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    Assessment of myocardial performance index and its association with aortic elasticity in patients with ascending aortic aneurysm
    (Turkish Soc Cardiology, 2016) Baykan, Ahmet Oytun; Gur, Mustafa; Kalkan, Gulhan Yuksel; Acele, Armagan; Seker, Taner; Sen, Omer; Borekci, Abdurrezzak
    Objective: Ascending aortic aneurysms (AAA) are a leading cause of morbidity and mortality. Nevertheless, their effects on global cardiac functions are yet to be fully understood. Myocardial performance index (MPI) has been widely used to quantitatively assess myocardial functions. The aim of this study was to evaluate left ventricular (LV) functions in patients with AAA using tissue Doppler (TD) echocardiography and MPI in addition to conventional echocardiographic methods. Methods: Fifty patients with AAA (33 men, 17 woman; mean age 55.5+/-7.90 years) were included, and 106 patients without aortic dilatation (mean age 54.1+/-8.18 years) were included as the control group. LV systolic and diastolic functions were analyzed using 2-dimensional, M-mode, and TD echocardiography. Results: Patients with AAA had significantly higher MPI (0.5+/-0.04 vs 0.4+/-0.05, p<0.001), TD-MPI (0.5+/-0.02 vs 0.4+/-0.03, p<0.001), and reduced aortic elasticity, as indicated by reduced aortic distensibility (AD) (1.7+/-1.27 vs 3.1+/-1.25, p<0.001). Multivariate linear regression analysis showed that TD-MPI was independently correlated with reduced aortic distensibility (B=-0.006, p=0.019, 95% confidence interval,-0.011 to -0.001). Conclusion: MPI and TD-MPI indicated impairment of global cardiac functions in patients with AAA, which may be attributed to reduced aortic elasticity.
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    Both Systemic and Pulmonary Artery Stiffness Predict Ventricular Functional Recovery after Successful Percutaneous Closure of Atrial Septal Defects in Adults
    (Tech Science Press, 2016) Baykan, Ahmet Oytun; Gur, Mustafa; Acele, Armagan; Seker, Taner; Kalkan, Gulhan Yuksel; Sahin, Durmus Yildiray; Koc, Mevlut
    BackgroundPercutaneous closure of atrial septal defect (ASD) has become the preferred method in treatment of the majority of cases. The aim of this study was to evaluate the echocardiographic effects of percutaneous closure of secundum ASD in adults and assess which parameters predict good response to closure. DesignWe prospectively included 42 patients with secundum ASD treated successfully with percutaneous device closure. All patients underwent transthoracic echocardiography examination with tissue Doppler imaging before, 24 hours after and within 3 months of intervention. Measurements of arterial stiffness were carried out using a Mobil-O-Graph arteriography system. ResultsRemodeling of heart chambers occurred immediately and persisted at 3 months after ASD closure. Significant decreases were observed in right ventricle (RV) end-diastolic diameter, right atrium volume index, and tricuspid annular plane systolic excursion both after the procedure and at 3 months (P<.01 for all). The RV and left ventricle (LV) tissue Doppler-myocardial performance index demonstrated to decline during follow up (P=.0001). Significant correlations were found between pulse-wave velocity, augmentation index, pulmonary artery stiffness, and LV-RV tissue Doppler-myocardial performance index at third month. Linear regression analyses showed that pulse-wave velocity is the most effective parameter of LV and pulmonary artery stiffness is the most effective parameter of RV functional recovery, respectively, assessed by tissue Doppler-myocardial performance index. ConclusionsPercutaneous closure of secundum ASD in adults has various sustained benefits on multiple echocardiographic parameters within 3 months. The changes in RV and LV function after device closure were significantly correlated with the degree of pulmonary artery stiffness and pulse-wave velocity, respectively.
