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    Comparison of the effects of new and conventional hormone replacement therapies on left ventricular diastolic function in healthy postmenopausal women: a Doppler and ultrasonic backscatter study
    (Springer, 2009) Duygu, Hamza; Akman, Levent; Ozerkan, Filiz; Akercan, Fuat; Zoghi, Mehdi; Nalbantgil, Sanem; Erturk, Umit; Akilli, Azem; Onder, Remzi; Akin, Mustafa
    We aimed to compare the effects of new treatment modalities to conventional hormone replacement therapy (HRT) on left ventricular (LV) diastolic function, by means of conventional and tissue Doppler echocardiography and the myocardial integrated backscatter (IBS) in postmenopausal women. One hundred and fifty healthy postmenopausal women were included in this study. Subjects were assigned to one of the five groups receiving 1 year of treatment (estrogen, estrogen plus progesterone, raloxifene, tibolone or placebo). E and A wave velocity, E/A ratio, isovolumic relaxation time (IVRT), deceleration time (DT), peak early (Em) diastolic mitral annular velocity, E/Em ratio, the cyclic variation of integrated backscatter (CVIBS) and the mean value of the IBS signal (MIBS) were determined before and 12 months after therapy. E (76 +/- A 10 vs. 98 +/- A 8 cm/s, P = 0.0001 and 78 +/- A 10 vs. 90 +/- A 12 cm/s, P = 0.02, respectively), Em (14.3 +/- A 2.4 vs. 16.4 +/- A 2.5 cm/s, P = 0.001 and 15.1 +/- A 3.4 vs. 16.2 +/- A 3.5 cm/s, P = 0.01, respectively), and E/A ratio (1.15 +/- A 0.3 vs. 1.42 +/- A 0.4, P = 0.0001 and 1.0 +/- A 0.2 vs. 1.22 +/- A 0.2, P = 0.01, respectively) were increased significantly compared to pretreatment in both estrogen and raloxifene groups while DT, A, E/Em, and IVRT were significantly decreased. A significant increase in CVIBS and decrease in MIBS were detected 12 months after estrogen and raloxifene administration while no significant changes were observed in other groups. Changes in the MIBS and CVIBS were found to be independently associated with the observed changes in the diastolic function indexes during therapy. Both estrogen and raloxifene regimens may improve LV diastolic functions in healthy postmenopausal women. This improvement may be a result of direct cardiac effects on LV myocardium.
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    Objective ischemic evidence in patients with myocardial bridging: Ultrasonic tissue characterization with dobutamine stress integrated backscatter
    (Mosby-Elsevier, 2007) Duygu, Hamza; Ozerkan, Filiz; Zoghi, Mehdi; Nalbantgil, Sanem; Kirilmaz, Bahadir; Akilli, Azem; Onder, Remzi; Erturk, Umit; Akin, Mustafa
    Background: in this study, we investigated the sensitivities of dobutamine stress echocardiography (DSE) and integrated backscatter (IBS) in detecting ischemia in patients with symptomatic myocardial bridging (MB). Methods: Fourteen patients given the diagnosis of MB in the left anterior descending coronary artery as shown by coronary angiography were enrolled. All patients underwent DSE and stress IBS. The cyclic variation of IBS (CVIBS) was taken from the midanteroseptal, midinferior, and midposterolateral areas of the parasternal short-axis images at rest, low dose, peak dose, and recovery. The low-dose, peak-dose, and recovery CVIBS data were compared with baseline values. Results: At peak dose, hypokinesia was observed in the left anterior descending coronary artery region in two patients (14%). A significant reduction in CVIBS was detected only when compared with the baseline at peak dose in the anteroseptal wall (8.4 +/- 1.3 vs 5.9 +/- 0.8, P = .003). A significant negative correlation was found between the CVIBS and the systolic narrowing percentage (R = -0.856, P = .001) and the length of MB (R = -0.576, P = .01) in the anteroseptal wall at peak dose. Conclusions. Whereas DSE is not sufficiently sensitive in the detection of ischemia in patients with symptomatic MB, the reduction in CVIBS during DSE may be an objective sign of ischemia.