Predestinating Role of Cardiac Ganglia on Heart Life Expectancy in Rabbits After Brain Death Following Subarachnoid Hemorrhage: An Experimental Study.

BACKGROUND: Cardiac ganglia are rechargeable batteries of the heart. The essential role of cardiac ganglia on cardiac life expectancy has not been examined following brain death. The aim of this study was to determine cardiac ganglia numbers and neuron density following subarachnoid hemorrhage (SAH). METHODS: Twenty-five hybrid rabbits were grouped as control (n = 5), sham (n = 5), and SAH (n = 15). The SAH groups' animals were subjected to injections of lethal dose of 2.00 cc autologous blood into their cisterna magna until linear EEG was obtained. The hearts of all animals were extracted following intracardiac formalin injection and examined. Cardiac ganglia and normal/degenerated neuron densities of cardiac neurons were recorded. RESULTS: The mean volume of normal neuron density of ganglia was 6.980 ± 830/mm3, and the degenerated neuron density of ganglia was 3 ± 1/mm3 in the control group, 6134 ± 712/mm3; 23 ± 9/mm3 in the sham group, 3456 ± 589; 1161 ± 72/mm3 in the surviving group; and 1734 ± 341/mm3, 4259 ± 865/mm3 in the dead animals in the SAH group. The algebraic results of heart work capacity (Wh) were estimated as 1375 ± 210 Wh in the control group, 1036 ± 225 in the sham group, 800 ± 110 Wh in the surviving group, and < 100 ± 20 in the dead animals in the SAH group. Degenerated cardiac neuron density/Wh correlation is statistically meaningful between the dead in the SAH group versus the SAH-surviving, sham, and control groups (P < .0005). CONCLUSIONS: Normal cardiac ganglia numbers and/or cardiac ganglia neuron density may be related to cardiac survival following brain death after subarachnoid hemorrhage.

[Snapshot evaluation of heart failure in Turkey: Baseline characteristics of SELFIE-TR]. / Türkiye'de kalp yetersizliginin anlik görüntüsü: SELFIE-TR bazal karakteristik özellikleri.

OBJECTIVE: Heart failure (HF) is an important health issue of the 21st century and the prevalence in Turkey has been reported as 2.9%. A national profile, frequency data, characteristics of different phenotypes, and risk factors have not yet been well established. The Snapshot Evaluation of Heart Failure Patients in Turkey (SELFIE-TR) was an analysis of a representative sample of HF patients from Turkey. METHODS: A total of 23 centers with at least 2 cardiologists from the 12 NUTS-1 regions of Turkey were invited to participate in the research. The contributing centers shared the data of a consecutive enrollment of HF patients, as confirmed by an investigator, on a pre-selected day of each week for the month of October or November of 2015. RESULTS: The mean age of the entire cohort was 63.3+-13.3 years (male/female ratio: 751/303, 71.3%/28.7%). There were 712 acute HF patients and 342 chronic HF patients. The total number of HF patients with reduced ejection fraction (HFrEF), heart failure with mid-range ejection fraction, and heart failure with preserved ejection fraction was 801 (75%), 176 (16.7%), and 77 (7.3%), respectively. The patients with chronic HF were younger than those with acute HF (61.1+-13.3 years vs 67.9+-12.1 years; p<0.001). Among the whole cohort, hypertension was observed in 46%, diabetes mellitus was present in 27.5%, chronic obstructive pulmonary disease was present in 12.8%, and previous myocardial infarction was noted in 45.2%. In patients with HFrEF, the use of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, a beta blocker, or a mineralocorticoid receptor antagonist was noted in 74.7%, 89.7%, and 60.9%, respectively. CONCLUSION: The SELFIE-TR findings provide important insight, since it is the first study to make a snapshot of HF patients in our country. These data may help to create standardized prevention and treatment strategies.

Coronary fat embolism following subarachnoid hemorrhage: an experimental study.

