ABSTRACT
PURPOSE: Systemic sclerosis (SSc) is associated with right ventricle (RV) remodeling and dysfunction. The primary aim of this study was to evaluate RV dyssynchrony (RV-Dys) in SSc patients using two-dimensional speckle tracking echocardiography (2D-STE). METHODS: Fifty-five SSc patients with functional class I-II and 45 healthy controls were consecutively included and underwent 2D-STE. RV-Dys was defined as the standard deviation of time to peak strain of mid and basal segments of RV free wall and interventricular septum. SSc group was further classified according to the presence of pulmonary arterial hypertension (PAH). Patients with tricuspid regurgitant velocity >2.8 m/s with additional echocardiographic PAH signs were defined as SSc PAH (+). RESULTS: SSc patients had lower RV longitudinal strain (RV-LS) (-17.6 ± 4.6% vs. -20.8 ± 2.8%, p < 0.001) and greater RV-Dys (49.9 ± 25.4 ms vs 24.3 ± 11.8 ms, p = 0.006) than controls despite no significant difference in conventional echocardiographic variables regarding RV function. Although SSc PAH(+) patients had lower RV-LS and higher RV-Dys than SSc PAH(-) patients, the differences were not statistically significant. The only independent predictor of RV-Dys was RV-LS (ß:-0.324 [-3.89- -0.45]; p = 0.014). CONCLUSION: SSc patients had not only reduced RV-LS but also impaired RV synchronicity even as conventional echocardiographic variables were preserved.
Subject(s)
Hypertension, Pulmonary , Scleroderma, Systemic , Ventricular Dysfunction, Right , Echocardiography , Heart Ventricles/diagnostic imaging , Humans , Hypertension, Pulmonary/complications , Hypertension, Pulmonary/diagnostic imaging , Reproducibility of Results , Scleroderma, Systemic/complications , Scleroderma, Systemic/diagnostic imaging , Ventricular Dysfunction, Right/diagnostic imaging , Ventricular Dysfunction, Right/etiology , Ventricular Function, RightABSTRACT
BACKGROUND AND AIM: We aimed to investigate the role of the Duke treadmill score (DTS) in predicting the presence and severity of coronary artery disease (CAD) by using the SYNTAX score (SS), and also to determine the cut-off value of DTS for both the presence and severity of CAD. METHODS: The study population consisted of 267 patients admitted to the outpatient clinic with chest pain, who under-went coronary angiography after a positive treadmill stress test. First the patients were divided into two groups: SS = 0 and SS > 0. Then the SS > 0 patients were classified into two subgroups with low (1-22) and high (> 22) SS. RESULTS: There was a strong negative correlation between DTS and SS (r = -072, p < 0.001). The area under the receiver-operating curve of DTS was 0.83 (0.77-0.88, p < 0.001) for predicting a significant presence of CAD. The optimal cut-off value of DTS to predict the significant presence of CAD was -3.7 (sensitivity of 74% and specificity of 73%). The area under the receiver-operating curve of DTS was 0.84 (0.78-0.90, p < 0.001) for predicting high SS. The optimal cut-off value of DTS to predict high SS was -11.2 (sensitivity of 81% and specificity of 80%). DTS was found to be an independent predictor of high SS in multivariate analysis. CONCLUSIONS: DTS can predict the presence and severity of stable CAD before coronary angiography and may enable the estimation of the revascularisation method that will be required after the procedure.
Subject(s)
Coronary Artery Disease/diagnosis , Exercise Test , Severity of Illness Index , Aged , Coronary Angiography , Female , Humans , Male , Middle Aged , PrognosisSubject(s)
Behcet Syndrome/diagnostic imaging , Heart Diseases/diagnostic imaging , Thrombosis/diagnostic imaging , Behcet Syndrome/blood , Behcet Syndrome/pathology , Female , Heart Atria/diagnostic imaging , Heart Atria/pathology , Heart Diseases/pathology , Humans , Middle Aged , Thrombosis/pathology , UltrasonographySubject(s)
Aorta/injuries , Aortic Valve Stenosis/surgery , Heart Ventricles/injuries , Postoperative Complications/diagnosis , Cardiac Catheterization , Diagnosis, Differential , Heart Valve Prosthesis Implantation/adverse effects , Humans , Iatrogenic Disease , Postoperative Complications/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
Decreased serum levels of high-density lipoprotein (HDL) cholesterol have been shown to be of prognostic significance in patients with severe infectious diseases. Serum HDL cholesterol levels were therefore investigated as a possible parameter for the prediction of clinical outcomes in patients with left-sided infective endocarditis (IE). Fifty-four patients with IE with available admission serum HDL cholesterol levels were included in the study. A clinical outcome was defined as a complicated course during hospitalization. Forty-two patients had complicated courses during their in-hospital stays. The median serum HDL cholesterol level was significantly lower in patients with IE (n = 54) than healthy controls (n = 26) (26 vs 47 mg/dl, p <0.0001). In the 42 patients with complicated courses, the median serum HDL cholesterol level was lower compared with that in 12 patients with uneventful courses (24 vs 36 mg/dl, p = 0.011). A cut point of serum HDL cholesterol level of 25 mg/dl had sensitivity of 62%, specificity of 75%, and a positive predictive value of 90% for predicting clinical outcomes. In conclusion, serum HDL cholesterol levels measured at admission were markedly reduced in patients with left-sided IE. Furthermore, low serum HDL cholesterol levels predicted complicated clinical courses in these patients.
