-
[show abstract]
[hide abstract]
ABSTRACT: Inflammation plays an important role in the pathophysiology of atherosclerosis. Some studies suggest a link between chronic infections, an inflammatory state, and endothelial dysfunction. However, data related to acute infections are scant. We have investigated: (i) the effect of acute infection on endothelial function; (ii) the role of potential mediators of endothelial dysfunction.
Forty patients 40 years old with acute infection (mean age 53.9 +/- 8.8 years), without coronary artery disease or its equivalents were enrolled. Endothelial function and blood levels of high sensitive C-reactive protein, interleukin-6, tumour necrosis factor-a, high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), apolipoprotein-A1 (Apo-A1) and apolipoprotein-B100 (Apo-B100) were assessed in the acute infection phase and 1 month after recovery. Endothelial function was evaluated by brachial artery flow-mediated vasodilation (FMD).
The intraclass correlation coefficients for intra- and interobserver agreement for FMD measurements were 0.98 (95% CI: 0.95-0.99) and 0.93 (95% CI: 0.83-0.97), respectively. FMD improved significantly 1 month after recovery (P < 0.001). Compared to the levels at 1 month, inflammatory markers, LDL cholesterol, LDL/HDL ratio, Apo-B100 and Apo-B100/Apo-A1 ratio were significantly higher. However, HDL and apo-A1 were significantly lower in the phase of acute infection. Change in FMD from baseline to 1 month after recovery correlated significantly only with the change in Apo-A1 (r = 0.35, P = 0.027).
Acute infection causes transient endothelial dysfunction. It increases inflammatory markers and generates an atherogenic lipid profile. Among the parameters evaluated, only the change in Apo-A1 level was associated with acute infection-induced endothelial dysfunction.
Acta cardiologica 10/2011; 66(5):581-7. · 0.61 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Hypertrophic cardiomyopathy (HCM) is characterized by disorganized myocardial architecture, and may cause ventricular arrhythmias and sudden death. The angiotensin-converting enzyme (ACE) with two deletion alleles (DD genotype) has been proposed to be associated with increased myocardial collagen content. We evaluated QT dispersion (QTd), which reflects regional differences in ventricular repolarization, in HCM patient and controls among the three different ACE genotypes.
Sixty-three patients with HCM and 20 healthy subjects were included in the study. QT parameters were measured from 12 lead electrocardiograms. ACE genotypes were determined from the DNA extracted from peripheral blood by a polymerase chain reaction (PCR) method. QT parameters were compared among the three ACE genotypes both in HCM patients and controls.
Median ages were similar in HCM and control groups. QTd and corrected QTd (QTcd) were significantly greater in the HCM group compared with the controls. The frequencies of each genotype were similar in both groups. Although QTd and QTcd did not differ among the three genotypes in the control subjects, they were significantly greater in patients with DD genotype compared with other genotypes in the HCM group.
QTd and QTcd are increased in patients with HCM, especially in those with the DD genotype.
Journal of Renin-Angiotensin-Aldosterone System 09/2010; 11(3):192-7. · 2.44 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Obesity is one of the most common diseases in the world. Particularly in elderly subjects, the effects of weight loss on cardiac functions have not been previously investigated by means of pulsed wave tissue doppler imaging (PWTDI). Using PWTDI, we examined the effects of weight loss on cardiac functions and left ventricular (LV) mass in obese geriatric women.
Thirteen obese women aged 66-83 years (mean age 71.2+/-4.9 yrs) with a body mass index 35.6-49 kg/m2 (mean body mass index 39.9+/-4.3 kg/m2) were evaluated by echocardiography and PWTDI. Only subjects with uncomplicated obesity were included. All measurements, including anthropometric variables, systolic and diastolic indices, and LV mass, were made before and after a 6-month Orlistat plus hypocaloric diet. Myocardial systolic wave (Sm) velocity, isovolumic acceleration (IVA), myocardial precontraction time (PCTm) and the PCTm to contraction time (CTm) ratio were calculated as systolic indices. Early diastolic wave (Em), late diastolic wave (Am), Em to Am ratio, myocardial relaxation time (RTm), deceleration time (DT) and isovolumic relaxation time (IVRT) were determined as diastolic measurements.
