Determining Subclinical Cardiovascular and Cardiac Diseases in Patients with Non-Alcoholic Fatty Liver Disease

BACKGROUND

The aims of the present study were to determine the subclinical coronary atherosclerosis and myocardial dysfunction in patients with non-alcoholic fatty liver disease, who were asymptomatic for cardiac disease.

METHODS

A total of 61 non-alcoholic fatty liver disease patients were enrolled in the study. The 10-year probability of cardiovascular events was evaluated according to the pooled cohort equation risk score (atherosclerotic cardiovascular disease). The coronary artery calcium score was measured. Conventional echocardiographic examination was followed by 2- and 3-dimensional speckle tracking echocardiography.

RESULTS

Patients with non-alcoholic steatohepatitis had significantly higher insulin resistance (P = .018), serum alanine aminotransferase (P = .002) and aspartate aminotransferase levels (P = .021), hepatic steatosis (P = .023), and fibrosis (P = .001) than non-alcoholic fatty liver disease patients. The mean Atherosclerotic Cardiovascular Disease score was 7.5% ± 6.9% and 37% of the patients had medium and high cardiovascular disease risk. Cardiovascular disease (>1) was found in 30% of the patients. Interestingly, 56% had significant and extended atherosclerotic plaques. Among the patients with moderate-to-high atherosclerotic cardiovascular disease scores, 63% had significant atherosclerotic plaques and 21% had extensive plaque burden. The presence of non-alcoholic steatohepatitis did not significantly affect cardiovascular risk. Non-alcoholic steatohepatitis was deleterious on left ventricle diastolic functions. Mean A velocity in non-alcoholic steatohepatitis patients was significantly increased compared to non-alcoholic fatty liver disease patients (87.0 ± 17.5 cm/s vs. 72.3 ± 13.6 cm/s, P = .002). Mean E/e' ratio was 8.1 ± 2.0. Submyocardial fibrosis detected had a slightly higher occurrence in non-alcoholic steatohepatitis patients than in non-alcoholic fatty liver disease patients (P = .530).

CONCLUSION

The presence of non-alcoholic steatohepatitis did not significantly increase the risk of cardiovascular disease and subclinical myocardial dysfunction in asymptomatic patients for cardiac disease compared to non-alcoholic fatty liver disease patients.

Assessment of Myocardial Perfusion by Angiographic Methods in Tortuous Coronary Arteries

The relationship between coronary tortuosity (CorT) and tissue-level myocardial perfusion is not clear. We investigated tissue perfusion in myocardial territories supplied by tortuous coronary arteries. Among patients who had undergone coronary angiography, patients with reported CorT, those with ≥1 coronary artery were included in the study group (100 patients). The control group included patients with normal coronary arteries (100 patients). Thrombolysis In Myocardial Infarction frame count (TFC) and myocardial blush grade (MBG) were calculated for each coronary artery. Mean TFC was significantly higher in tortuous right coronary artery (RCA), left anterior descending (LAD) artery, and circumflex (Cx) artery compared to their non-tortuous counterparts (28.81 ± 6.463 vs 21.94 ± 3.328, P = .009; 43.28 ± 5.698 vs 36.17 ± 3.875, P = .006; 29.35 ± 4.111 vs 23.821 ± 2.639; P < .001, respectively). Mean MBG was also significantly lower in tortuous RCA, LAD, and Cx, compared to their normal counterparts (2.78 ± 0.417 vs 2.98 ± 0.155, P < .001; 2.74 ± 0.483 vs 2.97 ± 0.164, P < .001; 2.92 ± 0.277 vs 2.99 ± 0.110, P < .001, respectively). For each tortuous coronary artery, TFC was similar for every MBG category. Tortuous coronary arteries have higher TFC and lower MBG, suggesting impaired epicardial and microvascular coronary flow, when compared to normal coronary arteries.

