Jugular vein diameter: A new player in normotensive pulmonary embolism.

PURPOSE: The majority of the patients with pulmonary embolism (PE) are those with normotensive PE. Right ventricular dysfunction (RVD) and myocardial injury markers are associated with mortality although they have a low predictive impact. Here, we aim to study the performance characteristics of jugular vein diameter to predict 30-day mortality. MATERIALS AND METHODS: In this prospective, observational cohort study, we included normotensive patients who were diagnosed with PE using computed tomography angiography or scintigraphy in the emergency service. The demographic characteristics, blood pressures, pulses, shock indexes, troponin and lactate levels, echocardiography findings, and internal jugular vein diameters (IJV) of the patients were recorded. Testing characteristics of IJV in predicting 30-day mortality were studied. RESULTS: The mean age of the 81 patients was 66.8±16.9 years and 37% of them were male. Age, shock index, lactate, RVD, PESI, and IJV diameters during inspiration and expiration were indicators for 30-day mortality. The cut-off value obtained using the ROC curve for mortality was an IJV-exp-AP of ≤8.9 mm (sensitivity,73.3%; specificity,92.4%; +LR,9.68; -LR,0.29; NPD,93.8%; PPD,68.7%; area under the curve, 0.76; 95% confidence interval, 0.65-0.84; p=0.004). CONCLUSION: IJV diameter is an indicator of 30-day mortality. It can be used to detect low-risk patients.

Comparison of myocardial performance index and right ventricular myocardial acceleration during isovolumic contraction in detection of right ventricular dysfunction in obese patients.

OBJECTIVE: Although obesity is a risk factor for heart failure, studies analyzing the effect of obesity on heart functions have primarily examined the left side of the heart. This study is an analysis of the effect of the severity of obesity on right heart functions and a comparison of the sensitivity and specificity of different echocardiographic modalities in the detection of right heart dysfunction. METHODS: A total of 116 subjects were included and divided into 4 age- and sex-matched groups according to body mass index (BMI) values. Right heart functions were evaluated with transthoracic echocardiography. RESULTS: The right atrium (RA) diameter was significantly larger in the obese group (OBG) and the morbidly obese group (MOG); the right ventricle (RV) diameter was significantly larger only in the MOG. In the overweight group, the OBG, and the MOG, the RV isovolumic acceleration (R-IVA) was significantly lower (p=0.020; p<0.001; p<0.001, respectively) and the myocardial performance index (MPI) value was significantly higher (p=0.015; p<0.001; p<0.001, respectively). There was a strong positive correlation between the MPI and the BMI (r=0.833, p<0.001), and a moderate negative correlation between the R-IVA and the BMI (r=-0.547, p<0.001). A cut-off value of 30.45 kg/m2 was associated with 93.3% sensitivity and 94.3% specificity in the prediction of RV systolic dysfunction defined by the MPI. A cut-off value of 30.50 kg/m2 was associated with 76.7% sensitivity and 72.3% specificity in the prediction of RV systolic dysfunction defined by the R-IVA. CONCLUSION: Obesity significantly affected right heart function and there was a significant correlation between the degree of obesity and right heart functional deterioration. The BMI could be used to predict RV systolic dysfunction.

Periaortic adipose tissue volume is associated with sclerotic changes in the adjacent aortic valve.

