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BACKGROUND Behcet's disease (BD) is a chronic systemic inflammatory disease in which early detection of cardiac involvement is essential. The aim of this study was to assess the left ventricular (LV) functions in BD patients using four-dimensional (4D) speckle tracking echocardiography (STE) and to test the correlation between LV dysfunction and the presence of QRS fragmentation. METHODS This cross-sectional study included 64 Behcet's patients and 48 healthy volunteers. The BD group was divided into two subgroups depending on the presence (fQRS+) or absence (fQRS-) of fragmented QRS (fQRS). In both groups, left ventricular global area strain (LV-GAS), global radial strain (GRS), global longitudinal strain (GLS), and global circumferential strain (GCS) were obtained with 4D echocardiography. RESULTS GAS, GRS, GLS, and GCS values were significantly different in Behcet's patients and in healthy volunteers. GLS and GAS values were lower in the fQRS+ than in the fQRS- group (-15.8 ± 1.8 and -17.9 ± 1.6, P = .001 vs -25.0 ± 3.1 and -29.2 ± 4.2, P

INTRODUCTION: Aortic stiffness is an important risk factor that reflects the mechanical tension and elasticity of the aorta and predicts cardiovascular mortality and morbidity. However, it has been found that aortic stiffness contributes to both symptom burden and clinical outcomes in patients with aortic stenosis (AS). In our study, we aimed to evaluate the effect of transcatheter aortic valve implantation (TAVI) on aortic elasticity parameters by echocardiography in patients with severe aortic stenosis, especially with preserved ejection fraction. METHODS: A total of 55 consecutive patients with symptomatic severe AS who underwent TAVI were included in the study. Demographic data, echocardiographic and aortic elasticity measurements of all patients were measured before and 6 months after the procedure. To evaluate the elastic properties of the aorta, aortic strain, distensibility and stiffness index were calculated. RESULTS: Left ventricular mass index (LVMI) (p

Although percutaneous transcatheter atrial septal defect (ASD) closure (TCC) has been performed on adults for a long time there is limited data about the effects of the procedure in the literature and the majority of studies have been performed on children. The study purposed to evaluate the impact of TCC on cardiac remodeling, electrical changes and exercise capacity in adults. Transthoracic echocardiography and electrocardiography were performed one day before and six months after TCC in 27 consecutive patients who underwent successful TCC. Twenty-seven age and sex matched healthy subjects were used as control group. Right ventricular (RV) diameter (had decreased from 44±6.3 to 34±3.9; p [Med-Science 2017; 6(2.000): 213-6]

Modafinil is used for the treatment of various sleep disorders; however, its usage among healthy individuals is also increasing. There are a limited number of cardiovascular side effects, including ischemic T-wave changes, dyspnea, hypertension, and tachycardia in the literature. Our research aimed to investigate the dose-dependent subacute cardiovascular effects of modafinil in rats. Thirty-two rats were randomly and equally assigned to a control group (vehicle-treated for 14 days), a subacute low-dose group (SALD, 10 mg/kg for 14 days), a subacute moderate-dose group (SAMD, 100 mg/kg for 14 days), and a subacute high-dose group (SHD, 600 mg/kg for 14 days). The cardiovascular effects of modafinil were evaluated using hemodynamic, biochemical, electrocardiographic, electrophysiologic, and histopathologic parameters. In terms of hemodynamic parameters, heart rate, and systolic/diastolic/mean blood pressure levels, electrophysiological parameters did not reach statistical significance among the groups (p > 0.05). The incidence of T-wave negativity in SAMD and SAHD groups was 25 and 37.5%, respectively. Moreover, one rat per group was affected by an atrioventricular blockage. Malondialdehyde, superoxide dismutase, catalase, and reduced glutathione levels in the heart and vascular tissues, serum troponin-I, and creatine kinase levels were similar between the modafinil-administered groups and the control group (p > 0.05); this indicates that modafinil activated neither oxidative stress nor antioxidant pathway. Also, there was no difference in histopathological parameters between groups (p > 0.05). Supratherapeutic doses of modafinil may have the potential to cause ischemic cardiac damage and atrioventricular blockage, despite inconsistency with literature findings; however, this does not pertain to hemodynamic changes.

BackgroundWhite-coat hypertension (WCH) is a disease based on the disparity of a patient-s blood pressure measurements between the physician-s office and the patient-s home environment. The aim of the present study is to evaluate the left atrial (LA) volume and functions in WCH.MethodsIn total, this study included 37 WCH (17 women, 20 men, mean age 48.45.7 years) and 30 healthy individuals (18 women, 20 men, mean age 47.97.5 years). All patients underwent real-time three-dimensional and comprehensive two-dimensional echocardiography (2DE) with tissue Doppler evaluation to estimate left atrial volumes and mechanical functions.ResultsLA diameters were significantly higher in the patients compared with the controls (37 +/- 2.8 vs. 35 +/- 3.1mm, P=0.017). LA total systolic volume and LA maximal volume were significantly higher in the patients. (41.1 +/- 6.9 vs. 35.5 +/- 3.7ml, P

