Unveiling cardiac insights: Exploring early left ventricular dysfunction in polycythemia vera through 4D-STE and fragmented QRS analysis

BACKGROUND

Polycythemia vera (PV), characterized by elevated red blood cell counts, poses challenges to cardiovascular health with potential impacts on cardiac function. Myocardial infarction (MI) and heart failure are major causes of mortality in PV patients. Early detection of left ventricular systolic dysfunction is crucial for optimizing outcomes.

METHODS

Fifty-two PV patients and 45 healthy controls were recruited. Four-dimensional speckle tracking echocardiography (4D-STE) and fragmented QRS complexes (fQRS) on electrocardiograms were utilized to assess cardiac mechanics. Hematological and echocardiographic parameters were measured, and statistical analyses were performed.

RESULTS

PV patients exhibited significantly higher hematocrit and red cell distribution width compared to controls. Global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS), and global area strain (GAS) were lower in PV patients. fQRS complexes were associated with longer disease duration and reduced GCS and GAS values. Hematocrit correlated positively with LV-GCS and LV-GAS. Multiple linear regression revealed that disease duration and fQRS presence independently predicted LV-GAS.

CONCLUSION

This study underscores the intricate link between elevated red blood cell counts, disease duration, and cardiac function in PV patients. Combining 4D-STE and fQRS complexes enhances the identification of early left ventricular systolic dysfunction. These findings offer potential improvements in recognizing and managing cardiovascular complications in PV patients, with implications for future research and clinical practice. Further investigations are needed to elucidate underlying mechanisms and validate these markers in larger cohorts.

Evaluation of pulmonary artery stiffness and right ventricle functions in polycythemia vera patients by transthoracic echocardiography

INTRODUCTION

Polycythemia vera (PV) is known to be a subgroup of chronic myeloproliferative neoplasms and is recognized as a cause of pulmonary hypertension (PH). Pulmonary artery stiffness (PAS) is a relatively new noninvasive echocardiographic index developed to evaluate the structural features and functions of the pulmonary vascular bed. In this study, we aimed to evaluate right ventricular (RV) functions and PAS in PV patients and healthy controls.

METHODS

A group of 65 consecutive PV patients and 40 healthy controls were included in the study. RV global longitudinal strain (RVGLS) and RV free wall longitudinal strain were (RVFwLS) evaluated using two-dimensional (2D) strain echocardiography. RV volume, systolic and diastolic functions were evaluated with three-dimensional (3D) echocardiography. PAS was calculated using the maximum frequency shift (MFS) and acceleration time of the pulmonary artery flow trace.

RESULTS

PAS values were significantly higher in the PV group than in the control group (25.2 ± 5.2 vs. 18.2 ± 4.2, p < .001). We found that tricuspid annular plane systolic excursion (TAPSE) (p < .001), RV fractional area change (p < .001) and RV ejection fraction (p < .001) measurements evaluated by 3D echocardiography were significantly lower in the PV group.

CONCLUSION

In our study, PAS values were higher in PV patients than in the healthy control group. Patients with PV may have subclinical RV dysfunction, and PAS value can be used in the early diagnosis of PH and RV dysfunction in this patient group.

Bone Marrow Transplantation as a Rare Cause of Pulmonary Arterial Hypertension

The development of pulmonary arterial hypertension after bone marrow transplantation (BMT) is a rare but serious complication. In this case report, we presented the development of pulmonary arterial hypertension in a 22-year-old woman who underwent BMT due to aplastic anemia. Her symptoms on admission included shortness of breath, palpitations and fatigue. Pulmonary hypertension was classified with right heart catheterization as pul monary arterial hypertension. The patient's laboratory, echocardiographic and hemodynamic findings improved with pulmonary arterial hypertension-specific treatment. Pul monary arterial hypertension should be considered in the differ ential diagnosis of BMT patients with 'unexplained' hypoxemia or respiratory distress.

