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Background: Diastolic function assessment has been reported to provide valuable data in patients with atrial fibrillation (AF). The purpose of this study was to evaluate the effects of diastolic parameters on predicting the effectiveness of medical cardioversion in restoring sinus rhythm among patients with acute AF. Methods: 40 non-valvular, new onset AF patients were included. All participants received an intravenous infusion of amiodarone. In patients whom sinus rhythm could not be restored with amiodarone, an electrical cardioversion was performed. Two groups, patients who achieved sinus rhythm with amiodarone (Group-1) and who failed to achieve sinus rhythm with amiodarone (Group-2) were compared with respect to initial echocardiographic measurements. Results: Group-1 patients were younger comparing with Group-2 (mean age; 54.4 +/- 13.9 years vs 63.3 +/- 10.3 years, p = 0.028). Comparing with Group-1, Group-2 patients had; a higher left atrium volume index (17.1 +/- 4.8 cm(3)/ m(2) vs 22.6 +/- 6.6 cm(3)/ m(2), p = 0.03); a shorter pulmonary vein S (49.6 +/- 3.8 cm/sec vs 41.1 +/- 3.0 cm/sec, p < 0.001); and a shorter pulmonary vein D peak velocity (55.9 +/- 2.4 cm/sec vs 52.3 +/- 1.8 cm/sec, p < 0.001). Moreover, both IVRT and DT were significantly shorter in Group-2, comparing with Group-1 (45.1 +/- 2.1 msec vs 51.1 +/- 2.5 msec, p < 0.001 and 51.3 +/- 2.4 msec vs 56.5 +/- 3.2 msec, p < 0.001, respectively). Conclusion: The present study revealed that admission pulmonary vein S and D wave peak velocities, IVRT, DT, and Pro-BNP levels could be predictors of failure of medical cardioversion among AF patients.

Aims The protective effect of beta-blockers, ACE inhibitors, and ARBs on anthracycline cardiotoxicity has already been demonstrated, but the effect of aldosterone antagonism, which inhibits the last step of the renin–angiotensin–aldosterone system (RAAS), was questioned. This study sought to investigate whether spironolactone protects the heart against anthracycline-induced cardiotoxicity. Methods and results Eighty-three female patients who were diagnosed with breast cancer were included in the study. The study population was randomized into spironolactone and control groups. A dose of 25 mg/day spironolactone was administered to the patients in the spironolactone group. There were 43 patients (mean age 50 ± 11 years) in the spironolactone group and 40 patients (mean age 51 ± 10 years) in the control group. LVEF decreased from 67.0 ± 6.1 to 65.7 ± 7.4 (P = 0.094) in the spironolactone group, and from 67.7 ± 6.3 to 53.6 ± 6.8 in the control group (P < 0.001). When the general linear model was applied, the interaction of LVEF decrease between groups was significantly lower in the spironolactone group than in the control group (P < 0.001). The diastolic functional grade of subjects in the spironolactone group was protected (P = 0.096), whereas it deteriorated in the control group (P < 0.001). Conclusion We showed that spironolactone administration used simultaneously with anthracycline group chemotherapeutics protects both myocardial systolic and diastolic functions. Spironolactone can be used to protect against anthracycline-induced cardiotoxicity. Trial registration: NCT02053974.

AIM Cardiovascular disease is a major cause of mortality in dialysis patients. Epicardial adipose tissue (EAT) has been proposed as a cardiovascular risk marker in this population. Subclinical hypothyroidism and low free triiodothyronine (fT3) levels are associated with EAT in patients without chronic renal failure. The aim of this study was to investigate the relationship between EAT and low free T3 levels in peritoneal dialysis (PD) patients. METHODS A total of 125 prevalent PD patients were enrolled in this cross-sectional study. The epicardial fat thickness (EFT) was measured by echocardiography, and the endothelial function was assessed by flow mediated dilatation (FMD). Thyroid function tests were performed by an enzyme immunoassay. RESULTS The mean age of the patients was 51 ± 13, and the time on PD was 36 months. The mean EFT was 6.7 ± 2.9 mm. The EFT correlated positively with the patient age, systolic blood pressure (BP), mean BP, high sensitivity C-reactive protein (hs-CRP) level and body mass index (BMI), and negatively with the fT3 level and FMD. The median fT3 value was 2.53, and patients were divided according to their serum fT3 values (within the normal range and below the reference level). Compared with patients in the low fT3 group, the subjects in the normal fT3 group had higher serum albumin levels and FMD, but a lower BMI, plasma fasting glucose level, EFT, TSH level, hs-CRP level, low density lipoprotein (LDL) cholesterol level and mean BP in office measurements, and both the diastolic BP and mean BP by ambulatory blood pressure measurement. A multivariate linear regression analysis showed that the EFT was predicted by the hs-CRP and fT3 levels. CONCLUSION Low free T3 levels are associated with the epicardial fat thickness in PD patients. Further studies are needed to evaluate the pathogenesis and to support these findings.

Background The coronary slow flow phenomenon (CSFP) is a coronary microvascular disorder angiographically defined by delayed opacification of the distal vasculature in the absence of obstructive coronary artery disease. We aimed to investigate and compare the effects of intracoronary nitrate and diltiazem on thrombolysis in myocardial infarction frame count (TFC) in patients with CSFP during coronary angiography. Methods Sixty patients with CSFP were randomly divided into 2 groups. The first group is nitroglycerin group with 30 patients (22 men; mean [SD] age, 50 [12] years), and the second is diltiazem group with 30 patients (27 men; mean age, 54 ± 11 years); intracoronary 5-mg diltiazem or 250-μg nitroglycerin was administered. Heart rate, systolic and diastolic blood pressures, and TFCs in all 3 coronaries were recorded before and after administering these medications. Results After nitroglycerin administration, systolic and diastolic blood pressures decreased, heart rates significantly increased, and TFCs decreased in all coronaries ( P < 0.001 for 3 coronaries). After the application of intracoronary 5-mg diltiazem, heart rate, systolic and diastolic blood pressures, and TFCs were found significantly lower than predrug values ( P < 0.001 for all values). When the percent TFC reductions, after the application of intracoronary diltiazem or nitroglycerin, in left anterior descending coronary artery, circumflex coronary artery, and right coronary artery were evaluated, diltiazem significantly reduced the TFCs of the left anterior descending coronary artery and circumflex coronary artery compared with nitroglycerin ( P < 0.01 for both coronaries). Conclusion Both intracoronary diltiazem and nitroglycerin improve the TFCs in CSFP, and intracoronary diltiazem is superior to nitroglycerin in reducing TFCs in CSFP.

We assessed the relationship between contrast-induced nephropathy (CIN) and SYNTAX score (SS) and serum uric acid (SUA) levels in patients with ST elevation myocardial infarction (STEMI). A total of 835 STEMI patients in whom primary percutaneous coronary intervention was performed in our cardiology clinic were included in this study (615 male, 220 female; mean age 58.1 ± 12.2 years). The patients were divided into 2 groups (CIN and non-CIN). Contrast-induced nephropathy was observed in 9.6% (80) of patients; SS (13.9 ± 6.2/22.1 ± 5.8) and SUA (5.1 ± 0.9/6.2 ± 0.9) values in the CIN group were higher compared with the non-CIN group ( P < .001, for all). All SS (95% confidence interval [CI] = 1.136-1.250, P = .001), SUA (95% CI = 1.877-3.236, P = .002), and diabetes (95% CI = 0.998-1.039, P = .026) were independent predictors of CIN in logistic regression analysis. Procedures that can prevent CIN may be beneficial in patients at high risk as identified by the SS and SUA levels.

