Eyup Buyukkaya

Right ventricular strain and strain rate properties in patients with right ventricular myocardial infarction.

Background: This study was planned to assess strain and strain rate properties of right ventricle in patients with RV myocardial infarction. Material and Method: Thirty patients with acute inferior myocardial infarction were included in this study. The presence of right ventricular infarction in association with an inferior myocardial infarction was defined by an ST‐segment elevation 0.1 mV in lead V4 R. According to this definition, 15 patients had electrocardiographic signs of inferior myocardial infarction without right ventricular infarction (group I), and 15 patients had electrocardiographic signs of inferior myocardial infarction with right ventricular infarction (group II). Echocardiography was performed using a Vivid 5 System (GE Ultrasound; Horten, Norway) and a 2.5‐MHz transducer. 2‐dimensional color doppler myocardial imaging (CDMI) data for longitudinal function were recorded from the RV free wall using standard apical view. Offline analysis of the myocardial color Doppler data for regional velocity (V), strain rate (Sr), and strain (S) curves was performed using a special software program (EchoPac 6.4 Vingmed, Horten, Norway). They were assessed in basal, middle and apical segments of the RV. The differences between different groups were assessed with the Mann‐Whitney U‐test. A value of P < 0.05 was considered statistically significant. Results: Systolic tissue velocity, strain, strain rate of basal (4.8 ± 0.8 cm/s vs 6.5 ± 1.2 cm/s, −12 ± 3% vs −24 ± 5%, 1.28 ± 0.3/s vs −1.9 ± 0.4/s; P < 0.001, <0.001, <0.001, respectively) and mid (4.2 ± 0.5 cm/s vs 5.4 ± 0.5 cm/s, −16 ±3% vs −26 ± 4%, −1.2 ± 0.3/s vs −2.1 ± 0.3/s; P < 0.001, <0.001, <0.001, respectively) segments of right ventricle were significantly lower in patients with RV infarction than in patients without RV infarction. There were no differences between groups for apical strain, strain rate, and systolic tissue velocity. Conclusion: This study demonstrates that right ventricular strain and strain rate were lower in patients with left ventricular inferior wall myocardial infarction with, compared to without, right ventricular infarction.

Coronary artery fistula in a patient with coronary artery disease: evaluation by coronary angiography and multidetector computed tomography

A 54-year-old man with acute miyocardial infarction was successfully treated with coronary artery stenting. Coronary angiography is the preferred diagnostic method for imaging the coronary arteries, but coronary artery fistulas origin and course may not be apparent. New tomographic cardiovascular imaging tests such as, multidetector computed tomography (MDCT) can be used to precise delineation of coronary fistulas.

The relationship between coronary collateral circulation and neutrophil/lymphocyte ratio in patients with coronary chronic total occlusion.

Objectives: To investigate the relationship between neutrophil/lymphocyte ratio (NLR) and coronary collateral circulation (CCC) in patients with coronary chronic total occlusion. Subjects and Methods: Our study population consisted of 275 consecutive patients with chronic total occlusion. One hundred and thirty-eight patients with chronic total occlusion were included in the study. They were classified into 2 groups as follows: impaired CCC (group 1: Rentrop grades 0-1) and good CCC (group 2: Rentrop grades 2-3). The NLR was calculated from the complete blood count. Results: The NLR values of the patients with impaired CCC (4.5 ± 0.7) were significantly higher than of those with good CCC (2.7 ± 0.6, p < 0.001). In the multivariate logistic regression test, NLR (OR 33.36, 95% CI 8.189-135.7, p < 0.001), high-sensitivity C-reactive protein (hs-CRP; OR 2.152, 95% CI 1.226-3.777, p = 0.008), estimated glomerular filtration rate (OR 1.167, 95% CI 1.049-1.298, p = 0.004) and systolic blood pressure (OR 1.068, 95% CI 1.009-1.1310, p = 0.025) were independent predictors of impaired CCC. The NLR value >3.55 yielded an area under the curve value of 0.957 (95% CI 0.921-0.992, p < 0.001) and demonstrated a sensitivity of 95% and a specificity of 90% for the prediction of CCC. A moderate correlation between NLR and hs-CRP was observed (r = 0.443; p < 0.001). Conclusion: Our findings reveal that NLR correlates with the impaired development of coronary collaterals.

