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

Comparison of the Effects of Dialysis Type on Right Heart Functions in Chronic Renal Failure Patients

Aim: The aim of this study was to compare the effects of dialysis type on right heart functionswith two-dimensional speckle tracking echocardiography (2D-STE).Material and Methods: A total of 53 patients who have peritoneal dialysis and hemodialysis,applied to cardiology and nephrology outpatient clinics, were included in the study. Those withleft heart failure, coronary artery disease, primary and secondary pulmonary hypertension,pulmonary embolism, deep vein thrombosis, moderate and severe heart valve failure and stenosiswere excluded from the study. Sociodemographic characteristics and biochemical parameters ofthe patients were recorded. Right heart functions of the patients were evaluated using 2D-STE.Results: There was no difference between groups with respect to age (p=0.496), the rate ofmale was higher in hemodialysis group (p=0.006). In comparison of 2D-STE measurements;right atrium (RA) maximum volume and RA minimum volume were significantly higher inhemodialysis patients (p=0.006, p=0.007, respectively). There were no difference between thegroups in RA maximum volume index, RA minimum volume index and tricuspid annular planesystolic excursion (TAPSE). RAS strain and RAA strain were significantly lower inhemodialysis patients (p=0.001, p=0.012, respectively). A positive correlation was foundbetween TAPSE and RA maximum volume in hemodialysis patients (r=0.484, p=0.036), andbetween TAPSE and RA minimum volume in peritoneal dialysis patients (r=0.486, p=0.025).Conclusion: Right ventricular functions were found to be similar in peritoneal dialysis andhemodialysis patients. It was observed that right atrial functions were better protected inperitoneal dialysis patients than hemodialysis patients

The Correlation Between Education Levels and Lifestyles of Patients Admitted Cardiology Clinics: A Subgroup Analysis of Medlife-TR Study

Objectives: The lifestyle, dietary habits, and cardiovascular (CV) risk perception of patients with CV risk factors and/or diseases in Turkish population may vary with education. We aimed to reveal the relationship between education level and lifestyles in patients who participated in the Medications and Lifestyles of Patients with Cardiovascular Risk Factors and/ or Diseases in Turkish Population (MedLife-TR) study. Materials and Methods: This study was conducted between November 2018 and March 2019 with 2793 patients. The male gender ratio was 47.91%, and the female gender ratio was 52.09%. The participants first completed a self administered questionnaire in four sections: baseline characteristics, awareness of CV risk factors and their CV risk levels ,lifestyle habits (exercise, diet, eating….) and use of drugs. This was a multicenter, national and observational study that included 27 centers in Turkey. Fisher-Freeman-Halton test was used for comparison of qualitative data. A p-value <0.05 was considered statistically significant. Results: According to the education level of patients, CV risk perception and eating habits vary as education level increases. The ratio of patients to exercise regularly was low. But as the level of education increases, the rate of regular exercise increases (p<0.001). The rate of using herbal products (p=0.086) or vitamins (p=0.384) did not change as the level of education increased. The university-level group stated that smoking was the highest risk factor for CV disease (28.33%). However, the other groups, especially the uneducated group (42.92%) think that hypertension is the most risk factor for CV diseases. The consumption of fast-food products such as hamburgers, pizza, and fries increased as the education level increased. The rate of skipping breakfast (17.69%) was higher in the university-level group than the other groups (p<0.001). Conclusion: Statistically significant differences were observed between education level and lifestyle of patients with CV risk factors and/or diseases. As the education level increases, the rate of skipping breakfast and the consumption of fast-food products increase; however, the rate of regular exercise and diet increases

Modified model for end-stage liver disease score predicts 30-day mortality in high-risk patients with acute pulmonary embolism admitted to intensive care units

Objectives The Model for End-stage Liver Disease excluding the international normalised ratio that is derived from prothrombin time which is calculated as a ratio of the patient's prothrombin time to a control prothrombin time standardized (MELD-XI) and modified MELD, which uses albumin in place of the international normalised ratio (MELD-Albumin) scores reflect liver and renal function and are predictors of mortality. However, their prognostic value in acute pulmonary embolism (APE) has not been studied. Design We assessed the predictive value of the MELD scores in patients diagnosed with high-risk APE admitted to the intensive care unit. The primary outcome was 30-day mortality. Results Of the 273 patients included in the study, 231 were survivors and 42 were non-survivors. The mortality rate was 15.3%. The mean MELD-XI and MELD-Albumin scores were significantly higher in the non-survivors than in the survivors (MELD XI, 11.8 +/- 1.8 and 10.6 +/- 1.43, respectively; p = .002; MELD-Albumin, 10.5 +/- 1.6 and 8.7 +/- 1.1, respectively; p = .001). The multiple logistic regression analysis identified the MELD-XI (hazard ratio: 3.029, confidence interval: 1.06-1.21, p = .007) and MELD-Albumin (hazard ratio: 1.13, confidence interval: 1.06-1.21, p = .002) scores as independent predictors of mortality. Receiver operating characteristic analysis revealed that the predictive power of the MELD-Albumin score (0.871 +/- 0.014; p < .001) was higher than those of the MELD-XI (0.726 +/- 0.022, p < .001), APACHE III (0.682 +/- 0.024, p < .001), and PESI (0.624 +/- 0.023, p < .001) scores. Conclusions The MELD-Albumin score is an easily calculable, reliable, and practical risk assessment tool and independent predictor of 30-day mortality in patients with high-risk APE

