Yelda Tayyareci

Assessment of right atrial pressure using echocardiography and correlation with catheterization.

Right ventricular systolic pressure is crucial for both treatment and prognosis of cardiovascular and pulmonary diseases. The proper measurement of right ventricular systolic pressure depends on an accurate estimation of right atrial pressure (RAP). There is no standard method for estimating RAP noninvasively. The purpose of this study was to compare different noninvasive methods, namely, inferior vena cava (IVC) size and inspiratory collapse, tissue Doppler derived E/E′ (TV E/E′) for estimating RAP, and their correlation with catheter‐based measurements in patients with mitral valve stenosis with atrial fibrillation (AF) or normal sinus rhythm (NSR).

The Impact of Body Mass Index on Right Ventricular Systolic Functions in Normal and Mildly Obese Healthy Patients: A Velocity Vector Imaging Study

Background: Increasing prevalence of obesity is a significant problem in Western countries. Obesity has many effects on cardiovascular structure, function, and hemodynamics. Our aim was to compare the impact of body mass index (BMI) on right ventricular (RV) functions among healthy subjects with conventional echocardiography, tissue Doppler imaging (TDI), and velocity vector imaging (VVI). Methods: Eighty‐one healthy subjects divided into three group according to their BMI. All subjects were evaluated by conventional echocardiography, TDI, and VVI. A full polysomnogram were performed in subjects with BMI ≥ 30 km/m2. Results: RV end‐diastolic and end‐systolic diameters of patients in these three groups were similar (P > 0.05). There were no differences between each group in RV outflow tract fractional shortening (P = 0.52) and tricuspid annular plane systolic excursion (P = 0.94). No correlation observed between BMI and RV systolic parameters obtained with TDI. Longitudinal peak systolic strain and SRs were similar in all groups through each segment (P > 0.05) Conclusion: The results of our study show no changes in the RV functions in obese and overweight who were otherwise healthy subjects. We also revealed a significant correlation between BMI and left ventricular diameters and wall thickness but no relation with RV diameters or functions. (Echocardiography 2011;28:746‐752)

Impact of Myocardial Acceleration during Isovolumic Contraction in Evaluating Subclinical Right Ventricular Systolic Dysfunction in Type 2 Diabetes Mellitus Patients

Aim: In diabetes mellitus (DM) patients, left ventricular dysfunction is widely evaluated and established by conventional diagnostic methods, whereas right ventricular (RV) function is not as sufficiently evaluated. The aim of this study is to assess the preclinical effects of DM on RV function by using novel Tissue Doppler Imaging (TDI)‐derived indices. Methods: The study included 96 patients with type II DM [60 with DM only and 36 patients with coexisting DM and hypertension (DMHT)] and 40 healthy controls. Conventional parameters and TDI‐derived systolic velocities of tricuspid annulus [isovolumic myocardial acceleration (IVA), peak myocardial velocity during isovolumic contraction (IVV), peak systolic velocity during ejection period (Sa), RV Tei index] were measured. Results: TDI‐derived RV IVA was significantly lower in both DM and DMHT patients compared to controls indicating subclinical impairment in RV systolic function in the study patients (P = 0,0001). However RV IVA was similar in DM and DMHT subgroup supporting RV systolic impairment in DM was independent from HT. In correlation analysis, RV IVA was significantly correlated with the existence of diabetic nephropathy (r =−0,38; P = 0,003), retinopathy (r =−0,35; P = 0,006), insulin resistance (r =−0,52; P = 0,0001). Conclusions: Diabetes is associated with subclinical RV systolic dysfunction, regardless of coexisting hypertension. Tissue Doppler‐derived IVA; is a novel, non‐invasive parameter which may be used in early detection of RV systolic dysfunction in patients with DM. (Echocardiography 2010;27:1211‐1218)

Echocardiographic diagnosis of a giant thrombus passing through a patent foramen ovale from right atrium to the left atrium.

Pulmonary embolus sourced by right atrial thrombus trapped in a patent foramen ovale is an unusual, rare condition. Thus in suspicion of massive pulmonary thromboembolus, echocardiographic examination carries great importance evaluate right ventricular functions and diagnose right sided intracardiac thrombus. We report a 76-year-old female with massive pulmonary embolism caused by a gigantic thrombus trapped in a patent foramen ovale. The echocardiography was the diagnostic procedure to display the source of the thromboembolism and urgent cardiac surgery was successful and life-saving treatment in this case.

