Objective: This study aimed to explore a possible relationship between aortic stiffness parameters and diastolic function in patients with asymptomatic or symptomatic diastolic dysfunction, and subsequently, the effect of aortic stiffness parameters on the progression from asymptomatic diastolic dysfunction to clinical diastolic heart failure.
Methods: Seventy-five subjects were enrolled in the study of whom 20 had diastolic heart failure with the left ventricle ejection fraction (LVEF) >50%, 20 had asymptomatic diastolic dysfunction with LVEF>50%, 16 had hypertension with normal diastolic function, and 19 were normotensive healthy subjects. Ascending aorta recordings for measuring aortic strain and distensibility as markers of aortic stiffness were obtained from a spot nearly 3 cm above the aortic valve using 2-D echocardiography under M-mode. Doppler echocardiography and 2-D echocardiographic measurements were used to determine diastolic function.
Results: While no statistically significant difference in aortic strain or distensibility values was observed between the asymptomatic group and the diastolic heart failure group; however, E/E’ values were higher in the heart failure group [12.1 (10.0-17.1) vs. 10.0 (6.2-22.5)] (p=0.014). Aortic strain and distensibility values significantly decreased as E/E’ values increased (r = −0.416; p < 0.001 and r = −0.576; p < 0.001, respectively) for pooled data from all groups.
Conclusion: Although aortic stiffness parameters did not have a direct effect on the progression from asymptomatic diastolic dysfunction to diastolic heart failure, echocardiographic monitoring of these parameters may be beneficial in identifying patients who would progress to clinical heart failure from diastolic dysfunction.
Introduction:The relationship between the appropriateness of the transthoracic echocardiography (TTE) and its clinical impact is still a matter of debate.Objective: The aim of this study was to assess the degree of adherence to the appropriate use criteria for echocardiography, in a tertiary public hospital in the United Kingdom, as well as the clinical impact of the exam on patient management.Methods: 859 TTE's performed consecutively during January 2014 were reviewed to assess its appropriateness, and were classified as appropriate, uncertain or inappropriate using the 2011 guidelines.Subsequently, patient's files were examined to determine the clinical impact of the TTE which was assigned to one of the following three categories: (1) active change in care, (2) continuation of current care, or (3) no change in care.Patients which files were not available were excluded (259).All classifications were evaluated by two independent cardiologists, with no direct relation to the study.Results: Our sample had a mean age of 63 + 17 years with a gender balance.The majority of the exams were requested at the outpatient (81.4%) clinic, by cardiologists (50.3%) and general practitioners (13.4%).Regarding the main findings, in 7.6% of the studies there were moderate to severe systolic dysfunction; 4.0% showed severe valvular heart disease and 5.1% had significant pulmonary hypertension.Relatively to the appropriateness of the TTE requests, 76.5% were considered appropriate, 7.1% inappropriate and 12.6% uncertain.With respect to the clinical impact of the TTE's, 42.7% of the exams led to an active change in care, 15.6% to a continuation of the care and 11.5% revealed no change in care.Age (b0.90, P=0.05) and outpatient setting (b4.4,P,0.01) were the most important predictors of an active change of care exam.On the contrary, the appropriateness of the TTE's requests (b1.1, P=0.56) and the specialist ordering the exams (b0.81,P=0.26) were not independently associated.Conclusion: Our data showed that almost 8 out of 10 TTE were considered appropriate, and 4 out of 10 exams had an active clinical impact. P537Implementation of proprietary plug-ins in the DICOM-based computerized echo reporting system fuels the use of 3D echo and deformation imaging in the clinical routine of a multivendor laboratory
Objectives: The primary aim of this study was to investigate the potential relationship between non-alcoholic fatty liver disease (NAFLD) and contrast-induced nephropathy (CIN) in patients with non-ST-elevation myocardial infarction (NSTEMI). As a secondary goal, we aimed to explore the impact of NAFLD on short-term adverse events and coronary artery disease (CAD) severity in patients with NSTEMI. Methods: Three hundred and seven NSTEMI patients were included in this study. Laboratory analyses of these patients were performed before the procedure and 48–72 h after the procedure, and all patients underwent pre-procedure 2-dimensional transthoracic echocardiography and pre-discharge abdominal ultrasonography. The NAFLD (-) and (+) groups were compared statistically in terms of CIN, major cardiovascular-cerebrovascular adverse events (MACCE), and coronary artery severity (assessed by syntax score). Results: The mean age of the 307 consecutive patients included in the study was 61.58±12.39 (min-max: 26–94). The rates of CIN (primary objective) and MACCE and syntax scores (secondary objective) were comparable in both groups. Conclusion: In patients with NSTEMI, there was no relationship between NAFLD and CIN and short-term MACCE. Furthermore, NAFLD may not have an impact on the CAD severity in such patients. Based on these results, NAFLD is not a risk factor for CIN, short-term mortality, or CAD severity in NSTEMI patients.
