The Relationship Between High-Sensitivity C-Reactive Protein Levels and Left Ventricular Hypertrophy in Patients With Newly Diagnosed Hypertension.

The authors aimed to evaluate the relationship between high-sensitivity C-reactive protein (hs-CRP) and presence of left ventricular hypertrophy and diastolic dysfunction in patients with hypertension. A total of 95 newly diagnosed hypertensive patients (mean age, 54±10 years) and 20 controls were included in this study. Patients were divided into four groups according to relative wall thickness as normal, concentric remodeling, concentric, and eccentric hypertrophy. hs-CRP was measured in all patients and serum hs-CRP level was shown to be increased in patients with hypertension compared with controls (0.57 mg/dL vs 0.25 mg/dL, respectively; P<.001). The hs-CRP level was highest in patients with concentric hypertrophy. When compared with controls, serum hs-CRP level was significantly higher in patients with concentric remodeling (0.61±0.3 mg/dL vs 0.43±0.5 mg/dL, P<.030) and concentric hypertrophy (0.69±0.3 mg/dL vs 0.43±0.5 mg/dL, P<.032). The present study shows that serum hs-CRP is significantly associated with left ventricular diastolic function and concentric hypertrophy in patients with hypertension.

[A case of symptomatic right atrial lipoma]. / Sag atriyumda semptomatik lipom: Olgu sunumu.

Cardiac lipomas are rarely diagnosed tumors of heart. They are encapsulated and matured lipoid tumors that are diagnosed equally in all age groups and sexes. Cardiac lipoma are diagnosed mostly in the left ventricle, right atrium, and interatrial septum. We present a 62-year-old symptomatic patient with right atrial lipoma suffering from effort dyspnea, upper extremity and facial edema and palpitation, and who had a by-pass operation approximately 1.5 years ago. In patient transthorasic echocardiography (TTE) revealed that the right atrial mass. It was decided that the audience may be receiving. She underwent interatrial septum resection followed by reconstruction of interatrial septum and atriocaval junction. In the third month after the operation, there was no intracardiac mass on TTE and right atrial size was within normal limits.

Stress-induced hypercontractility in patients with hypertension: an interesting imaging finding.

Excessive sympathetic activity and stress-induced LV hypercontractility may be detected in hypertensives or hypertensive LV hypertrophy. Recent quantitative data support that hypertensive patients may be associated with stress-induced LV hypercontractility. Stress-induced hypercontractility may also be related to basal LV cavity obliteration and dynamic LV outflow tract obstruction in hypertensives. In contrast to LV cavity dilation, stress-induced LV cavity obliteration may be associated with favorable outcome, however it has not been completely elucidated. Hypertensives with dynamic LVOT obstruction may clinically present with acute heart failure and normal systolic function. LV contractility may change and evaluation of LV geometry, contractility and volume by imaging techniques may be important in disease progression.

Index of myocardial performance in patients with type 2 diabetes without hypertension and its relationship with clinical and echocardiographic parameters.

BACKGROUND: Diabetes mellitus affects the systolic and diastolic function of the left ventricle (LV). The aim of the present study was to evaluate the index of myocardial performance (IMP), a new Doppler index, in asymptomatic, normotensive patients with type 2 diabetes mellitus (T2DM). METHODS: The study population consisted of 40 asymptomatic normotensive patients with T2DM (22 women, 18 men; mean [±SD] age 49 ± 7 years) and 20 healthy controls (13 women, seven men; mean age 45 ± 4 years). M-Mode and two-dimensional Doppler echocardiography was performed in all subjects to calculate IMP. Venous blood samples were collected for analysis and body mass index (BMI) was calculated. RESULTS: In normotensive T2DM patients, the mitral E wave was decreased, whereas mitral A wave, mitral E/A ratio, and septal wall thickening were increased compared with values obtained for the control group. The IMP was higher in normotensive T2DM patients than in the control group (P = 0.004). There was a significant correlation between IMP and triglyceride (TG) levels (P < 0.001), mitral E wave (P < 0.001), mitral E/A ratio (P < 0.001), ejection fraction (P = 0.001), fasting blood glucose (P =0.007), LV systolic dimension (P < 0.001), duration of diabetes (P = 0.017), and BMI (P = 0.029). Stepwise multiple regression analysis demonstrated that only TG levels (ß = 0.355, t = 2.487, P = 0.017) and the mitral E/A ratio (ß = -0.384, t = -2.690, P = 0.011) had an independent effect on IMP. CONCLUSION: The results of the present study indicate that IMP is increased in normotensive T2DM patients. The findings suggest that increased IMP may be an early sign of diabetic cardiomyopathy in normotensive diabetic patients with preserved LV function.