The evaluation of mitral valve stenosis: comparison of transthoracic echocardiography and cardiac magnetic resonance.

AIMS Echocardiographic assessment of patients with mitral valve stenosis (MS) requires a detailed evaluation of mitral valve anatomy, mitral valve area (MVA), and pressure gradient and presence concomitant valve diseases. Our aim was to evaluate planimetric MVA and transmitral flow velocities using cardiac magnetic resonance (CMR) in patients with isolated MS and to compare with transthoracic echocardiography (TTE) to determine the reliability. METHODS AND RESULTS Thirty-one patients (mean age 50.4 ± 10.2, 90.3% women) with isolated MS who were in a normal sinus rhythm were included in the study. Patients with ejection fraction <50%, atrial fibrillation, moderate-to-severe mitral valve insufficiency, moderate-to-severe stenosis and insufficiency of other valves, and previous commissurotomy and valvulotomy were excluded. Planimetric MVA and diastolic velocities were measured with TTE and CMR. There were strong correlations between measurements of planimetric MVA and transmitral diastolic velocities (P < 0.0001). Assessment of Bland-Altman analysis revealed strong agreement on measuring planimetric MVA with values -0.018 cm(2) (SD = 0.98 cm(2)) and the limits of agreement were -0.131 to 0.094. CONCLUSION CMR is a reliable method in patients with MS for diagnosis and follow-up.

Association of mitral annular calcification with endothelial dysfunction, carotid intima-media thickness and serum fetuin-A: an observational study.

OBJECTIVE Mitral annular calcification (MAC) is characterized by degenerative calcification of the mitral valve annulus. Atherosclerosis plays role in progression of MAC. Fetuin A is the inhibitor of pathological calcification. In the present study, we investigated the relationship between MAC and fetuin A with carotid intima media thickness (CIMT) and endothelial dysfunction. METHODS In this observational cross-sectional study, 40 patients with documented MAC on transthoracic echocardiography and 40 without MAC were included. All patients had coronary artery disease (CAD). Endothelial functions were assessed by brachial artery Doppler ultrasound (USG) and carotid artery Doppler USG. Serum fetuin-A level was also measured. Linear regression analysis and receiver operator curve analysis were performed. RESULTS Endothelial derived vasodilatory response (EDVR) was significantly decreased and CIMT value was increased in MAC group. There was a strong positive correlation between EDVR and serum fetuin-A value. There was a strong negative correlation between CIMT and EDVR, moderately negative correlation between CIMT and serum fetuin-A level. Simple linear regression analysis revealed that CIMT (β=0.367, p=0.001) and serum fetuin-A level (β=-0.291, p=0.009) were independent factors associated with MAC. The area under the curve (AUC) for serum fetuin-A level was 0.731 (95% 0.620-0.824) and AUC for CIMT was 0.724 (95% CI 0.613-0.818). CONCLUSION We observed that MAC is closely related with CIMT and serum fetuin-A level. Serum fetuin-A and CIMT can be used as independent markers in the diagnosis of MAC. We suggest that MAC can be used as an early determinant of CAD.

Assessment of Right Ventricular Endocardial Dysfunction in Mild‐to‐Moderate Mitral Stenosis Patients Using Velocity Vector Imaging

Purpose: Right ventricular (RV) function plays an important role in the development of clinical symptoms, exercise capacity, prognosis, and survival in patients with mitral stenosis (MS). The purpose of this study was to evaluate global and regional RV systolic functions using a novel technique, VVI, in mild‐to‐moderate MS patients without clinical symptoms of heart failure. Methods: The study population consisted of 60 patients (mean age 51.7 ± 11.6 years; 85% female) with isolated rheumatic mitral valve stenosis and 40 age‐ and sex‐matched control subjects (mean age 49.1 ± 10.5 years; 76.7% female). Conventional echocardiography, tissue Doppler imaging (TDI), strain (S), and strain rate (SRs) analysis were performed in all patients. Results: Transmitral mean pressure gradient was 6.1 ± 3.0 mmHg and mean mitral valve area was 1.41 ± 0.31 cm2 in patients with MS. TDI systolic velocity was significantly lower in MS patients compared to control subjects (0.13 ± 0.03 m/sec vs. 0.17 ± 0.03 m/sec; P < 0.0001). RV‐isovolumic acceleration was reduced in MS patients (3.75 ± 1.09 m/sec2 vs. 4.62 ± 1.0 m/sec2; P = 0.006). RV‐myocardial performance index was significantly increased in patients with MS (0.75 ± 0.05 in MS and 0.29 ± 0.04 in controls; P < 0.0001) revealing impaired RV systolic and diastolic function. The mean longitudinal peak systolic S and SR were significantly reduced in patients with MS (P < 0.0001). Conclusion: Our data revealed that RV systolic performance is reduced in patients with mild‐to‐moderate MS. (Echocardiography 2012;29:25‐33)

