Comparison of clinical characteristics of patients with heart failure and preserved ejection fraction with atrial fibrillation versus sinus rhythm: Insights from the APOLLON registry

OBJECTIVE

The aim of this study was to assess the clinical characteristics of patients with heart failure and preserved ejection fraction (HFpEF) and atrial fibrillation (AF) and compare them with those of HFpEF patients without AF.

METHODS

This study was a sub-group analysis of a multicenter, observational, and cross-sectional registry conducted in Turkey (ClinicalTrials.gov identifier: NCT03026114). Patients with HFpEF were divided into 2 groups: HFpEF with AF and HFpEF with sinus rhythm (SR), and the clinical characteristics of the groups were compared.

RESULTS

In a total of 819 HFpEF patients (median age: 67 years; 58% women), 313 (38.2%) had AF. Compared to the patients with SR, those with AF were older (70 years vs 66 years; p<0.001) and more symptomatic, with a higher rate of classification as New York Heart Association functional class III-IV, paroxysmal nocturnal dyspnea, orthopnea, palpitations, fatigue, pulmonary crepitations, and peripheral edema. The hospitalization rate for heart failure was higher (28.4% vs 12.6%; p<0.001) in patients with AF, and participants with AF had higher level of N-terminal pro-B-type natriuretic peptide (887 pg/mL vs 394.8 pg/mL; p<0.001) and higher left atrial volume index level. Patients without AF had a higher burden of diabetes mellitus, obstructive sleep apnea, and coronary artery disease. The prescription rate of nondihydropyridine calcium blockers, digoxin, loop diuretics, and anticoagulant drugs was higher in the AF group.

CONCLUSION

The results of this study revealed that in a large Turkish cohort with HFpEF, significant clinical differences were present between those with and without AF and. Further prospective studies are needed to clarify the prognostic implications of AF in this growing heart failure population in our country.

Influence of coronary calcification patterns on hemodynamic outcome of coronary stenoses and remodeling

OBJECTIVE

The histological characteristics of plaque may affect the hemodynamic outcome of a given coronary stenosis. In particular, the potential effect of volumetric calcium content and the topographical distribution in the lesion segment on physiological outcome has not yet been investigated. The aim of this study was to identify any potential correlation between patterns of calcification and the fractional flow reserve (FFR) and the coronary remodeling index (RMI).

METHODS

A total of 26 stable angina pectoris and 34 acute coronary syndrome patients without persistent ST-segment elevation constituted the study population. FFR was used to assess 70 intermediate coronary stenosis lesions. After obtaining hemodynamic measurements, quantitative grayscale and virtual histology-intravascular ultrasound analyses were performed. The depth, length, and circumferential distribution of calcification of the lesions were also recorded.

RESULTS

Within the analyzed segment (area of interest, lesion segment), FFR was correlated with maximal thickness of deep calcification (r=-0.285; p=0.021) and calcification angle (r=-0.396; p=0.001). In lesions with a calcification angle >180°, the mean FFR value was significantly lower compared with those <180° (0.64±0.17 vs. 0.78±0.08; p=0.024). RMI was correlated with maximal angle of superficial (r=-0.437; p<0.001) and deep (r=0.425; p<0.001) calcification. RMI was correlated with maximal thickness of superficial (r=-0.357; p=0.003) and deep (r=0.417; p<0.001) calcification. RMI was also correlated with FFR (r=-0.477; p<0.001).

CONCLUSION

This study demonstrated that the geometry, location, and amount of calcification of a plaque could affect hemodynamic and anatomical outcome measures in functionally significant stenoses by affecting vessel wall compliance.

Subjective and Objective Effects of Androgen Ablation Therapy on Voice

OBJECTIVES

The aim of present study was to evaluate possible side effects of androgen deprivation therapy (ADT) on voice quality by means of objective and subjective measures.

STUDY DESIGN

Cross-sectional.

METHODS

Thirty-five male patients who had been diagnosed with prostate cancer and who had been using bicalutamide and goserelin acetate combination for at least 12 months were included in the study. Thirty healthy nonsmoker males of similar age and without any laryngeal pathology constituted the control group. Acoustic and aerodynamic voice analyses and voice handicap index-10 were applied to both groups. Maximum phonation time, fundamental frequency, jitter, shimmer, and noise-to-harmonic ratio were determined during acoustic and aerodynamic voice analyses.

RESULTS

Maximum phonation times were 18.86 ± 5.24 and 24.20 ± 3.59 in ADT and control groups, respectively. It was significantly higher in the control group. Fundamental frequencies were 143.73 ± 18.47 and 135.00 ± 13.18 in ADT and control groups, respectively. Jitter values were 2.72 ± 0.62 and 1.99 ± 0.27 in ADT and control groups, respectively. Shimmer values were 11.50 ± 1.81 and 10.48 ± 1.36 in ADT and control groups, respectively. Fundamental frequency, jitter, and shimmer values were significantly higher in the ADT group. Noise-to-harmonic ratio values did not differ between groups. Voice handicap index-10 result was significantly higher in the ADT group.