BACKGROUND: Subarachnoid hemorrhage (SAH) can lead to neurogenic pulmonary edema (NPE), and chylomicron metabolism may be altered unfavorably in acute lung injury. This study aimed to investigate the possible effect of NPE on the development of coronary fat embolism. METHODS: This study was conducted on 27 rabbits, 5 of which were used as the control (n=5). Experimental SAH was induced in 15 of the animals by injecting homologous blood into the cisterna magna, and the remaining 7 animals were administered only isotonic saline solution (Sham, n=7) in the same manner under general anesthesia. After 21 days, all the animals were euthanized, and their hearts, lungs, and brains underwent histopathological examination. RESULTS: Six animals died of SAH during the experiment, and foamy hemorrhagic parenchymal lesions and intra-alveolar hemorrhage were observed in their lungs. The histopathologic findings revealed minimal changes in the lungs, heart, and brains of the surviving animals; however, an abundant amount of fat globules was found in the coronary arteries of the six nonsurviving animals. There was a meaningful difference between the number of occluded coronary arteries with fatty globules in the surviving and nonsurviving animals (P<.001). However, the difference between the survivors and the isotonic-saline-injected group was not meaningful (P>.05). Coronary fat embolism was an important mortality factor following SAH (P<.005). CONCLUSIONS: In SAH-induced NPE, the leakage of chylomicrons into the systemic circulation may lead to coronary fat embolism, which has not yet been reported in the literature.

Comparison of standard and Lewis ECG in detection of atrioventricular dissociation in patients with wide QRS tachycardia.

BACKGROUND: The atrioventricular (AV) dissociation, which is frequently used in differential diagnosis of wide QRS complex tachycardia (WQCT), is the most specific finding of ventricular tachycardia (VT) with lower sensitivity. Herein, we aimed to show the importance of Lewis lead ECG records to detect 'visible p waves' during WQCT. METHOD: A total of 21 consecutive patients who underwent electrophysiologic study (EPS) were included in the study. During EPS, by using a quadripolar diagnostic catheter directed to the right ventricular apex, a fixed stimulus was given and the ventriculoatrial (VA) Wenkebach point was found, and a VT was simulated by a RV apical stimulus at 300ms. The standard and Lewis lead ECG records were taken during this procedure. RESULT: We detected 'visible p waves' in 7 (33.3%) and 14 (66.7%) patients in the standard and Lewis lead ECG groups, respectively. In terms of the 'visible p waves', there was a statistically significant difference between groups (p=0.022). The sensitivity of standard and Lewis lead ECG in determination of the visible p waves was 33.3% and 66.7%, respectively. CONCLUSION: The Lewis lead ECG can be more informative about AV dissociation than the standard 12 lead ECG. As a result, we could suggest the assessment of the Lewis lead ECG recording in addition to the standard 12 lead ECG in differential diagnosis of VT in patients with WQCT.

The safety and efficacy of 12 versus 24 hours of tirofiban infusion in patients undergoing primary percutaneous coronary intervention.

AIM: We aimed to investigate the 6-month efficacy and safety of postprocedural 12-hour tirofiban administration versus 24-hour tirofiban administration in patients with ST-segment elevated myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI). METHODS: This retrospective study enrolled 349 patients with STEMI who underwent primary PCI. Following the administration of bolus tirofiban after primary PCI, those receiving a 12-hour tirofiban infusion as the maintenance dose were classified as group 1 (n = 123) while those receiving a 24-hour infusion were classified as group 2 (n = 226). In-hospital and 6-month major adverse cardiac events were recorded. RESULTS: There were no statistically significant differences between the 2 groups regarding in-hospital efficacy (in-hospital death: 4.4% vs 5.7%, P = .600 and stent thrombosis 1.8% vs 1.6%, P = .921) and in-hospital safety (2.6% vs 1.6% for major bleeding and 5.3% vs 4.1% for minor bleeding, P = .562). During the 6-month follow-up period, the incidence of the recurrent revascularization (16.1% vs 15.5%, odds ratio [OR] = 1.05 [0.47-3.67]), the repeated nonfatal acute coronary syndrome and/or stent thrombosis (27% vs 24.4%, P = .598, OR = 1.02 [0.42-2.48]), and the cardiovascular deaths (6.6% vs 6.5%, P = .943, OR = 1.03 [0.43-2.43]) were comparable between group 1 and group 2. CONCLUSION: Our study revealed that 12-hour tirofiban administration versus 24-hour tirofiban administration in STEMI who underwent primary PCI was similar with respect to in-hospital efficacy and safety and major adverse cardiac events during 6-month follow-up.

