- Email: [email protected]
PP-062 RELATION OF LEFT ATRIAL FUNCTIONS, P-TERMINAL FORCE AND INTERATRIAL BLOCK IN CHRONIC HAEMODIALYSIS PATIENTS
Poster Presentations / International Journal of Cardiology 163S1 (2013) S81–S211
PP-060 LEFT ATRIAL MECHANICAL FUNCTIONS IN PATIENTS WITH METABOLIC SYNDROME ¨ ¨ uk M. Yılmaz1 , O.A. Ozl ¨ 1 , A. Akgum ¨ u¨ s¸ 2 , T. Peker1 , A. Bekler3 , K. Karaa˘gac¸ 1 , F. Vatansever1 . 1 Department of Cardiology, Bursa ˙ Ihtisas Training and Research Hospital, Bursa, Turkey; 2 Department of Cardiology, Gemlik State Hospital, Bursa, Turkey; 3 Department of Cardiology, Esentepe Hospital, Bursa, Turkey Objective: Metabolic syndrome (MS) is a cluster of risk factors leading to cardiometabolic diseases. The aim of the present study was to investigate the effect of MS on left atrial function, which is an important determinant of left ventricular filling. Methods: Left atrial (LA) volumes were measured echocardiographically in 32 MS patients and 32 age-sex matched controls. LA volumes were determined at the time of mitral valve opening (maximal, Vmax), at the onset of atrial systole (p wave at the electrocardiography, Vp) and at the mitral valve closure (minimal, Vmin) according to the biplane area-length method in apical 4-chamber and 2-chamber view. All volumes were corrected to the body surface area, and following left atrial emptying functions were calculated. LA passive emptying volume = Vmax − Vp, LA passive emptying fraction = LA passive emptying volume/Vmax. Conduit volume = LV stroke volume − (Vmax − Vmin), LA active emptying volume = Vp − Vmin, LA active emptying fraction = LA active emptying volume/Vp, LA total emptying volume = (Vmax − Vmin), LA total emptying fraction = LA total emptying volume/Vmax. Results: LA maximal volume and LA presystolic volume were significantly higher in MS patients than in controls (p < 0.001). But LA minimum volume was significantly lower in MS patients than in controls (p < 0.001). Although LA passive emptying volume (p < 0.03), LA passive emptying fraction (p < 0.001) and conduit volume (p < 0.001) were found to be significantly lower in MS patients than in controls, LA active emptying volume (p < 0.001) and LA active emptying fraction (p < 0.001) were significantly greater in MS patients than in controls. Conclusion: In our study, metabolic syndrome was associated with increased left atrial volume, decreased left atrial passive emptying function and increased pump function. Increased left atrial pump function represents a compensatory mechanism in patients with MS. Thus, these results underline the importance of maintaining a sinus rhythm in these patients. Table: Mechanical function parameters of the left atrium Parameters LA LA LA LA LA LA LA LA LA LA
maximum volume (cm3 /m2 ) minimum volume (cm3 /m2 ) presystolic volume (cm3 /m2 ) passive emptying volume (cm3 /m2 ) passive emptying fraction (%) conduit volume (cm3 /m2 ) active emptying volume (cm3 /m2 ) active emptying fraction (%) total emptying volume (cm3 /m2 ) total emptying fraction (%)
Group I (n = 32)
Group II (n = 32)
p values
19.5±1.8 7±1.5 16.4±1.8 2.9±0.8 0.15±0.04 18.8±5.3 9.4±2 0.56±0.09 12.3±2 0.63±0.07
15.5±2.7 9.4±2.1 12±2.2 3.5±1.4 0.22±0.07 24.7±5.5 2.6±1 0.20±0.07 6.1±1.7 0.39±0.08