Subjects lost an average of 8.4+/-1.2 kg. LV mass decreased significantly after weight loss (p<0.001). In addition, IVRT decreased significantly (p=0.038). Only RTm decreased significantly (p=0.016), whereas other PWTDI parameters of LV remained the same. In the right ventricle, Sm velocity, IVA, Em, and Am velocities were similar. However, the PCTm to Am ratio decreased significantly (p=0.006), and the Em to Am ratio increased (p=0.04) and RTm decreased significantly (p=0.016) after weight loss.
In obese geriatric women, weight loss improves ventricular diastolic functions and decreases LV mass. It also contributes to partial improvement in right ventricular systolic function.
Aging clinical and experimental research 06/2010; 22(3):206-11. · 1.55 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Longitudinal two-dimensional strain deformation is a novel technique which evaluates global and regional left ventricular (LV) function with high reproducibility. The aim of the study was to investigate the global and regional systolic function using this method in patients with pure mitral stenosis (MS). Conventional echocardiography and longitudinal two-dimensional strain analysis were performed in 60 patients (41 +/- 5 years, 48 women) with mild to moderate MS (mitral valve area: 1.9 +/- 0.5 cm(2)), and 52 healthy controls (40 +/- 7 years, 37 women). For strain analysis standard apical views were obtained, and by using a software system peak systolic strain and strain rate were calculated off-line in each segment. In all, 88% of the segments could be optimally tracked by the software system. Despite normal LV systolic function as assessed by ejection fraction (66 +/- 8%), mean global longitudinal strain (GLS) and global longitudinal strain rate (GLSR) were significantly reduced in patients with isolated MS (GLS -17 +/- 3.3 vs. -19 +/- 2.5%, P = 0.006 and GLSR -1.3 +/- 0.3 vs. -1.5 +/- 0.3 s(-1), P < 0.0001). Regional analysis demonstrated that patients with MS had a significantly reduced longitudinal peak strain and strain rate in all basal, and some mid (inferior, anteroseptal, interventricular septum) segments of the left ventricle. For other segments longitudinal peak strain and strain rate values were similar among the groups. Evaluation of LV systolic function by longitudinal two-dimensional strain deformation identified early abnormalities in MS patients who had apparently normal standard systolic function.
The international journal of cardiovascular imaging 12/2009; 26(4):397-404. · 2.15 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Longitudinal two-dimensional strain (L2DS) deformation is a novel technique that evaluates global and regional right ventricular (RV) function. The aim of the study was to investigate the systolic function of RV by using this method in patients with pure mitral stenosis (MS).
Conventional echocardiography and L2DS analysis were performed in 45 MS patients and 21 healthy controls. For strain analysis apical four-chamber views were obtained and by using a software system, peak systolic strain and strain rates were calculated off-line in each segment.
The mean global longitudinal strain (GLS) of the whole RV (-20 + or - 7 vs. -24 + or - 6%, P= 0.02) and mean GLS of the septum (-19 + or - 7 vs. -23 + or - 5%, P = 0.03) were significantly reduced in the MS patients. Compared with the control group no significant change was determined in the mean GLS of the RV free wall (RVFW). While the mean global longitudinal strain rates (GLSR) of the entire RV and RVFW were similar between the groups, a significant difference in the mean GLSR of the septum (-1.2 + or - 0.4 vs. -1.5 + or - 0.3 s(-1), P= 0.005) was determined in the patients with MS. A regional analysis demonstrated that MS patients had significantly reduced strain and strain rates in the basal and mid-segments of the septum, whereas only lower strain values in the basal RVFW.
RV systolic function evaluated by L2DS analysis in patients with MS has shown decreased global and segmental systolic functions. (ECHOCARDIOGRAPHY 2010;27:525-533).
Echocardiography 10/2009; 27(5):525-33. · 1.24 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To determine whether subcutaneous administration of nitroglycerin mixed with local anesthetic agent results in effective vasodilation of the radial artery, and whether this technique improves access time and decreases complications.
This prospective study consisted of two consecutive investigations. In the first (n = 30), only local anesthetic agent (prilocaine 2%) was injected into one arm, and local anesthetic agent plus 500 microg nitroglycerin was injected into the other arm. Radial artery diameters before and after injections were measured by ultrasonography. In the second, 33 patients received local anesthetic agent (prilocaine 2%) plus 500 microg nitroglycerin (group A) and 30 received only local anesthetic agent (group B) to determine whether the addition of nitroglycerin would improve radial artery access time, duration of angiography, perception of arterial pulse (ie, pulse score), number of punctures before successful cannulation, and complication rates.
