L. Sahiner

Tissue Doppler echocardiography can be a useful technique to evaluate atrial conduction time

BACKGROUND The main purpose of this study is to determine the correlation of inter- and intraatrial conduction times between the electrophysiological and tissue Doppler echocardiographic measurements, and to evaluate the appropriateness of tissue Doppler echocardiography for this measurement. METHODS One-hundred and one patients were included in the study who underwent electrophysiological study for clinical arrhythmias. Inter- and intraatrial conduction times were measured from intracardiac electrograms. Atrial conduction times were also measured by tissue Doppler echocardiography by evaluating atrial electromechanical delay between lateral mitral annulus, septal mitral annulus, and right ventricular tricuspid annulus. The correlation between electrophysiological and echocardiographic atrial conduction times were analyzed. RESULTS We found a weak correlation between the measurements of interatrial conduction times with the electrophysiological and tissue Doppler techniques (r = 0.308; p = 0.002). The correlation for intraleft atrial conduction times was moderate (r = 0.652; p 〈 0.001). There was no correlation between the measurements of intra-right atrial conduction times. CONCLUSIONS We concluded that tissue Doppler echocardiography can be used for the measurement of interatrial and intra-left atrial conduction times. Tissue Doppler echocardiography can be a suitable technique to evaluate atrial substrate.

Left and Right Ventricular Function Is Impaired in Behcet's Disease

Objectives: Subclinical cardiac involvement may occur in patients with Behçets disease (BD). The purpose of our study was to assess the noninvasive parameters of biventricular function derived from Doppler tissue imaging (DTI) of the tricuspid and mitral annular motion in BD. Methods: Twenty‐one patients with BD and 20 control subjects were enrolled in this study. All subjects were selected to exclude those with cardiovascular risk factors. Standard echocardiography and pulsed DTI were obtained in every patient. Results: Peak systolic (13.71 ± 2.09 vs 20.01 ± 1.57, P < 0.001), peak early diastolic (11.26 ± 2.52 vs 15.35 ± 2.06, P < 0.001) tricuspid annular velocities were significantly lower in patients than controls. Peak systolic (8.68 ± 1.4 vs 12.25 ± 1.7, P < 0.001), peak early diastolic (7.89 ± 1.07 vs 9.94 ± 1.12, P < 0.001), and peak end diastolic (8.30 ± 1.32 vs 9.23 ± 0.91, P = 0.013) lateral mitral annular velocities were significantly lower in patients than controls. Conclusions: We demonstrated that myocardial velocities, were affected in patients with BD. Therefore, we conclude that right and left ventricular function is impaired in patients with BD.

Coronary Artery Bypass Grafting Is Associated with a Significant Worsening of QT Dynamicity and Heart Rate Variability

Background: Imbalance in autonomic nervous system and impaired myocardial repolarization has been shown to increase the risk for arrhythmias in patients with coronary artery disease. This study evaluated the effects of coronary artery bypass grafting (CABG) on heart rate variability and QT interval dynamicity in subjects with coronary artery disease undergoing elective CABG surgery. Methods: The study group consisted of 68 consecutive patients (mean age ±SD: 61 ± 9 years) with coronary artery disease who underwent elective CABG. Twenty-four-hour Holter monitoring was performed 2–5 days before cardiac surgery and was repeated 10 days after CABG. ELATEC holter software was used to calculate heart rate variability and QT dynamicity parameters. All subjects had a complete history, laboratory examination and transthoracic echocardiography. Results: All patients had beta-blocking agent medication pre- and postoperatively. Standard deviation of all NN intervals for a selected time period, square root of the mean of the sum of the squares of differences between adjacent RR intervals, the proportion of differences in successive NN intervals greater than 50 ms, normalized low-frequency power, and normalized high-frequency power were significantly decreased after CABG surgery, whereas low-frequency/high-frequency ratio was significantly increased after CABG. QT/RR slopes over 24 h were significantly increased after CABG surgery for QT end and QT apex (QTapex/RR: 0.16 ± 0.13 vs. 0.28 ± 0.19, p < 0.001; QTend/RR: 0.18 ± 0.13 vs. 0.36 ± 0.23, p < 0.001). Conclusion: This prospective study showed for the first time that CABG was associated with a significant worsening of heart rate variability and QT dynamicity parameters in the postoperative period.

