contribution of whole blood viscosity to the process of aortic valve sclerosis

Objective: We aimed to investigate whether increased whole blood viscosity [WBV] could be an important factor for the occurrence of aortic valve sclerosis [AVS]

Subjects and Methods: A total of 209 patients were enrolled in the study. WBV was calculated using the hematocrit and total plasma protein at a low shear rate [LSR] and a high shear rate [HSR]. AVS was defined as irregular valve thickening and calcification [without evidence of outflow obstruction] documented by a peak transvalvular velocity < 2.5 m/s on echocardiographic examination. The patient group consisted of 109 patients with AVS [77 females, 32 males], and 100 subjects without AVS [65 females, 35 males] were assigned to the control group

Results: In the AVS group, WBV values were significantly higher for HSR [17.4 +/- 0.5 vs. 17.1 +/- 0.7 208 s[-1], p < 0.001] and LSR [65.9 +/- 12.5 vs. 59.7 +/- 16.7 0.5 s[-1], p = 0.002]. In multivariate logistic regression analysis, WBV at HSR and LSR were independent predictors of AVS [odds ratio, OR: 2.24, 95% confidence interval, CI: 1.38-3.64, p = 0.001; OR: 1.026, 95% CI: 1.006-1.046, p = 0.01, respectively]. Receiver-

operating characteristic [ROC] curve analysis indicated that a WBV cutoff value of 65.4 at LSR had a sensitivity of 46.8% and a specificity of 60.0% [area under the ROC curve, AUC: 0.615, 95% CI: 0.535-0.696, p = 0.004], and a WBV cutoff value of 17.1 at HSR had a sensitivity of 61.5% and specificity of 53% [AUC: 0.648, 95% CI: 0.571-0.725, p < 0.001] for the prediction of AVS

Conclusion: This study demonstrated that WBV was independently associated with AVS. WBV could be an indicator of inflammation and vessel remodeling without evidence of outflow obstruction

The angiographic aspects of myocardial bridges in Turkish patients who have undergone coronary angiography

<p><b>INTRODUCTION</b>Little is known of the clinical significance of myocardial bridges, which may be recognised as the narrowing of the systolic coronary artery as seen in an angiography. In this study, our goal was to review the literature information about the anatomic aspects, the clinical manifestations and implications, and the angiographic characteristics.</p><p><b>MATERIALS AND METHODS</b>The angiographic data of 7200 adult patients undergoing coronary angiography were retrospectively analysed for the diagnosis of myocardial bridge. The main angiographic evidence of a myocardial bridge that we required was the narrowing of a systolic coronary artery resulting in at least 50% reduction of lumen diameter in comparison with the diastolic phase. All coronary angiograms were reviewed independently by at least 2 of the authors and the case was included only if there was a consensus that the myocardial bridge resulted in 50% narrowing or more.</p><p><b>RESULTS</b>Myocardial bridge was present in 29 (0.4%) of the 7200 coronary angiographies. The location of the myocardial bridge was in the left anterior descending coronary artery in 28 cases (96.5%), and the left circumflex coronary artery in 1 case (3.4%). Myocardial bridge was most common in the middle segment of the left anterior descending coronary artery (78.5 %). Each of these patients with myocardial bridge was referred for angiography because of symptom of chest pain alone or symptom of chest pain, palpitations and dyspnoea. Of the 29 patients with myocardial bridge, 2 patients without any symptom, demonstrated ischaemia as assessed by Tc- 99m MIBI myocardial perfusion scintigraphy.</p><p><b>CONCLUSION</b>Chest pain was the common reason for angiography in patients with myocardial bridge. The incidence of myocardial bridge may vary according to population. Myocardial bridge is more frequently found in the middle segment of the left anterior descending coronary artery.</p>

Single coronary artery arising from the left sinus of valsalva

A single coronary artery is a rare congenital anomaly of the coronary arteries where only one coronary artery arises from the aortic trunk by a single coronary ostium, supplying the entire heart. We report a case of a 57-year-old woman with atypical chest pain, in whom coronary angiography showed a L-I subtype single coronary artery [arising from a single ostium in the left sinus of valsalva] without associated cardiovascular disease. The clinical significance and subtype of the single coronary artery are discussed