In the first investigation, radial artery diameter increased significantly in the nitroglycerin-treated arm (2.3 mm +/- 0.4 vs 2.9 mm +/- 0.5; P = .05). In the second, there were no significant differences between groups with respect to age, sex, duration of angiography, and number of punctures before cannulation. However, the pulse score increased and radial artery access time improved significantly after addition of nitroglycerin (79% vs 10% [P < .001] and 75 sec +/- 47 vs 132 sec +/- 100 [P = .005], respectively). Radial artery spasm and thrombosis were less frequently observed in group A, albeit to an insignificant extent (P = .39 and P = .49, respectively).
Subcutaneous administration of nitroglycerin significantly increased radial artery diameter, which can lead to facilitation of catheterization of the radial artery for arteriography and interventions.
Journal of vascular and interventional radiology: JVIR 07/2009; 20(9):1151-6. · 1.81 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Endothelial dysfunction is thought to be a potential mechanism for the decreased presence of coronary collaterals. The aim of the study was to investigate the association between systemic endothelial function and the extent of coronary collaterals.
We investigated the association between endothelial function assessed via flow mediated dilation (FMD) of the brachial artery following reactive hyperemia and the extent of coronary collaterals graded from 0 to 3 according to Rentrop classification in a cohort of 171 consecutive patients who had high grade coronary stenosis or occlusion on their angiograms.
Mean age was 61 years and 75% were males. Of the 171 patients 88 (51%) had well developed collaterals (grades of 2 or 3) whereas 83 (49%) had impaired collateral development (grades of 0 or 1). Patients with poor collaterals were significantly more likely to have diabetes (p = 0.001), but less likely to have used statins (p = 0.083). FMD measurements were not significantly different among good and poor collateral groups (11.5 +/- 5.6 vs. 10.4 +/- 6.2% respectively, p = 0.214). Nitroglycerin mediated dilation was also similar (13.4 +/- 5.9 vs. 12.8 +/- 6.5%, p = 0.521).
No significant association was found between the extent of angiographically visible coronary collaterals and systemic endothelial function assessed by FMD of the brachial artery.
Cardiovascular Ultrasound 07/2009; 7:25. · 1.26 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The aim of the study is to evaluate the association of inflammatory markers with endothelial function in syndrome X.
The study population consisted of 59 prospectively enrolled patients (28 women and 31 men; mean age, 50.29 +/- 6.48 years) and 51 healty control subjects (18 women and 33 men; mean age, 51.04 +/- 7.25 years). High-sensitive CRP (hs-CRP), white blood cell (WBC) count and its subtypes [neutrophil (N), lymphocyte (L) and monocyte (M)] were measured in each subject. Endothelial function was assessed with the brachial artery flow-mediated dilatation (FMD) technique.
WBC counts and hs-CRP levels were significantly higher in patients who had syndrome X than in control subjects (7.53 +/- 1.52 x 10(9) cells/L versus 6.21 +/- 1.17 x 10(9) cells/L, P = 0.0001, and 3.11 +/- 0.63 mg/L versus 2.68 +/- 0.76 mg/L, P = 0.002, respectively). Neutrophil count and N/L ratio was significantly increased in syndrome X when compared with the control subjects (5.14 +/- 1.10 x 10(9) cells/L versus 4.11 +/- 0.76 x 10(9) cells/L, P = 0.0001 and 2.75 +/- 1.06 versus 2.37 +/- 0.65, P = 0.02, repectively). Other subtype counts were similar between the groups. FMD was impaired significantly in patients who had syndrome X in comparison with the control subjects (5.71 +/- 4.08% versus 16.02 +/- 4.13%, P = 0.0001). There was a significant correlation between hs-CRP levels and FMD measurements (r = -0.44; P = 0.0001). Furthermore, the correlation between WBC count and FMD measurements were also significant (r = -0.48; P = 0.0001).
The present study showed that hs-CRP and WBC count were higher in patients with syndrome X than in control subjects. Furthermore, endothelial function was impaired significantly in patients with syndrome X.The increased levels of hs-CRP and WBC count may suggest that these markers may be used in clinical practice for the assessment of the inflammatory status of the endothelium in syndrome X.