Serum Pentraxin-3 Levels Are Associated with the Severity of Metabolic Syndrome

Objectives: The aim of the present study was to assess the association between the level of pentraxin-3 (PTX-3) and the severity of metabolic syndrome (MS). Subjects and Method: One hundred and two patients with MS and 101 consecutive age- and sex-matched control subjects were included in the study. The MS patients were classified into three groups based on the number of MS criteria, i.e. group 1: patients with 3 MS criteria, group 2: patients with 4 MS criteria, and group 3: patients with 5 MS criteria. Serum PTX-3 and high-sensitivity C-reactive protein (hs-CRP) levels were measured. Results: Group 1 had higher PTX-3 levels compared to the control group (0.58 ± 0.11 ng/ml vs. 0.36 ± 0.15 ng/ml, p < 0.001). PTX-3 levels were higher in group 3 than in both group 1 (0.90 ± 0.06 ng/ml vs. 0.58 ± 0.11 ng/ml, p < 0.001) and group 2 (0.90 ± 0.06 ng/ml vs. 0.63 ± 0.12 ng/ml, p < 0.001). Group 3, however, had higher hs-CRP levels than both group 1 (1.89 ± 0.45 mg/dl vs. 1.40 ± 0.44 mg/dl, p = 0.007) and group 2 (1.89 ± 0.45 mg/dl vs. 1.47 ± 0.58 mg/dl, p = 0.01). The control group had lower hs-CRP levels than group 1 (0.81 ± 0.47 mg/dl vs. 1.40 ± 0.44 mg/dl, p < 0.001) and group 2 (0.81 ± 0.47 mg/dl vs. 1.47 ± 0.58 mg/dl, p < 0.001). Serum PTX-3 levels correlated with serum hs-CRP levels (r = 0.49, p < 0.001). Conclusions: PTX-3, a novel inflammatory marker, was found to be associated with the severity of MS.

Relation of presence and severity of metabolic syndrome with left atrial mechanics in patients without overt diabetes: a deformation imaging study

OBJECTIVE We aimed to investigate left atrium (LA) function by speckle tracking echocardiography in patients with metabolic syndrome (MetSyn) and to show a possible relationship between the severity of MetSyn and LA function and to determine the predictors of low strain in MetSyn patients. METHODS Our study design was observational and cross-sectional design consisted of 80 MetSyn patients without overt diabetes and 50 controls. The patients were classified into three groups based on the number of MetSyn criteria. The peak LA strain at the end of the ventricular systole (LAs-strain) as well as the LA strain with LA contraction (LAa-strain) was obtained. Correlation analysis performed to assess the association of LA strain parameters with the severity of MetSyn and logistic regression analysis performed to assess the relationship of low LA strain with MetSyn. RESULTS Both LAs (37.5±8.7 vs. 26.0±10.2, p<0.001) and LAa (19.9±6.3 vs. 13.0±6.4, p<0.001) strain measurements were found to be significantly decreased in patients with MetSyn when compared to the control group. Moreover, both LAs and LAa were found to be significantly decreased with the increasing severity of the MetSyn. A multiple logistic regression analysis demonstrated that the presence of MetSyn [OR:0.26 (95% CI 0.06-0.89), p=0.032] and left ventricular ejection fraction [OR:1.14 (95% CI 1.03-1.27), p=0.021] were independent predictors of LAs strain. CONCLUSION MetSyn is associated with reduced LAs strain and LAa strain representing LA reservoir and pump function, respectively. Furthermore, LA mechanical function decreases even more with the increasing severity of the MetSyn.

Can Transesophageal Pulse-Wave Tissue Doppler Imaging Be Used to Evaluate Left Ventricular Function?

