Determination of right ventricular dysfunction using the speckle tracking echocardiography method in patients with obstructive sleep apnea

Background: The speckle tracking echocardiography (STE) method shows the presence of right ventricular (RV) dysfunction before the advent of RV failure and pulmonary hypertension in patients with cardiopulmonary disease. We aimed to assess subclinical RV dysfunction in obstructive sleep apnea (OSA) using the STE method. Method: Twenty-one healthy individuals and 58 OSA patients were included. According to severity as determined by the apnea&#8211;hypopnea index (AHI), OSA patients were examined in three groups: mild, moderate and severe. RV free wall was used in STE examination. Results: Right ventricle strain (ST %) and systolic strain rate (STR-S 1/s) were decreasing along with the disease severity (ST &#8212; healthy: &#8211;34.05 &#177; &#8211;4.29; mild: &#8211;31.4 &#177; &#8211;5.37; moderate: &#8211;22.75 &#177; &#8211;4.89; severe: &#8211;20.89 &#177; &#8211;5.59; p < 0.003; STR-S &#8212; healthy: &#8211;2.93 &#177; &#8211;0.64; mild: &#8211;2.85 &#177; &#8211;0.73; moderate: &#8211;2.06 &#177; &#8211;0.43; severe: &#8211;1.43 &#177; &#8211;0.33; p < 0.03). Correlated with the disease severity, the RV early diastolic strain rate (STR-E) was decreasing and the late diastolic strain rate was increasing (STR-E &#8212; healthy: 2.38 &#177; 0.63; mild: 2.32 &#177; 0.84; moderate: 1.66 &#177; 0.55; severe: 1 &#177; 0.54; p < 0.003; STR-A &#8212; healthy: 2.25 &#177; 0.33; mild: 2.32 &#177; 0.54; moderate: 2.79 &#177; 0.66; severe: 3.29 &#177; 0.54; p < 0.03). The STR-E/A ratio was found to be in a decreasing trend along with the disease severity (healthy: 1.08 &#177; 0.34; mild: 1.06 &#177; 0.46; moderate: 0.62 &#177; 0.22; severe: 0.34 &#177; 0.23; p < 0.03). Conclusions: Subclinical RV dysfunction can be established in OSA patients even in the absence of pulmonary hypertension and pathologies which could have adverse effects on RV functions. In addition to the methods of conventional, Doppler and tissue Doppler echocardiography, using the STE method can determine RV dysfunction in the subclinical phase. (Cardiol J 2012; 19, 2: 130&#8211;139

Prognostic Value of the Residual SYNTAX Score on In-Hospital and Follow-Up Clinical Outcomes in ST Elevation Myocardial Infarction Patients Undergoing Percutaneous Coronary Interventions

Aims. We investigated the prognostic significance of residual SYNTAX score (RSS) in patients undergoing PCI due to STEMI and relationship between RSS and in-hospital and long-term ischemic cardiac events. Methods. Between June 2015 and December 2018, 538 patients who underwent primary PCI were evaluated for in-hospital events and 478 patients were evaluated for clinical events during follow-up. Primary and secondary endpoints for both in-hospital and follow-up periods were cardiac death and major adverse cardiac events (MACE). Results. 538 patients were included the study. RSS values of 131 patients were 0, and RSS values of 407 patients were >0. The median value of the RSS > 0 group was 7. According to this value, the RSS > 0 group was divided into 2 groups as R-ICR (RSS < 7, N = 188) and ICR (RSS ≥ 7, n = 219). In the RSS ≥ 7 group, during in-hospital and follow-up period, both mortality and MACE rates were higher than the other two groups. Area under the curve (AUC) for RSS for in-hospital death was found to be higher than SS (p=0.035) but similar to Grace Score (GS) (p=0.651). For MACE, RSS was higher than SS (p=0.025) and higher than the GS (p=0.041). For follow-up cardiac mortality, the AUC of the RSS was found to be higher than SS (0.870/0.763, p=0.02) and GS (0.870/0.733, p=0.001). For MACE, the AUC of RSS was higher than SS (p=0.03) and GS (p=0.004). Conclusions. High RSS values in STEMI patients are associated with increased risk of ischemic cardiac events. RSS may help determine revascularization and level of additional PCI to improve prognosis by reducing the risk of ischemic cardiac events after P-PCI

Relationship between White Blood Count to Mean Platelet Volume Ratio and Clinical Outcomes and Severity of Coronary Artery Disease in Patients Undergoing Primary Percutaneous Coronary Intervention

