The association between TAPSE and right atrial contractile strain

BACKGROUND: In the descending arm of tricuspid annular plane systolic excursion (TAPSE) there is a notch formation which corresponds to the contractile phase of the atrial strain curve. Theoretically, this notch formation stands for atrial contraction. AIMS: We aim to characterize the notch formation on the TAPSE, the predictors of its existence, its relationship with the right ventricle and right atrial strain (RAS) parameters. METHODS: Retrospectively selected 240 patients were investigated for the determinants of the notch formation on TAPSE and the relation between RAS and TAPSE. RAS was analyzed using 2D speckle tracking in a dedicated mode for atrial analysis and reported separately for the reservoir, conduit, and contractile phases. RESULTS: 71.7% (n = 172) of patients had the notch formation on the TAPSE and 70.4% (n = 169) had a normal value of right atrial contractile strain (RASct). Most of the patients with a notch formation also had preserved RASct (95.9%; P <0.001). In multivariable analysis, RASct (odds ratio [OR], 1.45; 95% confidence interval [CI]: 1.13­­‒1.77; P = 0.020) remained significant with the notch formation. Receiver operator characteristic (ROC) analysis demonstrated that a RASct of ‒19% was found as a cut-off for presence of notch formation. ROC area was 0.897 (95% CI 0.844–0.951; P <0.001). CONCLUSIONS: The changes in TAPSE configuration represents the changes in atrial contractile phase. The descending arm of the TAPSE indicates the RASct as whether it is preserved or not. The notch formation persists if the RASct is above ‒19%. So, an easier, more applicable, and more effortless tool TAPSE can be used as an indicator of atrial contractile phase by its configuration in daily routine

TSMK H.987 no'lu Divân-ı Câmî minyatürlerinin teknik analizi

Yazma eserler, içlerinde bulunan minyatürlülerle yapıldıkları döneme ait üslupları açıkça yansıtırlar.Bu üsluplar kendilerini desenlerde ve boyama tekniklerinde gösterirler. TMSK H-987 Divan-ı Câmî adlı eserde, İranlı mutasavvıf, sufi, şair Abdurrahmân Camî tarafından kaleme alınmış birinci divanına ait şiirler yer alır. Bu eserde bulunan minyatürler ise metinden bağımsız olarak Baykara devrinin saray kültürünü ve Ali Şîr Nevâî ile yapılan meclisleri görsel olarak anlatmaktadır. Eserde görsel olarak aktarılan hikâyelerin çözümlenmesi ve anlaşılması için resimlerde bulunan figürlerin kimlere ait olduğunun tespiti önemlidir. Figür tiplerinin belirlenmesi ardından her bir minyatürde tekrar eden yüzlerin çizim analizi eserde çalışan sanatçıların adedinin belirlenmesini sağlamıştır. Benzer dönemlere ait minyatürlü eserlerin kıyaslamaları ise eserin tarihlendirilmesi konusunda yardımcı olan bir yöntemdir. Yapılan renk analizi ile de minyatürlerin genelinde kullanılan renklerin ton oranları açıklanmaktadır. Bu yöntemlerin kullanılması ile eser inceleme çalışması dört ana başlıkta sunulmaktadır. Birinci ve ikinci bölümde Abdurrahmân Câmî hayatı eserleri ve devrin sanat hâmileri; üçüncü bölümde TSMK H-987 Divan-ı Câmî minyatürlerinin tanımı, fiziksel özellikleri, cild, mühür, notları ve tezhipleri; dördüncü bölümde ise on adet minyatür sınıflandırılarak çizimleri yapılmış teknik yapım analizi ile yapım teknikleri açıklanmıştır. Giriş, değerlendirme ve sonuç bölümleri bu ana gövdeden bağımsız olarak çalışmayı destekler nitelikte örneklemeler içermekte ve devrin minyatür üslubunu açıklamaktadır.Writing artifacts clearly reflect the manner in which they are made with the miniatures found in them. These styles show themselves in patterns and painting techniques. TSMK H-987 Divan-ı Câmi contains poems belonging to the first divan, which was taken by the Iranian Sufi, sufi poet Abdurrahman Câmi. The miniatures found in this work visually explain the palace cult of Baykara perios and the assemblies made with Ali Şir Nevâî independently of the text. It is important to determine who the figures in the painting belong to for the analysis and understanding of the stories conveyed visually. Following the identification of figure types, the drawing analysis of the repeating faces in each miniature ensured the identification of the artists' names in the work . Comparisons of miniature works belonging to similar periods are a way of helping to dated the work.The tonal ratios of the colors used in the miniatures are also explained by the color analysis. The use of these methods and the study of the works are presented in four main themes. In the first and second episodes Abdurrahman Câmi life, his works and devine arts poems; information about the art bosses of the period; In the third part, the definition, physical properties, skin, seal, notes and gildings of the TSMK H-987 Divan-ı Câmî miniatures; In the fourth section, ten miniatures were explained. technical construction analysis and construction techniques were explained. The introduction, evaluation and conclusion sections support the work independently from this main body, and include descriptive samples and explain the period miniature style

