The usefulness of left atrial volume index and left ventricular mass index in determining subclinical cardiac involvement in patients with early-stage sarcoidosis.

BACKGROUND AND AIM: Sarcoidosis is a multi-systemic granulomatous disease of unknown etiology. The present study has been designed to evaluate the importance of diastolic dysfunction with left atrial volume index (LAVi) and left ventricular mass index (LVMi) in determining subclinical cardiac involvement in subjects with stage I-II pulmonary sarcoidosis. METHODS: A total of 54 patients under follow-up for sarcoidosis without cardiac involvement and 56 healthy subjects were included in the study. The echocardiographic assessment of the patients revealed no significant difference between the two groups regarding left ventricular end-systolic and end-diastolic diameters, ejection fraction (LVEF) and annular velocity determined by tissue Doppler evaluation. RESULTS: The LVEF calculated was 61.8 ± 7.8 % in the sarcoidosis group versus 64.1 ± 2.7 % in the control group (p = 0.04). Left ventricular interventricular septum thickness, posterior wall thickness, and relative wall thickness were significantly higher in the sarcoidosis group compared to the control group (p < 0.001). The sarcoidosis group had higher LVM and LVMi values compared to the control group (145 ± 18.1 and 79 ± 14 g/m(2), 135 ± 27.7 and 74 ± 14.2 g/m(2); p = 0.020 and p = 0.021, respectively). Left atrial end-systolic volume and LAVi were higher in the sarcoidosis group (28.7 ± 18.5; 15.6 ± 10.2) compared to the control group (16.6 ± 10.9; 8.9 ± 5.5) with a statistically significant difference (p < 0.001). CONCLUSION: The present study indicates diastolic dysfunction and increased LVMi despite normal systolic function in patients with early-stage sarcoidosis without cardiac involvement. Also, the diastolic parameters were normal without showing any significant difference compared to the control group while there was a statistically significant increase in LAVi. This finding suggests that LAVi may be the earliest marker of diastolic dysfunction in patients with early-stage sarcoidosis without cardiac involvement.

Aortic Elastic Properties and Myocardial Performance Index Are Impaired in Patients with Lichen Planus.

OBJECTIVES: The aim of this study was to investigate the elastic properties of the aorta and the myocardial performance index of the left ventricle (LV) in patients with lichen planus (LP). SUBJECTS AND METHODS: A total of 54 patients with LP and 50 controls were enrolled in the study. The 2 groups were well-matched regarding age, gender, body mass index, any smoking history, diabetes mellitus and systolic and diastolic blood pressure (SBP and DBP). The echocardiographic examination was performed on the study subjects and the controls. Aortic elasticity parameters and the myocardial performance index of the LV were calculated. The Student t test, the x03C7;2 test and multiple linear regression were used for the statistical analysis. RESULTS: Aortic strain (AS, 4.77 ± 1.81 vs. 8.95 ± 2.22; p < 0.001) and aortic distensibility (AD, 0.25 ± 0.009 vs. 0.42 ± 0.120; p < 0.001) were significantly lower, and aortic stiffness index ß (ASIß, 3.65 ± 1.03 vs. 2.70 ± 0.91; p < 0.001) was significantly higher in the LP group than in the controls. The myocardial performance index (Tei index) was significantly higher in the LP group than in the control group (p = 0.001). The duration of the LP was negatively correlated with AS (r = -0.364, p < 0.001) and AD (r = -0.279, p = 0.006), and positively correlated with the Tei index (r = 0.324, p = 0.001) and ASIß (r = 0.364, p < 0.001). After adjustment for relevant confounders (age, male gender, smoking, SBP, DBP, diabetes mellitus and low- and high-density lipoprotein cholesterol), LP and its duration were still associated with AS, AD and ASIß. CONCLUSION: In this study, AS and AD were lower and ASIß and myocardial performance index higher in LP patients than in controls.

Predictors and incidence of access site complications in transcatheter aortic valve implantation with the use of new delivery systems.