MINOCA ile başvuran kadın hastaların demografik ve klinik özelliklerinin değerlendirilmesi ve erkek hastalarla farklılıkları: MINOCA-TR çalışmasının grup analizi

Objective: Although the prevalence and rate of myocardial infarction with non-obstructive coronary arteries (MINOCA) are higher in women than in men in previous cohorts, potential demographic and clinical differences between women who are diagnosed with MINOCA versus myocardial infarction with obstructive coronary arteries (MIOCA) have not been studied till date. In this study, we aimed to document these characteristics and to compare them between female patients with MINOCA and MIOCA. Methods: The study was a subgroup analysis of the MINO-CA-TR study. The study was a multi-center, observational cohort study that was conducted in Turkey between March 2018 and October 2018. In this study, 477 (29.3%) female patients who had been diagnosed with acute myocardial infarction were evaluated. Results: Of these women, 49 (10.3%) were diagnosed with MINOCA (mean age 58.9 +/- 12.9 years) and 428 (89.7%) had a final diagnosis of MIOCA (mean age 67.4 +/- 11.8 years). The prevalence of hypertension, hyperlipidemia, and diabetes mellitus was significantly lower in the MINOCA group than in the MIOCA group. In addition, the MINOCA group had higher rates of recent flu history and non-ST elevation myocardial infarction (NSTEMI) presentation than the MIOCA group. There were significant clinical differences in patients with MINOCA in terms of sex. The female patients were older, had higher systolic blood pressures, and lower hemoglobin levels than male patients. Conclusion: The study revealed that the prevalence of traditional coronary artery disease risk factors was lower in female patients with MINOCA than in those who had final diagnosis of MIOCA.Amaç: Daha önceki kohortlarda kadın hastalarda obstrüktif olmayan koroner arterlerle miyokart enfarktüsü (MINOCA) erkeklere göre daha yüksek oranda olmasına rağmen, MINOCA ve obstrüktif koroner arterli miyokart enfarktüsü (MIOCA) tanısı alan kadın hastalar arasındaki potansiyel demografik ve klinik farklılıklar bugüne kadar çalışılmamıştır. Bu çalışma, bu özellikleri araştırmayı ve kadın MINOCA ve MIOCA hastaları arasında karşılaştırmayı amaçladı. Yöntemler: Çalışma, Türk popülasyonu (MINOCA-TR) kayıtlarının subgrup analizidir. Kayıt, Türkiye’de Mart 2018- Ekim 2018 tarihleri arasında yürütülen çok merkezli, gözlemsel bir kohort çalışmasıydı. Bu çalışmada 477 (%29.3) akut miyokart enfarktüsü tanısı alan kadın hasta değerlendirildi. Bulgular: Kadınlardan 49’u (%10.3) MINOCA (ortalama yaş: 58.9±12.9 yıl) ve 428’i (%89.7) MIOCA (ortalama yaş: 67.4±11.8 yıl) tanısı almıştı. MINOCA grubunda hipertansiyon, hiperlipidemi ve diabetes mellitus prevalansları MIOCA grubuna göre anlamlı olarak daha düşüktü. Ek olarak, MINOCA grubunda MIOCA grubuna kıyasla daha yüksek oranlarda yakın zamanlı grip öyküsü ve ST yükselmesiz miyokart enfarktüsü (NSTEMI) prezentasyonu vardı. MINOCA hastalarında cinsiyet açısından önemli klinik farklılıklar vardı. Erkek vakalarla karşılaştırıldığında, kadın hastalar daha yaşlıydı, daha yüksek sistolik kan basıncına ve daha düşük hemoglobin seviyelerine sahipti. Sonuç: Çalışma, MIOCA kesin tanısı almış kadın hastalara göre, kadın MINOCA hastalarında geleneksel koroner arter hastalığı risk faktörünün daha düşük prevalansta olduğunu ortaya koymuştur.Cardiovascular Academy Societ