Ahmet Kaya

Impact of body mass index on left ventricular diastolic dysfunction.

Background: The prevalence of obesity is increasing in the developed and developing world. It is an independent risk factor for heart failure. Left ventricular (LV) diastolic dysfunction has been demonstrated to be a strong predictor of heart failure. In the present study we aimed to assess the impact of body weight on LV diastolic function. Methods: The study was conducted on 2,228 participants (1,424 women, 804 men with a mean age of 49). Traditional and tissue Doppler echocardiographic examination were performed in all of the participants. The demographic and echocardiographic data were compared. Multivariate logistic regression analysis was used to assess the independent predictors of association of LV diastolic function. The study sample was divided into four groups: group 1 (body mass index [BMI] < 25.0 kg/m2), group 2 (BMI 25.0–29.9 kg/m2), group 3 (BMI ≥ 30–39.9 kg/m2), and group 4 (BMI ≥ 40 kg/m2). Results: Septal E was significantly lower in groups 2 and 3 compared to group 1 (P = 0.003). Septal A and septal A’ were significantly higher whereas septal E’ and lateral E’ were significantly lower in the groups 2, 3, and 4 compared to the normal weight group (P < 0.001). Lateral A’, deceleration time, and ejection time were significantly higher in obese when compared to the normal weight (P = 0.025, P < 0.001, and P = 0.009, respectively). The E/E’ ratio was significantly higher in groups 2, 3, and 4 compared to the group 1 (P < 0.001). Logistic regression analysis revealed that age, BMI (OR = 1.060 [95% CI = 1.040 and 1.080]; P < 0.001), hypertension, and diabetes mellitus were independent predictors of LV diastolic dysfunction. Conclusion: BMI is an independent predictor of LV diastolic dysfunction along with age, hypertension, and diabetes mellitus. (Echocardiography 2012;29:647‐651)

The Novel Genetic Disorder Microhydranencephaly Maps to Chromosome 16p13.3-12.1

We studied a large consanguineous Anatolian family with children who exhibited hydranencephaly associated with microcephaly. The children were severely affected. This novel genetic disorder is autosomal recessive. We used autozygosity mapping to identify a locus at chromosome 16p13.3-12.1; it has a LOD score of 4.11. The gene locus is within a maximal 11-cM interval between markers D16S497 and D16S672 and within a minimal critical region of 8 cM between markers D16S748 and D16S490.

The effect of incremental endurance exercise training on left ventricular mechanics: a prospective observational deformation imaging study.

OBJECTIVE Exercise training has been known to cause structural and functional alterations in the heart called athletes heart. We aimed to investigate the effects of incremental endurance exercise training (IEET) on the left ventricular (LV) mechanics in healthy subjects. METHODS This prospective observational study included 34 healthy young men who participated in competitive sports. The participants were subjected to a six-month IEET program. The LV mechanics measured using two-dimensional speckle tracking echocardiography was recorded while the participants were in an inactive state before and at the end of the six months. To compare continuous variables before and after IEET, Wilcoxon or paired-t test were used. RESULTS Baseline and post training echocardiographic measurements showed that there was no significant change in LV ejection fraction (%) (p=0.64) and there were an increase in end-systolic and end-diastolic diameters, posterior and septal wall thickness, relative wall thickness and LV mass index (p<0.05, for all). LV mechanical parameters such as global strain (S) (19.8±1.33% vs. 20.4±1.26%, p=0.001), apical four -chamber S (19.4±1.96% vs. 20.1±1.86%, p=0.01), apical two- chamber S (19.9±1.75% vs. 20.7±1.75%, p=0.003), apical (23.0±3.1% vs. 23.6±3.2%, p=0.03), and basal circumferential S (21.1±2.2 % vs. 21.6±2.5%, p=0.03), and apical rotation (degree) (7.9±0.95 vs. 8.4±0.74, p=0.001) values were significantly increased by IEET. CONCLUSION We demonstrated that IEET has led to exercise related cardiac structural and functional changes such as LV dilatation and LV hypertrophy, accompanied by a significant increase in LV systolic S and LV twist measurements.

Relation of the metabolic syndrome with proarrhythmogenic electrocardiographic parameters in patients without overt diabetes.

OBJECTIVES We aimed to observe the relationship of the metabolic syndrome and proarrythmogenic ECG parameters and to evaluate a possible correlation of these parameters to the metabolic syndrome score in patients without overt diabetes mellitus. METHODS The study population consisted of 142 patients with the metabolic syndrome and 170 age- and gender-matched control subjects. In the ECG recordings, resting heart rate, QRS duration, corrected QT duration and corrected QT dispersion were measured. Patients were classified into three groups based on number of fulfilled metabolic syndrome criteria: group 1 (three metabolic syndrome criteria), group 2 (four metabolic syndrome criteria) and group 3 (five metabolic syndrome criteria). RESULTS Patients with the metabolic syndrome had a higher increased resting heart rate, QTcd, prolonged QRS and QTc duration. Resting heart rate increases significantly parallel to the increase in the metabolic syndrome score across the groups, whilst QRS duration remained unchanged. QTc duration and QTc dispersion were significantly higher in groups 2 and 3 when compared to group 1. However, no significant differences were observed between groups 2 and 3. CONCLUSION We demonstrated that the metabolic syndrome and its score related with increased resting heart rate and prolonged repolarization durations in patiens without overt diabetes mellitus. These pro arrhythmogenic parameters could be used in the development of risk stratification schemes for sudden cardiac death in patients with the metabolic syndrome.