The relationship of microalbuminuria with left ventricular functions and silent myocardial ischemia in asymptomatic patients with type 2 diabetes

İstanbul Bilim Üniversitesi, Tıp Fakültesi.Amaç: Son yıllarda, ilerleyici böbrek yetersizliğinin bir belirteci olan mikroalbüminürinin (MA) özellikle diyabetik hastalarda kardiyovasküler hastalıkla da ilişkili olduğu gözlenmiştir. Bu çalışmada, tip 2 diyabetli asemptomatik hastalarda MA ile sol ventrikül fonksiyonları ve efor testinde saptanan sessiz miyokart iskemisi arasındaki ilişki araştırıldı. Çalışma planı: Çalışmaya, kardiyak açıdan yakınmasız, tip 2 diyabet tanısı konan 50 hasta (36 kadın, 14 erkek; ort. yaş 63±7) alındı. Her hastaya transtorasik ekokardiyografik değerlendirmeyi takiben biyokimyasal değerlendirme ve egzersiz testi yapıldı. Her hastada iki ayrı günde 24 saatlik idrarda MA düzeyi ölçüldü. Hastalar MA miktarının 30 mg’nin üzerinde ve altında olmasına göre sırasıyla MA(+) ve MA(–) olarak gruplandırıldı.Objectives: Recently, microalbuminuria (MA), a marker of advanced renal failure, has been shown to be related with cardiovascular disease especially in diabetic patients. This study was designed to investigate the relationship between MA and left ventricular functions and silent myocardial ischemia documented by exercise test in patients with type 2 diabetes mellitus. Study design: The study included 50 asymptomatic patients (36 women, 14 men; mean age 63±7 years) with type 2 diabetes. All the patients underwent treadmill test and biochemical tests following transthoracic echocardiography. Microalbuminuria was diagnosed from a 24-hour urine sample on two different days and the patients were evaluated in two groups based on the presence (≥30 mg/dl) or absence (<30 mg/dl) of MA

Evaluation of carotid intima- media thickness and aortic elasticity in patients with nondipper hypertension

