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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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 Sjögren'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.

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.

Objective:We used real time, three-dimensional transthoracic echocardiography (3DTTE) to evaluate left atrial (LA) volume and mechanical function in patients with primary Sjögren'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. K E Y W O R D S echocardiography, left atrial volume, Sjögren's syndrome 716 | HIDAYET ET Al.clinics and 42 healthy volunteers were enrolled. SS was diagnosed using the American/European consensus criteria. 13 Written informed consent was obtained from all patients and control volunteers. Our local ethics committee approved the work. We recorded detailed medical histories, performed complete physical examinations, and calculated body surface areas (BSAs). Blood pressure was measured three times at 5-minute intervals with each subject sitting, and the mean was calculated. Age, sex, and patient disease duration were recorded. Resting 12-lead electrocardiography (ECG) was performed. Individuals under 18 or over 60 years of age, or those with structural heart disease, patients with any cardiac symptoms, hypertension, coronary artery disease, moderate or severe heart valve disease, atrial fibrillation, heart failure, a history of renal or hepatic insufficiency, diabetes mellitus, chronic systemic disease, and/or any history of malignancy, were excluded. | Two-dimensional echocardiography (2DE)A Philips IE-33 instrument (Bothell) fitted with an S5-1 transducer was used for transthoracic 2DE. All examinations were performed by two cardiologists blinded to clinical data, and the data were evaluated as suggested by the American/European communities. We measured the LA diameter and left ventricular (LV) end-systolic diameter (LVESD). Thicknesses of the left ventricular end-diastolic diameter (LVEDD), interventricular septum (IVSD), and left ventricular posterior wall (LVPW) were measured in end-diastole on the 2DE recordings. These measurements were used to calculate the LVM using the formula originally validated by Devereux et al 14 The LV mass index (LVMI) 15 was defined as LV mass/BSA (body weight × 0 .425 × height × 0.725 × 0.007184). The transmitral flow velocities (E and A) were measured during apical four-ca...