Acta cardiologica 01/2009; 63(6):723-8. · 0.61 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: We examined the endothelial nitric oxide (eNOS) gene Glu298Asp polymorphism to assess its possible association with the extent of coronary collaterals.
A total of 473 consecutive patients who had high grade coronary stenosis or occlusion were evaluated for the extent of coronary collaterals by using Rentrop classification. Patients with grade 0 or 1 collaterals were identified as having poor collaterals. The relation between collateral status and eNOS Glu298Asp polymorphism was studied by multivariate logistic regression analysis.
Subjects with poor collaterals were more likely to have diabetes mellitus (p<0.001) and unstable angina pectoris as clinical presentation (p=0.014) and more likely to carry Asp298 variant (p=0.02) but they were less likely to have received statins (p=0.031). Multivariate analysis demonstrated that Asp298 allele carriers were 1.7 times more likely to have poor collaterals than patients with GluGlu genotype (95% CI: 1.09-2.69, p=0.024). There was a significant interaction between diabetes mellitus and eNOS Glu298Asp polymorphism in the analysis of collateral development. Among 145 diabetic patients Asp298 allele was the only predictor of poor collateral development with OR of 5.38 (95% CI: 2.41-11.98, p<0.001). Once diabetic patients were excluded from the analysis Asp298 allele was no longer a significant correlate of poor collateral formation.
The present study suggests that the Asp298 allele of the eNOS gene is significantly associated with impaired collateral development, especially in patients with diabetes mellitus. Treatment strategies that modulate eNOS activity and/or NO production may improve coronary collateral development.
Atherosclerosis 06/2008; 198(2):354-9. · 3.79 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Inadequate platelet response to aspirin is associated with increased incidence of peri-procedural myonecrosis. Antiplatelet activity of aspirin can be improved by increasing the dose. High-dose aspirin pre-treatment, therefore, may reduce the incidence of myonecrosis post stenting.
Two-hundred patients taking 75-325 mg daily doses of aspirin for at least 2 weeks were randomized for addition or no addition of 500 mg aspirin before elective coronary stenting (aspirin 500 group, n=100 and control group, n=100). Primary endpoint was the occurrence of peri-procedural myonecrosis defined as creatine kinase-myocardial band (CK-MB) elevation of >1x upper limits of normal (ULN). Aspirin 500 patients were significantly younger and more likely to have family history of coronary artery disease, but less likely to have received statins than controls. Elevation of CK-MB was observed in 29% of aspirin 500 patients and 15% of controls (p=0.017). The incidence of non-Q wave myocardial infarction (CK-MB elevation of >3xULN) tended to be higher in the aspirin 500 group than in the control group (5% versus 0%, p=0.059). Multivariate analysis identified baseline aspirin dose (OR: 1.006; 95% CI: 1.002-1.010; p=0.004), aspirin 500 mg treatment (OR: 2.5; 95% CI: 1.2-5.5; p=0.021) and baseline CK-MB level (OR: 1.4; 95% CI: 1.1-1.7; p=0.012) as independent predictors of CK-MB elevation after coronary stenting.
For patients taking daily low-dose aspirin therapy, supplementation with high-dose aspirin before elective coronary stenting does not reduce, but may increase the incidence of peri-procedural myonecrosis.
Atherosclerosis 03/2008; 197(1):171-6. · 3.79 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Angiotensin II induces various growth factors such as vascular endothelial growth factor, platelet-derived growth factor, and fibroblast growth factor, and recent studies suggest that the expression of these growth factors promotes collateral growth. We hypothesized that the blockage of angiotensin II production by ACE inhibitors might interfere with collateral development in patients with coronary occlusion.
The study group consisted of 187 patients (114 males, mean ages, 62 +/- 11 years) who had chronic (> 1 month) coronary occlusion (TIMI flow grade < or = 1) in one of 3 epicardial coronary arteries. Collaterals were graded using the Rentrop classification, and the patients were divided into 2 groups according to having good (grade 2 and 3) or poor (grade 0 and 1) collaterals (n = 127 and 60, respectively). Clinical and angiographic characteristics were compared in the 2 groups.