Objective The aim of this study was to evaluate left atrial (LA) volume and function using real time three-dimensional echocardiography (RT3DE) in patients with cardiac syndrome X (CSX). Methods Fifty patients with CSX (28 females; mean age 50.9±10.9 years) and 50 age- and gender-matched healthy controls (30 females; mean age 52.3±9.8 years) who had negative treadmill exercise test and normal coronary arteries on invasive coronary angiography were included in the study. Comprehensive two-dimensional (2D), pulsed and tissue Doppler, speckle tracking echocardiography, and RT3DE for the assessment of LA dynamics were performed in all study participants. Results Cardiac syndrome X and control groups have similar clinical characteristics regarding age, sex, body mass index, hypertension, diabetes, and smoking habit. 2D echocardiographic parameters were also similar between groups. Pulsed- and tissue Doppler parameters, IVRT, A, and Am values, were higher in CSX group, while Em, E/A, and Em/Am ratios were higher in the control group reflecting mild diastolic dysfunction. Regarding RT3DE parameters, LA maximum volume, minimum volume, volume before atrial contraction, LA maximum volume index, total and active stroke volumes were found to be increased in CSX patients. However, LA total stroke fraction, passive stroke volume, passive stroke fraction, peak systolic, and diastolic longitudinal strains were found to be lower in CSX patients. Conclusion The main finding of this study was that CSX patients had altered LA booster pump, reservoir, and conduit functions. This finding may have clinical implications for early detection of abnormal LA dynamics in CSX patients.

Behçet disease (BD) is a multisystemic disorder characterized by endothelial dysfunction and inflammation. Monocyte to high-density lipoprotein cholesterol ratio (MHR) is a recently emerged indicator of inflammation and oxidative stress. Sixty patients with BD and 50 control individuals were included to investigate the relationship between MHR and endothelial dysfunction. Endothelial function was assessed by flow- and nitroglycerin-mediated dilatation technique (FMD and NMD, respectively). Serum high-sensitivity C-reactive protein (hsCRP) levels were measured in all study participants. The MHR and hsCRP levels were significantly higher in patients with active BD than in controls. Brachial artery FMD was significantly lower in patients with active BD than in controls. Brachial artery NMD was similar between groups. There was a strong inverse correlation between MHR and FMD and a strong positive correlation between MHR and serum hsCRP levels. Thus, elevated MHR may be a useful marker reflecting impaired endothelial function and systemic inflammation in patients with BD.

Objective To evaluate left atrial (LA) volume and functions in obese subjects using real time three-dimensional echocardiography (RT3DE) and also the relationship between LA mechanical functions and N-terminal pro-atrial natriuretic peptide (NT-proANP). Methods This study included 40 obese (26 females and 14 males, mean age 51.9 years) and 40 normal weight subjects (23 females and 16 males, mean age 53.5 years) with normal coronary angiograms. All the study participants underwent RT3DE to assess LA volume and mechanical function. Plasma NT-proANP was determined by ELISA method. Results There was no significant difference between groups in left ventricular (LV) diameters and ejection fraction, which reflect LV systolic function. However, transmitral deceleration time, isovolumetric relaxation time, and peak late diastolic tissue Doppler velocity values, which reflect LV diastolic function, were found to be significantly higher in obese subjects when compared with controls. LA maximum volume (LAVmax), LAVmax index (LAVI), LA minimal volume (LAVmin), before atrial contraction volume (LAVpreA), LA active emptying volume, LA total emptying volume, and LA active emptying fraction, which reflect LA reservoir and pump functions, were also higher in obese subjects when compared with controls. LA passive emptying fraction was significantly lower in obese subjects than in controls. NT-proANP levels were similar between groups. There were positive correlations between NT-proANP level and LAVI, LAVmax, LAVmin, LAVpreA, and LA total and active emptying volumes. Conclusions Left atrial mechanical functions and volumes are impaired in obese subjects. These findings may be regarded as early markers of subclinical cardiac failure in obese subjects who have not yet exhibited any clinical evidence of cardiovascular disease.

Objective Ramadan fasting is one of the five fundamental rituals of Islam. Heart rate variability (HRV) is an independent predictor of increased mortality of patients with myocardial infarction and congestive heart failure. Although many patients in this region fast once a year, the effects of fasting on the HRV, which has a prognostic significance for patients with myocardial infarction and congestive heart failure, are not known. Therefore, the study on the effects of one month fast of HRV in healthy volunteers seems to be reasonable to address. Methods Our study is a prospective cohort study that includes a total of 40 healthy volunteers with sinus rhythm between 19 and 40 years of age (16 female and 24 male). HRV was determined twice by ambulatory 24-hour Holter recordings at fasting in the middle of Ramadan and first week after Ramadan month. Mean values of continuous variables were compared by using the Student t-test or Mann-Whitney U test. Paired t-test or Wilcoxon test were used for comparison of variables between groups. Results When two groups compared, statistically significant differences were found in terms of RR (p=0.049), SDNNI (p=0.010), rMSSD (p=0.009), pNN50 (p=0.015), T power (p=0.009), LF (p=0.008), Lfnu (p=0.002), HF (p=0.022) and Hfnu (p=0.013) values. Conclusion In our study, HRV parameters were found to be increased in Ramadan month, so we think that Ramadan fasting enhances the activity of the parasympathetic system.

Summary Background Endothelial dysfunction plays a key role in the aetiopathogenesis of slow coronary flow (SCF) even if there is no obstructive epicardial lesion. Reduced plasma levels of endothelial nitric oxide synthase (eNOS) are an important indicator of endothelial dysfunction. We aimed to determine plasma levels of eNOS and their relationship with exercise in patients with SCF. Methods Twenty-two patients with SCF in at least one coronary artery and 17 healthy individuals were included in this study. The TIMI frame count method was used to determine SCF. Plasma levels of eNOS before and after effort were determined in the patient and control groups. Results Basal eNOS levels in the patient group were lower than in the control group (p = 0.040), and plasma eNOS levels after exercise decreased more significantly in the patient group compared to the control group (p = 0.002). Median decreases of eNOS in response to exercise were higher in the SCF group than in the control group (p < 0.001), and the decrease observed in the control group was not statistically significant (p = 0.35). There were significantly negative correlations between TIMI frame count and plasma levels of eNOS at baseline and after exercise (r = –0.51, p = 0.015, r = –0.58, p = 0.005, respectively). Moreover, there was also a positive correlation between the rate–pressure product and plasma levels of eNOS after exercise in patients with SCF (r = 0.494, p = 0.019). Conclusion Our findings indicate an important pathophysiological relationship between the severity of SCF in which endothelial dysfunction plays a role in its pathogenesis and the level of circulating plasma levels of eNOS.

