Analysis of YouTube videos as a source of information for myocarditis during the COVID-19 pandemic.

OBJECTIVE: In this study, we aimed to examine the content, reliability, and quality of YouTube video contents concerning myocarditis and its association with the COVID-19 for the first time in the literature. METHODS: The most viewed 50 videos were included in the analysis. The time since the videos were uploaded, video length, type of image (real/animation), video content, qualify of the uploaders, the number of daily and total views, likes, dislikes, comments and VPI were recorded. The reliability of the videos was determined using the modified DISCERN criteria for consumer health information, while the quality was determined with the GQS. RESULTS: The mean length of the videos was found as 6.25 ± 5.20 min. Contents of the videos included general information, COVID-19, vaccination, diagnosis, patient experience and treatment. The most common contents were regarding COVID-19 and vaccination by 44%. The uploaders of the videos were classified as physicians, hospital channels, health channels, patients and others. Fourteen (28%) videos were directly uploaded by physicians. The most viewed, liked and disliked videos were uploaded by health channels. The mean VPI score was calculated as 92.89 ± 12.29. The mean DISCERN score of all videos was 3.88 ± 0.77 and the mean GQS score was 3.63 ± 0.85. Reliability and quality of the videos were moderate. CONCLUSION: YouTube videos on myocarditis have mostly focused on the associations between myocarditis and COVID-19 disease and vaccination. Health-related contents on YouTube should be subjected to peer review and quality assessment.

Demographic, Clinical, and Angiographic Characteristics of Atrial Fibrillation Patients Suffering From de novo Acute Myocardial Infarction: A Subgroup Analysis of the MINOCA-TR Study Population.

BACKGROUND: Atrial fibrillation (AF) prevalence in patients with acute myocardial infarction (MI) ranges from 3% to 25%. However demographic, clinical, and angiographic characteristics of AF patients who admitted with de novo MI are unclear. The aim of this study was to investigate the prevalence of patients presenting with de novo MI with AF. METHODS: The study was performed as a sub-study of the MINOCA-TR (Myocardial Infarction with Non-obstructive Coronary Arteries in Turkish Population) Registry, a multicenter, cross-sectional, observational, all-comer registry. MI patients without a known history of stable coronary artery disease and/or prior coronary revascularization were enrolled in the study. Patients were divided into AF and Non-AF groups according to presenting cardiac rhythm. RESULTS: A total of 1793 patients were screened and 1626 were included in the study. The mean age was 61.5 (12.5) years. 70.7% of patients were men. The prevalence of AF was 3.1% (51 patients). AF patients were older [73.4 (9.4) vs. 61.0 (12.4) years, p<0.001] than non-AF patients. The proportion of women to men in the AF group was also higher than in the non-AF group (43.1% vs. 28.7%, p=0.027). Only 1 out of every 5 AF patients (10 patients, 19.6%) was using oral anticoagulants (OAC). CONCLUSIONS: AF prevalence in patients presenting with de novo MI was lower than previous studies that issued on AF prevalence in MI cohorts. The majority of AF patients did not have any knowledge of their arrhythmia and were not undergoing OAC therapy at admission, emphasizing the vital role of successful diagnostic strategies, patient education, and implementations for guideline adaptation.

Venous leg symptoms, ecchymosis, and coldness in patients with peripheral varicose vein: A multicenter assessment and validation study (VEIN-VIOLET study).

OBJECTIVES: We aimed to evaluate peripheral varicose vein symptoms including ecchymosis and coldness by using the Venous Insufficiency Epidemiological and Economic Study-Quality of Life/Symptoms (VEINES-QoL/Sym) questionnaire. METHODS: A total of 1120 patients were enrolled to the analysis after the exclusion of 199 patients who did not match the inclusion criteria. Patients were asked to answer the VEINES-Sym questionnaire and questions about ecchymosis and coldness. Scores of ecchymosis and coldness were calculated similar to VEINES-Sym questionnaire. Classifications of peripheral varicose vein were made according to the clinical part of clinical, etiological, anatomical, and pathophysiological classification system and patients with grade 2 or higher were considered as positive for peripheral varicose vein. RESULTS: Frequency of symptoms present in the VEINES-Sym instrument, ecchymosis and coldness were significantly higher in patients with peripheral varicose vein. Mean score of each symptom was significantly lower in peripheral varicose vein patients including scores of ecchymosis and coldness. Logistic regression analysis revealed that presence of hemorrhoids and all symptoms in VEINES-Sym questionnaire except restless leg were significantly and independently associated with peripheral varicose vein. Besides, ecchymosis (odds ratio: 2.04, 95% confidence interval: 1.34-3.08, p = 0.008) but not coldness was significantly and independently associated with peripheral varicose vein. There was also significant correlation of VEINES-Sym score with ecchymosis (r = 0.43, p < 0.001) and coldness (r = 0.47, p < 0.001). CONCLUSIONS: Venous leg symptoms present in VEINES-Sym questionnaire except restless legs, presence of hemorrhoids and ecchymosis are significantly and independently associated with peripheral varicose vein. Not only ecchymosis but also coldness has shown an independent association with total VEINES-Sym score.

