State of Utah v. Christena White : Appellant\u27s Reply Brief to Appellee\u27s Brief

DISTRICT COURT NO. 021900588FS APPELLANT COURT NO. 20040201-C

Diagnostic algorithms in pulmonary hypertension

İstanbul Bilim Üniversitesi, Tıp Fakültesi.Pulmoner hipertansiyon prognozu kötü olan ciddi bir hastalıktır. Pulmoner hipertansiyonun tanısı ve değerlendirilmesi, hastalığın tanımında, tanı tekniklerinde ve takibinde son yıllarda yapılan değişikliklerle beraber hızla gelişmektedir. Pulmoner hipertansiyon ile birlikteliği bulunan farklı durumlar ve yeni tanı yöntemleri sistematik bir tanı algoritması oluşturma ihtiyacını doğurmuştur. Bu derleme, pulmoner hipertansiyona son yıllarda yapılan değişiklikleri de kapsayan tanı yaklaşımından bahsetmektedir.Pulmonary hypertension is a serious disease with a poor prognosis. The diagnosis and assessment of pulmonary hypertension is evolving rapidly with changes in the definition of the disease, diagnostic techniques and follow-up assessment. Different conditions associated with pulmonary hypertension and new diagnostic techniques have led to a need for a systematic diagnostic approach. This review article presents an update on alterations in the diagnostic algorithm

Czynność mechaniczna lewego przedsionka u chorych, którzy przebyli zawał ściany przedniej serca: analiza na podstawie obrazowania wektorów prędkości

Background: The contribution of the left atrium (LA) to left ventricular (LV) function increases in myocardial infarction (MI).Aim: To evaluate LA function by using volume measurements and a novel strain imaging method, namely velocity vector imaging (VVI), in patients with acute anterior MI.Methods: Twenty-four patients with previous anterior MI (aged 63.8 ± 4.2 years, 56% men) and 30 healthy controls (aged 60.7 ± 5.3 years, 60% men) were enrolled. LA volume measurements and VVI-derived LA peak systolic strain (S), strain rate (SRs), early diastolic (ESRd) and late diastolic strain rate (LSRd) were measured. LV diastolic function was analysed by pulsed wave-Doppler and tissue velocity ımaging.Results: LA maximum volume index was increased in patients compared to controls (28.83 ± 7.2 vs. 19.72 ± 6.27 mL/m2,p = 0.0001). As LA active emptying volume index and fraction were increased (6.16 ± 0.7 vs. 5.46 ± 0.99 mL/m2, p = 0.009 and 22.16 ± 3.07 vs. 16.78 ± 2.93%, p = 0.0001, respectively), passive emptying volume index and fraction were decreased in the patient group (6.09 ± 0.57 vs. 7.57 ± 0.61 mL/m2, p = 0.0001 and 45.76 ± 6.86 vs. 56.45 ± 5.36%, p = 0.0001, respectively). However, total emptying volume index of the LA was similar between the two groups. VVI-derived LA peaksystolic S, SRs and ESRd were impaired in the patient group. LA LSRd was similar between the groups. LA active empty ingfraction was positively correlated with LV diastolic dysfunction and negatively correlated with LV systolic dysfunction.Conclusions: We demonstrated increased LA booster function and decreased LA conduit and reservoir functions in patients with prior anterior MI. Improvement in LA booster function correlated with the degree of LV systolic and diastolic dysfunction, suggesting a compensatory response of the LA.Wstęp: Wpływ czynności lewego przedsionka (LA) na czynność lewej komory (LV) zwiększa się w przypadku wystąpienia zawału serca (MI).Cel: Celem badania była ocena czynności LA na podstawie pomiarów parametrów objętościowych i nowych metod obrazowania odkształceń mięśnia sercowego, obrazowania wektorów prędkości (VVI) u chorych z ostrym MI ściany przedniej.Metody: Do badania włączono 24 chorych, którzy przebyli MI ściany przedniej (wiek: 63,8 ± 4,2 roku, 56% mężczyzn) i 30 zdrowych osób stanowiących grupę kontrolną (wiek: 60,7 ± 5,3 roku, 60% mężczyzn). Zmierzono parametry objętościowe LA i wykorzystano metodę VVI do oceny maksymalnego odkształcenia (S, strain) LA w czasie skurczu, tempa odkształcenia w czasie skurczu (SRs, strain rate), a także wczesnorozkurczowe (ESRd) i późnorozkurczowe (LSRd) tempo odkształcenia. Czynność rozkurczową LV oceniano na podstawie obrazowania metodą tkankowej echokardiografii doplerowskiej.Wyniki: U pacjentów po MI wskaźnik maksymalnej objętości LA był większy niż w grupie kontrolnej (28,83 ± 7,2vs. 19,72 ± 6,27 ml/m2; p = 0,0001). Ponieważ objętość i frakcja aktywnego opróżniania LA były zwiększone (odpowiednio 6,16 ± 0,7 vs. 5,46 ± 0,99 ml/m2.Wnioski: Wykazano, że u pacjentów, którzy przebyli MI, nastąpiło zwiększenie wspomagającej czynności LA i ograniczenie roli LA jako drogi przepływu oraz zbiornika. Poprawa wspomagającej czynności LA korelowała ze stopniem dysfunkcji skurczoweji rozkurczowej LV, co wskazuje na kompensacyjną odpowiedź LA

