Effects of CPAP on right ventricular myocardial performance index in obstructive sleep apnea patients without hypertension

OBJECTIVES: Obstructive sleep apnoea (OSA) might cause right ventricular dysfunction and pulmonary hypertension. We aimed to determine the effects of nasal continuous positive airway pressure (CPAP) therapy on right ventricular myocardial performance index (MPI) in OSA patients without hypertension. METHODS: 49 subjects without hypertension, diabetes mellitus, any cardiac and pulmonary disease had overnight polysomnography and echocardiography. In 18 moderate-severe OSA (apnea-hypopnea index ≥ 15) patients, right ventricular free wall diameter (RVFWD) was measured by M-mode, and right ventricular MPI was calculated as (isovolumic contraction time+ isovolumic relaxation time) / pulmonary ejection time using Doppler at baseline and after 6 months CPAP therapy. RESULTS: Mean age was 46.5 ± 4.9 year. Patients had high body mass index (BMI: 30.6 ± 4,0 kg/m(2)), but there was no change in either BMI or blood pressures after 6 months. Right ventricular end-diastolic and end-systolic diameters were in normal limits at baseline, and did not change after CPAP usage. Baseline RVFWD (7.1 ± 2.1 mm) significantly decreased after CPAP therapy (6.2 ± 1.7 mm, p < 0.001). 15 of patients (83%) had right ventricular diastolic dysfunction at baseline, and it was completely improved in 11 of them (73%) by CPAP usage. Right ventricular global dysfunction was shown in 11 patients (61%) with a high MPI (62.2 ± 9.3%) at baseline; and MPI was significantly decreased after CPAP therapy (47.3 ± 8.4%, p < 0.0001), and it was completely corrected in 4 of them (36%). CONCLUSION: CPAP therapy significantly decreases RVFWD and improves right ventricular diastolic and global functions (MPI) in OSA patients without hypertension

The evaluation of the relationship between the tissue doppler and isovolemic contaction velocity in patients with hypertension, diabetes or both

Sol ventrikülün diyastolik fonksiyonlarının değerlendirilmesi, kalp yetmezliğinin erken tanısı, tedavisi ve takibi açısından son derece önemlidir. Diyastolik fonksiyonların incelenmesinde en doğru yöntem kalp kateterizasyonudur. Yöntemin invazif olması nedeniyle noninvazif yöntemler tercih edilmektedir. Mitral, pulmoner ven akımları üzerinden diyastolik fonksiyonlar değerlendirilebilmektedir. Ancak bu yöntemleri etkileyen bir çok faktörün bulunması, pulmoner akım kayıtlarının her hastadan elde edilememesi yeni yöntemler arayışını gündeme getirmiştir. Biz bu çalışmada doku doppler görüntülemeyle sol ventrikülün sistolik ve diyastolik fonksiyonlarının değerlendirilmesini amaçladık. Ekim 2006 ile Aralık 2007 tarihleri arasında Pamukkale Üniversitesi Tıp Fakültesi Kardiyoloji Bölümü'ne başvuran hipertansif, diabetik ve kardiyak nedene bağlanamayan yakınmaları olan hastalarda, doku doppler görüntüleme yöntemiyle sol ventrikülün bölgesel sistolik ve diyastolik fonksiyonları retrospektif olarak değerlendirildi. Diyabetik(18), hipertansif(34), hipertansif ve diyabetik hastalardan oluşan karma(32), kontrol(31) gruplarının vücut ağırlığı, boy, vücut kitle indeksleri kaydedildi. Standart ekokardiyografi kayıtları incelenerek sol ventrikül boşluk, duvar çapları, ejeksiyon fraksiyon ölçümleri yapıldı. Pulsed wave Doppler ekokardiyografik incelemede E, A, DT ölçümleri, E/A oranı, isovolemik gevşeme zamanı, isovolemik kasılma zamanı, miyokard performans indeksi elde edildi. Pulsed wave doku Doppler incelemede ortalama E', A', E' ve A' diyastolik süreleri, E' dalgası üzerinden deselerasyon zamanı, isovolemik kasılma ve gevşeme süreleri ile velositeleri değerlendirildi. İsovolemik kasılma dalgası üzerinden akselerasyon zamanı, slope belirlendi. Pulsed wave ekokardiyografi verileri bakımından gruplar arasında istatistiksel fark saptanmadı (p>0,05). E' dalga velosite ve E'/A' oranının ortalaması karma grupta daha düşüktü (p0,005). We found decreased E? wave velocity and the E?/A? ratio in the diabetic and hypertensive groups (p<0,05). The ratio of E/E? was higher in the hypertensive and hypertensive and diabetic groups in comparison to control group (p:0,042, p:0,001). There were no difference in the velocity and time of the isovolemic contraction wave between the groups. There was a strong correlation between the isovolemic contraction peak velocity and different tissue Doppler parameters. E/E? ratio is stronger than E, A velocity and their ratios for the eveluation of diastolic functions. Isovolemic contarction peak velocity shows strong correlation with all the tissue Doppler parameters, so in the future it might gain more priority in the evaluation of diastolic functions

Anomalous origin of the left circumflex coronary artery: A case report

The anomalous origin of the left circumflex coronary artery from the right sinus of Valsalva is a relatively common anatomical variation. Difficulties may occur in the diagnostic procedure, but recognition and adequate visualization of the anomaly is essential for proper patient management, especially in patients undergoing evaluation for percutaneous coronary intervention, coronary artery surgery or prosthetic valve replacement. In the present report, a patient who had undergone percutaneous coronary intervention for a right coronary artery lesion after inferior myocardial infarction is described. The anomalous origin of the left circumflex coronary artery arising independently from the right sinus of Valsalva was previously undetected