İstanbul Bilim Üniversitesi, Tıp Fakültesi.BackgroundThe relationship between cardiovascular diseases and the diurnal blood pressure (BP) rhythm was researched in many studies. It has been demonstrated that the nondipping pattern has been associated with target organ damage and worsened cardiovascular outcomes. The aim of our study was to assess the relationship between aortic elasticity parameters and carotid intima-media thickness (CIMT) and diastolic dysfunction in terms of dipper and nondipper hypertension subtypes. MethodsA total of 60 hypertensive patients without known coronary heart disease were recruited to our study. All patients were classified as dipper or nondipper after ambulatory BP follow-up. Patients' left ventricular (LV) systolic and diastolic functions were assessed with transthoracic echocardiography. Ascending aorta diameters and CIMT were measured by ultrasonography and the elasticity parameters of aorta were calculated by using relevant formula. ResultsThere were no significant differences between the groups with respect to demographic, biochemical data, and cardiovascular risk factors. Aortic stiffness was significantly increased in nondippers, whereas aortic strain and distensibility were significantly decreased (P=0.005, P=0.005, and P=0.024, respectively). Carotid artery IMT was significantly increased in nondippers compared to dippers (P=0.013). A significant correlation was noted between CIMT and mean BP. No significant difference was detected between 2 groups in terms of LV hypertrophy and diastolic dysfunction. ConclusionIn our study, we showed that impairment of aortic elasticity parameters and increase in CIMT as a predictor of end organ damage were more often in the nondipper hypertensive patients

The comparison between the efficiency of different anti-arrhythmic agents in preventing postoperative atrial fibrillation after open heart surgery

İstanbul Bilim Üniversitesi, Tıp Fakültesi.Amaç: Atriyal fibrilasyon (AF); açık kalp cerrahisi sonrasında en sık görülen komplikasyonlardan biridir. Açık kalp cerrahisini takiben sinüs ritmini sağlamak için kullanılan değişik antiaritmik ilaçların etkisinin karşılaştırılması ile ilgili yeterli veri yoktur. Biz çalışmamızda; farklı sınıflarda yer alan çeşitli antiaritmik ilaçların, operasyon öncesi başlanmasının, postoperatif AF sıklığına, hastanede yatış zamanına, gelişebilecek komplikasyonlara etkisini karşılaştırmayı planladık. Yöntemler: Bu ileriye dönük tek-kör çalışmaya açık kalp cerrahisi planlanan 180 hasta (130 erkek, 50 kadın, ortalama yaş: 58.13±11.7) alındı. Hastalar beş gruba ayrıldı. İlaçlar operasyondan 7 gün önce başlandı. Birinci gruba (G1) propafenon 300mg /gün, ikinci gruba (G2) sotalol 80mg /gün, üçüncü gruba (G3) amiodaron 400mg/gün, dördüncü gruba (G4) diltiazem 180mg /gün; oral olarak verildi. Beşinci gruba (G5) antiaritmik ilaç verilmedi. Operasyon sonrası tüm gruplarda tedaviye yatış süresince devam edildi. İstatistiksel analiz Ki-kare ve tek yönlü ANOVA testleri ile yapıldı.Objective: Atrial fibrillation (AF) is one of the most frequent complications that may occur after open-heart surgery. Clinical reports regarding comparison of different anti-arrhythmic agent’s usage to maintain sinus rhythm after open-heart surgery are not conclusive. We examined the effects of different anti-arrhythmic agents administration before operation on postoperative AF incidence, duration of hospitalization and complications. Methods: Overall, 180 patients (130 men and 50 women, mean age 58.13±11.71 years) who were candidates for open-heart surgery, were included in this prospective, single-blind study. All patients divided into five different groups. All anti-arrhythmic drugs were administered approximately 7 days before the operation. Propafenone was given to Group 1 (G1); sotalol to Group 2 (G2); amiodarone to Group 3 (G3) and diltiazem to Group 4 (G4) at doses of 300 mg/day, 80 mg/day, 400 mg/day and 180 mg/day orally respectively. The fifth group (G5) did not receive any of anti-arrhythmic drugs. The medication was continued for ten days postoperatively. Statistical analysis was performed using Chi-Square and one-way ANOVA tests

Evaluation of left ventricular regional systolic functions in patients with coronary artery disease by two-dimensional strain imaging: a velocity vector imaging study

