Background Patent foramen ovale (PFO) is one of the causes of cardioembolism and closure of PFO is recommended by the current guidelines in patients with recurrent stroke. Transoesophageal echocardiography (TEE) using bubble-contrast study is the gold standard imaging modality for the assessment of interatrial septum. Upper-extremity veins are the most common way of injection, however, the presence of Eustachian valve and flow dynamics when bubble-contrast injection performed via upper extremity veins limits the assessment of interatrial septum in several cases. In this study, we aimed to compare the efficacy of bubble-contrast study between upper extremity injection and lower extremity injection. Material/Methods Patients with a suspicion of cardioembolism who were undergoing TEE study were included in this study. After routine assessment of cardiac structures, the bubble-contrast study was performed using agitated saline from both upper-extremity vein and lower-extremity vein with Valsalva manoeuvre. Right-to-left shunt and numbers of bubbles transmitted from the septum were recorded. Results We prospectively included 45 patients and 21 PFOs were detected. There were 9 patients with prominent Eustachian valve and in 6 patients Eustachian valve hampered the complete opacification of the right atrium. In 3 patients flow from the superior vena cava was directed towards the tricuspid valve and hampered the complete opacification. Among 21 patients with PFO, in 6 patients right-to-left shunt was not observed when agitated-saline was injected via the upper-extremity vein, however, the shunt was observed when the agitated-saline was injected via the lower-extremity vein. In 14 patients amount of bubbles passing through the interatrial septum were significantly higher when the injection was performed via the lower-extremity vein especially in patients with prominent Eustachian valve. Conclusion Our preliminary results indicated that compared to upper-extremity veins, injection via the lower-extremity veins provides better opacification of right atrial septum and assessment of interatrial septum. Therefore, injection through the lower-extremity veins would be the preferred choice particularly in patients with prominent Eustachian valve or downward directed flow from the superior vena cava. Figure 1 Funding Acknowledgement Type of funding source: None
Assessment of left ventricular filling pressure (LVFP) is crucial in patients with ST-segment elevation myocardial infarction (STEMI). Since current guideline recommended echocardiographic parameters have limited value, more comprehensive assessment methods are required in this patient subset.In this study, we aimed to investigate the clinical utility of left atrial reservoir strain (LARS) imaging in patients treated with primary percutaneous coronary intervention (pPCI). Patients who underwent successful pPCI were included. Left ventricular end-diastolic pressure (LVEDP) was measured invasively following pPCI. Left atrial strain imaging was performed following pPCI within 24 h of pPCI. Normal LARS value was accepted as above 23%. We prospectively enrolled 69 patients; there were 18 patients with LARS below 23% who were included into group 1 and rest of the study population included into group 2. There was no significant difference between groups in terms of comorbidities.Troponin and pro-BNP levels were significantly higher in group 1 (p: 0.036 and 0.047 respectively). Left atrial volume and tricuspid regurgitation velocity were similar between groups (p: 0.416 and p: 0.351 respectively). Septal tissue velocity was higher (p: 0.001) and Septal E/e’ ratio was lower (p: 0.004) in group 2. Left ventricular (LV) global longitudinal strain value was higher in group 1 which is consistent with observed lower ejection (LVEF) fraction in group 1 (p: 0.001 for LV strain and p: 0.001 for LVEF). Estimated mean LVFP was also higher in group 1 (p: 0.003).Correlation analyses revealed moderate correlation between LARS and LVEDP (r: − 0.300). Our results indicate that left atrial strain imaging is a promising tool for the assessment of left atrial pressure in patients with STEMI.
