Atrial flutter with 1:1 conduction in a 70-year-old man with hyperthyroidism

Atrial flutter (AFL) is a rapid, regular atrial tachyarrhythmia that occurs most commonly in patients with underlying structural heart disease. AFL with 1:1 atrioventricular (AV) conduction is a rare occasion. We describe a 70-year-old male patient with hyperthyroidism in whom AFL was associated with 1:1 AV conduction. This case report emphasizes that AFL with 1:1 AV conduction should be kept in mind as a diagnostic alternative in patients with rapid supraventricular tachycardia and hyperthyroidism

Trzepotanie przedsionków z przewodzeniem 1:1 u 70-letniego mężczyzny z nadczynnością tarczycy

Trzepotanie przedsionków (AFL) jest szybką, miarową tachyarytmią przedsionkową występującą najczęściej u pacjentów ze strukturalną chorobą serca. Trzepotanie przedsionków z przewodzeniem przedsionkowo-komorowym (AV) 1:1 występuje rzadko. W niniejszej pracy opisano 70-letniego mężczyznę z nadczynnością tarczycy, u którego występowało AFL z przewodzeniem AV 1:1. Opis tego przypadku zwraca uwagę, że należy pamiętać o AFL z przewodzeniem AV 1:1 jako alternatywnym rozpoznaniu u pacjentów z szybkim częstoskurczem nadkomorowym i nadczynnością tarczycy

Neutrophil-to-lymphocyte ratio and in-hospital mortality in patients with acute heart failure

OBJECTIVES: Previous studies have demonstrated the role of inflammation in acute heart failure. The neutrophil-to-lymphocyte ratio was found to be a useful inflammatory marker for predicting adverse outcomes. We hypothesized that an elevated neutrophil-to-lymphocyte ratio would be associated with increased mortality in acute heart failure patients. METHODS: The study cohort consisted of 167 acute heart failure patients with an ejection fractio

Early assessment of percutaneous coronary interventions for chronic total occlusions analyzed by novel echocardiographic techniques

OBJECTIVE: Successful revascularization of chronic total occlusions has been associated with improved left ventricular systolic function, reduced anginal symptoms, increased exercise capacity, and increased survival. This study was conducted to determine the impact of revascularization in chronic total occlusion on left ventricular function using novel echocardiographic techniques. METHODS: A total of 129 patients with chronic total occlusion who underwent revascularization between April 2011 and November 2012 were included in this study. Echocardiographic assessments with two-dimensional speckle tracking echocardiography and real-time three-dimensional echocardiography were performed before the procedure and one month after the procedure. The left ventricular ejection fraction, left ventricular volumes, and three-dimensional systolic dyssynchrony index were quantified. RESULTS: An immediate procedural success was obtained in 118 patients (91.5%). There were no acute or subacute stent thromboses during follow-up. The mean left ventricular ejection fraction significantly increased (

TİP II DİABETES MELLİTUS’ LU VE BOZULMUŞ GLUKOZ TOLERANS’LI HASTALARDA DOKU DOPPLER EKOKARDİYOGRAFİ İLE BAKILAN MİYOKARDİYAL PERFORMANS İNDEKSİ VE BNP İLİŞKİSİ

