Correlation between N-Terminal Pro-Brain Natriuretic Peptide and Doppler Echocardiographic Parameters of Left Ventricular Filling Pressure in Atrial Fibrillation

BACKGROUND: Atrial fibrillation (AF) is the most common cardiac arrhythmia with a population prevalence of about 1%. Natriuretic peptide level is elevated in patients with AF with diastolic dysfunction even with a normal left ventricular (LV) ejection fraction. The N-terminal pro-brain natriuretic peptide (NT-proBNP) level and Doppler echocardiographic parameters for diastolic function have shown correlation with LV filling pressures. We aimed to evaluate the relationship between echocardiographic parameters and serum NT-proBNP in patients with AF with preserved LV ejection fraction. METHODS: We examined transthoracic echocardiography and NT-proBNP levels in the patients with AF and patients with sinus rhythm. Blood samples were taken for serum NT-proBNP measurements within 24 hours of echocardiographic examination. The group 1 was the patients with sinus rhythm (n = 30, mean age 68 +/- 13 years) and the group 2 was the patients with AF (n = 33, mean age 70 +/- 14 years). RESULTS: The group 2 patients had significantly higher mitral E, E' (lateral annulus), E/E' (septal annulus), left atrial (LA) volume index, LA size, pulmonary vein diastolic velocity, and NT-proBNP level than those of group 1 patients (p 15 in patients with AF at cutoff value of 433 pg/mL. CONCLUSION: NT-proBNP level is well correlated with Doppler echocardiographic parameters of diastolic function in patients with AF and preserved LV ejection fraction. NT-proBNP level more than 433 pg/mL may suggest elevated LV filling pressure in patients with AF.

The Primary Patency of Percutaneous Transluminal Angioplasty in Hemodialysis Patients With Vascular Access Failure

BACKGROUND AND OBJECTIVES: Dysfunction of arteriovenous fistulas (AVFs) and arteriovenous grafts (AVGs) contributes significantly to morbidity and hospitalization in the dialysis population. We evaluated the primary patency of AVFs following percutaneous transluminal angioplasty (PTA) in haemodialysis patients. SUBJECTS AND METHODS: We performed 231 interventions in 118 patients with a mean age of 62.1+/-12.9 years. We performed 122 interventions in 53 AVG patients (44.9%), and 109 interventions in 65 AVF patients (55.1%). If there was thrombosis of the vascular access, urokinase was administered and/or thrombus aspiration was performed. The stent was inserted when balloon dilatation did not expand sufficiently or elastic recoil occurred. RESULTS: For the 118 patients, the median patency time was 10.45+/-10.29 months at 92 months of follow-up. The primary patencies for stenotic AVFs at 6, 12, 24, 36, 48, and 60 months were 63.4%, 41.4%, 17.0%, 9.7%, 7.3%, and 2.4%, respectively. The primary patencies for AVGs at 6, 12, 24, and 36 months were 36.9%, 19.5%, 10.8%, 2.1%, respectively, and were obtained by means of the Kaplan-Meier analysis (log rank=6.42, p<0.05). The median patency time was 11.0 months and 4.45 months in the non-thrombus and thrombus groups, respectively. The complication rate was 1.73% (4/231); two cases of pseudoaneurysms and two cases of extravasation were detected. All therapy failures (5/231) occurred in thrombotic lesions of AVGs and were treated surgically. CONCLUSION: PTA is an efficacious method for the correction of stenosis of AVFs for hemodialysis, thus prolonging the patency of the fistulas.

A Case of Staphylococcal Tricuspid Valve Endocarditis With Para-Aortic Abscess in a Patient With Bicuspid Aortic Valve

Paravalvular abscess is a serious complication of infective endocarditis. The aortic valve and its adjacent ring are more susceptible to abscess formation and paravalvular extension than the mitral valve. A 15-years old patient with bicuspid aortic valve presented with staphylococcal tricuspid valve endocarditis complicated by para-aortic abscess that ruptured into the aortic sinus. We report the clinical, laboratory and echocardiographic features and treatment of this patient and conduct a literature review on this subject.

Studies on E-cadherin Expression in the Fusion of Palatine Shelves and Apoptosis in Developing Fetal Rat

It is known that E-cadherin, playing a role in the differentiation of the various tissues, is expressed in the early stage of development. In this research, the expression of E-cadherin and the presence of the intracellular E-cadherin mRNA in the developing fetal rat palatine epithelium using immunohistochemistry and in situ RT-PCR are studied. The investigator also performs TUNEL method and TEM technique for detecting the apoptosis in the palatine epithelium. Fetal rats on the 14th, 15th, 16th and 18th day of gestation were used. The results obtained were as follows: Before the fusion of the both palatine shelves, E-cadherin was expressed in the oral part epithelium. After the fusion oral epithelium and original triangular area were reacted strongly. TUNEL positive cells were rarely found on the midline palatine epithelium in fused palatine processes. On the 18th day of gestation, the remodeling time, many apoptotic cells were observed in the original triangular area. It is suggested that E-cadherin plays a role in the fusion of the palatine shelves, especially in the fusion between the oral part and lower part of midline epithelium, and apoptosis plays a major role in the remodeling of the palate.