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Does left ventricular function deteriorate in patients with nasal polyposis?/nazal polipozisli hastalarda sol ventrikul fonksiyonlari bozuluyor mu?

Dear Editor,

We read with great interest the recent article entitled "Evaluation of right ventricular functions in patients with nasal polyposis: an observational study" written by Simsek et al. (1). They aimed to assess the right ventricular functions in patients with nasal polyposis using the strain and strain rate echocardiography. They showed a subclinical deficit of the right ventricular longitudinal functions in patients with nasal polyposis who are considered to have normal right ventricular functions. We believe that these findings will enlighten further studies about echocardiographic evaluation of patients with nasal polyposis. Thanks to the authors for their valuable contribution.

Nasal polyposis (NP) is a chronic inflammatory disorder of nasal and sinus mucosa. Larger nasal polyps can block nasal passage and may result in hypoxia and hypercapnia. Cardiovascular complications of NP depend on chronic upper airway obstruction. It has been clearly shown that right ventricle function is impaired in various diseases due to chronic hypoxia (2). However, there is little information on the left ventricular (LV) function in patients with chronic hypoxia. Although LV systolic function was preserved, diastolic function was impaired in hypoxia. Ventricular interaction may impair LV diastolic function (3). Obstructive sleep apnea is another cause of chronic hypoxia and can lead to cardiovascular disturbances. Altekin et al. (4) evaluated LV longitudinal functions with two- dimensional strain echocardiography and showed that OSA deteriorates LV systolic function, and the degree of deterioration is proportionate with the disease severity.

The current study (1) assessed the right ventricular function using the strain and strain rate echocardiography but not LV function. We strongly believe that future large-scale prospective studies are needed to examine the LV function in patients with NP. On the other hand, it would be better, if they also evaluated right ventricular function using several parameters including right ventricular index of myocardial performance, tricuspid annular plane systolic excursion, and myocardial acceleration during isovolumic contraction, right ventricular fractional area change. Because these quantitative measurement are simple and reproducible, and they does not require sophisticated equipment or prolonged image analysis.


(1.) Simsek E, Simsek Z, Tas MH, Kucur C, Gunay E, Ucuncu H. Evaluation of right ventricular functions in patients with nasal polyposis: an observational study. Anadolu Kardiyol Derg 2013; 13: 251-6.

(2.) Duman D, Naiboglu B, Esen HS, Toros SZ, Demirtunc R. Impaired right ventricular function in adenotonsillar hypertrophy. Int J Cardiovasc Imaging 2008; 24: 261-7. [CrossRef]

(3.) Itoh A, Tomita H, Sano S. Doppler echocardiographic assessment of left ventricular diastolic function in chronic hypoxic rats. Acta Med Okayama 2009; 63: 87-96.

(4.) Altekin RE, Yanikoglu A, Karakas MS, Ozel D, Yildirim AB, Kabukcu M. Evaluation of subclinical left ventricular systolic dysfunction in patients with obstructive sleep apnea by automated function imaging method; an observational study. Anadolu Kardiyol Derg 2012; 12: 320-30.

Sait Demirkol, Sevket Balta, Mustafa Cakar *, Ugur Kucuk Departments of Cardiology and * Internal Medicine, GATA, Ankara-Turkey

Address for Correspondence/Yazisma Adresi: Dr. Sait Demirkol GATA Kardiyoloji Anabilim Dali, Tevfik Saglam Cad., Etlik, Ankara-Turkiye

Phone: +90 312 304 42 81


Available Online Date/Cevrimici Yayin Tarihi: 10.09.2013

doi: 10.5152/akd.2013.209

Authors Reply

Dear Editor,

We have read the letter to the editor with great interest. Firstly, thank you for your comments about our paper published in The Anatolian Journal of Cardiology (1).

