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    Assessment of left atrial volume and function in patients with Sjogren's syndrome using three-dimensional echocardiography
    (Wiley, 2020) Hidayet, Siho; Yagmur, Julide; Karaca, Yucel; Bayramoglu, Adil; Yolbas, Servet; Hidayet, Emine; Ulutas, Zeynep
    Objective We used real time, three-dimensional transthoracic echocardiography (3DTTE) to evaluate left atrial (LA) volume and mechanical function in patients with primary Sjogren's syndrome (SS). Methods We prospectively included 42 consecutive patients with primary SS and 42 controls who were similar in terms of basal characteristics. 3DTTE was used to assess LA function. Results Maximum LA volume, minimum LA volume, pre-atrial contraction LA volume, LA Active Stroke Volume (ASV), LA Total Stroke Volume (TSV), maximal left atrial volume index (LAVImax), Left atrial pre-contraction volume index, and Left atrial minimum volume index, ASV index, and TSV index were significantly higher in the SS group, and the LA Total Emptying Fraction, LA Expansion Index, and LA Passive Emptying Fraction were significantly lower. Although the active emptying fraction was higher in the SS group, the difference was not statistically significant. LAVImax was positive correlated with disease duration (r = .753). Conclusion Left atrial function is impaired in SS patients and serves as an early marker of subclinical cardiac involvement.
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    Four-dimensional speckle tracking echocardiography and fragmented QRS in detection of early left ventricular systolic dysfunction in patients with subclinical hyperthyroidism
    (Wiley, 2023) Karaca, Yucel; Karasu, Mehdi; Tasolar, Hakan; Evren, Bahri
    Background: Thyroid disorders are associated with many cardiovascular risk factors. The importance of thyroid hormones in the pathophysiology of heart failure is underlined by the European guidelines of the European Society of Cardiology. However, the role of subclinical hyperthyroidism (SCH) in subclinical left ventricular (LV) systolic dysfunction is not entirely clear. Methods: This cross-sectional study included 56 SCH patients and 40 healthy volunteers. The 56 SCH group was divided into two subgroups depending on the presence of fragmented QRS (fQRS). In both groups, left ventricular global area strain (LV-GAS), global radial strain (GRS), global longitudinal strain (GLS), and global circumferential strain (GCS) were obtained with four-dimensional (4D) echocardiography. Results: GAS, GRS, GLS, and GCS values were significantly different in SCH patients and in healthy volunteers. GLS and GAS values were lower in the fQRS+ than in the fQRS- group (-17.06 +/- 1.00 vs. -19.08 +/- 1.71, p < .001, and -26.61 +/- 2.38 vs. -30.61 +/- 2.57, p < .001, respectively). ProBNP was positively correlated with LV-GLS (r = 0.278, p = .006) and LV-GAS (r = 0.357, p < .001). Multiple linear regression analysis showed that fQRS was an independent predictor of LV-GAS. Conclusions: 4D strain echocardiography may be helpful for the prediction of early cardiac dysfunction in patients with SCH. The presence of fQRS may be an indicator of subclinical LV dysfunction in SCH.
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    FragmentedQRScomplexes are associated with subclinical left ventricular dysfunction in patients with Behcet's disease:Four-dimensionalspeckle tracking echocardiography
    (Wiley, 2021) Hidayet, Siho; Yagmur, Julide; Bayramoglu, Adil; Cansel, Mehmet; Ermis, Necip; Tasolar, Hakan; Karaca, Yucel
    Background Behcet's disease (BD) is a chronic systemic inflammatory disease in which early detection of cardiac involvement is essential. The aim of this study was to assess the left ventricular (LV) functions in BD patients using four-dimensional (4D) speckle tracking echocardiography (STE) and to test the correlation between LV dysfunction and the presence of QRS fragmentation. Methods This cross-sectional study included 64 Behcet's patients and 48 healthy volunteers. The BD group was divided into two subgroups depending on the presence (fQRS+) or absence (fQRS-) of fragmented QRS (fQRS). In both groups, left ventricular global area strain (LV-GAS), global radial strain (GRS), global longitudinal strain (GLS), and global circumferential strain (GCS) were obtained with 4D echocardiography. Results GAS, GRS, GLS, and GCS values were significantly different in Behcet's patients and in healthy volunteers. GLS and GAS values were lower in the fQRS+ than in the fQRS- group (-15.8 +/- 1.8 and -17.9 +/- 1.6,P= .001 vs -25.0 +/- 3.1 and -29.2 +/- 4.2,P < .001, respectively). The duration of disease was longer in fQRS+ than in fQRS- patients (120.8 +/- 67.4 vs 71.0 +/- 40.5,P < .001). Multiple linear regression analysis showed that fQRS and disease duration were independent predictors of LV-GAS. Conclusions Four-dimensional STE may be helpful for the prediction of early cardiac dysfunction in patients with BD. The presence of fQRS may be an indicator of subclinical LV dysfunction.