The role of the nonspecific inflammatory markers in determining the anatomic extent of venous thromboembolism.

We aimed to investigate the relationship between the extent of venous thromboembolism (VTE) and nonspecific inflammatory markers such as neutrophil to lymphocyte ratio (NLR) and high-sensitivity C-reactive protein (hs-CRP). We retrospectively enrolled 77 patients with VTE (distal deep vein thrombosis [DVT], n = 19; proximal DVT, n = 32; and pulmonary thromboembolism [PTE], n = 26) and 34 healthy controls. In the performed analysis of variance, the levels of white blood cell, NLR, and hs-CRP were clearly different among the groups (control, distal and proximal DVT, and PTE) (P < .001). Especially, a significant increase from the control group to the DVT and PTE was observed in the analysis made for NLR. In the performed receiver-operating characteristic curve analysis, area under curve (AUC) = 0.849 and P < .001 were detected for NLR > 1.84. For this value, the sensitivity and specificity were determined as 88.2% and 67.6%, respectively. The NLR is an inexpensive and a readily available marker that may be effective in determining the extent of VTE, and it is useful for risk stratification in patients with VTE.

Clinical importance of hyperemic coronary blood flow (thrombolysis in myocardial infarction-intravenous flow) after primary percutaneous coronary intervention.

We aimed to investigate clinical, demographic and angiographic factors associated with hyperemic coronary blood flow (HCBF) and the relation of HCBF with mortality at 30 days. Our study included 809 consecutive patients with acute ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention (PCI). We divided corrected thrombolysis in myocardial infarction (TIMI) frame count (TFC) values into three tertiles: less than 14, 14-28 and more than 28. Corrected TFC less than 14 was defined as HCBF or TIMI intravenous flow. The primary end-point of the present study was all-cause mortality within 30 days. Among the HCBF group (n = 58), the patients with poor myocardial perfusion demonstrated the highest mortality rate within the 30-day follow-up period (33%). Low TIMI myocardial perfusion grade, history of no smoking, left ventricular ejection fraction (LVEF), and high Killip status and low LVEF were found to be independently associated with 1-month all-cause mortality. The present study showed that HCBF after primary PCI has a high 30-day mortality when associated with impaired reperfusion.

Determinants of angiographic thrombus burden in patients with ST-segment elevation myocardial infarction.

AIMS: We aimed to investigate the determinants of angiographic thrombus burden in patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (pPCI). METHODS: The study population consisted of 662 patients with nonanemic STEMI who underwent pPCI. Clinical, laboratory, and demographic properties of the patients were recorded. Baseline hematologic indices were measured at the time of admission. Angiographic coronary thrombus burden was scored based on thrombolysis in myocardial infarction (TIMI) thrombus grades. After wiring and/or small balloon dilation, patients with thrombus burden grades 4 and 5 were defined as high thrombus burden, and patients with thrombus burden

Assessment of agreement between transthoracic and transesophageal echocardiography techniques for left ventricular longitudinal deformation imaging and conventional Doppler parameters estimation: a cross-sectional study.

