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Öğe Dobutamine induced dynamic left ventricular outflow tract obstruction in patients with hypertrophic nonobstructive cardiomyopathy(Tohoku Univ Medical Press, 2002) Bolca, O; Özer, N; Eren, M; Dagdeviren, B; Norgaz, T; Akdemir, O; Tezel, TSome patients with hypertrophic nonobstructive cardiomyopathy (HNCM) suffer symptoms resembling those in obstructive type despite no left ventricular outflow tract (LVOT) gradient could be detected on resting echocardiography. To investigate the value of dobutamine stress echocardiography (DSE) in determining the dynamic left ventricular (LV) obstruction of patients with HNCM. The study was conducted on 31 patients who were diagnosed HNCM on resting echocardiography and 9 healthy person as a control group. Intraventricular flow acceleration of > 3 m/sec on DSE was accepted as dynamic LVOT obstruction. Group I and 2 included patients without and with dynamic LVOT obstruction, respectively. The occurrence of chest pain and dyspnea seen during DSE was more frequent in group 2 than group 1 and control group. The frequency of SAM was significantly higher (p < 0.05) and the septal angle was significantly lower (p < 0.001) in Group 2. The presence of SAM significantly correlated with the peak gradient (r = 0.61, p < 0.001). The septal angle had significant negative correlations with the peak gradient (r = .-0.77, p < 0.001) reached at DSE. The relative risk for peak gradient was highest when septal angle was less than or equal to 100degrees, with a sensitivity of 93%, specificity of 80%, positive predictive value of 82%, negative predictive value of 92%, and predictive accuracy of 87%. DSE is a reliable tool for the diagnosis of dynamic LV obstruction in patients with HNCM. The presence of SAM together with a low septal angle is highly predictive for the presence of a dynamic LVOT obstruction detected by DSE. (C) 2002 Tohoku University Medical Press.Öğe Echocardiographic prediction of long-term response to biventricular pacemaker in severe heart failure(Elsevier Science Bv, 2002) Oguz, E; Dagdeviren, B; Bilsel, T; Akdemir, O; Erdinler, I; Akyol, A; Ulufer, TBackground: Biventricular pacing substantially improves LV systolic function and symptom status in some patients with dilated cardiomyopathy. Aims: To assess whether the long-term benefit could be predicted from the echocardiographic parameters. Methods and Results: Sixteen patients with dilated cardiomyopathy who underwent atrio-biventricular pacemaker implantation were analyzed in two groups: the responders (n = 11) were those with a symptomatic improvement of one or more NYHA functional class; the non-responders (n = 5) failed to improve at follow-up (7.6 +/- 5 months). Echocardiography was performed at baseline, the day after the implantation and then every 3 months. Besides the conventional parameters, the following variables were included: LV diastolic filling time (DFT); the duration of mitral regurgitation (dMR); and LV dP/dt obtained from the continuous wave mitral regurgitation curve. While the baseline DFT and dP/dt were not significantly different between non-responders and responders (256 +/- 105 vs. 358 +/- 115, P = 0.14 and 564 +/- 199 vs. 468 +/- 117, P = 0.44, respectively), the QRS width (149 +/- 15 vs. 175 +/- 24 ms, P = 0.05) and the dMR (343 +/- 70 vs. 443 +/- 49 ms, P = 0.007) were higher in the responders. The changes of dMR, DFT and QRS width by pacing were not significantly different between groups (P = 0.18, 0.30 and 0.77, respectively). However, the change of LV dP/dt by pacing in the responders was significantly different than for non-responders (from 468 +/- 117 to 676 +/- 216 mmHg/s vs. from 564 +/- 199 to 483 +/- 94, P = 0.002). An acute increase in LV dP/dt over 22% by pacing yielded only two false negatives and no false positives in predicting the long-term responsiveness. Conclusion: Patients with longer QRS and dMR are more likely to benefit from atrio-biventricular stimulation. The acute changes of Doppler derived LV dP/dt may provide valuable information in predicting the long-term response to biventricular pacing. (C) 2002 European Society of Cardiology. All rights reserved.Öğe Left atrial maximum volume is a recurrence predictor in lone-atrial fibrillation - An acoustic quantification study(Japan Heart Journal, Second Dept Of Internal Med, 2002) Bolca, O; Akdemir, O; Eren, M; Dagdeviren, B; Yildirim, A; Tezel, TPredictors of recurrence in lone atrial fibrillation have not been clearly identified. Acoustic quantification (AQ) is a promising method in the assessment of left atrial (LA) volumes. The purpose of the present study was to investigate the potential of LA volumes obtained by standard manual tracing and AQ methods in predicting AF-recurrence after restoring the sinus rhythm in patients with lone AF, and to test the agreement between the two approaches. Standard echocardiography combined with AQ was performed in 28 patients with lone AF one hour after the sinus rhythm was regained, and in 10 controls. LA volumes were determined by conventional manual tracing and AQ methods. AQ waveforms of LA were obtained by drawing a region of interest around the LA border. The agreement of the two methods was tested by Bland-Altman analysis. Patients were followed up for 6 months for the occurrence of AF recurrence. A good correlation was observed between AQ and manual tracing methods in determining both minimal (r = 0.59) and maximal (r = 0.88) LA volumes. Patients with AF recurrence had a significantly larger maximum LA volume as assessed with both methods (P < 0.05 for both). M-mode derived LA dimension and isovolumic relaxation time were additional predictors of recurrence in patients with lone AF. In lone AF, patients prone to recurrence could be predicted by determining LA maximum volume assessed either by AQ or manual tracing methods. AQ provides on-line, accurate estimation of LA volumes.