Kursat Tigen

Fragmented QRS complexes are associated with cardiac fibrosis and significant intraventricular systolic dyssynchrony in nonischemic dilated cardiomyopathy patients with a narrow QRS interval.

Background: Myocardial scar causes heterogeneous ventricular activation, which results in fragmentation of QRS complexes on ECG. Myocardial fibrosis in patients with nonischemic cardiomyopathy (NDCM) can be identified as late gadolinium enhancement (LGE) areas on cardiac magnetic resonance (CMR) studies. We investigated the association of fragmented QRS (fQRS) complexes with systolic dyssynchrony and myocardial fibrosis in patients with NDCM. Methods: Twenty patients with NDCM and sinus rhythm who had fQRS complexes were evaluated with CMR. The association of fQRS complexes with LGE and systolic dyssynchrony was investigated. Results: Nineteen patients had significant systolic dyssynchrony with echocardiography. Among 19 patients with significant dyssynchrony, 14 (74%) patients had fQRS complexes in the most delayed contracting segment or one of the dyssynchronous segments, whereas five patients (26%) had fQRS complexes in a lead which is discordant with the dyssynchronous segment on echocardiography. Seventeen patients had LGE in their CMR. Among the 17 patients with LGE; 13 patients (76%) had fQRS complexes concordant with LGE present segments. Conclusion: Fragmentation of QRS complexes on ECG is associated with intraventricular systolic dyssynchrony and subendocardial fibrosis in NDCM patients with a narrow QRS interval and sinus rhythm. (Echocardiography 2011;28:62‐68)

The Effect of Cardiac Fibrosis on Left Ventricular Remodeling, Diastolic Function, and N‐Terminal Pro‐B‐Type Natriuretic Peptide Levels in Patients with Nonischemic Dilated Cardiomyopathy

Background: Cardiac fibrosis is common and associated with poor prognosis in patients with heart failure. We investigated the effect of cardiac fibrosis on the left ventricular (LV) diastolic function, functional capacity, LV remodeling, and biochemical parameters in patients with nonischemic dilated cardiomyopathy (NIDC). In addition, we investigated the biochemical and echocardiographic predictors of cardiac fibrosis in this group. Methods and Results: Forty patients with NIDC were enrolled. Cardiac fibrosis was evaluated according to the presence of late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) imaging. Nineteen patients had cardiac fibrosis (Group I) and 21 patients did not have cardiac fibrosis (Group II). LV systolic and diastolic parameters were assessed with conventional and tissue Doppler echocardiography. N‐terminal pro‐B‐type natriuretic peptide (NT‐pro BNP) levels of each patient were recorded. Patients with cardiac fibrosis had impaired diastolic function, higher functional class and NT‐pro BNP levels, and significant LV remodeling than the patients without cardiac fibrosis. A correlation analysis revealed that the cardiac fibrosis severity was associated with functional class, cardiac chamber sizes, NT‐pro BNP levels, diastolic parameters such as E/Se. A linear regression analysis demonstrated that NT‐pro BNP and E/Se were the independent predictors of cardiac fibrosis. Conclusion: Cardiac fibrosis correlates with impaired LV diastolic function and functional capacity, elevated NT‐proBNP levels, and adverse cardiac remodeling in patients with NIDC. Therefore, the assessment of cardiac fibrosis can be useful in the management of these patients. (Echocardiography 2010;27:954‐960)

Left Ventricular and Atrial Functions in Hypertrophic Cardiomyopathy Patients with Very High LVOT Gradient: A Speckle Tracking Echocardiographic Study

Determination of myocardial deformation (strain) by two‐dimensional (2D) speckle tracking echocardiography (STE) is a new method for evaluating left ventricular (LV) regional function in patients with hypertrophic cardiomyopathy (HCM). The aim of this study was to assess LV and left atrial (LA) functions with 2DSTE in HCM patients and to investigate relation between strain analysis and LV outflow tract (LVOT) gradient.

The predictive value of flow-mediated dilation and carotid artery intima-media thickness for occult coronary artery disease.

Background: Multidetector row computed tomography (MDCT) is an attractive noninvasive alternative to assess overall coronary artery disease (CAD) burden and may reveal coronary plaques, which may be underestimated by conventional coronary angiography. The aim of this study was to determine whether brachial artery flow‐mediated dilation (FMD) and carotid artery intima‐media thickness (CIMT) might accurately predict patients with occult coronary plaques whose conventional coronary angiographies revealed normal coronary arteries (NCA). Methods: Thirty‐five patients with angiographically NCA were consecutively recruited into the study. They underwent MDCT and were divided into NCA group (18 patients; 8 male; 47 ± 9 years) and occult CAD group (17 patients; 11 male; 50 ± 10 years) according to presence of coronary plaque. Nineteen consecutive patients with evident CAD (16 male; 54 ± 7 years) and 19 healthy subjects (10 male; 50 ± 6 years) were included as control groups. FMD and CIMT were measured by brachial and carotid artery ultrasonography. Results: Occult CAD group had significantly lower FMD and insignificantly higher CIMT than NCA group whereas they had significantly higher FMD and insignificantly lower CIMT than evident CAD group. NCA group had significantly lower CIMT than evident CAD group. Receiver operating characteristic curve analysis demonstrated FMD < 8% (sensitivity: 94.4%; specificity: 73.0%; PPV: 77.3%; NPV: 93.1%) and CIMT ≥ 0.65 cm (sensitivity: 72.2%; specificity: 62.2%; PPV: 65.0%; NPV: 69.7%) could predict patients with CAD. FMD and CIMT were independent predictors of CAD (P < 0.001; OR: 45.630; 95%CI: 5.38–386.983 and P = 0.015; OR: 14.226; 95%CI: 1.666–121.467, respectively). Conclusion: FMD and CIMT might predict patients with occult CAD and be helpful in selecting patients for MDCT. (Echocardiography 2011;28:1141‐1147)

