The CHA2DS2-VASc score as a predictor of left atrial thrombus in patients with non-valvular atrial fibrillation.

OBJECTIVE: To investigate whether or not the CHA2DS2-VASc score predicts left atrial (LA) thrombus detected on pre-cardioversion transoesophageal echocardiography (TEE). MATERIALS AND METHODS: The medical records of patients who had undergone TEE were reviewed to assess the presence of LA thrombus prior to direct-current cardioversion for atrial fibrillation (AF). The CHA2DS2-VASc score was calculated for each patient. Clinical TEE reports were reviewed for the presence of LA thrombus. Patients with a valve prosthesis or rheumatic mitral valve disease were excluded from this study. RESULTS: A total of 309 patients were identified. The mean age was 70.1 ± 9.8 years and 151 (49%) patients were males and 158 (51%) were females. LA thrombus was seen in 32 (10.3%) of the 309 patients. Fifty (16.2%) patients had a low CHA2DS2-VASc score (0-1), 230 (74.4%) had an intermediate score (2-4) and 29 (9.4%) had a high score (5-9). The incidence of LA thrombus in the low, intermediate and high CHA2DS2-VASc score groups was 0, 4.4 and 68.7%, respectively. The LA thrombus risk increased with increasing CHA2DS2-VASc scores. On multivariate logistic analysis, the CHA2DS2-VASc score (OR 3.26, 95% CI 2.3-4.65; p = 0.001) and age (OR 0.93, 95% CI 0.88-0.98; p = 0.004) were independent risk factors for LA thrombus in patients with non-valvular AF. CONCLUSION: A high CHA2DS2-VASc score was independently associated with the presence of LA thrombus in patients with non-valvular AF.

The association between plasma uric acid level and cardiovascular events in patients with stable coronary artery disease: a short-term follow-up study.

Aim The association of uric acid (UA) level with major cardiovascular risk factors has been well-known. However, whether UA is a risk factor for coronary artery disease (CAD) still remains controversial. We aimed to examine the short term effect of plasma UA level on cardiovascular events (CVEs) in patients with stable CAD. Methods The study included 147 consecutive patients with CAD. The patients were evaluated in two groups. Group 1: 101(68.7%) patients with UA level higher than 6.5 mg/dL for females and 7 mg/dL for males (n= 38 and 63, respectively); Group 2: 46 (31.3%) patients with UA level lower than those values (n= 15 and 31, respectively). The patients were followed for 15.3 ± 5.5 months. Death, acute coronary syndrome, stroke and other cardiovascular hospitalizations were defined as CVE. The relationship between CVEs and plasma UA level was examined using the Cox-regression analysis. Results The mean age was 63 ± 11 years [94 (63.9%) males, 53 (36.1%) females]. Forty-five (30.6%) had diabetes mellitus and 106 (72.1%) had hypertension. The mean UA level was 6.0 ± 1.5 mg/dL. In the follow-up, 23 (15.6%) had any defined CVEs. Only two patients died. No statistical significance was found in terms of the association between plasma UA level and CVEs (p = 0.61). Conclusion In patients with stable CAD no relation between plasma UA level and CVEs in the short-term was found. However, this subject still needs further studies with longer follow-up period.

Cardiovascular risk scores for coronary atherosclerosis.

OBJECTIVE: The objective of this study was to compare frequently used cardiovascular risk scores in predicting the presence of coronary artery disease (CAD) and 3-vessel disease. METHODS AND RESULTS: In 350 consecutive patients (218 men and 132 women) who underwent coronary angiography, the cardiovascular risk level was determined using the Framingham Risk Score (FRS), the Modified Framingham Risk Score (MFRS), the Prospective Cardiovascular Münster (PROCAM) score, and the Systematic Coronary Risk Evaluation (SCORE). The area under the curve for receiver operating characteristic curves showed that FRS had more predictive value than the other scores for CAD (area under curve, 0.76, P < or = 0.001), but all scores had good specificity and positive predictive value. For 3-vessel disease, the FRS had better predictive value than the other scores (area under curve, 0.74, P < or = 0.001), but all scores had good specificity and negative predictive value. CONCLUSION: The risk scores (FRS, MFRS, PROCAM, and SCORE) may predict the presence and severity of coronary atherosclerosis.The FRS had better predictive value than the other scores.

Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio are prolonged in patients with moderate and severe obstructive sleep apnea.

BACKGROUND: Prolongation of the peak and the end of T wave (Tp-e) has been reported to be associated with ventricular arrhythmias. Tp-e/QT ratio and Tp-e/QTc ratio are used as an index of ventricular arrhythmogenesis. An increased incidence of ventricular arrhythmias has been reported in patients with obstructive sleep apnea (OSA). The aim of this study was to assess ventricular repolarization in patients with OSA by using Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio. METHODS: We have studied 72 patients who underwent overnight polysomnography (PSG) between the years 2010-2011 at our institution. Patients with moderate and severe OSA (23 patients; mean age: 45±10), according to the apnea-hypopnea index, constituted the study group. Patients with normal PSG (23 patients; mean age: 42±11) were used as the control group. In all patients, Tp-e interval, Tp-e/QT ratio, Tp-e/QTc ratio, as well as some other electrocardiogram intervals were measured. Independent samples t-tests were used for comparison of continuous and categorical variables and correlations were calculated by Spearman rank correlation. RESULTS: Although QT and QTc intervals were not different between the groups, mean Tp-e interval (81.6±11.1 msn; 63.9±7.3 msn; respectively; P < 0.001), Tp-e/QT ratio (0.21±0.03; 0.17±0.02; respectively; P < 0.001), and Tp-e/QTc ratio (0.20±0.03; 0.16±0.02; respectively; P < 0.001) were prolonged in the study group compared to the control group. Correlation analysis showed a significant positive correlation between the presence of moderate and severe OSA and Tp-e interval (r = 0.72; P < 0.001), Tpe/QT ratio (r = 0.70; P < 0.001), and Tp-e/QTc ratio (r = 0.70; P < 0.001). CONCLUSIONS: Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio are prolonged in patients with moderate and severe OSA patients. There is a positive correlation between the presence of OSA and Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio.

Aortic flow propagation velocity as an early predictor of high coronary risk in hypertensive patients.

AIM: To assess the value of aortic flow propagation velocity (Vp) in detecting hypertensive patients with coronary risk. METHODS: The study included 120 patients with hypertension. According to the 10-year risk of coronary heart disease the patients were categorized in the three groups: 10-year risk < 10% (I),10 - year risk=%10 - 20 (II), and 10-year risk > 20% (III). The aortic flow propagation velocity (Vp) was measured from descending aorta with color M-mode echoardiography. The slope of the first aliasing contour was accepted as Vp. It was compared with Framingham coronary risk score, carotid intima media thickness and high sensitive C-reactive protein. Twelve patients were excluded from the study due to poor acoustic window. RESULTS: The Vp was significantly lower (p<0.001), carotid intima media thickness and high sensitive C-reactive protein was significantly higher in group III (p=0.002 and p=0.014). The area under ROC curve of Vp, carotid intima media thickness and high sensitive C-reactive protein were 0.890, 0,700 and 0.664, respectively. There was a significant inverse relation between Vp and carotid intima media thickness (r=-0.37; p<0.001). CONCLUSIONS: The aortic flow propagation velocity is a simple, feasible and reproducible marker of atherosoclerosis with an acceptable sensitivity and specificity. There is a need for longitudinal prospective studies to use it routinely.

CA-125 level is associated with right ventricular echocardiographic parameters in patients with COPD.

