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Gorgulu S, Kostantinis S, ElGuindy AM, Abi Rafeh N, Simsek B, Rempakos A, Karacsonyi J, Kalay N, Samir A, Jaoudeh FA, Maalouf A, Soylu K, Yildirim U, Tigen MK, Cincin A, Kalyanasundaram A, Aygul N, Altunkeser BB, El Sayed A, Sadek Y, Shelton C, Jbara K, Vemmou E, Nikolakopoulos I, Mastrodemos OC, Rangan BV, Allana SS, Sandoval Y, Burke MN, Brilakis ES, Goktekin O. Contemporary In-Hospital Outcomes of Chronic Total Occlusion Percutaneous Coronary Interventions: Insights from the MENATA (Middle East, North Africa, Turkey, and Asia) Chapter of the PROGRESS-CTO Registry. Am J Cardiol 2023; 206:221-229. [PMID: 37717475 DOI: 10.1016/j.amjcard.2023.08.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 08/09/2023] [Accepted: 08/17/2023] [Indexed: 09/19/2023]
Abstract
Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has been rapidly evolving in different parts of the world. We examined the clinical and angiographic characteristics and procedural outcomes of 1,079 consecutive CTO PCIs performed in 1,063 patients at 10 centers in the Middle East, North Africa, Turkey, and Asia regions between 2018 and 2022. The mean age was 61 ± 10 years and 82% of the patients were men. The prevalence of diabetes (49%) and previous PCI (50%) was high. The most common target vessel was the right coronary artery (51%), followed by the left anterior descending artery (33%) and the circumflex artery (15%). The mean Japanese CTO score was 2.1 ± 1.2 and mean PROGRESS-CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention) score was 1.2 ± 1.0. The technical and procedural success rates were high (91% and 90%, respectively) with a low incidence (1.6%) of in-hospital major adverse cardiac events. The incidence of perforation was 4.6% (n = 50): guidewire exit was the most common mechanism of perforation (48%) and 14 patients required pericardiocentesis (28%). Antegrade wire escalation was the most common crossing strategy used (91%), followed by retrograde approach (24%) and antegrade dissection and re-entry (12%). Median contrast volume, air kerma radiation dose, and fluoroscopy time were 300 (200 to 400) ml, 3.7 (2.0 to 6.3) Gy, and 40 (25 to 65) minutes, respectively. In conclusion, high success and acceptable complication rates are currently achieved at experienced centers in the Middle East, North Africa, Turkey, and Asia regions using a combination of crossing strategies.
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Affiliation(s)
- Sevket Gorgulu
- Department of Cardiology, Biruni University Medical School, Istanbul, Turkey.
| | - Spyridon Kostantinis
- Department of Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Ahmed M ElGuindy
- Department of Cardiology, Aswan Heart Center, Magdi Yacoub Foundation, Cairo, Egypt
| | - Nidal Abi Rafeh
- Department of Cardiology, North Oaks Health System, Hammond, Louisiana
| | - Bahadir Simsek
- Department of Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Athanasios Rempakos
- Department of Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Judit Karacsonyi
- Department of Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Nihat Kalay
- Department of Cardiology, Acibadem Kocaeli Hospital, Izmit, Turkey
| | - Ahmad Samir
- Department of Cardiology, Aswan Heart Center, Magdi Yacoub Foundation, Cairo, Egypt; Department of Cardiology, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Fadi Abou Jaoudeh
- Department of Cardiology, St. George Hospital University Medical Center, Beirut, Lebanon
| | - Assaad Maalouf
- Department of Cardiology, St. George Hospital University Medical Center, Beirut, Lebanon
| | - Korhan Soylu