İstanbul Bilim Üniversitesi, Tıp Fakültesi.Amaç: Bu çalışmada, koroner arter hastalığında (KAH) sol ventrikül (SV) bölgesel sistolik fonksiyonları yeni bir gerilim (strain) görüntüleme yöntemi olan hız vektör görüntüleme (HVG) ile değerlendirildi. Çalışma planı: Çalışmaya KAH tanısı konan 69 hasta (51 erkek, 18 kadın; ort. yaş 59.2±10.3) ve 30 sağlıklı gönüllü (22 erkek, 8 kadın; ort. yaş 58.1±13.8) alındı. Hastaların 33’ünde geçirilmiş miyokart enfarktüsü (ME) vardı. Tüm hastalarda, Amerikan Kalp Birliği’nin 16 segment modeli kullanılarak SV bölgesel duvar hareketleri (akinetik, hipokinetik ve normokinetik) belirlendi. Ayrıca, HVG yöntemi kullanılarak, SV’ye ait tüm segmentlerin zirve sistolik gerilimi (strain), gerilim hızı (SRs) ve segmenterejeksiyon fraksiyonları (SEF) hesaplandı.Objectives: The aim of the study was to assess left ventricular (LV) regional systolic functions in coronary artery disease (CAD) using a novel strain imaging method, namely, velocity vector imaging (VVI). Study design: The study included 69 patients (51 men, 18 women; mean age 52.9±10.3 years) with CAD and 30 healthy volunteers (22 men, 8 women; mean age 58.1±13.8 years). Thirty-three patients had previous myocardial infarction (MI). In all the patients, LV wall motions were analyzed as akinetic, hypokinetic, or normokinetic using the 16-segment model of the American Heart Association. In addition, LV peak systolic strain, strain rate (SRs), and segmental ejection fraction (SEF) of all the segments were calculated by using VVI

Evaluation of mean platelet volume and platelet distribution width in patients with asymptomatic intermediate carotid artery plaque

WOS: 000394705500006PubMed ID: 27714714Background: Platelets play a significant role in the pathogenesis of atherosclerosis. In atherosclerotic plaques, the risk of plaque rupture is more crucial than the severity of the stenosis they cause. Non-calcified carotid artery plaques are more unstable than calcified plaques, and they are associated with a higher risk of rupture, thromboembolism, and consequently, stroke. Aim: The purpose of the present study is to compare calcified and non-calcified plaques that cause intermediate carotid artery stenosis, with respect to mean platelet volume (MPV) and platelet distribution width (PDW). Methods: A total of 139 asymptomatic patients with 50-70% stenosis of the carotid artery were included in this study. Carotid Doppler ultrasound imaging and computed tomography angiography were performed to divide the carotid artery plaques into two groups as calcified and non-calcified. Patients included in the calcified (n = 73) and non-calcified (n = 66) plaque groups were compared with respect to MPV and PDW. Results: Mean platelet volume was statistically significantly higher in the non-calcified plaque group compared to the calcified plaque group (MPV in non-calcified/calcified plaque groups [fL]: 10.0/9.0, respectively) (p < 0.01). PDW was not significantly different between the two groups (p = 0.09). Platelet count was statistically significantly higher in the calcified plaque group compared to the non-calcified plaque group (platelet count in calcified/non-calcified plaque groups [10(3)/mm(3)]: 250 +/- 63/226 +/- 56, respectively) (p = 0.019). Multivariate regression analysis showed that MPV was independently associated with non-calcified carotid artery plaque (odds ratio 5.95, 95% confidence interval 2.63-13.45, p < 0.001). Conclusions: Mean platelet volume is increased in the presence of non-calcified carotid artery plaques that cause asymptomatic intermediate stenosis. Increased MPV can be used as a marker to predict the risk of rupture of the non-calcified carotid artery plaques

ST yükselmeli miyokart enfarktüsü sonrası gelişen kalp durması nedeniyle tedavi amaçlı hipotermi uygulanan hastalarda nörolojik sonlanım: Üçüncü basamak merkez tecrübesi