If the patients with nasal polyposis left untreated, it could affect firstly right ventricle functions and then it could cause cardiovascular complications. However, at the present time there is not any cut-off value (for hypoxia and pulmonary arterial pressure value) for these cardiovascular complications. Vonk-Noordegraf et al. (2) reported that left ventricle functions preserved in chronic obstructive pulmonary disease patients with mild hypoxemia by a study with MRI (magnetic resonance imaging). Amano et al. (3) showed left ventricle systolic functions did not change and irresponsive to even if right ventricle systolic pressures decreased in patients with pulmonary hypertension. In chronic hypoxemia it is expected that primarily effects on left ventricle diastolic functions. Increased right ventricle pressures and volume overload deviate interventricular septum to the left and decrease left ventricular filling and this could cause diastolic dysfunction (4). This effect compensates by increased atrial contraction in patients with chronic and mild pulmonary hypertension. However in acute and excessive pressure overload it could not compensate and develops diastolic dysfunction (5). Patient group of our study included chronic and mild pulmonary hypertension (31.2 [+ or -] 5.8 mmHg) patients.

Right ventricular functions can be evaluated by different echocardiographic techniques (RV MPI, TAPSE, RV IVA, RV FAC etc.). At the present time the most important limitations of conventional echocardiographic measurements are relation with operator and subjective values of measurements. Strain-strain rate echocardiographic evaluation of right ventricle functions are effective techniques because of minimal operator dependency and very low intra-interobserver variability rates (6, 7). Therefore, in our study we choose these techniques for evaluation of right ventricle functions.

Ziya Simsek, M. Hakan Tas

Department of Cardiology, Faculty of Medicine, Ataturk University, Erzurum-Turkey


(1.) Simsek E, Simsek Z, Tas MH, Kucur C, Gunay E, Ucuncu H. Evaluation of right ventricular functions in patients with nasal polyposis: an observational study. Anadolu Kardiyol Derg 2013; 13: 251-6.

(2.) Vonk-Noordegraaf A, Marcus JT, Holverda S, Roseboom B, Postmus PE. Early changes of cardiac structure and function in COPD patients with mild hypoxemia. Chest 2005; 127: 1898-903. [CrossRef]

(3.) Amano H, Toyoda S, Arikawa T, Inami S, Otani N, Nishi Y, et al. Left ventricular function in pulmonary hypertension. Heart Vessels 2012; 12: 505-9.

(4.) Morris-Thurgood JA, Frenneaux MP. Diastolic ventricular interaction and ventricular diastolic filling. Heart Fail Rev 2000; 5: 307-23. [CrossRef]

(5.) Allemann Y, Rotter M, Hutter D, Lipp E, Sartori C, Scherrer U, et al. Impact of acute hypoxic pulmonary hypertension on LV diastolic function in healthy mountaineers at high altitude. Am J Physiol Heart Circ Physiol 2004; 286: 856-62.

(6.) Voight JU, Exner B, Schmiedehausen K, Huc U, Hzermeyer C, Reulbach U, et al. Strain rate imaging during dobutamine stress echocardiography provides objective evidence of inducible ischemia. Circulation 2003; 107: 2120-6. [CrossRef]

(7.) Gondi S, Dokainish H. Right ventricular tissue Doppler and strain imaging: Ready for clinical use? Echocardiography 2007; 24: 522-32. [CrossRef]

Address for Correspondence/Yazisma Adresi: Dr. Ziya Simsek Osman Gazi Mah., Gokdemir Sitesi A Blok, Kat: 6 Daire No: 29, 25100 Erzurum-Turkiye

Phone: +90 505 884 15 96


Available Online Date/Cevrimici Yay?n Tarihi: 10.09.2013
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Article Details
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Author:Demirkol, Sait; Balta, Sevket; Cakar, Mustafa; Kucuk, Ugur
Publication:The Anatolian Journal of Cardiology (Anadolu Kardiyoloji Dergisi)
Article Type:Letter to the editor
Date:Sep 1, 2013
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