Öğe Myocardial texture analysis in idiopathic dilated cardiomyopathy(Mosby, Inc, 2002) Dagdeviren, B; Akdemir, O; Bolca, O; Eren, M; Gürlertop, Y; Tezel, TConventional resting echocardiography is not able to predict contractile reserve (CR) of patients with idiopathic dilated cardiomyopathy. The aim of this study was to investigate whether the videodensito-metric myocardial texture analysis could predict the CR of these patients. Myocardial texture analysis was performed on echocardiographic digitized images of 27 patients with IDC through a calibrated 256 gray level digitization system. Cyclic variation (CV) index of myocardial mean gray level (MGL) was calculated according to the formula: (MGL(diast) - MGL(syst))/ MGL(diast) x 100. CR was defined as the %-change of ejection fraction by 10 mug/kg per minute dobutamine infusion. A clinical follow-up was also performed for all patients for an average of 8 3 months. CR ranged from. -1.8% to 50.3%. CV index of both septum and posterior wall (PW) was the single parameter significantly correlated to CR (r = 0.69 and r = 0.77, respectively, P <.0001 for both). The mean resting CV index of septum and PW were significantly lower in patients with CR less than 17%--median value of all subjects-(5.7 +/- 5.6 vs 16.9 +/- 7.9 and 5.4 +/- 5.9 vs 16.1 +/- 6.4, respectively, P <.0001 for both). A CV index of 10% for both septum and PW yielded a sensitivity of 77% and 84%, and a specificity of 84% and 84% for predicting diminished CR, respectively. The event-free survival rate was significantly lower in patients with CR less than 17% (61.5% vs 92.8%, P <.05). The CV index of both septum and PW were also significantly lower in patients with cardiac events (13.6 +/- 8 vs 4.3 +/- 6, P <.05 and 14.7 +/- 7 vs 4.1 +/- 7, P <.01, respectively). Ultrasonic myocardial texture analysis in idiopathic dilated cardiomyopathy has a high ability to discriminate the patients with and without preserved CR, and patients with unfavorable outcome as well.Öğe Prediction of infarct-related coronary artery of patients with acute inferior myocardial infarction by a predischarge exercise test index(Westminster Publ Inc, 2004) Bolca, O; Eren, M; Akdemir, O; Yildirim, A; Dagdeviren, B; Tezel, TThe predictive accuracy of electrocardiographic markers in identifying the infarct-related artery of myocardial infarctions has been a subject of extensive investigation. The present study was designed to test whether the index L II/L III ratio adapted to exercise electrocardiograms could be utilized as a marker to distinguish right coronary and left circumflex arteries as culprit coronaries in acute inferior myocardial infarctions. For this purpose, 82 patients with a positive-symptom-limited and/or submaximal treadmill exercise test with modified Bruce protocol after an acute inferior myocardial infarction were studied. Those patients with ST segment elevation during the stress test were included in the study. ST segment index was defined as the ratio of exercise-induced ST elevation amplitude in L II/L III. Patients were classified as having an index > 1 (n = 24) and < 1 (n = 58), and the findings were compared with the findings on coronary angiography. The groups were comparable with respect to age, gender, peak exercise level, and double products achieved. Circumflex artery was the infarct-related one in the majority (21/24; 88%) of patients with an index > 1, whereas most (51/58; 88%) patients with an index < 1 had the culprit lesion in their right coronary artery (p < 0.001). The ratio of exercise-induced ST elevations in leads L II and L III has a significantly high ability to discriminate the infarct-related coronary artery in patients with uncomplicated inferior myocardial infarction. Considering the prognostic importance of the type of coronary involvement, this index could be a part of predischarge evaluation in this patient group.Öğe Prognostic implication of myocardial texture analysis in idiopathic dilated cardiomyopathy(Elsevier Science Bv, 2002) Dagdeviren, B; Akdemir, O; Eren, M; Bolca, O; Oguz, E; Gürlertop, Y; Tezel, TBackground and aim: Abnormal myocardial acoustic properties have been reported in patients with idiopathic dilated cardiomyopathy (IDC). The aim of this study was to investigate the relationship between quantitative ultrasonic textural alterations of myocardium and clinical outcome in IDC. Methods: Baseline clinical and echocardiographic variables were obtained from 28 patients with IDC. By using a videodensitometric approach, quantitative myocardial texture analysis was performed on images obtained from septum and posterior wall (PW). Cyclic variation (CV) index of mean gray level (MGL) was calculated