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    The Association between Left Ventricular Diastolic Dysfunction and Increased Aortic Stiffness Can Be Explained by Possible Neurohumoral Mechanisms
    (Wiley-Blackwell Publishing, Inc, 2010) Surucu, Huseyin; Tatli, Ersan; Boz, Hakki; Meric, Mehmet
    Objective: In our study, we tried to find an answer to the question How could the association between left ventricular diastolic dysfunction (LVDDF) and increased aortic stiffness (IAS) be explained? Methods: Cases without coronary artery disease (CAD) were divided into three groups according to their left ventricular (LV) inflow patterns and their LV basal-lateral annulus pulsed-wave tissue Doppler imaging (pw-TDI). Group 1 (n = 38) represented the normal LV inflow pattern while Group 2 (n = 54) represented impaired LV relaxation and Group 3 (n = 18) represented pseudonormalization. Aortic diameters were measured by using M-mode at a level that is 3 cm above the aortic valve. Aortic strain (AS) and aortic distensibility (AD) were calculated by using aortic diameters and pulse pressure. Results: In Group 3, AS was lower compared to Groups 1 and 2 (respectively P < 0.001, P = 0.040). AS was also lower in Group 2 compared to Group 1 (P = 0.012). AD was higher in Group 1 compared to Groups 2 and 3 (respectively P = 0.01, P < 0.001). Early diastolic velocity of aortic pw-TDI was higher in normal LV inflow compared to Groups 2 and 3 (respectively P = 0.022, P = 0.050). Unfortunately, none of echocardiographic parameters that evaluate LV and aortic functions together (stroke volume, pulse pressure/stroke volume, pulse pressure/stroke volume index) were different among the groups. Conclusion: The results of our study clearly showed the association between LVDDF and IAS in cases without CAD. Additionally, it was concluded that this togetherness could be explained not by hemodynamic factors but by possible neurohumeral mechanisms. (Echocardiography 2010;27:275-281).
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    Evaluation of Left Ventricular Circumferential Contraction Functions in Obese Patients
    (Wiley-Blackwell, 2010) Surucu, Huseyin; Tatli, Ersan; Boz, Hakki; Meric, Mehmet
    Background: We aim to evaluate left ventricular (LV) function abnormalities, especially circumferential contraction functions, in obese patients. Method: Cases without coronary artery disease (CAD) were divided into two groups according to their body mass indexes (BMI). Results: Female predominance (P = 0.002), systolic blood pressure (BP) (P = 0.001), diastolic BP (P = 0.001), waist circumference (P < 0.001), left atrium (P < 0.001), LV end-diastolic diameter (P = 0.046), LV mass index (P = 0.001), and LV stroke volume (P = 0.016) were prominent in obese patients (BMI >= 27). In obese patients, transmitral late velocity (P = 0.005) was prominent, and pulmonary vein antegrade diastolic velocity (PV-D) (P = 0.002) and mitral annular early diastolic pulsed-wave tissue Doppler imaging (pw-TDI) velocity (annular Ea) (P = 0.032) were lower. Transmitral late velocity was positively correlate with stroke volume (P = 0.029) and systolic BP (P < 0.001). Negatively correlation between PV-D and diastolic BP (P = 0.046) was found. And also, annular Ea velocity was negatively correlate with systolic BP (P = 0.017) and diastolic BP (P = 0.031). These findings may reflect LV longitudinal contraction abnormalities (LVLCA) and underlying mechanism that is responsible for LVLCA, may be volume and afterload alterations. However, LV circumferential contraction functions that evaluate by using pw-TDI, were not different among the groups. Conclusion: In obese patients without CAD, it was clearly said that while LVLCA were evident, LV circumferential contraction abnormalities were not. This differentiation may be explained by subepicardial myocardial fiber that is responsible for LV circumferential contractions is supplied by coronary arteries, subendocardial myocardial fiber that is responsible for LV longitudinal contractions, is supplied by systemic circulation via LV cavity penetration. (ECHOCARDIOGRAPHY 2010;27:378-383).