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Objective: We aimed to evaluate the subclinical left ventricular (LV) systolic dysfunction with the automated function imaging method (AFI) based on speckle tracking echocardiography (STE) in obstructive sleep apnea patients (OSA) with normal left ventricular ejection fraction (LVEF) and without any confounding disease that can cause myocardial dysfunction. Methods: Twenty-one healthy individuals and 58 OSA patients were included in this observational cross-sectional study. According to the severity of disease, OSA patients were examined in three groups; mild, moderate and severe OSA. Apical 2-, 3-and 4-chamber images were obtained for AFI evaluation. The global systolic longitudinal strain (GL S ) values were determined for each view, and averages of these were used in comparison of the patient groups. One-way ANOVA, Kruskal-Wallis, Pearson correlation tests and linear regression analysis were used for statistical analysis. Results: The GL S values of the OSA patients were lower than of the healthy individuals and these values were decreased along with the OSA severity (Healthy:-25.58±-2.16%, Mild:-23.93±-3.96%, Moderate:-21.27±-2.60%, Severe:-16.94±-2.66%, respectively). The difference was significant between moderate OSA patients and healthy individuals, and significant between severe OSA patients and all other groups (p<0.03). The apnea-hypopnea index was found to be correlated with the GL S (β=-0.659, 95% CI: 0.09-0.17, p<0.001). Conclusion: Longitudinal LV mechanics in OSA patients with normal LVEF are deteriorated in the subclinical stage being associated with the severity of disease. AFI can be used as an effective and safe method in the determination of subclinical myocardial dysfunction in OSA patients, because it is semi-automated and easy to use with a short analysis time.(Anadolu Kardiyol Derg 2012; 12: 320-30) Key words: Obstructive sleep apnea, speckle tracking echocardiography, myocardial strain, regression analysis 320 ÖZET Amaç: Sol ventrikül ejeksiyon fraksiyonu normal ve miyokart fonksiyonlarını etkileyecek ek hastalığı bulunmayan, obstrüktif uyku apneli (OUA) hastalarda, subklinik sol ventrikül sistolik disfonksiyonunu, iki boyutlu benek izleme ekokardiyografi tekniğine dayanan, otomatik fonksiyonel görün-tüleme yöntemi (OFG) ile değerlendirmeyi amaçladık. Yöntemler: Gözlemsel enine-kesitli çalışmamıza 21'i sağlıklı, 58'i OUA hastası olan toplam 79 kişi alındı. OUA'lı hastalar hastalığın ciddiyetine göre hafif, orta ve ağır olarak 3 gruba ayrıldı. OFG değerlendirmesi için sol ventrikülün apikal 2-, 3-, 4-boşluk görüntüleri kullanıldı. İlgili boşluk-lara ait sistolik longitüdinal deformasyon değerlerinin aritmetik ortalaması olan, global longitüdinal deformasyon değerleri gruplar arasında karşılaştırıldı. İstatistiksel analiz için tek -yönlü ANOVA, Kruskal-Wallis, Pearson korelasyon testleri ve doğrusal regresyon analizi kullanıldı. Bulgular: Sağlıklı gruba göre hafif OUA grubundan itibaren hastalığın ciddiyeti ile global longitüdinal deformasyon değerleri azalmaktaydı (Sağlıklı: -%25...

In this study, our aim was to evaluate the LV (left ventricle) subclinical myocardial dysfunction using the two-dimensional speckle tracking echocardiography (2D-STE) method on obstructive sleep apnea (OSA) patients with preserved left ventricular ejection fraction (LVEF) and without any confounding disease that may result myocardial dysfunction. Twenty-one healthy individuals and 58 OSA patients were enrolled in the study. The patients were categorized into mild, moderate and severe OSA groups according to the apnea-hypopnea index (AHI). Conventional- and tissue Doppler echocardiography imagings were performed in all the individuals besides the 2D-STE. The longitudinal strain (S) and systolic strain rate (SR(S)) values decreased as the severity of disease increased from moderate towards severe OSA. The circumferential S and SR(S) values were observed to be lower in the severe OSA patients. Despite the increase in the radial S and SR(S) in moderate and mild OSA patients, these measurements decreased in those with severe OSA. Although the longitudinal, circumferential and radial early diastolic strain rates (SR(E)) decreased as the severity of disease increased form moderate to severe, the late diastolic strain rates (SR(A)) were observed to increase. In the early stages of OSA, longitudinal systolic LV dysfunction is detected in addition to the diastolic dysfunction. The circumferential mechanics of the LV deteriorate in the later stages of the OSA. Despite a compensatory increase in the radial LV function in the early stages of OSA, in later stages, the LV radial function also deteriorates. The assessment of the myocardial functions using the STE method in patients with OSA with preserved LVEF has the potential to detect the subclinical LV dysfunction and might provide useful information for risk stratification.

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By using two-dimensional speckle tracking echocardiography, we aimed to investigate the structural and functional changes on myocardium in chronic asymptomatic alcoholics without any cardiovascular disease. Forty-one consecutive asymptomatic male alcoholics who were admitted to the outpatient alcoholism unit and 30 age matched healthy male volunteers selected as the control group were enrolled in the study. The study group were investigated by using standard two-dimensional echocardiography and speckle tracking echocardiography. The left ventricular (LV) global longitudinal strain and LV global circumferential strain were significantly lower in alcoholics when compared with control subjects. There was no difference in global radial strain between the two groups. To demonstrate the effect of total life time dose of ethanol (TLDE) on echocardiographic abnormalities, we assessed the correlation analysis. There was a nonsignificant weak correlation between global LV circumferential strain and TLDE (r = 0.27, p = 0.083). Speckle tracking echocardiography derived left ventricular systolic function was impaired in chronic alcoholic patients when compared with healthy controls.

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Although the definition of polypharmacy is not yet clear today, it is generally regarded as drug use more than the patient needs. Advanced age is the most important risk factor for polypharmacy. In addition, other risk factors are loss of current cognitive functions, low socioeconomic level and nursing care. It is seen in about 40% of people over 75 years of age worldwide, varying between countries of extreme poverty. Incorrect drug use, drug side effects and drug-drug interaction lead to unwanted hospitalizations. In particular, cardiovascular drugs pose risks in terms of drug side effects in advanced ages. Altering the pharmacokinetics and pharmacodynamics of the drug along with advanced age lead to more frequent side effects or no effect of the drugs. The most important point to prevent polypharmacy is to inform the patient or the patient's caregiver fully and to target treatment with a minimum number of drugs and doses.