Fenofibrate improves endothelial function and decreases thrombin-activatable fibrinolysis inhibitor concentration in metabolic syndrome

Procoagulant state, inflammation, and endothelial dysfunction have been documented in metabolic syndrome. Endothelial dysfunction is a strong predictor of cardiovascular events. Studies on the association of thrombin-activatable fibrinolysis inhibitor and thrombosis are still controversial, but substantial evidence suggests that increased thrombin-activatable fibrinolysis inhibitor or thrombin-activatable fibrinolysis inhibits or protects against arterial thrombosis. This study aimed to assess concomitantly the effects of fenofibrate therapy on thrombin-activatable fibrinolysis inhibitor concentrations and endothelial functions in patients with metabolic syndrome. Twenty-five patients (16 women; mean age 50.4 ± 7.0) were enrolled in the study. Plasma thrombin-activatable fibrinolysis inhibitor, C-reactive protein, and fibrinogen levels were measured before fenofibrate administration and after 8 weeks of fenofibrate treatment. Endothelial function was assessed by endothelial-dependent flow-mediated dilatation from brachial artery. Pretreatment (baseline) thrombin-activatable fibrinolysis inhibitor level was 52.3 (1.2–119.7) decreasing to 7.7 (0.9–51.2; P < 0.001) after 8 weeks of fibrate treatment. Endothelial functions, which were measured with flow-mediated dilatation, were significantly improved after treatment (mean flow-mediated dilatation was 6.76 ± 2.21 at baseline and 10.66 ± 1.17% after 8 week of fenofibrate treatment, P < 0.001). Fenofibrate decreases thrombin-activatable fibrinolysis inhibitor levels and improves endothelial function in metabolic syndrome and, thus, suggests a potential for protection against cardiovascular effects. Further studies are warranted to confirm the effects of fibrates on thrombin-activatable fibrinolysis inhibitor and for conclusive evidence on the association between thrombin-activatable fibrinolysis inhibitor and thrombosis.

Cardiac Autoantibody Levels Predict Recurrence Following Cryoballoon-Based Pulmonary Vein Isolation in Paroxysmal Atrial Fibrillation Patients.

Recent evidence has suggested that autoantibodies may play an important role in the development of atrial fibrillation (AF). The predictive value of preprocedural autoantibodies against beta‐1 adrenergic receptor (anti‐β1‐R) and M2‐muscarinic acetylcholine receptor (anti‐M2‐R) for AF recurrence following cryoballoon‐based pulmonary vein isolation (PVI) is still unclear. We aimed to determine the predictive value of preprocedural anti‐β1‐R and anti‐M2‐R levels for AF recurrence.

Epicardial Fat Thickness is Increased in Vitamin D Deficient Premenopausal Women and does not Decrease after Short-term Replacement

