Relationship between psychosocial status, diabetes mellitus, and left ventricular systolic function in patients with stable multivessel coronary artery disease

Background: Negative emotional conditions contribute to the development of coronary artery disease (CAD). Depression and anxiety are prognostic factors in patients with CAD. The aim of our study was to investigate the association between emotional conditions and left ventricular (LV) systolic functions in CAD. Methods: 168 patients (102 men, 66 women, mean age 66.3 &#177; 9.9 years) with stable angina and multivessel disease (MVD) were included in the study. According to the LV ejection fraction (LVEF) in echocardiography, patients were divided into two groups, the preserved group (LVEF > 50%), and the impaired group (LVEF < 50%). The preserved group consisted of 94 patients and the impaired group consisted of 74 patients. Emotional status was evaluated using the Hamilton Depression (HAM-D), Hamilton Anxiety (HAM-A), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) scores. Results: The prevalence of diabetes mellitus (DM) was significantly higher in the impaired group than in the preserved group (29.8% vs 56.8%, p < 0.01). The HAM-D, HAM-A, BAI and BDI scores were higher in the impaired group compared to the preserved group (HAM-D: 12.1 &#177; 3.3 vs 14.5 &#177; 2.3, p = 0.03; HAM-A: 12.7 &#177; 3.4 vs 14.3 &#177; 2.2, p = 0.01; BAI: 18.6 &#177; &#177; 6.4 vs 22.1 &#177; 6.6, p = 0.01 and BDI: 13.9 &#177; 2.5 vs 17.2 &#177; 2.0, p = 0.002, respectively). In multivariate analysis, BDI scores (odds ratio [OR]: 2.197, < 95% confidence interval [CI] 1.101&#8211;4.387; p = 0.026), HAM-A scores (OR: 1.912, < 95% Cl 1.092&#8211;2.974; p = 0.041) and DM (OR: 2.610, < 95% Cl 1.313&#8211;5.183; p = 0.006) were important risk factors for LV dysfunction in stable patients with MVD. Conclusions: This study demonstrated that emotional status and DM are factors associated with impaired LV systolic function in patients with stable CAD

Long term clinical outcomes of brachytherapy, bare-metal stenting, and drug-eluting stenting for de novo and in-stent restenosis lesions: Five year follow-up

Background: We aimed to investigate the effects of brachytherapy, drug-eluting stent (DES) and bare metal stent (BMS) applications in the treatment of coronary artery disease, on five- -year clinical outcomes and mortality. Methods: Two hundred and seventeen patients who were treated in our clinics between January 2000 and December 2003 with brachytherapy, DES, or BMS for both de novo and in- -stent restenosis lesions were included in this cohort study. Of these 217 patients, 69 received brachytherapy, 80 were given BMS and 68 were given DES. The clinical outcomes of the patients during hospitalization and over a long-term follow-up were evaluated. Cardiovascular events, revascularizations and mortality rates were compared among the three groups over a five-year follow-up. Results: The mean age was 60.1 &#177; 9.5 years in the brachytherapy group, 55.7 &#177; 9.2 years in the BMS group, and 58.9 &#177; 9.8 years in the DES group (p = 0.44). All-cause mortality rates were 20 (29%) brachytherapy patients, 22 (27.5%) BMS patients, and four (5.9%) DES patients (p = 0.01). Cardiovascular event was the cause of death for 14 (20.3%) brachytherapy patients, 16 (20%) BMS patients and four (5.9%) DES patients (p = 0.001). All-cause mortality rates were 20 (29%) brachytherapy patients, 22 (27.5%) BMS patients and four (5.9%) DES patients. All-cause and cardiovascular mortality rates were significantly lower in the DES group compared to both the BMS and the brachytherapy groups (p = 0.01 and p = 0.001, respectively). Conclusions: DES application for in-stent restenosis and de novo lesions was superior to brachytherapy and BMS application with respect to all-cause and cardiovascular mortalities. (Cardiol J 2011; 18, 6: 654&#8211;661

A Comparison of Pulmonary Function, PeripheralaAnd Respiratory Muscle Strength and Functional Capacity in the Heart Failure Patients with Different Functional Classes