Aortic sclerosis is associated with increased cardiovascular mortality and morbidity. Numerous studies have shown that visceral adiposity is associated with development of atherosclerosis, especially in the adjacent vascular wall. Considering the similar pathophysiology of aortic sclerosis and atherosclerosis, it can be hypothesized that visceral adipose tissue adjacent to aortic valve may be associated with aortic sclerosis. In this study, we investigated the relationship between periaortic adipose tissue volume and sclerotic changes in the adjacent aortic valve. In this retrospective study, 80 patients with a concurrent MSCT and echocardiography in the last 6 months were enrolled. Echocardiographic examinations were retrospectively evaluated regarding the presence of aortic sclerosis. Periaortic adipose tissue volume was calculated on a computer assisted work station (Leonardo Workstation, Siemens, Erlangen, Germany) by an experienced radiologist. Patient group (61.63 ± 8.55 years and 50% male) and the control group (61.45 ± 5.68 years, 50% male) each consisted 40 participants. Patient group had significantly higher BUN (42.50 (15.00-211.00) vs. 34.00 (12.00-107.00) mg/dL, p = 0.003), uric acid (5.40 (3.40-14.70) vs. 4.30 (2.30-6.70) ng/mL, p = 0.005) and LDL-C levels (121.50 (60.00-215.00) vs. 86.50 (49.00-209.00) mg/dL, p = 0.001) when compared to control group. Patient group had also significantly higher periaortic adipose tissue volume (32.45 (11.70-51.23) vs. 16.00 (6.29-32.96) ml, p < 0.001). Multivariate regression analysis revealed that periaortic adipose tissue volume was independently associated with the presence of aortic sclerosis (OR 0.241, 95% CI 0.143-0.946, p = 0.001). In this study, we demonstrated for the first time that periaortic adipose tissue volume was independently associated with the presence of sclerotic changes in the adjacent aortic valve.

Subclinical Atherosclerosis in Patients with Prior Pulmonary Thromboembolism.

OBJECTIVE: Recent studies have indicated that endothelial dysfunction is common in patients with a prior history of pulmonary thromboembolism (PTE). Based on the established relationship between endothelial dysfunction and atherosclerosis, we aimed to investigate carotid intima-media thickness (cIMT) as a marker of subclinical atherosclerosis in patients who have a prior history of PTE. SUBJECTS AND METHODS: Medical records belonging to patients with a history of PTE and age- and gender-matched control subjects among those who underwent transthoracic echocardiography in Konya Training and Research Hospital were reviewed. Echocardiographic findings and cIMT measurements were recorded. cIMT measurements were compared between patient and control groups, and then independent correlates of cIMT were investigated using appropriate statistical methods. RESULTS: A total of 110 patients (64.02 ± 12.67 years, males: n = 79 [71.81%]; females: n = 31 [28.19%]) were found to be eligible for assessment. Of these patients, 55 (50.00%) had a history of PTE. Patients with a history of PTE had significantly greater cIMT (p = 0.040). In this group of patients, cIMT positively and significantly correlated with basal right ventricular (RV) diameter (r = 0.271, p = 0.022), RV diastolic area (r = 0.376, p = 0.002), and systolic pulmonary artery pressure (r = 0.248, p = 0.037). In the multivariate linear regression analysis, only RV diastolic area was independently associated with cIMT in patients with PTE (p = 0.010). CONCLUSION: Patients with a history of PTE have increased cIMT when compared to healthy subjects, and cIMT, which is a marker of subclinical atherosclerosis, is independently associated with RV diameter in these patients.

Endothelial dysfunction in patients with pulmonary thromboembolism: neutrophil to lymphocyte ratio and platelet to lymphocyte ratio.

BACKGROUND AND AIMS: Pulmonary thromboembolism (PTE) is a common cardiovascular emergency. Activated leukocytes may produce free oxygen radicals and endothelial damage, and, thereby, increased inflammation and thrombogenesis. In this study, we aimed to investigate endothelial dysfunction in patients with PTE. METHODS: Between May 2012 and July 2013, a total of 71 patients with acute PTE (32 males, 39 females; mean age: 64.94 ± 15.27 years; range: 33 to 87 years) who were admitted to the Emergency and Thoracic Diseases Departments and 56 healthy controls (44 males, 12 females; mean age: 62.52 ± 9.80 years; range: 46 to 79 years) were included. Brachial artery flow-mediated dilation (BFMD) was performed. Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) were calculated. RESULTS: Significantly higher BFMD values were observed in patients with PTE (P < 0.05). Patients with PTE also had significantly higher NLR and PLR values, compared with the healthy control group (P < 0.05). CONCLUSION: The results of our study suggest that using non-invasive method such as ultrasonography combined with NLR and PLR in endothelial dysfunction diagnosis in PTE patients are both effective and inexpensive. We believe in PTE patients endothelial dysfunction may play a role in the development of probable cardiovascular events in future.