Subclinical Left Ventricular Dysfunction in Asymptomatic Chronic Mitral Regurgitation Patients with Normal Ejection Fraction: A Combined Tissue Doppler and Velocity Vector Imaging-Based Study: Subclinical LV Dysfunction in Asymptomatic Chronic MR Patients with Normal EF

Background: The optimal timing of the surgery in asymptomatic severe mitral regurgitation (MR) remains a challenge. The aim of the study is to evaluate the subclinical changes in LV longitudinal functions by using a novel strain imaging technique; velocity vector imaging (VVI); in patients with chronic MR. Methods and Results: We studied 54 patients with asymptomatic, nonischemic, chronic MR (56.8 ± 9 years and 56% male) and 30 healthy controls (55 ± 6.5 years and 55% male) with normal ejection fraction. Patients with MR were analyzed in tertiles according to their regurgitant volumes (RV) and regurgitant fractions (RF): mild MR (RV < 30 mL, RF < 30% n = 7), moderate MR (RV: 30–59 mL, RF = 30–50%; n = 29), and severe MR (RV > 60 mL, RF ≥ 50%; n = 18). Conventional echocardiography and VVI‐based strain imaging were performed to analyze LV functions. LV longitudinal peak systolic strain and strain rate (SRs) were significantly impaired in moderate and severe MR patients. Changes in LV longitudinal deformation were more significant in patients with severe MR. All deformation parameters showed a marked negative correlation with RV (LV Strain r =–0.583, P = 0.0001; LV SR r =–0.408, P = 0.002, respectively). Conclusions: LV long‐axis functions are important markers of LV contractility in MR patients. Novel echocardiographic techniques may provide additional data on subclinical changes in the LV and give way to the optimal timing for the surgery in severe MR patients. (Echocardiography 2011;28:877‐885)

Intracoronary autologous bone marrow-derived mononuclear cell transplantation improves coronary collateral vessel formation and recruitment capacity in patients with ischemic cardiomyopathy: a combined hemodynamic and scintigraphic approach.

This study investigated the effects of intracoronary autologous bone marrow−derived mononuclear cell (BMC) transplantation on coronary microcirculation. Fifteen patients with ischemic cardiomyopathy were treated by intracoronary infusion of BMCs via the patent infarct-related artery. The thermodilution-derived coronary flow reserve, index of microvascular resistance, pressure-derived collateral flow index, and coronary wedge pressure were measured at baseline and at 6 months. Successive balloon inflations during BMC transplantation were performed to observe the recruitment in pressure-derived collateral flow index and coronary wedge pressure, and the percentage changes between baseline and 6 months were calculated. The mean (SD) coronary flow reserve increased from 1.3 (0.4) to 2.1 (0.5), and the mean (SD) index of microvascular resistance decreased from 44.9 (24.4) to 21.2 (14.1) (P = .001 for both). The mean (SD) improvement in pressure-derived collateral flow index (from 0.14 [0.05] to 0.22 [0.08]) was also statistically significant (P = .001). Similarly, the percentage improvements in pressure-derived collateral flow index and coronary wedge pressure were statistically significant (P = .01 for both). The percentage improvement in perfusion assessed by single-photon emission computed tomography strongly correlated with the percentage changes in pressure-derived collateral flow index (r = 0.88, P = .001) and coronary wedge pressure (r = 0.69, P = .01). These results demonstrate for the first time (to our knowledge) that intracoronary autologous BMC transplantation improves coronary collateral vessel formation and recruitment capacity in human subjects.

Subclinical left and right ventricular systolic dysfunction in Behcet's disease: a combined tissue doppler and velocity vector imaging study.

Behcets disease (BD) is a chronic inflammatory disease characterized by recurrent oral and genital ulcerations and ocular lesions. Subclinical cardiac involvement may develop in BD patients. We aimed to evaluate subclinical left ventricular (LV) and right ventricular (RV) systolic dysfunction in BD patients without any apparent cardiovascular disease.