WOS: 000375094600003PubMed ID: 27111307Objective: Therapeutic hypothermia improves neurologic prognosis after cardiac arrest. The aim of this study was to report clinical experience with intravascular method of cooling in patients with cardiac arrest resulting from ST-segment elevation myocardial infarction (STEMI). Methods: Thirteen patients (11 male, 2 famele; mean age was 39.6+/-9.4 years) who had undergone mild therapeutic hypothermia (MTH) by intravascular cooling after cardiac arrest due to STEMI were included. Clinical, demographic, and procedural data were analyzed. Neurologic outcome was assessed by Cerebral Performance Category (CPC) score. Results: Anterior STEMI was observed in 9 patients. One patient died of cardiogenic shock complicating STEMI. Mean cardiopulmonary resuscitation (CPR) duration and door-to-invasive cooling were 32.9+/-20.1 and 286.1+/-182.3 minutes, respectively. Precooling Glasgow Coma Scale score was 3 in 9 subjects. Twelve patients were discharged, 11 with CPC scores of 1 at 1-year follow-up. No major complication related to procedure was observed. Conclusion: In comatose survivors of STEMI, therapeutic hypothermia by intravascular method is a feasible and safe treatment modality.Amaç: Kalp durması sonrası tedavi amaçlı hipotermi uygulamasının nörolojik prognoz üzerine olumlu etkisi gösterilmiştir. Bu yazıda, ST yükselmeli miyokart enfarktüsüne (STYME) bağlı kalp durması geçiren hastalarda damariçi yöntemle yapılan soğutma tedavisine ilişkin çalışmamız sunuldu. Yöntemler: ST yükselmeli miyokart enfarktüsü sonrası kalp durması nedeniyle damariçi yöntemle tedavi amaçlı hipotermi uygulanan 13 hasta (11 erkek, 2 kadın; ortalama yaş 39.6±9.4 yıl) çalışmaya dahil edildi. Klinik, demografik ve soğutma işlemine ait veriler incelendi. Nörolojik takipler Serebral Performans Kategorisi skorlaması kullanılarak yapıldı. Bulgular: Dokuz hastada akut ön duvar miyokart enfarktüsü tespit edildi. Bir hasta kardiyojenik şok nedeniyle kaybedildi. Ortalama kardiyopulmoner canlandırma süresi ve kapı invaziv soğutma süresi sırasıyla 32.9±20.1 ve 286.1±182.3 dakikaydı. Soğutma öncesi dokuz hastada Glaskow Koma Skalası 3 bulundu; 12 hasta taburcu edildi, 11 hastanın bir yıllık takipte Serebral Peformans Kategorisi skoru 1 olarak saptandı. Soğutma işleminden kaynaklanan ciddi komplikasyon gözlenmedi. Sonuç: ST yükselmeli miyokart enfarktüsü sonrası koma halinde bulunan hastalarda damariçi yöntemle yapılan tedavi amaçlı hipotermi faydalı ve güvenli bir tedavi seçeneğidir

Ocena średniej objętości płytek krwi i szerokości rozkładu objętości płytek krwi u chorych z blaszką miażdżycową tętnicy szyjnej powodującą bezobjawowe zwężenie pośredniego stopnia