Objective: The purpose of this study was to evaluate the tenascin-C levels in severe rheumatic mitral stenosis before and after percutaneous mitral balloon valvuloplasty (PMBV). Subjects and Methods: Forty patients with severe mitral stenosis requiring PMBV and 20 age-matched healthy subjects were included in the study. The mitral valve areas, mitral gradients and systolic pulmonary artery pressure (sPAP) were measured by echocardiography. The sPAP values and mitral gradients were also measured by catheterization before and after PMBV. The blood tenascin-C levels were measured before PMBV and 1 month after the procedure. Results: The echocardiographic mean mitral gradients had a significant decrease after PMBV (11.7 ± 2.8 vs. 5.6 ± 1.7 mm Hg; p < 0.001) and also those of catheterization (13.9 ± 4.4 vs. 4.0 ± 2.4 mm Hg; p < 0.001). Mitral valve areas increased significantly after PMBV (from 1.1 ± 0.1 to 1.8 ± 0.2 cm2, p < 0.001). Tenascin-C levels decreased significantly in patients after PMBV (from 15.0 ± 3.8 to 10.9 ± 3.1 ng/ml; p < 0.001). Tenascin-C levels were higher in patients with mitral stenosis before PMBV than in healthy subjects (15.0 ± 3.8 and 9.4 ± 2.9 ng/ml; p < 0.001, respectively). There were no significant differences between patients with mitral stenosis after PMBV and healthy subjects (10.9 ± 3.1 and 9.4 ± 2.9 ng/ml; p = 0.09, respectively). There was a significant positive correlation between tenascin-C levels and sPAP (r = 0.508, p < 0.001). In multivariant analysis, tenascin-C predicted mitral stenosis (p = 0.004, OR: 2.31). Conclusions: Tenascin-C was an independent predictor for rheumatic mitral stenosis.

Objective We have previously shown that acute passive smoking impaired left ventricular diastolic function in healthy volunteers. The aim of this study was to determine whether length of exposure and/or ambient smoke concentration is the key determinant of this outcome. Methods We measured blood carboxyhemoglobin (COHb)and lactate level to investigate the acute effects of passive smoking on tissue oxygenation. A total of 90 healthy nonsmoker volunteers were prospectively enrolled into the study. Each of 30 subjects were exposed to carbon monoxide (CO) less than 5.0 ppm smoke in group A for 30 minutes, to CO 5 to 10 ppm smoke in group B for 30 minutes, and to CO less than 5.0 ppm smoke in group C for 60 minutes. Hemodynamic parameters were obtained, blood samples for measuring COHb and lactate levels were taken and echocardiographic examinations were performed at baseline and after exposure to passive smoking. Results Mean ± SD CO levels in groups A, B, and C were 4.2 ± 0.5 ppm, 9.2 ± 0.3 ppm, and 4.1 ± 0.8 ppm, respectively. There was no change in left ventricular systolic functions in all groups. Left ventricular diastolic functions were impaired in groups B and C, whereas no change was observed in group A. Carboxyhemoglobin and lactate levels increased after passive smoking in groups B and C. However, group B had significantly higher COHb and lactate levels compared to group C ( P < 0.001). Conclusions Our results suggested that passive smoking at a certain dose in relation with length of exposure and ambient smoke concentration seems to cause relative left ventricular diastolic dysfunction.

We aimed to evaluate the long-term effect of hemodialysis (HD) treatment on left and right ventricular (LV and RV) functions in patients with end-stage renal disease. The study population consisted of 22 patients with newly diagnosed end-stage renal disease. Before an arteriovenous fistula was surgically created for HD, the patients were evaluated by echocardiography for systolic and diastolic functions. After the first HD session (mean 24.22 ± 2.14 months), the second echocardiographic evaluations were performed. Left ventricular and RV functions before and after long-term HD treatment were compared. The mean age was 55 ± 13 years and 10 (45%) of the patients were female. After long-term HD treatment, the isovolumic relaxation time was significantly decreased; however, the peak early (E) and late (A) diastolic mitral inflow velocities, E/A ratio, and deceleration time of E wave were not significantly different from the baseline measurements. Also, there was no significantly change in the early diastolic velocity (Ea) of the lateral mitral anulus and the E/Ea ratio. Pulmonary vein peak diastolic velocity, peak atrial reversal velocity, and peak atrial reversal velocity duration remained almost unchanged even though the pulmonary vein peak systolic velocity and the pulmonary vein peak systolic velocity/pulmonary vein peak diastolic velocity ratio were significantly lower after long-term HD treatment. In addition, LV systolic functions, LV diameters, LV mass index, left atrium size, and RV diastolic functions were not statistically different after long-term HD treatment. The myocardium is exposed to hemodynamic, metabolic, and neuro-humoral abnormalities during HD treatment; however, the long-term effects of HD on ventricular functions are not clearly known. The present study showed that the long-term effects of HD on LV and RV functions were insignificant in patients with end-stage renal disease. We have demonstrated that the LV and RV functions did not change significantly after long-term HD treatment. We suggest that this result may be due to regulated blood pressure levels of the patients, treatment of anemia and other metabolic disorders during the HD period and the prevention of weight gain and hypervolemia.

Human brucellosis is a systemic disease that involves multiple organs and tissues concomitantly. In this case, we describe a patient with pancarditis and nephrotic syndrome requiring hemodialyses, which is an unusually fatal condition resulting from brucellosis. He was successfully treated with early aortic valve replacement and intensive medical therapy.

Background: Numerous studies show that percutaneous coronary intervention has no clinical benefit in patients with total occlusion. Both regional and global left ventricle (LV) functions may be evaluated in detail by strain (S) and strain rate (SR) echocardiography. The purpose of this study is to evaluate whether S and SR echocardiography may be used to determine the total occlusion. Method: Sixty stable patients who have total or subtotal occlusion in the infarct-related left anterior descending artery were enrolled (Total occlusion group: 35 and subtotal occlusion group: 25 patients). In all patients, LV longitudinal S and SR data were obtained from total 14 segments. Results: S values of middle and apical segments of LV were significantly lower in the total occlusion groups. In SR analysis, middle and apical values of all walls were significantly different between the groups. The total SR of the middle and apical segments was significantly lower in the total occlusion group (respectively, total SR in middle segments: −3.4 ± 0.8% vs. −4.6 ± 1.0%, P < 0.00001 and total SR in apical segments: −1.7 ± 0.5% vs. −2.8 ± 0.6%, P = 0.001). The total SR values of four walls were also significantly lower in the total occlusion group (−10.3 ± 2.0% vs. −13 ± 3.1%, P < 0.0001). For predicting total occlusion, the highest sensitivity levels (84%) were obtained in SR of middle-anterior segment. SR of middle-septum and middle-lateral segments has the highest specificity levels (86%). Conclusion: Total occlusion in stable patients with acute coronary syndrome has an unfavorable effect on the LV regional and global functions. Patients with total occlusion may be identified by S and SR echocardiography. (Echocardiography 2011;28:203-209)

Aim: Numerous studies have shown an increase in NT-pro BNP, troponin I and D-dimer levels with right ventricular dysfunction on echocardiography in patients with acute pulmonary thromboembolism (PTE). We found no data about the relation between tenascin-C and acute PTE in the litera-ture. The aim of this study was to evaluate tenascin-C levels in acute PTE and correlate them with NT-pro BNP, troponin I and D-dimer.Method: Thirty-four patients who have massive or submassive PTE on spiral thorax CT (PTE group) and twenty healthy volunteers (non-PTE group) were evaluated. In all patients, right ventricular functions were obtained on transthoracic echocardiography and plasma tenascin-C, NT-pro BNP, troponin I, and D-dimer levels were measured.Results: The left ventricular systolic diameter, left ventricular diastolic diameter and left ventricular ejection fraction were similar in the two groups. The right heart chamber sizes and main pulmonary artery diameter were significantly larger in the PTE group and systolic pulmonary artery pressures were also significantly higher in this group. Tenascin-C, NT-pro BNP, and D-dimer levels were also significantly higher in the PTE group than in the non-PTE group (p< 0.001). The troponin I levels did not differ between the two groups (p=0.4). Tenascin-C was found to be highly correlated with sPAP and NT-pro BNP and correlated with D-dimer; however, troponin I was not correlated with tenascin-C.Conclusion: This study demonstrates that tenascin-C may be an indicator of acute PTE.