The relationship between cardiac troponins and left ventricular mass index in patients with chronic renal failure.

The abstract of this study was accepted as an oral presentation in the 10(th) Annual Meeting of the ESC Working Group on Echocardiography, December 6-9, 2006, Prague, Czech Republic.

CT assessment of main pulmonary artery diameter.

PURPOSE: The purpose of this study was to determine the normal range of the main pulmonary artery diameter (MPAD) by computed tomography (CT) in persons with normal pulmonary artery pressure, and then to evaluate the relationship of the diameter with age, gender, and body surface area (BSA). MATERIALS AND METHODS: Between October 2005 and June 2007, among patients who had previously undergone a contrast-enhanced thorax CT scan, 112 persons (47 females, 65 males) without pulmonary pathology were selected for the study. All patients had normal mean pulmonary artery pressure. The widest diameter perpendicular to the long axis of the main pulmonary artery was measured at the pulmonary artery bifurcation level. The outer limits of the contrast were used to determine vessel diameter. RESULTS: Pulmonary artery diameters showed a homogeneous distribution; the CT-determined mean pulmonary artery diameter was 26.6 +/- 2.9 mm. The mean MPAD in males was 27 +/- 2.8 mm, and 25.9 +/- 3.0 mm in females. This difference was considered to be statistically significant (P = 0.048). There was a significant relationship between the MAPD and age and BSA (P = 0.043, P < 0.001). CONCLUSION: The present study demonstrated that in individuals with normal pulmonary artery pressure, the upper limit of the MPAD is 32.6 mm and that MPAD is wellcorrelated with BSA.

Myocardial blush grade: to evaluate myocardial viability in patients with acute myocardial infarction.

Myocardial blush grade (MBG) is used to assess myocardial perfusion in the infarcted myocardium. The purpose of this study was to determine whether the analysis of myocardial blush grade after resolution of the acute phase of myocardial infarction is useful for assessing myocardial viability. The present study is consisted of 64 patients (55 men, mean age 55 +/-11 years) who had acute myocardial infarction and nonoccluded stenosis (>50%) in an infarct-related artery. All the patients had thrombolysis in myocardial infarction (TIMI)-3 flow in the infarct-related artery on coronary angiograms. Myocardial viability was determined by single-photon emission computed tomography (SPECT) within the same week after coronary angiograms. MBG 0 in 5 (8%) patients, grade 1 in 10 (16%) patients, grade 2 in 23 (36%) patients, and grade 3 in 26 (40%) patients were present. Fifty-four (84%) of 64 patients showed myocardial viability by SPECT. Myocardial viability was demonstrated in 11 of 15 patients (74%) with MBG 0/1 and 43 of 49 patients (88%) with MBG 2/3. There was a weak relation between MBG and myocardial viability by correlation analysis (r = 0.28, p = 0.025). If MBG 0 and 1 are regarded as a sign of nonviable myocardium, and if MBG 2 and 3 are regarded as a sign of viable myocardium, the sensitivity of MBG for the prediction of myocardial viability was 79%, specificity was 40%, positive predictive value was 88%, and negative predictive value was 27%. MBG has a weak correlation with myocardial viability. Although sensitivity is fairly good, specificity is very low. We concluded that the diagnostic value of MBG is limited to detect myocardial viability in the infarcted region.

Pulmonary hypertension in sickle-cell disease: comorbidities and echocardiographic findings.

BACKGROUND: Our aim is to determine comorbidities associated with pulmonary hypertension (PHT) in clinically stable sickle-cell disease (SCD) patients and to evaluate left ventricular (LV) and right ventricular (RV) function in those patients. METHODS: Echocardiography was performed in 87 SCD patients that were divided into group I (without PHT) and group II (with PHT). Both groups were compared with healthy controls. RESULTS: A history of retinopathy and leg ulcer was more frequent in group II than group I (p < 0.01). Haemoglobin levels were lower (p < 0.05), whereas blood urea nitrogen, lactate dehydrogenase and total bilirubin levels were higher in group II (p < 0.01). Although group II patients had larger LV end-diastolic, LV end-systolic and RV diastolic diameters compared with group I patients and controls (p < 0.05), LV ejection fraction was similar in the three groups. The mitral peak early diastolic inflow velocity to peak late diastolic inflow velocity (E/A) ratio was similar in group I, group II and the control group. The tricuspid E/A ratio was lower in group II than group I and controls (p < 0.05). CONCLUSION: End organ damage occurs more often and haemolysis is severer in SCD patients with PHT than SCD patients without PHT. Although LV systolic and diastolic function is well preserved, RV diastolic function is disturbed in those patients with PHT.