OBJECTIVES: The aim of this single-center study was to assess the incidence and predictors of in-hospital access site complications related to transcatheter aortic valve implantation (TAVI) performed with new delivery systems in our hospital which has the largest case series in Turkey. MATERIALS AND METHOD: We performed successful TAVI with the Edwards Sapien XT valve to 127 (46 male) patients via a transfemoral (121), trans-subclavian (5) and transapical (1) approach. Access site complications were defined according to the Valve Academic Research Consortium (VARC) end-point definitions. RESULTS: Vascular complications occurred in 10.1% of patients. There was negative correlation between vascular complications and diameter of the common femoral artery (r = - 0.301, p=0.004), external iliac artery (r = - 0.327, p=0.004) and common iliac artery (r = - 0.324, p=0.004), but positive correlation between diabetes (r =0.240, p=0.008), sheath to femoral artery ratio (SFAR), sheath to external iliac artery ratio (SEIAR), procedure time, discharge time and the Society of Thoracic Surgeons (STS) score (respectively; r=0.339, 0.001, 0.527, 0.361, 0.289, p=0.003, 0.001, 0.001, 0.001, 0.002). The incidence of vascular complications was significantly higher in patients with diabetes and a high STS score. VARC bleeding complications occurred in 11.7 % of patients. The learning curve pointing out the importance of experience was significantly important in decreasing both bleeding and vascular complications. CONCLUSIONS: In this study, we demonstrated that major vascular complications related to TAVI decrease with the use of smaller delivery systems and experience and increase with high-risk scores (STS) and the presence of diabetes. In addition, VARC major vascular complications, observed mostly in patients with diabete mellitus (DM) and high STS scores, were associated with vascular diameters. These results further underline the importance of experience and a multidisciplinary team in patient selection and management for TAVI.

The relationship between acute coronary syndrome and stress hyperglycemia.

BACKGROUND AND OBJECTIVE: Hyperglycemia on admission is associated with increased mortality and morbidity in acute coronary syndrome (ACS) irrespective of presence of diabetes mellitus. To the best of our knowledge, no evidence on the relationship between stress hyperglycemia (SH) and the extent of coronary artery disease is found in the literature. Our objective in this study is to assess the relationship of SH with the prognosis of acute coronary syndrome, extent of coronary artery disease (CAD), development of arrhythmia, and major adverse cardiac events. METHOD: 89 patients who were hospitalized in the coronary intensive care unit with diagnosis of ACS between January 2010 and June 2010 were enrolled in the study. The patients were separated into 2 groups as having stress hypergly-cemia or not, according to their blood glucose levels on admission. TIMI and GRACE risk scores were obtained and GENSINI scoring was performed to assess CAD extent for all the patients. Major adverse cardiac events (MACE) (death, MI, re-revascularization, stroke) were recorded for all patients while in the hospital and at 1st and 6th months. RESULTS: In our study, MACE, GENSINI scores at 6 months and development of in-hospital arrhythmia rates were statistically significantly higher and left ventricular ejection fractions were statistically significantly lower in the group with SH. The association of TIMI, GRACE, GENSINI, New York Heart Association (NYHA) and Killip classifications with blood glucose, fasting blood glucose and HbA1c on admission was confirmed. CONCLUSION: Prognostic course happens to be worse and CAD is more extensive in patients with SH. In addition, blood glucose values may have to be estimated lower compared to the samples in the literature, in order to diagnose SH.

Effect of coronary artery bypass surgery on left ventricular function as assessed by strain and strain rate imaging.

INTRODUCTION: This study examined the effect of coronary artery revascularization on left ventricular function and the results of strain imaging for the detection of ischemia before and after coronary artery bypass graft (CABG) surgery. MATERIAL AND METHODS: Sixty-eight patients with a history of coronary artery disease (CAD) were included, prospectively. Conventional echocardiography and color tissue Doppler-derived strain-strain rate echocardiographic imaging were performed 24 hours before and 3 months after CABG surgery. RESULTS: While strain rate values of the basal septum, middle segment of the lateral wall, middle segment of the inferior wall, and middle and basal segments of the anterior wall were significantly increased, other segments did not change after the operation. The mean systolic strain rate value was significantly increased after the operation. Left ventricle strain values in the middle segment of the septum, middle and basal segments of the inferior wall, and middle and basal segments of the anterior wall were significantly increased after the operation. No significant difference was noted in the basal septum or the middle and basal segments of the lateral wall after the operation. The mean systolic strain value was significantly increased after the operation. CONCLUSION: The results of this study suggest that strain and strain rate echocardiography can provide an accurate evaluation of regional contractile function after CABG, even in the segments that are apparently normal.