OBJECTIVE: A few studies have shown that elevated CA-125 levels are associated with chronic obstructive pulmonary disease (COPD). However, there are no data concerning the associaton between serum CA-125 levels and right ventricular (RV) function in COPD patients. This study aimed to evaluate the relationship between CA-125 level and RV echocardiographic parameters in COPD patients. METHODS: Fifty-two patients with COPD (39 male/13 female, mean age 68.9 ± 5.7 years) were studied. The control group consisted of 30 age-sex matched healthy volunteers (23 male/7 female, mean age 64.2 ± 6.3 years). Patients were divided into two subgroups: patients without pulmonary hypertension (group I, n = 25) and with pulmonary hypertension (group II, n = 27). Conventional echocardiographic parameters, tissue Doppler imaging (TDI) and CA-125 level measurements were performed in all subjects. RESULTS: Patients in group II had significantly higher CA-125 levels than those in group I and controls (P < 0.01). CA-125 levels in group I were also higher than control group (P < 0.05). CA-125 levels were correlated with left ventricle E/A ratio, systolic pulmonary artery pressure (sPAP), RV myocardial performance index, and RV fractional area change (r = 0.37, 0.56, 0.34, and -0.42, respectively, all with P < 0.05). There was an independent correlation between CA-125 levels and sPAP values (ß = 0.76, P < 0.001). CONCLUSIONS: Our results show an independent correlation between CA-125 levels and systolic pulmonary artery pressure in COPD patients. The clinical utility of these results at this point in time is unknown and deserves future research.

A simplified proximal isovelocity surface area method for mitral valve area calculation in mitral stenosis: not requiring angle correction and calculator.

AIM: To simplify proximal isovelocity surface area (PISA) method for mitral valve area (MVA) calculation that does not necessitate the usage of a calculator and angle correction, and to compare values estimated using this novel method with the values obtained by the conventional PISA, planimetry and pressure half-time (PHT) methods. METHODS: We evaluated patients with a wide range of mitral stenosis (MS) severity. The MVA was measured by the methods of PHT (MVA PHT), planimetry (MVApl), conventional PISA (MVAC-PISA) and the novel method of simple PISA (MVAS-PISA). Application of simple PISA was performed subsequently by division of the peak mitral inflow velocity by four; measurement of the radius by adjusting the aliasing velocity to this value; square of the radius gives the MVAS-PISA. RESULTS: Twenty patients were enrolled in the study. Peak and mean pressure gradients of patients were 20 ± 6 mmHg and 10 ± 4 mmHg, respectively. The average values of MVApl, MVAPHT, MVAC-PISA, and MVA S-PISA were 1,54 ± 0,41, 1,65 ± 0,40, 1,58 ± 0,42, 1,57 ± 0,44 cm2, respectively. MVAS-PISA had a strong correlation with the MVAC-PISA, MVApl and MVAPHT . Furthermore, there was no significant difference between simple PISA and the other methods. The agreement between planimetry and simple PISA methods for detecting severe mitral stenosis (MVA <1.5 cm2) determined by ROC analysis was very good with a sensitivity and specificity of 100 % and 92%, respectively. CONCLUSIONS: Simple PISA is a user friendly method which does not take time and gives simple and correct results. If the diagnostic power of the technique is proven by more comprehensive studies, it can supersede the conventional PISA method.

Coronary pseudoaneurysm and superior vena cava occlusion in a young patient with multicentric Castleman's disease and antiphospholipid antibody positivity.

Castleman disease is a non-malignant proliferative disease of the lymphoid system. It can be unicentric or multicentric. In this report, we present a case of multicentric Castleman disease to which coronary artery pseudoaneurysm, vena cava superior occlusion, and antiphospholipid antibody positivity was accompanying.

Effect of position changes on myocardial velocity in healthy subjects evaluated by tissue Doppler echocardiography.

