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ObjectiveThe objective of this study was to evaluate right ventricular systolic and diastolic functions with the use of conventional and tissue Doppler echocardiography in patients with slow coronary fl ow (SCF).Methods and resultsPatients who were detected to have SCF but otherwise normal epicardial coronary arteries between-10-2010 and July 2011 were included in our study. The control group was selected from the patients with normal coronary arteries but no SCF. All patients underwent echocardiography to evaluate left and right cardiac functions with conventional methods and tissue Doppler imaging. The study consisted of 86 patients [59 (68.6%) males, mean age: 54 ± 10 years) with SCF. Sixty-six subjects [42 (63.6%) males, mean age: 55 ± 8 years] with normal coronary arteries without SCF constituted the control group. Tissue Doppler fi ndings of left ventricular systolic and diastolic functions were signifi cantly disturbed in the SCF group (myocardial performance index: 0.37 ± 0.02 vs. 0.28 ± 0.02, P< 0.001; E/A ratio: 0.9 ± 0.1 vs. 1.1 ± 0.1, P< 0.001). However, when the right ventricular functions were considered, no signifi cant diff erence was observed between the 2 groups (myocardial performance index: 0.25 ± 0.10 vs. 0.25 ± 0.10, P= 0.9; E/A ratio: 0.50 ± 0.06 vs. 0.50 ± 0.08, P= 0.3; TAPSE: 26.2 ± 2.2 vs. 25.9 ± 2.2, P= 0.6).ConclusionsPreserved right ventricular diastolic and systolic functions in contrast to the impaired left ventricular functions in patients with SCF was the main fi nding of our study. The exact mechanisms of this new fi nding should be investigated by further studies.

Objective— In order to evaluate the prevalence of angiographically significant coronary artery disease (CAD) in patients with predominant mitral stenosis (mitral valve area ≤ 1.5 cm2), coronary angiograms of the 837 consecutive patients with mitral stenosis (482 women and 355 men; median age = 50 years [ranging from 35 to 77]) were retrospectively analysed.Methods and results— Significant CAD was defined as at least 50% diameter narrowing of a major coronary artery. Significant CAD was detected in 63 patients (7.5%, 30 men and 33 women). Patients with CAD were significantly older than those without CAD (median: 59 vs. 49 years; p < 0.0001, respectively). With respect to coronary risk factors, diabetes mellitus (28.6% vs. 9.4%; p < 0.0001), hypertension (46% vs. 16.7%; p < 0.0001) and family history of CAD (34.9% vs. 17.3%; p = 0.001) were significantly more frequent in the CAD+ group as compared to the CAD- group. Serum levels of cholesterol were significantly higher in CAD+ group as compared to the CADpatients (median: 199 vs. 176 mg/dl; p = 0.003). No significant differences were noted between the two groups in both serum levels of HDL-cholesterol (p = 0.12) and triglycerides (p = 0.08). Of the 63 patients with CAD, 21 (33.3%) had angina pectoris (AP) and, in patients free of CAD, AP was present in 106 (13.7%).The sensitivity and specificity of AP for the presence of significant CAD were 33.3% and 86.3%, respectively. The positive predictive value of AP for the presence of CAD was 16.5% and the negative predictive value of its absence was 94.1%.Conclusion— It is concluded that routine coronary angiography is not necessarily indicated in predominant mitral stenosis particularly in patients who are younger than 40 years and have no coronary risk factors and typical chest pain.

Objective— Dilated cardiomyopathy has been associated with left ventricular thrombosis, which leads to substantial morbidity and mortality as a site for peripheral emboli.There are some studies on patients with dilated cardiomyopathy showing altered haemostasis and platelet behaviour despite sinus rhythm. Mean platelet volume, which is the most accurate and simple estimate of platelet reactivity, may be associated with the development of left ventricular thrombosis.Methods and results— We prospectively enrolled 48 consecutive patients with dilated cardiomyopathy and sinus rhythm with left ventricular thrombosis and compared them with an age-sexmatched control group having dilated cardiomyopathy without left ventricular thrombosis.We found that in patients with left ventricular thrombosis mean platelet volume is significantly higher than those without (9.5 ± 0.8 vs. 8.7 ± 0.6, p < 0.001).Conclusions— Mean platelet volume is increased in patients with dilated cardiomyopathy and sinus rhythm having left ventricular thrombosis. This might be reflecting a causal relationship, which in turn requires further study to establish the role of antiplatelet agents both in prevention and in treatment