Objective: The aim of this study was to evaluate left ventricular (LV) systolic strain by speckle tracking echocardiography (STE) and real-time three-dimensional echocardiography (3-DE) for the early detection of myocardial dysfunction in patients with cardiac syndrome X (CSX). Methods: We compared 34 patients with CSX (18 females, mean age 47.9±10.0 years) with 41 healthy persons as a control group (23 females, mean age 50.6±9.9 years). Inclusion criteria for CSX were typical angina, a positive exercise ECG stress test, and angiographically documented normal coronary arteries. Exclusion criteria for both groups were hypertension, valvular heart disease, cardiomyopathies, inflammatory diseases, myocarditis, vasculitis, arthropathies, Tietze's syndrome, gastrointestinal diseases, aortic diseases, hormone replacement therapy, arrhythmias, liver diseases, and alcohol use. All subjects underwent two-dimensional STE and 3-DE to assess resting LV function. STE measures were taken from the basal septum, mid-septum, apical septum, apex, apicolateral, mid-lateral, basal lateral, anteroseptal, anterior, anterolateral, inferolateral, inferior, and inferoseptal walls. Student's t-test, Mann–Whitney U test, and chi-square test were used to statistically analyze data. Results: LV echo ejection fraction (EF) and systolic wave peak velocity were similar for both groups. Regional mean longitudinal strain (-17.7±2.5% vs. -19.8±1.8%; p

Objective: Non-dipper hypertension is associated with an increased cardiovascular morbidity and mortality. Besides this, the left atrial (LA) size and functions are accepted to be prognostic factors in various cardiovascular diseases. In this study, we aimed to evaluate the effect of non-dipper hypertension on LA volume and functions using real-time three-dimensional echocardiography (RT3-DE). Methods: Forty dipper and 52 non-dipper hypertensives enrolled in this prospective cross-sectional study. Patients with any comorbidities that have a potential for causing structural cardiac alterations were excluded. Two-dimensional echocardiography (2-DE) and RT3-DE were performed to assess LA volumes and functions. The statistical tests used in this study were Shapiro–Wilk's test, Student's t-test, Mann–Whitney U test, chi-square test, Spearman's test, and Pearson's correlation test. Results: LA minimal volume, LA volume before LA contraction, and LA total systolic volume were higher in non-dipper hypertensives than in dipper hypertensives (p

We are reporting the case of a 64-year-old woman with acute inferior ST elevation myocardial infarction with right ventricular infarction. She underwent primary angiography which revealed total occlusion of distal right coronary artery (RCA) by thrombus. Three runs of aspiration were performed and the thrombus was aspirated from RCA without additional ballooning or stenting. Postaspiration angiography revealed normal TIMI-3 flow down with the resolution of the thrombus and a residual noncritical trombus was seen also. She was started on glycoprotein (GP) IIb-IIIa inhibitor tirofiban for 48 h. A new angiography performed on the 4th post-intervention day and TIMI-3 flow down was seen in RCA with complete disappearance of the residual thrombus. Key words: Intracoronary thrombus, acute myocardial infarction, thrombus aspiration.

The aim of this study was to evaluate the relationship between cigarette smoking and atrial rhythm disorders with the use of noninvasive methods.The study population consisted of 50 healthy volunteer smokers and 40 healthy volunteer non-smokers who had normal echocardiographic parameters and similar sex and age profiles. P-wave dispersion (PWD) was calculated from the 12-lead surface ECG. Left ventricle (LV) end-systolic and end-diastolic diameters, LV ejection fraction, and interatrial and intraatrial electromechanical delay were measured by tissue Doppler imaging and conventional echocardiography.Isovolumetric relaxation time and deceleration time were significantly higher (91.5 ± 11 vs. 82.35 ± 8.6, p 0.0001; 215.7 ± 37.1 vs. 175.3 ± 17.7, p 0.0001, respectively), and HDL cholesterol was significantly lower in smokers (39.34 ± 7.5 vs.44.3 ± 8.07, p = 0.003). There were no significant differences between the groups with respect to Sm and Em values, Am value, and E/A and E/Em ratios. However, the Em/Am ratio was significantly lower in smokers (1.28 ± 0.21 vs. 1.44 ± 0.33, p 0.006). Inter- and intraatrial electromechanical delay were significantly higher in smokers when compared with non-smokers (51.11 ± 1.54 vs. 27.30 ± 3.36, p 0.0001, and 30.63 ± 3.2 vs. 12.24 ± 3.26, p 0.0001, respectively). The amount of smoking was strongly correlated with interatrial electromechanical delay (r = 0.567, p 0.0001), and a significant correlation was detected between PWD and interatrial electromechanical delay (r = 0.653, p = 0.001).We have demonstrated the relationship between inter- and intraatrial electromechanical delay and PWD. These parameters may be useful predictive markers for the development of AF in the asymptomatic period before cardiac rhythm disturbances occur. This finding may indicate that smokers have an increased risk of developing atrial rhythm disturbances.

