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

Missed Opportunities for Coronary Heart Disease Diagnoses: Primary Care Experience

Cilj Istražiti propuštene prilike da se u primarnoj zdravstvenoj zaštiti otkriju postojeće koronarne srčane bolesti koje prethodno nisu bile dijagnosticirane i rizične čimbenike koji su povezani s njima. Methods Istraživanje je obuhvatilo 850 osoba starijih od 30 godina, koji u povijesti bolesti nisu imali koronarnu srčanu bolest, a bili su pacijenti centra primarne zdravstvene zaštite u prigradskom dijelu grada Antalya u Turskoj. Prikupili smo podatke o njihovoj dobi, spolu, stupnju izobrazbe, zdravstvenom osiguranju, prihodima, pušenju i fizičkim aktivnostima. Pacijente s nedijagnosticiranom koronarnom srčanom bolešću otkrili smo s pomoću Roseova upitnika, fizikalnim pregledom i elektrokardiogramom. Mjerili smo im visinu, težinu, krvni tlak, serumsku koncentraciju glukoze i kolesterola, a indeks tjelesne težine i omjer opsega struka i bokova smo izračunali. Svakom je pacijentu dodijeljen broj bodova za rizične čimbenike koji su uključivali dob, spol, pušenje, sistolički krvani tlak i koncentraciju kolesterola. Za svakoga je pojedinca izračunat rizik da u sljedećem desetljeću razvije koronarnu srčanu bolest. Rezultati Bilo je 126 (14.8%) prethodno nedijagnosticiranih slučajeva nedijagnosticirane koronarne srčane bolesti. Ukupni srednji (±standardna devijacija) broj bodova za rizik dobivanja koronarne srčane bolesti u sljedećem desetljeću bio je 6.1±6.8. Bolesti koje potiču razvitak koronarne srčane bolesti – hipertenzije, šećerne bolesti i hiperkolesterolemije otkrivene su u 255 (30.4%), odnosno u 70 (8.2%) i u 364 (43.4%) ispitanika. Debljina je utvrđena u 315 (37.1%) ispitanika, a 222 (26.1%) su bili pušači. Za osobe koje se koriste primarnom zdravstvenom zaštitom procijenjeni postotni rizik za razvitak koronarne srčane bolesti u sljedećem desetljeću bio je 7 do 45% za muškarce i 2 do 45% za žene. Zaključak U primarnoj se zdravstvenoj zaštiti propušta prilika za bolje otkrivanje koronarne srčane bolesti kao i topoglednih rizičnih čimbenika. Potrebno je poduzeti mjere da se oni na vrijeme otkrivaju.Aim To investigate missed opportunities to reveal existing but not formerly diagnosed coronary heart disease cases and related risk factors in primary health care. Methods The study comprised 850 people aged over 30 years with no known history of coronary heart disease, receiving health services from a primary care center located in a suburban area of Antalya, Turkey. Data on their age, gender, education level, health insurance status, income, smoking behavior, and physical activities were collected. Undiagnosed coronary heart disease patients were determined by the Rose questionnaire, physical examination, and electrocardiogram. Height and weight, blood pressure, serum glucose and cholesterol levels were measured, and body-mass index and waist-hip ratio calculated. Each patient was given a risk score regarding age, smoking behavior, tolic blood pressure, and cholesterol levels. Estimated risk ratio of each person for developing coronary heart disease in the next decade was determined. Results The number of formerly undiagnosed coronary heart disease cases was 126 (14.8%). Overall mean (±standard deviation) risk score for developing coronary heart disease in the next decade in study group was 6.1 ± 6.8. Diseases facilitating development of coronary heart disease: hypertension, diabetes, and hypercholesterolemia were present in 255 (30.4%), 70 (8.2%), and 364 (43.4%) participants, respectively. Obesity was detected in 315 (37.1%) subjects and there were 222 (26.1%) current smokers. For patients who attended primary health care, the estimated percentage risk for developing coronary heart disease in the next ten years was 7 to 45% in men and 2 to 45% in women. Conclusion Opportunities to reveal coronary heart disease and its risk factors are being missed in primary care. Measures should be taken to ensure timely diagnosis of coronary heart disease and related risk factors

Primary percutaneous coronary interventions in acute myocardial infarction in diabetic versus non-diabetic patients. In-hospital and long-term results

Background: It has been well established that in the pre-thrombolytic era diabetic patients had poorer clinical outcome after acute myocardial infarction (AMI) compared to non-diabetic patients. Less is known about the impact of diabetes on early and late clinical outcomes in patients with AMI undergoing primary percutaneous coronary interventions (PCI).Aim: To compare the in-hospital and long-term clinical outcomes of AMI patients with and without diabetes.Methods: Seven hundred seventy-four patients who underwent primary PCI for AMI in our institution between 1997 and 2001 were included in the study. We compared the angiographic and clinical outcomes of 633 (81.8%) non-diabetic (aged 55.9&#177;10.6 years; 82.6% male) and 141 (18.2%) diabetic (aged 56.8&#177;11.7 years; 63.1% male) patients.Results: Diabetic patients had a higher incidence of hypertension, hyperlipidemia, and unstable hemodynamic status compared to non-diabetic patients (p=0.001, 0.003, 0.001, respectively). Smoking and male gender rates were significantly more frequent in non-diabetic patients (p=0.001, 0.001, respectively). Angiographic success and prominent clinical improvement were achieved in 96.4% and 90.7% of diabetics vs 96.7% and 95.1% of non-diabetics (p=NS and 0.04, respectively). Diabetic patients had a higher incidence of in-hospital deaths and overall events (p=0.028). At one-month follow-up, diabetic patients required more target vessel revascularisation (5.6% vs 1.6%; p=0.006), which accounted for the majority of major cardiac events at one month (20.6% vs 7.4%; p=0.003). At a mean follow-up of 7.2&#177;2.7 months, 92.9% of non-diabetic and 88% of diabetic patients were still alive (p=0.05). Overall survival without any major cardiac event (death, new MI or target vessel revascularisation) at 7.2&#177;2.7 month follow-up was 75.8% for non-diabetics and 58.1% for diabetic patients (

Aortic Valve Endocarditis and Cerebral Mycotic Aneurysm Due To Brucellosis

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