Background. The white blood cell count to mean platelet volume ratio (WMR) is an indicator of inflammation in patients with atherosclerotic disease. Residual SYNTAX Score (RSS) is an objective measure of degree and complexity of residual stenosis after percutaneous coronary intervention (PCI). We investigated the relationship between WMR and clinical prognosis and RSS in patients undergoing primary percutaneous coronary intervention (P-PCI). Method. Between June 2015 and December 2018, 537 patients who underwent primary PCI were evaluated for in-hospital events, and 477 patients were evaluated for clinical events during follow-up after discharge. The endpoint of our study is major adverse cardiac events (MACEs) seen in the in-hospital and follow-up periods. Results. In our study, 537 patients were stratified into two groups according to admission median WMR. There were 268 patients in the low WMR group (WMR1064 (sensitivity: 83.12%, and specificity: 36.29%) and >1130 (sensitivity: 69.15%, and specificity: 44.91%), respectively. The Kaplan-Meier analysis showed that the high WMR group had the significantly lowest MACE-free survival rate (log-rank test, p=0.006). A moderate correlation was observed between WMR and RSS (r: 456, p=0.002). Conclusion. A higher WMR value on admission was associated with worse outcomes in patients with P-PCI and independently predicted for follow-up MACEs. The WMR provides both a rapid and an easily obtainable parameter to identify reliably high-risk patients who underwent primary percutaneous coronary intervention due to STEMI

Ocena czynności lewego przedsionka metodą echokardiografii dwuwymiarowej z algorytmem śledzenia markerów akustycznych u osób w schyłkowym stadium choroby nerek z zachowaną frakcją wyrzutową lewej komory