OBJECTIVE: Studies investigating the comparison and interchangeability of transthoracic (TTE) and transesophageal echocardiography (TEE) regarding left ventricular (LV) systolic and diastolic function are limited. Therefore, in this study, we aimed to investigate agreement between TTE and TEE in the assessment of LV systolic functions by longitudinal myocardial deformation imaging (strain-S and strain rate-Sr) and LV diastolic functions by conventional Doppler parameters. METHODS: Thirty-five patients underwent a clinically indicated cross-sectional study on agreement between two methods. All the patients underwent TEE right after TTE. From both TTE and TEE Doppler parameters such as early and late diastolic velocities (E, A, E' and A`) deceleration time (DT), averaged mitral annular systolic velocity (Sm), isovolumic relaxation time (IVRT), isovolumic contraction time (IVCT), ejection time (ET), myocardial performance index (MPI) and longitudinal deformation imaging parameters (S, Sr) and systolic velocities were recorded. Agreement between TTE and TEE were evaluated by Bland-Altman analysis. RESULTS: Bland-Altman analysis showed good agreement between TEE and TTE in terms of E, A, DT, E', A', IVRT, IVCT, ET and MPI measurements. However, there was poor agreement in segmental systolic velocities and segmental Sr parameters assessed by TTE and TEE. Besides, septal wall segmental S analysis showed a better agreement than lateral wall segmental analysis between TTE and TEE recordings. CONCLUSION: TTE and TEE conventional Doppler parameters are compatible in the assessment of LV diastolic function; however, agreement was poor in longitudinal deformation parameters that have been used in the quantitative assessment of LV systolic function between two methods and cannot be used interchangeably.

The relation of serum gamma-glutamyl transferase levels with coronary lesion complexity and long-term outcome in patients with stable coronary artery disease.

BACKGROUND: Relation of serum gamma-glutamyl transferase (GGT) levels with extent, severity, and complexity of coronary artery disease has not been adequately studied. Therefore, we evaluated the relationship between GGT levels and coronary complexity, severity and extent assessed by SYNTAX score and long-term adverse events. METHODS: We enrolled 442 consecutive patients with stable angina pectoris who underwent coronary angiography. Baseline serum GGT levels were measured and SYNTAX score was calculated from the study population. Median follow-up duration was 363 days. Endpoints were all cause mortality and any revascularization. RESULTS: GGT levels demonstrated an increase from low SYNTAX tertile to high tertile. In multivariate analysis serum GGT, diabetes mellitus, HDL-cholesterol, eGFR and ejection fraction were found to be independent predictors of high SYNTAX score. The survival analysis showed that long-term revascularization rates were comparable between the GGT groups (for 36 U/l cut point) of the overall population (7.7% vs 8.6% logrank, p = 0.577), whereas long-term all cause mortality rate was higher in the GGT ≥ 36 U/l group (3.6% vs 11.6% logrank, p = 0.001). In Cox proportional hazards regression model, GGT ≥ 36 U/l group was found to be an independent predictor of long-term all cause mortality in the unadjusted (HR 2.54, 95% CI 1.17-5.48, p = 0.018) and age- and gender-adjusted (HR 2.58, 95% CI 1.19-5.58, p = 0.016) models. CONCLUSION: Serum GGT level was independently associated with coronary complexity and long-term mortality in patients with stable coronary artery disease.

Coexistence of idiopathic left ventricular aneurysm and aneurysm of right coronary artery.

A 40-year-old man was admitted to our hospital with dyspnea and atypical chest pain. Left ventricle (LV) apico-lateral wall aneurysm and right coronary artery aneurysm were found. We could find no etiological reason for this condition. Surgical treatment was considered but the patient refused. In this report, we describe an interesting and rare case of idiopathic LV aneurysm accompanied by coronary artery aneurysm.

[Assessment of regional left ventricular functions by strain and strain rate echocardiography in type II diabetes mellitus patients without microvascular complications]. / Mikrovasküler komplikasyonu olmayan tip II diabetes mellituslu hastalarda bölgesel sol ventrikül fonksiyonlarinin gerilim (strain) ve gerilim hizi (strain rate) ekokardiyografi ile degerlendirilmesi.