Background: This study aimed to evaluate the efficiency of transesophageal tissue Doppler echocardiography (TDE) in evaluation of the left ventricular functions. To this end, the data obtained by transoesophageal tissue Doppler echocardiography and by transthoracic tissue Doppler echocardiography were compared simultaneously. Methods: Nineteen consecutive patients (7 female and 12 male) underwent a clinically indicated study. In transthoracic (TTE) and transoesophageal (TEE) echocardiographic study, a Vingmed System Five Doppler echocardiographic unit (GE Vingmed) was used. For the assessment of the left ventricular function using transthoracic and transoesophageal TDE, the mitral annular peak systolic (S), early diastolic (E), late diastolic velocities (A), late to early velocity ratio (E/A), deceleration times (DT), left ventricular isovolumetric relaxation times (IVRT) were measured at the lateral, medial, anterior, and posterior corners at the mitral annulus by activating TDE mode in the transthoracic and transoesophageal apical four‐ and two‐chamber view. Bland–Altman plots were used to compare the two measurement techniques. The differences between the groups were assessed by Mann–Whitney U test. All the data were expressed as mean ± SD. A P‐value of <0.05 was considered significant. Results: There were no significant differences between two techniques in terms of blood pressure and heart rate. Two techniques were compared for the transthoracic and transoesophageal TDE parameters. Bland–Altman analysis showed comparable values for E, A, E/A, S, and mE/E, although the measurements of DT and IVRT were different. Conclusion: PW tissue Doppler echocardiographic approach during TEE may be suitable for assessment of the left ventricular function.

Streptokinaz ile tedavi edilen akut miyokart infaktüsünde gelişen retroperitoneal hematom: Olgu sunumu

Retroperitoneal hematoma (RPH) is a potentially life threatening condition commonly associated with trauma, vascular lesions, surgical intervention and anticoagulant therapy which may occasionally be seen as an idiopathic presentation. Treatment of RPH is usually supportive, with only a minority of cases undergoing surgical intervention. A 78 year old female diagnosed with acute myocardial infarction (anterior) received streptokinase treatment. She had severe left side pain, back pain and thigh pain following streptokinase administration. Paresthesia and movement restriction developed in her left lower extremity. The patient reported no history of trauma, falling or anticoagulant use. CT was performed due to suspected intraabdominal hemorrhage, and a lesion consistent with hematoma was detected in the retroperitoneal area. Subsequently, anticoagulant medications were discontinued and the patient received erythrocyte suspension. Size of the hematoma was not increased in the follow-up abdominal USG. Upon regression of her clinical complaints and with stabile vital findings, the patient was discharged and scheduled for a control visit. We would like to report this case as streptokinase related RPH cases are rare in the literature. Key Words: Retroperitoneal hematoma, streptokinase

Ailesel hiperkolesterolemi ile birlikte diffüz asendan aorta ve sol ana koroner arter tutulumu: Olgu Sunumu

Familial hypercholesterolemia (FH) is an inherited genetic disorder leading to increased plasma LDL levels due to defects in LDL-cholesterol metabolism. Atherosclerosis occurs early due to the high serum lipid levels and inability to eliminate LDL-cholesterol from circulation. This results in coronary artery disease and atherosclerotic aorta at early age. Atheromatous alterations in aortic root lead to coronary osteal lesions and irregularities in the inner aortic wall. We present an FH case with extensive involvement of ascending aorta with coronary ostial lesion. Keywords: Familial hypercholesterolemia, left main coronary artery

Assessment of aortic elasticity and its relation with left ventricular filling and diastolic parameters by transthoracic and transesophageal echocardiography

Ozet Background: There are limited data comparing aortic dimensions and elastic properties between transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE). Therefore, we aimed to investigate aortic dimensions and indices of aortic elastic properties as well as their relation with left ventricular (LV) filling and diastolic parameters obtained from TTE and TEE. Method: Forty two patients were included in the study. Aortic dimensions and related elasticity parameters, LV filling and diastolic parameters, left atrial volume index (LAVi), LV mass index were calculated from TTE and TEE recordings in all patients. The correlation analyses were performed for aortic elasticity indices and LV filling and diastolic parameters obtained from TTE and TEE. Results: There were no significant differences in aortic dimensions and elasticity indexes obtained from TTE and TEE. The correlation analysis r evealed that while age E/A, E/E` and LAVi were significantly correlated with aortic elasticity indexes obtained from both TTE and TEE, LV mass index was significantly correlated with only TEE aortic elasticity indices. Conclusion: When compared to TTE, aortic elastic properties obtained from TEE were more closely related with LV filling and diastolic parameters. In addition, the indexes of aortic function were comparable between TEE and TTE with good intra and interobserver variability. Amac: Aort boyutlar ve elastik ozelliklerini transtorasik ekokardiyografi (TTE) ve transozofageal ekokardiyografi