Impact of transcatheter aortic valve implantation on the left ventricular mass

Background: Aortic stenosis (AS) induces pressure overload of the left ventricle (LV) and results in left ventricular hypertrophy. The remodeling of the LV in patients with AS is a com­plex process including structural and functional disturbances. After aortic valve replacement, reverse remodeling of LV begins. The aim of this study was to evaluate the impact of transcatheter aortic valve ımplantation (TAVI) on LV mass (LVM) in early and mid-term follow-ups after the procedure. Methods and Results: We enrolled consecutive 75 patients who underwent successful TAVI. Transthoracic echocardiography was performed prior to TAVI and at hospital discharge, in the 1st month and 6th month of the follow-ups. The mean LV ejection fraction improved significantly after TAVI (54.2 ± 15.0% to 57.3 ± 11.7%, p < 0.001). There were no significant changes between the baseline and discharge mean LVM and LVM index values (LVMI; p = 0.1). However, LVMI decreased significantly in the 1st month of follow-up compared to baseline (123.3 ± 20.3 to 127.9 ± 21.3 g/m2, respectively, p < 0.001). Also, significant regression of LVM was observed at the 1st month of follow-up compared to baseline (228.3 ± 33.5 g vs. 236.5 ± 34.2 g, respectively, p < 0.001). Furthermore, the significant regression in both of LVM and LVMI continued at 1st and 6th months of the follow-ups (p < 0.001). Conclusions: A significant regression of LVM was observed after TAVI. These changes may have prognostic value in patients with severe AS

Immediate recovery of the left atrial and left ventricular diastolic function after transcatheter aortic valve implantation: A transesophageal echocardiography study

Background: Chronic increased afterload due to severe aortic stenosis (AS) results in com­pensatory concentric left ventricular (LV) hypertrophy and LV dysfunction. These in turn cause remodeling of the left heart. The aim of this study was to investigate the acute effect of transcatheter aortic valve implantation (TAVI) on left atrial (LA) mechanics and LV diastolic function. Methods: The study consisted of a total of 35 consecutive patients (mean age was 77.7 ± 5.0 years, 25 female) undergoing TAVI. All TAVI procedures have been performed under the transesophageal echocardiography (TEE) guidance. Before and 24 h after TAVI, all patients underwent transthoracic echocardiography (TTE) and mitral inflow velocities with pulsed-wave (PW) Doppler including early filling wave (E), late diastolic filling wave (A), and E/A ratio were obtained. LV diastolic function was also explored by pulsed tissue Doppler imaging (TDI). Early (E’) and late (A’) diastolic annular velocities, E’/A’ ratio and E/E’ ratio were obtained. In addition, during the procedure before and minutes after the valve implantation, the left atrial appendage-peak antegrade flow velocity (LAA-PAFV) was measured and recorded with TEE. Results: Compared with baseline, the mean mitral E, septal E’ and E’/A’ ratio increased significantly after TAVI. In addition, the LAA-PAFV increased significantly within minutes of TAVI (32.45 ± 10.7 cm/s vs. 47.6 ± 12.6 cm/s, p < 0.001). Conclusions: TAVI improves LV diastolic function and LA performance immediately

Impact of transcatheter aortic valve implantation in patients with reduced ejection fraction

Background: Aortic stenosis increases with age. According to guidelines, left ventricular systolic dysfunction is an indication for aortic valve replacement, even in asymptomatic patients. There is no clear data on the application of transcatheter aortic valve implantation (TAVI), which is a method showing continuous improvement in recent years, in patients with reduced ejection fraction (REF) having a poor prognosis for surgical aortic valve replacement. We therefore aimed to investigate the effect of TAVI on left ventricular ejection fraction (LVEF) and also its efficacy and safety in patients with REF. Methods and results: The study included 104 patients who underwent transfemoral TAVI in our clinic. The patients were divided into two groups: LVEF ≤ 45% (REF group, n = 28) and LVEF > 45% (preserved ejection fraction [PEF] group, n = 76). Follow-up measure­ments were performed at baseline, discharge, 1st, 6th and 12th months. No statistical difference was found between the groups with respect to complications and mortality rates. A statistically significant difference was detected in LVEF after TAVI, either in all patients (53.9 ± 14.6, 57.0 ± 11.4, 59.4 ± 8.4, 60.4 ± 6.8, 63.2 ± 3.9, respectively, at baseline, discharge, 1st, 6th and 12th months, p < 0.001) or in the groups separately. A statistically significant increase in LVEF (p < 0.001) was determined at discharge, 1st, 6th and 12th months, whereas LVEF increased in all follow-ups of the PEF group, however this elevation reached a statistical significance only at the 1st month (p = 0.04). Conclusions: Our study has shown the positive effect of TAVI on LVEF and its effective and safe applicability in patients with REF.

