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    Assessment of left atrial dysfunction in obstructive sleep apnea patients with the two dimensional speckle-tracking echocardiography
    (2012) Altekin R.E.; Yanikoglu A.; Karakas M.S.; Ozel D.; Kucuk M.; Yilmaz H.; Demir I.
    Background The aim of this study was to compare left atrial (LA) longutidinal myocardial function in obstructive sleep apnea (OSA) patients with healthy individuals using two-dimensional speckle-tracking echocardiography method (2D-STE). Method Twenty one healthy individuals and 58 OSA patients were included. According to the AHI (apnea hypopnea index) patients were examined in mild, moderate and severe OSA groups. Images of the LA were acquired from the apical two- and four-chamber views. LA strain (LAS) and strain rate(LASR) parameters [systolic (S), early diastolic (E), late diastolic (A) during atrial contraction] were assessed. Results LA S-S, LASR-S, LAS-E and LASR-E values decreased with severity of OSA. Severe OSA patients have lower LAS-S and LASR-S values (p < 0.03).While a difference in the LA SR-E value between groups was significant beginning with the moderate OSA group (p < 0.03), no LAS-E value differences were observed between moderate and mild OSA groups (p > 0.03). LAS-A and LA SR-A values were increasing with the disease severity up to moderate OSA. LAS-A and LASR-A values of moderate OSA were greater than the mild OSA patients and healthy individuals (p < 0.03). Thesewere lower in severe OSA than the moderate OSA (p < 0.03), however, theywere greater than the healthy individuals (p < 0.03). The AHI was found to be negatively correlated with the LAS-S, LASR-S LA S-E, LASR-E, whereas AHI was not correlated with the LAS-A, LASR-A values. Conclusion LA remodeling and dysfunction that accompany OSA can be detected in the subclinical stage with a detailed evaluation of active and passive functions of the LA using the 2D-STE method. © Springer-Verlag 2012.
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    Evaluation of left atrial function using two-dimensional speckle tracking echocardiography in end-stage renal disease patients with preserved left ventricular ejection fraction
    (Via Medica, 2013) Altekin R.E.; Yanikoglu A.; Karakas M.S.; Ozel D.; Yilmaz H.; Demir I.
    Background: Left atrial (LA) deformation analysis by two-dimensional speckle tracking echocardiography (2D-STE) has recently been proposed as an alternative approach for estimating left ventricular (LV) filling pressure and dysfunction. Aim: To assess the LA myocardial function using 2D-STE in end-stage renal disease (ESRD) patients with preserved LV ejection fraction (PLVEF) and to evaluate the relationship of the obtained results with echocardiographically estimated pulmonary capillary wedge pressure (ePCWP). Methods: Eighty-five ESRD patients and 60 healthy individuals were enrolled in the study. Images of the LA were acquired from apical two- and four-chamber views. The LA volumes (LAV) were calculated using the biplane area-length method. The LA volume indices (LAVI) were calculated by dividing the LA volumes by the body surface area. The LA strain (%) (LAS) parameters (systolic [LAS-S], early diastolic [LAS-E], late diastolic [LAS-A] during atrial contraction) were assessed, and the ePCWP was calculated according to the following formula: ePCWP = 1.25(E/E') + 1.9. LA stiffness was calculated non-invasively and based on the ratio of E/E' to LAS-S. Results: In patients with ESRD, the LAS-S (32.22 ± 7.64% vs. 57.93 ± 8.71%; p < 0.001), LAS-E (-15.86 ± 5.7% vs. -33.37 ± 7.71%; p < 0.001), and the LAS-A (-15.41 ± 4.16% vs. -24.57 ± 4.68%; p < 0.001) values were observed to be lower than the healthy group; while the LA stiffness (0.4 ± 0.19 vs. 0.17 ± 0.05; p < 0.001) value was higher. When the patients with ESRD were divided into two groups as those with a maximum LAVI value over 31.34 mL/m2 and those with a maximum LAVI below this value, the LAS-S (30.36 ± 8.32% vs. 34.11 ± 6.43%; p = 0.023) and the LAS-E (-14.97 ± 5.88% vs. -16.76 ± 5.42%; p = 0.039) values were lower in the group with a LAVI value over 31.34 mL/m2; while the LA S-A (-16.06 ± 4.44% vs. -14.75 ± 3.8%; p < 0.001) and LA stiffness (0.4 ± 0.19 vs. 0.17 ± 0.05; p < 0.001) values were higher. An association was observed between the ePCWP and LAS-S (p < 0.001), LAS-E (p = 0.01), LAS-A (p < 0.001), and LA stiffness (p < 0.001) values. Conclusions: The results of our study have demonstrated that LA myocardial function assessed using the 2D-STE method is associated with the ePCWP, which is an echocardiographically calculated marker of LV dysfunction. The LA deformation parameters may be used as echocardiographic findings to predict the LV dysfunction in ESRD patients with PLVEF. Further studies are needed to determine the independent prognostic power of the atrial strain measurement as a predictor of future cardiovascular events in ESRD patients. Copyright © Polskie Towarzystwo Kardiologiczne.
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    Evaluation of subclinical left ventricular systolic dysfunction using two-dimensional speckle- tracking echocardiography in patients with non- alcoholic cirrhosis
    (Hellenic Cardiological Society, 2014) Altekin R.E.; Caglar B.; Karakas M.S.; Ozel D.; Deger N.; Demir I.
    Introduction: Cirrhosis is associated with certain abnormalities in left ventricular (LV) structure and function. Two-dimensional speckle-tracking echocardiography (2D-STE) enables a rapid and accurate analysis of regional LV systolic mechanics in the longitudinal, radial and circumferential directions. The aim of this study was to precisely assess the differences among the 3 directions in the early impairment of LV myocardial contraction in non-alcoholic cirrhotic patients with preserved LV pump function.Method: A total of 75 subjects, including 38 cirrhotic patients and 37 healthy individuals, were enrolled. Using 2D-STE, the strain (S) and systolic strain rate (SRS) values belonging to the radial (R), circumferential (C), and longitudinal (L) functions of the LV were measured.Results: In the cirrhotic group, the LS(20.57 ± 2.1 vs. 28.7 ± 43.1, p<0.001) and LSR-S(1.1 ± 0.24 vs. 1.6 ± 0.3) values were found to be lower, whereas the CS(24.82 ± 2.57 vs. 19.16 ± 4.58, p<0.001) and C SRS(1.41 ± 0.3 vs. 1.2 ± 0.4, p±0.004) values were found to be higher than in the healthy control group. The RSand RSR-Svalues did not differ among the groups. A relationship was observed between the MELD score, which shows the severity of the disease, and the CS value (â: 0.211, p<0.01, 95%CI: 0.086-0.503).Conclusion: LV myocardial contraction was impaired in the longitudinal direction. However, LV pump function was augmented by the circumferential shortening during the ventricular systole. Using the 2D-STE method for the regional evaluation of the LV, the LV damage can be detected in the subclinical phase in cirrhotic patients. © 2014, Hellenic Cardiological Society. All rights reserved.