<0.001 <0.001 <0.001 0.03 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001
PP-061 SPECKLE-TRACKING ECHOCARDIOGRAPHIC IMAGING OF THE RIGHT VENTRICULAR SYSTOLIC AND DIASTOLIC PARAMETERS IN CHRONIC EXERCISE Z. Sim ¸ sek ¸ 1 , M. Hakan Tas1 , E. Gunay2 , H. De˘girmenci1 . 1 Department of Cardiology, Ataturk University, Erzurum, Turkey; 2 Department of Pulmonary Medicine, School of Medicine, Afyon Kocatepe University, Afyon, Turkey Background: Morphology and functions of the right ventricle (RV) show differences in the athletes based on whether exercising acutely or chronically. Temporary RV dysfunction occurs during
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acute exercise. However, RV functions during chronic exercise are speculative. In the present study, we aimed to evaluate RV functions of long-distance runners, who perform chronic exercise, by both conventional and speckle-tracking echocardiography (STE). Method: In this study, we examined 44 long-distance runner and 30 sedentary subjects. RV longitudinal strain (LS), RV systolic longitudinal strain rate (LSRs), RV early diastolic longitudinal strain rate (LSRe) and late diastolic longitudinal strain rate (LSRa) parameters were evaluated by apical 4-chamber gray-scale imaging through the septum and free wall of RV in accordance with automated function imaging (AFI) protocol. Results: It was observed on the conventional echocardiographic parameters of long-distance runners that RA and RVED diameter have been increased (p = 0.028; p = 0.003 respectively), whereas systolic right ventricle fractional area change (RVFAC) and tricuspid annular plane systolic excursion (TAPSE) values were similar to those of sedentary subjects (p = 0.65; p = 0.75 respectively). Longitudinal strain and systolic and diastolic strain rate functions were also similar. Conclusion: Morphological adaptation, but not functional change, occurs in the athletes performing chronic exercise. Table: Demographic and echocardiographic data of the long-distance runners group and the control group
Gender (F/M) Age (year) BMI (kg/m2 ) SBP (mmHg) DBP (mmHg) Heart rate (beat/min) LVED (mm) LVES (mm) IVSd (mm) LVEF Teicholz (%) LA (mm) LVm (g) RA (mm) RVED (mm) RV end-diastolic area (cm2 ) RV end-systolic area (cm2 ) RVFAC (%) TAPSE (mm)
Group I (n = 44) Long-distance runners
Group II (n = 30) Control
P-value
32/12 24.10±2.90 22.60±2.20 105±12 69±11 55.20±5.20 51±4.30 31.30±3.80 11.20±1.20 69.50±6.50 32±4.10 196±18 32.50±2.20 32.80±2.60 22±3.10 13.8±2.0 41.70±6.90 20.60±2.70
22/8 23.80±2.10 23.10±2.40 109±15 72±12 66.40±5.80 46.20±4.20 27.60±4.30 9.50±1.40 67.40±6.70 27.90±4.40 152±15 30.80±2.90 30.30±2.80 19.50±2.40 11.90±1.60 40.60±5.70 20.80±2.20
0.86 0.72 0.45 0.15 0.35 <0.001 <0.001 0.004 <0.001 0.41 0.045 <0.001 0.028 0.003 0.003 0.001 0.65 0.75
BMI: Body mass index; DBP: Diastolic arterial tension; IVSd: interventricular septum end diastolic; LA: Left atrium; LVED: Left ventricle end-diastolic diameter; LVEF: Left ventricle ejection fraction; LVm: left ventricle mass; LVES: Left ventricle endsystolic diameter; RA =Right atrium; RVED =Right ventricle end-systolic diameter; RVFAC: Right ventricle fractional area change; SBP: Systolic arterial tension; TAPSE: tricuspid annular plane systolic excursion.