Transfemoral balloon expandable aortic valve implantation in a patient with myelodysplastic syndrome.

In this case presentation, the transcatheter aortic valve implantation (TAVI) intervention successfully performed on a 76-year-old male patient with severe degenerative aortic stenosis and diagnosed with myelodysplastic syndrome (MDS) is discussed. This case presentation represents the first case on the treatment of severe aortic stenosis on a patient with myelodysplastic syndrome through the use of the TAVI method and may form an alternative to surgery in patients with severe aortic stenosis who have a known haematological disease. For a successful procedure, the patient must be evaluated in cooperation with the haematology clinic and all necessary precautions regarding bleeding and infection complications of the patient must be taken prior to the procedure.

Early outcomes of carotid artery stenting.

BACKGROUND AND AIM: Ischemic cerebrovascular events are the most common reason for patients to be bedridden and the third most common reason for death. Many studies in recent years have demonstrated that carotid artery stenting (CAS) may be an alternative to carotid endarterectomy (CEA). In this study, we aimed to report early outcomes of patients who were treated with CAS in our clinic and discuss practicability, advantages and safety of CAS. METHODS AND FINDINGS: Eighty patients who underwent CAS between December 2009 and May 2011 were eligible. The mean age was 65 years (range, 49 - 89 years). Of the study group, 73.75% were males and 26.25% were female. The percentage of asymptomatic patients was 11.7%, and the remaining patients were symptomatic. A distal embolic protection device (Angioguard®) was used in 22% of the patients whereas, in the other patients (78%), a proximal blockage system (Mo.MA®) was used. Self-expandable hybrid stents were implanted in all patients and post-dilatation was performed after implantation. None of the patients suffered from stroke, myocardial infarction or death due to CAS during their hospital stay. The mean follow-up period was 10 months (range 2 - 18 months) after discharge. None of the patients had died or had a stroke, a transient ischemic attack (TIA), or a myocardial infarction during the follow-up period. Re-stenosis was not observed in the follow-up carotid Doppler ultrasonography; flow rates were within normal limits. CONCLUSION: No major complication was observed during the early follow-up period in patients who underwent CAS in our clinic. Only 2 (2.5%) patients showed transient numbness and weakness and these did not lead to morbidity. In the management guide of extracranial carotid and vertebral artery diseases, CAS, in the light of recent studies, is recommended as an alternative to CEA in recommendations for revascularization. One of the important issues emphasized in this guide is the experience of centers. Very low complication rates after CAS suggested that, with suitable patient selection and an experienced team, similar results may be obtained.

Measurement of the ionization state and electron temperature of plasma during the ablation stage of a wire-array Z pinch using absorption spectroscopy.

Wire-array plasmas were investigated in the nonradiative ablation stage via x-ray absorption spectroscopy. A laser-produced Sm plasma was used to backlight Al wire arrays. The Sm spectrum was simultaneously observed by two spectrometers: one recorded the unattenuated spectrum and the other the transmission spectrum with 1.45-1.55 keV K-shell absorption lines. Analysis of absorption spectra revealed electron temperature in the range of 10-30 eV and the presence of F-, O-, N- and C-like Al ions in the absorbing plasma. A comparison of this electron temperature with the postprocessed absorption spectra of a 2D MHD simulation yields results in general agreement with the data analysis.

Aortic elastic properties are impaired in patients with Graves' ophtalmopathy.

