Abstract
SummaryObjectiveIn Turkey, a type of smokeless tobacco called Maras powder (MP) is widely used in the south-eastern region. Smokeless tobacco is found in preparations for chewing and for absorption by the nasal and oral mucosae. The purpose of this study was to investigate whether MP damages intra- and inter-atrial conduction delay and left atrial (LA) mechanical function as much as cigarette smoking.MethodA total of 150 chronic MP users (50 males, 32.5 ± 5.4 years), smokers (50 males, 32.1 ± 6.0 years) and controls (50 males, 30.1 ± 5.8 years) were included in the study. LA volumes were measured echocardiographically according to the biplane area–length method. Atrial electromechanical coupling was measured with tissue Doppler imaging and LA mechanical function parameters were calculated.ResultsThe LA passive emptying fraction was significantly decreased and LA active emptying volume (LAAEV) was significantly increased in the MP group (p = 0.012 and p = 0.024, respectively), and the LA active emptying fraction (LAAEF) was significantly increased in the smokers (p = 0.003). There was a positive correlation between the amount of MP used and smoking (pack years) with LAAEV and LAAEF (r = 0.26, p = 0.009 and r = 0.25, p = 0.013, respectively). Lateral atrial electromechanical intervals (PA) were significantly higher in MP users, and the septal mitral PA was statistically higher in the smokers (p = 0.05 and p = 0.04, respectively).ConclusionWe suggest that atrial electromechanical coupling intervals were prolonged and LA mechanical function was impaired in MP users and smokers, but there was no significant difference between the MP users and smokers. These findings may be markers of subclinical cardiac involvement and tendency for atrial fibrillation.
Highlights
We suggest that atrial electromechanical coupling intervals were prolonged and left atrial (LA) mechanical function was Department of Cardiology, Faculty of Medicine, Kahramanmaras Sutcuimam University, Kahramanmaras, Turkey Ahmet Akcay, MD M Naci Aydin, MD Gurkan Acar, MD Mehmet Akgungor, MD Eren Cabioglu, MD İdris Ardic, MD
Body mass index (BMI), body surface area (BSA), systolic and diastolic blood pressure, heart rate, LV end-diastolic diameter, interventricular septal thickness, posterior wall thickness, left ventricular ejection fraction (LVEF), LA dimension, mitral E velocity, mitral A velocity, E/A ratio, systolic pulmonary artery pressure, and glucose, total cholesterol, triglyceride, high-density lipoprotein (HDL) cholesterol and low-density lipoprotein (LDL) cholesterol levels were similar between the three groups (p > 0.05)
The main finding of this study was that atrial electromechanical coupling intervals were prolonged and left atrial mechanical function was impaired in Maras powder (MP) users and cigarette smokers
Summary
A total of 150 chronic MP users (50 males, mean age 32.5 ± 5.4 years), cigarette smokers (50 males, mean age 32.1 ± 6.0 years) and controls (50 males, mean age 30.1 ± 5.8 years) who referred to various out-patient departments (cardiology clinic, public health clinic, internal medicine clinic, cardiovascular surgery clinic) and were matched for age and gender, were included in the study. A 12-lead electrocardiogram recording obtained from the same derivation (DII derivation) was recorded continuously during the echocardiographic examination in all study subjects. Two-dimensional, M-mode, pulsed and colour-flow Doppler echocardiographic examinations were performed by a cardiologist who was blinded to the clinical details and findings of other examinations of each subject and control. M-mode measurements and conventional Doppler echocardiographic examinations were performed according to the guidelines of the American Society of Echocardiography.[18]. For atrial electromechanical intervals in the apical four-chamber view, the pulsed Doppler sample volume was placed at the level of the LV lateral mitral annulus, septal mitral annulus and right ventricular (RV) tricuspid annulus. Intra-observer variability was assessed in 20 subjects selected randomly from the study groups by repeating the measurements under the same basal conditions. Reproducibility of atrial electromechanical intervals obtained by TDI was assessed by coefficient of variation (CV) between measurements. The power of our study was calculated to be 0.96
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