Objective: Behcet's disease is a chronic inflammatory vasculitis. Vascular involvement is one of the major complications of Behcet's disease, during the course of the disease. Previous studies showed that ACE inhibitors and statins may improve endothelial functions in endothelial dysfunction. The aim of our study is to compare the effects of atorvastatin and lisinopril to placebo on endothelial dysfunction in patients with Behcet's disease. Patients and methods: We prospectively studied 92 (48 female) Behcet's patients who were diagnosed according to the International Study Group criteria. Endothelial dysfunction was evaluated by brachial artery flow-mediated dilatation (FMD) method using high-resolution vascular ultrasound device at baseline and after for 3-month therapy. Patients were consecutively randomized into three groups as (atorvastatin (n = 31), lisinopril (n = 31), and placebo groups (n = 30). Patients in atorvastatin group received 20 mg atorvastatin, lisinopril group received 10 mg lisinopril per day, and placebo group received placebo per day for 3 months. Results: The baseline characteristics of patients were similar among three groups; however, high-sensitive C-reactive protein (hs-CRP) levels were lower in atorvastatin group than placebo group. A significant improvement in FMD was observed in both atorvastatin (5.0 ± 1.4 vs. 12.8 ± 3.6%, P < 0.001) and lisinopril groups (5.0 ± 1.2 vs. 11.4 ± 5.0%, P < 0.001). Partial significant enhancement was observed in placebo group (4.9 ± 1.1% vs. 5.7 ± 1.0, P = 0.002). However, it was lower than the cutoff value for endothelial dysfunction. Conclusion: These findings suggest that atorvastatin and lisinopril improve endothelial functions in Behcet's disease patients. However, large studies are needed to determine the long-term effects of atorvastatin and lisinopril therapy. (Echocardiography 2010;27:997-1003)

Background The prevalence of smoking is high in Turkey. However, there are no data available evaluating the differences between smokers and nonsmokers according to their sex in patients with acute myocardial infarction (AMI) in Turkey. Hypothesis The aim of the study was to determine the prevalence of smoking and its relationship to age, localization, and extension of coronary heart disease (CHD), and other risk factors in Turkish men and women with first AMI. Methods This study included, 1502 patients with first AMI from 3 different cities in Turkey. The baseline characteristics and traditional risk factors for CHD, Coronary angiographic results, and in-hospital outcome were recorded. Results The proportion of male smokers was significantly higher than that of women (68% vs 18%, P < 0.001). Smokers were younger by almost a decade than nonsmokers (P < 0.001). Male nonsmokers were younger than females; however, the mean age of first AMI was similar in male and female smokers. In both genders, prevalence of hypertension and diabetes mellitus was significantly lower in smokers than in nonsmokers (P < 0.001). Smokers had less multivessel disease and less comorbidity as compared to nonsmokers. Although the in-hospital mortality rate was lower in smokers, smoking status was not an independent predictor of mortality. Conclusions Smoking, by decreasing the age of first AMI in women, offsets the age difference in first AMI between men and women. The mean age of first AMI is lower in Turkey than most European countries due to a high percentage of smoking. Copyright © 2010 Wiley Periodicals, Inc.

Objectives. Increased platelet activation plays an important role in the development of atherosclerosis. Mean platelet volume (MPV) is a determinant of platelet activation. In our study, we aimed to determine whether MPV levels are elevated in non-dipper patients compared with dippers and healthy controls. In addition, we tried to find out if MPV levels are correlated with blood pressure measurements in hypertensive patients. Methods. This cross-sectional study included 56 hypertensive patients; 27 age- and sex-matched healthy volunteers were enrolled to study as a control subjects. Ambulatory blood pressure monitoring was performed for all patients. Hypertensive patients were divided into two groups: 28 dipper patients (10 male, mean age 51 +/- 8 years) and 28 non-dipper patients (11 male, mean age 53 +/- 10 years). MPV was measured in a blood sample collected in EDTA tubes and was also used for whole blood counts in all patients. Results. In non-dipper patients, 24-h systolic blood pressure (141.5 +/- 10.21 vs 132.3 +/- 7.7 mmHg, p < 0.001), 24-h diastolic blood pressure (88.2 +/- 8.5 vs 81.0 +/- 8.2 mmHg, p < 0.01) and 24-h average blood pressure (105.7 +/- 8.5 vs 97.7 +/- 7.4 mmHg, p < 0.001) are significantly higher than dippers. Whereas daytime measurements were similar between dippers and non-dippers, there was a significant difference between each group during night-time measurements (night-time systolic 137.1 +/- 11.0 vs 120.2 +/- 8.0 mmHg, p < 0.001; night-time diastolic 85.3 +/- 8.0 vs 72.8 +/- 7.9 mmHg, p < 0.001). Non-dipper patients (9.61 +/- 0.42 fl) demonstrated higher levels of MPV compared with dippers (9.24 +/- 0.35 fl) and normotensives (8.87 +/- 0.33 fl) (p < 0.001 and p < 0.001, respectively). There was significant correlation between MPV and ambulatory diastolic and systolic blood pressure in non-dipper hypertensives. Conclusion. Our results suggest that MPV, a determinant of platelet activation, has a positively correlation with blood pressure and elevated in non-dipper compared with dippers and controls. Increased platelet activation could contribute to increase the atherosclerotic risk in non-dipper patients compared with dippers.

Objectives The role of Helicobacter pylori (HP) in the progression of atherosclerosis is controversial. We investigated the relation between HP IgG antibody titres and severity and intensity of coronary atherosclerosis and also clinical presentation of coronary artery disease (CAD). Methods The patient group consisted of 353 patients with angiographically proven CAD, which contains 3 different subgroups: 163 patients with myocardial infarction (MI), 106 patients with unstable angina (USAP) and 84 patients with stable angina (SAP). Control group included 163 subjects with angiographically proven normal coronary arteries. Helicobacter pylori IgG antibody titres were measured by an enzyme immunoassay method in all patients. Gensini and Extent scores were used to evaluate the angiographic severity and extent of atherosclerosis. C-reactive protein levels were measured by Behring nephelometry system kits. Results Seropositivity rates for HP were similar between groups (82.7% in the patient group and 86.6% in the control group (P > 0.05)). Also HP-IgG levels were similar among the MI, USAP and SAP groups. No significant correlation was observed between CRP levels and HP-LgG level titres. There was no significant correlation between HP-IgG level (r = 0.086, P = 0.2) and Gensini score but a significant poor correlation was observed between HP-IgG level and Extent score (r = + 0.156, P = 0.03). Conclusions Helicobacter pylori IgG titres do not play an important role in the presentation of CAD and do not increase systemic inflammatory response. However, Helicobacter pylori IgG antibody titres may be correlated with the extent of CAD.

Migraine is a common type of primary headache predominantly seen in women. This study aimed to evaluate endothelial function in patients with migraine using pulse wave velocity (PWV).The study included 73 patients with newly diagnosed migraine and 80 healthy subjects. All patients and controls underwent baseline transthoracic echocardiography and PWV measurements. Patients were randomized to three groups to receive propranolol, flunarizine or topiramate, and the measurements were repeated at the end of 1 month.The newly diagnosed migraine patients and the control group exhibited no differences in baseline clinical characteristics, and the measurements showed that PWV was 7.4 ± 1.0 m/s in the patient group and 6.0 ± 1.0 m/s in the control group (p0.001). The same measurements were repeated during a control visit at the end of 1 month. Following treatment, a significant decrease was observed in PWV in all patient groups compared to baseline (p0.001). Subgroup analysis showed significantly decreased PWV in all drug groups, with the most prominent decrease in the topiramate group.The increased PWV demonstrated in migraine patients in this study stands out as an additional parameter elucidating endothelial dysfunction in these patients. Decreasing the number of migraine attacks with prophylactic treatment may reduce PWV and decrease cardiovascular risk in long-term follow-up.

Acquired pseudoaneurysm of the left ventricle is a rare disorder that usually ofvccurs after transmural myocardial infarction or after cardiac surgery. Pseudoaneurysms are usually detected because of symptoms; less often incidentally. Here we present a case of pseudoaneurysm as a result of unknown etiology causing myocardial bridging like image at angiography.

