title: Evaluation of left atrial mechanical function and atrial conduction abnormalities in Maras powder (smokeless tobacco) users and smokers.
abstract: OBJECTIVE
  In 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.
  
  
  METHODS
  A 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.
  
  
  RESULTS
  The 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).
  
  
  CONCLUSIONS
  We 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.
authors.affiliation: Department of Cardiology, Faculty of Medicine, Kahramanmaras Sutcuimam University, Kahramanmaras, Turkey.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Akcay
authors.affiliation: Department of Cardiology, Faculty of Medicine, Kahramanmaras Sutcuimam University, Kahramanmaras, Turkey.
authors.forename: M Naci
authors.initials: MN
authors.lastname: Aydin
authors.affiliation: Department of Cardiology, Faculty of Medicine, Kahramanmaras Sutcuimam University, Kahramanmaras, Turkey.
authors.forename: Gurkan
authors.initials: G
authors.lastname: Acar
authors.affiliation: Department of Cardiovascular Surgery, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey.
authors.forename: Bulent
authors.initials: B
authors.lastname: Mese
authors.affiliation: Department of Cardiology, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Çetin
authors.affiliation: Department of Cardiology, Faculty of Medicine, Kahramanmaras Sutcuimam University, Kahramanmaras, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Akgungor
authors.affiliation: Department of Cardiology, Faculty of Medicine, Kahramanmaras Sutcuimam University, Kahramanmaras, Turkey.
authors.forename: Eren
authors.initials: E
authors.lastname: Cabioglu
authors.affiliation: Department of Cardiovascular Surgery, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey.
authors.forename: Orhan
authors.initials: O
authors.lastname: Bozoglan
authors.affiliation: Department of Cardiology, Faculty of Medicine, Kahramanmaras Sutcuimam University, Kahramanmaras, Turkey.
authors.forename: Idris
authors.initials: I
authors.lastname: Ardic
authors.affiliation: Department of Cardiology, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey.
authors.forename: Musa
authors.initials: M
authors.lastname: Çakici
mesh_terms: D000328:Adult; D001281:Atrial Fibrillation / Q000139:chemically induced* / Q000000981:diagnostic imaging; D016279:Atrial Function, Left / Q000187:drug effects*; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D018619:Echocardiography, Doppler, Pulsed; D005260:Female; D006329:Heart Conduction System / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000503:physiopathology; D006801:Humans; D008297:Male; D011208:Powders; D011237:Predictive Value of Tests; D012307:Risk Factors; D014030:Tobacco, Smokeless / Q000009:adverse effects*; D014421:Turkey
chemical_list: D011208:Powders