ACE inhibitor use (52% versus 35%, P = 0.04) and the prevalence of diabetes mellitus (DM) (43% versus 27%, P = 0.02) was higher in patients with poor collaterals. Patients with poor collaterals had a higher frequency of circumflex artery (Cx) occlusion, worse wall motion, and lower ejection fraction. In multivariate analysis, ACE inhibitor use (OR: 2.4; 95% CI = 1.23-4.68, P = 0.01) and the occlusion of Cx (OR: 3.3, 95% CI; 1.33-8.12, P = 0.01) were found to be independent predictors for poor collateral development, whereas there was a trend for DM as a predictor for poor collaterals (OR: 1.9, 95% CI = 0.97-3.8, P = 0.06).
The findings suggest that ACE inhibitor therapy may contribute to poor collateral development in patients with coronary occlusion.
International Heart Journal 08/2007; 48(4):435-42. · 1.16 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The relationship between androgens and the risk of development of coronary artery disease has not been clarified well. This study was planned to determine the relationship between serum androgen levels and premature development of coronary artery disease in men.
Sixty-nine men below 45 years of age with documented coronary artery disease (mean age 41.0+/-4.7) constituted the study group. Control group consisted of 56 men with similar age and normal coronary angiograms (mean age 41.3+/-3.8). Total and free testosterone, estradiol, and fasting plasma total, low-density lipoprotein, and high-density lipoprotein cholesterol, and triglyceride levels were measured, and compared between the two groups.
Mean age, body mass index, and the frequency of hypertension were similar between the two groups; however, diabetes mellitus, smoking, hyperlipidemia, and family history of coronary artery disease were more frequent in the coronary artery disease group. Total and free testosterone levels of the patients with coronary artery disease were significantly lower than those of controls, whereas estradiol levels did not differ. Multivariate logistic regression analysis revealed that free testosterone levels (P=0.014; odds ratio=0.90; 95% confidence interval=0.87-0.99), hyperlipidemia (P<0.001; odds ratio=8.2; 95% confidence interval=3.17-21.0), and smoking (P=0.026; odds ratio=3.12; 95% confidence interval=1.15-8.48) were independent predictors of premature coronary artery disease. Moreover, using receiver operating characteristic analysis, patients with free testosterone levels below the cut-off value of 17.3 pg/ml had an adjusted 3.3-fold risk of developing premature coronary artery disease compared to those with free testosterone levels above the cut-off level (odds ratio=3.3; 95% confidence interval=1.57-6.87).
A low level of free testosterone may be related to the development of premature coronary artery disease.
Coronary Artery Disease 06/2007; 18(3):159-62. · 1.24 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Increased left ventricular mass (LVM) is an independent risk factor for cardiovascular morbidity and mortality, and may be used for risk stratification. Two-dimensional echocardiography, the most commonly used technique for estimation of LVM, uses the third power of the left ventricular internal diameter (LVID) for the calculation.
To determine whether a decrease in intravascular volume after dialysis may cause inaccurate estimation of LVM by echocardiography.
Thirty-eight patients undergoing hemodialysis due to chronic renal failure constituted the study group (14 women [37%] and 24 men [63%], mean age +/- SD 38.7+/-10.9 years). LVID, and interventricular and posterior wall thicknesses were measured by two-dimensionally guided M-mode echocardiography. Stroke volume and cardiac output were calculated using left ventricular outflow tract diameter and the pulsed-wave Doppler time-velocity integral obtained from left ventricular outflow tract. LVM was calculated by using Devereux's formula, and was indexed for body surface area and height. All echocardiographic parameters were measured or calculated before and after dialysis (on the same day), and then compared.
There were no significant changes in wall thickness; however, LVID, LVM, the LVM/body surface index and the LVM/height index significantly decreased after dialysis (P<0.001 for each parameter). There was a significant correlation between the change in LVID and the change in LVM (P<0.001, r=0.59). Stroke volume and cardiac output also decreased significantly after hemodialysis (P<0.001 for each parameter).
Intravascular volume-dependent change in LVID causes inaccurate estimation of LVM, so volume status should be kept in mind, especially in serial assessment of LVM.
The Canadian journal of cardiology 03/2007; 23(3):219-22. · 3.36 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Aim of this study was to investigate the value of systolic indices of tricuspid valve annular motion measured by tissue Doppler imaging for the diagnosis right ventricular failure in patients with chronic obstructive pulmonary disease (COPD).