Non-dipper hypertension is associated with increased cardiovascular morbidity and mortality. We aimed to evaluate serum gamma-glutamyl transferase (GGT) level, which is accepted as a marker for oxidative stress and its relationship with inflammatory activity in patients with non-dipper hypertension. Age and sex matched 43 dipper hypertensive patients, 40 non-dipper patients, and 46 healthy subjects were included into the study. Serum GGT and C-reactive protein (CRP) levels were measured and compared between each of the groups. Serum GGT activity was higher in the non-dipper and the dipper hypertensive groups than in the control group (33.5 +/- 11.8 and 28.1 +/- 10.1 U/l, respectively, vs. 21.2 +/- 6.5U/l; p < 0.001). There was a statistically significant difference in serum GGT activity between the non-dippers and the dippers (p = 0.021). When compared with the control group, serum CRP levels were significantly increased in both the non-dipper and the dipper hypertensive groups (6.1 +/- 2.6 and 5.4 +/- 2.1 mg/l, respectively, vs. 2.8 +/- 1.7mg/L; p < 0.001). Increased CRP levels were higher in non-dippers than dippers (p = 0.046). A significant correlation was found between GGT and CRP measurements (r = 0.37, p = 0.002). Serum GGT levels, which are markers of the oxidative stress and CRP levels, are both increased in non-dipper hypertension. Increased GGT activity, found to be correlated with CRP levels, may be one of the reasons behind the non-dipper hypertension related cardiovascular complications.

This study evaluated heart rate variability and its changes in 30 patients before and after transcatheter closure of secundum atrial septal defects. Heart rate variability data from 30 healthy volunteers with normal echocardiographic parameters and no history of atrial septal defects were included as controls. Values for the SD of all the normal RR intervals (SDNN), the SD of the means of all the 5-min segment normal RR intervals (SDANN), and the mean of all the 5-min SDs of normal RR intervals during the 24-h period (SDNN index) in patients with atrial septal defects before transcatheter closure were statistically significantly different from controls. At 6 months after closure of the defects these values were not statistically different from controls. It is concluded that transcatheter closure of secundum atrial septal defects had positive effects on heart rate variability and, consequently, may contribute to less mortality and morbidity.

The relationship between Behcet-s disease (BD) and platelet aggregation has not sufficiently been investigated yet. Mean platelet volume (MPV) is a marker of platelet function, and the increase in MPV has been identified as an independent risk factor of recurrent vascular events. BD is characterized by a relapsing vasculitis of the venous as well as arterial thrombosis. However, the precise pathogenic mechanisms underlying thrombotic tendency in BD are not known. We hypothesized that there might be an association between thrombotic complication and MPV in these patients. Therefore, we investigated activation of platelets in patients with BD using a simple marker, MPV, the most accurate measure of platelet size. A total of 60 patients with BD and 40 age- and gender-matched controls were included. The BD patients were divided into subgroups based on the presence (n = 22) or absence of thrombosis (n = 38) and clinically active (n = 30) or inactive (n = 30) state. MPV was higher in patients with BD than controls (8.14 +/- 0.8 vs. 7.48 +/- 0.3 fl, p = 0.001). Among BD patients, MPV was larger in patients with thrombosis than those without thrombosis (8.45 +/- 1.0 vs. 7.96 +/- 0.7 fl, p = 0.038). However, there was no significant difference in MPV between BD patients with active and inactive states. The increase in MPV is independent of the disease activity, and the presence of thrombosis is associated with higher MPV in BD patients. Therefore, antiplatelet therapy may be useful to prevent thrombotic complications in BD patients.

Background: Transient ischemic attack (TIA) is presumed to be of cardiovascular origin. The aim of the study was to evaluate the electrocardiographic, echocardiographic, and clinical signs for predicting TIA recurrence. Methods: A total of 100 consecutive patients presenting with a first episode of TIA without atrial fibrillation, previous stroke, and uncontrolled diabetes or hypertension were enrolled in the study. The electrocardiographic, echocardiographic, and clinical parameters were obtained in those patients. The patients received a follow-up of bimonthly visits and were grouped according to the presence (or lack) of TIA recurrence in the follow-up period. Results: Of these patients, 23 experienced recurrent TIA and 72 did not; 5 patients dropped out. Independent risk factors evaluated for TIA recurrence were aortic diameter, left atrial diameter, P-wave dispersion, hyperlipidemia, absence of lipid lowering, and warfarin treatment. Conclusion: Careful electrocardiographic and echocardiographic evaluation of patients with TIA may help assess the outcome of patients and guide therapeutic interventions.

Anomalous right coronary artery is a rare entity. Here we present an anomalous right coronary artery coursing on the right atrium detected during CABG operation and confirmed by multislice computed tomography thereafter. The images demonstrated that RCA arises from the right coronary sinus of Valsalva and runs forward between the pulmonary trunk and the right auricle. Then it was giving branch to the right ventricle and coursing approximately 0.5 cm on the right side of atrioventricular junction on the right atrium. Key words: Coronary Vessel Anomaly; Coronary Artery Bypass; Coronary Disease., Sağ koroner arter anomalisi nadir bir anomali olup CABG operasyonu esnasında sağ atrium üzerinde seyrettiğini tespit ettiğimiz ve daha sonra da multislice bilgisayarlı tomografi ile kanıtladığımız sağ koroner arter anomalisini sunmayı amaçladık. Görüntülerde sağ koroner arterin, sağ koroner sinüsünden çıkmakta ve ana pulmoner arter ile sağ aurikula arasında ilerlemekte olduğu izledik. Anormal arter sağ ventrikül dalını verdikten sonra atrioventriküler bileşkenin 0,5 cm sağında sağ atrium üzerinde seyretmekte idi. Anahtar kelimeler: Koroner Damar Anomalisi; Koroner Arter Bypass; Koroner Hastalık.