AIM Vitamin D deficiency, which is prevalent among young women in Middle Eastern populations, has been linked to cardiovascular disease. Epicardial adipose tissue (EAT) has also been found to be associated with coronary artery disease. However, data on the relationship between vitamin D status and epicardial adiposity is limited. This study aims to investigate the effect of vitamin D deficiency and replacement therapy on EAT thickness in healthy, young premenopausal women. METHODS Thirty-one premenopausal women with vitamin D deficiency and 31 age-matched women with normal vitamin D levels were enrolled in this study. EAT thickness was measured echocardiographically. Measurements were performed at baseline in both groups and were repeated at the 6-month follow-up in vitamin D deficient subjects after vitamin D replacement therapy. RESULTS The baseline plasma 25-hydroxyvitamin D levels were lower in the vitamin D deficient group compared to the control group and were significantly improved following replacement therapy. EAT thickness was significantly higher in the vitamin D deficient group, and no significant change occurred following replacement therapy. In the linear regression analysis, waist circumference (β=0.031 [0.005-0.057], p=0.020) and 25(OH)D level (β=－0.020 [(－0.028)－(－0.013)], p＜0.001) independently correlated with EAT thickness. CONCLUSION Vitamin D deficiency is associated with a significant increase in EAT thickness in premenopausal women; however, a net beneficial response to adequate replacement therapy was not observed during the short period of therapy during our study. Longer periods of replacement therapy and follow-up may be useful to demonstrate the potential beneficial effects of vitamin D replacement on epicardial adiposity.

Percutaneous coronary sinus interventions to facilitate implantation of left ventricular lead: a case series and review of literature.

BACKGROUND Valves, stenosis, and occlusion in the coronary sinus (CS) may affect the success of left ventricular (LV) lead implantation in cardiac resynchronization therapy (CRT). We present our experience in percutaneous CS intervention (PCSI) to facilitate LV lead implantation and stabilization. METHODS AND RESULTS Transvenous LV lead implantation was attempted for CRT in a total of 255 patients (mean age 61.0 ± 12.5 y; 60 female, 160 ischemic etiologies) from January 2005 to November 2010. Seventeen patients (6.7%) needed PCSI. PCSI indications were stenosis in 10 patients, CS valve in 5 patients, chronic venous occlusion in 1 patient, and LV lead stabilization in 1 patient. CS angioplasty was performed in 16 patients (6.2%) and stenting in 3 patients (1.2%) to facilitate LV lead placement. Two patients needed both balloon angioplasty and stenting. LV leads were successfully inserted in 15/17 (88.2%) of the patients who needed PCSI. There were no complications related to PCSI. The overall success rate of LV lead implantation increased from 238/255 (93.3%) to 253/255 (99.2%) with the use of PCSI. CONCLUSIONS PCSI is a useful and safe technique in transvenous LV lead placement in case of CS stenosis, valves, and lead instability.

Prolonged Tp-e interval and Tp-e/QT correlates well with modified Rodnan skin severity score in patients with systemic sclerosis

BACKGROUND Ventricular arrhythmias can be seen in systemic sclerosis (SSc) patients and are thought to be a result of fibrosis or ischemia of the ventricular myocardium. Tp-e interval and Tp-e/QT ratio are electrocardiographic (ECG) indices to predict ventricular tachyarrhythmia and cardiovascular mortality. We aimed to evaluate Tp-e interval and Tp-e/QT ratio in patients with SSc. METHODS A total of 107 patients with SSc (mean age, 48.6 ± 14.0 years; 96 females) and 100 healthy controls (mean age, 49.4 ± 8.6 years; 90 females) were enrolled. The standard 12-lead ECG was recorded; QTc, Tp-e interval and Tp-e/QT ratio were measured. Modified Rodnan skin severity score (MR-SSS) calculated for all SSc patients. RESULTS Tp-e interval (90.7 ± 23.8 ms vs. 84.0 ± 20.6 ms, p = 0.032) and Tp-e/QT ratio (0.20 ± 0.05 vs. 0.18 ± 0.04, p = 0.007, respectively) were significantly prolonged in SSc patients than in the control group. Pearsons correlation analyses revealed positive correlations of MR-SSS with QTc (r = 0.427, p = 0.001), Tp-e interval (r = 0.620, p = 0.001) and Tp-e/ /QT ratio (r = 0.615, p = 0.001). MR-SSS (b = 2.108, p = 0.001) and CRP (b = 2.273, p = 0.027) were found to be significant independent predictors of Tp-e interval. Similarly, MR-SSS (b = 0.004, p = 0.001) was only a significant independent predictor of Tp-e/QT ratio among patients with SSc. CONCLUSIONS The patients with SSc had a prolonged Tp-e interval and Tp-e/QT ratio compared with normal subjects. Furthermore, this prolongation was well correlated with clinical severity score among patients with SSc. Ventricular repolarization dispersion as a predictor of ventricular arrhythmias was found to be diminished in patients with SSc. Patients with SSc, particularly with higher MR-SSS, should be followed closely for adverse cardiovascular outcomes.