Koroner arter hastalarında yaşam kalitesini etkileyen faktörler

Amaç: Günümüzde tüm dünyada kardiyovasküler hastalıklar en sık ölüm nedenidir ve yaşam kalitesinde ciddi azalmaya yol açmaktadır. Bu çalışmada ülkemizde, koroner arter hastalarında yaşam kalitesi ve yaşam kalitesini etkileyen faktörler araştırılmıştır. Gereç ve Yöntemler: Çalışmaya koroner arter hastalığı (KAH) tanısı konulmuş 85 hasta alınmıştır. Veriler Ferrans ve Power yaşam kalitesi endeksinin kardiyak versiyonu ve araştırmacılar tarafından hazırlanan anket ile toplanmış ve değerlendirilmiştir. Bulgular: Evli ve daha yüksek gelir düzeyine sahip hastalarda sosyal yaşam kalitesi değerleri daha yüksektir. Kalp sorunları nedeniyle günlük işlerinde zorluk yaşayan hastalarda ise yaşam kalitesi düşük bulunmuştur. İlginç olarak daha önce geçirilmiş perkütan koroner girişim veya cerrahi öyküsü olanlarda yaşam kalitesi değerleri benzer öyküsü olmayan hastalarla benzer bulunmuştur. Duygusal ve sosyal destek alanlarda sosyal/ekonomik ve enstrümental destek alanlarda ise global yaşam kalitesi değerleri daha yüksek bulunmuştur. Global yaşam kalitesini etkileyen bağımsız değişkenler ise medeni ve maddi durum, geçirilmiş miyokard enfarktüsü (ME) ve günlük işlerde zorluk yaşamak olarak bulunmuştur. Sonuç: Medeni ve maddi durum, geçirilmiş ME ve günlük işlerde zorluk yaşamak KAH olanlarda yaşam kalitesini etkileyen temel faktörlerdir. Sosyal destek, hastaların rehabilitasyonu kolaylaştırıp psikososyal aktivitesini düzelterek yaşam kalitesini artırabilir. Etkin halk sağlığına yönelik girişimler özellikle en duyarlı gruplar olmak üzere KAH olan bireylerde yaşam kalitesini iyileştirmeye yönelik uygulanmalıdır.Background: Cardiovascular diseases are currently the most common cause of death worldwide and associated with significant impairment of quality of life (QOL). In this study, we aimed to evaluate the QOL patients with coronary heart disease (CHD) in our country and the factors associated with QOL in these patients. Materials and Methods: The study population was composed of 85 patients diagnosed with stable CHD. The data were collected using Ferrans and Powers' Quality of Life Index Cardiac Version- IV and the query designed by the investigators. Results: Eighty-five patients (29 female, 56 male; ages between 38 and 72 years) were enrolled in this study. Married patients and those with greater incomes had greater QOL scores. Patients who had difficulties in daily works due to cardiac problems had lower QOL. Interestingly, patients with previous coronary intervention or surgey had similar QOL scores compared to those without. Patients who got emotional and social support had a greater social/economic score and who were able to get tangible social support had a higher global QOL score. Independent variables affecting the global QOL were marital and financial status, prior myocardial infarction (MI), and having difficulty in daily works. Conclusion: Marital and financial status, prior MI, and having difficulty in daily works are the main determinants for the QOL in patients with CHD. Social support may increase the effectiveness of their rehabilitation and psychosocial activity, thereby QOL. Effective public health interventions should be aimed at improving QOL, especially in the most vulnerable groups