Coronary collateral vessels can provide a perfusion reserve in case of increased myocardial oxygen demand. Development of coronary collateral vessels (CCV) is triggered by the pressure gradient between the coronary bed of arteries caused by an obstruction and myocardial ischemia. Myocardial hypoxia can facilitate development of CCVs. There is a chronic hypoxemia in patients with chronic obstructive pulmonary disease (COPD). The aim of this study was to evaluate the effect of COPD on CCVs. The study included 98 patients with COPD who underwent coronary angiography. Those patients in whom coronary angiography is normal or severity of coronary artery stenosis in thought not to be sufficient for the development of CCVs (

Doppler tissue imaging (DTI) has been proposed as a tool for the evaluation of diastolic function. Controversy exists regarding whether DTI measurements are influenced by preload. Changes in the circulating volume associated with hemodialysis result in preload reduction. To determine the influence of preload reduction on DTI and standard pulsed-Doppler transmitral diastolic velocities, 30 patients (mean age 41 +/- 14) with chronic renal insufficiency without overt heart disease were studied by DTI and standard pulsed Doppler before and after hemodialysis. From the apical window, DTI sample volume was placed at the lateral and septal mitral annulus and at the midsegment of lateral and septal myocardial wall of the left ventricle. Peak early diastolic annular and myocardial, and peak late diastolic annular and myocardial velocities were measured. Transmitral peak early and late diastolic velocities were also recorded by standard pulsed Doppler. The peak velocity of early diastolic mitral flow decreased from 100 +/- 30 to 85 +/- 34 cm/s (P < 0.001) after hemodialysis. Hemodialysis elicited marked reduction in early diastolic lateral mitral annular and midlateral myocardial velocities (6.9 +/- 3.2 to 6.3 +/- 2.9 cm/s, P < 0.04 and 6.7 +/- 0.3 to 5.5 +/- 2 cm/s, P < 0.001, respectively). Early diastolic, septal mitral annular, and midseptal myocardial velocities were also significantly decreased (5.8 +/- 2.8 to 4.6 +/- 2 cm/s, P < 0.006 and 6.2 +/- 2 to 5.1 +/- 1 cm/s, P < 0.008, respectively). Late diastolic mitral annular and myocardial velocities did not change. It is concluded that early diastolic mitral annular and myocardial velocities are affected by acute preload reduction. It is necessary to consider preload when diastolic function is assessed by DTI.

Octreotide, a somatostatin analogue, has been found effective in the treatment of acromegalic cardiomyopathy. We investigated whether intermittent octreotide therapy had beneficial effects in patients with ischemic or idiopathic dilated cardiomyopathy, which are refractory to conventional therapy. Twelve patients with ischemic or idiopathic dilated cardiomyopathy were enrolled in the study. In addition to conventional treatment, octreotide (first 50 microg and then 25 microg three times per day for 4 days) was administered and repeated after 1, 2, and 3 months. The patients were evaluated 3 times, before and immediately after the first treatment and after 3 months of treatment, using echocardiography, exercise stress testing, ambulatory ECG, right ventricular catheterization, cardiac enzymes, and the Minnesota living with heart failure questionnaire for quality of life. There were no significant changes in parameters after the first treatment. However, after 3 months of treatment, there were significant improvements in the left ventricular ejection fraction, left ventricular posterior wall thickness, hemodynamics, exercise capacity, and quality of life. Additionally, ischemic burden and the number of ventricular premature beats also decreased slightly. Intermittent octreotide therapy led to significant improvements in patients with ischemic and idiopathic dilated cardiomyopathy refractory to conventional treatment. We believe that this therapy should be attempted as an adjunctive therapy in these patients, and that in this respect, randomized, double-blind, clinical, and large-scale studies are required before regular usage is undertaken.

The protective effect of beta-blockers, ACE inhibitors, and ARBs on anthracycline cardiotoxicity has already been demonstrated, but the effect of aldosterone antagonism, which inhibits the last step of the renin-angiotensin-aldosterone system (RAAS), was questioned. This study sought to investigate whether spironolactone protects the heart against anthracycline-induced cardiotoxicity.Eighty-three female patients who were diagnosed with breast cancer were included in the study. The study population was randomized into spironolactone and control groups. A dose of 25 mg/day spironolactone was administered to the patients in the spironolactone group. There were 43 patients (mean age 50 ± 11 years) in the spironolactone group and 40 patients (mean age 51 ± 10 years) in the control group. LVEF decreased from 67.0 ± 6.1 to 65.7 ± 7.4 (P = 0.094) in the spironolactone group, and from 67.7 ± 6.3 to 53.6 ± 6.8 in the control group (P0.001). When the general linear model was applied, the interaction of LVEF decrease between groups was significantly lower in the spironolactone group than in the control group (P0.001). The diastolic functional grade of subjects in the spironolactone group was protected (P = 0.096), whereas it deteriorated in the control group (P0.001).We showed that spironolactone administration used simultaneously with anthracycline group chemotherapeutics protects both myocardial systolic and diastolic functions. Spironolactone can be used to protect against anthracycline-induced cardiotoxicity.NCT02053974.

WOS: 000288462900006, PubMed ID: 20682610, Impairment of endothelial functions has been shown to occur after acute and chronic exposure to passive smoking (PS), as assessed by flow-mediated dilatation (FMD) of the brachial artery. A total of 61 participants, 30 male and 31 female, mean ages 26 (18-36) were enrolled in the study. All were clinically well and nonsmokers. All participants stayed for 30 minutes in the smoking room. Carbon monoxide (CO) level was 7.42 +/- 0.98 ppm (4.71-10.50). Mean carboxyhemoglobin (COHb) levels of participants were significantly elevated after PS. Mean FMD was 18.6% +/- 9% and decreased to 12.4% +/- 7% after PS (P < .001). In the current study, with more number of participants at lower CO concentrations (7.42 ppm) and with smaller increase in COHb (51%) significant reduction (33%, P < .001) in FMD was observed.

Dobutamine stress echocardiography (DSE) is a valuable tool for evaluating patients with established or suspected coronary artery disease (CAD). However, conventional DSE assesses visually ; the visual assessment of regional wall motions is subjective and strongly dependent on experience (1, 2). Tissue Doppler-based longitudinal strain and strain rate (SR) permit the more quantitative and sensitive assessment of wall motions (3). Heart-type fatty acidbinding protein (hFABP) levels rapidly and sensitively increase in serum after myocardial damage (4). hFABP levels could increase after DSE in response to ischemia, and ischemia can be detected by measuring hFABP levels before and after DSE. Combination strain and SR imaging with hFABP levels on DSE could give additional information for predicting the severity of coronary lesions. In this study, we evaluated the diagnostic accuracy of strain, SR, and hFABP levels and compared it to frasionatal flow reserve (FFR) val ues in intermediate coronary lesions on DSE. A total of 31 patients undergoing coronary angiography with a diagnosis of stable angina pectoris (SAP) were enrolled in this prospective observational study. Each patient had only one intermediate coronary lesion in a major epicardial coronary artery. The stenosis diameters of all coronary lesions, which were measured by quantitative coronary analysis, were between 40% and 70%. FFR was planned for all lesions. Coronary angiography and FFR were performed in two different sessions. DSE was performed after coronary angiography and before FFR. DSE images were recorded for the analyses of strain and SR imaging. Blood samples were collected to measure hFABP levels before and 4 h after DSE. The analysis of tissue Doppler derived-strain and SR measurements was performed offline by two independent cardiologists without knowledge of the FFR results. Measurements were performed in each of the following culprit segments in line with the AHA recommendations: the anterior wall was analyzed from apical two-chamber images for the left anterior descending artery, the lateral wall was analyzed from apical four-chamber images for the left circumflex artery, and the inferior wall was analyzed from api cal two-chamber images for the right coronary artery (5). Longitudinal strain, SR, and post-systolic strain indices (PSIs) of each wall were determined. PSIs were calculated as the ratio of post-systolic shortening to peak systolic strain. The diagnostic accuracies of the mean SR values and PSIs of three segments (basal, mid-, and apical) of the wall parameters of the culprit vessel were determined as areas under the curve (AUC)receiver operating characteristics (ROC). In all tests, a p-value of

Spontaneous coronary artery dissection (SCAD) still is a rare cause of acute coronary syndrome. SCAD has been observed in three groups of patients: those with coronary atherosclerosis, peripartal women and idiopathic group. SCAD may be associated with some conditions. We report an unusual association: SCAD and pulmonary thromboembolism.

