Huseyin Senocak

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.

Massive Pulmonary Embolism Complicated by a Patent Foramen Ovale with Straddling Thrombus: Report of a Case

We report a case of massive right pulmonary embolism with a patent foramen ovale and straddling thrombus, occurring a few days after cesarean section in a 31-year-old woman. Preoperatively, a mass was seen echocardiographically in four cardiac cavities. We performed emergency surgery because of the patients acute hemodynamic deterioration. Intraoperatively, we found a thrombus entrapped in the patent foramen ovale. Most of the thrombus was floating in the right atrium and a long end was found in the left atrium, in addition to the pulmonary emboli. We removed the thrombus, closed the patent foramen ovale by direct suturing, and performed pulmonary embolectomy. Histological examination confirmed thrombi. Doppler examination of the venous system did not reveal any possible source of the thrombus. The patient is now well and free from recurrence of embolic disease 1 year after surgery. We review the literature on this relatively unusual thromboembolic disease.

Tissue Doppler properties of the left atrial appendage in patients with mitral valve disease.

Objective: The purpose of this study was to compare the left atrial appendage (LAA) tissue Doppler imaging (TDI) with the classical LAA function parameters in patients with mitral valve disease. Methods: Twenty patients who had pure mitral regurgitation (group 1), 20 patients who had pure rheumatic mitral stenosis (group 2), and 20 healthy patients (group 3) were included in this study. All the cases were sinus rhythm. In order to determine the LAA functions, LAA late filling (LAALF), and late emptying (LAALE) flow velocities and LAA fractional area change (LAAFAC) were measured. LAA tissue Doppler evaluations were obtained from the PW Doppler, which was placed on the LAA lateral wall in a transverse basal short‐axis approach. LAA late systolic (LAALSW) and late diastolic (LAALDW) wave velocities were obtained from TDI records transesophageal echocardiography (TEE). Results: There were no significant differences among groups 1, 2, and 3 in terms of age, left ventricular (LV) ejection fraction, gender, and heart rate. No differences were observed between group 1 and the control group with respect to LAALE, LAALF, and LAAFAC. LAALE velocity and LAAFAC were significantly decreased in group 2 than group 1. LV diastolic diameter was significantly greater, whereas LAALSW and LAALDW velocities were significantly decreased in group 1 compared with group 3. There were no differences between groups 1 and 2 regarding to LAALSW and LAALDW velocities. LAALE, LAALF, LAALSW, LAALDW velocities, and LAAFAC were significantly decreased in group 2 than group 3. Conclusion: The TDI method may detect the LAA systolic dysfunctions, which cannot be detected using classical methods, on tissue level in patients with mitral regurgitation. In addition, the deterioration of the LAA functions at tissue level in patients with rheumatic mitral stenosis was also detected. (ECHOCARDIOGRAPHY, Volume 21, May 2004)

Treatment and control of hypertension in Turkish population: a survey on high blood pressure in primary care (the TURKSAHA study)

Although the management and the control rates of hypertension are generally low throughout the world, there are substantial differences between the countries. The aim of this study was to determine the control rate of blood pressure and the characteristics of the patients who have been admitted to primary care units in Turkey. Our study included 16 270 patients aged above 18 years who were diagnosed as hypertensive in representative nationwide sample of 1000 primary care units in Turkey. The mean age of the patients was 60±11 years (60.1% women). Of 16 270 patients, 15 187 (93.3%) were on an antihypertensive treatment, whereas 1083 (6.7%) were receiving no treatment. The patients who were women, diabetic, smoker, obese, and those who had a concomitant cardiovascular disease (CVD) had a higher rate of antihypertensive treatment. Of 15 187 treated patients, 4912 (30.2%) had a controlled systolic blood pressure, 7063 (43.4%) a controlled diastolic blood pressure, and in 3931 (24.2%), both were under control. A logistic regression analysis demonstrated that age (OR 1.33), diabetes (OR 4.96), body mass index (OR 1.41) and the presence of a CVD (OR 1.19) were predictors for blood pressure being under control. The blood pressure control rates ranged between 16.6 and 30.5% among seven geographical regions. In the primary care units in Turkey, the blood pressure control rate is consistently low in treated hypertensive patients. In addition, there are differences between the geographical regions in both the proportion of those receiving medications and the blood pressure control rates.

