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Left ventricular hypertrophy (LVH) is a significant risk factor for cardiovascular complications in hemodialysis (HD) patients. Hypervolemia has been accepted as an independent risk factor for progressive LVH in HD patients. Additionally, high FGF23 levels have been a significant predictor of cardiovascular mortality and morbidity in chronic kidney disease and HD patients. The aim of our study is to investigate the correlation among LVH, interdialytic volume increase and FGF-23 in the patients on a chronic hemodialysis program.A total of 97 chronic hemodialysis patients (64.43 ± 11.28 years old, M/F:47/50) were included in the study. Human FGF-23 ELISA kit was used for FGF-23 analysis of predialysis blood samples. Echocardiographic evaluation was performed in all of the patients after dialysis. Left Ventricular Mass Index (LVMI) was calculated by using the Devereux Formula. We collected the following data: LVMI, FGF-23 levels, interdialytic fluid gain, blood pressure changes, and the other biochemical and clinical parameters.Mean LVMI of the patients was 184.41 ± 48.62 g/m(2). LVMI of the patients with daily urine output250 mL was found significantly lower. Statistically significant positive correlation was found between predialysis systolic blood pressure, predialysis diastolic blood pressure, predialysis mean arterial blood pressure and LVMI measurements (p0.01). Mean interdialytic volume excess was correlated with LVMI measurements of the patients (r = 0.459; p0.01). Increased FGF-23 levels (159.79 ± 134.99 ng/L) predicted increased LVMI measurements of the patients (r = 0.322; p0.01). In addition, FGF-23 levels were also increased as the interdialytic fluid volume increased (r = 0.326; p0.05). A positive correlation was also found between FGF-23 levels and interventricular septum thickness (r = 0.238; p0.05). Predialysis mean arterial blood pressure, predialysis volume overload and presence of diabetes were determined to be independent risk factors on LVMI on multivariate regression analysis.Our study showed that interdialytic volume overload increased both LVMI and FGF-23 values. We can consider that interdialytic volume control exerts positive effects on increased FGF-23 levels which predict the negative cardiovascular outcomes.

Aim: We aimed to present a case with ventricular myocardial noncom- paction involving both ventricles. Methods and results: Noncompaction of ventricle is a rare and unclassified congen- ital cardiac malformation is due to an arrest in intrauterine endomyocardial mor- phogenesis. We presented a ventricular myocardial noncompaction case involving both left and right ventricles. The physical examination of this case is consistent with mitral regurgitation and the echocardiographic findings are consistent with noncompaction of ventricular myocardium involving both ventricles with left ven- tricular systolic failure. Conclusion: Transthoracic echocardiography is a useful clinical tool for diagnosing noncompaction of both the right and left ventricular myocardium. The LVNC defini- tion can also be utilized for RVNC, which this diagnosis has never been reported in a Turkish patient. a 2005 Published by Elsevier Ltd on behalf of The European Society of Cardiology.

Background Interference between pacemaker (PM) lead and tricuspid apparatus may cause tricuspid regurgitation (TR). However, data regarding TR in patients with implanted PM are controversial. Our aim is to find out the degree of TR in a group of patients before and following PM implantation in a prospective manner. Methods The study group consisted of the patients referred for implantation of permanent PM or implantable cardioverter defibrillator (ICD). All patients underwent two-dimensional and Doppler echocardiographic evaluation before and after device implantation. The severity of TR was qualitatively classified into four groups as normal or trivial, mild, moderate, or severe. All studies were reviewed for accuracy by a second independent interpreter. Results Sixty-one patients (mean age 53 +/- 8 years, 44 male) referred for PM (n = 55) or ICD (n = 6) implantation consisted of the study population. Echocardiographic degree of TR was mild in 21 (70%), moderate in 7 (23%) and severe in 2 (7%) patients before PM implantation. Following device implantation, mild TR was noted in 23 (76%), moderate in 10 (33%), and severe in 2 (6%) cases. After the procedure, the TR severity was increased from normal/trivial to mild in 5 (16%) cases and from mild to moderate in 3 (10%). There was no worsening of the severity of TR in patients with moderate regurgitation following device implantation. The severity of TR did not change at a mean follow-up of 6 +/- 3 months. Conclusions New or worsening TR is relatively rare after PM implantation. It is not associated with an acute worsening or clinical deterioration. But echocardiographic follow-up is recommended to monitor other complications in chronic phase.