Carbon monoxide (CO) poisoning is an important health problem. Cardiac abnormalities may occur in patients with CO poisoning; however, the severity and duration of cardiac abnormalities are not well known. In this study, cardiac structures and function in CO poisoning were evaluated prospectively. Twenty patients were enrolled in the study. Echocardiographic examination was performed in all patients on admission, at 24 hours, and within the first week. B-type natriuretic peptide and carboxyhemoglobin levels were measured. Patients with increased cardiac markers underwent coronary angiography. Cardiac markers were high in 6 patients. Patients with high cardiac markers had significantly higher carboxyhemoglobin levels and longer exposure to CO. Left ventricular ejection fraction (LVEF) was < 45% in 8 patients (group I) on admission and > 55% in 7 patients in group 124 hours after echocardiography. A significant negative correlation was found between B-type natriuretic peptide and LVEF on admission (r = -0.586, p < 0.01). The decrease in LVEF was also negatively correlated with carboxyhemoglobin level and CO exposure duration. All angiograms showed normal coronary arteries. In conclusion, despite normal coronary arteries, myocardial dysfunction may occur in patients with CO poisoning. LV systolic function might be normal or mildly to severely impaired. However, most of the myocardial dysfunction dissipates, at 24 hours in patients with CO poisoning. (c) 2007 Elsevier Inc. All rights reserved.

To the Editor: We read the article by Dogan and colleagues1 regarding the cardiac effects of chronic graft-versus-host disease (cGVHD) in patients who had undergone allogeneic stem cell transplantation. Chronic GVHD is a severe complication after allogeneic bone marrow transplantation, which is an immunotherapeutic option in several hematologic diseases. Although the pathogenesis of cGVHD remains unclear, it is solidly linked to graft-versus-leukemia (GVL) reactions; the balance between GVHD and the beneficial GVL-effect anticancer capacity of donor immune cells is crucial to the outcome of transplantation. Several variables have been observed clinically, such as the type of disease, the conditioning regimen, and relevant polymorphisms of the genes that might contribute to interpatient variability in alloimmune responses. Investigators in Spain have found that the cytotoxic T-lymphocyte antigen 4 (CTLA-4) CT60 AA genotype is associated with an increased risk of relapse and a higher transplant-related mortality rate.2 In addition, investigators have proposed that the major histocompatibility complex class I chain-related protein A (MICA) is a genetic marker of cGVHD: MICA is a molecule of particular interest because of its participation in non-T-cell receptor-mediated immune function. In particular, Boukouaci and colleagues3 have found that the presence of MICA-129 values increases the risk of cGVHD in an allele dose-dependent manner. Unfortunately, it is unclear how to use these genetic markers as candidate biomarkers for cGVHD in the clinical setting. We agree that high-sensitivity C-reactive protein (hs-CRP) is a useful biomarker in patients in whom cGVHD develops after bone marrow transplantation.4 Other investigators have studied the tissue damage caused by the conditioning regimen, infections, and allogeneic immune reactions accompanying the initial elevation of hs-CRP levels during the course of allogeneic hematopoietic stem cell transplantation.5 These findings indicate the possible association of hs-CRP values with the substantial increase in tissue damage that leads to GVHD.5 However, results of a recent study6 show that cGVHD has no impact on cardiovascular risk and that hs-CRP (which is usually considered to be an important biomarker that predicts the risk of cardiovascular events) does not correlate with profiles of high cardiovascular risk. Hence, does hs-CRP exert a direct cardiac effect through an increase in left ventricular mass, or is it a surrogate biomarker only for cGVHD patients? Future efforts in biomarker discovery and consequent validation are needed for an understanding of the pathogenesis of cGVHD.

Background: There is growing evidence that aortic distensibility (AD) is a subclinical marker of early atherosclerosis. Aortic intima-media thickness (IMT) was an earlier marker than carotid IMT of preclinical atherosclerosis. In this study, we aimed to assess the relationship between thoracic aortic IMT and AD. Methods: We studied 192 patients (mean age: 45.5 ± 8.4 years) who underwent transesophageal echocardiography (TEE) for various indications. Four different grades were determined according to IMT of thoracic aorta (Grade 1

Abnormal left ventricular (LV) geometric patterns, particularly concentric LV hypertrophy, are associated with a greater risk of hypertensive complications. The aim of this study was to investigate the association between LV myocardial performance index (LVMPI) and aortic distensibility (AD) with different LV geometric patterns in patients with newly diagnosed hypertension (HT).We studied 181 patients with newly diagnosed HT (mean age 51.7 ± 5.4 years) and 39 healthy control subjects (mean age 51.2 ± 5.1 years). Echocardiographic examination was performed in all subjects. Four different geometric patterns were determined in hypertensive patients according to LV mass index (LVMI) and relative wall thickness (RWT). AD was calculated from the echocardiographically derived ascending aorta diameters and haemodynamic pressure measurements. LVMPI was calculated from the tissue Doppler-derived ejection time, isovolumic contraction and relaxation times.The highest LVMPI and the lowest AD values were observed in concentric hypertrophy group compared with control, normal geometry, concentric remodelling and eccentric hypertrophy groups (p0.05, for all). LVMPI was associated with LVMI (r = 0.497, p0.001), RWT (r = 0.270, p0.001), AD (r = -0.316, p0.001) and E deceleration time (r = 0.171, p = 0.02) in bivariate analysis. In multiple linear regression analysis, LVMPI was independently related to LVMI (β = 0.381, p0.001) and AD (β = -0.263, p = 0.001).The LVMPI was highest and AD was lowest in patients with concentric hypertrophy. The LVMPI was independently associated with LVMI and AD in hypertensive patients.

Rheumatic mitral stenosis (MS) is still a common disease in developing countries with high morbidity and mortality rates. The purpose of the study was to evaluate arterial stiffness in severe MS before and after percutaneous mitral balloon valvuloplasty (PMBV).Thirty patients with MS in sinus rhythm requiring PMBV and 20 age-gender matched healthy volunteers. The analyze of pulse wave velocities (PWV) were performed using of the carotid artery at the femoral by PWV technique on patients at baseline and a week after PMBV.The values of PWV were significantly decreased after successful PMBW in MS patients. Mitral mean gradients and systolic pulmonary artery pressures (sPAP) both on echocardiography and catheterization also had a significant decrease after PMBW. The mitral valve areas were significantly increased after PMBW. There was a highly significant negative correlation between mitral valve areas and PWV values. A highly significant positive correlation was seen between mitral mean gradient on catheterization and PWV (r = 0.830, p 〈 0.001). There was also a significant correlation between sPAP on catheterization and PWV values (r = 0.639, p 〈 0.001). Echocardiographic mitral mean gradients and PWV were highly positive correlated with each other (r = 0.841, p 〈 0.001). The sPAP on echocardiography had also a highly positive correlation with PWV (r = 0.681, p 〈 0.001).Mitral stenosis is a cause of impaired arterial stiffness and after the enlargened mitral valve area arterial stiffness improved in patients with MS.

We investigated whether the mean platelet volume (MPV) is associated with the extent and complexity of coronary artery disease in patients with ST elevation myocardial infarction (STEMI). We prospectively included 912 STEMI patients (663 male and 249 female; mean age 58.7 ± 12.4 years) who underwent primary percutaneous coronary intervention. The patients were divided into 3 groups according to MPV tertiles. Highest SYNTAX score (SS) was observed in MPVhigh group compared with MPVmid and MPVlow groups ( P < .001 for all). The SS of MPVmid group was higher than MPVlow group ( P = .036). The MPV in diabetic STEMI patients was higher than in nondiabetic STEMI patients ( P < .001). Multivariate linear regression analysis showed that the MPV was associated with diabetes (β = .115, P = .001), troponin level (β = .131, P = .001), platelet count (β = −.241, P < .001), and SS (β = .216, P < .001). The relation between MPV and SS in diabetic STEMI patients was stronger than for nondiabetic STEMI patients ( r = .473, P < .001 vs r = .129, P = .001).