Serum Endocan Levels Predict Angiographic No-Reflow Phenomenon in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Coronary Intervention.

No-reflow phenomenon (NRP) is an important problem in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI). Endocan is synthesized and secreted by activated vascular endothelium, and it has been shown to be related to endothelial dysfunction and inflammation. We aimed to evaluate the relationship between endocan levels and NRP. Consecutive patients (n = 137) with STEMI who had undergone coronary angiography and pPCI were enrolled into the study. The clinical characteristics of the patients were obtained and endocan levels were measured. Endocan levels were significantly higher in the NRP (+) group compared with the NRP (-) group (P < .001). In multivariate analysis, endocan (P < .001, OR = 2.39, 95% CI = 1.37-4.15) was found to be an independent predictor of NRP. An endocan value of >2.7 ng/mL has 89.6% sensitivity and 74.2% specificity for the prediction of the NRP (area under the curve: 0.832, P < .001). The present study demonstrated that the endocan level is an independent predictor of the NRP in patients with STEMI who underwent pPCI. Endocan levels may be helpful in detecting patients with a higher risk of insufficient myocardial perfusion and worse clinical outcome.

Prevalence and clinical profile of patients with myocardial infarction with non-obstructive coronary arteries in Turkey (MINOCA-TR): A national multi-center, observational study.

OBJECTIVE: Myocardial infarction (MI) with non-obstructive coronary arteries (MINOCA) is a relatively new term that is characterized by clinical evidence of MI with normal or near-normal coronary arteries on coronary angiography (QCA). To date, there have been no population-based studies on the prevalence of MINOCA in Turkey. The aim of this nationwide study was to document the prevalence and demographics of MINOCA in a Turkish population. METHODS: MINOCA-TR is national, multi-center, prospective, all-comer study that was conducted in 32 hospitals. All consecutive patients who were ≥18 years old, diagnosed with MI according to the Third Universal Definition of Myocardial Infarction, and had undergone QCA were included in the study. Patients with stable coronary artery disease, unstable angina pectoris, a history of revascularization, and type 4/5 MI were excluded. RESULTS: A total of 1793 patients who were diagnosed with MI and had undergone QCA were screened between March 2018 and October 2018, of whom 1626 (mean age: 61.5±12.5 years, 70.7% male) were enrolled from 32 centers. The prevalence of MINOCA was 6.7% (n=109) in the overall study population. Compared with non-MINOCA patients, those with MINOCA were younger, had a higher prevalence of the female gender, and had a history of flu. The percentages of current smokers, ST-segment elevated myocardial infarction patients, and those with a history of hypertension, diabetes mellitus, and hyperlipidemia were significantly lower in MINOCA patients (p<0.05, for all). Also, the median left ventricular ejection fraction as seen on echocardiography and the ratio of Killip Class I status at presentation was significantly higher in MINOCA patients than in non-MINOCA patients (p<0.001). Patients with MINOCA received a preload dose of P2Y12 antagonist before QCA less often than non-MINOCA patients (p<0.001). CONCLUSION: The prevalence of MINOCA in Turkey is 6.7% in patients who were admitted with MI. Also, as compared to non-MINOCA patients, the MINOCA patients were exposed to fewer traditional risk factors of coronary artery disease.

Evaluation of Arterial Stiffness Using Pulse Wave Velocity and Augmentation Index in Patients with Chronic Venous Insufficiency.