PP-062 RELATION OF LEFT ATRIAL FUNCTIONS, P-TERMINAL FORCE AND INTERATRIAL BLOCK IN CHRONIC HAEMODIALYSIS PATIENTS Z. Sim ¸ sek ¸ 1 , M. Hakan Tas1 , Y. Bilen2 , E. I˙ pek3 , E. Cankaya2 , H. Duman1 , H. De˘girmenci1 , U. Aksu1 , Z. Lazoglu1 . 1 Department of Cardiology, Ataturk University, Erzurum, Turkey; 2 Department of Internal Medicine, Ataturk University, Erzurum, Turkey; 3 Department of Cardiology, Erzurum Education and Research Hospital, Erzurum, Turkey Objective: Interatrial block (IAB) connotes a P wave duration (≥110 ms) on electrocardiography (ECG). P-terminal force corresponds to a biphasic P wave with its terminal negative phase (≥40 ms·mm) in V1 derivation on ECG. IAB and P-terminal force are closely related parameters and they are accepted as predictors for left atrial dysfunction, left atrial dilatation, atrial fibrillation and stroke. Left atrial functions in chronic haemodialysis patients get worse in the course of time because of long standing pressure and volume overload. The aim of this study is to evaluate
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Poster Presentations / International Journal of Cardiology 163S1 (2013) S81–S211
the relationship between IAB, P-terminal force and left atrial functions. Materials and Methods: 68 chronic haemodialysis patients and 60 control subjects were included in the study. Conventional echocardiography and left atrial dynamic functions were measured in all cases. The subjects with IAB and P-terminal force on ECG were identified. Results: Left ventricular size, wall thickness and left atrial diameters were statistically greater in hemodialysis patients than the control group (p < 0.001). 42 (62%) patients had IAB (≥110 ms) and 45 (66%) patients had P-terminal force (≥40 ms·mm) in hemodialysis group. Left atrial reservoir, conduit and pump functions were statistically lower in the haemodialysis group than the control group (p < 0.001) (Table 1). There was a statistically significant correlation between left atrial functions, IAB (≥110 ms) and P-terminal force (≥40 ms·mm) in all parameters (p < 0.001). Conclusion: This study showed that decreased left atrial functions in chronic hemodialysis patients are closely correlated with IAB and P-terminal force. Table 1. Relationship between interatrial block, P-terminal force, left atrial functions and left atrial diameter Interatrial block
Reservoir function (%) Conduit function (%) Pump function (%) Left atrial diameter (mm)
P-terminal force
(+) (n = 42)
(−) (n = 26)
P-value
(+) (n = 45)
(−) (n = 23)
P-value
35.5±6.5 15.8±3.5 31.4±4.6 46.8±5.6
46.2±8.9 21.2±5.1 39.4±7.2 38.4±3.9
<0.001 <0.001 <0.001 <0.001
37.2±5.9 15.9±3.7 32.5±5.2 45.5±5.7
44.8±6.7 20.7±5.2 39.8±7.1 39.5±5.5
<0.001 <0.001 <0.001 <0.001
PP-063 EVALUATION OF LEFT ATRIAL PHASIC FUNCTIONS IN END-STAGE RENAL DISEASE PATIENTS Z. Sim ¸ sek ¸ 1 , M. Hakan Tas1 , Y. Bilen2 , E. Cankaya2 , H. De˘girmenci1 , H. Duman1 , S. Karakelleoglu1 , H. Senocak1 . 1 Department of Cardiology, Ataturk University, Erzurum, Turkey; 2 Department of Internal Medicine, Ataturk University, Erzurum, Turkey Aim: In this study we aimed to compare the Left Atrial (LA) volume and function of End-Stage Renal Disease (ESRD) patients on renal replacement therapy via haemodialysis (HD) or Peritoneal Dialysis (PD). Methods: Thirty eight HD and 34 PD patients enrolled in the study. Left ventricle diameter, mass and the left ventricle wall thickness of all the patients was measured with M-mode echocardiography. Without visualisation of apical four chambers with two-diameter echocardiography, minimal, maximal and presystolic LA volumes measured. via the help of these volumetric measurements LA reservoir, conduit and pump functions were calculated. Results were compared with age and sex in the matched healthy control group. Table 1 Left atrium
Haemodialysis (HD) (n = 38)
Peritoneal dialysis (PD) (n = 34)
Control (n = 32)
P-value
Maximum volume index (ml/m2 ) Minimum volume index (ml/m2 )
38.8±5.9*d 19.1±1.9*d
35.2±4.4↑d 17.1±2.9↑d
25.1±2.3
<0.001
12.3±1.7
30.5±3.2*d 44.4±8.5*d
27.8±3.3↑d 49.7±9.4↑d
<0.001
Presystolic volume index (ml/m2 )
18.8±2.2
<0.001
56.8±4.1
21.2±5.8↑d 39.3±8.7↑d
<0.001
18.7±4.1*d 34.9±7.2*d
30.4±3.7
<0.001
44.5±4.4
<0.001
Reservoir function (%) Conduit function (%) Pump function (%)
*p < 0.05 compared to PD, ↑ p < 0.05 compared to HD, d p < 0.05 compared to the control.