Mean platelet volume (MPV) is an indicator of platelet activation. We investigated the acute effect of passive smoking on MPV in healthy volunteers. Healthy nonsmoker volunteers (n = 90) spent 120 minutes in a smoke-free room. Then they were exposed to passive smoking in 3 groups consisting of 30 volunteers each in group A (carbon monoxide [CO] 15 ppm) for 120 minutes in a smoking room. Mean platelet volume did not change in group A and in the smoke-free room. Mean platelet volume increased significantly at the 60th minute and continued to increase at the 90th and 120th minute in group B. Mean platelet volume increased significantly at the 30th minute and continued to increase at the 60th, 90th, and 120th minute in group C. In conclusion, acute exposure to passive smoking affected MPV according to the duration and intensity of smoke.

A 32-year-old man with Behcet’s disease presented with typical chest pain of 36-hour onset. His physical examination was normal. Levels of cardiac enzymes and troponin I were increased. Electrocardiography showed ST-segment depression in precordial leads. An emergency invasive intervention was initiated with the diagnosis of subacute anterior myocardial infarction. Coronary angiography showed a large aneurysm in the proximal segment of the left anterior descending artery with TIMI 0 flow (Fig. A). The large aneurysm was also demonstrated by multislice computed tomography (Fig. B, C). The patient underwent an emergency surgical intervention for repair of the coronary aneurysm. Behcet syndrome is a vasculitis that can affect all the arteries and veins. Coronary artery aneurysms are uncommon in Behcet’s disease. Ali Dogan Ahmet Celik† Serap Dogan# Ibrahim Ozdogru

Background : The purpose of this study is to evaluate the importance of tenascin-C ( TNC), N-terminal pro brain natriuretic peptide (NT-proBNP) and C-reactive protein (CRP) on LV remodelling after myocardial infarction (MI). Methods : Fifty-seven stable patients with subacute anterior MI who had total or subtotal occlusion in the infarct-related left anterior desending artery in coronary angiography were enrolled the study. 18 of patients who had total occlusion received only medical theraphy, 19 of patients who had total occlusion received successful PCI + medical theraphy and 20 of patients who had subtotal occlusion received successful PCI + medical theraphy. Left ventricular volumes and ejection fractions (EF) were measured with echocardiography. Serum TNC, NT-proBNP and CRP levels were measured at admission and a month after treatment. Results : There was significant increase in LV end-diastolic volume (LVEDV) and LV end-systolic volume (LVESV) baseline to follow-up in total-PCI group. Baseline to follow-up; a borderline significant increase was observed in LVEDV in the total-medical group. No significant difference was seen in LV volumes and EF in the subtotal-PCI group. NT-proBNP, TNC and CRP levels were decreased in all groups. The decrease in NT-proBNP and CRP values were significant in the total-medical and subtotal-PCI group but in the total-PCI group they were not significant. The decrease of TNC was significant in all groups but the lowest decrease was seen in the total-PCI group. Conclusion : TNC, NT-proBNP and CRP reflect LV remodelling in accordance with echocardiography after MI. doi:10.4021/jocmr759w

Aims To determine the association of platelet indices with spontaneous echo contrast (SEC) in patients with mitral stenosis. Methods and results A total of 232 consecutive patients with mitral stenosis who undergoing mitral balloon valvuloplasty were enrolled to the study. Patients were divided into two groups according to the formation of SEC in the left atrium. Group 1: mitral stenosis complicated with SEC; Group 2: mitral stenosis without SEC. Transthoracic echocardiography and transoesophageal echocardiography were performed for each patient. Complete blood counting parameters were measured and all routine biochemical tests were performed. There were 133 patients (mean age 42 ± 11 and 74% female) in the SEC(−) group and 99 patients (mean age 45 ± 10 and 64% female) in the SEC(+) group. Plateletcrit (0.25 ± 0.06 vs. 0.27 ± 0.07, P = 0.043) and mean platelet volume (MPV) levels (9.4 ± 1.1 vs. 10.4 ± 1.2, P < 0.001) were significantly higher in the SEC(+) group. When we divided the SEC(+) patients into four subgroups according to previously reported criteria, MPV levels increased to correlate with the degree of SEC ( P < 0.001). At multivariate analysis, MPV levels [odds ratio (OR) 2.365, 95% confidence interval (CI) 1.720–3.251; P < 0.001] and PCT levels (OR 2.699, 95% CI 1.584–4.598; P = 0.033) are independent risk factors of SEC in patients with mitral stenosis. Conclusion In patients with mitral stenosis, cheaply and easily measurable platelet indices including MPV and PCT levels are associated with the presence of SEC and are independent risk factors of SEC.

Background: Large randomized studies revealed that percutaneous coronary intervention has no clinical benefit in patients with total occlusion. The purpose of this study is to evaluate left ventricular remodelling after PCI for total and subtotal infarct-related left anterior desending artery in stable patients who have not received trombolytic theraphy. Methods: Sixty stable patients with subacute anterior myocardial infarction who have total or subtotal occlusion in the infarct-related left anterior descending artery were enrolled the study (20 patient in the total-medical group, 20 patient in the total-PCI group and 20 patient in the subtotal-PCI group). All patients’ left ventricular diameters, volumes and ejection fractions measured at admission and after a month. Results: The necrotic segment number in scintigraphy were similar in three groups. In the total-PCI group, there were significant increases in left ventricular diastolic diameter, left ventricular end-diastolic volume and left ventricular end-systolic volume at first month. A borderline significant increase was observed in LVEDV in the total-medical group at first month. No significant difference was seen in all echocardiographic parameters in the subtotal-PCI group at a month after discharge. The percentage of increase in LVEDV was significantly higher and the percentage of increase in LVESV was borderline significantly higher in the total-PCI group than the other groups. Conclusions: In stable patients, PCI for total occlusion in the subacute phase of anterior MI causes an increase in LV remodeling. Nevertheless PCI for subtotal occlusion in the subacute phase of anterior MI may prevent LV remodeling. Cardiol Res. 2011;2(5):229-235 doi: https://doi.org/10.4021/cr83w

Objectives. Endothelial dysfunction is a well known risk factor for atherosclerosis. Uric acid levels are associated with endothelial dysfunction and atherosclerosis even if in physiological range. Xanthine oxidase inhibition with allopurinol decreases uric acid levels and oxidative stress and improves endothelial function. We have investigated the effect of high-dose and long-term allopurinol therapy on endothelial function in diabetic normotensive patients. Methods. This study is a randomized, single-blind, placebo-controlled trial. Both treatment and placebo groups consisted of 50 patients. In the treatment group, daily oral 900 mg allopurinol was started after randomization and maintained for 12 weeks. Brachial artery flow-mediated dilatation (FMD) and nitrate-induced dilatation (NID) were measured at baseline and after the allopurinol therapy to evaluate endothelial function. Results. HbA1c and uric acid levels decreased after allopurinol therapy (6.1 +/- 2.1 vs 5.5 +/- 1.0%, 5.0 +/- 0.8 vs 3.3 +/- 0.5 mg/dl, respectively, p = 0.01) but no change was observed in the placebo group (7.7 +/- 1.9% vs 7.6 +/- 2.0%, 5.3 +/- 2.1 vs 5.6 +/- 0.8 mg/dl, respectively, p > 0.05). FMD and NID increased significantly in the treatment group (5.6 +/- 2.1% vs 8.5 +/- 1.2%, 10 +/- 7.4% vs 14 +/- 4.0%, 10 +/- 7.4% vs 14 +/- 4.0%, respectively, p = 0.01), whereas no change was observed in the placebo group (5.8 +/- 1.8% vs 6.1 +/- 0.8%, 12 +/- 9.5 vs 10 +/- 3.8%, respectively, p > 0.05). Conclusion. Long-term and high-dose allopurinol therapy significantly improved endothelial function in diabetic normotensive patients. In addition, allopurinol therapy contributes to the lower HbA1c levels.

