Gülhanım Kırış

Relationship between epicardial fat tissue and left ventricular synchronicity: An observational study

Objective: Left ventricular (LV) systolic synchrony is defined as simultaneous activation of corresponding cardiac segments. Impaired synchrony has some adverse cardiovascular effects, such as LV dysfunction and impaired prognosis. Epicardial fat tissue (EFT) is visceral fat around the heart. Increased EFT thickness is associated with some disorders, such as LV dysfunction and hypertrophy, which play a role in the impairment of LV synchrony. However, the relationship between EFT and LV systolic synchrony has never been assessed. Thus, we aimed to evaluate the possible relationship between EFT and LV synchrony in this study. Methods: The study population consisted of 55 consecutive patients (mean age 46.4±13.4 years, 32 female) without bundle branch block (BBB). EFT and LV systolic synchrony were evaluated by transthoracic echocardiography using 2D and tissue Doppler imaging. Maximal difference (Ts-6) and standard deviation (Ts-SD-6) of time to peak systolic (Ts) myocardial tissue velocity obtained from 6 LV basal segments were used to assess LV synchrony. Multiple regression analysis was used to detect the independently related factors to LV synchrony. Results: The mean values of EFT thickness, Ts-6, and Ts-SD-6 were found to be 2.7±1.6 mm (ranging from 1-7 mm), 20.1±14.2 msec, and 7.7±5.6, respectively. EFT thickness also was independently associated with Ts-6 (β =0.332, p=0.01) and Ts-SD-6 (β =0.286, p=0.04). Conclusion: EFT thickness is associated with LV systolic synchrony in patients without BBB.

Relationship between Nitrate-Induced Headache and Coronary Artery Lesion Complexity.

Objective: The aim of the present study was to investigate the association between nitrate-induced headache (NIH) and the complexity of coronary artery lesions in patients with stable coronary artery disease (CAD). Subjects and Methods: Two hundred and seventy-five patients with anginal chest pain who underwent coronary angiography were enrolled in the present study. NIH was defined as the presence of headache due to nitrate treatment (isosorbide mononitrate 40 mg) after excluding confounding factors. Coronary artery lesion complexity was assessed by the SYNTAX score (SXscore) using a dedicated computer software system. Results: The mean SXscore was lower in the patients with NIH than in patients without NIH (7.3 ± 5.2 vs. 14.4 ± 8.5, respectively; p < 0.001). Additionally, patients with NIH had a lower rate of multivessel disease compared with those without NIH (the mean number of diseased vessels was 1.5 ± 0.7 and 2.0 ± 07, respectively; p < 0.001). In multivariate analysis, increasing age (p = 0.02) and headache (p = 0.001) were found to be independent determinants of SXscore. Conclusion: The present study demonstrated an independent inverse association between NIH and SXscore. The NIH could provide important predictive information about coronary artery lesion complexity in patients with stable CAD.

The relationship between epicardial fat tissue thickness and frequent ventricular premature beats

BACKGROUND Ventricular premature beats (VPBs) are one of the most common rhythm abnormalities. Structural heart diseases such as myocardial hypertrophy and left ventricular dysfunction are associated with VPBs. However, the exact mechanism of VPBs in patients without structural heart disease has not been revealed yet. Epicardial fat tissue (EFT) is a visceral fat around the heart. Increased EFT thickness is associated with myocardial structural and ultrastructural myocardial abnormalities, which may play a role in the development of VPBs. AIMS To evaluate the possible relationship between EFT thickness and frequent VPBs. METHODS AND RESULTS The study population consisted of 50 patients with VPBs and 50 control subjects. Frequent VPBs were defined as the presence of more than 10 beats per hour assessed by 24-h Holter electrocardiography monitoring. EFT thickness was measured by transthoracic echocardiography. Multivariable logistic regression analysis was used to assess factors related with frequent VPBs. Baseline demographic and biochemical features including age, gender, and rates of hypertension and diabetes mellitus were similar in both groups. EFT thickness was significantly higher in patients with frequent VPBs than in controls (3.3 ± 1.3 mm vs. 2.2 ± 0.8 mm, p < 0.001). In multivariable logistic regression analysis, EFT thickness was independently associated with VPB frequency (B = 1.030, OR = 2.802, p < 0.001). CONCLUSIONS Patients with frequent VPBs had increased EFT thickness compared to control subjects. EFT thickness was independently associated with frequent VPBs.

Multiple cardiac myxomas originating in mitral apparatus

A 20-year-old male patient was admitted to our hospital for intermittent attacks of shortness of breath and palpitations. He and his family had no notable cardiac disease in their medical history. There was no remarkable finding on his physical examination. An electrocardiogram revealed a normal sinus rhythm without abnormalities. Transthoracic echocardiography (TTE) showed normal left ventricular function and a mobile left atrial mass arising out of the anterior mitral leaflet (Figure A). Then, transesophageal echocardiography (TEE) revealed two different well-circumscribed masses originating in the mitral anterior leaflet (2.8x1.8 cm) and mitral annulus (1.2x1.1 cm) (Figure B, Video 1*). Careful examination of all cardiac chambers by TEE revealed no additional mass in the heart. The patient was examined for pigmented skin lesions, testes tumors, adrenal cortical disease and cutaneous myxomas. No findings were detected to support a diagnosis of Carney syndrome. Surgery confirmed the echocardiographic findings and the masses were excised (Figure C). The diagnosis of cardiac myxoma was confirmed by pathological evaluation. The patient was discharged on the seventh postoperative day without complications. Cardiac myxomas usually originate in the interatrial septum and those originating in the mitral apparatus are extremely rare. In this report, we present multiple myxomas arising from the mitral apparatus. 119