Results: The calculated LA volume in HD and PD patients were statistically significantly higher than the control group (p < 0.001). LA functions (reservoir, conduit and pump function) of HD and PD patients were detected statistically significantly lower than the control group (p < 0.001). LA volumes of HD patients were significantly higher than PD patients and LA functions of PD patients were detected lower than HD patients (Table 1). It was detected that there was a significant correlation between LA functions with LV diameter and wall thickness. The LA linear
diameter significantly correlated only with LA conduit function (r = 0.33, p = 0.001). Conclusion: It was detected that the LA volume increased significantly in ESRD patients, while LA functions decreased significantly compared to the control group. These results were further pronounced in HD patients. PP-064 THE ROLE OF TWO-DIMENSIONAL TRANSTHORACIC ECHOCARDIOGRAPHY IN THE DIAGNOSIS OF LEFT ATRIAL APPENDAGE THROMBUS S. ¸ Balta1 , S. Demirkol1 , M. Unlu2 , A. Guler ¨ 3 , A. I˙ yisoy1 , M.A. Sahin3 , U. Ku¨ c¸ uk ¨ 1 , Z. Arslan4 . 1 Department of Cardiology, Gulhane Medical Faculty, Ankara, Turkey; 2 Department of Cardiology, Beytepe Military Hospital, Ankara, Turkey; 3 Department of Cardiovascular Surgery, Gulhane Medical Faculty, Ankara, Turkey; 4 Department of Cardiology, Gelibolu Military Hospital, Ankara, Turkey Forty-nine-year-old male patient was admitted to our clinic because of a routine checkup. His medical history revealed rheumatic mitral stenosis, diabetes mellitus, hypertension. He had not taken warfarine for 6 months. On physical examination, heart rate was 112/min and irregular, blood pressure was 130/80 mmHg and diastolic rulman was heard at the apex. Two-dimensional transthoracic echocardiography modified parasternal long axis view showed mitral stenosis and thrombus in the left atrium (Figure 1A). Two-dimensional transesophageal echocardiography demonstrated the thrombus, in the left atrial appendage, which spread into the left atrium (Figure 1B). Three-dimensional transesophageal echocardiography zoom modality displayed thrombus in the left atrium appendage (Figure 1C). The incidence of left atrial thrombi is higher in patients with mitral valve stenosis and atrial fibrillation. Its presence and location have important implications in deciding on the therapeutic approach. Echocardiography is essential in establishing the diagnosis in patients with cardiac masses. Although the visualization of thrombi is mostly difficult especially in left atrial appendix by transthoracic echocardiography, we herein demonstrated that a thrombus of the left atrial appendage can also be revealed by modified transthoracic echocardiographic windows.
Figure 1.
