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    Clinical Significance of Positive Isovolumetric Relaxation Velocity of Pulsed-Wave Tissue Doppler Imaging
    (Wiley, 2009) Sueruecue, Hueseyin; Tatli, Ersan; Degirmenci, Ali; Okudan, Selnur; Aktoz, Meryem; Boz, Hakki
    Objective: Among the pulsed-wave tissue Doppler imaging (pw-TDI) parameters, there are two different pw-TDI velocities (IVRa and IVRb) after systolic velocity, but before Ea velocity. In our study, we investigated the clinical importance of these two velocities in left ventricular diastolic dysfunction (LVDDF) evaluation. Methods: One hundred and eighty cases without exclusion criteria were included in the study. Cases with a transmitral E to A flow (E/A) ratio below 1 were assigned to group 2. In cases with an E/A ratio between 1 and 2, the pw-TDI parameters were taken into consideration. Cases with an Ea/Aa ratio above 1 were assigned to group 1 and cases with an Ea/Aa ratio 1 or below than 1 were assigned to group 3. Group 1 (n: 68) represented normal diastolic left ventricular (LV) inflow while group 2 (n = 87) represented impaired relaxation and group 3 (n = 25) represented pseudonormal LV inflow. Results: In our study, we found that IVRa velocity was lower in group 1 compared to group 2 and group 3 (P < 0.001 and P = 0.038, respectively). Similarly, this velocity was significantly different in group 3 and group 2 such as it was higher in group 2 compared to group 3 (P = 0.022). There was no difference in IVRb velocity and IVRa/IVRb ratio among the groups. A negative correlation was found between IVRa velocity and Ea velocity (r = 44%, P < 0.001). Positive correlation was found between IVRa velocity and isovolumetric relaxation time (r = 18%, P = 0.014) and also between IVRa velocity and Aa velocity (r = 19%; P = 0.010). Conclusion: Based on the results of our study, we concluded that IVRa velocity is an important pw-TDI parameter in the evaluation of LVDDF, especially in differentiating pseudonormal LVDDF type from normal LV inflow. (ECHOCARDIOGRAPHY, Volume 26, January 2009).
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    Evaluation of Subendocardial and Subepicardial Left Ventricular Functions Using Tissue Doppler Imaging after Complete Revascularization
    (Wiley, 2009) Sueruecue, Hueseyin; Tatli, Ersan; Okudan, Selnur; Aktoz, Meryem
    Objective: We aim to evaluate subepicardial and subendocardial left ventricular (LV) functions in patient single coronary artery lesion at early stage after percutaneous coronary intervention (PCI). Additionally, a comparison of LV functions between patients and control cases was aimed. Method: Patients with culprit left anterior descending (LAD) lesion (n = 25) and subjects with normal coronary angiography (n = 25) were evaluated. Patients underwent PCI and at least one coronary stent was placed. After PCI, the pulsed-wave tissue Doppler imaging (pw-TDI) parameters taken from subepicardial and subepicardial layers were compared among the patients. Results: Left atrium (P = 0.050), LV end-diastolic (P = 0.049), and end-systolic (P = 0.006) diameters were larger compared to the control group. LV inflow velocities were not different between the patient and the control group. But, the myocardial performance index was different (P = 0.049). The systolic and diastolic pw-TDI parameters were apparently different between the patient and the control group. While the systolic pw-TDI parameters did not change, the diastolic pw-TDI parameters taken from both subepicardial (circumferential contraction) and subendocardial layers (longitudinal contraction) improved after PCI. After PCI, it was shown that while Ea velocity (P = 0.012) taken from the subendocardial layer increased, IVRa velocity (P < 0.001) taken from the subepicardial layer decreased. Conclusion: In our study, it could be said that LV, left atrium, and aortic valve diameter increase in patients with coronary artery disease. The systolic and diastolic functions were impaired at subendocardial and subepicardial layers. These dysfunctions can be easily presented with pw-TDI. Although systolic dysfunction persists, diastolic dysfunction improves at early stage after PCI. (ECHOCARDIOGRAPHY, Volume 26, February 2009).