A 55-year-old woman with stable angina pectoris who had undergone elective coronary catheterization five years ago, no coronary artery disease had been reported at that time. Recent noninvasive stress testing was performed and the result was positive. Coronary angiography was repeated by using iodinated contrast medium. At catheterization, no angiographically significant coronary stenoses was found. About 36 hours after coronary angiography she presented to the emergency department for swelling of face and throat bilaterally. Her parotid glands were diffusely and symmetrically enlarged to twice the normal size and glands were firm and non-tender. This case had taken iodinated contrast medium before and she had the same symptoms. So she might be an example of recurrent parotitis caused by repeated iodide exposure. (Hong Kong j.emerg.med. 2011;18:421-423)

Behçet's disease is characterized by increased inflammatory activity, and there there might be an increased risk of atrial arrhythmia in patients with this disease. Our study is aimed to evaluate a novel method of measuring atrial electromechanical features expressed as interatrial and intraatrial electromechanical delay by tissue Doppler echocardiography in patients with Behçet's disease.We evaluated 57 patients (mean age: 36.3±12.1 years) with Behçet's disease and 34 sex and age matched healthy volunteers (mean age: 38.4±8.6 years) as control group. P-wave dispersion (PWD) was calculated from the 12-lead surface ECG, interatrial and intraatrial electromechanical delay were measured by tissue Doppler imaging and conventional echocardiography.Interatrial electromechanical delay and intraatrial electromechanical delay were prolonged in patients with active Behçet's disease compared with the patients with inactive disease and the controls (p0.0001, p0.0001, p=0.013 and p=0.001, respectively). Erythrocyte sedimentation rate and high-sensitivity C-reactive protein values of of patients with active Behçet's were significantly higher than those with inactive Behçet's disease and the controls (p0.0001 and p0.0001, respectively). High-sensitivity C-reactive protein and erythrocyte sedimentation rate were correlated with interatrial electromechanical delay in patients with Behçet's disease (r=0.44, p=0.001 and r=0.64, p0.0001, respectively).The prolongation of atrial electromechanical conduction might be related with changes in structure and electrophysiological properties of the atrial myocardium or the conduction system in patients with active Behçet's disease.

A 49-year-old woman who had idiopathic thrombocytopenic purpura was admitted to our hospital with severe chest pain. Electrocardiography revealed inferolateral myocardial infarction. The patient underwent immediate coronary angiography, which revealed thrombi in the left coronary system. Percutaneous intervention was not indicated, because the thrombi had occluded the distal segments of multiple coronary arteries. Administration of tirofiban satisfactorily dissolved the thrombi.

The aim of this study was to evaluate left atrial (LA) volume and mechanical functions by real time three-dimensional echocardiography (RT3DE) in prehypertensive subjects. The study included 54 (34 male and 20 female) prehypertensive subjects and 36 (14 male and 22 female) healthy control subjects. Transthoracic echocardiography and RT3DE were performed in all patients. Interventricular septum thickness and isovolumetric relaxation time were significantly higher in prehypertensives than in controls (10.7 +/- 0.7 vs. 10.1 +/- 0.8 P = 0.001 and 89.9 +/- 10 vs. 82.4 +/- 11 P = 0.002, respectively). LA maximum volume, volume before atrial contraction, total and active stroke volume, total and active emptying fractions, expansion index, and LA max volume index were significantly higher in prehypertensives when compared with controls (P < 0.0001 for all). However, the passive emptying fraction was significantly lower in prehypertensives than controls (45.7 +/- 5.6 vs. 48.6 +/- 4.1, P = 0.006), and the minimum LA volume between the two groups was similar. The main finding of this study was that although LA volume and LA active systolic functions were significantly increased in prehypertensive people, there was a reduction in passive LA systolic functions. These parameters may be important in showing hemodynamic and structural changes in cardiac tissue caused by prehypertension. (Echocardiography 2012;29:1211-1217)

