Effect of Exercise on Left Atrium Mechanics in Mild Mitral Stenosis.

OBJECTIVE: A significant number of individuals with mild mitral stenosis (MS) experience exertional symptoms that are disproportionate to the hemodynamic severity of their condition. This study aims to determine whether exercise-induced left atrial (LA) dysfunction occurs in these patients and whether it is related to the development of symptoms. METHODS: In this observational study, we recruited 46 patients with mild MS. Echocardiographic measurements were initially taken at rest, followed by a maximal exercise stress test. Patients were then returned to the echocardiography laboratory for post-exercise measurements. RESULTS: Our study cohort exhibited considerably higher left atrial volume index (LAVI) values (mean: 40.52 ± 18.27) compared to those of a healthy population. Furthermore, the LA reservoir strain (mean: 17.1 ± 8.33) was reduced relative to reference values. Following exercise, there was no change in the LA reservoir strain. However, trans-mitral pressure gradients and systolic pulmonary artery pressures increased. The post-exercise mean trans-mitral gradient was identified as the sole predictor of symptom development in patients with mild MS. CONCLUSION: The LA reservoir strain is already reduced in individuals with mild MS, and exercise does not lead to further decline in LA reservoir function in these cases. To our knowledge, this study is the first to explore the effects of exercise on LA mechanics in MS.

Favoring Inequalities and Mind-Reading: Social Dominance Orientation Relates to Poor Mentalizing.

Although studies have so far investigated social dominance orientation (SDO) in relation to its association with prejudice and discrimination toward outgroups, it is not known whether SDO's link with poor intergroup relations might be underlined by specific socio-cognitive factors such as reduced mind-reading motivation (MRM) and poor mind-reading performance. The present study tested whether endorsement of SDO is associated with decreased MRM and mind-reading accuracy toward both ingroup and outgroup targets. We randomly assigned one hundred and 20 Turkish university students (Mage = 22.02) into two target groups for mind-reading, Turkish ingroup (N = 60) and Syrian outgroup (N = 60), and asked them to infer minds of either ingroup or outgroup members depending on their target group. Participants also reported their level of MRM and SDO through questionnaires. When the target was a Turkish ingroup member, SDO negatively and directly predicted mind-reading, when the target was an outgroup member, however, higher SDO indirectly predicted lower mind-reading through reduced MRM. These results pointed that favoring intergroup hierarchies relates to poor understanding of others' mental states although the mechanism of the relation changes depending on the group membership of the target.

A novel echocardiographic index for prediction of malnutrition in acute heart failure.

INTRODUCTION: Malnutrition is common among heart failure (HF) patients. The prognostic nutritional index (PNI) and controlling nutritional status (CONUT) are widely used for evaluation of nutritional status in HF patients. Right ventricular dysfunction, functional tricuspid regurgitation, and elevated right atrial pressure might exacerbate malnutrition by promoting bowel congestion and malabsorption in HF patients. We aimed to investigate the relationship between echocardiographic measures of right heart function and nutritional status in patients hospitalised for acutely decompensated HF, and to define a simple nutritional heart failure index based on non-invasively measured right heart functions to predict nutritional status. METHODS: 133 consecutive patients who were admitted to inpatient cardiology clinics for acutely decompensated HF were included in the study. All patients underwent a comprehensive echocardiographic examination on admission day. PNI and CONUT scores were calculated in order to assess the nutritional status. RESULTS: We defined a novel nutritional heart failure index (HFI-N) based on the echocardiographic measurements of inferior vena cava diameter (IVC), IVC collapsibility and right atrial pressure to predict the nutritional status of the patients. The HFI-N index was a significant predictor for both PNI and CONUT scores. In addition, both PNI and CONUT scores were significantly correlated to length of hospital stay. CONCLUSION: Malnutrition was associated with a prolonged hospital stay in HF patients. The newly defined HFI-N index is a good predictor of the nutritional status in patients with heart failure.

Evaluation of Cardiac Function in Uncomplicated COVID-19 Survivors by 2-Dimensional Speckle Tracking Imaging.