Determination of Direct and Indirect Effects on Milk Yield of Anatolian Buffaloes Using Path Analysis

This study aimed to determine the direct and indirect effects of the independent variables presented by the lactation lenght (LL), age of calving (CAGE), and daily milk yield (DMY) on the dependent variable of lactation milk yield (LMY) in Anatolian buffaloes. In this study, a total of 3761 LMY records of the 834 Anatolian buffaloes calving between 2012 and 2017 in Tokat province and around were used as the research material. In the study, the simple correlation coefficients between the dependent variable of LMY and independent variables were determined positive and significant (P<0.001). The research specified the direct determination coefficients of the independent variables of the LL, CAGE, and DMY on the dependent variable of LMY as 0.378, 0.004, and 0.350, respectively. The path coefficients related to LL, CAGE, and DMY were determined as 0.615, 0.021, and 0.592, respectively. Since the DMY and LL examined in the study had a high direct impact on the lactation milk yield, therefore it could be suggested that using these data as criteria in breeding programs conducted in the herds evaluated in the study will increase the success in the selections applied.

The relationship between bioelectrical impedance parameters and pulmonary artery stiffness in obese subjects

OBJECTIVES

Obesity is a public health problem that needs to be treated and it occurs as a result of excessive fat accumulation in the body. The relationship between obesity and pulmonary hypertension is well known. The aim of this study is to evaluate the relationship between pulmonary artery stiffness, right ventricular functions and bioelectrical impedance parameters in obese, overweight, and healthy individuals.

METHODS

In this study, 41 obese (17 female and 24 male, mean age 43.5±10.3), 39 overweight (20 female and 19 male, mean age 38.6±10.4), 34 healthy control group (19 female and 15 male, mean age 40.5±8.6) were included. Anthropometric measurements and bioelectrical impedance parameters of all participants were performed. Right ventricular functions and pulmonary artery stiffness were evaluated by using conventional echocardiography.

RESULTS

Right ventricle myocardial performance index, pulmonary artery stiffness values were statistically different between groups. Positive correlation was observed between pulmonary artery stiffness and Body Mass Index, Waist and Hip circumferences. Significant negative correlation was observed between muscle to fat ratio and pulmonary artery stiffness. In the linear regression analysis, it was observed that the muscle to fat ratio was independent predictor of pulmonary artery stiffness (β = -1.835; 95%CI(-2.434 - - .784); p < 0.001).

CONCLUSIONS

This study showed that right ventricular function was impaired and pulmonary artery stiffness increased in obese individuals. These findings could be considered as early markers of pulmonary hypertension in obese patients who do not yet have clinical evidence of cardiovascular disease.

Fragmented QRS complexes are associated with subclinical left ventricular dysfunction in patients with Behcet's disease: Four-dimensional speckle tracking echocardiography

BACKGROUND

Behcet's disease (BD) is a chronic systemic inflammatory disease in which early detection of cardiac involvement is essential. The aim of this study was to assess the left ventricular (LV) functions in BD patients using four-dimensional (4D) speckle tracking echocardiography (STE) and to test the correlation between LV dysfunction and the presence of QRS fragmentation.

METHODS

This cross-sectional study included 64 Behcet's patients and 48 healthy volunteers. The BD group was divided into two subgroups depending on the presence (fQRS+) or absence (fQRS-) of fragmented QRS (fQRS). In both groups, left ventricular global area strain (LV-GAS), global radial strain (GRS), global longitudinal strain (GLS), and global circumferential strain (GCS) were obtained with 4D echocardiography.

RESULTS

GAS, GRS, GLS, and GCS values were significantly different in Behcet's patients and in healthy volunteers. GLS and GAS values were lower in the fQRS+ than in the fQRS- group (-15.8 ± 1.8 and -17.9 ± 1.6, P = .001 vs -25.0 ± 3.1 and -29.2 ± 4.2, P < .001, respectively). The duration of disease was longer in fQRS+ than in fQRS- patients (120.8 ± 67.4 vs 71.0 ± 40.5, P < .001). Multiple linear regression analysis showed that fQRS and disease duration were independent predictors of LV-GAS.