This study aimed to investigate the aortic elastic properties of young pregnant women by comparing them with those of age-matched healthy females. The study group consisted of 21 pregnant women at a mean age of 26 +/- 1 years; 22 healthy women at a mean age of 25 +/- 1 years constituted the control group. Doppler-color echocardiographic variables and serum estradiol (E2) levels were measured from both groups. The blood samples were obtained from the control group in the first week after menstrual bleeding. Diastolic and systolic blood pressure (DBP and SBP, respectively) were measured with a sphygmomanometer. Systolic and diastolic aortic diameters (AOS and AOD, respectively) were measured 3 cm proximal to the aortic valves. Aortic elastic properties were assessed according to the following formulas: 1, Aortic strain = (AOS - AOD)/AOD; 2, Aortic distensibility = 2 x (AOS - AOD)/(PP x AOD); 3, Aortic diameter change = AOS - AOD; 4, Aortic stiffness index = ln(SBP/DBP)/(AOS - AOD)/AOD. The results were expressed as mean +/- standard deviation and compared by t-test between groups. P0.05 was considered as statistically significant. All women in the study group were in their first pregnancy and second trimester. The height and weight were 160 +/- 5 vs 164 +/- 6 cm and 60 +/- 9 vs 54 +/- 3 kg in the study vs control groups, respectively (P0.05). The AOD was 26 +/- 3 vs 26 +/- 4 mm and AOS 29 +/- 3 vs 28 +/- 4 mm. Pulse pressure was 43 +/- 3 vs 45 +/- 8 mmHg in the study vs control groups, respectively (P0.05). The serum E2 level was significantly higher in pregnant women (21 300 +/- 2 300 pg/ml). Derived aortic elastic properties in pregnant women were also increased significantly (P0.0005). The indexes of aortic elastic properties are altered and aortic stiffness is decreased among young pregnant women. This may be due to the adaptation mechanisms including high estradiol levels detected in pregnancy.

Objective: This study was designed to test defibrillation threshold (DFT) with the least number of fibrillation inductions using upper limit of vulnerability (ULV) and to describe the most practical set of ICD during DFT following implantation. Background: Although the correlation between ULV and DFT has been well described, there has been no uniform DFT testing protocol taking the advantage of ULV after defibrillator (ICD) implantation. Methods: A total of 26 patients undergoing a new ICD implantation had a DFT induced with scanned T wave shock. The hypothesis that ventricular fibrillation (VF) could be defibrillated with 5 J higher than the highest T wave shock needed to induce VF or with 10 J if the T wave shock needed to induce VF was less than 5 J, was tested and 20 patients fulfilled these criteria. The methodology is improved by detecting peak T wave with 12-lead ECG, applying biphasic T wave shock and scanning the T wave shock in a wider window. Results: Five patients in the first group (n = 15) and one patient in the second group (n = 11) did not fulfill the above hypothesis. The common features of six patients who did not fulfill the hypothesis were that T wave shock needed to induce VF was either under 5 J (5 patients) or high (1 patient). Conclusion: This study revealed the importance of methodology in studies regarding ULV and DFT. Following ICD implantation, we propose the first biphasic T wave detected by 12-lead ECG and rescue shock set at 10 and 15 J, respectively. If any of the scanned T wave (40 ms before and 40 ms after the peak T wave with decrements and increments of 20 ms) shocks could not induce VF, then the T wave and the first rescue shock should be set at 5 and 10 J, respectively. If the induction of VF has been unsuccessful with T wave shock at 5 J, then a safe defibrillation with 10 J should be expected in majority.