P wave dispersion in patients with rheumatoid arthritis: its relation with clinical and echocardiographic parameters.

P wave dispersion (PWD) is a sign for the prediction of atrial fibrillation (AF). The aim of this study was to assess P wave dispersion and its relation with clinical and echocardiographic parameters in patients with rheumatoid arthritis (RA). Thirty RA patients (mean age 49 +/- 10 years) and 27 healthy controls (mean age 47 +/- 8 years) were included in the study. We performed electrocardiography and Doppler echocardiography on patients and controls. Maximum and minimum P wave duration were obtained from electrocardiographic measurements. PWD defined as the difference between maximum and minimum P wave duration was also calculated. Maximum P wave duration and PWD was higher in RA patients than controls (P = 0.031 and P = 0.001, respectively). However, there was no significant difference in minimum P wave duration between the two groups (P = 0.152). There was significant correlation between PWD and disease duration (r = 0.375, P = 0.009) and isovolumetric relaxation time (r = 0.390, P = 0.006). P wave duration and PWD was found to be higher in RA patients than healthy control subjects. PWD is closely associated with disease duration and left ventricular (LV) diastolic dysfunction.

Increased QT dispersion in sickle cell disease: effect of pulmonary hypertension.

BACKGROUND: QT dispersion has been proposed to be a predictor of adverse outcomes in a variety of cardiac disease states. The objective of this study was to examine QT dispersion in patients with sickle cell disease (SCD) and to assess the effect of pulmonary hypertension (PHT) on QT dispersion. METHODS: We performed Doppler echocardiographic assessments of pulmonary artery systolic pressure in 73 (mean age 18.5 +/- 8.0 years) steady-state SCD patients and 25 (mean age 19.6 +/- 7.2 years) healthy subjects. Resting 12-lead electrocardiogram was recorded and QT dispersion was calculated as the difference between maximum and minimum QT intervals. Bazett's formula was used to obtain a rate-corrected value of the QT interval (QTc). RESULTS: Maximum QTc, minimum QTc and QTc dispersion were significantly increased in SCD patients compared to the control subjects (p < 0.0001, p < 0.05, p < 0.0001, respectively). Among SCD patients, patients with PHT had higher maximum QTc and QTc dispersion than patients without PHT (p < 0.0001). However, minimum QTc showed no significant differences between the two patient groups. CONCLUSION: QTc dispersion is significantly increased in SCD patients, especially those with PHT indicating regional inhomogeneity of ventricular repolarization.

Autonomic dysfunction and cardiac repolarization abnormalities in patients with migraine attacks.

The clinical symptoms of migraine are widely accepted to be related to the involvement of the autonomic nervous system, and especially to dysfunction in the regulation of the circulatory system and autonomic balance. Disturbance of the autonomic nervous system is a primary characteristic of migraine Therefore, patients with migraine have a variety of symptoms, such as vasodilatation (flushing), pilo-erection, nausea, vomiting, diarrhea, cutaneous vasoconstriction (pallor), and diaphoresis. The electrocardiographic changes seen during a migraine attack compared with the pain-free period could be secondary to reversible disturbances of the state of autonomic innervation of the heart and coronary arteries. Dysfunction of ANS may affect atrial and ventricular repolarization. For instance, increased sympathetic activity causes sinus tachycardia, but increased parasympathetic activity causes sinus bradycardia, atrioventricular block, and ST-segment and T-wave abnormalities. Comprehensive electrocardiographic analyses have been providing more details in terms of the detection of abnormalities in atrial and ventricular repolarization which potentially may result in arrhythmias in patients with migraine. However, there is no information in literature reporting the frequency of cardiac arrhythmias in migraine patients who had cardiac repolarization abnormalities. In this review, detailed electrocardiographic findings and their relation with the autonomic nervous system, including recent observations, have been evaluated. However, further studies are needed to investigate the association between autonomic dysregulation and cardiac repolarization abnormalities in patients with migraine.

Effect of weight loss on P wave dispersion in obese subjects.