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    Coronary Flow Velocity Reserve in Donor Artery and Myocardial Performance Index After Successful Recanalization of Chronic Total Coronary Occlusions
    (H M P Communications, 2015) Baykan, Ahmet Oytun; Kalkan, Gulhan Yuksel; Sahin, Durmus Yildiray; Elbasan, Zafer; Gur, Mustafa; Seker, Taner; Turkoglu, Caner
    Background. Percutaneous recanalization of chronic total coronary occlusion (CTO) tends to show a positive effect on left ventricular remodeling and ejection fraction (LVEF). Coronary flow velocity reserve (CFVR) is an important diagnostic index of the functional capacity of coronary arteries. The aim of this study was to evaluate, by non-invasive CFVR, whether the blood flow of donor artery reverts to normal after CTO percutaneous coronary intervention (PCI). Also, we assessed the effects of CTO recanalization on global cardiac functions by using myocardial performance index (MPI). Methods. We evaluated 25 patients (mean age, 57.5 +/- 14.1 years) who underwent CTO-PCI of the right coronary artery, whose collaterals were provided by the left anterior descending (LAD) artery. The coronary flow velocities in the distal LAD were measured using transthoracic echocardiography (TTE) before, 24 hours after, and within 3 months of PCI. Both two-dimensional and tissue Doppler (tD) echocardiography were used to calculate MPI. Results. CFVR at month 3 was significantly increased compared to the basal and early CFVR (1.8 +/- 0.3 vs 2.3 +/- 0.3 [P<.001] and 1.8 +/- 0.2 vs 2.3 +/- 0.3 [P<.001], respectively). MPI at month 3 was significantly decreased compared to the basal and early MPI (0.61 +/- 0.09 vs 0.53 +/- 0.07 [P<.001] and 0.60 +/- 0.08 vs 0.53 +/- 0.07 [P<.001], respectively). Also, tD-MPI within 3 months was significantly decreased (0.58 +/- 0.9 vs 0.53 +/- 0.8 [P=.01] and 0.57 +/- 0.07 vs 0.53 +/- 0.8 [P<.001], respectively, for tD-MPI septal and 0.59 +/- 0.08 vs 0.51 +/- 0.07 [P<.001] and 0.58 +/- 0.08 vs 0.51 +/- 0.07 [P<.001], respectively, for tD-MPI lateral). Conclusion. Successful recanalization of CTO results in increased CFVR-indicated blood flow in the donor artery and MPI-indicated global cardiac functions.
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    Coronary Flow Velocity Reserve in Patients with Ascending Aorta Aneurysm
    (Wiley-Blackwell, 2015) Baykan, Ahmet Oytun; Kalkan, Gulhan Yuksel; Gur, Mustafa; Ucar, Hakan; Acele, Armagan; Seker, Taner; Sen, Omer
    BackgroundAscending aorta aneurysms (AAA) are one of the leading causes of morbidity and mortality. Impairment in coronary flow may contribute to cardiovascular consequences in AAA patients. Coronary flow velocity reserve (CFVR) has been considered an important diagnostic index of the functional capacity of coronary arteries noninvasively. The aim of this study was to evaluate, by noninvasive CVFR, whether patients with AAA demonstrate significant coronary microvascular dysfunction in the absence of coronary artery disease (CAD). MethodsWe prospectively included 44 patients with thoracic AAA in the absence of concomitant CAD (30 men, 14 women; mean age 57.58.4years). A total of 36 patients without aortic dilatation (mean age 55.29.9years) were selected as the control group. Coronary flow velocities in the distal left anterior descending (LAD) artery were measured using transthoracic echocardiography. CFVR was calculated as the hyperemic to resting coronary diastolic peak velocities ratio. ResultsCompared with controls, patients with AAA had higher baseline LAD peak diastolic coronary flow velocities (28.3 +/- 5.8 vs. 25.2 +/- 4.5cm/sec, P=0.01), lower hyperemic LAD flow velocities (54.0 +/- 10.3 vs. 57.2 +/- 12.7cm/sec, P=0.220), and consequently lower CFVR (1.9 +/- 0.3 vs. 2.3 +/- 0.5, P<0.001). Multivariate linear regression analysis showed that CFVR was independently associated only with aortic systolic diameter (AoSD) (=-0.679, P=<0.001). ConclusionsOur study demonstrates that noninvasive CFVR is significantly reduced in patients with AAA and AoSD is the most important determinant of impaired CFVR.