Kararlı anjina pektoriste koroner arter hastalığının yaygınlığını ve ciddiyetini saptamada 3 boyutlu speckle-tracking ekokardiyografi ve arteriyel stiffness'in öngördürücü rolü

Giriş ve Amaç: Kararlı anjina pektoris sık karşılaşılan ve bazen fonksiyon kaybına yol açan bir hastalıktır. Çalışmamızda kararlı anjina pektoris hastalarında Gensini Skoruna göre KAH ciddiyeti ile istirahat 3B-STE ve PWV'nin ilişkisini araştırdık. Gereç ve Yöntem: Hasta seçimi kardiyoloji kliniğinde egzersiz testi veya miyokardiyal perfüzyon sintigrafisi ile değerlendirme sonrası koroner anjiografi planlanan ardışık 18-80 yaş aralığındaki kararlı anjina pektoris hastaları arasından yapıldı. Dahil edilme ve dışlanma kriterlerini karşılayan 120 olgu çalışmaya dahil edildi. KAH ciddiyetini değerlendirmede Gensini Skoru hesaplandı ve KAG öncesi istirahat halinde ölçülen 3B-STE strain parametreleri ve PWV,Aix ile karşılaştırıldı. Bulgular: 3B-STE parametrelerinden olan Longitudinal Strain (LS),Circumferansiyel Strain (CS),Radial Strain (RS) ve Area Strain (AS) ; özellikle yaş ve cinsiyetten etkilendiği için yaş ve cinsiyete göre düzeltme yapıldı ve elde edilen sonuçlar Gensini Skoru ile kıyaslandığında aralarında yüksek korelasyon izlenmiş olup istatistiksel olarak anlamlı saptandı.Gensini Skoru arttıkça 3B-STE strain parametrelerinde de korele olarak bozulma (mutlak değer olarak azalma ) olduğu görüldü.PWV,Aix ile Gensini Skoru kıyaslandığında istatistiksel olarak anlamlı fark saptanmadı. Nabız Dalga Hızı (PWV) ile Longitudinal Strain arasında pozitif yönde zayıf korelasyon izlendi ve bu korelasyon istatistiksel olarak anlamlı saptandı. Sonuç ve Tartışma: Günümüzde mortalite ve morbiditenin en sık nedenlerinden olan KAH'nın erken dönemde saptanması için yeni yöntemler araştırılmaktadır.Subklinik sol ventrikül disfonksiyonunun saptanmasında 3B-STE girişimsel olmayan ve kullanışlı bir parametredir. Kararlı anjina pektoris'te KAG öncesi ya da risk değerlendirilmesinde 3B-STE kullanılabilir.Çalışmamızda saptanan 3B-STE strain parametreleri ile KAH ciddiyeti arasındaki anlamlı korelasyon öngörülebilir bir bulgudur.Introduction and Aim: Stable angina pectoris is a common disease, that may cause disability. In this study; we evaluated the relationship between coronary artery disease severity according to Gensini Score and resting 3D-STE with PWV in stable angina pectoris patients. Methods: Patients were randomly selected from stable angina pectoris patients between 18-80 years of age to whom coronary angiography was planned following evaluation with exercise test or myocardial perfusion scinthigraphy in cardiology outpatient clinic.120 patients fulfilling inclusion and exclusion criteria were included in the study. Gensini Score was calculated to detect the severity of coronary artery disease and was compared with strain parameteres calculated via 3 dimensional speckle-tracking echocardiography and PWV prior to coronary angiography. Results: Longitudinal Strain (LS),Circumferantial Strain (CS),Radial Strain (RS) and Area Strain (AS) which are the parameters of 3D-STE were corrected by age and sex,and then we detected a statistically significant correlation between 3D-STE and Gensini Score.There was no statistically significant correlation between PWV,Aix and Gensini Score.In this study ,we detected a statistically significant and positive, however weak correlation between PWV and Longitudinal Strain (LS). Discussion and Conclusion: Today, the new methods are investigated in the detection of early-stage coronary artery disease that is the most common causes of the mortality and morbidity.In the detection of subclinical left ventricular dysfunction,3D-STE is a non-invasive and handy parameter.3D-STE can be used before coronary angiography or while evaluating risk.The statistically significant correlation between 3D-STE and the severity of coronary artery disease in our study is a predictable finding