- Department of Cardiology, Ondokuz Mayis University Medical Faculty, Samsun, Turkey
| | - Ufuk Yildirim
- Department of Cardiology, Ondokuz Mayis University Medical Faculty, Samsun, Turkey
| | | | - Altug Cincin
- Department of Cardiology, Marmara University Medical Faculty, Istanbul, Turkey
| | | | - Nazif Aygul
- Department of Cardiology, Selcuk University Medical Faculty, Konya, Turkey
| | | | - Ali El Sayed
- Department of Cardiology, Al Zahraa University Hospital, Beirut, Lebanon
| | - Yasser Sadek
- Department of Cardiology, National Heart Institute, Cairo, Egypt
| | - Charlie Shelton
- Department of Cardiology, Aswan Heart Center, Magdi Yacoub Foundation, Cairo, Egypt
| | - Kassem Jbara
- Department of Cardiology, St. George Hospital University Medical Center, Beirut, Lebanon
| | - Evangelia Vemmou
- Department of Cardiology, Yale New Haven Hospital, New Haven, Connecticut
| | | | - Olga C Mastrodemos
- Department of Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Bavana V Rangan
- Department of Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Salman S Allana
- Department of Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Yader Sandoval
- Department of Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - M Nicholas Burke
- Department of Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Emmanouil S Brilakis
- Department of Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Omer Goktekin
- Department of Cardiology, Memorial Bahcelievler Hospital, Istanbul, Turkey
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Simsek EE, Kanar HS, Kanar BG, Cetin H, Arsan A, Tigen MK. Can ocular OCT findings be as a predictor for end-organ damage in systemic hypertension? Clin Exp Hypertens 2020; 42:733-737. [PMID: 32579082 DOI: 10.1080/10641963.2020.1783548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE Detection of end-organ damage (EOD) in systemic hypertension is essential for the management of systemic hypertension. We aimed to evaluate subfoveal choroidal thickness (SFCT) and retinal layers' thicknesses by using spectral domain optical coherence tomography (SD‑OCT) in patients with systemic hypertension and to assess the relationship between EOD and SD-OCT parameters. METHODS A total of 189 consecutive patients with systemic hypertension and 100 controls were included. Patients were examined to detect EOD including hypertensive retinopathy (HTRP), left ventricular hypertrophy assessed by transthoracic echocardiography and microalbuminuria assessed by 24-h urine analysis. SFCT, inner plexiform-ganglion cell complex (IP-GCC), peripapillary retinal nerve fiber layer (pRNFL) and central macular thickness (CMT) were measured with SD-OCT. RESULTS Patients with systemic hypertension had significantly lower SFCT and retinal layer thicknesses than controls (P˂0.001). In the dilated fundus photographic evaluation, 94 patients with systemic hypertension had HTRP and these patients had lower SFCT, CMT, IP-GCC and pRNFL thicknesses compared to hypertensive patients without HTRP and healthy controls. Patients with EOD had significantly lower SFCT, CMT, IP-GCC and pRNFL thicknesses and as the number of EOD increased, the SFCT decreased significantly. In the multivariate analysis, SFCT was found as an independent predictor of EOD (P˂0.001, odds ratio: 0.0605). CONCLUSION Hypertensive patients, especially with EOD had significantly lower SD-OCT parameters compared to controls. It would be rational to add SD-OCT assessment to conventional hypertensive retinopathy evaluation in patients with systemic hypertension for early diagnosis of end-organ damage, burden of target organ involvement and monitoring anti-hypertensive treatment.