Background: Left atrial (LA) deformation analysis by two-dimensional speckle tracking echocardiography (2D-STE) has recentlybeen proposed as an alternative approach for estimating left ventricular (LV) filling pressure and dysfunction.Aim: To assess the LA myocardial function using 2D-STE in end-stage renal disease (ESRD) patients with preserved LV ejectionfraction (PLVEF) and to evaluate the relationship of the obtained results with echocardiographically estimated pulmonarycapillary wedge pressure (ePCWP).Methods: Eighty-five ESRD patients and 60 healthy individuals were enrolled in the study. Images of the LA were acquiredfrom apical two- and four-chamber views. The LA volumes (LAV) were calculated using the biplane area-length method.The LA volume indices (LAVI) were calculated by dividing the LA volumes by the body surface area. The LA strain (%) (LAS)parameters (systolic [LAS-S], early diastolic [LAS-E], late diastolic [LAS-A] during atrial contraction) were assessed, and the ePCWPwas calculated according to the following formula: ePCWP = 1.25(E/E’) + 1.9. LA stiffness was calculated non-invasively andbased on the ratio of E/E’ to LAS-S.Results: In patients with ESRD, the LAS-S (32.22 ± 7.64% vs. 57.93 ± 8.71%; p &lt; 0.001), LAS-E (–15.86 ± 5.7% vs. –33.37 ± 7.71%;p &lt; 0.001), and the LAS-A (–15.41 ± 4.16% vs. –24.57 ± 4.68%; p &lt; 0.001) values were observed to be lower than the healthygroup; while the LA stiffness (0.4 ± 0.19 vs. 0.17 ± 0.05; p &lt; 0.001) value was higher. When the patients with ESRD weredivided into two groups as those with a maximum LAVI value over 31.34 mL/m2 and those with a maximum LAVI below thisvalue, the LAS-S (30.36 ± 8.32% vs. 34.11 ± 6.43%; p = 0.023) and the LAS-E (–14.97 ± 5.88% vs. –16.76 ± 5.42%; p = 0.039)values were lower in the group with a LAVI value over 31.34 mL/m2; while the LAS-A (–16.06 ± 4.44% vs. –14.75 ± 3.8%;p &lt; 0.001) and LA stiffness (0.4 ± 0.19 vs. 0.17 ± 0.05; p &lt; 0.001) values were higher. An association was observed betweenthe ePCWP and LAS-S (p &lt; 0.001), LAS-E (p = 0.01), LAS-A (p &lt; 0.001), and LA stiffness (p &lt; 0.001) values.Conclusions: The results of our study have demonstrated that LA myocardial function assessed using the 2D-STE methodis associated with the ePCWP, which is an echocardiographically calculated marker of LV dysfunction. The LA deformationparameters may be used as echocardiographic findings to predict the LV dysfunction in ESRD patients with PLVEF. Furtherstudies are needed to determine the independent prognostic power of the atrial strain measurement as a predictor of futurecardiovascular events in ESRD patients.Wstęp: Analiza deformacji lewego przedsionka (LA) metodą echokardiografii dwuwymiarowej z algorytmem śledzenia markerówakustycznych (2D-STE) może być alternatywną metodą oceny ciśnienia wypełniania lewej komory (LV) i jej dysfunkcji.Cel: Badanie przeprowadzono w celu oceny czynności LA metodą 2D-STE u osób w schyłkowym stadium choroby nerek(ESRD) z zachowaną frakcją wyrzutową lewej komory (PLVEF) i określenia zależności między uzyskanymi wynikami a oszacowanymechokardiograficznie ciśnieniem zaklinowania w kapilarach płucnych (ePCWP).Metody: Do badania włączono 85 chorych z ESRD i 60 osób zdrowych. Obrazy LA uzyskano w projekcjach koniuszkowych— 2- i 4-jamowej. Objętość LA (LAV) obliczano, posługując się dwupłaszczyznową metodą pole/wymiar podłużny.Wskaźnik objętości LA (LAVI) obliczano, dzieląc LAV przez powierzchnię ciała. Oceniono parametry odkształcenia LA (%)(LAS) [skurczowe (LAS-S), wczesnorozkurczowe (LAS-E), późnorozkurczowe (LAS-A), w czasie skurczu przedsionków] i obliczonoePCWP, stosując następujący wzór: ePCWP = 1,25 (E/E’) + 1,9. Sztywność LA określono metodą nieinwazyjną na podstawiestosunku E/E’ do LAS-S.Wyniki: U chorych z ESRD wartości LAS-S (32,22 ± 7,64% vs. 57,93 ± 8,71%; p &lt; 0,001), LAS-E (–15,86 ± 5,7%vs. –33,37 ± 7,71%; p &lt; 0,001) i LAS-A (–15,41 ± 4,16% vs. –24,57 ± 4,68%; p &lt; 0,001) były niższe, a wskaźniki sztywnościLA (0,4 ± 0,19 vs. 0,17 ± 0,05; p &lt; 0,001) — wyższe niż u osób zdrowych. Po podzieleniu chorych z ESRD na dwie grupy(osoby z maksymalnym LAVI &gt; 31,34 ml/m2 i osoby z maksymalnym LAVI &lt; 31,34 ml/m2) stwierdzono, że w grupie, w którejLAVI wynosił ponad 31,34 ml/m2 wartości LAS-S (30,36 ± 8,32% vs. 34,11 ± 6,43%; p = 0,023) i LAS-E (–14,97 ± 5,88%vs. –16,76 ± 5,42%; p = 0,039) były niższe; natomiast LAS-A (–16,06 ± 4,44% vs. –14,75 ± 3,8%; p &lt; 0,001) i wskaźnik sztywności LA (0,4 ± 0,19 vs. 0,17 ± 0,05; p &lt; 0,001) były większe niż w drugiej grupie chorych z ESRD. Zaobserwowano zależnościmiędzy ePCWP a wartościami LAS-S (p &lt; 0,001), LAS-E (p = 0,01), LAS-A (p &lt; 0,001) i wskaźnika sztywności LA (p &lt; 0,001).Wnioski: W niniejszym badaniu wykazano, że wyniki oceny czynności LA miokardium z zastosowaniem metody 2D-STE wiążąsię z wartościami ePCWP, które stanowi obliczany echokardiograficznie wskaźnik dysfunkcji LV. Parametry odkształcenia LAmogą być przydatne jako echokardiograficzne wskaźniki pozwalające prognozować dysfunkcję LV u chorych z ESRD i PLVEF.Należy przeprowadzić dalsze badania w celu określenia znaczenia pomiarów odkształcenia przedsionka jako niezależnychczynników prognostycznych przyszłych zdarzeń sercowo-naczyniowych u osób z ESRD

The relationship between subclinic atherosclerosis and red cell distribution width in patients with metabolic syndrome

Objectıve: We have investigated the possible associationbetween red cell distribution width (RDW) and subclinicatherosclerosis which can assessed by carotidintima-media thickness (CIMT) measurement in patientswith metabolic syndrome (MetS).Methods: 74 patients with MetS were enrolled to thestudy. Patients were divided into 2 groups according tocarotid intima-media thickness (CIMT) measurement: 35patients with CIMT≥1.0 mm were at group 1 and 39 patientswith CIMT<1.0 mm were at group 2. RDW weremeasured using an automated blood cell counter.Results: The RDW level was not statistically significantin patients with CIMT≥1,0 mm than in patients withCIMT<1,0 mm (13.73±0.79% vs. 13.77±1.04 %; p=0.85).Conclusion: In our study, we found that RDW was notdifferent in the MetS patients with CIMT≥1.0 mm comparedwith the MetS patients with CIMT<1.0 mm.Key words: red cell distribution width, metabolic syndrome,complete blood coun