OBJECTIVES: We evaluated regional left ventricular myocardial functions by strain (S) and strain rate (Sr) echocardiography in patients with type II diabetes mellitus (DM) without microvascular complications. STUDY DESIGN: The study included 40 DM patients (20 women, 20 men; mean age 52.4 ± 7.9 years) without microvascular complications, and 40 healthy controls (20 women, 20 men; mean age 52.8 ± 10.1 years). Left ventricular functions were evaluated by conventional Doppler, tissue Doppler, and S-Sr echocardiography. Longitudinal peak systolic S and Sr were measured from the basal, mid and apical segments of the left ventricle walls. Patients with DM duration of >3 years (n=24) and receiving medical therapy for DM (n=30) were also evaluated. RESULTS: Conventional Doppler findings were similar in the patient and control groups. Among tissue Doppler variables, only early diastolic mitral annular velocity (Em) was significantly decreased (10 ± 2.9 vs. 11.4 ± 3.2 cm/sec, p<0.05), and accordingly, mitral inflow E/Em ratio was significantly increased (7.3 ± 2.5 vs. 6.3 ± 2, p<0.05) in patients with DM. The two groups were similar with respect to systolic S and Sr values, except for apical-lateral S, mid-anterior S, basal-anteroseptal S, apical-anterior Sr, and mid-anteroseptal Sr (p<0.05, for all). Patients with DM duration of >3 years and receiving medical therapy showed similar changes as the overall patient group. CONCLUSION: The frequency of left ventricular diastolic dysfunction was higher in patients with DM. Irregular distribution of systolic S and Sr indices in the left ventricular segments may indicate that DM leads to heterogeneous myocardial involvement also in the early period.

The effect of pulmonary hypertension on left ventricular diastolic function in chronic obstructive lung disease: a tissue Doppler imaging and right cardiac catheterization study.

BACKGROUND: Pulmonary hypertension (PH) caused by chronic obstructive lung disease (COLD) essentially involves the right heart. Also left ventricular (LV) systolic and diastolic functions may be affected. OBJECTIVES: The aim of this study was to investigate the effect of on LV diastolic function in patients with COLD. METHODS: A total of 47 patients with COLD and 20 controls were included in this study. All patients underwent Doppler echocardiography, tissue Doppler imaging examinations and right cardiac catheterization. The patients were divided into 2 subgroups according to mean pulmonary arterial pressure (mPAP): patients without PH (group1, n = 25) and with PH (group 2, n = 22). The following measurements were taken: peak velocity of early diastolic filling (E), peak late filling with atrial contraction (A), E/A ratio, deceleration time (DT) of E, isovolumic relaxation time (IVRT), early (Em) and late (Am) diastolic mitral lateral annulus velocity. RESULTS: Mitral E/A < 1 and Em < 8 cm/sec were higher in group 2 than in group 1 and the control group. There were significant correlations between mPAP and both mitral E/A (r:- 0.60) and Em (r:- 0.45). In multivariate model, mPAP was not found to be significant on mitral E/A ratio < 1, but there was a significant effect on mitral Em < 8 cm/sec (odds ratio [OR]:1.14, P < 0.05). CONCLUSION: This study shows that LV diastolic dysfunction in COLD is closely correlated to PH levels. Although increased mPAP may affect the mitral E/A ratio, it seems to have no effect on mitral E/A < 1, whereas it has an independent effect on Em < 8 cm/sec.

A case with the longest angiographically documented left main coronary artery.

The left main coronary artery (LMC) is generally considered to be between 5 and 15 mm long. We report a case with the longest angiographically documented LMC (41 mm) in a patient with acute inferior myocardial infarction.

Evaluation of ultrasonographic fatty liver and severity of coronary atherosclerosis, and obesity in patients undergoing coronary angiography.

