Yekta Gurlertop

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)

ST segment elevation in leads V1 to V3 due to isolated right ventricular branch occlusion during primary right coronary angioplasty

It is rare to observe ST elevation in anterior derivations caused by isolated right ventricular branch occlusion. We described the case with acute inferior and right ventricular myocardial infarction (MI) who developed ST segment elevation in precordial leads V1 to V3 due to isolated right ventricular branch occlusion during primary right coronary angioplasty. Catheter Cardiovasc Interv 2003;60:32–35.

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.

Left Ventricular Outflow Tract Myxoma

This article reports a left ventricular outflow tract (LVOT) myxoma, presenting with peripheral embolus, in a 90-year-old patient during the follow-up due to ischemic heart disease. Among LVOT myxomas, which are usually very rare and most likely to present with manifestations due to obstruction, this is the first case presenting with peripheral embolus. In this study, diagnosis was based on the histopathological evaluation of the embolectomy material. The report emphasizes the importance of evaluation of the embolectomy material in appropriate patients who present with peripheral emboli, and where an intracardiac mass is suspected.

The Effect of Pulmonary Hypertension on Left Ventricular Diastolic Function in Chronic Obstructive Lung Disease: A Tissue Doppler Imaging and Right Cardiac Catheterization Study

Pulmonary hypertension (PH) caused by chronic obstructive lung disease (COLD) essentially involves the right heart. Also left ventricular (LV) systolic and diastolic functions may be affected.

Left atrial remodeling in acute anterior myocardial infarction.

Background: Our goal in this study was to examine the changes in the left atrial functions over a period of 3 months by using left atrial volume measurements in patients with anterior myocardial infarction (MI). Methods and Results: Seventy‐three patients with anterior MI who consulted our hospital in the first 12 hours starting from the onset of the chest pain and who exhibited ST elevation were enrolled in the study. The left atrial functions of the patients were evaluated by transthoracic echocardiography for a total number of four times; first at the time of the visit to the hospital, then in the first week, and then in the first and third months. Eight (10.95%) of the 73 patients included in the study died during the follow‐up. The remaining 65 patients completed the 3‐month study period. Of these 65 patients, primary percutaneous transluminal coronary angioplasty (PTCA) was performed for 24 (36.9%) patients and thrombolytic therapy was given to 13 (20%), whereas 28 (43.1%) patients were given only medical treatment. Left atrium (LA) maximum transverse diameter, LA maximum, minimum, and presystolic volume, LA active emptying volume and fraction were found to increase significantly in comparison to baseline detected for this parameter in the first and third months (P < 0.001). However, LA passive emptying volume and fraction was found to decrease significantly in comparison to baseline detected for this parameter in the first and third months (P < 0.001). Conclusions: An increase in the diameter, volume, and dimensions of LA during atrial remodeling was detected. LA passive emptying fraction was found to decrease, whereas atrial active emptying function was found to increase to compensate for this change.

The effect of incremental endurance exercise training on left ventricular mechanics: a prospective observational deformation imaging study.

OBJECTIVE Exercise training has been known to cause structural and functional alterations in the heart called athletes heart. We aimed to investigate the effects of incremental endurance exercise training (IEET) on the left ventricular (LV) mechanics in healthy subjects. METHODS This prospective observational study included 34 healthy young men who participated in competitive sports. The participants were subjected to a six-month IEET program. The LV mechanics measured using two-dimensional speckle tracking echocardiography was recorded while the participants were in an inactive state before and at the end of the six months. To compare continuous variables before and after IEET, Wilcoxon or paired-t test were used. RESULTS Baseline and post training echocardiographic measurements showed that there was no significant change in LV ejection fraction (%) (p=0.64) and there were an increase in end-systolic and end-diastolic diameters, posterior and septal wall thickness, relative wall thickness and LV mass index (p<0.05, for all). LV mechanical parameters such as global strain (S) (19.8±1.33% vs. 20.4±1.26%, p=0.001), apical four -chamber S (19.4±1.96% vs. 20.1±1.86%, p=0.01), apical two- chamber S (19.9±1.75% vs. 20.7±1.75%, p=0.003), apical (23.0±3.1% vs. 23.6±3.2%, p=0.03), and basal circumferential S (21.1±2.2 % vs. 21.6±2.5%, p=0.03), and apical rotation (degree) (7.9±0.95 vs. 8.4±0.74, p=0.001) values were significantly increased by IEET. CONCLUSION We demonstrated that IEET has led to exercise related cardiac structural and functional changes such as LV dilatation and LV hypertrophy, accompanied by a significant increase in LV systolic S and LV twist measurements.

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.