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Affiliation(s)
- Engin Ersin Simsek
- Department of Family Medicine, Health Science University, Kartal Dr. Lutfi Kirdar Trainig and Research Hospital , Istanbul, Turkey
| | - Hatice Selen Kanar
- Department of Ophthalmology, Health Science University, Kartal Dr. Lutfi Kirdar Trainig and Research Hospital , Istanbul, Turkey
| | - Batur Gonenc Kanar
- Department of Cardiology, Marmara University Faculty of Medicine , Istanbul, Turkey
| | - Huseyin Cetin
- Department of Family Medicine, Health Science University, Kartal Dr. Lutfi Kirdar Trainig and Research Hospital , Istanbul, Turkey
| | - Aysu Arsan
- Department of Ophthalmology, Health Science University, Kartal Dr. Lutfi Kirdar Trainig and Research Hospital , Istanbul, Turkey
| | - Mustafa Kursat Tigen
- Department of Cardiology, Marmara University Faculty of Medicine , Istanbul, Turkey
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Kanar BG, Tigen MK, Sunbul M, Cincin AA, Gurel E, Sayar N, Kepez A, Sadıc BO. Evaluation of right ventricular dyssynchrony in patients with acute inferior myocardial infarction and its relation with mortality. Echocardiography 2020; 37:1610-1616. [PMID: 32986898 DOI: 10.1111/echo.14865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/22/2020] [Accepted: 08/31/2020] [Indexed: 12/01/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate right ventricle (RV) dyssynchrony and its relation with mortality using speckle-tracking echocardiography (STE) in patients with acute inferior myocardial infarction (IMI). METHODS One hundred and fifty-eight consecutive patients with acute IMI treated with primary percutaneous coronary intervention, and 44 healthy subjects were included. RV myocardial involvement (RVMI) was defined as an elevation >1 mm in V1 or V4R and/or the presence of a culprit lesion at the proximal portion of the first RV marginal branch after reviewing coronary angiography. Patients were followed for 3 years to determine the cardiovascular mortality. RESULTS Overall, 70 patients with IMI had RVMI. IMI patients had significantly higher RV peak systolic longitudinal strain dyssynchrony (PLSSD) index, lower peak longitudinal systolic strain (PLSS), longer time to PLSS, and time to PLSS differences compared to healthy controls while the patients with RVMI had significantly worse values compared to patients without RVMI and healthy controls. Twenty-seven patients (17.1%) died within 2 years. RVMI was more prevalent in mortality group, and they had significantly higher RV PSSD index, whereas they had lower RV free wall PLSS and longer time to PLSS differences. Receiver operating characteristics (ROC) analysis revealed that a RV PLSSD index > 65 ms predicted mortality with a sensitivity of 88.9% and specificity of 71.8% in IMI patients. CONCLUSIONS Intra- and inter-ventricular dyssynhcrony may develop in patients with acute IMI, especially in those with RV involvement, which might have a negative effect on the prognosis of these patients.
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Affiliation(s)
- Batur Gonenc Kanar
- Department of Cardiology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Mustafa Kursat Tigen
- Department of Cardiology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Murat Sunbul
- Department of Cardiology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Ahmet Altug Cincin
- Department of Cardiology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Emre Gurel
- Department of Cardiology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Nurten Sayar
- Department of Cardiology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Alper Kepez
- Department of Cardiology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Beste Ozben Sadıc
- Department of Cardiology, Faculty of Medicine, Marmara University, Istanbul, Turkey
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Kanar BG, Tigen MK, Özben B. Reply to the Letter to the Editor: Evaluation of right atrial volumes and functions by real time three‐dimensional echocardiography in patients after acute inferior myocardial infarction. Echocardiography 2019; 36:622. [DOI: 10.1111/echo.14280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Batur Gonenc Kanar
- Department of CardiologyMarmara University Faculty of Medicine Istanbul Turkey
| | | | - Beste Özben
- Department of CardiologyMarmara University Faculty of Medicine Istanbul Turkey
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Kanar BG, Sunbul M, Sahin AA, Dogan Z, Tigen MK. Evaluation of right atrial volumes and functions by real-time three-dimensional echocardiography in patients after acute inferior myocardial infarction. Echocardiography 2018; 35:1806-1811. [PMID: 30192408 DOI: 10.1111/echo.14133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 07/24/2018] [Accepted: 08/11/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Right ventricle (RV) involvement causes acute systolic and diastolic functional alterations in the RV in patients after inferior myocardial infarction (IMI), which may result in an increase in left ventricle (LV) end-diastolic and right atrial (RA) pressure. In our study, we sought to evaluate RA volumes and mechanical functions using real-time three-dimensional echocardiography (RT3DE) in IMI patients with or without RV involvement. METHODS Ninety-six consecutive patients with IMI (mean age: 59.7 ± 10.2 years, 60 female) were included. RV myocardial involvement (RVMI) was defined as the presence of a culprit lesion at the proximal portion of the first RV marginal branch in coronary angiography. The study population was divided into two groups: IMI (58.3%) and IMI + RVMI (41.7%). Patients were evaluated using conventional two-dimensional echocardiography (2DE) and RT3DE. RESULTS In RT3DE measurements, IMI + RVMI patients had significantly higher RA phasic volumes and worse conduit mechanical function. A receiver operating characteristic (ROC) curve analysis revealed that an RT3DE RA maximum volume (Vmax) index > 27.9 mL/m2 was an independent predictor of RV involvement in patients after acute IMI, with a sensitivity of 80.0% and a specificity of 89.3%. CONCLUSIONS Right ventricle involvement may cause an increase in RA phasic volumes and deterioration of conduit function in patients with acute IMI.