Acute myocardial infarction results in not only left ventricular but also left atrial dysfunction. Left atrial function is important for optimal filling of the left ventricle. In this study, we aimed at evaluating left atrial functions 6 months after acute myocardial infarction in three different patient groups (thrombolytic therapy, primary percutaneous intervention, or no reperfusion strategies). Between October 2002 and May 2003, 48 patients with ST elevation myocardial infarction who were either administered thrombolytic therapy (group T, n=16), underwent primary angioplasty (group A, n=20), or underwent no reperfusion therapy (group C, n=12) at our unit were enrolled into the study. Echocardiography was performed in these patients 6 months after acute myocardial infarction. Left atrial contractility was assessed by atrial ejection force. Left atrial contribution was assessed by atrial fractional shortening and left atrial volume was calculated. The left atrial volume was significantly higher in group C (P0.05), but there was no significant difference between groups A and T (P0.05). Patients in group C had significantly lower atrial ejection force values compared with the other groups (P0.05). Atrial fractional shortening was not significantly different among the three groups (P0.05). Atrial ejection force, which is an indicator of left atrial contractility, is better with either angioplasty or thrombolysis. Left atrial volume is higher in patients who were not treated with reperfusion strategies. Further studies are needed to explain the mechanism involved.

Continuous-wave (CW) Doppler recording of mitral regurgitation (MR) is a reflection of the left ventriculoatrial pressure gradient. Accordingly, this jet may yield information about pulmonary artery wedge pressure (PAWP). In this study, we derived and then evaluated a novel method for prediction of PAWP. Patients (n=80) with moderate to severe MR and left ventricular dysfunction were included in the study. Transthoracic echocardiography was performed in patients during pulmonary artery pressure monitoring. A satisfactory CW Doppler recording of MR was obtained in 63/80 (78%). On the late descending portion of the CW recording, the time from a velocity of 4 m/sec to the end of the jet was defined as t1, and from 3 m/sec to the end of the jet as t2. Mathematical derivation of t1/t2 as a predictor of PAWP, was performed based on Weiss' derivation. If t1/t2 was 1.44, the PAWP was > 16 mmHg. With this new mathematical derivation, it appears that the downslope of the CW Doppler MR waveform may be able to distinguish a normal from elevated PAWP.

Objective - Thoracic impedance cardiography (TIC) is a noninvasive method which has proved to be useful in monitoring the haemodynamic status of the patients. In this study, we evaluated the TIC findings in patients with pericardial effusion and cardiac tamponade. Methods and results -The study consisted of patients with pericardial effusion with (group A) or without (group B) cardiac tamponade (CT).The stroke volume, cardiac output and ejection fraction was measured by both echocardiography and TIC.The measurements were done at baseline in both groups and following pericardiocentesis in group A. The variables were compared by linear regression analysis, paired sample's t test and chi-square test.The study included 32 patients. Group A consisted of 16 patients and group B of 14 patients. Two patients were excluded from comparisons because of insufficient quality of the echocardiographic examination. There were no significant differences between group A and B with regard to demographic features. Both echocardiographic and TIC measurements at baseline revealed decreased cardiac output, EDV and SV in group A and EF was not different. Linear regression analysis revealed that echocardiography and TIC were in significant correlation with regard to cardiac output, enddiastolic volume, stroke volume (p < 0.01) but not ejection fraction (p = 0.8910). The correlation was also present after pericardiocentesis. Conclusions - TIC can be safely used in patients with pericardial effusion. It provides suggestive data for the diagnosis of CT and can be used as a means of monitoring the results of the pericardiocentesis.