A Rare Congenital Anomaly: Biatrial Appendage Aneurysm with Atrial and Ventricular Septal Defect

Atrial appendage aneurysms are extremely rare entities in cardiology practice. There are reports of solitary left and right atrial appendage aneurysms in the literature. A case of biatrial appendages aneurysms is reported here. This is the first report of such an anomaly.

Strain and Strain Rate Imaging in Evaluating Left Atrial Appendage Function by Transesophageal Echocardiography

Background: This study was planned to assess whether strain rate (Sr) and strain (S) echocardiography is a useful method for functional assessment of the left atrial appendage (LAA). Material and Methods: Fifty‐seven consecutive patients underwent a clinically indicated study. LAA late empty velocity (LAAEV) was calculated as a gold standard for left atrial appendage function. Real‐time 2‐dimensional color Doppler myocardial imaging data were recorded from the LAA at a high frame rate. Analysis was performed for LAA longitudinal strain rate and strain from midsegment of lateral wall of LAA. LAA strain determines regional lengthening expressed as a positive value or shortening expressed as a negative value. Peak systolic values were calculated from the extracted curve. Results: Spearman correlation test results showed a statistically significant positive correlation was between the S, Sr variables and LAAEV (LAAEV vs S; r = 0.886, P < 0.001; LAAEV vs Sr: r = 0.897, P < 0.001, respectively). Strain and strain rate values were also significantly lower in patients with spontaneous echocardiographic contrast when compared with those without (strain; 2.42 ± 0.98 vs 13.1 ± 5.9, P < 0.001 and strain rate: 0.97 ± 0.54 vs 3.34 ± 1.15, P < 0.001, respectively). In addition, LAA strain and strain rate values were significantly lower in the patients with LAA thrombus (strain; 2.15 ± 0.96 vs 8.35 ± 6.9, P < 0.001, strain rate; 0.79 ± 0.46 vs 2.30 ± 1.48, P < 0.001, respectively). Conclusion: S and Sr imaging can be considered a robust technique for the assessment of the LAA systolic deformation.

Evaluation of left ventricular function with strain/strain rate imaging in patients with rheumatic mitral stenosis

OBJECTIVE The most important sequel of acute rheumatic fever is mitral stenosis in long-term. The aim of the study is to determine left ventricular (LV) functions by tissue Doppler imaging (TDI) and strain/strain rate echocardiography (SE/SRE) in mitral stenosis patients who had no clinical signs of heart failure. METHODS Our study was designed as cross-sectional study. The study population consisted of 32 patients with isolated mitral stenosis and mitral valve area = 2.0 cm(2) (Group 1) and 25 healthy control subjects (Group 2). In addition to standard echocardiographic methods, TDI and SE/SRE were performed to assess LV functions in all participants. Students t-test was used to compare continuous variables. Fisher- exact test was used to compare categorical variables. RESULTS Systolic myocardial velocity (Sm) were significantly lower in Group 1 than in Group 2 (6.0+/-1.4 cm/sec vs 7.9+/-1.8 cm/sec, p=0.001) also, early diastolic myocardial velocity (Em) were significantly lower in Group 1 than in Group 2 (4.4+/-1.5 cm/sec vs 10.8+/-2.1 cm/sec, p=0.001). But there was no significant difference in late diastolic myocardial velocity (Am) between two groups. Peak systolic strain and strain rate of septal wall in Group 1 were significantly lower than Group 2 (p=0.001 for both). Besides, peak systolic strain and strain rate of lateral wall in Group 1 were significantly lower than in Group 2 (p=0.001 for both). CONCLUSION Although, global ejection fraction was normal and there were no symptoms of heart failure clinically in the patients with mitral stenosis, LV dysfunction demonstrated that using by echocardiography. TDI and strain/strain rate imaging to be new echocardiographic methods may be used reliably for detection LV function in early stage of mitral stenosis.