CONCLUSIONS

Four-dimensional STE may be helpful for the prediction of early cardiac dysfunction in patients with BD. The presence of fQRS may be an indicator of subclinical LV dysfunction.

Subclinical left ventricular dysfunction in Sjögren's syndrome assessed by four-dimensional speckle tracking echocardiography

OBJECTIVE

The aim of this study was to evaluate the left ventricular (LV) systolic strain by four-dimensional speckle tracking echocardiography (4D-STE) in order to provide the early detection of myocardial dysfunction in patients with Sjögren's syndrome (SS).

METHODS

Forty consecutive patients with primary SS diagnosed at the rheumatology outpatient clinic and 35 age- and sex-matched healthy volunteers were included in the study. 4DSTE was performed, and global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS), and global area strain (GAS) were measured. 4DSTE results were compared with the healthy volunteers.

RESULTS

No significant differences were observed between the GRS and GCS values of the two groups. A significant difference was observed in the GLS and GAS measurements between the two groups (P = .005 for GLS, P < .001 for GAS). Positive correlation was detected between disease duration and LV-GLS and LV-GAS.

CONCLUSION

We demonstrated subclinical systolic dysfunction in SS patients by 4DSTE, which is a sensitive marker of ventricular dysfunction. Deterioration of the LV became more evident as duration of the disease increased. Therefore, we believe that a cardiac evaluation will be of benefit to patients with long-term SS.

Assessment of left atrial volume and function in patients with Sjögren's syndrome using three-dimensional echocardiography

OBJECTIVE

We used real time, three-dimensional transthoracic echocardiography (3DTTE) to evaluate left atrial (LA) volume and mechanical function in patients with primary Sjögren's syndrome (SS).

METHODS

We prospectively included 42 consecutive patients with primary SS and 42 controls who were similar in terms of basal characteristics. 3DTTE was used to assess LA function.

RESULTS

Maximum LA volume, minimum LA volume, pre-atrial contraction LA volume, LA Active Stroke Volume (ASV), LA Total Stroke Volume (TSV), maximal left atrial volume index (LAVImax), Left atrial pre-contraction volume index, and Left atrial minimum volume index, ASV index, and TSV index were significantly higher in the SS group, and the LA Total Emptying Fraction, LA Expansion Index, and LA Passive Emptying Fraction were significantly lower. Although the active emptying fraction was higher in the SS group, the difference was not statistically significant. LAVImax was positive correlated with disease duration (r = .753).

CONCLUSION

Left atrial function is impaired in SS patients and serves as an early marker of subclinical cardiac involvement.

Meat production characteristics of Turkish native breeds: I. Fattening, slaughter and carcass traits of lambs

The present study was conducted to determine the slaughter and carcass traits of male lambs of the Akkaraman (A), Morkaraman (M), Awassi (IW), Karayaka (KR), Kıvırcık (KV) and Middle Anatolian Merino (MAM) sheep breeds. Fattening of all lambs started when they were at 90 days at weaning and finished when they reached bodyweight of 40 kg. The cold dressing percentage of lambs of A, M, and IW breeds were significantly lower than those of KV, KR and MAM. Fat depth and muscle area were significantly greater in KV and MAM lambs than those of the other breeds. There were significant differences among breeds in shoulder, leg and lean weights. Weights of back loin in KV and MAM lambs were significantly greater than those of the other breeds. The highest values for carcass fleshiness were obtained in MAM and IW lambs, but they had a significantly lower carcass fatness score. There were significant differences among the breeds in carcass compactness and leg conformation. The results of the present study indicated that A and MAM breeds could be recommended for desirable carcass characteristics.Keywords: Carcass cuts, indigenous sheep breed, intensive lamb finishing, meat formation, SEUROP classification