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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 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.
