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.

Objective:The purpose of this study was to investigate the factors predicting the maintenance of sinus rhythm in patients with paroxysmal atrial fibrillation (PAF) who underwent cryoablation of the pulmonary veins (PVs).Methods:Fifty-one patients (54.6±10.4 years) with paroxysmal AF who underwent the cryoablation of the PVs were to the prospective trial. The clinical risk factors and echocardiographic parameters [left atrial (LA) diameter, left ventricular ejection fraction and dimensions, left atrial spontaneous echo contrast (LASEC), mitral annulus calcification (MAC), left atrial appendage emptying peak flow velocity (LAAV), and PV flow] were assessed before the cryoablation procedure. Patients with PAF who refused to use any medication because of intolerance or presentation of resistant symptoms, despite the use of at least one antiarrhythmic drug were enrolled to the study, patients with LA/LAA thrombus on echocardiographic examination, severe valvular disease, pericardial fluid, and abnormal thyroid function tests as well as systemic disease were excluded from the study. All parameters were tested for their ability to predict the recurrence of AF during a 1-year follow-up period.Results:During the period of follow-up, AF recurred in 16 of 51 patients (31.3%/year). All significant parameters associated with the recurrence of AF were evaluated in multivariate logistic regression analysis. The presence of MAC (p<0.001) as well as LA diameter (p<0.0001), LAAV of <30 cm/s (p<0.0001), PV flow systolic wave velocity (p<0.0001), and LASEC (p<0.0001) were detected as independent predictors of recurrence. In the receiver operating characteristic analysis, LAAV of >30 cm/s had a sensitivity of 85% and a specificity of 95% for predicting success after ablation (AUC=0.813; 95% CI:0.76–0.92; p<0.0001).Conclusion:The presence of MAC, increased LA diameter, the existence of LASEC, low LAAV, and low peak PV systolic wave velocity are parameters that can predict the recurrence of AF after cryoablation.

A long QT interval, which is the surface electrocardiogram (ECG) manifestation of a prolonged repolarization phase, is associated with an increased risk of torsade de pointes (TdP). If transient, it may present with syncope, and if is not transient, it may cause sudden death. A long QT interval may be congenital or acquired. The most common cause of an acquired long QT interval is drug administration (1). The drugs that interfere with potassium influx, commonly by blocking the human ether-a-go-go-related gene channel-dependent potassium current (as with fluoroquinolones) in myocyte membranes produce a prolongation of the corrected QT (QTc) interval and increase the risk of spontaneous arrhythmia generation (2). Fluoroquinolones have been reported to prolong the QTc interval and precipitate TdP in patients at high risk (1,3). We present a patient with bradycardia who developed TdP during oral moxifloxacin therapy for pneumonia. CASE PRESENTATIONAn 87-year-old woman with hypertension, chronic renal failure and dementia was admitted to the emergency department with presyncope. Junctional rhythm with a rate of 30/min was present on ECG, and the QT interval was 0.66 s; the QTc interval, according to Bazett's formula, was 0.47 s (Figure 1). There were no previous ECGs performed. Medications she was using at the time of admission included ginkgo glycosides (19.2 mg/day), valsartan 80 mg plus hydrochlorothiazide (12.5 mg/day), acetylsalicylic acid (100 mg/day) and citalopram (20 mg/day). Her serum creatinine level was 283 μmol/L and potassium level was 4.2 mmol/L at admission. Other biochemical tests were normal. A temporary transvenous cardiac pacemaker was implanted and set to a rate of 60 beats/min. The pacemaker was turned off 24 h after the implantation because sinus rhythm resumed, but it was left in place in case of bradycardia. On that day, 400 mg/day oral moxifloxacin was prescribed to the patient for aspiration pneumonia. At the beginning of moxifloxacin treatment, the rhythm was normal, with normal QT (0.40 s) and QTc (0.43 s) intervals at a heart rate of 68 beats/min. The patient was transferred to the intensive care unit for telemetric follow-up due to the possible recurrence of symptomatic bradycardia. Intermittant junctional rhythms were observed on the monitor, but sinus rhythm was dominant. On the fourth day of moxifloxacin therapy, TdP developed following a short-long-short sequence of junctional rhythm (Figure 2) and recovered spontaneously after 36 s. The QT interval on the ECG taken on the same 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 moxifloxa...

In this study, we investigated pre-service physics teachers' mental models of light in different contexts, such as blackbody radiation, the photoelectric effect and the Compton effect. The data collected through the paper-and-pencil questionnaire (PPQ) were analyzed both quantitatively and qualitatively. Sampling of this study consists of a total of 110 physics education students who were taking a modern physics course at two different state universities in Turkey. As a result, three mental models, which were called the beam ray model (BrM), hybrid model (HM) and particle model (PM), were being used by the students while explaining these phenomena. The most model fluctuation was seen in HM and BrM. In addition, some students were in a mixedmodel state where they use multiple mental models in explaining a phenomenon and used these models inconsistently. On the other hand, most of the students who used the particle model can be said to be in a pure model state.