OBJECTIVE: The aim of this study was to investigate effect of loss weight on P wave dispersion in obese subjects. RESEARCH METHODS AND PROCEDURES: After a 12-week weight loss program (diet and medical therapy), a total of 30 (24 women and six men) obese subjects who had lost at least 10% of their original weight were included in the present study. All subjects underwent a routine standard 12-lead surface electrocardiogram. Electrocardiograms were transferred to a personal computer by a scanner and then magnified 400 times by Adobe Photoshop software (Adobe Systems, Mountain View, CA). P wave dispersion, which is also defined as the difference between the maximum P wave duration and the minimum P wave duration, was also calculated. RESULTS: After a 12-week weight loss program, BMI (p < 0.001), maximum P wave duration (p < 0.001), and P wave dispersion (p < 0.001) significantly decreased. The mean percentage of weight loss was 13% (10% to 20.3%). The decrease in the level of P wave dispersion (21 +/- 10 and 7 +/- 12 ms, p < 0.002) was more prominent in Group II (>or=12% loss of their original weight) than Group I (<12% loss of their original weight) after the weight loss program. A statistically significant correlation between decrease in the level of P wave dispersion and percentage of weight loss was found (r = 0.624, p < 0.001). DISCUSSION: Substantial weight loss in obese subjects is associated with a decrease of P wave duration and dispersion. Therefore, these observations suggest that substantial weight loss is associated with improvement in atrial repolarization abnormalities in obese subjects.

Subclinical left ventricular dysfunction in multiple sclerosis.

OBJECTIVES: To investigate the left (LV) and right ventricular (RV) function in multiple sclerosis (MS) using standard echocardiography and Doppler tissue imaging (DTI). MATERIALS AND METHODS: A total of 41 patients with definite MS and 32 healthy controls were included in the study. RESULTS: LV end-systolic dimension was increased and LV ejection fraction was decreased in MS patients compared with controls (P < 0.05). LV end-diastolic dimension was increased in MS patients, however, did not reach significance. Among DTI parameters, mitral annular peak early diastolic velocity to peak late diastolic velocity ratio (Em/Am) was decreased in MS patients, but not reach statistical significance. No significant differences in tricuspid annular Em/Am ratio was found between MS patients and controls. A statistically significant increase of DTI derived LV myocardial performance index was found in MS patients as compared with controls. RV myocardial performance index showed a tendency to be increased in MS patients, however, did not reach significance. CONCLUSIONS: These findings suggest subclinical LV dysfunction and preserved RV function in patients with MS.

Right ventricular and pulmonary function in sickle cell disease patients with pulmonary hypertension.

The effects of sickle cell disease (SCD) on right ventricular (RV) and pulmonary function in SCD patients with pulmonary hypertension is not well-known. The aim of this study was to investigate RV and pulmonary functions in patients suffering from SCD with or without pulmonary hypertension using color tissue Doppler imaging and spirometry. We evaluated 48 asymptomatic patients with SCD. All patients underwent echocardiography with tissue Doppler imaging and pulmonary function test. Patients were divided into two groups: Group 1 consisted of 27 patients (age, 18.1 +/- 7.1 years) with normal pulmonary artery pressure, and group 2 consisted of 21 patients (age, 21.4 +/- 7.4 years) with pulmonary hypertension. Both groups were compared with a sex- and age-matched control group including 24 normal healthy subjects (age, 19.8 +/- 9.2 years). Tricuspid lateral annular systolic (S (m)) and early diastolic velocity (E (m)) were higher in group 1 than group 2 and the control group (p < 0.05). Tricuspid lateral annular late diastolic velocities (A (m)), isovolumetric contraction time, and myocardial performance index (MPI) were higher and the E (m)/A (m) ratio was lower in group 2 than group 1 and the control group (p < 0.05). However, no differences were found in the tricuspid lateral annular E (m) deceleration time, ejection time, and isovolumetric relaxation time between group 1, group 2, and the control group. Tricuspid lateral annular S (m) and E (m) were similar in group 2 and the control group. Forced expiratory volume in 1 second (FEV(1)), forced vital capacity (FVC), and the diffusion capacity of the lung for carbon monoxide were decreased in both groups of patients compared to the control group (p < 0.05). However, there was no difference in respiratory rate, FEV(1)/FVC ratio, peak expiratory flow, and total lung capacity between group 1, group 2, and the control group. There were no differences in any indices of lung function between the two groups of patients. MPI is useful index to evaluate RV function in patients with SCD. RV diastolic function was disturbed in only SCD patients with pulmonary hypertension. On the other hand, the restrictive pattern of pulmonary function abnormalities had developed in both groups of patients.

Effect of weight loss on QTc dispersion in obese subjects.

