocardiopatia dilatada, associada a elevada mortalidade e morbilidade materna. A doença manifesta-se habitualmente entre o último mês de gravidez até ao 5.° mês depois do parto. A MPP apresenta-se habitualmente com sinais e sintomas de insuficiência cardíaca e, raramente, com complicações tromboembólicas. A verdadeira incidência de tromboembolismo na MPP não é conhecida. Apresentamos um caso, pouco habitual, de MPP em mulher previamente saudável que se apresentou com acidentes isquémicos transitórios recorrentes, devido à presença de trombo no ventrículo esquerdo. Keywords: Peripartum cardiomyopathy, Transient ischemic attacks, Transthoracic echocardiography, Palavras-chave: Miocardiopartia periparto, Acidente isquémico transitório, Ecocardiografia transtorácica

Background: The aim of this study was to determine right ventricular (RV) and right atrial (RA) deformation assessed by two-dimensional echocardiographic and three-dimensional echocardiographic (3DE) imaging in patients with prediabetes and type 2 diabetes mellitus. Methods: This cross-sectional study included 47 untreated normotensive subjects with prediabetes, 57 recently diagnosed normotensive patients with diabetes, and 54 healthy controls of similar sex and age distributions. All subjects underwent laboratory analyses and complete two-dimensional echocardiographic and 3DE examinations. Results: Three-dimensional echocardiographic RV end-diastolic volume index gradually decreased from controls across patients with diabetes to those with diabetes (69 ± 10 vs 63 ± 8 vs 58 ± 8mL/m2, P < .001), whereas 3DE RV end-systolic volume index was higher in controls compared with patients with diabetes and those with diabetes (25 ± 4 vs 23 ± 4vs 22 ± 4mL/m2, P < .001). However, there was no difference in 3DE RV ejection fraction among the three groups (63 ± 4% vs 62 ± 4% vs 61 ± 5%, P = .063). RV and RA global strain and systolic and early diastolic strain rates were decreased in patients with prediabetes and in those with diabetes compared with controls, whereas RV and RA late diastolic strain rates were increased in these patients. Multivariate regression analysis showed that RV global strain was associated with glycated hemoglobin, independent of left ventricular parameters. Conclusions: RV and RA myocardial deformation and function obtained by 3DE and two-dimensional echocardiographic strain, even in normal ranges, were decreased in patients with prediabetes and in those with diabetes compared with controls. The long-term parameter of glucose control was correlated with the right heart mechanics.

The clinical and angiographic predictors of coronary artery aneurysm (CAA) formation in patients with ST-segment elevation acute myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) are not clear. This study aims to assess the predictors of CAA formation after primary PCI. 3,428 patients who underwent PCI for STEMI were enrolled. The average period of follow-up was mean 48 months (range 35–56 months) after PCI. During this time, 1,304 patients were underwent follow-up coronary angiography. CAA was detected in 21 patients (1.6 %). CAA occurred at the segment of stent implantation in all patients. The clinical and angiographic data were compared between patients with CAA group (n = 21) and without CAA group (n = 1,283). Patients who developed CAA had longer reperfusion time, higher high-sensitiviy C-reactive protein (hs-CRP) levels and neutrophil to lymphocyte ratio than those who had without CAA. Angiographically, CAA developed proximally located lesions and lesion length was significantly greater in patients with CAA than without CAA. Statin and beta-blocker discontinuation were found higher in stent-associated CAA. Every 1 mg/l increase in hs-CRP and implantation of drug eluting stent (DES) were independent predictor of CAA formation after STEMI. Baseline elevated inflammation status and DES implantation in the setting of STEMI may predict the CAA formation.

PP-232 Although very high gradient levels were measured during the evaluation of ventricular septal defect (VSD) in daily practice, these measurements are generally interpreted as irrational and thus neglected. Our aim was to show that Doppler may overestimate interventricular pressure gradient in

PP-234 Bicuspid aortic valve (BAV) is the result of abnormal aortic leaflet formation during valvulogenesis. Recently, it has been shown that BAV is associated with abnormal aortic stiffness, which has a negative impact on left ventricular (LV) diastolic function. The purpose of this study was to

The presence of the metabolic syndrome is a strong predictor for the presence of NASH (non-alcoholic steatohepatitis) in patients with NAFLD (non-alcoholic fatty liver disease). In the present study, we assessed LA (left atrial) deformation parameters in patients with NAFLD using 2D-STE (speckle tracking echocardiography) and to investigate if any changes exist between subgroups of the NAFLD. A total of 55 NAFLD patients and 21 healthy controls were included in the study. The diagnosis of NAFLD was based on liver biopsy. After patients were categorized into groups according to histopathological analysis (simple steatosis, borderline NASH, definitive NASH), all patients underwent echocardiography with Doppler examination. In the 2D-STE analysis of the left atrium, LA-Res (peak LA strain during ventricular systole), LA-Pump (peak LA strain during atrial systole), LA-SRS (peak LA strain rate during ventricular systole), LA-SRE (peak LA strain rate during early diastole) and LA-SRA (peak LA strain rate during atrial systole) were obtained. LA-Res, LA-Pump and LA-SRA were lower in the NAFLD group than in the control group. LA-Res was found to be significantly lower in NAFLD subgroups compared with healthy subjects (43.9±14.2 in healthy controls compared with 31.4±8.3 with simple steatosis, 32.8±12.8 with borderline NASH and 33.8±9.0 with definitive NASH). LA-Pump was significantly lower in the NAFLD group (18.2±3.1 in healthy controls compared with 13.3±4.7 with borderline NASH and 14.4±4.7 with definitive NASH). There were significant differences in LA-SRA between healthy controls compared with simple steatosis and borderline NASH (−1.56±0.36 compared with 1.14±0.38 and 1.24±0.32 respectively). Correlation analysis showed significant correlation of LA-Res values with E (early diastolic peak velocity)/Em (early diastolic mitral annular velocity) ratio (r=−0.50, P≤0.001), with LAVI (LA volume index; r=−0.45, P≤0.001) and with Vp (propagation velocity; r=0.39, P≤0.001). 2D-STE-based LA deformation parameters are impaired in patients with NAFLD with normal systolic function. Although LA-Res and pump function parameters might be useful in estimating LV (left ventricular) filling pressure in the NAFLD patient group, it could not be used for differentiating the subgroups.

To the Editor We read with interest Plonczak et al ’s1 article depicting the two-vessel spontaneous coronary artery dissection (SCAD) as a cause of acute coronary syndrome (ACS). SCAD is uncommon, accounting for 0.1–0.28% of all patients with ACS or sudden cardiac …