BACKGROUND AND OBJECTIVES: Chronic venous insufficiency (CVI) is a common pathology of the circulatory system and is associated with a high morbidity for the patients and causes high costs for the healthcare systems. Arterial stiffness has been shown to be a predictor of cardiovascular events and mortality. The relationship between CVI and arterial stiffness using pulse wave velocity (PWV) and augmentation index (Aix) was evaluated in this study. METHODS: Sixty-two patients with the stage of C3-C5 chronic venous disease (CVD) and 48 healthy subjects were enrolled in the study. To assess arterial stiffness, all cases were evaluated with I.E.M. Mobil-O-Graph brand ambulatory blood pressure monitor device. PWV and Aix were used to assess arterial stiffness in this study. RESULTS: The mean age was 61.9±11.05 years and 54 % of the patient population was females. PWV and Aix were significantly higher in CVI patients than controls (8.92±1.65 vs. 8.03±1.43, p=0.001; 25.51±8.14 vs. 20.15±9.49, p=0.003, respectively) and also positive linear correlation was observed between CVI and all measured arterial stiffness parameters (r=0.675 for CVI and PWV, r=0.659 for CVI and Aix, respectively). A PWV value of > 9.2 has 88.9 % sensitivity and 71.4 % specificity to predict the presence of CVI. CONCLUSIONS: PWV and Aix are the most commonly used, easy, reproducible, reliable methods in the clinic to assess arterial stiffness. Logistic regression analysis showed that PWV and Aix were the independent predictors of CVI. PWV has the sensitivity of 88.9 % and specificity of 71.4 % to detect the presence of CVI.

The effects of a single dialysis session on atrial electromechanical conduction times and functions.

BACKGROUND/AIMS: Abnormalities in atrial electromechanical delay (EMD) times and mechanical functions are considered as independent predictors of atrial fibrillation. However, to date, effects of a single hemodialysis (HD) session and acute volume-preload changes on atrial-EMD functions have not been investigated by Tissue Doppler Echocardiography (TDE). The aim of the present study was to evaluate atrial-EMD times and mechanical functions in HD patients. METHODS: Thirty-five non-diabetic, normotensive HD patients and 35 healthy control subjects were enrolled in the study. Standard and TDE performed before mid-week dialysis session for hemodialysis group and on admission for control group. RESULTS: Interatrial and left-right intraatrial-EMD intervals and left atrial mechanical volumes were significantly longer in hemodialysis group compared to controls (all p<0.01) and were reduced after HD session. Furthermore, removed ultrafiltration volume was associated with reduction in atrial-EMD intervals and functional volumes. LA-passive emptying volume, ultrafiltration volume, LV-E/E' ratio, and Vp were independent predictors of interatrial-EMD. CONCLUSIONS: The present study confirms negative effects in HD patients of structural remodeling and reveals negative effects of electrical remodeling. Prolonged inter and intraatrial-EMD intervals should be the underlying pathophysiological factors of increased rate of atrial fibrillation in the HD population.

Hematological parameters and coronary collateral circulation in patients with stable coronary artery disease.

BACKGROUND: Although hematological parameters have been associated with prognosis in patients with various cardiovascular diseases, their relationship with coronary collateral (CC) circulation in patients with stable coronary artery disease (CAD) is unknown. OBJECTIVE: To investigate the relationship between hematological parameters and CC vessel development in patients with stable CAD. METHODS: A total of 96 patients who underwent coronary angiography were retrospectively enrolled. All study participants had at least one occluded major coronary artery. Development of CCs was classified using the method of Rentrop. Rentrop grades of 0 and 1 indicate poor CCs, whereas grades 2 and 3 indicate good CCs. Hematological parameters, including mean platelet volume (MPV) and neutrophil/lymphocyte (N/L) ratio, were measured. Multivariate logistic regression analysis was performed to identify independent variables. RESULTS: The MPV and N/L ratio were significantly higher in the poor CC group compared with the good CC group. Negative correlations were found in the analyses comparing Rentrop score with MPV and N/L ratio (r=-0.274; P=0.012 and r=-0.339; P=0.001, respectively). In multivariate analysis, the N/L ratio was independently related to CC circulation (OR 0.762 [95% CI 0.587 to 0.988]; P=0.04). CONCLUSION: The results suggest that N/L ratio and MPV are associated with poor CCs, and a high N/L ratio is a significant predictor of poor CC development in patients with stable CAD.

