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Background Cirrhotic cardiomyopathy (CCM) is a well-known entity. The aim of this study was to compare left atrial three-dimensional (3D) volume and P-wave dispersion (PWd) in patients with cirrhosis and a healthy population. The secondary purpose was to assess the left phasic volumes and reservoir functions with 3D echocardiography for the prediction of an increased risk of poor outcomes in patients with cirrhosis. Methods The study included 50 patients with cirrhosis and 43 healthy control subjects without atrial fibrillation. All patients were assessed with two-dimensional (2D), 3D, and tissue Doppler transthoracic echocardiography. The PWd was calculated using a 12-lead surface electrocardiogram (ECG). Cirrhotic patients were followed up for 2.5 years for the evaluation of poor outcomes and the development of atrial fibrillation. Results Patients with cirrhosis were observed to have significantly higher left atrial phasic volumes such as minimal left atrial volume (3D-LAVmin, P = 0.004) and indexed LAVmin (3D-LAVImin, P = 0.0001), and significantly decreased left atrial reservoir functions such as left atrial emptying volume (3D-LAEV, P = 0,001), left atrial ejection fraction (3D-LAEF, P = 0,001) on 3D echocardiography. PWd was determined to be significantly longer in the cirrhotic group compared with the control group (P = 0.003). In the 2.5-year follow-up period, poor outcomes occurred in 34 patients (22 patients died, six patients had liver transplantation, six patients developed atrial fibrillation/AHRE episodes). In Cox regression analysis, the MELD score (HR, 1.16 (1.06-1.26), P = 0.001) and 3D-LAVImin (HR, 0.95 (0.86-1.00), P = 0.040) were significantly associated with all-cause mortality. Cirrhotic patients with LAVImin of >15 ml/m2 were seen to have poor survival (long rank P = 0.033). Conclusion The results of this study showed that patients with cirrhosis had higher left atrial volume, longer PWd and worse diastolic functions compared with the control group. Higher disease severity scores were associated with left atrial function and volume. In addition, left atrial volume measured with 3DE was a strong predictor of future adverse events, and minimal left atrial volumes had a higher prognostic value than any other left atrial function indices.

Cardiovascular iron load is the leading cause of morbidity and mortality in beta-thalassemia major (β-TM). However, many patients remain asymptomatic until the late stage. In this cross-sectional study, we investigated the role of three-dimensional (3D) echocardiography and endothelial dysfunction parameters in asymptomatic β-TM patients, and the relationship between these parameters and cardiac magnetic resonance imaging (MRI) T2* value.A total of 51 asymptomatic β-TM patients receiving regular blood transfusions were divided into two groups based on cardiac MRI-T2* values (MRI-T2*20 ms and ≥20 ms), which MRI-T2*20 ms determines myocardial iron load and evaluated by two-dimensional (2D) and 3D-echocardiography including endothelial dysfunction parameters. The relationships between ferritin levels, 2D and 3D-echocardiography measurements, endothelial dysfunction parameters, and cardiac MRI-T2* values were investigated.All left ventricle ejection fraction (LVEF) obtained by 2D-echocardiography were normal (≥50%). LVEF-3D (53.25 ± 2.33 vs. 58.81 + 1.02), SDI12 (6.53 ± 0.56 vs. 2.85 + 0.48), and SDI16 (7.65 ± 0.75 vs. 3.26 + 0.49) were significantly different and negatively correlated between groups with MRI-T2*20 ms and ≥20 ms, respectively. Flow-mediated dilatation (FMD) (6.08% ± 0.34% vs. 14.46% ± 1.12), aortic strain (7.79% ± 2.19% vs. 12.76% ± 4.19), ferritin levels were significantly different and negatively correlated between groups with MRI-T2*20 ms and ≥20 ms, respectively. Higher ferritin, SDI12/16 were significant independent predictors of MR-T2* 20 ms. SDI16 5.5, SDI12 4.3 predicted MRI-T2*20ms with a sensitivity of 92%, specificity of 81% (AUC 0.85, P .001), and sensitivity of 92%, specificity of 78% (AUC 0.83, P .001), respectively.SDI12/16 calculated by 3D-echocardiography may be a promising predictors of cardiovascular iron load and, decreased LVEF-3D, FMD, and aortic strain might be good indicators of subclinical cardiovascular involvement of β-TM.

The sclerotic lesions of the aortic valve share common features with atherosclerosis. An anti-inflammatory protein, adiponectin, seems to have a protective effect on the cardiovascular system. The goal of our study is to determine adiponectin levels in patients with aortic sclerosis and to compare these values with the control group with similar age and cardiovascular risk profile.Sixty-eight patients with aortic sclerosis and 40 controls were included. Serum adiponectin levels were measured by solid-phase enzyme-linked immunosorbent assay.There were no significant differences regarding age, sex and other cardiovascular risk factors between groups. Also, mean body mass index values were similar. The rate of mitral annular calcification and left ventricular hypertrophy were significantly higher in patients with aortic sclerosis. Among laboratory variables, high-sensitive C-reactive protein (hsCRP) levels were significantly higher in patients with aortic sclerosis than in those without (4.0 ± 2.9 vs. 2.9 ± 2.3 mg/dl, P = 0.04). Adiponectin levels were found to be significantly lower in aortic sclerosis group than in controls (9.7 ± 4.4 vs. 11.7 ± 4.9 μg/ml, P = 0.034). In the whole group, adiponectin levels were significantly correlated with BMI (r = -0.22, P = 0.02), white blood cell count (r = -0.2, P = 0.03), hsCRP (r = -0.25, P = 0.008), total cholesterol (r = -0.18, P = 0.05), high-density lipoprotein (HDL) cholesterol (r = 0.31, P = 0.001) and triglyceride (r = -0.36, P 0.001).In patients with aortic sclerosis, serum adiponectin levels were significantly lower compared with those with normal aortic valves. Our findings suggested that adiponectin might play a role in the progression of degenerative aortic valve disease.