Evaluation of endothelial dysfunction with flow-mediated dilatation after transradial coronary angiography

Objective Transradial coronary angiography (TRCA) may lead to endothelial dysfunction. Therefore, this study investigated the TRCA-related endothelial dysfunction and its relation to operator experience, the number of punctures and procedure duration. Methods and results A total of 57 patients (42 males and 17 females) who underwent TRCA were included in this single-centre study. Nine months after the procedure, all patients underwent radial artery B-mode ultrasound imaging, and flow-mediated dilatation (FMD) and nitroglycerin-mediated dilatation (NMD) techniques were employed. The non-intervened right radial artery was accepted as control. The percentage change in diameter after FMD was significantly greater in the right radial artery compared to the left radial artery (right 13.6% vs left 10.1%, P = 0.041). The percentage change in diameter after NMD was similar in both right and left radial arteries (right 23.8% vs left 23.4%, P = 0.932). According to the puncture numbers, the percentage change was significantly lower in the intervened artery among patients with more than one puncture (13.3% vs 7.8%, P = 0.005). According to the operator experience, the percentage change in the intervened artery was significantly higher in patients in whom the procedure was performed by experienced operators (13.7% vs 7.6%, P = 0.002). The procedure duration also showed a negative correlation with the percentage change in the intervened artery (r = -0.349, P = 0.008). Conclusions TRCA may lead to endothelial dysfunction represented by FMD. Moreover, higher puncture numbers for sheath insertion, longer procedure durations and less experience in radial interventions may have adverse effects on the endothelial function.

The outcomes of home treatment for borderline personality disorder

Aims and method There is currently no trial or other scientific evidence informing the efficacy of any crisis intervention for people with borderline personality disorder (BPD). We aimed to assess the patterns of service use by patients with BPD taken on for crisis resolution and home treatment between 2010 and 2013. Patients with a diagnosis of BPD were identified and demographic and clinical data were collected. Results All patients were female, and a high proportion had recurrent presentations to crisis and home treatment services in Edinburgh. Many appeared to benefit from intensive home treatment, as measured by the Clinical Global Impression scale. A small number of patients (n = 5) were responsible for more than half of all referrals. Polypharmacy, or regular use of multiple medications, was common, with 62% of all patients receiving three or more regular medications. Clinical implications Crisis and home treatment services can be beneficial to most people with BPD in crisis. The high rate of polypharmacy seen in this study is of concern.

Association between Proliferative Scars and In-Stent Restenosis

Background:

Keloid and hypertrophic scars are two types of proliferative scars at sites of cutaneous injury that form as a result of an abnormal wound-healing process. Proliferative scar formation after skin injury and restenosis after coronary stenting have common features. The aim of this study was to investigate the association of proliferative scars with coronary stent restenosis.

Methods:

Patients with previous open heart surgery with median sternotomy who had coronary stenting after the surgery and were admitted for control angiography were included in the study. The patients were divided into two groups according to the presence or absence of proliferative scars. The primary end point was the incidence of angiographic restenosis in patient groups.

Results:

The study group consisted of 80 patients (64 men; mean age 64 ± 9 years). Twenty-three patients (29%) have a proliferative scar. In general, two groups were comparable with regard to baseline lipid profiles, demographics, and cardiovascular risk factors. Restenosis was significantly more prevalent in patients with proliferative scars than with controls ( p = .04). By multivariate logistic regression analysis, stent length (odds ratio [OR] 1.12, p = .005), diabetes (OR 3.3, p = .03), and proliferative scar (OR 4.2, p = .02) independently predicted in-stent restenosis.

Conclusion:

The findings of this study suggest that patients with proliferative scars may have a higher risk of in-stent restenosis.

Evaluation of global function of the heart in scleroderma patients

OBJECTIVE

Scleroderma is a connective tissue disease characterized by diffuse vascular lesions and fibrosis of the skin and major organs including lungs, kidneys, and heart. When cardiac involvement is clinically evident, it is recognized as a poor prognostic factor. The early detection of cardiac involvement in scleroderma would be desirable both for implementation of preventive measures in the early stages of the disease and for optimal treatment.