BACKGROUND: COVID-19 is a multi-systemic infectious disease. Nearly 20%-30% of hospitalized patients have evidence of acute myocardial involvement, portending a poorer prognosis. However, information about the long-term effects of the disease on cardiac functions is sparse. As a result, there is a growing concern about the cardiac sequelae of COVID-19 among survivors. This study aimed to investigate the effects of prior mild-moderate COVID-19 infection on cardiac functions, using speckle tracking echocardiography. METHODS: Patients who have been diagnosed with COVID-19 within the previous 6 months and age-, sex-, and risk factor-matched healthy adults were included. All patients underwent a comprehensive echocardiographic examination. Both conventional and 2-dimensional speckle tracking echocardiographic measurements were performed. Serum cardiac biomarkers were also obtained on the day of the echocardiographic study. RESULTS: Compared with healthy controls, COVID-19 survivors had similar left and right ventricular longitudinal strain values at 6 months. Also, left and right atrial peak systolic strain values did not differ between the groups. CONCLUSION: Our study is valuable in putting forth the unaffected ventricular and atrial functions on long term in uncomplicated COVID-19 cases and may decrease the survivors' anxiety and the number of unnecessary applications to cardiology clinics.

The role of three dimensional transesophageal echocardiography in predicting the effect of cardiac resynchronization therapy on mitral regurgitation in patients with low ejection fraction heart failure.

PURPOSE: Cardiac resynchronization therapy (CRT) positively affects the improvement of functional mitral regurgitation (MR) in patients with heart failure with reduced ejection fraction (HFrEF). However, geometric changes in the mitral valve apparatus, subvalvular structures and their contribution to improving mitral regurgitation after CRT have not been clearly defined. Our study aimed to evaluate the geometric parameters of mitral valve apparatus measured with three-dimensional (3D) transesophageal echocardiography (TEE) before CRT implantation and to determine the parameters predicting the improvement of MR after CRT. METHODS: In this prospective study, we included thirty patients with moderate or severe MR and HFrEF planned for CRT implantation who had an indication for TEE. Before CRT implantation, effective regurgitant orifice (ERO) and regurgitant volume (RV) measurements were performed. Detailed quantitative measurements of the mitral valve were done from recorded images by 3D TEE. ERO and RV measurements were repeated to evaluate MR at the end of the third month. RESULTS: There were no significant changes in left ventricular EF and left ventricular diameters at third-month follow-up, whereas ERO and RV values were decreased. The posterior leaflet angle was higher in the non-responder group than the responder group (28.93 ± 8.41 vs 41.25 ± 10.90, p = 0.006). The posterior leaflet angle was an independent predictor of decreased RV and ERO. CONCLUSION: Among HFrEF patients with moderate or severe functional MR who underwent CRT implantation had a lower posterior leaflet angle, which was measured by 3D TEE, in the patient group whose MR improved after CRT.

The diastolic function abnormalities in hemodialysis session: a two-dimensional speckle tracking echocardiographic (2DSTE) study.

Hemodialysis (HD) decreases preload and its acute effect on the diastolic function is still controversial even with the introduction of new non-volume-dependent tissue Doppler echocardiographic indices. This study is designed to evaluate these acute changes following HD sessions. We enrolled 39 patients receiving standard thrice weekly HD for more than 6 months and performed two dimensional speckle tracking echocardiography (2DSTE) and tissue Doppler studies with a standard cardiac ultrasound device shortly before and after HD. We observed significant changes in most of the transmitral flow and tissue Doppler echocardiographic parameters after HD. The left atrial volume index, left ventricular mass index, mitral E, mitral E/A, and lateral annular E/é levels decreased after HD (p: < 0.001, p: 0.026, p: < 0.001, p: 0.011, p: < 0.001, respectively). Medial á, medial myocardial performance index (MPI), medial s, lateral s, and lateral MPI values increased significantly after HD (p: 0.049, p: 0.007, p: 0.001, p: < 0.001, p: 0.01, respectively). Diastolic parameters like diastolic strain ratio early diastole (DSRE), diastolic strain ratio late diastole (DSRA), E/DSRE, and E/DSRA did not change significantly after HD (p: 0.716, p: 0.117, p: 0.114, and p: 0.211, respectively). The global longitudinal strain value obtained with 2DSTE worsened after HD (- 18.4 ± 4.0 before vs - 15.9 ± 5.4 after HD, p: 0.011). Transmitral flow and tissue Doppler parameters changed significantly after HD while the change in 2DSTE findings was not significant. The diastolic measurements made with 2DSTE may be less volume and cardiac preload dependent compared to conventional echocardiography and this may explain the difference.

A case report of an acute reversible increase in pacing impedance of a ventricular epicardial lead after catheter ablation of ventricular tachycardia.