Intracardiac thrombus is an important clinical co ndition because of its potential complications. Detection of ventricular thrombi is generally performed by transthoracic echocardiography while atrial thrombi are generally evaluated by transesophageal echocardiography. Contrast-enhanced computerized tomography is more sensitive for detecting ventricular and atrial thrombi than transthoracic echocardiography, but the technique has been demonstrated to be inferior to transesophageal echocardiography for displaying atrial thrombi. Cardiac magnetic resonance imaging provides superior specifi city for evaluation of tissue characteristics and helps to differentiate thrombi from other masses. SOUHRNVzhledem k možnosti různých komplikací představuje přítomnost trombů v srdci závažný klinický stav. K vyhledávání trombů v pravé komoře se obvykle používá transthorakální echokardiografi e, zatímco tromby v pravé síni odhalí transezofageální echokardiografi e. I když výpočetní tomografi e se zesíleným kontrastem vyhledává tromby v komorách i v síních spolehlivěji než transthorakální echokardiografi e, nedokáže zjistit tromby v pravé síni tak přesně jako transezofageální echokardiografi e. Díky své vysoké specifi citě umožňuje vyšetření srdce magnetickou rezonancí určit charakteristiky srdeční tkáně a pomáhá odlišit tromby od jiných nitrosrdečních útvarů.

Coronary artery ectasia (CAE) is defi ned as localized or diffuse dilation of coronary artery lumen exceeding the largest diameter of an adjacent normal vessel more than 1.5 fold. The incidence of CAE is reported as 0.3-4.9% of patients undergoing coronary angiography. The rate of recognition may increase with the use of new non-invasive imaging methods as computed tomography (CT) and magnetic resonance (MR) coronary angiography. Atherosclerosis is considered as the main etiologic factor responsible for more than 50% of cases in adults while Kawasaki disease is the most common cause in children or young adults. Coronary ectasia is thought to be a result of exaggerated expansive remodeling, which is eventuated as a result of enzymatic degradation of the extracellular matrix and thinning of the vessel media. Patients with CAE without signifi cant coronary narrowing may present with angina pectoris, positive stress tests or acute coronary syndromes. Ectatic vessel may be an origin of thrombus formation with distal embolization, vasospasm or vessel rupture. The prognosis of CAE depends directly on the severity of the concomitant coronary artery disease. Antiplatelet drugs underlie the therapy. Other management strategies in CAE involve both the prevention of thromboembolic complications and percutaneous or surgical revascularization. SOUHRNKoronární ektázie (coronary artery ectasia -CAE) je defi nována jako lokalizované nebo difuzní rozšíření lumen koronární tepny o více než 1,5násobek průměru největší přilehlé nepostižené tepny. U pacientů absolvujících koronarografi cké vyšetření se incidence CAE uvádí v rozmezí 0,3-4,9 %. Vyhledávání osob s tímto postižením se může zvýšit při použití nových neinvazivních zobrazovacích metod, např. výpočetní tomografi e (computed tomography -CT) a MR angiografi e. Za hlavní etiologický faktor odpovědný za více než 50 % případů u dospělých je považována ateroskleróza, zatímco u dětí a mladých dospělých je nejčastější příčinou Kawasakiho nemoc. Předpokládá se, že koronární ektázie vzniká na podkladě nadměrné expanzivní remodelace v důsledku enzymatické degradace extracelulární matrix a ztenčování medie tepen. U pacientů s CAE bez významného zúžení koronárních tepen lze při vyšetření zjistit anginu pectoris, pozitivní výsledek zátěžového testu nebo akutní koronární syndromy. Při ektázii může v tepnách docházet k tvorbě trombů s následnou distální embolizací, vasospasmy nebo jejich rupturou. Prognóza CAE přímo závisí na závažnosti již přítomné ischemické choroby srdeční. Základem léčby jsou protidestičkové léky; mezi další formy léčby CAE patří prevence tromboembolických komplikací a perkutánní nebo chirurgická revaskularizace.

No abstract

We aimed to examine whether intracoronary high-dose bolus of tirofiban plus maintenance would result in improved clinical outcome in STEMI patients undergoing primary PCI in this pilot trial. A total of 56 patients were enrolled to receive either intracoronary high-dose bolus plus maintenance (n = 34) or intravenous high-dose bolus plus maintenance (n = 22) of tirofiban. Pre and post intervention TIMI flow grades, myocardial blush grades, peak CKMB and troponin levels, time to peak CKMB and troponin, time to 50% ST resolution and major composite adverse cardiac event rates at 30 days were recorded. Although incidence of major adverse cardiac events was not different, post intervention TIMI flow and TIMI blush grades, peak CKMB and troponin levels, and time to peak CKMB and time to peak troponin were significantly different, favoring intracoronary strategy. In conclusion, this regimen improved myocardial reperfusion and coronary flow, and reduced myocardial necrosis, but failed to improve clinical outcomes at 30 days.