METHODS

Left (LV) and right (RV) ventricular function were examined in 31 scleroderma patients and 21 healthy controls. Conventional and tissue Doppler echocardiography was used to evaluate systolic and diastolic function. Systolic indices including systolic (S) velocity, isovolumetric acceleration (IVA), ejection time (ET), and isovolumetric contraction time (IVCT) were measured. Early diastolic (E) velocity, late diastolic (A) velocity, E/A and E'/A' ratios, isovolumetric relaxation time (IVRT), and deceleration time (DT) were the diastolic measurements obtained. Myocardial performance index (Tei index) calculated by 2 different methods was used to assess global ventricular function.

RESULTS

In our study; mitral S velocity, biventricular ET, E', E/A, E'/A', RV IVA, LV IVA, and tricuspid S velocity were significantly lower in scleroderma patients. Mitral DT, IVCT, and biventricular IVRT, were significantly higher in scleroderma patients (P < 0.0001). In addition, RV and LV Tei indices were significantly increased in scleroderma patients compared with the control group (P < 0.0001 and P < 0.001, respectively).

CONCLUSIONS

In scleroderma patients, global function was depressed prior to the onset of clinical symptoms. Biventricular diastolic and systolic function abnormalities were also observed.

Left ventricular inferoapical diverticulum associated with normal coronary arteries

Isolated congenital left ventricular (LV) diverticulum, which is characterized by the local failure of the ventricular muscle, is a rare cardiac abnormality with a reported prevalence of 0.4%. Clinically, it has been reported to follow an asymptomatic course in the majority of cases; however, it may cause heart failure, thrombus formation, arrhythmia, rupture or chest pain in some patients. Due to its asymptomatic course, it is difficult to diagnose an isolated LV diverticulum. Our patient was admitted to hospital with the complaint of typical chest pain and no any electrocardiogram ischemic changes. Transthoracic echocardiogram showed a diverticulum in the inferoapical wall. Coronary computed tomography angiography was performed, which revealed LV diverticulum at inferoapical region and normal coronary anatomy.

A potential link between endothelial function, cardiovascular risk, and metabolic syndrome in patients with Non-alcoholic fatty liver disease

BACKGROUND

Asymmetric dimethylarginine (ADMA) is an endogenous competitive inhibitor of nitric oxide (NO) synthetase. Elevated ADMA reduces NO formation and is associated with endothelial dysfunction. The aims of this study were to evaluate endothelial function and the cardiovascular risk (CVR) profile in patients with non-alcoholic fatty liver disease (NAFLD), and to determine whether or not an association with metabolic syndrome (MS) increases these parameters.

METHODS

A total of 100 consecutive patients with NAFLD, who were seen in Liver Disease Outpatient clinic and 45 age- and sex-matched controls were included. Endothelial function was evaluated based on the serum ADMA level measured using a validated ELISA kit (DLD Diagnostika GMBH, Hamburg, Germany) and flow-mediated vasodilatation (FMV) measured via high-resolution external ultrasonography. The CVR profile was calculated according to the Framingham equation.

RESULTS

At baseline there weren't any significant differences in brachial artery diameter between the NAFLD and control groups (3.7 ± 0.6 mm vs. 3.6 ± 0.6 mm, respectively). FMV and flow-independent vasodilatation in response to sublingual nitroglycerin did not differ between the NAFLD and control groups (mean: 16% ± 9.4% vs. 17.9% ± 12.4%, and 21.4% ± 14% vs. 17.8% ± 11.3%, respectively, p > 0.05). No significant difference in the serum ADMA concentration between the NAFLD and control groups was observed (mean: 0.8 ± 0.07 μmol L(-1) vs. 0.74 ± 0.2 μmol L(-1), respectively). The CVR profile was significantly higher in the NAFLD group than in the control group (mean: 9% ± 6.9% vs. 4.6% ± 3.8%, P = 0.000). MS associated with NAFLD significantly increased the CVR profile (mean: 11.2% ± 7.4%, P = 0.000). An abnormal serum alanine aminotransferase level (>37 IU L(-1)) and the presence of fibrosis did not increase the CVR profile (p > 0.05).

CONCLUSIONS

The risk of cardiovascular events is increased in patients with NAFLD. The association with MS is further increased such risk.