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Affiliation(s)
- Batur Gonenc Kanar
- Department of Cardiology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Murat Sunbul
- Department of Cardiology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Ahmet Anıl Sahin
- Department of Cardiology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Zekeriya Dogan
- Department of Cardiology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Mustafa Kursat Tigen
- Department of Cardiology, Marmara University Faculty of Medicine, Istanbul, Turkey
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Ileri C, Dogan Z, Bulut B, Midi I, Tigen MK, Sayar N, Sadic BO. High Troponin Levels in Ischemic Stroke Patients; Is It an Expected Finding or an Important Sign? Am J Cardiol 2018. [DOI: 10.1016/j.amjcard.2018.03.308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kanar B, Kanar HS, Karatay A, Tigen MK. P1113Relationship between left atrium and hypertensive retinopathy in patients with systemic hypertension: a real-time three-dimensional echocardiography-based study. Eur Heart J Cardiovasc Imaging 2016; 17:ii234-ii241. [PMID: 28415121 DOI: 10.1093/ehjci/jew262.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background The fundoscopic examination of hypertensive patients, which is an established hypertension-related target organ damage (TOD), tends to be underutilized in clinical practice. We sought to investigate the relationship between retinal alterations and left atrium (LA) volumes by means of real-time, three-dimensional echocardiography (RT3DE), which is the most pivotal predictor of diastolic dysfunction. Methods Our population consisted of 88 consecutive essential hypertensive patients (age 59.2 ± 1.2 years, 53 females) without overt cardiovascular disease. All subjects underwent a fundoscopy examination and were distributed into five groups according to the Keith-Wagener-Barker (KWB) classification. Comprehensive transthoracic echocardiographic and RT3DE measurements were performed to assess LA volumes and phasic functions. Results The four groups (KWB grades 0-4: including 26, 20, 26, and 16 patients, respectively) did not differ with regards to age, gender, or metabolic profile. There were no significant differences between groups with regards to parameters reflecting left ventricle (LV) systolic function and diastolic dysfunctions in conventional echocardiography, except isovolemic relaxation time (IVRT) and deceleration time (DT). Nevertheless, patients in the higher KWB category had higher values of LA volumes (LA maximal volume, LA minimal volume, preatrial contraction volume, LA total stroke volume, LA active stroke volume, p< 0.001) regarding RT3DE (table 1). There is also a significant relationship between preatrial contraction volume and duration of HT (r: 0.67, p<0.001). Conclusion Patients with arterial hypertension were found to have increased LA volume and impaired atrial compliance and contractility. Moreover, RT3DE identifies early functional LA changes in these patients better than conventional echocardiography. Assessment of the hypertensive patient by using RT3DE atrial volume analysis may facilitate early recognition of TOD, which is such a crucial determinant of cardiovascular mortality and morbidity in patients with systemic hypertension.