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    A New Parameter of Pulsed-Wave Tissue Doppler Imaging: IVRa
    (Wiley, 2008) Sueruecue, Hueseyin; Tath, Ersan; Degirmenci, Ali; Okudan, Selnur; Aktoz, Meryem; Boz, Hakki
    Objective: We investigated how velocity of isovolumetric relaxation period on pulsed-wave tissue Doppler trace (IVRa and IVRb) is affected by the left ventricular (LV) geometry changes. Methods: Two hundred cases without exclusion criteria were included in the study. Normal LV mass index (LVMI) and normal relative wall thickness (RWT) was assigned to group 1 (n = 72). Concentric remodeling (normal LVMI and increased RWT) was defined to group 2 (n = 25). Eccentric LV hypertrophy (LVH) (increased LVMI and normal RWT) was defined to group 3 (n = 62). And finally, concentric LVH (increased LVMI and increased RWT) was defined to group 4 (n = 41). Results: Patients with LVH (groups 3 and 4) were older than group 1 (P = 0.017 and 0.001). It was observed in the assessment of M-mode ECHO parameters that the aortic valve diameter, aortic valve opening, LV end-systolic diameter (LVESD), LV end-diastolic diameter (LVEDD), and left atrium (LA) were higher in cases with eccentric LVH. It was shown that Ea velocity and Sa velocity time integral (Sa-VTI) were decreased with LV geometry change. However, IVRa velocity and E/Ea were increased as LV geometry change. A positive correlation between IVRa velocity and LVMI (correlation ratio = 34%, P = 0.000) was found. Similarly, a positive correlation between IVRa velocity and RWT (correlation ratio = 17%, P = 0.025) was found. Conclusion: IVRa velocity exhibits a positive correlation with LV geometry changes indicating that IVRa velocity is affected by LV geometry like the other parameters influenced by LV geometry. (ECHOCARDIOGRAPHY, Volume 25, November 2008)
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    Response to Letter Regarding, A New Parameter of Pulsed-Wave Tissue Doppler Imaging: IVRa
    (Wiley-Blackwell Publishing, Inc, 2009) Sueruecue, Hueseyin; Tatli, Ersan; Degirmenci, Ali; Okudan, Selnur; Aktoz, Meryem; Boz, Hakki
    [Abstract Not Available]
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    Subtle Systolic Dysfunction May Be Associated with the Tendency to Develop Diastolic Heart Failure in Patients with Preserved Left Ventricular Ejection Fraction
    (Wiley, 2009) Sueruecue, Hueseyin; Tath, Ersan; Degirmenci, Ali; Okudan, Selnur; Boz, Hakki
    Background: We looked for an answer to the question of whether diastolic heart failure (DHF) is a reality or all heart failures are systolic. Method: 300 cases (hypertensive, aged, obese, etc.), not being diagnosed DHF, with preserved left ventricular (LV) ejection fraction (EF) but having the tendency to develop DHF in future were examined. One hundred and eighty cases without exclusion criteria were selected. Cases were assigned to three groups according to noninvasively obtained pulmonary capillary wedge pressure (PCWP). Results: In cases with higher PCWP (> 10 mmHg), transmitral A velocity was increased (P < 0.001) and among the pulsed wave tissue Doppler imaging (pw-TDI) parameters Ea velocity was decreased (P < 0.001) and Ea-dt was prolonged (P < 0.005). In cases with lower PCWP (< 8 mmHg), transmitral E velocity was higher (P < 0.001). Furthermore, a more meaningful relationship was found between PCWP and systolic pw-TDI parameters. In all the groups, it was observed that Sa velocity was progressively decreased and Q-Sa interval was progressively prolonged as PCWP increased (for all the groups P < 0.046). Conclusion: The question whether DHF is a reality or all heart failures are systolic may be answered as follows. Subtle systolic dysfunction may be associated with the tendency to develop DHF in patients with preserved LV ejection fraction. As in systolic heart failure (EF < 45%), in patients with preserved systolic function (EF >= 45%), systolic and diastolic functions may impair together. The pw-TDI method may be more sensitive than standard echocardiography parameters in detection of systolic dysfunction in cases with preserved EF. (ECHOCARDIOGRAPHY, Volume 26, April 2009).