The Use of Anatomic M‐Mode Echocardiography to Determine the Left Atrial Appendage Functions in Patients with Sinus Rhythm

Left atrial appendage (LAA) contractile dysfunction is associated with thrombus formation and systemic embolism. LAA function is determined by its flow velocities and fractional area change. This study was performed in order to determine the LAA functions with the anatomic M‐mode echocardiography (AMME). Our study comprised 74 patients who had sinus rhythm and underwent transesophageal echocardiography (TEE) for various reasons. LAA fractional change (LAAFAC) was measured by manual planimetry in a transverse basal short‐axis approach and LAA emptying and filling velocities also were measured. The AMME values were determined by an M‐mode cross section from a cursor placed beneath the orifice of the LAA in transverse basal short‐axis imaging. From these values LAA fractional shortening (LAAFS) and ejection fraction (LAAEF) were calculated. LAAEF was calculated by the Teicholz method. The comparisons were conducted, and no correlations between the LAA late filling and the anatomic M‐mode values were found (for LAAFS r = 0.18; P > 0.05 and for LAAEF r = 0.19; P > 0.05). There were significant but poor correlations among the LAA late emptying with the anatomic M‐mode measurements (for LAAFS r = 0.26; P < 0.05 and for LAAEF r = 0.30; P < 0.01), whereas, there were significant and good correlations between the LAAFAC and the anatomic M‐mode values (for LAAFS r = 0.75; P < 0.01 and for LAAEF r = 0.78; P < 0.01). There were significant differences between the valvular heart disease group and the normal group, and between the valvular heart disease group and the ASD group (for LAAFAC P < 0.01, for LAAEF P < 0.01, for LAAFS P < 0.01). There was no difference between the normal group and the ASD group. Our study showed that the LAAEF and LAAFS in patients with sinus rhythm obtained via anatomical M‐mode echocardiography is a new method, which can be used instead of left atrial appendage area change.

Assessment of the regional myocardial deformation changes and viability in anterior acute myocardial infarction patients by strain and strain rate imaging.

OBJECTIVE To prospectively evaluate the regional myocardial deformation changes and viability in anterior acute myocardial infarction (AMI) patients before and after primary coronary intervention (PCI) by strain (S)/strain rate (Sr) imaging. METHODS Twenty-one patients presented during the first six hours of an anterior AMI and twenty controls were included in this study. Echocardiographic recordings were obtained from the apical/parasternal images just before PCI, one week and one month after PCI. The S/Sr and velocity (V) were measured from the basal mid and apical segments of the walls supplied by the left anterior descending artery. Myocardial perfusion scintigraphy was performed in the 1st month after PCI. Mann-Whitney U and Wilcoxon tests were used for statistical analysis. RESULTS Acute myocardial infarction resulted in the reduction of deformation indices (S/Sr/V) in all segments. Deformation indices were increased after successful PCI. The S/Sr values of the normal and ischemic segments after PCI were higher compared to the baseline (ischemic Sr:-1.3 ± 0.3 vs. -1.1 ± 0.3, p=0.04). No difference was noted in the S/Sr values of the necrotic segments during the first week (Sr:-1.1 ± 0.3 vs. -1.0 ± 0.3, p=0.054). For V measurements, no difference was observed between the viability types at the follow-up measurements (p ≤ 0.05). CONCLUSION The remedial effect of PCI on the deformation values was observed in the first week and continued during the first month. In the early reperfusion period, S/Sr indices have the potential to differentiate necrotic tissue from other viability types. Strain/Strain rate imaging can be used for determination of myocardial deformation changes and parameters of viability. However, V values were insufficient.

Association between factor V Leiden mutation and coronary artery disease in the northeast region of Turkey.

Factor V Leiden (FVL) has recently been described as a genetic factor with a propensity towards venous thromboembolism; however, it is thought to have a doubtful role in coronary artery disease (CAD). This study aimed to investigate whether FVL is one of the risk factors for CAD in north-east Turkey. Seventy-five patients with angiographically documented CAD and 78 individuals without angiographically documented CAD were studied to examine the association of the frequency of the FVL mutation with CAD and control individuals. Blood samples from the patients and controls were analyzed for the FVL mutation by DNA analysis, using the polymerase chain reaction–sequence-specific primers method. FVL mutation was found in eight of 75 (10%) patients with CAD and was totally absent in control individuals (P = 0.001). There were no significant differences in terms of diabetes mellitus, hypertension, dyslipidemia, plasma fibrinogen level, smoking, gender and family history of CAD with and without the FVL mutation in the patient group. The results of this study suggest that FVL mutation may be one of the important risk factors in developing CAD in northeast Turkey.