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Affiliation(s)
- B Kanar
- Sureyyapasa Research and Training Hospital, cardiology, Istanbul, Turkey
| | - H S Kanar
- Fatih Sultan Mehmet Research and Education Hospital, department of opthalmology, Istanbul, Turkey
| | - A Karatay
- Dr Lutfi Kirdar Kartal Training And Research Hospital , department of opthalmology, Istanbul, Turkey
| | - M K Tigen
- Marmara University, cardiology, Istanbul, Turkey
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Guler A, Guler Y, Acar E, Aung SM, Efe SC, Kilicgedik A, Karabay CY, Barutcu S, Tigen MK, Pala S, İzgi A, Esen AM, Kirma C. Clinical, angiographic and procedural characteristics of longitudinal stent deformation. Int J Cardiovasc Imaging 2016; 32:1163-70. [PMID: 27198891 DOI: 10.1007/s10554-016-0905-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 05/02/2016] [Indexed: 01/14/2023]
Abstract
Recently, longitudinal stent deformation (LSD) has been reported increasingly. Even though the reported cases included almost all stent designs, most cases were seen in the Element™ stent design (Boston Scientific, Natick, MA, USA). It is considered that stent design, lesion and procedural characteristics play a role in the etiology of LSD. Yet, the effect of LSD on long-term clinical outcomes has not been studied well. Element stents implanted between January 2013 and April 2015 in our hospital were examined retrospectively. Patients were grouped into two according to the presence of LSD, and their clinical, lesion and procedural characteristics were studied. Twenty-four LSD's were detected in 1812 Element stents deployed in 1314 patients (1.83 % of PCI cases and 1.32 % of all Element stents). LMCA lesions (16.7 % vs 1.6 %, p < 0.001), complex lesions (75 % vs 35.1 %, p < 0.001), bifurcation lesions (37.5 % vs 18.3 %, p = 0.017), ostial lesions (33.3 % vs 12.8 %, p = 0.003), using of extra-support guiding catheter (54.2 % vs 22.3 %, p < 0.001) and extra-support guidewire (37.5 % vs 16.2 %, p = 0.005) were found to be more frequent in cases with LSD than in cases without it. In addition, the number of stents, stent inflation pressure and the use of post-dilatation were significantly different between the two groups. Two patients had an adverse event during the follow-up period. LSD is a rarely encountered complication, and is more common in complex lesions such as ostial, bifurcation and LMCA lesions. The use of extra-support guiding catheter, extra-support guidewires and low stent inflation pressure increases the occurrence of LSD. Nevertheless, with increased awareness of LSD and proper treatment, unwanted long-term outcomes can be successfully prevented.
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Affiliation(s)
- A Guler
- Department of Cardiology, Kosuyolu Heart, Education & Research Hospital, Istanbul, Turkey.
| | - Y Guler
- Department of Cardiology, Kosuyolu Heart, Education & Research Hospital, Istanbul, Turkey
| | - E Acar
- Department of Cardiology, Kosuyolu Heart, Education & Research Hospital, Istanbul, Turkey
| | - S M Aung
- Department of Cardiology, Kosuyolu Heart, Education & Research Hospital, Istanbul, Turkey
| | - S C Efe
- Department of Cardiology, Kosuyolu Heart, Education & Research Hospital, Istanbul, Turkey
| | - A Kilicgedik
- Department of Cardiology, Kosuyolu Heart, Education & Research Hospital, Istanbul, Turkey
| | - C Y Karabay
- Department of Cardiology, Kosuyolu Heart, Education & Research Hospital, Istanbul, Turkey
| | - S Barutcu
- Department of Cardiology, Kosuyolu Heart, Education & Research Hospital, Istanbul, Turkey
| | - M K Tigen
- Department of Cardiology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - S Pala
- Department of Cardiology, Kosuyolu Heart, Education & Research Hospital, Istanbul, Turkey
| | - A İzgi
- Department of Cardiology, Kosuyolu Heart, Education & Research Hospital, Istanbul, Turkey
| | - A M Esen
- Department of Cardiology, Kosuyolu Heart, Education & Research Hospital, Istanbul, Turkey
| | - C Kirma
- Department of Cardiology, Kosuyolu Heart, Education & Research Hospital, Istanbul, Turkey
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Atas H, Kepez A, Atas DB, Kanar BG, Dervisova R, Kivrak T, Tigen MK. Effects of diabetes mellitus on left atrial volume and functions in normotensive patients without symptomatic cardiovascular disease. J Diabetes Complications 2014; 28:858-62. [PMID: 25130919 DOI: 10.1016/j.jdiacomp.2014.07.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 07/22/2014] [Accepted: 07/23/2014] [Indexed: 02/05/2023]
Abstract