PP-221 THE RELATION OF SERUM GAMMA-GLUTAMYL TRANSFERASE LEVELS WITH CORONARY LESION COMPLEXITY AND LONG-TERM OUTCOME IN PATIENTS WITH STABLE CORONARY ARTERY DISEASE

a b s t r a c t Background: Relation of serum gamma-glutamyl transferase (GGT) levels with extent, severity, and complexity of coronary artery disease has not been adequately studied. Therefore, we evaluated the rela- tionship between GGT levels and coronary complexity, severity and extent assessed by SYNTAX score and long-term adverse events. Methods: We enrolled 442 consecutive patients with stable angina pectoris who underwent coronary angiography. Baseline serum GGT levels were measured and SYNTAX score was calculated from the study population. Median follow-up duration was 363 days. Endpoints were all cause mortality and any revascularization. Results: GGT levels demonstrated an increase from low SYNTAX tertile to high tertile. In multivariate analysis serum GGT, diabetes mellitus, HDL-cholesterol, eGFR and ejection fraction were found to be independent predictors of high SYNTAX score. The survival analysis showed that long-term revascular- ization rates were comparable between the GGT groups (for 36 U/l cut point) of the overall population (7.7% vs 8.6% logrank, p = 0.577), whereas long-term all cause mortality rate was higher in the GGT ≥ 36 U/l group (3.6% vs 11.6% logrank, p = 0.001). In Cox proportional hazards regression model, GGT ≥ 36 U/l group was found to be an independent predictor of long-term all cause mortality in the unadjusted (HR 2.54, 95% CI 1.17-5.48, p = 0.018) and age- and gender-adjusted (HR 2.58, 95% CI 1.19-5.58, p = 0.016) models. Conclusion: Serum GGT level was independently associated with coronary complexity and long-term mortality in patients with stable coronary artery disease.

Relationship between Serum Gamma-glutamyl Transferase Levels with Ascending Aortic Dilatation

OBJECTIVE Increased serum gamma-glutamyl transferase levels (GGT) have been shown to directly promote oxidative stress. Previous studies have shown the relationship between the dilatation of the ascending aorta and oxidative stress. This study was designed to examine the relationship between serum GGT concentrations with dilatation of the ascending aorta. MATERIALS AND METHODS Ninety patients with ascending aortic dilatation and 90 age-sex-matched patients without aortic dilatation were included in the study. The patients were evaluated by a complete transthoracic echocardiographic examination including measurement of the aortic dimensions, where a diameter of 3.7 cm and above was accepted as ascending aortic dilatation. Serum GGT concentration was measured in all patients. RESULTS In the group with aortic dilatation, HT frequency, serum uric acid, hs-CRP and GGT levels, the LV mass index, and the left atrial volume index were found to be higher than the control group. The logistic regression analysis showed that only HT frequency (OR:1.23, 95% CI 1.11-1.35, p value: 0.02), the LA volume index (OR: 1.34, 95% CI 1.21±1.4, p:0.005) and serum GGT levels (OR: 1.12, 95% CI 1.01±1.20, p:0.03) were found to be independent predictors. There was a significant correlation between serum GGT levels and ascending aortic diameter (r: 0.268, p<0.001). In the ROC curve analysis, AUC was 0.659 (0.580±0.738) for a 23.5 serum GGT cut-off value (64% sensitivity and 53% specificity). CONCLUSION We found that serum GGT concentration was significantly associated with ascending aortic dilatation. Large epidemiological studies are required to correlate the findings from this study with clinical outcome.

Two-dimensional strain imaging to predict the localization of an accessory pathway.

A 26-year-old male with frequent palpitation episodes was referred to our clinic for electrophysiological study (EPS). His surface electrocardiogram showed short PR, delta wave, and wide QRS, consistent with a left accessory pathway (Fig. A). Before EPS, twochamber and apical long-axis two-dimensional (2D) strain imaging demonstrated that time to peak longitudinal strain was shortest in the mid-basal inferior wall and mid-basal posterior wall, respectively. Electrophysiological study revealed that the accessory pathway was localized in the left posterolateral region and it was then ablated successfully (Fig. B). After the procedure, 2D strain imaging showed complete resolution of the early inferoposterior ventricular activation (Fig. C-F). Two-dimensional strain imaging may be useful to predict the localization of accessory pathways. İbrahim Halil Tanboğa Turgay Işık Ahmet Kaya Mustafa Kurt

The effects of dialysis-type on left ventricular function in non-diabetic end-stage renal disease patients