Time Course of Right Ventricular Remodeling after Percutaneous Atrial Septal Defect Closure: Assessment of Regional Deformation Properties with Two‐Dimensional Strain and Strain Rate Imaging

Background: Quantitative assessment of the right ventricular (RV) function in atrial septal defect (ASD) patients before and after closure remains difficult. The aim of this study was to assess the regional RV function in ASD patients, to evaluate the extent and time course of RV remodeling following ASD closure, and to investigate whether any regional difference exists in RV remodeling. Methods: Twenty patients with ASD and 20 age‐matched controls were included. All underwent standard echocardiography and two‐dimensional strain (S) and strain rate (SR) imaging by speckle tracking before, and 24 hours and 1 month after the defect closure. Results: Right ventricular S was higher in ASD patients except apical lateral segment S, which was lower when compared with controls. There was no difference in RV SR between ASD patients and controls. RV septal S and SR, and lateral SR decreased in 24 hours after the procedure and remained the same at 1 month. RV lateral basal and mid S decreased and apical S increased in 24 hours after the closure. All 3 segments showed some more increase at 1 month. RV apical S showed strong correlations with systolic pulmonary artery pressure and global RV systolic function indices. Conclusions: Chronic volume overload in ASD patients causes alterations in RV deformation. Percutaneous closure results in rapid remodeling and normalization of RV deformation. The major geometrical and deformational changes are completed in 24 hours. Lateral wall S seems to reflect the RV deformational changes due to volume loading and unloading better than SR in ASD patients.

Biventricular Noncompaction: A Case Report

Myocardial noncompaction is an extremely uncommon cardiomyopathy. It can present as an isolated cardiac malformation or in association with other congenital anomalies. The left ventricle is usually affected, but a biventricular involvement rarely occurs. A predominant right ventricular involvement has not been reported. Here, we report an 18‐year‐old woman with biventricular noncompaction that predominantly involves the right ventricle.

Rosiglitazone, but Not Pioglitazone, Improves Myocardial Systolic Function in Type 2 Diabetic Patients: A Tissue Doppler Study

Objective: Despite many potential benefits, thiazolidinedione (TZD) use has been associated with increased exacerbation rate of heart failure due to fluid retention. In our study, the effect of rosiglitazone and pioglitazone on myocardial function in patients with type 2 diabetes mellitus (DM) and normal left ventricular systolic function was evaluated by both conventional echocardiography and tissue Doppler imaging (TDI). Methods: Forty patients who were diagnosed type 2 DM according to the American Diabetes Association criteria were included in the study. After baseline evaluation, all patients were randomly assigned to receive either rosiglitazone 4 mg twice daily or pioglitazone 30 mg daily for 4 months. Blood samples were taken and detailed pulsed‐wave and tissue Doppler echocardiographic examination was performed at baseline and 4 months after TZD therapy. Results: Left ventricular systolic velocity (Sm) values were found to be significantly increased in the rosiglitazone group (+2.6 ± 0.7 cm/sec, P < 0.0001), while they remained unchanged in the pioglitazone group. Left ventricular early diastolic velocity (Em) increased at the same extent in both groups after treatment (rosioglitazone: +0.7 ± 0.7 cm/sec; pioglitazone: +0.5 ± 0.4 cm/sec, P < 0.05). Conclusion: In conclusion, while rosiglitazone and pioglitazone therapy improved metabolic parameters, blood pressure values and diastolic function similarly, in type 2 diabetic patients, only rosiglitazone improved systolic myocardial function significantly. (Echocardiography 2010;27:512‐518)

Effect of Increased Severity of Mitral Regurgitation and Preprocedural Right Ventricular Systolic Dysfunction on Biventricular and Left Atrial Mechanical Functions Following Percutaneous Mitral Balloon Valvuloplasty

Severe mitral stenosis (MS) may impair left atrial (LA) pump function, and increase LA and pulmonary venous pressure resulting in right ventricular (RV) systolic dysfunction. The aim of this study was to evaluate biventricular and LA function after percutaneous mitral balloon valvuloplasty (PMBV) by tissue Doppler (TDI) and speckle tracking echocardiography (STE).

Giant Purulent Pericarditis with Cardiac Tamponade Due to Streptococcus intermedius Rapidly Progressing to Constriction

Purulent pericardial effusion, although rare, is a life‐threatening condition usually produced by the extension of a nearby bacterial infection locus or by blood dissemination in the immune‐suppressed subjects or in the course of cardiothoracic surgery. Because clinical features of purulent pericardial effusion are often nonspecific, it can cause delay in diagnosis. Therefore, a high index of suspicion is required for timely diagnosis and management. Herein, we describe a case of giant purulent pericardial effusion due to Streptococcus intermedius with the history of bronchiectasis and pneumonia, which was successfully treated with pericardiocentesis via parasternal approach, appropriate antibiotics, and pericardiectomy.

Two-Dimensional Strain and Strain Rate Imaging of the Left Atrium and Left Ventricle in Adult Patients with Atrial Septal Defects before and after the Later Stage of Percutaneous Device Closure

Atrial septal defect (ASD) causes chronic volume overload of the right heart. The potential adverse effects of this long‐standing volume overload to left atrium (LA) and left ventricle (LV) and their response to ASD closure has been poorly studied.