BACKGROUND: Aortic elastic properties have been shown to be an important predictor of cardiovascular morbidity and mortality. Hyperthyroidism was shown to be an important cause of impaired aortic elastic properties both due to the direct effect of the thyroid hormones on the aorta and also due to modulating effects of thyroid hormones on the vascular renin angiotensin system. However, there is no study investigating the aortic elastic properties in Graves's patients who were euthyroid. The goal of the present study was to investigate the aortic elastic properties of patients with Graves' Ophtalmopathy (GO) who had been euthyroid for at least 3 months. PATIENTS AND METHODS: A cross-sectional study was performed on 47 GO patients and 27 controls. Aortic-diastolic and aortic-systolic diameters, aortic strain, aortic distensibility, and aortic stiffness indices were calculated from the diameter of the thoracic aorta as measured by transthoracic echocardiography. RESULTS: The aortic stiffness index was markedly increased (31 ± 26 vs. 17 ± 8.9; p = 0.015) and aortic strain was markedly reduced (20.3 ± 10 % vs. 25.9 ± 12 %; p = 0.046) in the GO group relative to the control group. Aortic distensibility was statistically significantly decreased in the GO group as compared to the control group (9.5 ± 5.7 10(-3)/kPa vs. 13.5 ± 7.1 10(-3)/kPa; p = 0.022). Weak correlations were detected between GO severity and aortic distensibility (r = -0.333, p = 0.011) as well as the aortic stiffness index (r = 0.266, p = 0.044). CONCLUSIONS: Aortic elastic properties were impaired in patients with GO. Therefore, patients with GO, especially those with severe manifestations of the condition, should be followed closely with regard to the occurrence of future cardiovascular events.

Data processing of absorption spectra from photoionized plasma experiments at Z.

We discuss the processing of x-ray absorption spectra from photoionized plasma experiments at Z. The data was recorded with an imaging spectrometer equipped with two elliptically bent potassium acid phthalate (KAP) crystals. Both time-integrated and time-resolved data were recorded. In both cases, the goal is to obtain the transmission spectra for quantitative analysis of plasma conditions.

A case of Brucella endocarditis in association with superficial femoral artery thrombus.

We report here a case of Brucella endocarditis associated with superficial femoral artery thrombus. The patient was treated only with medical treatment. The clinical significance of the case was the presence of two rare complications of brucellosis:endocarditis and arterial thrombus.

Evaluation of risk factors in predicting coronary artery disease in patients with left bundle branch block.

This retrospective study examined whether classical risk factors for coronary artery disease (CAD) could also be used to predict CAD in patients with left bundle branch block (LBBB). Clinical and demographic features were studied in patients with/without CAD who presented with LBBB on their surface electrocardiograms and had undergone coronary angiography. Of the 312 patients with LBBB, 161 (51.6%) had CAD. Patients with CAD were more likely to be older, male, have CAD risk factors and to be taking acetylsalicylic acid or angiotensin-converting enzyme inhibitors. A model with six independent variables (family history, smoking, angina, advanced age, hypertension and total cholesterol levels) was statistically significant in predicting CAD in patients with LBBB, with an ability to predict patients with and without CAD of 87.1% and 90.6%, respectively. Predictors of CAD in patients with LBBB are consistent with classical risk factors and may help the accurate prediction of patients with CAD.

Aortic valve endocarditis with aortic wall thickening requires close follow-up for a possible abscess formation.

A 67-year-old woman was admitted with aortic valve endocarditis and aortic wall thickening (AWT). Physical examination and laboratory findings yielded infective endocarditis. Echocardiography revealed several small vegetations on the aortic valve, leading to moderate aortic insufficiency together with a small ventricular septal defect. We also became aware of the AWT on and over the aortic root by transesophageal echocardiography (Figure 1). At the one month follow-up period, we also noticed an abscess formation originating from the AWT, which grew into a mature abscess form, day by day (Figure 2). The aortic valve endocarditis, with destruction of the aortic annulus and abscess formation, in this patient, is considered as a grave condition which, essentially, requires an aggressive combined surgical and medical approach. We would like to intimate here with this patient that AWT needs to be considered seriously important in aortic valve endocarditis and, even if the detected vegetations are small, a close follow-up for a possible abscess formation is essential.