PP-065 MULTIMODALITY IMAGING OF MAJOR AORTAPULMONARY COLLATERAL ARTERY IN A PATIENT WITH TYPE IV TRUNCUS ARTERIOSUS U.N. Karakulak, C. ¸ Sabanov, ¸ S.G. ¸ Fatiho˘glu, N. Maharjan, K. Aytemir, A. Oto. Hacettepe University Faculty of Medicine Department of Cardiology, Turkey A 30-year-female was admitted with fatigue, exertional dyspnea and frequently infection. The patient had a history of an operation of modified left sided Blalock–Taussing (BT) shunt due to type 4 truncus arteriosus when she was 9 years old. Physical examination revealed mild cyanotic appearance of skin and mucous membranes and clubbing of the fingers (Panel A). On auscultation, there was a remarkable, continuous systolic murmur in precordium. Electrocardiography disclosed sinus rhythm with right axis and p pulmonale in accordance with right ventricular overload (Panel B). Chest X-ray revealed widened upper mediastinum with cardiomegaly and a large lung nodule in the left upper lobe due to
PP-060 LEFT ATRIAL MECHANICAL FUNCTIONS IN PATIENTS WITH METABOLIC SYNDROME ¨ ¨ uk M. Yılmaz1 , O.A. Ozl ¨ 1 , A. Akgum ¨ u¨ s¸ 2 , T. Peker1 , A. Bekler3 , K. Karaa˘gac¸ 1 , F. Vatansever1 . 1 Department of Cardiology, Bursa ˙ Ihtisas Training and Research Hospital, Bursa, Turkey; 2 Department of Cardiology, Gemlik State Hospital, Bursa, Turkey; 3 Department of Cardiology, Esentepe Hospital, Bursa, Turkey Objective: Metabolic syndrome (MS) is a cluster of risk factors leading to cardiometabolic diseases. The aim of the present study was to investigate the effect of MS on left atrial function, which is an important determinant of left ventricular filling. Methods: Left atrial (LA) volumes were measured echocardiographically in 32 MS patients and 32 age-sex matched controls. LA volumes were determined at the time of mitral valve opening (maximal, Vmax), at the onset of atrial systole (p wave at the electrocardiography, Vp) and at the mitral valve closure (minimal, Vmin) according to the biplane area-length method in apical 4-chamber and 2-chamber view. All volumes were corrected to the body surface area, and following left atrial emptying functions were calculated. LA passive emptying volume = Vmax − Vp, LA passive emptying fraction = LA passive emptying volume/Vmax. Conduit volume = LV stroke volume − (Vmax − Vmin), LA active emptying volume = Vp − Vmin, LA active emptying fraction = LA active emptying volume/Vp, LA total emptying volume = (Vmax − Vmin), LA total emptying fraction = LA total emptying volume/Vmax. Results: LA maximal volume and LA presystolic volume were significantly higher in MS patients than in controls (p < 0.001). But LA minimum volume was significantly lower in MS patients than in controls (p < 0.001). Although LA passive emptying volume (p < 0.03), LA passive emptying fraction (p < 0.001) and conduit volume (p < 0.001) were found to be significantly lower in MS patients than in controls, LA active emptying volume (p < 0.001) and LA active emptying fraction (p < 0.001) were significantly greater in MS patients than in controls. Conclusion: In our study, metabolic syndrome was associated with increased left atrial volume, decreased left atrial passive emptying function and increased pump function. Increased left atrial pump function represents a compensatory mechanism in patients with MS. Thus, these results underline the importance of maintaining a sinus rhythm in these patients. Table: Mechanical function parameters of the left atrium Parameters LA LA LA LA LA LA LA LA LA LA