Assessment of the neutrophil to lymphocyte ratio in young patients with acute coronary syndromes.

OBJECTIVES: It is well known that inflammation plays a key role in both initiation and propagation of acute coronary syndrome (ACS). White blood cell (WBC) and its subtypes are an indicator of inflammation in patients with ACS. We aimed to evaluate the WBC and its subtypes in patients aged <45 year with acute coronary syndromes. STUDY DESIGN: We retrospectively analyzed WBC and its subtypes (including neutrophil and lymphocyte) in 84 patients (<45 year) who were admitted to the emergency department for chest pain suggestive of ACS (44 unstable angina pectoris, 40 non-ST-segment elevation myocardial infarction [NSTEMI]), and 40 healthy controls. RESULTS: Hypertension, diabetes mellitus, smoking, and family history were significantly higher in NSTE-ACS patients. Also, LDL levels was significantly higher and HDL levels was significantly lower in NSTE-ACS patients (p=0.041 and p=0.009). The difference in percent of lymphocytes between the groups was significant (p=0.048). N/L ratio was significantly different between all groups and between the NSTEMI and USAP (p<0.001 and p=0.041). Our results demonstrated that hypertension, percent of neutrophils, and N/L ratio was a significant independent predictor of NSTE-ACS (Beta=0.251, 95% CI=0.002-0.523, p=0.048; beta=0.561, 95% CI=0.008-0.137, p=0.028 and beta=0.260, 95% CI=0.042-0.438, p=0.018, respectively). CONCLUSION: N/L was found to be elevated in young patients with NSTE-ACS compared with control group. The inflammation assessed using WBC and its subtypes may be more important in young NSTE-ACS patients.

[Relation of neutrophil/lymphocyte ratio with the presence and severity of coronary artery ectasia]. / Nötrofil/lenfosit oraninin koroner ektazisi varligi ve yayginligi ile iliskisi.

OBJECTIVES: It has been shown that the neutrophil to lymphocyte ratio (N/L ratio) is associated with cardiovascular events and mortality. In this study, we investigated the N/L ratio in patients with coronary artery ectasia (CAE). STUDY DESIGN: Fifty patients diagnosed with CAE using coronary angiography were included in the study (29 male, 21 female; mean age, 51.1±7.1 years). The control group consisted of 28 patients who had normal coronary arteries as determined by coronary angiography (16 male, 12 female; mean age, 49.5±9.4 years). Basal characteristics were recorded. The number of ectatic segments was noted. Hematologic parameters were measured and the N/L ratio was calculated. RESULTS: The N/L ratio was significantly higher in the CAE group compared with control group (median [25-75% percentile] 2.2 [1.6-3.0] vs. 1.8 [1.4-2.0], p=0.014, respectively). The Spearman correlation analysis demonstrated that the N/L ratio positively correlated with number of ectatic segments (r=0.35; p<0.002). Multivariable logistic regression analysis showed an independent relationship between CAE and the N/L ratio (odds ratio 2.674, 95% confidence interval 1.184-6.039, p=0.018). CONCLUSION: The N/L ratio is higher in patients with CAE. This ratio is related to presence and severity of CAE.

Detection of subclinical atrial dysfunction by two-dimensional echocardiography in patients with overt hyperthyroidism.