Kan basinci (KB) kontrollu olan ve gece olculen kan basincinda yeterli dusme olmayan (non-dipper) hipertansiflerin egzersiz testi sonrasi kalp hizi toparlanmasinda gecikme gosterip gostermedigi incelendi. Tum hastalara Bruce protokolune gore maksimal efor testi uygulandi. Kalp hizi toparlanmasi (KHT), efor testi bittigindeki kalp hizi ile bir dakika sonraki kalp hizi arasindaki fark olarak tanimlandi. Sirkadiyen KB, 24 saatlik ambultuvar KB monitorizasyonu ile tespit edildi. Dipper KB profili olan hastalarin “non-dipper” olanlara gore gece ortalama sistolik ve diyastolik KB daha dusuk, sistolik ve diyastolik KB gece gunduz farki yuzdesi ise daha yuksekti. Dipper olanlarin KHT degerleri “non-dipper” bireylerden daha yuksekti (34.36±14.55/dak-32.48±8.60/dak, p=0.025). Ortalama gece sistolik-diyastolik KB degerleri ve KB gece gunduz farki yuzdesi ile KHT arasinda korelasyon yoktu. Sonuc olarak “Non-dipper” durum ile KHT gecikmesi arasinda istatistiksel olarak anlamli ancak klinik acidan cok da onemli olmayan bir iliski vardir. Bu bulgular “non-dipper” durumun duzeltilmesinden cok KB kontrolunun onemini gosterebilir.
ABSTRACT Background COVİD 19 is a relapsing and reccurrent infectious disease caused by SARS-CoV-2. It can be associated with cardiac pathologies . we present a case of COVİD 19 reinfection leading to cardiac involvement . Case Summary A 22 year old men who had a history of COVID-19 pneumonia one and a half month ago arrived at the emergency department with progressive dyspnea. He was . under treatment for chronic idiopathic urticaria with levocetirizine dihydrochloride .He was hypoxic, tachycardic and hypotensive. Thorax computed tomography images demonstrated bilateral ground-glass opacity ,right-sided pleural effusion and cardiomegaly, Bedside transthoracic echocardiography revealed global Left Ventricul (LV)systolic dysfunction with ejection fraction of%28, dilation of the LV cavity and anteriorly directed eccentric jet of severe mitral. regurgitation .The COVID-19 RT-PCR test was re-positive. whereas the blood cultures remain negative. Coronary angiogram performed was normal.The patient improved clinically within one week by furosemid, dopamin favipravir methylprednisolone and antibiotic treatments. C-reactive protein (CRP) levels returned to normal.. The follow-up echocardiography showed normal. ejection fraction and mild mitral. regurgitation. Conclusion This case highlights characteristics of
Objectives: Kidney transplantation recipients (KTRs) have higher cardiovascular complications risk compared to the general population. Cardiovascular risk factors (CVRF, Traditional and non-traditional) are widely studied to understand the causes of increased cardiovascular disease (CVD) risk in KTRs. Fetuin-A prevents from vascular calcification (VC) by inhibiting production and collapsing of apatite crystals to the vascular wall. The relationship between fetuin-A levels and CVRF in KTRs was investigated in this study. Methods: Sixty-two KTRs with no prior CVD history participated. Anthropometrical, laboratory (fetuin-A, inflammation markers, antioxidants, lipid peroxidation products) and cardiological (echocardiographic, pulse wave velocity) measurements were performed. Participants were divided into two groups according to normal (≥ 0.5 g/L, n = 32, NFA) and low (< 0.5 g/L, n = 30, LFA) fetuin-A levels according to manufacturer’s reference range, and the results were compared. Results: No significant difference was observed in demographic features, body mass index, systolic and diastolic blood pressures, left ventricle mass index, waist and hip circumferences, left ventricle hypertrophy and waist-hip ratios between the two groups (p > 0.05). The ratios of drug usage such as immunosuppressives, anti-hypertensives and statin were comparable between two groups. Parathormone levels were significantly higher in the NFA group (p = 0.015) and glomerular filtration rate was calculated significantly higher in LFA group (p = 007). The comparison of other CVRF reveals no significant difference (p > 0.05). Conclusions: Although many CVRF improved in KTRs, subclinical inflammation markers were still higher than the healthy population. Identification and early recognition of CVRF in high-risk individuals may contribute to the reduction of cardiovascular mortality. In our study, we observed no significant relationship between fetuin-A levels and CVRFs. We evaluated the relationship between serum fetuin-A levels on cardiovascular risk factors by its role in pathophysiology.