Background The adrenergic system plays a central role during the clinical course of hypertrophic cardiomyopathy (HCM) and hence beta-blocker therapy is the first-line treatment option according to current guidelines. Previous studies demonstrated variable cellular response to an adrenergic stimulus due to adrenoceptor-1 (ADRB-1) gene polymorphism in several patient groups including hypertension and dilated cardiomyopathy. Moreover, the impact of beta-blockers is also variable in these patients. Purpose We aimed to investigate the impact of ADRB-1 gene polymorphism on structural and functional features among patients with HCM. Methods In this study, we investigated the roles of Arginin389Glycine and Glycine49Serine polymorphism. Patients with a clear diagnosis of HCM according to current guidelines were included. Structural features including maximal wall thickness, interstitial fibrosis and left ventricular/atrial volumes were obtained using cardiac MRI and transthoracic echocardiography. Functional features including heart rate, blood pressure, left ventricular outflow obstruction were also recorded. The risk of sudden cardiac death was calculated using the HCM risk score. The impact of beta-blocker therapy on heart rate and blood pressure were also compared. Results After the exclusion of patients, 147 patients were included in the study. 77% of the study population were male and the mean age was 49.5 years. The hypertrophic segment was septum in 83% of the study population. The mean maximum wall thickness was 20 mm (19–23). With respect to Ser49Gly polymorphism, Serine homozygotes demonstrated higher late-gadolinium enhancement and indicator of interstitial fibrosis (p: 0.007). In concordance with higher LGE, the presence of fragmented QRS on surface ECG (p: 0.026) and a higher prevalence of non-sustained ventricular tachycardia (p: 0.016) in these patients were observed. The risk of sudden cardiac death was also higher in Ser49 homozygotes (p: 0.041). However, with respect to Arg389Gly gene polymorphism, there was no significant difference between Arg389 homozygotes, Arg389Gly heterozygotes and Gly389 homozygotes in terms of structural and functional features. The vast majority of patients reported improved functional capacity and decreased shortness of breath during the follow-up regardless of ADRB-1 gene polymorphism which is objectively validated by decreased pro-BNP levels in all patients. Conclusion Our results indicated that ADRB-1 gene polymorphism, particularly Ser49Gly gene polymorphism may have a significant role during the clinical course of HCM. Since Ser49 homozygote patients demonstrated higher interstitial fibrosis and a higher risk of sudden cardiac death, further studies are required to determine the significance of Ser49Gly gene polymorphism in HCM patients. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Bilimsel Arastırma Projesi (BAP) - Istanbul University - Cerrahpasa, Cerrahpasa Medical School
Purpose: Assessment of left ventricular filling pressure(LVFP) is crucial in patients with ST-segment elevation myocardial infarction(STEMI).Since current guideline recommended echocardiographic parameters have limited value, more comprehensive assessment methods are required in this patient subset.In this study, we aimed to investigate the clinical utility of left atrial reservoir strain(LARS) imaging in patients treated with primary percutaneous coronary intervention(pPCI). Methods: Patients who underwent successful pPCI were included.Left ventricular end-diastolic pressure(LVEDP) was measured invasively following pPCI. Left atrial strain imaging was performed following pPCI within 24 hours of pPCI. Normal LARS value was accepted as above 23%. Results: We prospectively enrolled 69 patients; there were 18 patients with LARS below 23% who were included into group 1 and rest of the study population included into group 2.There was no significant difference between groups in terms of comorbidities.Troponin and pro-BNP levels were significantly higher in group 1(p: 0.036 and 0.047 respectively). Left atrial volume and tricuspid regurgitation velocity were similar between groups(p: 0.416 and p:0.351 respectively). Septal tissue velocity was higher(p:0.001) and Septal E/e’ ratio was lower(p:0.004) in group 2. Left ventricular(LV) global longitudinal strain value was higher in group 1 which is consistent with observed lower ejection(LVEF) fraction in group 1(p: 0.001 for LV strain and p: 0.001 for LVEF). Estimated mean LVFP was also higher in group 1(p: 0.003).Correlation analyses revealed moderate correlation between LARS and LVEDP(r: -0.300). Conclusion Our results indicate that left atrial strain imaging is a promising tool for the assessment of left atrial pressure in patients with STEMI.
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