Background: Thorax impedance cardiography (TIC) can provide important information about the hemodynamic state of patients. In this study, we aimed at finding out if TIC can be used in the early follow-up of acute right ventricular myocardial infarction (RVMI). Methods: The study consisted of patients with RVMI who were admitted to our coronary care unit between March 1998 and October 1999. The patients were divided into two groups: group A: patients with hemodynamically significant RVMI, and group B: patients with hemodynamically insignificant RVMI. All impedance measurements were performed with the commercially available device BoMed NCCOM3. We measured stroke volume index, cardiac index and ejection fraction by TIC. The measurements were done on the day of admittance (day O), first day and second day continuously, and on the third to fifth day during bed rest. Comparisons of TIC measurements and vital signs were made by Friedman analysis. Group A and group B were compared by Mann Whitney U test and chi square. The level of statistical significance was set at P < 0.05. Results: There were 26 patients in group A (mean age: 62 ± 10) and 14 patients in group B (mean age: 61 ± 12). There were no statistically significant differences between the groups in age and sex. There were statistically significant differences between group A and B with regard to stroke volume index (32 ± 5 vs 28 ± 5; P = 0.0147), total peripheral resistance (19 ± 5 vs 23 ± 5; P = 0.0084); ejection fraction (0.44 ± 0.16 vs 0.58 ± 0.08; P = 0.0131). The vital signs with statistically significant differences were systolic arterial blood pressure (110 ± 17 vs 88 ± 7, P < 0.0001); diastolic arterial blood pressure (72 ± 12 vs 55 ± 13; P = 0.0002) and heart rate (89 ± 12 vs 71 ± 11; P < 0.0001). The differences disappeared on the second day. The lack of significance continued on the fifth day. Friedman analysis revealed that all the TIC parameters except for left ventricular ejection fraction change towards the normal range. Ejection fraction did not change in group B but decreased in group A on the second day; however it was stable later. Conclusion: TIC can provide easily obtained parameters which may have a role in the treatment of hemodynamically significant RVMI. This is particularly important in coronary care centers with limited invasive capabilities. A.N.E. 2000;5(4):330–335

Our case is a 38-year-old man, admitted to Cardiology Department with shortness of breath. Echocardiography yields a hyperechogenic mass localized to papillary muscle with severe mitral regurgitation. Coronary angiography demonstrated radiopacity localized to the papillary muscle. The excision of the mass was consistent with elastic tumor, which was reported as papillary fibroelastoma attached to the papillary chordae of the mitral valve. A 29 no St-Jude bileaflet mechanical valve was implanted to mitral position. Papillary fibroelastoma (PF) can be found in young age and originate from the papillary muscle, which the radiopaque angiographic appearance of the mass supports the diagnosis.