maximum volume (cm3 /m2 ) minimum volume (cm3 /m2 ) presystolic volume (cm3 /m2 ) passive emptying volume (cm3 /m2 ) passive emptying fraction (%) conduit volume (cm3 /m2 ) active emptying volume (cm3 /m2 ) active emptying fraction (%) total emptying volume (cm3 /m2 ) total emptying fraction (%)
Group I (n = 32)
Group II (n = 32)
p values
19.5±1.8 7±1.5 16.4±1.8 2.9±0.8 0.15±0.04 18.8±5.3 9.4±2 0.56±0.09 12.3±2 0.63±0.07
15.5±2.7 9.4±2.1 12±2.2 3.5±1.4 0.22±0.07 24.7±5.5 2.6±1 0.20±0.07 6.1±1.7 0.39±0.08
<0.001 <0.001 <0.001 0.03 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001
PP-061 SPECKLE-TRACKING ECHOCARDIOGRAPHIC IMAGING OF THE RIGHT VENTRICULAR SYSTOLIC AND DIASTOLIC PARAMETERS IN CHRONIC EXERCISE Z. Sim ¸ sek ¸ 1 , M. Hakan Tas1 , E. Gunay2 , H. De˘girmenci1 . 1 Department of Cardiology, Ataturk University, Erzurum, Turkey; 2 Department of Pulmonary Medicine, School of Medicine, Afyon Kocatepe University, Afyon, Turkey Background: Morphology and functions of the right ventricle (RV) show differences in the athletes based on whether exercising acutely or chronically. Temporary RV dysfunction occurs during
S105
acute exercise. However, RV functions during chronic exercise are speculative. In the present study, we aimed to evaluate RV functions of long-distance runners, who perform chronic exercise, by both conventional and speckle-tracking echocardiography (STE). Method: In this study, we examined 44 long-distance runner and 30 sedentary subjects. RV longitudinal strain (LS), RV systolic longitudinal strain rate (LSRs), RV early diastolic longitudinal strain rate (LSRe) and late diastolic longitudinal strain rate (LSRa) parameters were evaluated by apical 4-chamber gray-scale imaging through the septum and free wall of RV in accordance with automated function imaging (AFI) protocol. Results: It was observed on the conventional echocardiographic parameters of long-distance runners that RA and RVED diameter have been increased (p = 0.028; p = 0.003 respectively), whereas systolic right ventricle fractional area change (RVFAC) and tricuspid annular plane systolic excursion (TAPSE) values were similar to those of sedentary subjects (p = 0.65; p = 0.75 respectively). Longitudinal strain and systolic and diastolic strain rate functions were also similar. Conclusion: Morphological adaptation, but not functional change, occurs in the athletes performing chronic exercise. Table: Demographic and echocardiographic data of the long-distance runners group and the control group
Gender (F/M) Age (year) BMI (kg/m2 ) SBP (mmHg) DBP (mmHg) Heart rate (beat/min) LVED (mm) LVES (mm) IVSd (mm) LVEF Teicholz (%) LA (mm) LVm (g) RA (mm) RVED (mm) RV end-diastolic area (cm2 ) RV end-systolic area (cm2 ) RVFAC (%) TAPSE (mm)
Group I (n = 44) Long-distance runners
Group II (n = 30) Control
P-value
32/12 24.10±2.90 22.60±2.20 105±12 69±11 55.20±5.20 51±4.30 31.30±3.80 11.20±1.20 69.50±6.50 32±4.10 196±18 32.50±2.20 32.80±2.60 22±3.10 13.8±2.0 41.70±6.90 20.60±2.70
22/8 23.80±2.10 23.10±2.40 109±15 72±12 66.40±5.80 46.20±4.20 27.60±4.30 9.50±1.40 67.40±6.70 27.90±4.40 152±15 30.80±2.90 30.30±2.80 19.50±2.40 11.90±1.60 40.60±5.70 20.80±2.20
0.86 0.72 0.45 0.15 0.35 <0.001 <0.001 0.004 <0.001 0.41 0.045 <0.001 0.028 0.003 0.003 0.001 0.65 0.75
BMI: Body mass index; DBP: Diastolic arterial tension; IVSd: interventricular septum end diastolic; LA: Left atrium; LVED: Left ventricle end-diastolic diameter; LVEF: Left ventricle ejection fraction; LVm: left ventricle mass; LVES: Left ventricle endsystolic diameter; RA =Right atrium; RVED =Right ventricle end-systolic diameter; RVFAC: Right ventricle fractional area change; SBP: Systolic arterial tension; TAPSE: tricuspid annular plane systolic excursion.
