We read the article entitled ''Association of Glomerular Filtration Rate With Slow Coronary Flow in Patients With Normal to Mildly Impaired Renal Function'' by Akin et al 1 with interest. The authors 1 concluded that estimated glomerular filtration rate (eGFR) was significantly correlated with slow coronary flow in patients with normal to mildly impaired kidney function.The Kidney Disease: Improving Global Outcomes organization developed clinical practice guidelines 2 in 2012, recommending that the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation is used for reporting eGFR, particularly in patients with a GFR 60 mL/min/1.73 m 2 . Compared with the Modification of Diet in Renal Disease (MDRD) equation, the CKD-EPI equation may be more accurate in patients with measured 3 GFR 60 mL/min/1.73m 2 . Additionally, the CKD-EPI study equation more appropriately categorizes individuals at risk of CKD and cardiovascular disease in a middle-aged population with normal or near-normal kidney function. 4 It has been shown in several communitybased cohorts that people who were reclassified to a higher GFR stage using the CKD-EPI study equation compared with the MDRD study equation had lower risk of adverse events. 5,6 Estimated glomerular filtration rate overestimates measured GFR when serum creatinine is rising and underestimates measured GFR when serum creatinine is falling. 7 Altered muscle mass (eg, reduced by amputation, paraplegia, immobilization, or a neuromuscular disorder and increased by dietary protein intake or creatine dietary supplements), some medications (like aminoglycosides or trimethoprim), and dietary intake (eg, vegetarians) can affect the creatinine levels and eGFR. 7 Akin et al 1 did not mention these factors as exclusion criteria.Finally, the National Kidney Disease Education Program recommends calibrating serum creatinine measurement to isotope dilution mass spectrometry. 8 In the ''Laboratory Measurements'' section of the article, Akin et al 1 mention cholesterol, uric acid, and hemoglobin measurements but the most important parameter of this study, creatinine, was not mentioned.In conclusion, in the light of recently published data, it is probably better to use the CKD-EPI equation to calculate eGFR in patients with near-normal or mildly impaired renal function.

Background Cirrhotic cardiomyopathy (CCM) is a well-known entity. The aim of this study was to compare left atrial three-dimensional (3D) volume and P-wave dispersion (PWd) in patients with cirrhosis and a healthy population. The secondary purpose was to assess the left phasic volumes and reservoir functions with 3D echocardiography for the prediction of an increased risk of poor outcomes in patients with cirrhosis. Methods The study included 50 patients with cirrhosis and 43 healthy control subjects without atrial fibrillation. All patients were assessed with two-dimensional (2D), 3D, and tissue Doppler transthoracic echocardiography. The PWd was calculated using a 12-lead surface electrocardiogram (ECG). Cirrhotic patients were followed up for 2.5 years for the evaluation of poor outcomes and the development of atrial fibrillation. Results Patients with cirrhosis were observed to have significantly higher left atrial phasic volumes such as minimal left atrial volume (3D-LAVmin, P = 0.004) and indexed LAVmin (3D-LAVImin, P = 0.0001), and significantly decreased left atrial reservoir functions such as left atrial emptying volume (3D-LAEV, P = 0,001), left atrial ejection fraction (3D-LAEF, P = 0,001) on 3D echocardiography. PWd was determined to be significantly longer in the cirrhotic group compared with the control group (P = 0.003). In the 2.5-year follow-up period, poor outcomes occurred in 34 patients (22 patients died, six patients had liver transplantation, six patients developed atrial fibrillation/AHRE episodes). In Cox regression analysis, the MELD score (HR, 1.16 (1.06–1.26), P = 0.001) and 3D-LAVImin (HR, 0.95 (0.86–1.00), P = 0.040) were significantly associated with all-cause mortality. Cirrhotic patients with LAVImin of >15 ml/m2 were seen to have poor survival (long rank P = 0.033). Conclusion The results of this study showed that patients with cirrhosis had higher left atrial volume, longer PWd and worse diastolic functions compared with the control group. Higher disease severity scores were associated with left atrial function and volume. In addition, left atrial volume measured with 3DE was a strong predictor of future adverse events, and minimal left atrial volumes had a higher prognostic value than any other left atrial function indices.

In patients with LBBB and high SDI (≥6%), LVEF values were overestimated and systolic volumes were underestimated by 2D echocardiography compared to 3D echocardiography.

Objective: Cardiovascular iron load is the leading cause of morbidity and mortality in beta-thalassemia major (β-TM). However, many patients remain asymptomatic until the late stage. In this cross-sectional study, we investigated the role of threedimensional (3D) echocardiography and endothelial dysfunction parameters in asymptomatic β-TM patients, and the relationship between these parameters and cardiac magnetic resonance imaging (MRI) T2* value.Methods: A total of 51 asymptomatic β-TM patients receiving regular blood transfusions were divided into two groups based on cardiac MRI-T2* values (MRI-T2*<20 ms and ≥20 ms), which MRI-T2*<20 ms determines myocardial iron load and evaluated by two-dimensional (2D) and 3D-echocardiography including endothelial dysfunction parameters. The relationships between ferritin levels, 2D and 3D-echocardiography measurements, endothelial dysfunction parameters, and cardiac MRI-T2* values were investigated.Results: All left ventricle ejection fraction (LVEF) obtained by 2D-echocardiography were normal (≥50%). LVEF-3D (53.25 ± 2.33 vs. 58.81 ± 1.02), SDI12 (6.53 ± 0.56 vs. 2.85 ± 0.48), and SDI16 (7.65 ± 0.75 vs. 3.26 ± 0.49) were significantly different and negatively correlated between groups with MRI-T2*<20 ms and ≥20 ms, respectively. Flow-mediated dilatation (FMD) (6.08% ± 0.34% vs. 14.46% ± 1.12), aortic strain (7.79% ± 2.19% vs. 12.76% ± 4.19), ferritin levels were significantly different and negatively correlated between groups with MRI-T2*<20 ms and ≥20 ms, respectively. Higher ferritin, SDI12/16 were significant independent predictors of MR-T2* < 20 ms. SDI16 > 5.5, SDI12 > 4.3 predicted MRI-T2*<20ms with a sensitivity of 92%, specificity of 81% (AUC 0.85, P < .001), and sensitivity of 92%, specificity of 78% (AUC 0.83, P < .001), respectively. Conclusion:SDI12/16 calculated by 3D-echocardiography may be a promising predictors of cardiovascular iron load and, decreased LVEF-3D, FMD, and aortic strain might be good indicators of subclinical cardiovascular involvement of β-TM. How to cite this article: Solmaz H, Cabuk AK, Altin Z, Albudak Ozcan E, Ozdogan O. Left ventricular systolic dyssynchrony index and endothelial dysfunction parameters as subclinical predictors of cardiovascular involvement in patients with beta-thalassemia major. Echocardiography.