Amaç: Sağ ventrikül (SV) fonksiyonu birçok kardiyopulmoner hastalıklarda klinik sonlanım olarak önemli rol oynar. Pulmoner emboli (PE) ve ciddi pulmoner darlık (PD) SV basınç yüklenmesi ile seyreden iki ayrı hastalıktır. SV’ nin artmış basınç yüklenmesine karşı verdiği uyum mekanizmaları iyi bilinmesine karşın hala bazı tanımlanmamış boşluklar devam etmektedir. SV basınç yüklenmesinin elektrokardiyografik (EKG) olarak nasıl bir deği- şiklik yaptığı pek bilinmemektedir. Çalışmamızdaki amaç akut ve kronik basınç yüklenmesini EKG olarak ayrımının yapılabileceğini araştırmaktır. Yöntemler: Bu retrospektif gözlemsel çalışmamıza 20 PD ve 38 PE tanısı kesinleşmiş hasta dahil edildi. SV yüklenmesini gösterdiği daha önceki çalışmalarda kabul edilmiş EKG kriterleri her iki grupta araştırıldı. Logistic regression analysis was used to define the predictors of chronic RV overload. Bulgular: Bakılan EKG değişikliklerinden, prematür atriyal atım (OR-12.2, %95 CI, 1.3-107, p0.008), sağ aks deviasyonu (OR-20.4, %95 CI 4.2-98, p0.001), indetermine aks (OR-0.11, %95 CI 0.02-0.44, p0.001), inkomplet sağ dal bloğu (OR-4.2, %95 CI, 1.1-15.4, p0.02), aVR de geç R dalgası (OR-8.3, %95 CI 1.2-74.8, OR-8.4, %95 CI 2.1-33.2 p0.001), V1’ de qR dalgası (OR-8.3, %95 CI 1.2-74.8 p0.02) SV kronik basınç yüklenmesini gös- teren bağımsız prediktörlerdir. Sonuç: PE için kabul edilen EKG kriterleri PD grubunda daha sık saptandı. Daha da ötesi istatiksel olarak anlamı bulunan EKG kriterlerin basınç yüklenmesinin zamanlaması hakkında sınırlı tanısal değeri olduğu saptandı. Objective: Pulmonary embolism (PE) and severe pulmonary stenosis (PS) are two distinct conditions accompanied by increased pressure load of the right ventricle (RV). Despite major advances in our understanding of the mechanisms of RV adaptation to the increased pressure, substantial gaps in our knowledge remain unsettled. One of much less known aspect of pressure overload of RV is its impact on electrocardiographic (ECG) changes. In this study, we aimed to study whether acute and chronic RV overload are accompanied by different ECG patterns. Methods: Thirty-eight patients with PE underwent ECG monitoring were compared with 20 matched patients with PS in this observational retrospective study. ECG abnormalities suggestive of RV overload were recorded and analyzed in both groups. Logistic regression analysis was used to define the predictors of chronic RV overload. Results: Among the ECG changes studied, premature atrial contraction (OR-12.2, 95% CI, 1.3-107, p0.008), right axis deviation (OR-20.4, 95% CI 4.2-98, p

The objectives of this study are noninvasive assessment of endothelial dysfunction (ED) and diagnosing the possible early vascular development of atherosclerosis in psoriasis disease (PD). Twenty-eight PD patients (study group) without any obstructive vascular involvement were compared with 28 healthy controls (control group) in terms of ED utilizing endothelium-dependent dilation as well as endothelium-independent dilation, which was assessed by measuring changes in brachial artery diameter following sublingual glyceryl trinitrate (400 microg Nitrolingual spray). All patients underwent a complete transthoracic echocardiographic and tissue Doppler study. A standard form was utilized for the documentation of the presence or absence of the known risk factors for atherosclerotic vascular disease. Statistical analysis was performed by utilizing SPSS version 11. There was no difference between patients and controls in terms of echocardiographic and tissue Doppler parameters as well as baseline brachial artery diameters. Flow-mediated dilation showed 37% impairment in study group compared with control (p < 0.05). Endothelium-independent NTG dilatation did not differ in both groups. Noninvasive methods such as ultrasonography, saving time and cost-effective, can be utilized for following outpatient PD patients for the risk of ED, which may preclude to atherosclerosis.

Noninvasive assessment of endothelial dysfunction (ED) and diagnosing the early vascular development of atherosclerosis in active mucocutaneous Behçet's disease. Twenty-nine active BD patients (study group) without any obstructive vascular involvement were compared with twenty-nine healthy controls (control group) in terms of ED utilizing endothelium-dependent dilation as well as endothelium-independent dilation (FMD), which was assessed by measuring changes in brachial artery diameter following sublingual glyceril trinitrate (400 microg Nitrolingual spray). All patients underwent a complete transthoracic echocardiographic and tissue Doppler study. A standard form was utilized for the documentation of the presence or absence of the known risk factors for atherosclerotic vascular disease. Statistical analysis was performed by utilizing SPSS version 11. There was no difference between patients and controls in terms of echocardiographic and tissue Doppler parameters as well as baseline brachial artery diameters. Flow-mediated dilation showed 38% impairment in study group compared with control (P0.05). Endothelium-independent NTG dilatation did not differ in both groups. Ultrasonography is an easily applicable noninvasive method for following BD patients for the risk of ED, which may preclude to atherosclerosis, save time and cost-effective.