Doppler ultrasound imaging of the carotid and vertebral arteries

Özet – Karotis arter hastalığının sıklığı yaş ve kardiyovasküler risk faktörlerine bağlı olarak artmaktadır. Belirgin karotis arter darlığı, inme ve diğer serebrovasküler olayların gelişimi ile yakından ilişkilidir. Doppler ultrasonografi, karotis ve vertebral arterlerin incelenmesinde kullanılan güvenilir, invaziv olmayan bir görüntüleme yöntemidir. Karotis arter sisteminin doğru bir şekilde değerlendirilmesi yeterli teknik bilgi ve deneyimi gerektirmektedir. Bu derlemede, karotis arter sisteminin Doppler ultrasonografi ile doğru bir şekilde nasıl değerlendirilmesi gerektiği hakkında bilgi verilmesi amaçlandı.Summary – The prevalence of carotid artery diseases increases with age and exposure to cardiovascular risk factors. Significant carotid artery stenosis is closely associated with the development of stroke and cerebrovascular events. Doppler ultrasound imaging is a noninvasive and useful modality for the examination of carotid and vertebral arteries. However, proper investigation of the carotid artery system requires sufficient technical knowledge and experience. This review gives information about the techniques of appropriate examination of the carotid artery system

The interaction between endothelin-1 and C-reactive protein and their impact on long-term prognosis after percutaneous coronary interventions

WOS: 000267405600008Introduction: Previous studies have demonstrated unfavourable outcomes in coronary artery disease and percutaneous coronary intervention (PCI) patients with high endothelin-1 (ET-1) or high sensitivity C-reactive protein (hs-CRP) levels. The aim of our study was to investigate the impact of pre-procedural ET-1 and hs-CRP levels on major adverse coronary events (MACE) after PCI and to analyse a possible correlation between ET-1 and hs-CRP in this study population. Material and methods: Eighty consecutive PCI patients with a single de novo, non-occlusive coronary lesion were included. Blood samples were obtained immediately before the procedure. The study endpoint was the occurrence of MACE, which was defined as death (all causes), non-fatal myocardial infarction or repeat coronary revascularization (PCI or surgery). Results: At the end of the 24 months' follow-up, 28 patients (35%) reached an end-point. We could not observe any correlation between ET-1 and hs-CRP in the overall patient group (r = 0.141, p = 0.213). Neither ET-1 nor hs-CRP levels were found to be predictive for MACE after PCI in multivariate analyses (p = 0.605 and 0.757 respectively). Conclusions: We could not demonstrate a relationship between pre-procedural ET-1 or hs-CRP levels and MACE at 24 months after successful PCI with single stent implantation to single de novo lesions. This study also could not show any correlation between ET-1 and hs-CRP levels in PCI patients

Assessment of subclinical left ventricular systolic function using strain imaging in the follow-up of patients with chronic mitral regurgitation