Determination of natural radioactivity by gross alpha and beta measurements in ground water samples

In this study, the activity concentrations of the gross α and β in ground water samples collected from the different drilled wells in Nevşehir province were measured to assess annual effective dose due to the ingestion of the water samples. Nevşehir province is one of the major cities of Cappadocia Region which is a popular tourist destination as it has many areas with unique geological, historic, and cultural features. Sampling and measurements were carried out in the autumn of 2011 and the spring of 2012. The values of the activity concentrations of the gross α and β measured in the water samples ranged from 80 to 380 mBq L(-1) with a mean of 192 mBq L(-1) and 120-3470 mBq L(-1) with a mean of 579 mBq L(-1) respectively. All values of the gross α were lower than the limit value of 500 mBq L(-1) while two ground water samples were found to have gross β activity concentrations of greater than 1000 mBq L(-1). Therefore two water samples were the subject of further radioisotope-specific analysis. The obtained result indicated that the elevated activity concentrations of the gross β in these water samples are dominated by (40)K activity. Annual effective doses ranged from 0.04 to 0.20 mSv y(-1).

A survey of distribution of terrestrial radionuclides in surface soil samples in and around the Osmaniyeprovince, Turkey

The purpose of this survey was to determine the distribution of terrestrial radionuclides ((238)U, (232)Th and (40)K) in surface soil samples collected from different locations in and around Osmaniye and assess the radiological implications of outdoor external exposure. The activity concentrations of (238)U, (232)Th and (40)K in soil samples ranged from 2.6 to 38.1 Bq kg(-1) with a mean of 10.4±0.7 Bq kg(-1), 3.7-40.5 Bq kg(-1) with a mean of 12.2±0.7 Bq kg(-1) and 30.0-639.7 Bq kg(-1) with a mean of 243.4±12.8 Bq kg(-1), respectively. The concentrations of these radionuclides, presented in this article, were compared with those obtained from similar studies related to Turkey reported in the literature as well as earth's crust average values. The results of the activity concentrations were used to assess the external absorbed gamma dose rate (GDR) in outdoor air and the annual effective dose (AED). The outdoor absorbed GDRs fluctuate from 5.2 to 53.6 nGy h(-1) with a mean of 22.4±9.5. The corresponding mean AED is found to be 0.03 mSv.

Investigation of the activity level and radiological impacts of naturally occurring radionuclides in blast furnace slag

The activity level and possible radiological impacts of naturally occurring radionuclides on the health of workers and members of the public, as a result of utilisation of blast furnace slag (BFS) samples as a substitute for aggregate in road construction were investigated by using a gamma-ray spectrometer and potential exposure scenarios given in Radiation Protection 122. The mean activity concentrations of the (226)Ra, (232)Th and (40)K in BFS samples were found to be 152.4, 54.9 and 183.1 Bq kg(-1), respectively. These values are compared with typical values measured in BFS samples from the European Union countries, which are 270, 70 and 240 Bq kg(-1) for (226)Ra, (232)Th and (40)K, respectively. The values of radium equivalent activity index calculated for BFS samples were within the recommended safety limits. The highest total annual effective doses evaluated as 0.9 and 0.4 mSv y(-1) for members of the public and workers, respectively, were lower than the annual limit of 1 mSv y(-1).

Car-borne survey of natural background gamma dose rate in Çanakkale region, Turkey

Natural background gamma radiation was measured along roads in the environs of Çanakkale region by using a car-borne spectrometer system with a plastic gamma radiation detector. In addition, activity concentrations of ²³⁸U, ²²⁶Ra, ²³²Th and ⁴⁰K in soil samples from the Çanakkale region were determined by using a gamma spectrometer with an HPGe detector. A total of 92,856 data of the background gamma dose rate were collected for the Çanakkale region. The background gamma dose rate of the Çanakkale region was mapped using ArcGIS software, applying the geostatistical inverse distance-weighted method. The average and population-weighted average of the gamma dose are 55.4 and 40.6 nGy h⁻¹, respectively. The corresponding average annual effective dose to the public ranged from 26.6 to 96.8 µSv.