BACKGROUND: Hyperthyroidism is an important cardiovascular risk factor in the development of atrial fibrillation and heart failure. Increased atrial electromechanical intervals are used to predict atrial fibrillation, measured by tissue Doppler imaging (TDI). AIMS: To evaluate atrial electromechanical delay (EMD) and left atrial (LA) mechanical function in patients with overt hyperthyroidism. METHODS: Thirty-four patients with overt hyperthyroidism and 34 controls were included. A diagnosis of overt hyperthyroidism was reached with decreased serum thyroid-stimulating hormone (TSH) and increased free T4 (fT4) concentrations. Using TDI, atrial electromechanical coupling (PA) was obtained from the lateral mitral annulus (PA lateral), septal mitral annulus (PA septum) and right ventricular tricuspid annulus (PA tricuspid). LA volumes (maximum, minimum and presystolic) were measured by the disks method in apical four-chamber view and indexed to body surface area. LA active and passive emptying volumes and fractions were calculated. RESULTS: LA diameter was significantly higher in hyperthyroid patients (P=0.001). LA passive emptying volume and fraction were significantly decreased in hyperthyroid patients (P=0.038 and P<0.001). LA active emptying volume and fraction were significantly increased in hyperthyroid patients (P<0.001 and P<0.001). Left and right intra-atrial (PA lateral-PA septum and PA septum-PA tricuspid) and interatrial (PA lateral-PA tricuspid) EMDs were significantly higher in hyperthyroid patients (29.2 ± 4.4 vs 18.1 ± 2.6, P<0.001; 18.7 ± 4.3 vs 10.6 ± 2.0, P<0.001; and 10.5 ± 2.9 vs 7.1 ± 1.2, P<0.001, respectively). Stepwise linear regression analysis demonstrated that fT4 and TSH concentrations were independent predictors of interatrial EMD (ß=0.436, P<0.001 and ß=-0.310, P=0.005, respectively). CONCLUSION: This study showed prolonged atrial electromechanical intervals and impaired LA mechanical function in patients with overt hyperthyroidism, which may be an early sign of subclinical cardiac involvement and dysrhythmias in overt hyperthyroidism.

Coronary artery ectasia is associated with atrial electrical and mechanical dysfunction: an observational study.

OBJECTIVE: The aim of our study was to investigate total atrial conduction time and left atrial (LA) mechanical function in patients with isolated coronary artery ectasia (ICAE). METHODS: Sixty patients with ICAE without any visible coronary stenosis were enrolled to this cross-sectional observational study. The control group consisted of 40 age- and gender-matched patients. Left atrial mechanical functions were measured by the method of discs in the apical-four chamber echocardiographic view. LA mechanical function parameters were calculated. P wave dispersion was measured on electrocardiography (ECG). The total atrial conduction time (PA-tissue Doppler imaging (TDI) duration) was assessed by measuring the time interval between the beginning of the P wave on the surface ECG and point of the peak A wave on TDI from LA lateral wall just over the mitral annulus. Student t, Mann-Whitney U, Pearson's, and Spearman's correlation analysis and multiple regression analysis were used for statistical analysis. RESULTS: The clinical and laboratory characteristics were similar in two groups. Both groups were similar in terms of Vmax and LA total emptying volume (29.0 ± 7.3 vs. 31.9 ± 6.5 mL/m², p=0.082 and 19.9 ± 5.1 vs. 20.0 ± 5.2 mL/m², p=0.821). However, LA passive emptying volume and LA passive emptying fraction were significantly decreased with ICAE patients (11.1 ± 3.2 vs. 13.5 ± 3.8 ml/m², p=0.005 and 35.2 ± 7.2 vs. 47.8 ± 9.4 mL/m², p<0.001). But LA active emptying volume and LA active emptying fraction were significantly increased in ICAE patients (9.1 ± 2.6 vs. 6.4 ± 3.0 mL/m², p<0.001 and 45.3 ± 8.1 vs. 40.7 ± 6.7 mL/m², p=0.002). PA-TDI duration was measured significantly higher in patients with ICAE than control group (131.8 ± 5.7 vs. 114.4 ± 9.1 ms, p<0.001). Multiple linear regression analyses showed that ectatic segment number was an independent factor of PA-TDI duration (ß=0.581, 95% CI=4.046-6.295, p<0.001). CONCLUSION: Our study demonstrated presence of LA electrical and mechanical dysfunction in patients with ICAE. LA dysfunction may be associated with cardiac pathologies as arrhythmias, decrease in cardiac output and congestive failure.

Evaulation of atrial conduction abnormalities and left atrial mechanical functions in patients with subclinical thyroid disorders.