Amaç: Semptomsuz mitral yetersizliğinde (MY) en uygun cerrahi zamanı tartışmalı bir konudur. Çalışmamızda kronik MY olan semptomsuz hastaların takibinde sol ventrikül (SV) sistolik fonksiyonlarındaki değişiklikleri. Bir strain inceleme yöntemi olan hız vektör görüntüleme (HVG) metodu ile incelemeyi amaçladık.Yöntemler: Çalışmamıza orta-ileri MY ve SV ejeksiyon fraksiyonu (EF) normal olan 54 hasta (ortalama yaş 57.9±8, %55 erkek) ve 30 sağlıklı gönüllü (ortalama yaş 56±6.5, %55 erkek) ilk değerlendirmede geleneksel ekokardiyografi ve HVG yöntemi ile incelendi. Bulgular: Takiplerinde, 12. ayın sonunda 45 hastanın klinik ve ekokardiyografik incelemeleri yapıldı. SV boyutlarında ve EF'sinde anlamlı bir değişiklik olmadı. SV strain değerleri başlangıçdaki ölçümlere göre önemli derecede azaldı. SV zirve sistolik strain (S) ve strain rate (SR) değerleri başlangıçta sağlıklı kontrol grubuna göre anlamlı derecede düşük idi (S: 16.29±3.30, 23.4±1.9, p=0.0001 ve SR: 0.93±0.39, 4.9±0.6, p=0.0001). İzlemdeki azalış anlamlı bulundu (S: 13.76±2.68 ve SR: 0.27±0.14, p=0.0001).Sonuç: Kronik MY olan hastalarda, cerrahi zamanlamanın doğru belirlenmesi ve özellikle SV sistolik fonksiyon bozukluğunun klinik öncesi dönemde değerlendirilmesi için HVG kaynaklı strain inceleme kullanılabilir.Objective: Determining optimal timing for surgery in asymptomatic mitral regurgitation (MR) remains a challenge. The aim of this study was to evaluate subclinical changes in left ventricular (LV) systolic functions using velocity vector imaging (VVI) during follow-up of patients with chronic mitral regurgitation (MR).Methods: A total of 54 patients (mean age: 57.9±8 years; 55% male) with moderate-to-severe MR and normal LV ejection fraction (EF), and 30 healthy controls (mean age: 56±6.5 years; 55% male) were evaluated using conventional echocardiography and VVI at baseline. Results: At the end of 12 months, measurements of 45 MR patients were repeated. There was no significant change in LV dimensions or EF on follow-up. LV peak systolic strain and strain rate (SR) were decreased in patients with MR compared with controls (strain: 16.29±3.30 to 23.4±1.9; p=0.0001 and SR: 0.93±0.39 to 4.9±0.6; p=0.0001) at baseline. Impairment was more significant on follow-up. (strain: 13.76±2.68 and SR: 0.27±0.14; p=0.0001).Conclusion: VVI-derived strain imaging might be used in the assessment of subclinical LV dysfunction and its progression during follow-up of patients with chronic MR especially in the decision of optimal timing for surgery

Assessment of subclinical left ventricular systolic function using strain imaging in the follow-up of patients with chronic mitral regurgitation

WOS: 000411505100006PubMed ID: 28694396Objective: Determining optimal timing for surgery in asymptomatic mitral regurgitation (MR) remains a challenge. The aim of this study was to evaluate subclinical changes in left ventricular (LV) systolic functions using velocity vector imaging (VVI) during follow-up of patients with chronic mitral regurgitation (MR). Methods: A total of 54 patients (mean age: 57.9 +/- 8 years; 55% male) with moderate-to-severe MR and normal LV ejection fraction (EF), and 30 healthy controls (mean age: 56 +/- 6.5 years; 55% male) were evaluated using conventional echocardiography and VVI at baseline. Results: At the end of 12 months, measurements of 45 MR patients were repeated. There was no significant change in LV dimensions or EF on follow-up. LV peak systolic strain and strain rate (SR) were decreased in patients with MR compared with controls (strain: 16.29 +/- 3.30 to 23.4 +/- 1.9; p=0.0001 and SR: 0.93 +/- 0.39 to 4.9 +/- 0.6; p=0.0001) at baseline. Impairment was more significant on follow-up. (strain: 13.76 +/- 2.68 and SR: 0.27 +/- 0.14; p=0.0001). Conclusion: VVI-derived strain imaging might be used in the assessment of subclinical LV dysfunction and its progression during follow-up of patients with chronic MR especially in the decision of optimal timing for surgery

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

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

WOS: 000256807300006PubMed ID: 18524727Objective: 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 IN) 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. Results: Atrial fibrillation developed during postoperative period in 18.1% patients in G1, 9.1% patients in G2, 16.2% patients in G3, 28.6% patients in G4 and 38.1 % patients in G5. The prevalence of postoperative AF was significantly higher in G5 as compared with other groups (p=0.026). There were significant differences across groups in duration of hospitalization (p=0.033), with shortest mean duration of hospitalization in G2 (8.9 +/- 2.7 days). Conclusion: Any anti-arrhythmic agent started 7 days before the operation and continued for 10 days, may reduce the prevalence of postoperative AF, morbidity and duration of hospitalization. However, we found that sotalol and amiodarone were more effective than other anti-arrhythmic agents in our patient population