Effects of weight loss on ventricular systolic and diastolic functions and left ventricular mass assessed by tissue doppler imaging in obese geriatric women: preliminary report

BACKGROUND AND AIMS

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

The relationship between angiotensin converting enzyme gene I/D polymorphism and QT dispersion in patients with hypertrophic cardiomyopathy

INTRODUCTION

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.

MATERIALS AND METHODS

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.

RESULTS

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.

CONCLUSION

QTd and QTcd are increased in patients with HCM, especially in those with the DD genotype.

Endothelial function in normotensive men with obstructive sleep apnea before and 6 months after CPAP treatment

STUDY OBJECTIVES

To evaluate endothelium-dependent flow-mediated dilation (FMD) and endothelium-independent nitroglycerin (NTG)-induced dilation of the brachial artery with Doppler ultrasound in patients with obstructive sleep apnea (OSA) and impact of six months of continuous positive airway pressure (CPAP) treatment.

DESIGN

A prospective, controlled, observational study.

SETTING

Single-site, clinic-based.

PATIENTS

Twenty-nine normotensive men with OSA (apnea-hypopnea index [AHI], mean +/- SD, 60.4 +/- 22.1-h), and 17 men without OSA (AHI 2.5 +/- 0.6-h).

INTERVENTIONS

Six months of CPAP therapy in OSA patients.

MEASUREMENTS AND RESULTS

FMD was lower in patients with OSA compared with in controls (7.19 +/- 1.78% vs 10.93 +/- 2.59%; P < 0.001) while NTG-induced vasodilation was similar in both groups (13.75 +/- 1.01% vs 14.25 +/- 1.83%; n.s.). An inverse relationship was found between FMD and AHI adjusted for age and body mass index (BMI) (beta = - 0.05, P < 0.001). Following 6 months of CPAP treatment in the OSA group, FMD was increased from 7.38 +/- 2.06% to 10.45 +/- 1.68; P = 0.001) in 20 patients compliant with the device whereas the corresponding values did not change in the non-user group (7.08 +/- 1.50% vs 7.26 +/- 1.01%). No significant changes were observed regarding the NTG-induced vasodilation after CPAP compared with the baseline values.

CONCLUSIONS

Our results confirm the previous reports suggesting impaired endothelium-dependent FMD in OSA, and additionally document the sustained improvement in endothelial function after 6 months of CPAP treatment in complaint patients.

Prediction of subclinical left ventricular dysfunction with longitudinal two-dimensional strain and strain rate imaging in patients with mitral stenosis

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.

Natural radionuclide content and radiological hazard associated with usage of quartzite sand samples from Ovacik-Silifke-Mersin open pit as building material in Turkey

Activity concentrations of (238)U, (232)Th, (226)Ra and (40)K in quartzite sand samples collected from the Ovacik-Silifke-Mersin open pit located in the East Mediterranean region of Turkey were determined by using a gamma-ray spectrometry technique. The mean activity concentrations of the (238)U, (232)Th, (226)Ra and (40)K in quartzite sand samples were found as 81.7 +/- 22.9 Bq kg(-1), 6.3 +/- 2.8 Bq kg(-1), 77.5 +/- 24.3 Bq kg(-1)and 140.0 +/- 124.1 Bq kg(-1), respectively. The gamma index (I(gamma)), the internal exposure index (I(alpha)), the indoor absorbed dose rate (D(in)) and the corresponding annual effective dose (H(in)) were evaluated for the public exposure to radiological hazard arising due to the use of quartzite sand samples as building material. The values of I(gamma), I(alpha), D(in) and H(in) ranged from 0.20 to 0.75, with a mean of 0.34 +/- 0.11, 0.23 to 0.77 with a mean of 0.39 +/- 0.12, 58.27 to 201.51 nGy h(-1) with a mean of 93.33 +/- 27.63 nGy h(-1) and 0.29 to 0.99 mSv with a mean of 0.46 +/- 0.14 mSv, respectively.