Objective: This cross-sectional, observational study was planned to compare pulmonary function, respiratory and peripheral muscle strength, and functional capacity in different functional classes of heart failure patients. Methods: Thirty-four heart failure patients, in New York Heart Association (NYHA) Class II and III 168.59 +/- 9.84 years, left ventricular ejection fraction (LVEF)=34.24 +/- 7.59%) were included. Class II and Ill patients' pulmonary function was assessed using spirometry, respiratory muscle strength using a mouth pressure device, functional capacity using six minute walk test (6MWT), quadriceps femoris and biceps brachii muscle strength were evaluated using a hand-held dynamometer, and variables were compared. Student t, Chi-square, Mann-Whitney U tests, and Spearman correlation coefficients were used for statistical analysis. Results: There were no statistically significant differences in pulmonary function and respiratory muscle strength between the two groups (p>0.05). The 6MWT distance (328.35 +/- 101.56 m; vs. 480.05 +/- 104.19 m) quadriceps lemons (218.83 +/- 63.62 N; vs. 290.69 +/- 115.53 N) and biceps brachii (164.22 +/- 44.78 N; vs. 219.19 +/- 49.37 N) muscle strength of Class Ill patients were significantly lower than of Class II patients (p<0.05 for all). The NYHA classification system was significantly correlated with measured and predicted 6MWT distance (r=-0.59, r=-0.65, respectively), biceps brachii muscle strength (r=-0.46, r=-0.40, respectively), and % quadriceps femoris muscle strength (r=-0.43) (p<0.05). Conclusion: Functional capacity and peripheral muscle strength decrease as the illness progresses in heart failure. Pulmonary function and respiratory muscle strength are preserved. The NYHA classification system is a reliable method in the detection of changes in functional capacity and peripheral muscle strength. Changes in functional capacity and peripheral muscle strength are consistent with the NYHA classification system. (Anadolu Kardiyol Derg 2011; 11: 101-6)WoSScopu

Coexistence Of Cor Triatriatum And Rheumatic Mitral Stenosis In An Adult Patient

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Exercise Capacity, Peripheral Muscle Strength, and Inactivity in Diabetic Patients With Heart Failure

Aim: Studies investigating the effects of type II diabetes mellitus on exercise capacity, peripheral muscle strength, and physical activity level in patients with heart failure are limited. This study aimed to compare maximal exercise capacity, peripheral muscle strength, and physical activity level in patients with heart failure with and without diabetes mellitus

Effects Of Inspiratory Muscle Training In Patients With Heart Failure

Aim: To investigate the effects of inspiratory muscle training (IMT) on functional capacity and balance, respiratory and peripheral muscle strength, pulmonary function, dyspnea, fatigue, depression, and quality of life in heart failure patients. Methods: A prospective, randomized controlled, double-blinded study. Thirty patients with heart failure (NYHA II-III, LVEF<40%) were included. Sixteen patients received IMT at 40% of maximal inspiratory pressure (MIP), and 14 patients received sham therapy (15% of MIP) for 6 weeks. Functional capacity and balance, respiratory muscle strength, quadriceps femoris muscle strength, pulmonary function, dyspnea, fatigue, quality of life, and depression were evaluated. Results: Functional capacity and balance, respiratory and peripheral muscle strength, dyspnea, depression were significantly improved in the treatment group compared with controls; quality of life and fatigue were similarly improved within groups (p < 0.05). Functional capacity (418.59 +/- 123.32 to 478.56 +/- 131.58 m, p < 0.001), respiratory (MIP = 62.00 +/- 33.57 to 97.13 +/- 32.63 cmH(2)O, p < 0.001) and quadriceps femoris muscle strength (240.91 +/- 106.08 to 301.82 +/- 111.86 N, p < 0.001), FEV1%, FVC% and PEF%, functional balance (52.73 +/- 3.15 to 54.25 +/- 2.34, p < 0.001), functional dyspnea (2.27 +/- 0.88 to 1.07 +/- 0.79, p < 0.001), depression (11.47 +/- 7.50 to 3.20 +/- 4.09, p < 0.001), quality of life, fatigue (42.73 +/- 11.75 to 29.07 +/- 13.96, p < 0.001) were significantly improved in the treatment group. Respiratory muscle strength (MIP = 78.64 +/- 35.95 to 90.86 +/- 30.23 cmH(2)O, p = 0.001), FVC%, depression (14.36 +/- 9.04 to 9.50 +/- 10.42, p = 0.011), quality of life and fatigue (42.86 +/- 12.67 to 32.93 +/- 15.87, p = 0.008) were significantly improved in the control group. Conclusion: The IMT improves functional capacity and balance, respiratory and peripheral muscle strength; decreases depression and dyspnea perception in patients with heart failure. IMT should be included effectively in pulmonary rehabilitation programs. (C) 2011 Elsevier Ltd. All rights reserved.WoSScopu