Objective: Pericardial effusion (PE) is a common clinical condition that can develop as a result of systemic or heart disease. In our study, we synthesized the cytopathological and clinical results of patients who underwent pericardiocentesis due to pericardial effusion. Method: A total of 213 patients who underwent percutaneous pericardiocentesis between 2007-2017 were included in the study: their cytologic and histopathologic diagnoses were noted and their relations were examined. Results: Hundred and thirty-two cases were male (61.9%), 81 were female (38.1%) and the mean of the study population age was 59.9 (min 13-max 97) years. Hundred and sixty-eight patients had benign (78.9%), 10 suspicious (4.6%), 3 non-diagnostic (1.4%) and 32 malignant cytologies (15.1%). Benign pericardial effusion was the most common diagnosis. Malignant cytology findings were interpreted as lung carcinoma (n=20: 62.5%), rhabdomyosarcoma (n=1: 3.1%), poorly differentiated adenocarcinoma (n=2: 6.2%), a gastrointestinal system carcinoma (n=4: 12.5%), undifferentiated epithelial tumor (n=1: 3.1%), breast carcinoma (n=1: 3.1%), and unspecified malignant tumor (n=3: 9%). Four (2.4%) of the 168 patients having diagnosis of benign cytology had previously received diagnosis of a malignant disease, however examination of cytological specimen. Did not reveal any malignancy. Three (30%) of the 10 patients with suspicious cytology, had received diagnosis of a malignant disease previously. Conclusion: In developed countries, it is reported that more than 50% of the PE’s are idiopathic. The percentage of cancer-associated PE’s is 10-25%. In our study, 78.9% of our cases had a benign diagnosis, and 15.1% had malignant PE consistent with the literature findings. Cytological sampling in pericardial fluid is a method that can shed light on the diagnosis of many diseases. Amaç: Perikardiyal efüzyon (PE) sistemik veya kalp hastalıklarının bir sonucu olarak gelişebilen yaygın bir klinik tablodur. Çalışmamızda, perikardiyal efüzyon nedeniyle perikardiyosentez uygulanan hastaların sitopatolojik ve klinik sonuçlarını sentezledik. Yöntem: Çalışmaya 2007-2017 yılları arasında perkütan perikardiyosentez yapılan 213 hasta alınmış, sitolojik ve histopatolojik tanıları not edilmiş ve ilişkileri irdelenmiştir. Bulgular: Olguların 132’si erkek (%61,9), 81’i kadın (%38,1) olup, yaş ortalaması 59,9 (min. 13 - maks. 97)’dur. Sitolojik bulgulara göre; 168’i benign sitoloji (%78,9), 10’u kuşkulu sitoloji (%4,6), 3’ü tanısal olmayan (%1,4) ve 32’si malign sitoloji (%15,1) tanısı almıştır. En sık benign perikardiyal efüzyon tanısı mevcuttur.Malign sitoloji tanılı olguların 20’si akciğer karsinomu (%62,5), 1’i rabdomyosarkom (%3,1), 2’si az diferansiye adenokarsinom (%6,2), 4’ü gastrointestinal sistem ilişkili karsinom (%12,5), 1’i indifferansiye epitelyal tümör (%3,1), 1’i meme karsinomu (%3,1), 3’ü tiplendirme yapılamayan malign tümör (%9) olarak yorumlanmıştır. Benign sitoloji tanılı 168 hastanın 4 (%2,4)’ünün malignite tanısı var olmakla birlikte, sitolojik örneğe yansıyan malignite bulgusu yoktur. Kuşkulu sitoloji olarak tanı almış 10 olgunun 3’ünün (%30) malignite tanısı mevcuttur. Sonuç: Gelişmiş ülkelerde PE’lerin %50’sinden fazlasının idiyopatik olduğu bildirilmektedir. Kanser ilişkili PE’lerin oranı %10-25’tir. Çalışmamızda, literatürle uyumlu olarak %78,9 olgu benign, %15,1 olgu malign PE’dir. Perikardiyal sıvılarda sitolojik örnekleme birçok hastalığın tanısına ışık tutabilen bir inceleme yöntemidir.

AIMS Left bundle branch block (LBBB) causes a dyssynchronized contraction of left ventricle. This is a kind of regional wall-motion abnormality and measuring left ventricular ejection fraction (LVEF) by two-dimensional (2D) echocardiography could be less reliable in this particular condition. Our aim was to evaluate the role of dyssynchrony index (SDI), measured by three-dimensional (3D) echocardiography, in assessment of LVEF and left ventricular volumes accurately in patients with LBBB. METHODS AND RESULTS In this case-control study, we included 52 of 64 enrolled participants (twelve participants with poor image quality were excluded) with LBBB and normal LVEF or nonischemic cardiomyopathy. Left ventricular ejection fraction (LVEF) and left ventricular volumes were assessed by 2D (modified Simpson's rule) and 3D (four beats full volume analysis) echocardiography and the impact of SDI on results were evaluated. In patients with SDI ≥6%, LVEF measurements were significantly different (46.00% [29.50-52.50] vs 37.60% [24.70-45.15], P