OBJECTIVE: Increased QTc dispersion is a predictor for ventricular arrhythmias. The aim of this study was to investigate whether QTc dispersion decreases after weight loss program with diet and medical treatment. METHODS: Total 30 (24 women and 6 men, mean age: 44+/-8 years) obese subjects who lost at least 10% of their original weight after 12 week weight loss program were included in present study. Obesity was defined as > or =30 kg/m(2) of body mass index (BMI). Normal weight was defined as < or = 25 kg/m(2) of BMI. RESULTS: After 12 week weight loss program, BMI decreased from 42+/-5 kg/m(2) to 36+/-4 kg/m(2) (p<0.001) and mean weight of obese subjects decreased from 110+/-17 kg to 95+/-15 kg (p<0.001). The mean amount of weight loss was 14.5+/-5.0 kg (range 9-32 kg). The average percent of weight loss was 13% (10.0%-20.3%). Maximum QTc interval (from 446+/-19 ms to 433+/-27 ms, p=0.024) and QTc dispersion (from 66+/-18 ms to 52+/-25 ms, p=0.024) significantly decreased after weight loss program. A statistically significant correlation was found between decrease in level of QTc dispersion and amount of weight loss (r=0.487, p=0.007). CONCLUSION: Substantial weight loss in obese subjects is accompanied by significantly decreased QTc dispersion. The degree of QTc dispersion reduction is associated with amount of weight loss.

Right ventricular diastolic abnormalities in rheumatoid arthritis and its relationship with left ventricular and pulmonary involvement. A tissue Doppler echocardiographic study.

OBJECTIVES: To investigate right ventricular diastolic function in rheumatoid arthritis (RA) and its relationship with left ventricular and pulmonary involvement. METHODS: Thirty-five RA patients and 30 healthy subjects were submitted to conventional Doppler (CE) and tissue Doppler echocardiography (TDE) to assess left and right systolic and diastolic function and to estimate maximal arterial systolic pulmonary pressure (PAP). To detect pulmonary involvement, pulmonary function tests and high-resolution computed tomography (HRCT) scans were performed in all RA patients. RESULTS: An abnormal RV filling, as expressed byan inverted tricuspid (Tr.) E/A ratio, was detected in 12 (34%) of the 35 RA patients and in 2 (7%) of the 30 controls (P<0.004). If compared to CE findings, prevalence of RV diastolic abnormalities were found higher in patients with RA by TDE (RV annulus Em/Am ratio <1 (in 31 (89%) of 35 patients) (P = 0.002). Twenty-two (63%) of 35 patients had abnormal HRCT findings. Pulmonary involvement with pulmonary hypertension (PHT) (36+/-5 mmHg) was detected in 10 (29%) of 35 RA. In this group, increase of RV annulus and basal Am wave, decrease of Tr. E/A ratio and RV annulus Em/Am ratio were statistically significant compared to RA (12 (34%) of 35) patients with pulmonary involvement who had normal PAP (19+/-5 mmHg), (P = 0.014, P = 0.006, P = 0.015, P = 0.049, respectively). CONCLUSIONS: This study points out an impaired RV filling in a significant part of RA patients without overt heart failure. Impairment of RV diastolic function may be a predictor of subclinic myocardial and pulmonary involvement in patients with RA.

Evaluation of right ventricular function in patients with thyroid dysfunction.

BACKGROUND: Thyroid gland dysfunction affects the structure and function of the heart. Tissue Doppler echocardiography is a new technique, and it has been used frequently in the evaluation of ventricular function. In the present study, right ventricular function was assessed in patients with overt or subclinical hypothyroidism and hyperthyroidism and in healthy subjects using the tissue Doppler method, and results were compared. PATIENTS AND METHODS: 20 healthy subjects and 63 patients diagnosed with overt and subclinical hypothyroidism and hyperthyroidism were included in the study. Annular and myocardial systolic peak velocities, early and late diastolic peak velocities, precontraction, total contraction and relaxation times of the right ventricle were recorded by tissue Doppler echocardiography. The results of the patients were compared to those of the controls. RESULTS: Myocardial systolic velocity was significantly higher in patients with hyperthyroidism. Annular and myocardial late diastolic velocities were found to be significantly lower in patients with overt hypothyroidism. Annular precontraction time was increased in patients with overt and subclinical hypothyroidism. Myocardial precontraction time was decreased in patients with hyperthyroidism, and increased in patients with overt hypothyroidism patients. Annular relaxation time was increased in patients with overt hypothyroidism. CONCLUSIONS: Right ventricular function is affected in patients with thyroid diseases. The tissue Doppler technique is a suitable tool to detect impairments in right ventricular function. There is a significant correlation between serum thyroid hormone levels and right ventricular velocities and time intervals.