AMAÇ : Diabetes Mellitus (DM) ve bozulmuş glukoz toleransı (IGT ), bozulmuş sol ventrikül fonksiyonları ile ilişkilidir. Bizim amacımız bu iki klinik tabloda doku Doppler ile bakılan miyokardiyal performans indeksi ( MPİ&#8217; ) ve beyin natriüretik peptidin ( BNP ) miyokardiyal fonksiyon bozukluğunu gösterebilmesini ve birbiriyle ilişkili olup olmadığını test etmektir. YÖNTEM : Çalışmaya hipertansiyon, koroner arter hastalığı tanıları olmayan ve antihipertansif ajan kullanmayan DM&#8217; li ve IGT&#8217; li hastalar alındı. Aynı dışlanma kriterlerine uyan sağlıklı gönüllülerden oluşan bir kontrol grubu oluşturuldu.Hastaların bazal klinik özellikleri, rutin laboratuar parametreleri ve BNP düzeyleri kaydedildi. Her hastada ekokardiyografik olarak hem geleneksel yöntemle MPİ hem de doku Doppler ile bakılan MPİ&#8217; değerleri ve ayrıca E dalgası deselerasyon zamanı (EDZ), E \ A , E \ E&#8217; parametreleri bakıldı.Gruplar arasında farklar ve hem tüm hastalarda hem de DM ve IGT alt gruplarında parametrelerin birbirleriyle ilişkileri test edildi. BULGULAR : Çalışmaya 31 tane tip II DM&#8217;li ve 21 tane bozulmuş glukoz toleransı olan hastalar alındı. Kontrol grubu olarak sağlıklı, gönüllü bireylerden oluşan 30 kişilik bir grup oluşturuldu. Erkek cinsiyet oranı, vücut kitle indeksi, Hb, BUN, kr, LDL, HDL , sol ventrikül sistol ve diyastol sonu çapları her üç grupta da benzerdi. BNP değerleri açısından DM grubu IGT ve kontrol grubuna göre, IGT grubu da kontrol grubuna göre daha yüksek değerlere sahipti (36 ± 17&#8217;e karşılık 61 ± 20 ve 75 ± 17, p< 0,001 ). Geleneksel yöntemle bakılan 49 MPİ değerleri, en yüksek DM, en düşük kontrol grubu olacak şekilde her üç grupta anlamlı derecede farklı idi ( 0,41 ± 0,05, 0,53 ± 0,1, 0,62 ± 0,06, p< 0,001 ). Doku Doppler ile hesaplanan MPİ&#8217; değerleri de aynı sıralamayı gösterir şekilde anlamlı derecede farklı idi ( 0,51 ± 0,05, 0,57 ± 0,11, 0,63 ± 0,07, p< 0,001 ). Sadece IGT ve DM gruplarından oluşan bir gruba ; BNP ve ortalama MPİ&#8217; değerlerinin birbiriyle ve diğer parametrelerle ilişkisi bakımından korelasyon testi yapıldı. BNP ve ortalama MPİ&#8217; değerleri arasında anlamlı derecede pozitif ilişki bulundu ( r değeri : 0,574, p< 0,001 ). Hem BNP hem de ortalama MPİ&#8217;; EDZ , E/E&#8217; ve geleneksel yöntemle ölçülen MPİ oranıyla anlamlı bir ilişkiye sahiplerdi.. Sadece DM&#8217; lu hastalardan alınan bir grup oluşturulduğunda da BNP ve ortalama MPİ&#8217; değerleri arasında pozitif ilişki devam ediyordu ( r değeri : 0,499, p = 0,04 ). Sadece IGT hastaları alındığında da benzer ilişki sürüyordu. ( r değeri : 0,543, p = 0,01 ). EDZ, E/E&#8217; ve geleneksel yöntemle ölçülen MPİ değerleri de benzer şekilde her iki alt grup çalışmasında da anlamlı ilişkilerini korudular SONUÇ : IGT ve DM hastalarında BNP ve MPİ gibi iki prognoz belirteci parametre riskli hastaları belirlemede kullanılabilir. BNP ya da MPİ&#8217; den herhangi birinin net ayrım yapmaya yetecek kadar bilgi veremediği durumlarda bu iki parametrenin birbiri ile ilişkisi kullanılarak hastanın riskinin belirlenebileceği kanaatindeyiz.Background and Objectives: Diabetes Mellitus(DM) and impaired glucose tolerance are releated left ventricular dysfunction.In this study we aimed to look for, if myocardial performance index(MPI) measured by tissue doppler and brain natriuretic peptide(BNP) can show myocardial functional abnormality and to test if they are interrelated to each other. Methods: The patients excluded in the study were having the diagnosis of hypertension, coronary artery disease and use of antihypertensive agent. We established a control group which had the same exclusion criterias. Basal clinical findings, routine labaratory findings and BNP levels of patients were recorded. In all patients, MPIs which were measured by both conventional method and also by tissue dopper and E wave deceleration time(EDT), E/A, E/E&#8217; parameters were recorded. Differences between groups were also tested between all patients and also between subgroups of patients with DM and IGT. Results: 31 type II DM patients and 21 patients with IGT were included in the study.As a control group we established 30 persons of healty volunteers.Male sex ratio, body mass index, Hb,BUN,Creatinine, LDL, HDL, end-systolic and end-diastolic measures of left ventricle were similar in each three groups. The BNP values of the DM group were greater than IGT and the control group and the BNP values of IGT were also greater compared to the control group (36 ±17 vs. 61±20 and 75±17, p<0.001). MPI values measuered by the conventional method were significantly different between groups, highest in the DM group and lowest in the control group(0,41 ± 0,05, 0,53 ± 0,1, 0,62 ± 0,06, p< 0,001 ). The findings with tissue Doppler were similar and were significantly different between groups ( 0,51 ± 0,05, 0,57 ± 0,11, 0,63 ± 0,07, p< 0,001 ). We performed correlation test in a group composed of DM and IGT patients in order to look if there is a relation between BNP and MPI and also with other parameters. We found a significant positive correlation between BNP and mean MPI values(r value: 0,574, p< 0,001).Both BNP and mean MPI were having a significant relationship with EDT, E/E&#8217; and MPI measured by the conventional method. The positive correlation between BNP and mean MPI values still held in a subgroup of patients which were all type II DM patients( r value : 0,499, p = 0,04 ). The same correlation continued to be true in the patient group with IGT (r value: 0,543, p = 0, 01). The EDT, E/E&#8217; and MPI values measured by the conventional method kept their significant relationship between these subgroups. Conclusion: BNP and MPI which are two important prognostic parameters can be used in DM and IGT patients to define risky groups. We think that in patients where enough discrimination cannot be provided by either BNP or MPI, the relationship between these parameters can be used to define the risk of the patient