Impact of scanning direction on heart rate at certain levels of heart in electrocardiogram-gated 16-multidetector computed tomography angiography of coronary artery bypass grafts.

Objective: To assess impact of scanning direction on heart rates at certain levels of heart in electrocardiogram-gated 16-multidetector computed tomography (MDCT) detection of coronary artery bypass grafts and native coronary arteries. Methods: Ninety patients with 219 grafts were studied by 16-MDCT. Forty-five patients were scanned craniocaudally. The remaining 45 patients were scanned caudocranially. Heart rates at each level were noted and compared between the 2 groups. Results: The difference between mean heart rates of craniocaudal and caudocranial groups was found to be statistically significant at midcardiac, internal mammary artery origin, and cardiac base levels (P < 0.05). For the remaining levels, there was no statistically significant difference in mean heart rates. Conclusions: Performing electrocardiogram-gated 16-MDCT angiography for the evaluation of coronary arteries and bypass grafts in caudocranial direction provides lower heart rate at midcardiac and cardiac base levels of the heart, which are more prone to motion artifacts.

Impaired ventricular electrical stability and sympathetic hyperactivity in patients with multivessel coronary artery disease.

ObjectivesThe extent of atherosclerotic disease is identified as one of the most important predictors of long-term cardiac events in patients with coronary artery disease. Heart rate variability and QT dynamicity have been used as independent predictors for sudden death in coronary artery disease. Heart rate variability and QT dynamicity, however, have never been investigated in multivessel coronary artery disease. The aim of this study was to identify autonomic nervous system activity and ventricular vulnerability in multivessel coronary artery disease. MethodsWe examined 204 patients who underwent coronary angiography. According to the number of the three major coronary vessels with significant stenosis (>70%), we divided the patients into three groups: normal coronary arteries (n=61), single-vessel coronary artery disease (n=53) and the multivessel coronary artery disease (n=90). Twenty-four-hour ambulatory electrocardiographic recording was performed by a three-channel recorder. Heart rate variability and QT dynamicity parameters were obtained by ELA TEC software. ResultsBaseline characteristics were similar in multivessel coronary artery disease, single-vessel coronary artery disease and controls. SDNN (90±35, 117±52, 134±53, respectively; P<0.001) and HFnu (9.6±8.2, 8.9±3.7, 12.2±7.4, respectively; P=0.011) were significantly lower, whereas LFnu (27.2±11.3, 26.1±8.4, 22.0±13.4, respectively; P=0.014) and LF/HF ratio (4.4±3.2, 3.3±1.4, 2.1±1.6, respectively; P<0.001) were significantly higher in multivessel coronary artery disease. QTend/RR and QTapex/RR slopes were more significantly increased in multivessel coronary artery disease than in single-vessel coronary artery disease and control participants [QTend/RR: 0.15 (0.04–0.66), 0.12 (0.02–0.33), 0.12 (0.01–0.22), respectively; P=0.002; QTapex/RR: 0.16 (0.06–0.30), 0.12 (0.02–0.29), 0.11 (0.01–0.19), respectively; P<0.001]. ConclusionsHeart rate variability and QT dynamicity are impaired in patients with multivessel coronary artery disease. Our results may indicate that heart rate variability and QT dynamicity parameters can be useful noninvasive methods that may detect autonomic nervous system activity and ventricular vulnerability in multivessel coronary artery disease.