Assessment of left atrial mechanics and left ventricular functions using 3D speckle-tracking echocardiography in patients with inappropriate sinus tachycardia

Purpose Inappropriate sinus tachycardia (IST) is defined as a sinus heart rate > 100 bpm at rest (with a mean 24-h heart rate > 90 bpm not due to primary causes) and is associated with distressing symptoms of palpitations. The effect of IST on left atrial (LA) and left ventricular (LV) myocardial dynamics is uncertain. Thus, the aim of this study was to identify early changes in LA mechanics and LV myocardial functions in patients with IST using 3D-STE. Methods Sixty patients with IST and 65 age- and gender-matched controls were enrolled into the study. Conventional 2D echocardiography and 3D-STE were performed, and LAS-r, LAS-active, LAS-passive, LAEF, LAEF-active, LAEF-passive, LV-GLS, LV-GCS, LV-GAS, and LV-GRS were obtained for every patient. Results The LAS-r and LAS-active were significantly decreased in the IST group than in the control group (p < 0.001, p = 0.004, respectively). The multivariate logistic regression models revealed that LAS-r (p = 0.008, Odds ratio (OR) 5.98, 95% confidence interval (CI) 2.36-11.18), and LAS-active (p = 0.032, OR 2.16, 95% CI 1.97-4.69) were found to be independent factors for predicting IST. Conclusions The present study is the first to evaluate the left atrial mechanics and left ventricular functions in the patients with IST using 3D-STE. We found that IST had a negative effect on left atrial mechanics. According to our findings, we can say that IST is not a completely innocent, benign clinical condition, but rather, it causes subclinical left atrial dysfunction

Coronary tortuosity affects left ventricular myocardial functions: a 3D-speckle tracking echocardiography study

Coronary artery tortuosity (CAT) is a common finding in coronary angiography, and is defined as three fixed bends during both systole and diastole in at least one epicardial coronary artery, with each bend showing a 45° change in vessel direction. The impact of CAT on the myocardial deformation has not been completely evaluated using 3D-STE. As a result of this, we aimed to assess the effects of CAT on LV functions using 3D-STE in the present study. Eighty-two patients with CAT and 80 age- and gender-matched controls who proved to have normal coronary angiograms were enrolled into the study. 3D-STE was performed and LV-GLS, LV-GCS, LV-GAS, and LV-GRS were obtained for every patient after coronary angiography. The LV-GLS was significantly depressed in the CAT (+) group than in the control group (p = 0.001). ROC analysis was performed to find out ideal LV-GLS cut off value to predict the presence of CAT. A LV-GLS value of > ? 17 has 81.3% sensitivity, 56.7% specificity to detect the presence of CAT. The present study is the first to focus on the assessing LV myocardial functions in patients with CAT by 3D-STE. CAT has a considerable negative effect on LV myocardial longitudinal deformation as evaluated by 3D strain parameters. Our results support that patients with CAT may have subclinical LV longitudinal deformation abnormalities even though they are apparently healthy. © 2020, Springer Nature B.V

Angiotensin receptor-neprilysin inhibition by sacubitril/valsartan attenuates doxorubicin-induced cardiotoxicity in a pretreatment mice model by interfering with oxidative stress, inflammation, and caspase 3 apoptotic pathway

Objective: Doxorubicin (DOX) is a well-known cardiotoxic agent, whereas sacubitril/valsartan (Sac/Val) is an effective treatment option in heart failure. In this study, we aimed to evaluate the effect of Sac/Val on DOX-induced cardiotoxicity in pretreatment mice model. Methods: A total of 24 mice were equally classified into 4 groups; control group, DOX (20 mg/kg; fifth day), Sac/Val (80 mg/kg), and Sac/Val+DOX (Sac/Val was given from day one of the study before doxorubicin administration). Electrocardiography parameters, including durations of QRS, ST, QT, PP segment, and QT/PQ index were measured. Total antioxidant status (TAS), total oxidant status (TOS), tumor necrosis factor-? (TNF-?), interleukin 1? (IL-1?), IL-6, NT-proBNP concentrations, and Caspase 3 activity were evaluated. Results: At the end of the 9-day study duration, QRS, ST, QT intervals, QT/PQ index and TAS, TOS, TNF-?, IL-1?, IL-6 levels were significantly higher in the DOX group than in the control group (p<0.001). Moreover, there were significant differences only in the PP interval when comparing the Sac/Val+DOX and control groups (p<0.001). QRS, ST, QT intervals, and QT/PQ index, TAS, TOS, TNF-?, IL-1?, IL-6 levels were significantly lower in the Sac/Val+ DOX group compared with the DOX group (p<0.001). Furthermore, NT-proBNP levels were lower in the Sac/Val+DOX group compared with the DOX group along with less Caspase 3 apoptosis. Conclusion: Sac/Val seems to be cardioprotective against DOX-induced cardiotoxicity in pretreatment mice model. These findings can be attributed to the antiarrhythmic, anti-inflammatory, antioxidant, and antiapoptotic effects of Sac/Val as shown in this study. ©Copyright 2021 by Turkish Society of CardiologyWe would like to thank Nurullah Hatip for his valuable contributions