Ortalama trombosit hacmi ve otonomik sinir sistemi fonksiyonları arasındaki ilişki: Artmış ortalama trombosit hacmi sempatetik aktivite artışını yansıtır

Amaç: Artmış ortalama trombosit hacmi (OTH) trombosit aktivasyonundaki artışı yansıtır ve bağımsız bir koroner risk faktörü olarak kabul edilir. Adrenerjik sistemin trombosit aktivasyonu ve trombosit oluşumunda etkileri vardır. Bu çalışmada, akut miyokard enfarktüslü (ME) hastalarda otonomik sinir sistemi aktivasyonunun OTH üzerine etkileri araştırılmıştır. Yöntem ve Gereç: Akut ön duvar enfarktüslü 47 hasta koroner arterleri normal olan 32 hasta ile karşılaştırılmıştır. Tüm hastalara 24 saatlik holter monitörizasyonu ile kalp hız değişikliği analizi yapılmış ve OTH ölçümü için kan örnekleri alınmıştır. Bulgular: Akut ME’lü hastalarda ortalama kalp hızı (KH), Düşük frekans (LF), LF/Yüksek frekans (HF) oranı, OTH kontrol grubundan daha yüksek, Tüm NN aralıklarının standart sapması (SDNN), takip eden farkların kare kökü (RMSSD), bir sonrakinden 50 ms’den fazla farklılık gösteren NN aralıklarının tüm NN aralıklarına oranı (PNN50), HF ve trombosit sayısı daha düşük bulunmuştur. Her iki grupta gündüz LF, LF/HF, ve OTH değerleri geceki değerlerden daha yüksek bulunmuş ancak akut ME’lü hastalarda bu farkın çok daha anlamlı olduğu görülmüştür. Korelasyon analizinde OTH ile ventrikül skoru, sol ön inen arterdeki darlık derecesi, ortalama KH, LF, LF/HF arasında pozitif bir ilişki; SDNN, HF ve trombosit sayısı arasında negatif bir ilişki olduğunu göstermiştir. Multivaryant analiz OTH’nin ventrikül skoru ve LF/HF oranından etkilendiğini göstermiştir. Sonuç: ME’lü hastalarda OTH anlamlı olarak yüksektir. Her iki çalışma grubunda da gündüz ve gece OTH değerlerinde önemli değişim görülmekte ve bu değişim otonomik sinir sistemindeki değişimden kaynaklanmaktadır. Miyokard enfarktüslü hastalarda artmış OTH’nin prognostik değerinin bu hastalardaki artmış sempatetik aktivite ve azalmış kalp hızı değişikliği ile yakın ilişkili olduğu düşünülebilir.Aim: Increased mean platelet volume (MPV) may reflect increased platelet activation and accepted as an independent coronary risk factor. Adrenergic system has effects on platelet activation and thrombocytopoiesis. In this study, we assessed the effects of autonomic nervous system activity on MPV in patients with acute myocardial infarction (MI). Materials and Methods: Forty-seven patients with acute anterior MI were compared with 32 patients having normal coronary arteries. All patients underwent heart rate variability analysis by 24-h holter monitoring and blood samples were taken for MPV measurements during day and night times during holter monitoring. Results: Mean heart rate (HR), Low frequency (LF), LF/High frequency (HF) ratio, MPV were higher, standard deviation of all NN intervals (SDNN), root mean square of successive differences (RMSSD), the number of NN intervals that differed by more than 50 ms from adjacent interval divided by the total number of all NN intervals (PNN50), HF and platelet counts were lower in the patients with anterior MI compared to the control group. Day time LF, LF/HF, and MPV were significantly higher and HF were significantly lower compared to those measured during night time in both groups. Pearson's correlation analysis showed that MPV was positively correlated with ventricle score, degree of left anterior descending artery stenosis, mean HR, LF, LF/HF, and negatively correlated with SDNN, HF, and platelet count. Multivariate analysis revealed that MPV was affected by ventricle score and LF/HF ratio. Conclusions: MPV is significantly higher in the patients with MI and MPV in both groups shows great diurnal and nocturnal variation that is attributed to the alterations in the autonomic nervous system. We suggest that prognostic role of increased MPV in patients with MI are closely associated with increased sympathetic activity and decreased heart rate variability in these patients