In recent studies, novel corticotropin releasing factor (CRF)- related peptides, named Ucn-1, Ucn-2, and Ucn-3 have been identified (1-3). The actions of these peptides are mediated by binding to two G-coupled receptors; CRF receptor type 1 and 2 (CRF-R1, CRF-R2) (1-4). CRF-R1 is found predominantly in the pituitary and brain regions, whereas the CRF-R2 is more localized in the heart chambers and peripheral vascular system (1-6). Although Ucn-1 binds to both receptors, Ucn-2 and Ucn-3 show more affinity to CRF2 receptor (2, 3). Kimura et al. (7) reported that urocortins and CRF2 receptor were detected in all chambers of human hearts, especially in the left ventricle. The available evidence from animal models and human clinical studies indicate that urocortins have many important pathophysiological and regulatory roles in the cardiovascular system. These effects of urocortins can be summarized as follows; a dose-dependent increase in heart rate, cardiac output, coronary blood flow (8), coronary vasodilatation and positive inotropic effect (9), protection against ischemic and reperfusion injury in ventricular myocytes, a diminution in free radical damage following myocardial infarction (10, 11), stimulation of cardiac natriuretic peptide secretion, decrease in left atrial pressure and peripheral vascular resistance (12), decrease in blood pressure, reduction of serum catecholamine levels in hyperadrenergic hypertension (13)., Amaç: Urocortin (Ucn) hormonları kardiyovasküler sistemde önemli rol oynamaktadır. Sistolik işlev bozukluğu (SD) dışında, diyastolik işlev bozukluğu (DD) veya koroner arter hastalığının (KAH) serum Ucn-2 ile ilişkisine dair yeterli veri bulunmamaktadır. Bu çalışmamızda SD, DD ve KAH’da serum Ucn-2 düzeyini araştırdık. Yöntemler: Bir gözlemsel enine-kesitli olan bu çalışmanın popülasyonu KAH ön tanısı ile koroner anjiyografi işlemine alınan bireyler arasından belirlendi. Koroner anjiyografi sonrası ekokardiyografi yapılarak 86 kişi seçildi. Ucn-2 ile SD arasındaki ilişkiyi araştırmak için ejeksiyon fraksiyonu (EF) farklı üç grup oluşturuldu: orta-ileri düzey SD olanlar (Grup A, EF=%33.6), hafif-orta SD olanlar (Grup B, EF=%46.1) ve SD olmayanlar (Grup C, EF= %64.5). Ayrıca, DD sahip olan ve olmayanlar (EF≥ %45) arasında ve KAH’ı olan ve olmayanlar (EF≥ %55) arasında da Ucn-2 düzeyi karşılaştırıldı. İstatistiksel analizde tek yönlü ANOVA, Kruskal-Wallis, Ki-kare, Mann-Whitney U, Spearman korelasyon ve çoklu regresyon testleri kullanıldı. Bulgular: Grup C’ye göre, Ucn-2 düzeyinin Grup A’da azaldığı ve Grup B’de arttığı saptandı (Grup A, B ve C’de sırasıyla Ucn-2; 9.4±3.4, 12.8±3.6 ve 10.4±3.9 pg/mL, p=0.003). SD’den farklı olarak; Ucn-2 düzeyi bakımından, DD olan ve olmayanlar arasında (11.4±4.1 ve 11.7±3.9 pg/mL, p=0.8) veya KAH olan ve olmayanlar arasında (10.7±4.7 ve 10.2±3.2 pg/mL, p=0.7) anlamlı bir fark saptanmadı. Sonuç: Serum Ucn-2 düzeyi hafif-orta sistolik disfonksiyonda yükselmektedir. Ancak, DD (azalmış gevşeme bozukluğu) veya KAH’ın (miyokart enfarktüsü olmadan) serum Ucn-2 düzeyini etkilemediği görülmektedir. (Anadolu Kardiyol Derg 2012; 12: 115-20)

Objective: The aim of our study was to evaluate serum uric acid level and its relationship with carotid intima-media thickness (CIMT) in patients with cardiac syndrome X (CSX). Subjects and Methods: A total of 50 patients with CSX (28 females/22 males, 51.0 ± 10.9 years) and 40 controls (27 females/13 males, 53.0 ± 10.2 years) were included in the study. All subjects underwent a noninvasive stress test and conventional coronary angiography. Serum uric acid levels were measured and B mode ultrasonography was performed to assess CIMT in all subjects. Results: Serum uric acid levels were higher in patients with CSX than in the control subjects (5.1 ± 1.8 vs. 3.9 ± 1.3 mg/dl; p = 0.002). The CIMT was higher in patients with CSX than in the control subjects (0.75 ± 0.18 vs. 0.63 ± 0.09 mm; p < 0.001). A significant correlation was found between serum uric acid values and CIMT measurements in patients with CSX (r = 0.666, p < 0.001). Conclusions: Serum uric acid levels were higher in patients with CSX and elevated serum uric acid levels were associated with carotid atherosclerosis, thereby indicating that elevated serum uric acid levels might contribute to the development of subclinical atherosclerosis in CSX patients.

OBJECTIVE Cardiomyopathy (CMP) is a disorder associated with an increased risk of thromboembolism due to blood stasis, platelet activation and altered coagulation status. In this study, we aimed to investigate mean platelet volume (MPV) in patients with idiopathic CMP and ischemic CMP and to compare with those of the controls, and aimed to determine whether there is a relationship between MVP and echocardiographic parameters in patients with CMP. METHODS This study was designed as an observational cross-sectional study. A total of 100 subjects with idiopathic CMP (n=35), ischemic CMP (n=35) and controls (n=30) were included in the study. The MPV values were measured in all participants. All subjects underwent transthoracic echocardiography and angiographic evaluation. We used Chi-square test, one-way ANOVA and Pearson correlation tests for statistical analysis. RESULTS The MPV values were significantly higher in patients with idiopathic CMP and ischemic CMP than those of the controls (9.03±1.3 and 8.77±0.9 vs. 7.95±1.0 fl, respectively, p

Saddle pulmonary embolism is defined as a visible thromboembolus straddling the bifurcation of the main pulmonary artery. It is very unusual to visualize a pulmonary artery thrombus on transthoracic echocardiography. We describe a case of a saddle embolus of the main pulmonary artery visualized by real time three-dimensional echocardiography and successfully treated with intravenous unfractionated heparin, followed by oral anticoagulation achieving a complete dissolution of the thrombus.

Left atrial free-floating thrombus is a rare disorder, which has a high embolic potential and may also cause sudden death because of the occlusion of the mitral orifice. In the evaluation of intracardiac masses, real-time three-dimensional echocardiography (RT3DE) appears to be a new promising technique, which acquires a definite information …

The aim of this study was to evaluate the left ventricular (LV) systolic strain by speckle tracking echocardiography (STE) in order to provide the early detection of myocardial dysfunction in patients with Behcet's disease (BD). We also aimed to examine the relationship between LV systolic strain and N-terminal pro-B type natriuretic peptide (NT-proBNP), which is a cardiac biomarker of ventricular dysfunction. Methods and results Longitudinal and circumferential systolic strain assessed by STE was obtained in 32 BD patients and 27 age-matched controls. NT-proBNP levels were also measured in all subjects. Regional and mean longitudinal strain (217.8+ 2.7 vs. 220.5+ 1.8%; P , 0.0001) was significantly lower in BD patients when compared with the healthy controls. Whereas regional and mean circumferential strain values (222.0+ 1.6 vs. 222.2+ 2.3%; P ¼ 0.62) did not reveal a significant difference between the patients and the controls. NT-proBNP was significantly higher in the patients than in the controls (65.18+ 84.51 vs. 30.84+ 14.75 pg/mL; P ¼ 0.003). Linear regression analyses revealed only NT-proBNP as the independent correlate of mean LV longitudinal strain (R ¼ 0.603, P ¼ 0.001). Conclusion Longitudinal myocardial systolic function assessed by STE, which is a sensitive marker of subclinical ventricular dys- function is impaired in BD. Increased NT-proBNP levels may be a sign of subclinical ventricular dysfunction in these patients.