INTRODUCTION: Changes of thyroid hormones levels may lead to effects, not only in ventricular function, but also atrial function. The aim of this study was to investigate left atrial (LA) mechanical functions, atrial electromechanical coupling and P wave dispersion in patients with subclinical thyroid disorders. MATERIAL AND METHODS: Eighty patients with subclinical thyroid disorders and forty controls were included. A diagnosis of subclinical thyroid disorders were reached with increased or decreased serum TSH and normal free T4 (fT4) levels. LA volumes were measured using the biplane area length method and LA active and passive emptying volumes and fraction were calculated. Intra- and interatrial electromechanical delay were measured by tissue Doppler imaging (TDI). RESULTS: All groups had similar demographic findings. LA mechanical functions significantly impaired in subclinical thyroid disorders than control group. Intra- and Interatrial delay, were measured significantly higher in patients with subclinical thyroid disorders than control group. PA lateral and interatrial delay were positively correlated with TSH (r = 0.507, p = 0.006 and r = 0.455, p = 0.015, respectively) in subclinical hypothyroid patients. There was negative correlation between TSH and interatrial delay (r = -0.492, p = 0.006) in subclinical hyperthyroid patients. Linear multivariate regression analysis demonstrated that, TSH was the only an independent factor of interatrial delay in patients with subclinical thyroid disorders. CONCLUSIONS: This study showed that impaired LA mechanical and electromechanical function in subclinical thyroid disorders. TSH was an independent determinant of interatrial delay. Prolonged atrial electromechanical coupling time and impaired mechanical atrial functions may be related to the increased incidence of arrhythmias.

Evaluation of left ventricular systolic asynchrony in patients with subclinical hypothyroidism.

BACKGROUND: The heart was very sensitive to fluctuating thyroid hormone levels. To assess intra-left ventricular (LV) systolic asynchrony in patients with subclinical thyroid dysfunction. METHODS: Fifty patients with subclinical hypothyroidism and 40 controls were included. A diagnosis of subclinical hypothyroidism was reached with increased TSH and normal free T4. All subjects were evaluated by echocardiography. Evaluation of intra-LV systolic asynchrony was performed by tissue synchronization imaging (TSI), and four TSI parameters of systolic asynchrony were calculated. LV asynchrony was defined by these parameters. RESULTS: All of the groups were similar in terms of demographic findings and conventional and Doppler echocardiograpic parameters except peak systolic velocity and early diastolic velocity. LV systolic asynchrony parameters of TSI including; standard deviation of Ts of the 12 LV segments (Ts-SD-12), maximal difference in Ts between any 2 of the 12 LV segments (Ts-12), standard deviation of TS of the 6 basal LV segments (Ts-SD-6), maximal difference in Ts between any of the 6 basal LV segments (Ts-6) were significantly lengthened in patients with subclinical hypothyroidism than controls (p <0.001, p < 0.001, p < 0.001 and p < 0.001, respectively). The prevalence of LV asynchrony was significantly higher in patients with subclinical hypothyroidism than control. CONCLUSIONS: Patients with subclinical hypothyroidism present evidence of LV asynchrony by TSI. LV systolic asynchrony could be a warning sign of the early stage in cardiac systolic dysfunction in subclinical hypothyroid patients.

Evaluation of left atrial mechanical functions and atrial conduction abnormalities in patients with clinical hypothyroid.

BACKGROUND: The aim of this study was to investigate left atrial (LA) mechanical functions, atrial electromechanical delay and P wave dispersion in hypothyroid patients. METHODS: Thirty-four patients with overt hypothyroid and thirty controls were included. A diagnosis of overt hypothyroid was reached with increased serum TSH and decreased free T4 (fT4) levels. LA volumes were measured using the biplane area length method and LA active and passive emptying volumes and fraction were calculated. Intra- and interatrial electromechanical delay (EMD) were measured by tissue Doppler imaging (TDI). P wave dispersion was calculated by 12 lead electrocardiograms. RESULTS: LA diameter were significantly higher in patients with overt hypothyroid (p = 0.021). LA passive emptying volume and LA passive emptying fraction were significantly decreased with hypothyroid patients (p = 0.002 and p < 0.001). LA active emptying volume and LA active emptying fraction were significantly increased with hypothyroid patients (p < 0.001 and p < 0.001). Intra- and interatrial EMD, were measured significantly higher in hypothyroid patients (30.6 ± 6.1 vs 18.0 ± 2.7, p< 0.001; and 10.6 ± 3.4 vs 6.9 ± 1.4, p < 0.001, respectively). P wave dispersion were significantly higher in hypothyroid patients (48.8 ± 6.2 vs 44.3 ± 7.2, p = 0.022). In stepwise regression analysis demonstrated that, interatrial EMD and LA active emptying fraction related with TSH and fT4. CONCLUSIONS: This study showed that impaired LA mechanical and electromechanical function in hypothyroid patients. TSH and T4 were independent determinant of interatrial EMD and LA active emptying fraction.