The Early Predictors Of Ventricular Remodeling After Myocardial Infarction: The Role Of Tumor Necrosis Factor-Alpha

Objective: Ventricular remodeling (VR) is a pathologic process characterized by progressive ventricular dilatation occurring after acute myocardial infarction (MI) leading to left ventricular systolic dysfunction. The purpose of the study was to evaluate the efficacy of plasma tumor necrosis factor alpha (TNF-alpha) levels to predict the left VR. Methods: This prospective observational cohort study included 72 consecutive patients with newly diagnosed MI with age ranging between 38-87 years (mean 59 +/- 12 years). Control group was consisted of 30 patients with no additional systemic disease and normal coronary arteriograms. Transthoracic echocardiography was performed to all patients and controls both in the beginning of the study and in the 6th follow-up. A coronary arteriography was also performed to all patients. Patients with an increment in the diastolic volume index more than 20% in the follow-up compared with basal values included in the VR subgroup. The patient subgroup with VR consisted of 19 patients. Statistical analyses were performed using ANOVA and Kruskal Wallis tests for comparison of variables between groups. Logistic regression and ROC analyses were used for evaluation of accuracy of TNF-alpha in prediction of VR. Results: There were no significant differences between groups according to demographic characters. The basal plasma levels of TNF-alpha were higher in the patient subgroup with VR as compared with patients without VR and controls (14.59 +/- 4.28 pg/ml vs 7.30 +/- 4.48 pg/ml, and 1.64 +/- 1.49 pg/ml, p = 10.33 pg/ml were found to have 89.5% sensitivity and 79.3% specificity to predict the development of VR. Conclusion: These results demonstrate the increment of plasma TNF-alpha levels in the acute phase of MI and the close relationship between the TNF-alpha levels and VR in the patients with first MI. (Anadolu Kardiyol Derg 2009; 9: 84-90)Wo

Relationship between psychosocial status, diabetes mellitus, and left ventricular systolic function in patients with stable multivessel coronary artery disease

Background: Negative emotional conditions contribute to the development of coronary artery disease (CAD). Depression and anxiety are prognostic factors in patients with CAD. The aim of our study was to investigate the association between emotional conditions and left ventricular (LV) systolic functions in CAD

Atrial Myocardial Deformation Properties Are Temporarily Reduced After Cardioversion For Atrial Fibrillation And Correlate Well With Left Atrial Appendage Function

Aim This study was conducted to evaluate whether left atrial strain and strain rate correlate well with transesophageal parameters of stunning after atrial fibrillation. Methods and results Twenty-two consecutive patients with chronic atrial fibrillation >= 3 months and < 1 year were enrolled in the study. Transthoracic (TTE) and transesophageal (TEE) echocardiography with color Doppler myocardial imaging were performed before, 1 day after and 10 days after successful cardioversion. Left atrial transthoracic strain (S) and strain rate (SR) from lateral, inferior and anterior atrial walls, left atrial appendage tissue velocities, strain and strain rate values were measured with offline analysis. Left atrial appendage emptying (LAAEV) and filling (LAAFV) velocities were obtained from transesophageal echocardiography. Left atrial transthoracic, and left atrial appendage strain and strain rates were significantly lower following 1 day after cardioversion (TTE S/SR, 5.0 +/- 2.8%/2.3 +/- 1.0; TEE (septal) S/SR, 7.6 +/- 3.6%/1.6 +/- 0.7). There was a good correlation between these parameters and LAAEV (LA systolic strain and LAAEV, r = 0.73, P = 0.007). Left atrial and LAA strain and strain rate values improved over time, and correlated well with LAAEV, measured 10 days after cardioversion. Conclusions Transthoracic atrial and TEE LAA strain and strain rate, which are quantitative measures of atrial function, are reduced after cardioversion, and recover subsequently. The good correlation between LAA function and TTE strain and strain rate suggests that TTE atrial parameters may help determine duration of anticoagulation.WoSScopu