Increase in mean platelet volume in patients with myocardial bridge.

AIM: Myocardial bridge is associated with atherosclerosis altered in shear stress and endothelial dysfunction. Mean platelet volume (MPV), a determinant of platelet activation, is shown to be related with atherosclerosis and endothelial dysfunction. In this study, we aimed to evaluate platelet function assessed by MPV in patients with myocardial bridge. METHODS: Forty-two patients with myocardial bridge in the left anterior descending artery (LAD) and 43 age- and gender-matched healthy participants were included in the study. Myocardial bridging was defined as an intramyocardial systolic compression or milking of a segment of an epicardial coronary artery on angiography. For the entire study population, MPV was measured using an automatic blood counter. RESULTS: The study population consisted of 42 patients with myocardial bridge (52.7 ± 10.2, 76.2% male) and 43 age- and sex-matched healthy control participants (52.1 ± 10.4, 74.4% male). Compared to the control group, MPV value was significantly higher in patients with myocardial bridge (8.9 ± 1.24 vs 8.3 ± 0.78; P = .01). Further, there were no significant differences between groups regarding hemoglobin level, platelet count, fasting blood glucose, and creatinine levels. CONCLUSIONS: Our study findings indicated that myocardial bridge is associated with elevated MPV values. Our results might partly explain the increased cardiovascular events in patients with myocardial bridge.

Aortic elastic properties and left ventricular diastolic function in patients with isolated bicuspid aortic valve.

BACKGROUND AND AIM OF THE STUDY: Bicuspid aortic valve (BAV) is one of the most common congenital heart defects. BAV disease is not only a disorder of valvulogenesis, but also represents a genetic disorder of aorta and cardiac development. Recent studies have shown that BAV is associated with abnormal aortic elasticity, and that a reduced distensibility of the aortic root may have a negative impact on left ventricular function. Hence, the study aim was to investigate left ventricular diastolic function and its relationship to aortic elasticity in this patient group. METHODS: Thirty-nine patients with isolated BAV with a normal left ventricular ejection fraction, and 29 age- and gender-matched healthy (control) subjects, were studied prospectively. In none of the patients with BAV was the aortic velocity >2m/s, and no aortic regurgitation (other than mild) was present. Parameters of aortic elasticity (aortic strain, distensibility index, stiffness index and elastic modulus), left ventricular diastolic parameters (E, A, E/a, deceleration time, E', ratio of E/E', left atrial volume index) and valvulo-arterial impedance were calculated in all patients. RESULTS: Aortic strain and distensibility were lower, and aortic stiffness index and aortic modulus higher, in patients with BAV than in controls. Compared to controls, the E/E' ratio and left atrial volume index were significantly higher in BAV patients (E/E' ratio 8.26 +/- 2.56 versus 6.85 +/- 1.45, p = 0.01; left atrium volume index 24.23 +/- 5.78 versus 21.68 +/- 4.11 ml/m2, p = 0.04). However, no significant correlations were identified between the aortic elasticity parameters, valvulo-arterial impedance, and left ventricular diastolic parameters. CONCLUSION: These findings indicated that BAV is associated with an increased left atrial volume and a decreased E/E' ratio. In addition, these parameters did not correlate with any parameters of aortic elasticity, nor valvulo-arterial impedance. These data suggest that BAV disease might have subclinical cardiac dysfunction, and further studies are required to confirm these findings and any causal relationship.

[Assessment of left atrial phasic functions in heart failure patients with preserved or low ejection fractions]. / Ejeksiyon fraksiyonu korunmus veya düsük kalp yetersizligi olgularinda fazik sol atriyal islevlerin degerlendirilmesi.

OBJECTIVES: We aimed to evaluate left atrial (LA) volumes and phasic functions in heart failure patients with preserved or low ejection fractions. STUDY DESIGN: The study consisted of 59 patients (36 men, 23 women; mean age 63.8 years) with heart failure accompanied by low (n=26) or preserved (n=33) ejection fractions. Two-dimensional echocardiographic LA volumes (maximal, minimal and pre-contraction volumes) were obtained and LA phasic functions (reservoir, conduit, and pumping functions) were calculated. The findings were compared with those of age- and sex-matched 30 controls (20 men, 10 women; mean age 60.3 years) without heart failure. RESULTS: All LA volumes were found to be significantly increased in both groups with heart failure compared with controls. Left atrial reservoir and pumping functions were significantly lower in patients with preserved ejection fraction than in those with low ejection fraction (p=0.02 and p=0.009, respectively). Left atrial conduit function was significantly lower in heart failure patients with low ejection fraction than in those with preserved ejection fraction (p=0.005). Compared with controls, heart failure patients with either low or preserved ejection fractions exhibited significantly decreased LA phasic functions (p<0.001). CONCLUSION: Our results demonstrate that, compared to subjects without heart failure, all phasic LA functions are impaired in heart failure patients with either low or preserved ejection fraction. However, impairment in LA reservoir and pumping functions is more prominent in heart failure patients with preserved ejection fraction.

Assessment of P-wave dispersion in patients with isolated bicuspid aortic valve and its relationship with aortic elasticity.

OBJECTIVES: We evaluated P-wave duration and P-wave dispersion (PWD) in patients with isolated bicuspid aortic valve (BAV) without significant valve dysfunction and investigated the relationship between P-wave measurements and aortic elasticity. STUDY DESIGN: This prospective study consisted of 39 patients with isolated BAV with normal ejection fraction and 29 age- and gender-matched healthy subjects. P-wave duration and P-wave dispersion were calculated on 12-lead electrocardiograms. Echocardiographic examination was performed and aortic elasticity parameters were calculated including aortic strain, aortic stiffness index, aortic distensibility, and aortic elastic modulus. RESULTS: Patients with BAV had significantly greater Pmax and PWD compared to controls (128±11 vs. 115±11 msec, p=0.006; 70±10 vs. 66±13 msec, p=0.02, respectively), whereas Pmin was similar. Aortic strain and distensibility were significantly lower and aortic stiffness index and aortic elastic modulus were significantly greater in patients with BAV (for all, p=0.0001). In correlation analysis, Pmax was significantly correlated with aortic strain (r=-0.30, p=0.01), aortic distensibility (r=-0.27, p=0.02), aortic stiffness index (r=0.36, p=0.004), and aortic elastic modulus (r=0.38, p=0.003), while PWD was correlated with aortic strain (r=-0.23, p=0.05) and aortic elastic modulus (r=0.25, p=0.05). CONCLUSION: Our data showed that isolated BAV without valve dysfunction was associated with prolonged P-wave duration and increased PWD, both of which were related to aortic elasticity parameters.

Mean platelet volume is increased in patients with bicuspid aortic valve.

BACKGROUND: It has been demonstrated that platelet activation occurs in patients with aortic stenosis. However, no study has assessed platelet activation in patients with a normally functioning bicuspid aortic valve (BAV). Therefore, we aimed to investigate relationship between platelet activation assessed by mean platelet volume (MPV) and normally functioning BAV. METHODS: Thirty-nine patients with isolated BAV and 25 age- and gender-matched healthy participants were included in the study. Patients with more than mild aortic regurgitation and aortic velocity >2 m/s were excluded from the study. For the entire study population, MPV was measured using an automatic blood counter. RESULTS: Compared to control group, MPV value was significantly higher in patients with BAV (8.6 ± 1.0 vs 8.0 ± 0.8, p: .01). In the correlation analysis, there was a significant correlation between MPV measures with aortic stiffness (r: .32 and p: .01) and aortic elastic modulus (r: .37 and p: .003). CONCLUSION: Our study results indicate that BAV is associated with elevated MPV values.