Reply to Letter to the Editor: "Can ARNI Prevent Doxorubicin-Induced Cardiotoxicity?"

We thank the authors for reading with great interest. In our study, as in previous studies, semi-quantitative histological analysis was performed.1 It was stated that the limitations of our study were that imaging methods, especially invasive methods and hemodynamic measurements, were not used. Doxorubicin (DOX)-induced cardiotoxicity can occur in acute and chronic periods. It is known in the literature that left ventricular systolic dysfunction accompanies DOX-induced ventricular-related acute arrhythmogenic events.2,3 In a recent study, it was found that natriuretic peptide levels predicted late-stage cardiotoxicity due to DOX.4 In our study, the ability of electrocardiography and natriuretic peptide data to predict both acute and chronic cardiotoxicities due to DOX has been already proven in clinical studies in the literature

Prognostic significance of medical therapy in patients with heart failure with reduced ejection fraction

Aims: The use of guideline-directed medical therapy (GDMT) among patients with heart failure (HF) with reduced ejection fraction (HFrEF) remains suboptimal. The SMYRNA study aims to identify the clinical factors for the non-use of GDMT and to determine the prognostic significance of GDMT in patients with HFrEF in a real-life setting. Methods and results: The SMYRNA study is a prospective, multicentre, and observational study that included outpatients with HFrEF. Patients were divided into three groups according to the status of GDMT at the time of enrolment: (i) patients receiving all classes of HF medications including renin-angiotensin system (RAS) inhibitors, beta-blockers, and mineralocorticoid receptor antagonists (MRAs); (ii) patients receiving any two classes of HF medications (RAS inhibitors and beta-blockers, or RAS inhibitors and MRAs, or beta-blockers and MRAs); and (iii) either patients receiving class of HF medications (only one therapy) or patients not receiving any class of HF medications. The primary outcome was a composite of hospitalization for HF or cardiovascular death. The study population consisted of 1062 patients with HFrEF, predominantly men (69.1%), with a median age of 68 (range: 20–96) years. RAS inhibitors, beta-blockers, and MRAs were prescribed in 76.0%, 89.4%, and 55.1% of the patients, respectively. The proportions of patients receiving target doses of guideline-directed medications were 24.4% for RAS inhibitors, 11.0% for beta-blockers, and 11.1% for MRAs. Overall, 491 patients (46.2%) were treated with triple therapy, 353 patients (33.2%) were treated with any two classes of HF medications, and 218 patients (20.6%) were receiving only one class of HF medication or not receiving any HF medication. Patient-related factors comprising older age, New York Heart Association functional class, rural living, presence of hypertension, and history of myocardial infarction were independently associated with the use or non-use of GDMT. During the median 24-month period, the primary composite endpoint occurred in 362 patients (34.1%), and 177 of 1062 (16.7%) patients died. Patients treated with two or three classes of HF medications had a decreased risk of hospitalization for HF or cardiovascular death compared with those patients receiving ≤1 class of HF medication [hazard ratio (HR): 0.65; 95% confidence interval (CI): 0.49–0.85; P = 0.002, and HR: 0.61; 95% CI: 0.47–0.79; P < 0.001, respectively]. Conclusions: The real-life SMYRNA study provided comprehensive data about the clinical factors associated with the non-use of GDMT and showed that suboptimal GDMT is associated with an increased risk of hospitalization for HF or cardiovascular death in patients with HFrEF