OBJECTIVE: Aims were to examine associations (1) between non-alcoholic fatty liver disease (NAFLD) and the presence and severity of coronary artery disease (CAD) and obesity, (2) between CAD and NAFLD with aspartate aminotransferase (AST), alanine aminotransferase (ALT) and gamma glutamiltransferase (GGT) levels. METHODS: In this cross-sectional study, the study group consisted of 355 patients (mean age: 57.5+/-11.4 years), that comply with inclusion criteria and selected of 414 consecutive patients who underwent coronary angiographies. Coronary artery disease was defined as a stenosis at least 50% in at least one major coronary artery. Modified Gensini scoring was used to determine the severity of coronary atherosclerosis. Fatty liver was diagnosed by abdominal ultrasonography (4 stages: Grades 0, 1, 2 and 3). Obesity was defined as body mass index (BMI) >or=30 kg/m2. Statistical evaluations were performed using Student's t test, ANOVA, Chi- square, kappa tests and logistic regression analysis. RESULTS: There were significant differences among Grades 0, 1 and 2-3 according to presence of CAD and Gensini score. In univariate analysis, age (OR=1.03, p=0.004), gender (OR=3.05, p<0.0001), dyslipidemia (OR=4.40, p<0.0001), diabetes mellitus (OR=2.15, p=0.048), smoking (OR=3.19, p<0.0001), AST (OR=1.01, p=0.042), GGT (OR=1.04, p<0.0001), NAFLD (OR=1.87, p=0.036) and obesity+NAFLD (OR: 2.1, p=0.018) have effects on presence of CAD. In multivariate model, age (OR=1.04, p<0.001), AST (OR=1.01, p<0.05), GGT (OR=1.04, p<0.001), NAFLD (OR=2.58, p<0.01) have independent effects on CAD; however BMI and obesity were ineffective. Non-alcoholic fatty liver disease has an independent effect on Gensini score (OR=2.02, p<0.05). CONCLUSION: Ultrasonographic fatty liver have independent effects on both the presence of CAD and severity of coronary atherosclerosis. In addition, increased serum AST and GGT levels may be independently associated with CAD.

Cardiac echinococcosis: recurrent intramyocardial-extracardiac hydatid cysts with pericardial protrusion.

A 26-year-old male patient was diagnosed with an isolated recurrent intramyocardial-extracardiac hydatid cyst with pericardial protrusion after being admitted with chest pain and palpitation. He had undergone surgical resection of an intramyocardial pericardial hydatid cyst without cardiopulmonary bypass 10 years earlier. In the current admission, the results from transthoracic and transesophageal echocardiography and multislice computed tomography were confirmed by serological and histopathological tests. The cyst was excised under cardiopulmonary bypass, and the patient was treated postoperatively with albendazole for 9 months. His clinical status improved postoperatively and he was asymptomatic without signs of recurrence as determined by echocardiography.

Comparison of serum levels of inflammatory markers and allelic variant of interleukin-6 in patients with acute coronary syndrome and stable angina pectoris.

OBJECTIVES: Although the relationship between atherosclerosis and inflammatory cells has been recognized in recent years, the effect of interleukin-6 (IL-6) genetic variants associated with atherosclerosis is still controversial. Therefore, we investigated the association between IL-6 polymorphism and levels of IL-6 in patients with coronary artery disease (CAD). METHODS: We conducted a case-control study on 294 unrelated participants who were referred to the cardiology department of the university hospital for coronary angiography because of suspected ischemic heart disease. Group I comprised patients with clinically acute coronary syndrome, and group II comprised patients (individuals matched for age and sex) with clinically stable angina pectoris; both groups were categorized, based on their angiographic findings, as either having angiographically documented less extensive CAD (1 vessel narrowed) or extensive CAD (> or =2 vessels narrowed). They were studied to examine effect of the IL-6 gene variants in CAD. Genotyping was determined by polymerase chain reaction. RESULTS: The IL-6 G/C-174 polymorphism was found in 19 of 106 (18%) in group I and in four of 188 (2%) in group II (P<0.001). Median IL-6 levels were significantly higher in group I (6.7+/-13.6 pg/ml) than in group II (4.1+/-3.8 pg/ml) (P<0.05). In addition, high sensitivity C-reactive protein levels were significantly higher in group I (8.2+/-6.2 mg/dl) than in group II (4.6+/-3.4 mg/dl) (P<0.001). CONCLUSION: These results demonstrated that the presence of the IL-6 G/C-174 polymorphism and increased IL-6 and high sensitivity C-reactive protein levels are strongly associated with the inflammatory system and the course of clinical and hemodynamically significant CAD.