Relationship between mean platelet volume and left ventricular systolic function in patients with metabolic syndrome and ST-elevation myocardial infarction

Purpose: Mean platelet volume (MPV) is an indicator of platelet activation, which is a central process in the pathophysiology of coronary heart disease. Metabolic syndrome (MS) may lead to worsened left ventricular systolic function by causing recurrent thrombotic events and by aggravating systemic inflammation in the course of acute myocardial infarction. The present study was designed to investigate the relationship between MPV and left ventricular systolic function in patients with metabolic syndrome who had first ST-elevation myocardial infarction. Methods: MPV was measured on admission in 33 patients who had preserved left ventricle systolic function (mean age, 56.9±10.2 years) and in 48 patients who had depressed left ventricle systolic function (mean age, 57.9±10.5 years) with metabolic syndrome and first ST elevation myocardial infarction. Depressed left ventricle systolic function was defined as ≤50% ejection fraction value. MPV levels were compared in the two groups. Results: MPV was significantly higher in patients with depressed left ventricle systolic function in comparison with patients showing preserved left ventricle systolic function (p=0.02). Logistic regression analysis showed an independent relationship between MPV and deteriorated left ventricular systolic function, even after adjustment for potential confounders (1.08 (1.04-1.20), CI: 95%, p=0.02). Conclusions: Increased MPV on admission can be associated with degree of left ventricle systolic depression in patients with metabolic syndrome with first ST-elevation myocardial infarction. MPV may prove to be useful as a prognostic marker in patients with metabolic syndrome and ST elevation MI

Associaton of angiotensin converting enzyme insertion/deletion gene polymorphism with functional capacity markers and echocardiographic parameters in patients with aortic stenosis

Amaç: Fonksiyonel durumda bozulma aort darlığının doğal seyrinde kritik bir nokta olup kapak değişimi operasyonun en önemli endikasyonunu oluşturur. Bu çalışmada hafif ve orta dereceli aort darlığı (AD) olan hastalarda anjiyotensin dönüştürücü enzim (ADE) geni insersiyon/delesyon (I/D) polimorfizminin fonksiyonel kapasite belirteçleri ve ekokardiyografide sol ventrikül fenotipi ile ilişkisi araştırıldı. Gereç ve Yöntem: Ekokardiyografi ile doğrulanmış hafif-orta dereceli AD’si olan 22 asemptomatik hastanın ADE gen polimorfizmleri ile fonksiyonel kapasiteleri New York Kalp Cemiyeti sınıflaması, 6 dakika yürüme testi, plazma NT-proBNP ölçümleri yapılarak değerlendirildi. Bulgular: Yaş, hipertansiyon, dejeneratif darlık ve aort kapak kalsifikasyonu daha kötü fonksiyonel kapasiteyle ilişkili bulundu (p0.05). ADE gen polimorfizmi ile fonksiyonel kapasite arasında ilişki saptanmadı. DD genotipi normotansif hastalarda egzantrik şekillenmeyle ilişkili bulundu (p:0,03) Hipertansif hastalarda ve 40 yaş üzeri DD genotipli hastalarda daha belirgin sol ventrikül hipertrofisi saptandı (sırasıyla 190,122,2g/m2 vs 132,112,8g/m2; p:0,004 ve 181,929,6g/m2 vs 143,836,3g/m2; p:0,02) . Sonuç: Yaşlı, hipertansif, dejeneratif veya kalsifik hafif orta dereceli AD’si olan hastaların fonksiyonel kapasitenin bozulması açısından daha yakın takip edilmeleri uygun olabilir. DD genotipli hipertansif ve 40 yaş üstünde hafif-orta dereceli aort darlığı olan hastalarda sol ventrikül hipertrofisi daha belirgindir.Aim: Deterioration of functional status is a critical point being the most important indication for valve replacement surgery. In this study on patients with mild or moderate aortic stenosis (AS), association of angiotensin converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism with functional capacity markers and left ventricular phenotype in echocardiography was evaluated. Material and Method: ACE gene polymorphism and functional capacity which was measured with New York Heart Association clas- sification, 6 minute walk test and plasma NT-proBNP levels were assessed in twenty two asymptomatic patient with echocardio- graphically documented mild-moderate AS. Results: Age, hypertension, degenerative stenosis and aortic valvular calsification were related with worse functional capacity (p<0,05). ACE gene polymorphism was not associated with functional capacity. DD genotype was associated with eccentric modelling in normotensive patients (p:0.03). Among either hypertensive patients or patients over 40 years subjects with DD genotype had more significant left ventricular hypertrophy (190.1±22.2 g/m2 vs 132,1±12,8 g/m2; p:0.004 and 181,9±29,6 g/m2 vs 142,8±36,3 g/m2; p:0,02 respectively). Conclusion: Closer follow up of elderly, hypertensive, degenerative and calcified mild-moderate AD patients for deterioration of func- tional capacity may be suitable. Mild-moderate AD patients older than 40 years or with hypertension have more significant left ventricular hypertrophy if they have DD genotype