Assessment of left ventricular functions by tissue Doppler echocardiography in patients with Cushing's disease.

OBJECTIVE: To verify whether tissue Doppler imaging (TDI) could contribute to a better understanding of the natural history of cardiomyopathy in active Cushing's disease (CD), through its enhanced sensitivity to diastolic dysfunction, and identifying preliminary regional signs of systolic dysfunction before the appearance of clinical symptoms of cardiac pathologies. METHODS: Eleven women with newly diagnosed CD and 32 control cases, purposely matched for gender, age, body mass index and co-incidental diseases were enrolled in this study. Echocardiographic examinations were assessed by conventional echocardiography and tissue Doppler imaging. The peak systolic velocity (S'm), early diastolic myocardial peak velocity (E'm), late diastolic myocardial peak velocity (A'm), isovolumic acceleration (IVA), myocardial pre-contraction time (PCT'm), myocardial contraction time (CT'm) and myocardial relaxation time (RT'm) were measured at septal and lateral mitral anulus. RESULTS: In TDI, E'm and, E'm/A'm ratio were significantly lower, and PCT'm/CT'm ratio was higher, S'm, A'm, peak early diastole/E'm ratio, PCT'm, and isovolumetric myocardial relaxation time values were similar at lateral and septal anulus in patients with CD than controls (p>0.05). Lateral and septal anulus IVA were significantly lower in patients with CD than the control group (p<0.05). Correlation analysis showed that IVA time at lateral anulus correlated positively with S'm at lateral anulus (r=0.58; p=0.002) and IVA time at septal anulus correlated positively with S'm at septal anulus (r=0.51; p=0.008). CONCLUSION: Our study confirms that patients with CD have impaired diastolic function. More importantly, we also demonstrated an impairment of myocardial systolic function in patients with CD by TDI. We recommend using TDI in addition to conventional echocardiography parameters for the cardiovascular risk assessment of patients with Cushing' syndrome.

QTc dispersion measurement for risk of syncope in patients with aortic stenosis.

The purposes of this study are to evaluate the clinical usefulness of maximum QTc and QTc dispersion determination in aortic stenosis, and to compare the effects of maximum QTc and QTc dispersion on the risk of syncope in aortic stenosis. The QT interval dispersion has long been known to be a marker of dispersion of ventricular repolarization and, hence, electrical instability. Additionally, it has been shown that these patients have a propensity to ventricular tachyarrhythmic syncope. The study included 86 patients with aortic stenosis who underwent left-heart catheterization and coronary angiography during investigation of syncope and 30 healthy subjects. The patients were characterized with regard to the presence or absence of a history of syncope and the severity of aortic stenosis (the degree of peak transvalvular gradient). In addition, QT max and QT dispersion measurements were corrected for heart rate according to Bazett's formula. The QTc max and QTc dispersion were greater in patients with aortic stenosis than in the healthy subjects (477 +/- 49 ms vs 370 +/- 22 ms, p < 0.001; 60 +/- 13 ms vs 38 +/- 1 ms, p < 0.001). Similarly, the QTc max and QTc dispersion were greater in the patients with a history of syncope than in the patients with no history of syncope (493 +/- 48 ms vs 459 +/- 4 ms, p < 0.001; 68 +/- 12 ms vs 53 +/- 10 ms, p < 0.001). In addition, both parameters were greater in the patients with a high transvalvular gradient than in the patients with a low transvalvular gradient (489 +/- 49 ms vs 451 +/- 39 ms, p < 0.001; 65 +/- 12 ms vs 50 +/- 9 ms, p < 0.001). Multivariate logistic regression analysis showed that only a increased QTc dispersion had significant value for the risk of syncope in aortic stenosis. An increased QTc dispersion caused a 10.4% increase in the occurrence of syncope in aortic stenosis. These results suggest that high values of QTc dispersion are sensitive noninvasive markers to determine the risk for syncope in aortic stenosis.