Background. The lack of nocturnal BP fall less than 10% of the daytime, called non-dipper hypertension, is associated with increased cardiovascular morbidity and mortality. The aim of our study was to investigate atrial conduction time in patients with non-dipper hypertension using electromechanical coupling interval and P-wave dispersion (PWD), measured with the surface electrocardiogram and tissue Doppler echocardiographic imaging (TDI). Methods. Age-and sex-matched 43 dipper hypertensive patients (19 male, 24 female, mean age: 53.9 +/- 10.5 years), 40 non-dipper patients (18 male, 22 female, mean age 54.3 +/- 9.6 years) and 46 healthy subjects (22 male, 24 female, mean age: 52.8 +/- 9.6 years) were included in the study. The difference between the maximum and minimum P-wave durations was calculated and defined as PWD. Atrial electromechanical coupling (PA), inter-atrial and intra-atrial electromechanical delays were measured with TDI. Results. PWD was significantly higher in patients with non-dippers compared with dippers (p < 0.02) and controls (p < 0.001). The inter-atrial conduction time was delayed in non-dippers compared with dippers (p < 0.01) and controls (p < 0.001). There was a positive correlation between left atrial (LA) diameter and inter-atrial conduction times (r = 0.46, p < 0.001). LA diameter was also correlated with PWD (r = 0.44, p < 0.001). Conclusion. The patients with non-dipper hypertension have higher P-wave duration, PWD and delayed inter-atrial electromechanical coupling intervals compared with those of dippers and controls. This indicates that these subjects may be more prone to atrial rhythm disturbances.

Prehypertension is a predictor for the future development of hypertension and represents an increased risk for cardiovascular morbidity and mortality. Prolonged intra/interatrial conduction times demonstrated by P wave dispersion (PD) and tissue Doppler echocardiography (TDE) are related to the development of atrial fibrillation. The aim of this study was to evaluate atrial conduction time by PD and TDE in patients with prehypertension.In 46 prehypertensive patients (22 males, 24 females; mean age 56.5±12.3 years) and 39 normotensive healthy controls (19 males, 20 females; mean age 55.8±11.7 years), we measured P wave duration and dispersion on 12-lead electrocardiography, and atrial electromechanical coupling intervals (PA) by TDE.Maximum P wave duration (Pmax) and PD were prolonged in prehypertensives compared to controls (Pmax 110.1±13.8 vs. 91.4±7.7 msec, p0.001; PD 55.7±11.1 vs. 36.8±5.7 msec, p0.001). Atrial PAs measured at the lateral and septal mitral annuluses were significantly delayed in the prehypertensive group (lateral PA 76.5±10.1 vs. 65.4±10.4 msec, p0.001; septal PA 59.0±6.4 vs. 53.5±7.5 msec, p=0.002). Both interatrial (lateral PA-tricuspid PA) and intra-atrial (septal PA-tricuspid PA) conduction times were delayed in the prehypertensive group (25.8±9.3 vs. 17.0±9.5 msec, p0.001; 9.2±3.7 vs. 6.7±3.0 msec, p=0.008, respectively). Correlation analysis showed that both Pmax and PD were correlated with interatrial (r=0.38, p0.001 and r=0.40, p0.001, respectively) and intra-atrial (r=0.31, p=0.01 and r=0.38, p0.001, respectively) electromechanical delays.Our finding of significant prolongation of atrial electromechanical coupling and PD may indicate an increased risk for the development of atrial fibrillation in prehypertensive subjects.

We aimed to evaluate serum gamma-glutamyl transferase (GGT) activity and its relationship with carotid intima media thickness (CIMT) in patients with cardiac syndrome X (CSX).The study population consisted of 40 patients with CSX, 35 controls and 40 patients with coronary artery disease (CAD). All patients underwent a noninvasive stress test and conventional coronary angiography. Serum GGT and C-reactive protein (CRP) levels were measured and CIMT was assessed in all subjects.Serum GGT activity was higher in the CSX and the CAD groups than in the control group (32.6 +/- 16.0 and 30.4 +/- 15.3 U/L, respectively, vs. 17.9 +/- 4.2 U/L; P0.001). There was no statistically significant difference in serum GGT activity between the CSX and the CAD groups. When compared to the control group, serum CRP levels were significantly increased in both the CSX and the CAD groups (4.1 +/- 2.0 and 4.7 +/- 2.6 mg/L, respectively, vs. 2.2 +/- 1.8 mg/L; P0.001). Patients with CSX and CAD had significantly higher CIMT values than the controls (0.74 +/- 0.17 and 0.94 +/- 0.12 mm, respectively, vs. 0.62 +/- 0.08 mm; P0.001). A significant correlation was found between GGT activity and CIMT measurements (r = 0.640, P0.001), but serum GGT activity did not correlate with serum CRP levels in patients with CSX (r = 0.277, P0.05).The present study showed that serum GGT activity in patients with CSX was as high as those in patients with CAD. Increased GGT levels may play a role in the pathogenesis of the microvascular atherosclerotic process of CSX.