The relation between endothelial dependent flow mediated dilation of the brachial artery and coronary collateral development - a cross sectional study

BACKGROUND

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.

METHODS

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.

RESULTS

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).

CONCLUSION

No significant association was found between the extent of angiographically visible coronary collaterals and systemic endothelial function assessed by FMD of the brachial artery.

Effects of humic substances supplementation provided through drinking water on performance, carcass traits and meat quality of broilers

The present study aimed at evaluating the effects of different doses of humic substances (HS) in waterer pan on broiler performances and meat quality. For the trial, 480 chicks (ROSS 308) were allocated into four groups (HS0, HS150, HS300 and HS450) of 120 equally mixed-sex birds, each receiving a drinking water supplemented with 0, 150, 300 and 450 ppm of a humic acid (provided by 0.0%, 0.5%, 1.0% and 1.5% of HS, v/v) respectively. At the age of 21 and 42 days, feed consumption and live weight were taken. At the age of 42 days, 16 birds per treatment were slaughtered, dressing percentages, digestive tract traits were evaluated and samples of breast (pectoralis major) and thigh (iliotibialis) meat were taken to evaluate the changes in colour characteristics (CIE L*, a* and b*) and chemical composition. The body weight gain increased by the HS300 in relation to the HS0 and HS450, and decreased by the HS450 in relation to the HS0. The feed consumption of birds in the HS450 and feed efficiency of birds in the HS300 were lower and higher than those in the other treatments respectively. The carcass weight of broilers in the HS150 and HS300 were higher than those of in the HS0 and HS450. The carcass weight decreased by the HS450 in relation to the other treatments. The dressing percentage increased by the HS150 in relation to the HS450. The HS450 resulted in breast and thigh meat colour that were lighter than those found in the HS0 birds. The HS450 increased fat content of thigh meat in relation to the HS0. It was concluded that the humic acid supplementation at 300 ppm and 450 ppm appears to have a measurable impact on live performance improving feed efficiency and lightness of breast and thigh meat colours in broilers respectively.

The association of elevated white blood cell count and C-reactive protein with endothelial dysfunction in cardiac syndrome X

BACKGROUND

The aim of the study is to evaluate the association of inflammatory markers with endothelial function in syndrome X.

METHODS

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.

RESULTS

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).

CONCLUSIONS

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.

Measurement of the natural radioactivity in building materials used in Ankara and assessment of external doses

A total of 183 samples of 20 different commonly used structural and covering building materials were collected from housing and other building construction sites and from suppliers in Ankara to measure the natural radioactivity due to the presence of (226)Ra, (232)Th and (40)K. The measurements were carried out using gamma-ray spectrometry with two HPGe detectors. The specific activities of the different building materials studied varied from 0.5 +/- 0.1 to 144.9 +/- 4.9 Bq kg(-1), 0.6 +/- 0.2 to 169.9 +/- 6.6 Bq kg(-1) and 2.0 +/- 0.1 to 1792.3 +/- 60.8 Bq kg(-1) for (226)Ra, (232)Th and (40)K, respectively. The results show that the lowest mean values of the specific activity of (226)Ra, (232)Th and (40)K are 0.8 +/- 0.5, 0.9 +/- 0.4 and 4.1 +/- 1.4 Bq kg(-1), respectively, measured in travertine tile while the highest mean values of the specific activity of the same radionuclides are 78.5 +/- 18.1 (ceramic wall tile), 77.4 +/- 53.0 (granite tile) and 923.4 +/- 161.0 (white brick), respectively. The radium equivalent activity (Ra(eq)), the gamma-index, the indoor absorbed dose rate and the corresponding annual effective dose were evaluated to assess the potential radiological hazard associated with these building materials. The mean values of the gamma-index and the estimated annual effective dose due to external gamma radiation inside the room for structural building materials ranged from 0.15 to 0.89 and 0.2 to 1.1 mSv, respectively. Applying criteria recently recommended for building materials in the literature, four materials meet the exemption annual dose criterion of 0.3 mSv, five materials meet the annual dose limit of 1 mSv and only one material slightly exceeds this limit. The mean values of the gamma-index for all building materials were lower than the upper limit of 1.