Objective: Obesity is a risk factor for cardiovascular disease and mortality, however several studies have been reported that patients with obesity who have admitted with acute myocardial infarction or have undergone percutaneous coronary intervention (PCI) have better clinical outcomes than their normal weight counterparts. The impact of body mass index (BMI) on myocardial perfusion and early clinical outcomes in ST-segment elevation myocardial infarction (STEMI) patients revascularized totally with manual thrombus aspiration remains unclear. Design and method: The study included 94 consecutive patients who underwent thrombus aspiration and stent-based primary PCI for STEMI between the years 2009 and 2013. Revascularization success was achieved in 83 patients with STEMI. These patients were divided into two groups according to BMI as normal weight (BMI < 25) or overweight (BMI > 25). At least 50% resolution of ST-segment up to 90 minutes after the procedure was defined as electrocardiographic good flow. Results: Among the 83 patients, 80% were overweight. While good flow observed in 79% of the patients, electrocardiographic perfusion success rates were similar in both groups. Overweight patients had better Killip class and higher initial left ventricular ejection fraction than normal weight patients. Angiographic characteristics were similar between the two groups except for the stent diameter which was higher in normal weight patients(Table 1). The usage of Glycoprotein IIb-IIIa antagonists was similar between the groups. In hospital and 30 day period, major adverse cardiac events (MACE) were not significantly different among the BMI categories.Conclusions: In the study, we demonstrated that despite similar myocardial reperfusion, patients with normal BMI had lower initial left ventricular ejection fraction and worse Killip class. The better results in overweight patients might indicate the presence of the phenomenon “obesity paradox” in patients who underwent thrombus aspiration in stent-based primary PCI for STEMI.
Objective: Pulmonary vascular remodeling and inflammation play a major role in pulmonary arterial hypertension (PAH). Novel hematologic biomarkers have recently been recognized as a risk predictor for cardiovascular, oncologic, and inflammatory diseases. We aimed to investigate the association of hematologic biomarkers with mortality in PAH patients. Materials and Methods: Fourty-five patients diagnosed with PAH and 45 healthy volunteers were evaluated retrospectively. Concurrent data included clinical, echocardiographic, hemodynamic and hematologic variables. The study population was divided into subgroups based on admission neutrophil to lymphocyte ratio (NLR), neutrophil to monocyte ratio (NMR), platelet to lymphocyte ratio (PLR) values. Results: The median NMR and NLR levels were lower in healthy subjects than in PAH patients (7.7 (7-8.8) vs 9.2 (6.5-11.6); p= 0.03 and 1.9 (1.4-2.9) vs 2.6 (1.9-3.3); p= 0.04) respectively). The estimated mean survival duration was longer in patients with low NMR levels (93 (95% CI, 86-100) vs. 67 (95% CI, 45-88) months (p=0.006) respectively). NMR independently predicted poor outcome and improved the power of the other prognostic markers (OR 1.4 (95% CI, 1-1.8) p= 0.04); (AUC= 0.91; p< 0.0001). Conclusions: NMR levels alone or combined with other prognostic factors may predict mortality in patients with PAH.
Background: We assessed the value of monocyte to high-density lipoprotein cholesterol ratio (MHR) in predicting in-hospital and 5-year mortality and major adverse cardiovascular events (MACE) in ST-segment elevation myocardial infarction (STEMI) patients. Methods: A group of 1,598 patients were enrolled and divided into tertiles according to MHR values. The effects of different variables on clinical outcomes were assessed by Cox regression analysis. Results: MHR was found as an independent predictor of in-hospital mortality (HR = 3.745, 95% CI 1.308–5.950), in-hospital MACE (HR 1.501, 95% CI 1.015–1.993, p = 0.022) and 5-year mortality (HR = 2.048, 95% CI 1.225–4.091, p = 0.014) and 5-year MACE (HR 1.285, 95% CI 1.064–1.552, p = 0.009). Conclusions: MHR is an independent predictor of in-hospital and long term mortality and MACE in STEMI.
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