PURPOSE Left atrial (LA) size has been shown to be a predictor of adverse cardiovascular outcomes. The aim of the study was to evaluate the direct effect of diabetes mellitus (DM) on left atrial volume and phasic functions by using real-time three-dimensional echocardiography (RT3DE) in a population of patients free of symptomatic cardiovascular disease and hypertension. METHODS Comprehensive transthoracic echocardiographic examination was performed on 40 consecutive patients with DM (20 male, age: 50.5±7.3 years) and 40 healthy controls (20 male, age: 48.4±6.7 years). In addition to conventional 2D echocardiographic measurements RT3DE was performed to assess LA volumes and phasic functions. RESULTS There were no significant difference between groups regarding parameters reflecting LV systolic function as LV diameters and ejection fraction. However, regarding parameters reflecting LV diastolic function; transmitral deceleration time and E/E' ratio values were significantly higher and majority of early diastolic tissue Doppler velocity values were significantly lower in diabetic patients compared with controls. RT3DE demonstrated significantly higher LA maximum and minimum volumes for diabetic patients compared with controls (40.9±11.9 vs 34.6±9.3 mL, p: 0.009 and 15.6±5.9 vs 11.9±4.6 mL, p: 0.002, consecutively). LA total emptying fraction (TEF), expansion index (EI) and active emptying fraction (AEF) were found to be significantly lower in diabetics reflecting depressed LA reservoir and pump functions. There was no significant difference between groups regarding passive emptying fraction (PEF) which is assumed to be a marker of left atrial conduit function. CONCLUSION Patients with type 2 diabetes mellitus were found to have increased LA volume and impaired atrial compliance and contractility. Evaluation of asymptomatic diabetic patients by using RT3DE atrial volume analysis may facilitate recognition of subtle myocardial alterations related with type 2 diabetes.
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Affiliation(s)
- Halil Atas
- Marmara University Training and Research Hospital, Cardiology Clinic, Istanbul, Turkey
| | - Alper Kepez
- Marmara University Training and Research Hospital, Cardiology Clinic, Istanbul, Turkey.
| | - Dilek Barutcu Atas
- Marmara University Training and Research Hospital, Internal Medicine Clinic, Istanbul, Turkey
| | - Batur Gonenc Kanar
- Marmara University Training and Research Hospital, Cardiology Clinic, Istanbul, Turkey
| | - Ramile Dervisova
- Marmara University Training and Research Hospital, Cardiology Clinic, Istanbul, Turkey
| | - Tarik Kivrak
- Marmara University Training and Research Hospital, Cardiology Clinic, Istanbul, Turkey
| | - Mustafa Kursat Tigen
- Marmara University Training and Research Hospital, Cardiology Clinic, Istanbul, Turkey
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Akgun T, Kalkan S, Tigen MK. Variations of QRS Morphology in Patients with Dilated Cardiomyopathy; Clinical and Prognostic Implications. J Cardiovasc Thorac Res 2014; 6:85-9. [PMID: 25031822 PMCID: PMC4097857 DOI: 10.5681/jcvtr.2014.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 06/15/2014] [Indexed: 02/04/2023] Open
Abstract
The QRS represents the simultaneous activation of the right and left ventricles, although most of the QRS waveform is derived from the larger left ventricular musculature. Although normal QRS duration is <100 millisecond (ms), its duration and shape are quite variable from patient to patient in idiopathic dilated cardiomyopathy (IDCM). Prolongation of QRS occurs in 14% to 47% of heart failure (HF) patients. Left bundle branch block (LBBB) is far more common than right bundle branch block (RBBB). Dyssynchronous left ventricular activation due to LBBB and other intraventricular conduction blocks provides the rationale for the use of cardiac resynchronization therapy with biventricular pacing in patients with IDCM. Fragmented QRS (fQRS) is a marker of depolarization abnormality and present in significant number of the patients with IDCM and narrow QRS complexes. It is associated with arrhythmic events and intraventricular dyssynchrony. The purpose of this manuscript is to present an overview on some clinical, echocardiographic and prognostic implications of various QRS morphologies in patients with IDCM.
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Affiliation(s)
- Taylan Akgun
- Kartal Kosuyolu Heart & Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Sedat Kalkan
- Kartal Kosuyolu Heart & Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Mustafa Kursat Tigen
- Marmara University, Faculty of Medicine, Department of Cardiology, Istanbul, Turkey
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