Background: Platelets play a significant role in the pathogenesis of atherosclerosis. In atherosclerotic plaques, the risk of plaque rupture is more crucial than the severity of the stenosis they cause. Non-calcified carotid artery plaques are more unstable than calcified plaques, and they are associated with a higher risk of rupture, thromboembolism, and consequently, stroke.   Aim: The purpose of the present study is to compare calcified and non-calcified plaques that cause intermediate carotid artery stenosis, with respect to mean platelet volume (MPV) and platelet distribution width (PDW).   Methods: A total of 139 asymptomatic patients with 50–70% stenosis of the carotid artery were included in this study. Carotid Doppler ultrasound imaging and computed tomography angiography were performed to divide the carotid artery plaques into two groups as calcified and non-calcified. Patients included in the calcified (n = 73) and non-calcified (n = 66) plaque groups were compared with respect to MPV and PDW.   Results: Mean platelet volume was statistically significantly higher in the non-calcified plaque group compared to the cal­cified plaque group (MPV in non-calcified/calcified plaque groups [fL]: 10.0/9.0, respectively) (p &lt; 0.01). PDW was not significantly different between the two groups (p = 0.09). Platelet count was statistically significantly higher in the calcified plaque group compared to the non-calcified plaque group (platelet count in calcified/non-calcified plaque groups [103/mm3]: 250 ± 63/226 ± 56, respectively) (p = 0.019). Multivariate regression analysis showed that MPV was independently associ­ated with non-calcified carotid artery plaque (odds ratio 5.95, 95% confidence interval 2.63–13.45, p &lt; 0.001).   Conclusions: Mean platelet volume is increased in the presence of non-calcified carotid artery plaques that cause asymp­tomatic intermediate stenosis. Increased MPV can be used as a marker to predict the risk of rupture of the non-calcified carotid artery plaques.   Wstęp: Płytki krwi odgrywają istotną rolę w patogenezie miażdżycy. Ważniejsze znaczenie ma ryzyko pęknięcia blaszki miażdżycowej niż powodowane przez nią zwężenie. Nieuwapnione blaszki miażdżycowe są bardziej niestabilne niż blaszki uwapnione i wiążą się z większym ryzykiem pęknięcia, powikłań zakrzepowo-zatorowych i, w konsekwencji, udaru mózgu.   Cel: Przedstawione badanie przeprowadzono w celu porównania uwapnionych i nieuwapnionych blaszek miażdżycowych powodujących zwężenie tętnic szyjnych pośredniego stopnia w odniesieniu do średniej objętości płytek krwi (MPV) i szerokości rozkładu objętości płytek krwi (PDW).   Metody: Do badania włączono 139 chorych z 50–70-procentowym zwężeniem tętnicy szyjnej bez objawów klinicznych. Wykonano ultrasonografię doplerowską i angiografię metodą tomografii komputerowej w celu podzielenia blaszek na dwie grupy w zależności od uwapnienia. Grupy pacjentów z blaszkami uwapnionymi (n = 73) i nieuwapnionymi (n = 60) porównano pod względem MPV i PDW.   Wyniki: W grupie chorych z nieuwapnionymi blaszkami MPV była statystycznie istotnie większa niż w grupie z blaszkami uwapnionymi (MPV w grupie z blaszkami nieuwapnionymi i w grupie z blaszkami uwapnionymi wynosiła odpowiednio 10,0 fl i 9,0 fl; p &lt; 0,01). Wartości PDW nie różniły się znamiennie między grupami (p = 0,09). Liczba płytek krwi była statystycznie istotnie wyższa w grupie z uwapnionymi blaszkami niż w grupie z blaszkami nieuwapnionymi (liczba płytek krwi w grupie z blasz­kami nieuwapnionymi i w grupie z blaszkami uwapnionymi wynosiła odpowiednio 250 ± 63 103/mm3 i 226 ± 56 103/mm3; p = 0,019). W wieloczynnikowej analizie regresji wykazano, że MPV była niezależnie związana z występowaniem blaszek nieuwapnionych w tętnicy szyjnej (iloraz szans 5,95; 95% przedział ufności 2,63–13,45; p &lt; 0,001).   Wnioski: Stwierdzono zwiększone wartości MPV w przypadku obecności w tętnicy szyjnej nieuwapnionych blaszek miażdżycowych powodujących bezobjawowe zwężenie pośrednie tętnicy szyjnej. Zwiększona MPV może być stosowana jako wskaźnik ryzyka pęknięcia nieuwapnionych blaszek miażdżycowych.