Can flow cytometry detect successful ticlopidine treatment in patients with VVI pacemakers?

An increased platelet activation status is present in patients with VVI pacemakers. With platelet activation, there is modulation of platelet surface molecule expression. In the current study, the expression of platelet surface markers in VVI patients before and after ticlopidine treatment and control subjects was investigated by means of flow cytometry. The study group consisted of 25 patients with VVI pacemaker, and 15 control subjects. CD42b, CD61, and CD62p expression were significantly increased in VVI patients compared with control subjects (CD42b p < 0.001, CD61 p< 0.005 and CD62p p < 0.001). In addition, after ticlopidine treatment, platelets showed a significant fall in expression of all these markers in VVI patients (CD42b p < 0.001, CD61 p < 0.005 and CD62p p< 0.001). Our data suggest an increase of the surface expression of all these markers on platelets and demonstrate the efficacy of ticlopidine in reducing them.

Comparison of exercise stress testing with dobutamine stress echocardiography and radionuclide ventriculography for diagnosis of coronary artery disease.

Dobutamine stress echocardiography, Tc-99m radionuclide ventriculography (RNVG), and exercise stress testing were performed prospectively in 63 patients with suspected coronary artery disease to compare the values of exercise testing, dobutamine stress echocardiography and RNVG in the non-invasive diagnosis of coronary artery disease. The sensitivities of dobutamine stress echocardiography and RNVG were found to be higher than that of exercise testing (93-62%, p < 0.001; 83-62%, p < 0.05). The sensitivities of dobutamine stress echocardiography and RNVG were similar (p > 0.05). There were no differences between the sensitivities of the three techniques in multiple vessel disease (p > 0.05). The specificities of dobutamine stress echocardiography and RNVG were higher than that of exercise testing (for both of the tests 86-62%, p < 0.05). The diagnostic accuracy of dobutamine stress echocardiography and RNVG were similar (p > 0.05). The results of dobutamine stress echocardiography RNVG were concordant with each other in 46 patients (76%, kappa = 65%) in sectional analysis. Dobutamine stress echocardiography and RNVG tests were comparable with each other in 85% of the 189 segments (kappa = 64%). The expected 5% decrease at peak doses of dobutamine was not detected in stress echocardiography in 25 patients and in RNVG in 26 of the patients. Dobutamine stress echocardiography and RNVG are superior to exercise testing in the diagnosis of single vessel disease and there is no significant difference between the two techniques. When the ejection fraction is considered in dobutamine stress echocardiography and RNVG, it does not make an additional contribution to the diagnosis of coronary artery disease.

Comparison of exercise stress testing with dobutamine stress echocardiography and exercise technetium-99m isonitrile single photon emission computerized tomography for diagnosis of coronary artery disease.

To compare the value of exercise electrocardiography with dobutamine stress echocardiography and exercise technetium-99m isonitrile single-photon emission computed tomography for coronary artery disease, 70 patients with either suspected or proven coronary artery disease underwent dobutamine stress echocardiography, exercise technetium-99m isonitrile single-photon emission computed tomography (mibi-SPECT) and treadmill exercise electrocardiography (ECG). Dobutamine echocardiography and exercise mibi-SPECT revealed a higher overall sensitivity than exercise testing (90 vs 57%, p < 0.001; 96 vs 57%, p < 0.001, respectively). Dobutamine stress echocardiography showed a higher specificity than both exercise mibi-SPECT and treadmill exercise electrocardiography (90 vs 71%, p > 0.05; 90 and 62% p < 0.05, respectively) but the difference between dobutamine stress echocardiography and exercise mibi-SPECT was not statistically significant. Diagnostic accuracy of dobutamine stress echocardiography and exercise mibi-SPECT was higher than that of exercise testing (90 vs 59%, p < 0.001; 89 vs 59%, p < 0.001, respectively). Dobutamine stress echocardiography and exercise mibi-SPECT have superiority over exercise testing in the diagnosis of coronary artery disease and dobutamine stress echocardiography is an alternative for exercise mibi-SPECT.