The interaction between moderate-to-severe obstructive sleep apnea (OSA) and cardiac arrhythmias, especially atrial fibrillation (AF), is well known. We aimed to determine whether atrial electromechanical parameters assessed by tissue Doppler imaging (TDI) would be affected in moderate-to-severe OSA, and detect the influential factors of atrial electromechanical parameters in these patients. Interatrial and intra-atrial electromechanical delay was measured by TDI in patients with moderate-to-severe OSA (n = 64) and control subjects (n = 39). P-wave dispersion (PWD) was calculated on the 12-lead ECG. Interatrial and intra-atrial electromechanical delay was significantly higher in the OSA group when compared with the controls (52.26 ± 12.9 vs 29.61 ± 11.26, P

Behçet’s disease (BD) is a multisystemic disorder characterized by endothelial dysfunction. However, the relationship between oxidative stress and endothelial function has not been clearly shown. We investigated the relationship between oxidative stress markers and endothelial function in patients with BD. Patients with BD (n = 40) having active disease and sex- and age-matched 40 controls were included. Endothelial function was assessed by flow-mediated dilatation (FMD) technique. Serum gamma-glutamyltransferase (GGT) and high-sensitive C-reactive protein levels (hsCRP) were measured in all participants. Brachial artery FMD was significantly lower in patients with BD than in controls. Gamma-glutamyltransferase and hsCRP levels were higher in patients with BD than in controls. Also, GGT and hsCRP levels were inversely correlated with endothelial function. Oxidative stress markers are elevated in patients with BD having active disease. This may be one of the reasons behind the vasculitis in active BD.

SummaryBackgroundRecently, the Occlutech Figulla ASD Occluder (FSO) has been introduced for transcatheter closure of atrial septal defects. This device can be used for transcatheter closure of small as well as large atrial septal defects.AimsTo evaluate the feasibility and short-term results of transcatheter closure of secundum type atrial septal defects using the FSO device in adult patients.MethodsSeventy-four consecutive adult patients were referred for transcatheter closure of secundum large atrial septal defects (“stretched” diameter>20mm and/or invasive pulmonary/systemic flow [Qp/Qs] ratio>1.5) using the FSO device.ResultsThe FSO device was successfully implanted in 68 patients (mean±SD [range] age: 31.8±12.3 [17–64] years; weight: 71.5±18.4 [49–98]kg). All patients had right atrial and ventricular volume overload with a mean Qp/Qs ratio of 2.5±0.6 (range 1.5–3.8). Mean atrial septal defect diameter was 22.3±4.8 (range 12–33)mm and the size of the implanted FSO was 24.1±4.9 (range 12–36)mm. Two patients had trivial (jet width

The aim of our study was to investigate atrial conduction time in patients with mitral annulus calcification (MAC) using P-wave dispersion (PWD) and electromechanical coupling measured with the surface electrocardiogram and the tissue Doppler echocardiography. Fifty-nine patients with MAC and 43 control subjects underwent resting the surface electrocardiogram and tissue Doppler echocardiography. The difference between the maximum (Pmax) and minimum P-wave durations was calculated and defined as PWD. Interatrial and intraatrial electromechanical delays were measured with tissue Doppler echocardiography. Both Pmax and PWD were higher in patients with MAC compared with controls (111.4 +/- 15.8 vs 97.3 +/- 18.8 milliseconds; P < .0001 and 46.4 +/- 14.6 vs 31.4 +/- 13.1 milliseconds; P < .0001, respectively). Both interatial and intraatrial conduction time were also delayed in patients with MAC compared with controls (29.8 +/- 13.3 vs 17.6 +/- 12.5 milliseconds; P < .0001; 9.4 +/- 5.1 vs 6.8 +/- 4.0 milliseconds; P < .008, respectively). Left atrial (LA) diameter was significantly higher in patients with MAC compared with controls (35.4 +/- 5.0 mm vs 32.3 +/- 4.2 mm; P < .001). The LA diameter correlated significantly with both interatrial conduction times and PWD (r = 0.56; P < .0001 and r = 0.47; P < .0001, respectively). There is a delay in both intraatrial and interatrial electromechanical coupling intervals in patients with MAC. (C) 2010 Elsevier Inc. All rights reserved.

Saddle pulmonary embolism is defined as a visible thromboembolus straddling the bifurcation of the main pulmonary artery. It is very unusual to visualize a pulmonary artery thrombus on transthoracic echocardiography. We describe a case of a saddle embolus of the main pulmonary artery visualized by real time three-dimensional echocardiography and successfully treated with intravenous unfractionated heparin, followed by oral anticoagulation achieving a complete dissolution of the thrombus.

Introduction: Right­sided cardiac thrombi may develop due to secondary causes. Their incidence is very low and only a few case reports of right atrial (RA) thrombi exit in literature. Case Report: We report the case of a 56­year­old patient with orthotopic liver transplantation (OLT) about six months back, who was admitted to our clinic with symptoms of worsening chest pain and shortness of breath. Two and three­ dimensional transthoracic echocardiography (3DTTE) and transesophageal echocardiogram (TEE) showed a mobile right atrial thrombus 3.9×1.8 cm in size, traversing the right atrial cavity during the whole cardiac cycle. After one week of therapeutic anticoagulation, the thrombus began to shrink and after three weeks echocardiography confirmed no evidence of residual thrombus. Conclusion: In contrast to previously reported cases of massive RA thrombosis developing intraoperatively during OLT, in our case a RA thrombus developed six months after OLT. The right atrial thrombus was derived from inferior vena cava.