The effect of high-dose aspirin pre-treatment on the incidence of myonecrosis following elective coronary stenting

BACKGROUND

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.

METHODS AND RESULTS

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.

CONCLUSION

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.

Assessment of the natural radioactivity and radiological hazards in Turkish cement and its raw materials

The natural radioactivity due to presence of (226)Ra, (232)Th and (40)K radionuclides in raw materials, intermediate products (clinker) and end products (22 different cement types) was measured using a gamma-ray spectrometry with HPGe detector. The specific radioactivity of (226)Ra, (232)Th and (40)K in the analyzed cement samples ranged from 12.5+/-0.3 to 162.5+/-1.7Bqkg(-1) with a mean of 40.5+/-26.7Bqkg(-1), 6.7+/-0.3 to 124.9+/-2.5Bqkg(-1) with a mean of 26.1+/-18.9Bqkg(-1) and 64.4+/-2.3 to 679.3+/-18.2Bqkg(-1) with a mean of 267.1+/-102.4Bqkg(-1), respectively. The radium equivalent activity (Ra(eq)), the gamma-index, the emanation coefficient, the (222)Rn mass exhalation rate and the indoor absorbed dose rate were estimated for the radiation hazard of the natural radioactivity in all samples. The calculated Ra(eq) values of cement samples (37.2+/-8.7-331.1+/-15.5Bqkg(-1) with a mean of 98.3+/-53.8) are lower than the limit of 370Bqkg(-1) set for building materials. The Ra(eq) values were compared with the corresponding values for cement of different countries. The mean indoor absorbed dose rate is slightly higher than the population-weighted average of 84nGyh(-1).

Radiological significance of cement used in building construction in Turkey

The activity concentration of (226)Ra, (232)Th and (40)K in seven cement types from different factories and grinding plants were measured using a gamma ray spectrometry with HPGe detector. The average activity concentrations observed in the studied cement samples (all from 141 samples) were 40.0 +/- 27.1, 28.0 +/- 20.9 and 248.3 +/- 95.0 Bq kg(-1) for (226)Ra, (232)Th and (40)K, respectively. The radium equivalent activity (Ra(eq)), the representative level index, the indoor absorbed dose rate and the corresponding annual effective dose were estimated for the potential radiological hazard of the cement. The Ra(eq) values were compared with the corresponding values for cement of different countries. The mean indoor absorbed dose rate (87.4 +/- 48.5 nGy h(-1)) is slightly higher than the population-weighted average of 84 nGy h(-1), whereas the corresponding effective dose rate (0.4 +/- 0.2 mSv y(-1)) is lower than the dose criterion of 1 mSv y(-1). The obtained results indicate no significant radiological hazards arise from using Turkish cement in building construction.

Torsade de pointes associated with moxifloxacin: a rare but potentially fatal adverse event

Torsade de pointes occuring due to a long QT interval is a rare but potentially fatal arrhythmia. Acquired long QT develops most commonly because of drugs that prolong ventricular repolarization. It has been reported that fluoroquinolone antimicrobials prolong the corrected QT interval but rarely cause torsade de pointes. A patient with torsade de pointes risk factors (female sex, advanced age, extreme bradycardia and renal failure) who developed the condition on the fourth day of 400 mg/day of oral moxifloxacin treatment is presented. After the moxifloxacin was stopped, the corrected QT interval normalized and a permanent cardiac pacemaker was implanted. During 11 months of follow-up, arrhythmia did not recur.