OBJECTIVES: This study designed to assess the effect of different positions of head of the bed on myocardial velocity by tissue Doppler echocardiography in healthy subjects. METHODS: Thirty-nine healthy subjects (32 males/7 females, mean age 24.7 ± 4.9 years) were studied. Tissue Doppler imaging (TDI) was performed and velocities were recorded during systole (Sm) and early (Em) and late (Am) diastole at the tricuspid annulus, septum, and mitral annulus in the four-chamber view. Measurements were performed from different positions of left lateral decubitus (0°, 30°, and 60°). Repeated-measures general linear models were used to assess the change in myocardial velocities. RESULTS: No significant difference between myocardial velocities was found at the mitral anulus and septal TDI recordings in the different angles of left lateral decubitus positions (P > 0.05). However, there were statistically significant difference among tricuspid anulus myocardial tissue velocities in these positions (P < 0.05). CONCLUSIONS: Tricuspid anulus myocardial tissue velocities may be significantly influenced by changing of position in healthy subjects. Effect of position changes should be considered in the assessment of these velocities.

Elastic characteristics of aorta in patients with epilepsy.

AIM: To investigate elastic characteristics of the aorta in patients with epilepsy. METHODS: Seventy five patients with a diagnosis of epilepsy through clinical and EEG findings and age and sex matched, 50 healthy controls were included. Systolic and diastolic blood pressures plus systolic and diastolic diameter of the aortic root was measured. Aortic strain (AS) and aortic distensibility (AD) and aortic distensibility index (BSI) were calculated. RESULTS: The average age of the epilepsy group was 23.8.8 +/- 8.2 years, and of the control group it was 24.1 +/- 6.2 years (p > 0.05). AS and AD were lower in the epileptic group while the aortic stiffness index was higher (10.4 +/- 4.2 vs 16.9 +/- 0.2, p: 0.001, for AS; 8.7 +/- 4.0 vs 17.2 +/- 0.1, p: 0.001, for AD and 20.1 +/- 0.1 vs 3.5 +/- 1.2, p: 0.001 for BSI). CONCLUSION: Elastic characteristics of the aorta change in epileptic patients, with a decrease of the distensibility of the aorta and an increase of the stiffness. After this preliminary study, new controlled studies are needed.

Association of plasma B-type natriuretic peptide levels with shunt size in young adults with atrial septal defect.

OBJECTIVE: This study was designed to investigate the validity of brain natriuretic peptide (BNP) levels for the estimation of the shunt size in young adults with atrial septal defect (ASD), and to determine the relationship between BNP levels and echocardiographic parameters of right heart chambers. METHODS: Fifty-six patients with ASD (mean age 22.9 ± 2.0 years) were studied. The control group consisted of 31 age-gender matched healthy volunteers (mean age 22.7 ± 1.9 years). Coventional echocardiography, tissue Doppler imaging (TDI) and plasma BNP level measurement was performed in all participants. The ratio of pulmonary to systemic blood flow (Qp/Qs) was measured noninvasively using transthoracic echocardiography. RESULTS: Plasma BNP levels were significantly higher in ASD patients than in controls (42.9 ± 29.4 vs. 8.3 ± 2.6 pg/mL, P < 0.05). Pulmonary artery pressure (PAP) (P = 0.0001), right atrium (RA) volume (P = 0.0001), and right ventricular end-diastolic volume (RVEDV) (P = 0.0001) values were higher in ASD patients. There was a powerful correlation between plasma BNP levels and Qp/Qs ratio (r = 0.71, P < 0.0001). The plasma BNP levels significantly correlated with PAP (r = 0.61, P < 0.0001), RA volume (r = 0.54, P < 0.0001), RVEDV (r = 0.55, P < 0.0001), and right ventricular myocardial performance index (r = 0.50, P < 0.0001). CONCLUSION: This study shows that there is a significant correlation between right heart echocardiographic parameters and concentrations of BNP in the plasma of young adults with ASD. BNP levels may provide a supplemental data to predict of shunt size in these patients.