PP-062 RELATION OF LEFT ATRIAL FUNCTIONS, P-TERMINAL FORCE AND INTERATRIAL BLOCK IN CHRONIC HAEMODIALYSIS PATIENTS Z. Sim ¸ sek ¸ 1 , M. Hakan Tas1 , Y. Bilen2 , E. I˙ pek3 , E. Cankaya2 , H. Duman1 , H. De˘girmenci1 , U. Aksu1 , Z. Lazoglu1 . 1 Department of Cardiology, Ataturk University, Erzurum, Turkey; 2 Department of Internal Medicine, Ataturk University, Erzurum, Turkey; 3 Department of Cardiology, Erzurum Education and Research Hospital, Erzurum, Turkey Objective: Interatrial block (IAB) connotes a P wave duration (≥110 ms) on electrocardiography (ECG). P-terminal force corresponds to a biphasic P wave with its terminal negative phase (≥40 ms·mm) in V1 derivation on ECG. IAB and P-terminal force are closely related parameters and they are accepted as predictors for left atrial dysfunction, left atrial dilatation, atrial fibrillation and stroke. Left atrial functions in chronic haemodialysis patients get worse in the course of time because of long standing pressure and volume overload. The aim of this study is to evaluate
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Poster Presentations / International Journal of Cardiology 163S1 (2013) S81–S211
the relationship between IAB, P-terminal force and left atrial functions. Materials and Methods: 68 chronic haemodialysis patients and 60 control subjects were included in the study. Conventional echocardiography and left atrial dynamic functions were measured in all cases. The subjects with IAB and P-terminal force on ECG were identified. Results: Left ventricular size, wall thickness and left atrial diameters were statistically greater in hemodialysis patients than the control group (p < 0.001). 42 (62%) patients had IAB (≥110 ms) and 45 (66%) patients had P-terminal force (≥40 ms·mm) in hemodialysis group. Left atrial reservoir, conduit and pump functions were statistically lower in the haemodialysis group than the control group (p < 0.001) (Table 1). There was a statistically significant correlation between left atrial functions, IAB (≥110 ms) and P-terminal force (≥40 ms·mm) in all parameters (p < 0.001). Conclusion: This study showed that decreased left atrial functions in chronic hemodialysis patients are closely correlated with IAB and P-terminal force. Table 1. Relationship between interatrial block, P-terminal force, left atrial functions and left atrial diameter Interatrial block
Reservoir function (%) Conduit function (%) Pump function (%) Left atrial diameter (mm)
P-terminal force
(+) (n = 42)
(−) (n = 26)
P-value
(+) (n = 45)
(−) (n = 23)
P-value
35.5±6.5 15.8±3.5 31.4±4.6 46.8±5.6
46.2±8.9 21.2±5.1 39.4±7.2 38.4±3.9
<0.001 <0.001 <0.001 <0.001
37.2±5.9 15.9±3.7 32.5±5.2 45.5±5.7
44.8±6.7 20.7±5.2 39.8±7.1 39.5±5.5
<0.001 <0.001 <0.001 <0.001
PP-063 EVALUATION OF LEFT ATRIAL PHASIC FUNCTIONS IN END-STAGE RENAL DISEASE PATIENTS Z. Sim ¸ sek ¸ 1 , M. Hakan Tas1 , Y. Bilen2 , E. Cankaya2 , H. De˘girmenci1 , H. Duman1 , S. Karakelleoglu1 , H. Senocak1 . 1 Department of Cardiology, Ataturk University, Erzurum, Turkey; 2 Department of Internal Medicine, Ataturk University, Erzurum, Turkey Aim: In this study we aimed to compare the Left Atrial (LA) volume and function of End-Stage Renal Disease (ESRD) patients on renal replacement therapy via haemodialysis (HD) or Peritoneal Dialysis (PD). Methods: Thirty eight HD and 34 PD patients enrolled in the study. Left ventricle diameter, mass and the left ventricle wall thickness of all the patients was measured with M-mode echocardiography. Without visualisation of apical four chambers with two-diameter echocardiography, minimal, maximal and presystolic LA volumes measured. via the help of these volumetric measurements LA reservoir, conduit and pump functions were calculated. Results were compared with age and sex in the matched healthy control group. Table 1 Left atrium
Haemodialysis (HD) (n = 38)
Peritoneal dialysis (PD) (n = 34)
Control (n = 32)
P-value
Maximum volume index (ml/m2 ) Minimum volume index (ml/m2 )
38.8±5.9*d 19.1±1.9*d
35.2±4.4↑d 17.1±2.9↑d
25.1±2.3
<0.001
12.3±1.7
30.5±3.2*d 44.4±8.5*d
27.8±3.3↑d 49.7±9.4↑d
<0.001
Presystolic volume index (ml/m2 )
18.8±2.2
<0.001
56.8±4.1
21.2±5.8↑d 39.3±8.7↑d
<0.001
18.7±4.1*d 34.9±7.2*d
30.4±3.7
<0.001
44.5±4.4
<0.001
Reservoir function (%) Conduit function (%) Pump function (%)
*p < 0.05 compared to PD, ↑ p < 0.05 compared to HD, d p < 0.05 compared to the control.