We aimed to evaluate the long-term effect of hemodialysis (HD) treatment on left and right ventricular (LV and RV) functions in patients with end-stage renal disease. The study population consisted of 22 patients with newly diagnosed end-stage renal disease. Before an arteriovenous fistula was surgically created for HD, the patients were evaluated by echocardiography for systolic and diastolic functions. After the first HD session (mean 24.22 ± 2.14 months), the second echocardiographic evaluations were performed. Left ventricular and RV functions before and after long-term HD treatment were compared. The mean age was 55 ± 13 years and 10 (45%) of the patients were female. After long-term HD treatment, the isovolumic relaxation time was significantly decreased; however, the peak early (E) and late (A) diastolic mitral inflow velocities, E/A ratio, and deceleration time of E wave were not significantly different from the baseline measurements. Also, there was no significantly change in the early diastolic velocity (Ea) of the lateral mitral anulus and the E/Ea ratio. Pulmonary vein peak diastolic velocity, peak atrial reversal velocity, and peak atrial reversal velocity duration remained almost unchanged even though the pulmonary vein peak systolic velocity and the pulmonary vein peak systolic velocity/pulmonary vein peak diastolic velocity ratio were significantly lower after long-term HD treatment. In addition, LV systolic functions, LV diameters, LV mass index, left atrium size, and RV diastolic functions were not statistically different after long-term HD treatment. The myocardium is exposed to hemodynamic, metabolic, and neuro-humoral abnormalities during HD treatment; however, the long-term effects of HD on ventricular functions are not clearly known. The present study showed that the long-term effects of HD on LV and RV functions were insignificant in patients with end-stage renal disease. We have demonstrated that the LV and RV functions did not change significantly after long-term HD treatment. We suggest that this result may be due to regulated blood pressure levels of the patients, treatment of anemia and other metabolic disorders during the HD period and the prevention of weight gain and hypervolemia.

Numerous studies show that percutaneous coronary intervention has no clinical benefit in patients with total occlusion. Both regional and global left ventricle (LV) functions may be evaluated in detail by strain (S) and strain rate (SR) echocardiography. The purpose of this study is to evaluate whether S and SR echocardiography may be used to determine the total occlusion.Sixty stable patients who have total or subtotal occlusion in the infarct-related left anterior descending artery were enrolled (Total occlusion group: 35 and subtotal occlusion group: 25 patients). In all patients, LV longitudinal S and SR data were obtained from total 14 segments.S values of middle and apical segments of LV were significantly lower in the total occlusion groups. In SR analysis, middle and apical values of all walls were significantly different between the groups. The total SR of the middle and apical segments was significantly lower in the total occlusion group (respectively, total SR in middle segments: -3.4 ± 0.8% vs. -4.6 ± 1.0%, P0.00001 and total SR in apical segments: -1.7 ± 0.5% vs. -2.8 ± 0.6%, P = 0.001). The total SR values of four walls were also significantly lower in the total occlusion group (-10.3 ± 2.0% vs. -13 ± 3.1%, P0.0001). For predicting total occlusion, the highest sensitivity levels (84%) were obtained in SR of middle-anterior segment. SR of middle-septum and middle-lateral segments has the highest specificity levels (86%).Total occlusion in stable patients with acute coronary syndrome has an unfavorable effect on the LV regional and global functions. Patients with total occlusion may be identified by S and SR echocardiography.

WOS: 000286809300010, PubMed ID: 21145704, Background: The aim of this study was to investigate the acute effects of passive smoking on left ventricular (LV) function in healthy volunteers. Methods: Sixty-one healthy nonsmoking volunteers were enrolled in this study. LV M-mode, two-dimensional, conventional Doppler, and color tissue Doppler echocardiography were performed, and carboxyhemoglobin (COHb) levels were obtained from subjects before and immediately after exposure to passive smoking for 30 min in a smoking room. The differences between baseline and post-smoke exposure measurements of transmitral E and mitral annular Em velocities, heart rate, systolic blood pressure, diastolic blood pressure, and COHb levels were assessed. Results: Mean COHb levels were statistically higher after exposure. There were no changes in LV systolic function and volumes. LV diastolic function changed significantly immediately after passive smoking. The transmitral E wave (0.89 +/- 0.12 vs 0.70 +/- 0.14 m/sec, P =.001), the pulmonary venous D wave (0.52 +/- 0.12 vs 0.49 +/- 0.13 m/sec, P = .01), and the transmitral E/A ratio 1.79 +/- 0.48 vs 1.47 +/- 0.32, P =.001) decreased, while the transmitral A wave did not change. The mitral annular Em velocity decreased (12.5 +/- 2.1 vs 11.7 +/- 1.9 cm/sec, P =.001), the Am velocity increased (6.3 +/- 2.1 vs 6.8 +/- 1.6 cm/sec, P =.001), and the Em/Am ratio decreased (2.28 +/- 0.82 vs 1.78 +/- 0.42, P =.001). Color Doppler echocardiography determined diastolic impairment in only women, whereas color tissue Doppler echocardiography demonstrated diastolic dysfunction in both genders. Acute deleterious effects of passive smoking on color Doppler echocardiographic parameters were more prominent in women. Change in E was related to changes in heart rate and systolic blood pressure and with COHb levels, while change in Em was related only to COHb levels. Conclusions: Acute exposure to passive smoking impairs LV diastolic function in healthy volunteers. The mechanism whereby passive smoking affects diastolic function is probably complex; however, carbon monoxide exposure and an increment in COHb level may be among the causes. (J Am Soc Echocardiogr 2011; 24: 185-91.)

Objective.Systemic lupus erythematosus (SLE) is an autoimmune disorder resulting in multisystemic inflammatory damage. It is reported that cardiovascular diseases (CVD) are responsible for 20%–30% of deaths in patients with SLE. Heart rate recovery after exercise is a function of vagal reactivation, and its impairment is an independent prognostic indicator for cardiovascular and all-cause mortality. The aim of our study was to evaluate the heart rate recovery index in patients with SLE.Methods.The study population included 48 patients with SLE (35 women, mean age 46.3 ± 12.8 yrs, mean disease duration 6.0 ± 2.3 yrs) and 44 healthy controls (30 women, mean age 45.7 ± 12.9 yrs). Basal electrocardiography, echocardiography, and treadmill exercise testing were performed on all patients and controls. The heart rate recovery index was defined as the reduction in the heart rate from the rate at peak exercise to the rate at the first minute (HRR1), second minute (HRR2), third minute (HRR3), and fifth minute (HRR5) after stopping exercise stress testing.Results.There were significant differences in HRR1 and HRR2 indices between patients with SLE and the control group (24.1 ± 6.5 vs 33.3 ± 9.3; p < 0.001, and 44.6 ± 13.3 vs 53.7 ± 9.9; p < 0.001, respectively). Similarly, HRR3 and HRR5 indices of the recovery period were lower in patients with SLE, compared with indices in the control group (57.6 ± 13.0 vs 64.9 ± 11.7; p = 0.006, and 67.2 ± 12.3 vs 75.0 ± 15.4; p = 0.009, respectively). Effort capacity was markedly lower (9.0 ± 1.9 vs 11.1 ± 2.3 metabolic equivalents; p = 0.001, respectively) among the patients with SLE.Conclusion.The heart rate recovery index is deteriorated in patients with SLE. When the prognostic significance of the heart rate recovery index is considered, these results may contribute to explain the increased occurrence of cardiac death. It points to the importance of the heart rate recovery index in the identification of high-risk patients.

Background. Significant numbers of asymptomatic hypertensive patients are attacked by subclinical target organ damage (TOD) such as proteinuria, left ventricular hypertrophy and carotid atherosclerosis. Platelets become activated in uncontrolled hypertension and play a crucial role in increased thrombotic tendency. Mean platelet volume (MPV) is one of the markers that correlate closely with platelet activity. We aimed to investigate the relationship between MPV levels and subclinical TOD in newly diagnosed hypertensive patients. Methods. 80 newly diagnosed hypertensive patients were enrolled to this cross-sectional study. Ambulatory blood pressure monitoring was performed for all patients. Left ventricular mass index (LVMI), carotid intima-media thickness (IMT) and urine albumin/creatinine ratio (UACR) were measured as indices of cardiac, vascular and renal damage, respectively. MPV was measured from blood samples collected in EDTA tubes and high-sensitivity C reactive protein (hs-CRP) was measured by using nephlometer. Results. MPV was significantly correlated with 24-h systolic-diastolic blood pressure (r = 0.52 and r = 0.55, respectively). Correlation analysis indicated that MPV was moderately related with UACR, LVMI, carotid IMT and hs-CRP (r = 0.50, r = 0.55, r = 0.60 and r = 0.69, respectively, p = 0.0001). Multivariable analysis identified that MPV levels were independently associated with severity of proteinuria, carotid IMT and LVMI (p = 0.001). Conclusion. Our findings suggested that MPV levels were associated with severity of subclinical TOD including; carotid atherosclerosis, left ventricular hypertrophy and renal damage, in hypertensive patients. In addition to this, MPV levels were significantly correlated with hs-CRP levels and 24-h ambulatory blood pressure measurements.