according to the formula: (MGLdiast - MGLsyst)/MGLdiast x 100. All patients were followed for an average of 11 5 months for the occurrence of cardiac death or repeated hospitalization due to worsening of heart failure. Results: During follow-up, 10 patients experienced cardiac events (6 cardiac deaths and 4 heart failure events). The CV indexes of both septum and PW were significantly lower in patients with cardiac events than those of event free patients (6.8 +/- 9.6% vs. 13.6 +/- 8.2%, P < 0.05 and 5.3 +/- 6.4% vs.15.7 +/- 7.2% P < 0.001, respectively). Univariate analysis defined the following variables as predictors of outcome: PW-CV index (chi(2) = 13.0, P = 0.0003), transmitral E/A ratio (chi(2) = 12.5, P = 0.0004), symptom status (chi(2) = 8.7, P = 0.003), and septum-CV index (chi(2) = 4.7, P = 0.03). Multivariate stepwise regression analysis showed that the PW-CV index (chi(2) = 7.5, P = 0.006) and E/A ratio (chi(2) = 6.5, P = 0.01) were the independent predictors of outcome. The event-free survival rate of patients with PW-CV index < 11% was significantly lower than those with an index greater than or equal to 11 (35.7% vs. 92.8%, P = 0,001). Conclusion: The assessment of severely depressed CV index provides valuable prognostic information in patients with IDC. (C) 2002 European Society of Cardiology. All rights reserved.Öğe Right ventricular function in patients with acute anterior myocardial infarction(Acta Cardiologica, 2002) Akdemir, O; Yildiz, M; Sürücü, H; Dagdeviren, B; Erdogan, O; Ozbay, GObjective - Our purpose was to investigate the right ventricular (RV) performance of patients with a first acute anterior myocardial infarction (AAMI) by using pulsed wave Doppler tissue (PWDT) samplings of tricuspid annulus and RV free wall. Methods and results - The study group included 31 patients with AAMI and 20 age-matched controls. Conventional indexes of RV functions were the magnitude of tricuspid annular plane systolic excursion (TAPSE), and the transpulmonary and transtricuspid Doppler parameters. PWDT velocities were obtained by placing the sample volume at the lateral tricuspid annulus and the mid-segment of RV free wall; the peak systolic (S), early (E) and late (A) diastolic PWDT velocities and time intervals from ECG-Q wave to their peaks were analysed. Standard indexes were comparable except TAPSE that was significantly lower in AAMI-patients (p < 0.001). S velocities were similar; A of both regions (p = 0.0 18 and 0.0 12) and E of RV free wall (p = 0.0 11) were significantly increased in AAMI-group. Q-Sa intervals in both regions (p = 0.007 and 0.0 IS) and Q-Ea of tricuspid annulus (p = 0.045) were significantly shorter in patients with AAMI. TAPSE and E of RV free wall had significant negative correlations with left ventricular systolic volume index and right atrial filling fraction (AFF), respectively (r -0.46, p = 0.0 1 for both). A of tricuspid annulus had a positive correlation with left AFF (r = 0.42, p 0.02). Conclusion - PWDT imaging of tricuspid annulus and RV free wall is capable to sensitively detect the adaptive mechanisms and unfavourable diastolic properties of RV dynamics in patients with AAMI.Öğe Specific tissue Doppler predictors of preserved systolic and diastolic left ventricular function after an acute anterior myocardial infarction(Japan Heart Journal, Second Dept Of Internal Med, 2003) Akdemir, O; Dagdeviren, B; Yildiz, M; Gül, Ç; Sürücü, H; Özbay, GThe degree of left ventricular (LV) dysfunction determines the outcome of patients suffering an acute anterior myocardial infarction (AAMI). Many recent studies have utilized tissue Doppler echocardiography (TDE) parameters in the assessment of LV function. We sought to investigate whether some variables easily obtained from TDE profiles of mitral annulus corners would predict a relatively preserved LV global function traditionally assessed with ejection fraction (EF) and deceleration time (DT), within the acute phase of AAMI Included were 50 consecutive patients with a first AAMI. Standard echocardiography and TDE of mitral annulus were performed within 36 hours of admission Pulsed wave sample volumes were set at the septal, lateral, anterior, and inferior corners of the mitral annulus. Preserved LV function was defined as an EF > 40% together with a DT greater than or equal to 140 ms and < 220 ms. An inferior annular systolic velocity of > 7.5 cm/s predicts preserved global left ventricular function with a sensitivity of 81% and specificity of 71%. An anterior mitral annular early diastolic velocity of > 8cm/s had a sensitivity of 69% and specificity of 85%. When these two velocities both exceed the limits above, such a combined index yielded a sensitivity of 69%, specificity of 94%, and an overall diagnostic accuracy of 86% for the estimation of preserved LV global function. The parameters derived from TDE profiles of inferior and anterior mitral annulus corners provide valuable information to predict preserved global left ventricular function during the early period of AAMI.Öğe Specific tissue Doppler predictors of preserved systolic and diastolic left ventricular function after an acute anterior myocardial infarction [Meeting Abstract](W B Saunders Co Ltd, 2002) Akdemir, O; Dagdeviren, B; Yildiz, M; Gul, C; Surucu, H; Ozbay, G[Abstract Not Available]