Pacemakers are lifesaving devices that are being implanted with various indications, such as sinus node disease, atrioventricular block, and cardiac resynchronization therapy. Impedance measurement is one of the integral tests by which electrical resistance in pacing lead is tested. In this paper, we report an interesting observation of sudden impedance rise after ventricular tachycardia ablation with transmural lesions, which subsequently normalized without any need for intervention. The clinical implication of our findings is that careful observation might be indicated instead of lead replacement in case of a sudden surge in epicardial lead impedance after endocardial ablation owing that the impedance surge might be reversible.

Onco-cardiology: Drug-drug interactions of antineoplastic and cardiovascular drugs.

Cardiovascular diseases (CVD) and cancer are still the leading causes of death. There are many common etiologic factors, especially smoking and obesity. Therefore, it is not uncommon for CVD and cancer to coexist. Drug-drug interactions (DDIs) inevitably occur in this group of patients, where polypharmacy is increasing due to older age and multiple comorbidities. However, multidisciplinary studies, especially close collaboration of medical oncologists and cardiologists, who deals with the diagnosis and treatment of these diseases, awareness and preventive approaches to DDIs may reduce serious morbidity and mortality. In this review, information about the common treatments used in cardiology and oncology and possible DDIs are discussed.

Prevention of minor myocardial injury after elective percutaneous coronary intervention: comparison of ticagrelor versus clopidogrel.

BACKGROUND: Elective percutaneous coronary intervention (ePCI) may cause minor elevation of cardiac enzymes, so-called minor myocardial injury (MMI) which can be due to different pathophysiological mechanism (e.g. distal embolisation, side branch occlusion, increased platelet activation triggered by the intracoronary metallic stents). We aimed to compare the effectiveness of ticagrelor versus clopidogrel for the prevention of MMI and major adverse clinical events (MACEs) after ePCI. METHODS: Study population consisted of two groups of patients based on the treatment: Group I, receiving clopidogrel (n = 104), Group II, receiving ticagrelor (n = 96). Cardiac troponin I (cTnI), CK-MB were studied before and 12 hours after the procedure. Elevation of cTnI greater than 0.06 ng/ml was considered as MMI. All patients were also evaluated for the MACEs (death, myocardial infarction, stroke and transient ischaemic attack). RESULTS: Fifty-two of 200 patients (26%) had MMI after the procedure. The minor myocardial injury was significantly more prevalent in clopidogrel group than that of ticagrelor group (33% vs. 19%, p = .03). Myocardial infarction (MI) and MACEs were significantly higher in the clopidogrel group (15% vs. 6%, for MI, p = .04; 16% vs. 6%, for MACEs, p = .03, respectively). Multivariate analysis demonstrated antiplatelet treatment, saphenous graft intervention, type-C lesion as independent predictors of MMI. CONCLUSIONS: Present study showed that the combination of ticagrelor and aspirin was more effective than combination of clopidogrel and aspirin in decreasing MMI and MACEs after elective stenting.

Evaluation of the effect of dipping pattern in hypertensive patients on the left ventricular systolic functions by two-dimensional strain analysis.

BACKGROUND: Nondipping blood pressure pattern carry a high risk of cardiovascular and cerebrovascular complications due to a higher cumulative pressure overload. We aimed to define the role of strain analysis for detecting subclinical left ventricular systolic dysfunction in recently diagnosed nondipper and dipper hypertensive patients with normal left ventricular systolic function. METHODS: Study population consisted of two groups of patients, Group 1: 45 dipper patients and Group 2: 43 nondipper patients. Global and segmental two-dimensional longitudinal strain analysis were measured by speckle tracking method. RESULTS: The analysis of two-dimensional left ventricular global longitudinal strain and strain rates showed that there was a significant difference between groups (-18.1%±3.1% for nondippers vs -20.5%±2.4% for dippers, P<.001 for global longitudinal strain and -1.2±0.2 1/s for nondippers vs -1.31±0.16 1/s for dippers, P<.001 for global longitudinal strain rate). The nighttime systolic, diastolic, and mean blood pressure measurements were significantly higher in the nondipper group. Nocturnal dipping rates were statistically different between the groups (P<.001). Interventricular septum, posterior wall thickness, relative wall thickness, left atrial dimension, left ventricular mass, and mass index were higher in the nondipper group. Multivariate analysis demonstrated left atrium size, nocturnal dipping rate, daytime mean blood pressure, and nighttime systolic, diastolic, and mean blood pressure as independent predictors of global longitudinal strain. CONCLUSION: In our study, two-dimensional speckle tracking examination showed that the left ventricular systolic function is impaired even in the subclinical period in recently diagnosed nondipper hypertensive patients with deformational analysis.