Patients with COPD with right heart failure symptoms and/or right ventricular dilatation were enrolled for the study. The control group consisted of age and sex matched patients referred to the echocardiography laboratory who had normal echocardiographic examination. Tricuspid valve annulus peak systolic velocity and myocardial acceleration during isovolumic contraction were recorded by tissue Doppler imaging.
IVA and Sa wave velocities were found to be significantly decreased in patients with right ventricular failure. For the prediction of right heart failure IVA <3.8 m/sec2 had 91% sensitivity, 80% specificity, 90% positive predictive value (PPV), and 82% negative predictive value (NPV) and Sa wave velocity <9.2 cm/sec had 80% sensitivity, 62% specificity, 75% PPV, and 68% NPV.
Tricuspid valve annular velocities measured by tissue Doppler imaging especially IVA, offer potential diagnostic value for the diagnosis of right heart failure in patients with COPD.
Echocardiography 02/2007; 24(2):126-33. · 1.24 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Recent studies have documented that elevation of C-reactive protein (CRP) levels after percutaneous coronary intervention (PCI) have been predictive of adverse outcome. This study was performed to test the hypothesis that preprocedural use of naproxen sodium is associated with a reduction in the extent of inflammatory response and myocardial injury after PCI.
Ninety-seven patients who were scheduled for elective PCI were randomized either for naproxen sodium (500 mg bid) (n:39, 75% male, 59+/-10 years) or control (n:58, 76% male, 60+/-10 years). All patients were troponin negative before the procedure. Blood samples for CRP, Troponin I and CK-MB were collected at baseline and after the procedure.
The characteristics were similar between the two groups. After coronary stenting, the rise in CRP levels was significantly higher in controls than those treated with naproxen (DeltaCRP=6.4 mg/L in the controls and 0.43 mg/L in the naproxen group, p<0.0001). The incidence of any troponin I elevation or CK-MB elevation above upper limit of normal was not statistically different between groups. During follow up (12+/-2 months), major cardiac adverse events (death, myocardial infarction, and revascularization of target lesion) was similar between groups.
Our data show that naproxen pretreatment leads to significant suppression in PCI related CRP elevation. However this improvement in CRP levels was not associated with any significant reduction in post-PCI myonecrosis.
Thrombosis Research 01/2007; 119(4):453-9. · 2.44 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The effects of l-thyroxine (l-T(4)) replacement for subclinical hypothyroidism (SH) on right ventricle (RV) functions has not been previously studied by means of pulsed wave tissue Doppler imaging (PWTDI). We investigated the effects of l-T(4) therapy on RV function in patients with SH using PWTDI.
Fifty-three patients with newly diagnosed SH and 25 controls were evaluated by standard echocardiography and PWTDI. After euthyroidism was restored by l-T(4), measurements were repeated. Myocardial systolic wave (S(m)) velocity, isovolumic acceleration (IVA), myocardial precontraction time (PCT(m)), and PCT(m) to contraction time (CT(m)) ratio were calculated as systolic indices. Early (E(m)) velocity, late (A(m)) velocity, E(m) to A(m) ratio, and myocardial relaxation time (RT(m)) were determined as diastolic measurements.
S(m) was similar in patients and controls, whereas IVA was significantly lower in patients with SH (P < 0.001). SH patients had significantly decreased E(m) velocity, whereas A(m) velocity and E(m) to A(m) ratio did not differ. PCT(m) and RT(m) were significantly longer, and PCT(m) to CT(m) ratio was significantly higher in patients (P = 0.002, P = 0.002, P < 0.001, respectively). S(m) velocities were similar before and after l-T(4) replacement, whereas IVA significantly increased after therapy (P < 0.001). E(m) tended to increase (P = 0.05), whereas A(m) and E(m) to A(m) ratio were not changed. PCT(m), PCT(m) to CT(m) ratio, and RT(m) decreased significantly (P < 0.001 for all).
SH is associated with RV systolic and diastolic dysfunction, and l-T(4) treatment improves these abnormalities. PWTDI, especially IVA, may be a suitable tool for the early detection of RV systolic dysfunction.
Journal of Clinical Endocrinology & Metabolism 10/2006; 91(9):3490-3. · 6.50 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The coronary collateral circulation is an alternative source of blood supply to myocardium in the presence of advanced coronary artery disease and the therapeutic promotion of collateral growth appears to be a valuable treatment strategy in these patients. Although it has been shown in in-vivo studies that 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) promote vasculogenesis and accelerate coronary collateral development in ischemic tissues, there are discordant results in clinical studies. Our aim was to investigate the effect of statin therapy, including dosage and duration of treatment, on coronary collateral growth in patients with advanced coronary artery disease.