CONCLUSIONS

ADT has adverse effects on the human voice. Prospective studies with long-term follow-up of a larger cohort are required for more detailed analysis.

Comparison of two partial middle turbinectomy techniques for the treatment of a concha bullosa

OBJECTIVES/HYPOTHESIS

To assess the nasal functions, nasal resistance, and olfactory function in middle turbinate surgery.

STUDY DESIGN

Randomized controlled trial.

METHODS

This prospective controlled study was carried out on patients who underwent laminectomy for aeration of the middle turbinate. Patients participating in the study were divided into two groups-group 1: medial laminectomy (n = 34) and group 2: lateral laminectomy (n = 38). Patients underwent the preoperative visual analogue score, sinonasal outcome test-22 (SNOT-22), peak nasal inspiratory flowmeter, and Connecticut Chemosensory Clinical Research Center smell test. All patients were reevaluated 3 months after the operation.

RESULTS

The study group comprised 72 consecutive patients. The mean age of the patients was 31.03 ± 9.7, with a range of 17 to 54 years. A total of 47.2 % (n = 34) had medial and 52.8% (n = 38) had lateral laminectomy. Bilateral turbinate intervention was performed in 27.8% (n = 20), whereas unilateral middle turbinate intervention was performed in 72.3% (n = 52). Overall, both groups showed strong significant improvement over time in visual analogue scale results, SNOT-22 scores, peak flowmeter results, and olfactory function between preoperative and postoperative scores (P < 0.001). There was no significant difference between the groups for all parameters (P > 0.05).

CONCLUSIONS

This study revealed that medial laminectomy for aeration of the middle turbinate was as effective as lateral laminectomy.

LEVEL OF EVIDENCE

1b. Laryngoscope, 125:1062-1066, 2015.

Evaluation of voice quality after supraglottic laryngectomy

OBJECTIVE

Supraglottic laryngectomy is a surgical procedure that preserves laryngeal functions. This technique allows extensions including removal of tongue base or 1 arytenoid. We aimed to compare vocal results of supraglottic laryngectomy and extended procedures.

STUDY DESIGN

Cross-sectional study.

SETTING

Tertiary care hospital.

SUBJECTS AND METHODS

Thirty-three males who underwent supraglottic laryngectomy were included in the study. Fifteen patients (45.5%) were applied standard supraglottic laryngectomy (standard supraglottic laryngectomy group). In 11 patients (33.3%), unilateral arytenoid cartilage was totally resected by separation at the cricoarytenoid joint (laterally extended group), and the tongue base was removed in 7 patients (anteriorly extended group) (21.2%). Twenty male smokers constituted control group. Acoustic and aerodynamic voice analyses were performed for the assessment of objective results. Grade, roughness, breathiness, asthenia, and strain scale (GRBAS) scores were analyzed for perceptual assessment. Voice Handicap Index-30 was used to evaluate subjective results.

RESULTS

The comparison of supraglottic laryngectomy group with the control group revealed that the mean maximum phonation time and fundamental frequency were significantly lower in the supraglottic laryngectomy group (P < .001), and the mean jitter, shimmer, and noise-to-harmonics ratio were significantly higher in the supraglottic laryngectomy group (P < .001). Maximum phonation time and fundamental frequency were higher in the standard supraglottic laryngectomy group in comparison to extended groups. Jitter value was also lower in the standard supraglottic laryngectomy group compared to extended groups. Perceptual and subjective analyses revealed no difference among standard supraglottic laryngectomy and extended groups.

CONCLUSION

The results of this study indicate that supraglottic laryngectomy patients have acceptable voice quality, as determined by perceptual and subjective assessment.

Effectiveness of azelastine nasal spray in the treatment of adenoidal hyper-trophy in children

AIM

To evaluate the effects of topical azelastine treatment on symptoms related to adenoid hypertrophy and the size of adenoid tissue in children.

MATERIAL AND METHODS

In total, 60 children who were found to have adenoid hypertrophy were included. A questionnaire on nasal symptoms, nasal endoscopy and skin prick tests was administered to all patients. All patients had complaints of chronic nasal obstruction symptoms and nasal endoscopy showed > 75% choanal obstruction, attributable to adenoid pads. The adenoid/nasopharyngeal areas were calculated. All of the patients underwent azelastine nasal spray therapy (1 spray per nostril, twice daily; 0.28 mg/dose) for 30 days. After 1 month, all children were reassessed. The efficacy of therapy, symptoms, adenoid / nasopharynx ratio, and obstruction ratio, obtained by endoscopy, were compared.

RESULTS

Azelastine treatment was well tolerated by all patients. After the first treatment period, the severity of symptoms, endoscopic grade, and adenoid size decreased in all of the 60 patients. There were significant improvements in total subjective symptoms (nasal obstruction, rhinorrhea, cough, snoring, and obstructive sleep apnea) post-treatment.

CONCLUSIONS

Azelastine nasal spray may be useful in decreasing adenoid pad size and the severity of symptoms related to adenoidal hypertrophy. Hippokratia 2014; 18 (4): 340-345.