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    The importance of pulmonary pulse transit time in indicating right ventricular dysfunction and pulmonary arterial stiffness in rheumatoid arthritis
    (Wiley, 2023) Ulutas, Zeynep; Tasolar, Hakan; Bayramoglu, Adil; Yigit, Yakup; Kuloglu, Huseyin Emre; Karaca, Yucel; Yolbas, Servet
    Subject Rheumatoid arthritis patients are at risk of developing cardiovascular disease such as right heart failure and pulmonary hypertension (PH). Arterial stiffness can be used to assess pulmonary hemodynamics. Noninvasive approaches can also be used to assess pulmonary hemodynamics. Recently, there have been reports that pulmonary pulse transit time (PPTT) may also be a useful measure. This study aims to examine the effects of pulmonary hemodynamic alterations on PPTT in RA patients.Methods Forty RA patients and 40 healthy controls were included in the study. Sociodemographic characteristics, laboratory data, and echocardiographic examinations were performed in both groups. Conventional echocardiographic examination included left and right ventricular systolic and diastolic diameters, right ventricular myocardial performance index (RVMPI), right ventricular diastolic function, estimated pulmonary artery systolic pressure (sPAP), tricuspid annular plane systolic excursion (TAPSE), pulmonary artery stiffness (PAS), and PPTT. Right ventricular diastolic and systolic volumes, right ventricular ejection fraction (RVEF), and right ventricular fractional area change (RVFAC) were determined by four-dimensional echocardiography (4DE).Results There was no difference between the sPAP values of the patients. RVMPI and PAS were increased in RA patients compared with controls. The PPTT was shortened in RA patients and correlated with RVEF, RVFAC, RVMPI, TAPSE/sPAP, disease duration, and C-reactive protein (CRP). In univariate linear regression analysis, PPTT (p < .001) was thought to be an independent predictor of PAS. RVFAC, disease duration, and PAS were also independent predictors of PPTT.Conclusion In RA patients, PPTT may be the first evidence of early abnormalities in pulmonary vascular hemodynamics. PPTT and PAS are the values that may predict each other in RA patients. Due to its more practical application, PPTT can be used instead of PAS to assess pulmonary hemodynamics.
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    The relationship between bioelectrical impedance parameters and pulmonary artery stiffness in obese subjects
    (Wiley, 2022) Hidayet, Siho; Bayramoglu, Adil; Hidayet, Emine; Ulutad, Zeynep; Dagtekin, Firat; Guven, Fatih; Karaca, Yucel
    Objectives Obesity is a public health problem that needs to be treated and it occurs as a result of excessive fat accumulation in the body. The relationship between obesity and pulmonary hypertension is well known. The aim of this study is to evaluate the relationship between pulmonary artery stiffness, right ventricular functions and bioelectrical impedance parameters in obese, overweight, and healthy individuals. Methods In this study, 41 obese (17 female and 24 male, mean age 43.5 +/- 10.3), 39 overweight (20 female and 19 male, mean age 38.6 +/- 10.4), 34 healthy control group (19 female and 15 male, mean age 40.5 +/- 8.6) were included. Anthropometric measurements and bioelectrical impedance parameters of all participants were performed. Right ventricular functions and pulmonary artery stiffness were evaluated by using conventional echocardiography. Results Right ventricle myocardial performance index, pulmonary artery stiffness values were statistically different between groups. Positive correlation was observed between pulmonary artery stiffness and Body Mass Index, Waist and Hip circumferences. Significant negative correlation was observed between muscle to fat ratio and pulmonary artery stiffness. In the linear regression analysis, it was observed that the muscle to fat ratio was independent predictor of pulmonary artery stiffness (beta = -1.835; 95%CI(-2.434 - - .784); p < 0.001). Conclusions This study showed that right ventricular function was impaired and pulmonary artery stiffness increased in obese individuals. These findings could be considered as early markers of pulmonary hypertension in obese patients who do not yet have clinical evidence of cardiovascular disease.
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    Subclinical left ventricular dysfunction in Sjogren's syndrome assessed by four-dimensional speckle tracking echocardiography
    (Wiley, 2020) Akaycan, Julide; Hidayet, Siho; Bayramoglu, Adil; Yolbas, Servet; Karaca, Yucel; Yigit, Yakup; Ulutas, Zeynep
    Objective The aim of this study was to evaluate the left ventricular (LV) systolic strain by four-dimensional speckle tracking echocardiography (4D-STE) in order to provide the early detection of myocardial dysfunction in patients with Sjogren's syndrome (SS). Methods Forty consecutive patients with primary SS diagnosed at the rheumatology outpatient clinic and 35 age- and sex-matched healthy volunteers were included in the study. 4DSTE was performed, and global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS), and global area strain (GAS) were measured. 4DSTE results were compared with the healthy volunteers. Results No significant differences were observed between the GRS and GCS values of the two groups. A significant difference was observed in the GLS and GAS measurements between the two groups (P = .005 for GLS,P < .001 for GAS). Positive correlation was detected between disease duration and LV-GLS and LV-GAS. Conclusion We demonstrated subclinical systolic dysfunction in SS patients by 4DSTE, which is a sensitive marker of ventricular dysfunction. Deterioration of the LV became more evident as duration of the disease increased. Therefore, we believe that a cardiac evaluation will be of benefit to patients with long-term SS.