Objectives Sarcoidosis is an inflammatory granulomatous disease of unknown cause that involves multiple organ systems. Myocardial involvement is usually associated with poor prognosis, but diagnosis of cardiac sarcoidosis is frequently difficult. The aim of this study was to investigate the atrial conduction time in patients with sarcoidosis by using high-usefulness tissue Doppler echocardiography. Methods The study population included 49 patients with sarcoidosis (19 men; mean age, 40.5 ± 9.8 years; mean disease duration, 35.7 ± 15.3 months) and 45 healthy control subjects (17 men; mean age, 40.7 ± 7.2 years). From the 12-lead electrocardiogram, P wave dispersion (PWD) was calculated. The timing of atrial contractions (PA) was measured as the intervals between the onset of P wave on electrocardiogram and the beginning of A-wave on TDI, and atrial electromechanical delay (EMD) was calculated from the lateral (PA lateral) and septal (PA septal) mitral annulus and lateral tricuspid annulus (PA tricuspid). Results Both PA lateral and PA septal were significantly longer in patients with sarcoidosis than control subjects (67.9 ± 16.1 vs 56.3 ± 13.1, P < 0.001; and 54.8 ± 15.2 vs 45.1 ± 14.2 ms, P = 0.002, respectively). Intra-atrial (PA septal-PA tricuspid) and interatrial (PA lateral-PA tricuspid) EMD were significantly higher in sarcoidosis groups (12.6 ± 7.5 vs 8.0 ± 7.1, P = 0.003; and 25.7 ± 9.8 vs 19.3 ± 7.7 ms, P = 0.001, respectively). Similarly, maximum P-wave duration and PWD were significantly longer in patients with sarcoidosis than control subjects (105.2 ± 11.8 vs 96.7 ± 15.4, P = 0.004 and 24.7 ± 5.6 vs 19.7 ± 7.1 ms, P = 0.001, respectively). There were significant positive correlations between the disease duration and interatrial EMD ( r = 0.56, P < 0.001) and intra-atrial EMD ( r = 0.66, P < 0.001). Positive correlation also was present between the disease duration and PWD ( r = .62, P < 0.001). Conclusions Atrial EMD was found prolonged in patients with sarcoidosis. We also have demonstrated that PWD, interatrial and intra-atrial EMD were significantly correlated with disease duration. This study calls attention to measurement of atrial conduction time that may be clinically helpful in the recognition of cardiac involvement.

Carbon monoxide (CO) is suspected of playing a major role in cigarette smoke-induced cardiovascular diseases. Hypertension is one of the common chronic cardiovascular diseases that lead to heart attacks, strokes, chronic heart failure, and chronic renal failure. We aimed to investigate the immediate effects of passive smoking on blood pressure and heart rate during and after exposure in healthy females. In addition, we examined that whether carboxyhemoglobin (COHb) levels were correlated with heart rate and blood pressure measurements.Thirty healthy nonsmoker female volunteers (mean age: 26±5 years) were prospectively enrolled in the study. Systolic and diastolic blood pressure and heart rate were obtained at baseline, 5th, 10th, 15th, 30th minute of exposure and at 5th, 15th, and 30th minute after exposure. Blood samples for measuring COHb were taken at baseline and after spending 30 min in the smoking room from all volunteers. Difference between baseline and second measurements of COHb were described as ΔCOHb.Mean COHb level was significantly higher at the end of exposure when compared with baseline values (COHb 0.5±0.1 vs. 1.8±0.4%, P0.05). Heart rate and systolic blood pressure measurements at 15th and 30th minute of exposure were higher than at baseline and 5th minute of exposure (88±3.2 and 90±3.7 vs. 76±3.9 and 78±4.5 beats/min, P0.05; 135±1.1 and 136±4.0 vs. 113±5.7 and 115±3.5 mmHg, P0.05). They elevated significantly at the same time interval. Diastolic blood pressure was significantly increased at 30th minute of exposure when compared with earlier measurements (90±5.1 vs. 74±2.2, 72±3.2 vs. 71±4.5 mmHg, P0.05). Heart rate and systolic blood pressure decreased notably at 15th minute and returned to baseline values at 30th minute after exposure (80±1.2 and 76±3.2 vs. 88±4.5 beats/min, P0.05; 120±4.4 and 115±1.9 vs. 135±2.2 mmHg, P0.05). Diastolic blood pressure decreased significantly at 30th minute and returned to baseline values at 60th minute after exposure (75±3.6 and 70±2.5 vs. 89±4.3 mmHg, P0.05). Heart rate and diastolic blood pressure measurements were moderately correlated and systolic blood pressure measurements were closely correlated with ΔCOHb values at the end of the exposure.Our results suggested that passive smoking has remarkable acute effect on heart rate and blood pressure in young healthy females. Beside this, we found that ΔCOHb level is closely correlated with systolic blood pressure and moderately correlated with heart rate and diastolic blood pressure measurements.

Behçet's disease is a chronic inflammatory vasculitis. Vascular involvement is one of the major complications of Behçet's disease, during the course of the disease. Previous studies showed that ACE inhibitors and statins may improve endothelial functions in endothelial dysfunction. The aim of our study is to compare the effects of atorvastatin and lisinopril to placebo on endothelial dysfunction in patients with Behçet's disease.We prospectively studied 92 (48 female) Behçet's patients who were diagnosed according to the International Study Group criteria. Endothelial dysfunction was evaluated by brachial artery flow-mediated dilatation (FMD) method using high-resolution vascular ultrasound device at baseline and after for 3-month therapy. Patients were consecutively randomized into three groups as (atorvastatin (n = 31), lisinopril (n = 31), and placebo groups (n = 30). Patients in atorvastatin group received 20 mg atorvastatin, lisinopril group received 10 mg lisinopril per day, and placebo group received placebo per day for 3 months.The baseline characteristics of patients were similar among three groups; however, high-sensitive C-reactive protein (hs-CRP) levels were lower in atorvastatin group than placebo group. A significant improvement in FMD was observed in both atorvastatin (5.0 ± 1.4 vs. 12.8 ± 3.6%, P0.001) and lisinopril groups (5.0 ± 1.2 vs. 11.4 ± 5.0%, P0.001). Partial significant enhancement was observed in placebo group (4.9 ± 1.1% vs. 5.7 ± 1.0, P = 0.002). However, it was lower than the cutoff value for endothelial dysfunction.These findings suggest that atorvastatin and lisinopril improve endothelial functions in Behçet's disease patients. However, large studies are needed to determine the long-term effects of atorvastatin and lisinopril therapy.

OBJECTIVE Our aim was to investigate the effects of serotonin, which is a severe vasoconstrictor agent, on the occurrence of no-reflow phenomenon. METHODS In this cross-sectional controlled study, 40 patients, admitted to our clinic with chest pain in the first 12 hours and underwent primary percutaneous coronary intervention because of acute myocardial infarction were enrolled. Patients with TIMI 0 grade basal flow and normal post-procedure flow were included in group 1 and patients with flow grade TIMI < or =were enrolled in group 2. To measure the serotonin levels, blood samples were collected from the coronary ostium before the procedure. RESULTS In group 1, there were 25 patients (20 males, 5 females) and the mean age was 58+/-11 years; in group 2 there were 15 patients (13 males, 2 females) and the mean age was 62+/-8 years. The mean serotonin level in platelet in group 1 was 476+/-208 ng/109 platelet and in group 2-542+/-273 ng/109 platelet. The difference was not statistically significant (p=0.39). When we compared the serum serotonin levels, it was 41.4+/-40.8 ng/ml for group 1, but 66.7+/-45.7 ng/ml for group 2. Although the serum serotonin levels were higher in group 2, the difference was not statistically significant (p=0.07). CONCLUSION There was no effect of serotonin level in the development of no-reflow, in patients to whom primary coronary percutaneous intervention was applied.