Gadolinium:nonionic contrast media (1:1) coronary angiography in patients with impaired renal function

This study was to test safety and efficacy of 1:1 mixture of gadolinium:nonionic contrast media in avoiding contrast nephropathy during coronary angiography in patients with renal dysfunction. Although "off label" for x-ray angiography, gadolinium has drawn attention for its potential to avoid contrast nephropathy during coronary angiography. Initial data seem promising. Patients with a baseline creatinine of 1.5 mg/dl or more were included. In order to minimize contrast nephropathy risk, all patients were thoroughly hydrated and treated by N-acetylcysteine. After coronary angiography and/or percutaneous coronary intervention, renal function tests were remeasured on days 1, 2, and 3. A rise of 0.5 mg/dl or more in creatinine value in the following 3 days or the need for dialysis were considered as a contrast nephropathy event. Twenty-six patients were enrolled in this study. Ten were women and 16 were men. The mean age was 65.7 +/- 11. Baseline creatinine value was 2.47 +/- 0.74 mg/dl. The total amount of contrast medium used on 1:1 fashion was 57.1 +/- 27.2 ml. No procedure-related cardiac complication or contrast nephropathy event occurred in this study. Although there was a slight loss in image quality, we felt that the results were adequate for interpretation. Although "off label," using gadolinium contrast media in a 1:1 mixture with standard nonionic low osmolar contrast media seems to be a viable option in decreasing the likelihood of contrast nephropathy. Further evaluation appears to be warranted.

The association between androgen levels and premature coronary artery disease in men

OBJECTIVE

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.

METHODS

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.

RESULTS

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).

CONCLUSION

A low level of free testosterone may be related to the development of premature coronary artery disease.

Intravascular volume dependency of left ventricular mass calculation by two-dimensional guided M-mode echocardiography

BACKGROUND

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.

OBJECTIVES

To determine whether a decrease in intravascular volume after dialysis may cause inaccurate estimation of LVM by echocardiography.

METHODS

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.

RESULTS

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).

CONCLUSIONS

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.

Natural radioactivity measurement in pumice samples used raw materials in Turkey

The activity concentrations of 232Th, 226Ra, and 40K in different pumice samples have been determined by high-resolution gamma-ray spectrometry using a 110% HpGe detector. The radium equivalent activities (Raeq), external hazard index (Hex), and internal hazard index (Hin) associated with the natural radionuclides and representative level index (Igamma r) are calculated to assess the radiation hazard of the natural radioactivity in the pumice samples. The mean values of the measured radioactivity concentrations of 232Th, 226Ra, and 40K for pumice samples from the region of lakes (ROL) are 232.4+/-8.0, 196.9+/-7.8, and 1325.8+/-20.4 Bqkg(-1) and for pumice samples from Cukurova region (CR) 16.3+/-4.0, 16.1+/-4.9, and 479.7+/-170.4 Bqkg(-1), respectively. The calculated Raeq values vary from 435.9+/-12.5 to 883.6+/-41.5 Bqkg(-1) with a mean of 630.9+/-20.2 Bqkg(-1) for the ROL samples and from 49.7+/-3.3 to 101.9+/-7.2 Bqkg(-1) with a mean of 76.3+/-23.7 Bqkg(-1) for the CR samples. For the ROL samples, Raeq are above the limit of 370 Bqkg(-1), equivalent to external gamma dose of 1.5 mSv yr(-1), recommended for the safe use of construction materials by NEA-OECD, while for the CR samples, Raeq values are lower than the limit.

Value of Tissue Doppler Myocardial Velocities of Tricuspid Lateral Annulus for the Diagnosis of Right Heart Failure in Patients with COPD

OBJECTIVE

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).

METHODS

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.

RESULTS

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.

CONCLUSION

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.

The Relationship of Chronic Angiotensin Converting Enzyme Inhibitor Use and Coronary Collateral Vessel Development

BACKGROUND

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.

METHODS

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.

RESULTS

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).

CONCLUSION

The findings suggest that ACE inhibitor therapy may contribute to poor collateral development in patients with coronary occlusion.

Naproxen treatment prevents periprocedural inflammatory response but not myocardial injury after percutaneous coronary intervention

BACKGROUND AND AIM

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.

Association between the dosage and duration of statin treatment with coronary collateral development

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.

Effects of thyroxine therapy on right ventricular systolic and diastolic function in patients with subclinical hypothyroidism: a study by pulsed wave tissue Doppler imaging

INTRODUCTION

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.

PATIENTS AND METHODS

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.

RESULTS

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).

CONCLUSIONS

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.