Results: The calculated LA volume in HD and PD patients were statistically significantly higher than the control group (p < 0.001). LA functions (reservoir, conduit and pump function) of HD and PD patients were detected statistically significantly lower than the control group (p < 0.001). LA volumes of HD patients were significantly higher than PD patients and LA functions of PD patients were detected lower than HD patients (Table 1). It was detected that there was a significant correlation between LA functions with LV diameter and wall thickness. The LA linear
diameter significantly correlated only with LA conduit function (r = 0.33, p = 0.001). Conclusion: It was detected that the LA volume increased significantly in ESRD patients, while LA functions decreased significantly compared to the control group. These results were further pronounced in HD patients. PP-064 THE ROLE OF TWO-DIMENSIONAL TRANSTHORACIC ECHOCARDIOGRAPHY IN THE DIAGNOSIS OF LEFT ATRIAL APPENDAGE THROMBUS S. ¸ Balta1 , S. Demirkol1 , M. Unlu2 , A. Guler ¨ 3 , A. I˙ yisoy1 , M.A. Sahin3 , U. Ku¨ c¸ uk ¨ 1 , Z. Arslan4 . 1 Department of Cardiology, Gulhane Medical Faculty, Ankara, Turkey; 2 Department of Cardiology, Beytepe Military Hospital, Ankara, Turkey; 3 Department of Cardiovascular Surgery, Gulhane Medical Faculty, Ankara, Turkey; 4 Department of Cardiology, Gelibolu Military Hospital, Ankara, Turkey Forty-nine-year-old male patient was admitted to our clinic because of a routine checkup. His medical history revealed rheumatic mitral stenosis, diabetes mellitus, hypertension. He had not taken warfarine for 6 months. On physical examination, heart rate was 112/min and irregular, blood pressure was 130/80 mmHg and diastolic rulman was heard at the apex. Two-dimensional transthoracic echocardiography modified parasternal long axis view showed mitral stenosis and thrombus in the left atrium (Figure 1A). Two-dimensional transesophageal echocardiography demonstrated the thrombus, in the left atrial appendage, which spread into the left atrium (Figure 1B). Three-dimensional transesophageal echocardiography zoom modality displayed thrombus in the left atrium appendage (Figure 1C). The incidence of left atrial thrombi is higher in patients with mitral valve stenosis and atrial fibrillation. Its presence and location have important implications in deciding on the therapeutic approach. Echocardiography is essential in establishing the diagnosis in patients with cardiac masses. Although the visualization of thrombi is mostly difficult especially in left atrial appendix by transthoracic echocardiography, we herein demonstrated that a thrombus of the left atrial appendage can also be revealed by modified transthoracic echocardiographic windows.
Figure 1.
PP-065 MULTIMODALITY IMAGING OF MAJOR AORTAPULMONARY COLLATERAL ARTERY IN A PATIENT WITH TYPE IV TRUNCUS ARTERIOSUS U.N. Karakulak, C. ¸ Sabanov, ¸ S.G. ¸ Fatiho˘glu, N. Maharjan, K. Aytemir, A. Oto. Hacettepe University Faculty of Medicine Department of Cardiology, Turkey A 30-year-female was admitted with fatigue, exertional dyspnea and frequently infection. The patient had a history of an operation of modified left sided Blalock–Taussing (BT) shunt due to type 4 truncus arteriosus when she was 9 years old. Physical examination revealed mild cyanotic appearance of skin and mucous membranes and clubbing of the fingers (Panel A). On auscultation, there was a remarkable, continuous systolic murmur in precordium. Electrocardiography disclosed sinus rhythm with right axis and p pulmonale in accordance with right ventricular overload (Panel B). Chest X-ray revealed widened upper mediastinum with cardiomegaly and a large lung nodule in the left upper lobe due to