Left ventricular (LV) diastolic dysfunction (LVD) is a common complication secondary to hypertension. It has been reported that bisoprolol is effective in reducing blood pressure and has beneficial cardiac effects in patients with hypertension. However, its effect on LV diastolic function has not been studied in detail. In this study, we sought to determine bisoprolol’s effect on left ventricle diastolic function. Data from 25 patients were statistically analyzed. Peaks E and A wave, E/A ratio, isovolumetric relaxation time and E wave deceleration time were measured echocardiographically. Doppler echocardiography measurements after bisoprolol treatment revealed an improvement in LV diastolic function. In conclusion, our results show that treatment with bisoprolol, improves echocardiographic parameters of LV diastolic function after 3 months of treatment.

Twelve-lead electrocardiograms revealed no atrial activity and a wide QRS escape rhythm at 38 beats/min in a 20-year-old man who presented with syncope. Doppler echocardiography documented the absence of A wave both in the tricuspid and mitral valve flow. The only mechanical activity was documented at the left atrial appendage. An electrophysiologic study demonstrated electrical inactivity in the right atrium and an atrial tachycardia in the left atrium. Atrial pacing with maximum output did not capture the atria. Our case represents an advanced stage of partial atrial standstill, with a mechanical and electrical atrial activity confined only to the left trial appendage. The patient remained asymptomatic after receiving a VVIR pacemaker and anticoagulation therapy.

Twelve-lead electrocardiograms revealed fine atrial fibrillation and a short QT interval (SQTI) (

OBJECTIVE This study was performed to determine the effect of homocysteine-lowering therapy (HLT) on endothelium-dependent vasodilation (EDD) and exercise performance in patients with coronary artery disease. METHODS AND RESULTS Among the patients who were on the waiting list for coronary intervention, 26 male patients (plasma homocysteine (Hcy) levels > 15 micromol/l) who had a focal stenosis of at least 70% in the left anterior descending artery were included in the study. The patients were matched to receive HLT (n = 15; 0.4 mg of folic acid, 2 mg vitamin B6 and 6 microg of vitamin B12) or placebo (n = 11) until the coronary intervention was performed (mean 3.8 +/- 0.9 weeks). Brachial artery vasomotion test and treadmill stress testing were performed at baseline and 4 weeks after HLT before the time of coronary intervention in each patient. Hcy levels were found to be decreased significantly after HLT compared to baseline (23.4 +/- 6 vs. 11.3 +/- 4 micromol/l; p < 0.001) whereas placebo had no effect. HLT but not placebo produced a marked improvement in EDD, from 3.9 +/- 1.1% to 9.4 +/- 2.3% (p < 0.0001). Endothelium-independent nitroglycerin-induced dilation was similar in the HLT and placebo groups compared with the baseline. In the exercise testing, HLT resulted in a significant improvement in exercise duration and reduction in the amount of maximal ST-segment depression, (from 6.5 +/- 2 to 6.9 +/- 2 min, p = 0.02 and from 1.2 +/- 0.7 to 0.8 +/- 0.5 mm, p = 0.01, respectively) whereas placebo did not. CONCLUSION Lowering Hcy levels improves EDD and exercise performance while reducing the exercise-induced myocardial ischaemia in patients with coronary heart disease and hyperhomocysteinaemia.

We have read the article by Schoen et al. entitled ‘Nomograms for severity of aortic valve using peak aortic valve pressure gradient and left ventricular ejection fraction’.1 The authors have developed a nomogram to quantify the aortic valve area. As the authors have notified, the nomogram has a number of advantages: (a) The errors in measuring the left ventricular outflow tract diameter is eliminated; (b) the systolic function of the left ventricle is taken into consideration; (c) it eliminates the need for the complex computation process of continuity equation. …