Objective In this study we aimed to investigate a possible difference in left ventricular function in patients undergoing peritoneal dialysis (PD) and haemodialysis (HD) using 2D echocardiography. Methods A total of 84 patients were recruited in the study. Both PD and HD groups consisted of 42 end-stage renal disease patients. Patients with left ventricular ejection fraction (EF) < 50%, diabetes mellitus and coronary artery disease were excluded. Baseline characteristics and conventional tissue Doppler echocardiography parameters were recorded. Left ventricular longitudinal (Ls), circumferential (Cs) and radial strain (R) along with strain rate were also recorded in the speckle-tracking echocardiography. These values were compared between the two groups. Results No significant difference was observed between PD and HD patients, in terms of mean time from diagnosis of chronic kidney disease to initiation of the study, mean time from first dialysis to initiation of the study, left ventricular EF, age, sex and heart rate. Left ventricular hypertrophy was also more frequent in HD group and the patients had a higher left ventricular mass index. Left ventricular global Ls, LSRs, LSRe, LSRa and global Rs, RSRs, RSRe, RSRa were detected to be lower in HD patients. Conclusions Longitudinal and radial left ventricular mechanics were found to be better preserved in patients undergoing peritoneal dialysis when compared to haemodialysis patients. Consequently, it can be concluded that peritoneal dialysis provides better protection on left ventricular systolic function compared to haemodialysis.

The relationship between fibrinogen to albumin ratio and severity of coronary artery disease in patients with STEMI

OBJECTIVE Previous studies show that serum fibrinogen levels are established risk factors for coronary artery disease (CAD) and that serum albumin levels are of a higher specificity and sensitivity in ST-elevation myocardial infarction (STEMI). In this study, we sought to evaluate the association between fibrinogen to albumin ratio (FAR) and the extent and severity of CAD evaluated by TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries (SYNTAX) Score (SS) in patients with STEMI. METHODS A total of 278 patients with STEMI were included in the study. FAR was calculated using specified variables. The extent and severity of CAD were evaluated using the SS. The patients were divided into low- (SS <22) and high- (SS ≥22) risk groups. A Spearman rank correlation coefficient analysis was used for the relationship between FAR and SS. The cutoff points for sensitivity and specificity of FAR in predicting SS were estimated by performing a receiver operator characteristic curve analysis. RESULTS There were significant differences in the mean age (P=.016), admission serum albumin (P=.041), serum fibrinogen (P<.001), FAR (P<.001), and SS risk groups. Positive correlation was detected between FAR and SS (r=0.458, P<.001). A cutoff level of >87 FAR predicted SS (sensitivity, 70%; specificity, 70%), and an area under the curve of 0.758 serum fibrinogen and albumin level was an independent predictor for SS in patients with STEMI (b=0.039; 95% confidence interval, 0.016-0.062; P=.001 and b=-6.906; 95% confidence interval, -12.284 to -1.527; P=.013, respectively). CONCLUSION In the present study, we showed that FAR is significantly related to SS in predicting the severity of CAD in patients with STEMI.

Lingual hematoma due to streptokinase in a patient with acute myocardial infarction

Thrombolysis with streptokinase is routinely used for the treatment of acute myocardial infarction. Hematoma of the tongue, vocal cord, uvula, and pharyngeal hemorrhage after streptokinase treatment is a very rare condition. Herein, we describe a case of lingual hematoma after thrombolysis with streptokinase in a patient with acute myocardial infarction. Thrombolysis with streptokinase is routinely used for the treatment of acute myocardial infarction [1], and the value of thrombolysis in these patients is well established. It has been reported that the frequency of major bleeding after thrombolytic treatment is 5% to 7%. Complications such as hematoma of the tongue, vocal cord, uvula, and pharyngeal hemorrhage after thrombolytic treatment have been reported [2]. However, hematoma of the tongue is a very rare complication of thrombolysis [3]. We describe a case of lingual hematoma after thrombolysis with streptokinase in a patient with acute myocardial infarction. A 54year-old male patient presented to emergency department (ED) with severe chest pain. Electrocardiogram revealed ST-segment elevation in leads V1 to V6. Shortly after his arrival to ED, ventricular fibrillation occurred. He was defibrillated, and sinus rhythm was restored in first attempt. Respiratory arrest did not develop, and he did not require endotracheal intubation. The patient was admitted to coronary intensive care unit, and aspirin (300 mg), heparin (5000 IU intravenous bolus), and streptokinase infusion (1 500 000 IU) was administered for 45 minutes. Five hours later, the patient could not speak clearly but did not have dyspnea or stridor. Physical examination revealed significant swelling and purple discoloration of the lingua and conjunctiva. The diagnosis of extensive spontaneous hematoma of the lingua and conjunctivae was concluded (Fig. 1). There had been no trauma (eg, laceration of intraoral soft tissue structures and bleeding) or instrumentation in the mouth. In the literature, of the few reported cases of hemorrhage into the subcutaneous neck tissues post-thrombolysis, 3 required endotracheal intubation. Two of these cases 0735-6757/