Study population consisted of 400 (306 men, with the mean age of 62+/-10 years) consecutive patients who have undergone clinically indicated coronary angiography and had at least one major coronary artery stenosis of > or =95%. Coronary collaterals were graded from 0 to 3 according to the Cohen-Rentrop method and patients with grade 0-1 collateral development were regarded as having poor collateral and patients with grade 2-3 collateral development were regarded as having good collateral.
Among 400 patients, 196 (48%) were on statin therapy. Patients with good collateral score were more likely to have stable angina pectoris as clinical presentation (P<0.001), and were on statin therapy (P=0.001), and have multivessel disease (P=0.003). Statin therapy for less than 3 months had no effect on collateral development (P=0.19); however, patients who were on statin therapy for more than 3 months had significantly better collateral development (P=0.002). Statin therapy had no effect on coronary collateral development in patients having <10 mg atorvastatin-equivalent dose (P=0.13); however, patients having > or =10 mg atorvastatin-equivalent dose had better collateral development (P<0.001). Diabetes mellitus was the only negative predictor for coronary collateral formation (P=0.03). On multivariate analysis, stable angina pectoris [odds ratio 2.88, 95% confidence interval (1.8-4.7), P<0.001], statin therapy with > or =10 mg atorvastatin-equivalent dose [odds ratio 2.06, 95% confidence interval (1.3-2.6), P<0.001] and having multivessel disease [odds ratio 1.86, 95% confidence interval (1.16-3), P=0.01] were found to be associated with rich collateralization.
Statin therapy (> or =10 mg atorvastatin-equivalent dose), stable angina pectoris and having multivessel disease are associated with enhanced coronary collateral development in patients with advanced coronary artery disease.
Coronary Artery Disease 10/2006; 17(6):561-5. · 1.24 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Quadricuspid aortic valve is a rare congenital malformation of the aortic valve. Most cases are discovered incidentally at autopsy or at aortic valve replacement. Recent advances in echocardiography epecially transesophageal echocardiography led to diagnosis of more cases before surgery. Two cases of quadricuspid aortic valve are presented.
European Heart Journal – Cardiovascular Imaging 09/2006; 7(4):330-1. · 2.32 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Coronary collateral development is an important compensatory mechanism in advanced coronary artery disease, and patients with diabetes mellitus have impaired coronary collateral development. This study tested the hypothesis that statin treatment may increase coronary collateral development in patients with diabetes mellitus. The study population consisted of 149 consecutive diabetic patients who underwent clinically indicated coronary angiography and had >95% stenosis of > or =1 major coronary artery. Clinical information, including age, gender, history of hypertension, smoking, myocardial infarction, clinical presentation, and medications, was recorded before coronary angiography. Coronary collaterals were graded according to the Cohen-Rentrop method. Collateral grading was classified as poor when the collateral grade was 0 to 1 and good when it was 2 to 3. Among 149 patients (85 men; mean age 62 +/- 10 years), 74 (56%) were receiving statin treatment. In multivariate analysis, among demographic, clinical, and angiographic parameters, only statin therapy (odds ratio 3, 95% confidence interval 1.5 to 6.03, p = 0.002) and stable angina pectoris (odds ratio 3.24, 95% confidence interval 1.42 to 7.41, p = 0.005) were found to be independent predictors of better collateral formation. In conclusion, stable angina pectoris and statin treatment are associated with better coronary collateral development in patients with diabetes mellitus.
The American Journal of Cardiology 03/2006; 97(6):772-4. · 3.37 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Most left atrial appendage masses have been reported to be thrombus, particularly in the presence of atrial fibrillation. The presence of any mass other than thrombus is extremely rare in the left atrial appendage. This report presents the rare case of a 70-year-old woman presenting with paroxysmal atrial fibrillation and syncope who was given the diagnosis of having 3 myxomas originating from the left atrial appendage. The diagnosis was established by the help of transesophageal echocardiography and confirmed by histologic examination after operation. The advantage of transesophageal echocardiography in this case and for patients with atrial fibrillation is emphasized.
Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography 07/2005; 18(6):694. · 2.98 Impact Factor