Relation of left atrial volume index with subclinical atherosclerosis at patients with metabolic syndrome

Metabolik sendrom (MetS) ateroskleroza, sol ventrikül yapı ve fonksiyonlarında bozulmaya neden olur. Diyastolik disfonksiyon (DD) subklinik kardiyak hasarın erken dönem bulgusudur. Sol atriyal volüm DD’un ciddiyetini ve süresini göstermede bir belirteç olarak kullanılabilir. Çalışmamızda, MetS’lu hastalarda sol ventrikül DD ve derecesini, sol atriyal volüm indeksi (SAVİ) ile birlikte değerlendirdik ve bunun karotis intima media kalınlığı (KİMK) ile tespit edilen subklinik aterosklerozla ilişkisini araştırdık. Çalışmaya MetS’lu 82 hasta alındı. Hastalar KİMK ölçümüne göre, KİMK?1,0 mm olan 35 hasta grup 1, KİMK<1,0 mm olan 47 hasta ise grup 2 olarak ikiye ayrıldı. Gruplarda sol ventrikül sistolik ve diyastolik fonksiyonları değerlendirildi, SAVİ hesaplandı. Grup 1’de DD görülme oranı istatistiksel olarak anlamlı yüksek tespit edildi (p:0,001). Evre 1 DD ve evre 2 DD açısından gruplar arasında istatistiksel olarak anlamlı fark tespit edilmedi (p:0,079). SAVİ değerleri grup 1 ve grup 2’de sırasıyla 32,6±6,0 ml/m2 ve 26,6±4,7 ml/m2 olarak hesaplandı. İki grup arasında istatistiksel olarak anlamlı fark tespit edildi (p: 0,001). SAVİ ile korelasyon bakıldığında; KİMK ile pozitif korelasyon izlendi. Konvansiyonel ve doku Doppler görüntülemede elde edilen verilerle SAVİ arasında korelasyon bakıldığında; sol ventrikül kitle indeksi, septal ve lateral E/Em oranları arasında pozitif korelasyon, septal ve lateral Em/Am oranları ile negatif korelasyon izlendi. Çalışmamızda subklinik aterosklerozun noninvazif göstergesi olan KİMK’nın yüksek olduğu grupta SAVİ değerleri yüksek bulunmuştur. Buna ek olarak çalışmaya alınan tüm hastalar değerlendirildiğinde, diyastolik disfonksiyonun varlığı ve şiddetiyle ilişkili olarak SAVİ değerlerinin arttığı gözlenmiştir.Metabolic syndrome (MetS) increases the frequency of cardivovascular events by causing atherosclerosis and impairment at left ventricle structure and function. Diastolic dysfunction (DD) is an early finding of subclinical cardiac injury. Left atrial volume may be used as an indicator for demonstrating severity and duration of DD. With this study, we investigated the relationship between subclinical atherosclerosis ,evaluated by carotid intima-media thickness (CIMT) measurement and subclinical cardiac injury evaluated by diastolic functions and left atrial volume index (LAVI) in MetS patients. 82 patients with MetS were enrolled to the study. Patients were divided into 2 groups according to CIMT measurement: 35 patients with CIMT&#8805;1.0 mm were at group 1 and 47 patients with CIMT<1.0 mm were at group 2. Systolic and diastolic functions were evaluated, LAVI was calculated. Frequency of DD was found statistically significantly higher in group 1 (p=001). There was no difference between groups for grade I DD and grade (p=0079). LAVI values were calculated as 32.6±6.0 ml/m2 and 26.6±4.7 ml/m2 at group 1 and 2,respectively.There was a statistically significant difference between two groups.When correlation with LAVI was investigated,a positive correlation with CIMT was observed. When correlation between data from conventional and tissue Doppler imaging and LAVI was evaluated,there were positive correlations for left ventricle mass index, septal and lateral E/Em rates, and negative correlations for septal and lateral Em/Am rates. LAVI was found to be high in-patient with higher CIMT value which is non-invasive indicator of subclinical atherosclerosis. In addition, in all patients, a relation was observed between presence and severity of diastolic dysfunction and increase in LAVI value