Batur Gonenc Kanar

The impact of right ventricular function assessed by 2-dimensional speckle tracking echocardiography on early mortality in patients with inferior myocardial infarction

Right ventricular (RV) involvement in inferior myocardial infarction (MI) increases in‐hospital morbidity and mortality.

Relationship Between Angiographic Coronary Slow Flow Phenomenon and Subfoveal Choroidal Thickness: What is The Effect of Atorvastatin Therapy?

Objective: Although the pathophysiological mechanisms underlying coronary slow flow (CSF) phenomenon still remains uncertain, the microvascular dysfunction has been first implicated. The CSF phenomenon may not only affect the coronary arteries but it may also be a part of vascular problem that affect other arteries. The aim of the present study is to evaluate the relationship between CSF phenomenon and subfoveal choroidal thickness (SFCT) and to investigate the effect of short-term atorvastatin therapy on SFCT in patients with CSF. Methods: The study population consisted of 48 patients with CSF and 41 healthy control participants. Coronary flow patterns of the patients were determined by thrombolysis in myocardial infarction (TIMI) frame count method. Spectral-domain optical coherence tomography (SD-OCT) measurements of SFCT and lipid parameters were obtained before and after 2 weeks of daily single dose of 80 mg atorvastatin therapy. Results: We found that patients with CSF had thinner SFCT compared with control group. There was a significant negative correlation between mean TIMI frame count and baseline SFCT (r=-0.69, p=0.001). ROC curve analysis revealed that SFCT <259 m predicted CSF with a 85% sensitivity and 88% specificity. The SFCT significantly increased after the short-term atorvastatin therapy. Conclusion: There was a close negative correlation between CSF phenomenon and SFCT. Endothelial dysfunction (ED) and the resultant microvascular dysfunction might be operative on both coronary and ocular choriocapillary arteries in patients with CSF. Increase of SFCT after the short-term atorvastatin therapy might be an indicator of microvascular dysfunction improvement in patients with CSF.

Right ventricular dyssynchrony and its improvements after pulmonary rehabilitation in patients with chronic obstructive pulmonary disease

Whether pathologic alterations of right ventricle (RV) in chronic obstructive pulmonary disease (COPD) affect intra‐ and interventricular dyssynchrony due to changes in mechanical activation of the septum and RV is unclear. The aim of this study was to determine mechanical activation and its changes after pulmonary rehabilitation program (PRP) with speckle tracking echocardiography (STE) in COPD patients.

Evaluation of right atrial volumes and functions by real-time three-dimensional echocardiography in patients after acute inferior myocardial infarction

Right ventricle (RV) involvement causes acute systolic and diastolic functional alterations in the RV in patients after inferior myocardial infarction (IMI), which may result in an increase in left ventricle (LV) end‐diastolic and right atrial (RA) pressure. In our study, we sought to evaluate RA volumes and mechanical functions using real‐time three‐dimensional echocardiography (RT3DE) in IMI patients with or without RV involvement.

Right Ventricular Functional Improvement after Pulmonary Rehabilitation Program in Patients with COPD Determined by Speckle Tracking Echocardiography

Background Although right ventricular (RV) dysfunction in pulmonary diseases has been associated with increased morbidity, tools for RV dysfunction identification are not well defined. Objective The aim of this study was to evaluate the magnitude of RV dysfunction by means of speckle tracking echocardiography (STE) in patients with chronic obstructive pulmonary disease (COPD) and to investigate whether STE could be used as an index of RV improvement after a pulmonary rehabilitation (PR) program. Methods Forty-six patients with COPD undergoing PR program and 32 age-sex matched healthy subjects were enrolled. RV function was evaluated at admission and after PR program by conventional two-dimensional echocardiography (2DE) and STE. In addition, exercise tolerance of subjects was evaluated using the six-minute walk test (6MWT). Results COPD patients had worse RV function according to STE and 2DE as well. STE was more sensitive than conventional 2DE in determining RV improvement after PR program - RV global longitudinal strain (LS): 20.4 ± 2.4% vs. 21.9 ± 2.9% p < 0.001 and RV free wall LS: 18.1 ± 3.4% vs. 22.9 ± 3.7%, p < 0.001). RV free wall LS was directly related to distance walked at baseline 6MWT (r = 0.58, p < 0.001) and to the change in the 6MWT distance (6MWTD Δ) (r = 0.41, p = 0.04). Conclusions We conclude that STE might be as effective as 2DE for evaluation of global and regional RV functions. STE may become an important tool for assessment and follow-up of COPD patients undergoing PR program to determine the relationship between RV function and exercise tolerance.

Subacute aortic prosthetic mechanical valve thrombosis complicated with acute coronary syndrome

Abstract A prosthetic valve thrombosis (PVT), which is a potentially fatal complication, refers to the presence of non‐infective thrombotic material on a prosthetic valve apparatus, interfering with its function. Possible complications of a PVT include transient neurologic embolic events, cardiac arrest due to a stuck valve prosthesis, and cardio‐embolic myocardial infarction (MI). The choice of treatments, including a redo surgery, a percutaneous coronary intervention (PCI), and a fibrinolysis with PVT or MI dosages, depends on the patients clinical and hemodynamic status and thrombotic burden involving the prosthetic valve and surrounding tissues. An early postoperative mechanical valve thrombosis is associated with increased risks due to the need for unforeseen early redo surgery complications and excessive bleeding risk in case of thrombolytic therapy usage. Here, we present a fifty‐seven‐year old female patient who was admitted to the emergency department with the complaint of acute chest pain seven days after an aortic prosthetic mechanical valve implantation. The clinical presentation was consistent with ST segment elevated MI and echocardiography revealed a large mass on the recently implanted prosthetic aortic valve. Valvular thrombotic complications after heart valve replacement operations are associated with high morbidity and mortality rates. Efficient and urgent treatment is necessary. Considering the clinical status of the patient, we preferred fibrinolytic therapy rather than PCI or surgery. The aim of this case report was to show the efficiency and safety of low‐dose slow‐infusion fibrinolytic therapy in PVT complicated with acute coronary syndrome.

The Relationship between Vitamin D Deficiency and Pulmonary ArteryAtherosclerosis in Chronic Thromboembolic Patients

Background: Our aim of our study was to determine the relationship between vitamin D level and pulmonary artery’s atherosclerosis in patients with chronic pulmonary thromboembolic pulmonary hypertension (CTEPH) who underwent pulmonary endarterectomy (PEA). Methods: Fifty-six patients with CTEPH who underwent PEA included in our study. Pathologic examination performed to the excised chronic thromboembolic material for the presence of atherosclerosis. We determined patients’ 25-OH vitamin D level in our study. Results: The average 25-OH vitamin D level in the group of the patients with atherosclerosis was lower than the average 25-OH vitamin D level in the patients with no atherosclerosis (9 ± 6.8 and 16 ± 5.9 pg/ml; p=0.005). There were no significant differences between two groups regarding hypercholesterolemia, high sensitive CRP (hsCRP) and the neutrophile-lymphocyte ratio (N/L ratio). Conclusions: We believe that vitamin D can be routinely used in patients with CTEPH vitamin D. Vitamin D replacement may be protective against atherosclerosis in these patients.

Left atrial volume changes is an early marker of end-organ damage in essential hypertension: A multidisciplinary approach to an old problem

Left atrial (LA) volume has been shown to be a predictor of adverse cardiovascular outcomes. The aim of this study was to evaluate the relation between LA phasic volumes and hypertensive end‐organ damage (EOD), by using real time three‐dimensional echocardiography (RT3DE) in patients with essential hypertension (HT).