Homosistein ve akut miyokard infarktüsü sonrası erken dönemde koroner kollateral gelişimi

Amaç: Homosisteinin endotelyal hücre proliferasyonunu inhibe ettiği bilinmektedir. Koroner kollateral dolaşımın gelişimini etkileyen faktörler iyi bilinmemektedir. Bu çalışmada plazma homosistein düzeylerinin akut miyokard infarktüsü sonrası anjiyografik olarak saptanabilen kollaterallerin gelişimi üzerine tekisi araştırılmıştır. Yöntem ve Gereç: Çalışmaya akut ST yükselmeli miyokard infarktüsü geçiren 60 hasta alınmıştır. Tüm hastalara hastaneye yatırıldıktan sonraki 1-4. günler arasında koroner anjiyografi yapılmıştır (ortalama 2,3 ± 1,2 gün). Kollateral damar gelişimi rentrop sınıflamasına göre derecelendirilmiş, 0 ve 1 kötü kollateral gelişimi, 2 ve 3 ise iyi kollateral gelişimi olarak gruplandırılmıştır. Bulgular: 35 hastada (% 58,3) kötü kollateral gelişimi saptanmıştır. Geri kalan 25 hastada ise (% 41,7) kollateral gelişimin iyi olduğu görülmüştür. Ortalama plasma homosistein konsantrasyonu kötü ve iyi kollateral grublarında sırasıyla 18,2 ± 8,6 ?mol/l ve 12,7 ± 2,4 ?mol/l bulunmuştur (P = 0,008). Rentrop sınıfı ile homosistein düzeyi arasında anlamlı negatif korelasyon olduğu görülmüştür (r = –0,391, P = 0,002). Yaş, cinsiyet, hipertansiyon, diyabet varlığı, sigara alışkanlığı, plazma lipid parametreleri ve homosistein konsantrasyonlarının kollateral gelişimi üzerine etkisine bakıldığında, kollateral gelişini etkileyen tek bağımsız değişkenin homosistein olduğu görülmüştür (OR: 0,71; % 95 güven aralığı 0,57-0,89, P = 0,003). Sonuç: Bu çalışma ile plazma homosistein konsantrasyonları ile akut miyokard infarktüsü sonrası erken dönemdeki kollateral gelişimi arasındaki negatif ilişkinin varlığı ilk kez gösterilmiştir.Aim: Homocysteine is known to inhibit endothelial cell proliferation, which is a key event in angiogenesis. Factors responsible for the presence or absence of coronary collateral circulation are poorly understood. Therefore, in this study we investigated the effect of plasma homocysteine level on the early formation of angiographically visible collaterals after acute myocardial infarction. Materials and Methods: The study included 60 patients that had ST-segment elevation myocardial infarction (STEMI). All the patients underwent coronary angiography 1-4 days after admission (mean: 2.3 ± 1.2 days). Patients were graded according to Rentrop classification. Patients with grade 0 or 1 collateral vessels were classified as poor collaterals; patients with grade 2 or 3 collateral vessels were classified as good collaterals. Results: In all, 35 (58.3%) patients had poor collateral vessel filling and the remaining 25 (41.7%) patients had good collateral filling. Plasma homocysteine concentration in patients with poor and good collateral formation was 18.2 ± 8.6 µmol/l and 12.7 ± 2.4 µmol/l, respectively (P = 0.008). There was a negative linear correlation between Rentrop subclasses and plasma homocysteine concentration (r = –0.391, P = 0.002). We assessed the effect of demographic variables, such as age, gender, hypertension, diabetes mellitus, smoking, lipid parameters, and plasma homocysteine concentration, on the development of collaterals. The only independent variable that affected the development of collaterals was homocysteine level (OR: 0.71; 95% CI = 0.57-0.89, P = 0.003). Conclusions: This study demonstrates for the first time that there is an inverse relationship between the early development of collateral circulation after acute myocardial infarction and plasma homocysteine concentration