Strain and strain rate imaging in evaluating left atrial appendage function by transesophageal echocardiography.

BACKGROUND: This study was planned to assess whether strain rate (Sr) and strain (S) echocardiography is a useful method for functional assessment of the left atrial appendage (LAA). MATERIAL AND METHODS: Fifty-seven consecutive patients underwent a clinically indicated study. LAA late empty velocity (LAAEV) was calculated as a gold standard for left atrial appendage function. Real-time 2-dimensional color Doppler myocardial imaging data were recorded from the LAA at a high frame rate. Analysis was performed for LAA longitudinal strain rate and strain from midsegment of lateral wall of LAA. LAA strain determines regional lengthening expressed as a positive value or shortening expressed as a negative value. Peak systolic values were calculated from the extracted curve. RESULTS: Spearman correlation test results showed a statistically significant positive correlation was between the S, Sr variables and LAAEV (LAAEV vs S; r = 0.886, P < 0.001; LAAEV vs Sr: r = 0.897, P < 0.001, respectively). Strain and strain rate values were also significantly lower in patients with spontaneous echocardiographic contrast when compared with those without (strain; 2.42 +/- 0.98 vs 13.1 +/- 5.9, P < 0.001 and strain rate: 0.97 +/- 0.54 vs 3.34 +/- 1.15, P < 0.001, respectively). In addition, LAA strain and strain rate values were significantly lower in the patients with LAA thrombus (strain; 2.15 +/- 0.96 vs 8.35 +/- 6.9, P < 0.001, strain rate; 0.79 +/- 0.46 vs 2.30 +/- 1.48, P < 0.001, respectively). CONCLUSION: S and Sr imaging can be considered a robust technique for the assessment of the LAA systolic deformation.

Can transesophageal pulse-wave tissue Doppler imaging be used to evaluate left ventricular function?

BACKGROUND: This study aimed to evaluate the efficiency of transesophageal tissue Doppler echocardiography (TDE) in evaluation of the left ventricular functions. To this end, the data obtained by transoesophageal tissue Doppler echocardiography and by transthoracic tissue Doppler echocardiography were compared simultaneously. METHODS: Nineteen consecutive patients (7 female and 12 male) underwent a clinically indicated study. In transthoracic (TTE) and transoesophageal (TEE) echocardiographic study, a Vingmed System Five Doppler echocardiographic unit (GE Vingmed) was used. For the assessment of the left ventricular function using transthoracic and transoesophageal TDE, the mitral annular peak systolic (S), early diastolic (E), late diastolic velocities (A), late to early velocity ratio (E/A), deceleration times (DT), left ventricular isovolumetric relaxation times (IVRT) were measured at the lateral, medial, anterior, and posterior corners at the mitral annulus by activating TDE mode in the transthoracic and transoesophageal apical four- and two-chamber view. Bland-Altman plots were used to compare the two measurement techniques. The differences between the groups were assessed by Mann-Whitney U test. All the data were expressed as mean +/- SD. A P-value of <0.05 was considered significant. RESULTS: There were no significant differences between two techniques in terms of blood pressure and heart rate. Two techniques were compared for the transthoracic and transoesophageal TDE parameters. Bland-Altman analysis showed comparable values for E, A, E/A, S, and mE/E, although the measurements of DT and IVRT were different. CONCLUSION: PW tissue Doppler echocardiographic approach during TEE may be suitable for assessment of the left ventricular function.