Reduced-Dose Systemic Fibrinolysis in Massive Pulmonary Embolism: A Pilot Study.

OBJECTIVE: Severe pulmonary embolism (PE) has a high mortality rate, which can be lowered by thrombolytic therapy (TT). However, full-dose TT is associated with major complications, including life-threatening bleeding. The aim of this study was to explore the efficacy and safety of extended, low-dose administration of tissue plasminogen activator (tPA) on in-hospital mortality and outcomes in massive PE. METHODS: This was a single-center, prospective cohort trial at a tertiary university hospital. A total of 37 consecutive patients with massive PE were included. A peripheral intravenous infusion was used to administer 25 mg of tPA over 6 hours. The primary endpoints were in-hospital mortality, major complications, pulmonary hypertension, and right ventricular dysfunction. The secondary endpoints were 6-month mortality and pulmonary hypertension and right ventricular dysfunction 6 months after the PE. RESULTS: The mean age of the patients was 68.76±14.54 years. The mean pulmonary artery systolic pressure (PASP; 56.51±7.34 mmHg vs. 34.16±2.81 mmHg, P<0.001) and right/left ventricle diameter (1.37±0.12 vs. 0.99±0.12, P<0.001) decreased significantly after TT. Tricuspid annular plane systolic excursion (1.43±0.33 cm vs. 2.07±0.27 cm, P<0.001), myocardial performance index (0.47±0.08 vs. 0.55±0.07, P<0.001), and systolic wave prime (9.6±2.8 vs. 15.3±2.6) increased significantly after TT. No major bleeding or stroke was observed. There was one in-hospital death and two additional deaths within 6 months. No cases of pulmonary hypertension were identified during follow-up. CONCLUSION: The results of this pilot study suggest that an extended infusion of low-dose tPA is a safe and effective therapy in patients with massive PE. This protocol was also effective in decreasing PASP and restoring right ventricular function.

The predictive value of galectin-3 levels on left atrial low voltage areas assessed by high-density mapping in patients with paroxysmal atrial fibrillation.

Aims: Galectin-3 is an inflammation biomarker that is associated with atrial fibrosis and plays a role in the development of atrial fibrillation (AF). Low voltage areas (LVAs) identified using an electroanatomical mapping system represent the presence of fibrotic tissue. The present study aimed to determine the relationship between coronary sinus (CS) serum sampling of galectin-3 levels and the presence and extent of LVA in patients with paroxysmal AF. Methods: A total of 115 consecutive paroxysmal AF patients underwent pulmonary vein isolation (PVI) included prospectively in the study. Voltage mapping was performed before PVI during sinus rhythm guided by multipolar high-density mapping catheter and LVAs were defined as regions where bipolar peak to peak voltage was <0.5 mV. Galectin-3 levels were measured via enzyme-linked immunosorbent assay. Results: CS serum sampling of galectin-3 levels was significantly higher in paroxysmal AF patients with LVA than those without LVA (16.5 ± 3.7 ng/ml vs. 10.2 ±2.7 ng/ml, respectively, p < .001). CS serum sampling of galectin-3 levels was significantly higher in paroxysmal AF patients with moderate and severe LVA than in paroxysmal AF patients with mild LVA (17 ± 3.5 ng/ml and 20.1 ± 1.3 ng/ml vs. 13.3 ± 2.3 ng/ml, respectively, p = .002). In the multivariate analysis female gender (odds ratio [OR] = 7.537, 95% confidence interval [CI]: 1.011-56.195; p = .049), left atrium volume (OR = 1.326, 95% CI: 1.052-1.67; p = .017), and CS serum sampling of galectin-3 levels (OR = 1.704, 95% CI: 1.169-2.483; p = .006) were significant and independent predictors for LVAs. Conclusion: In this study, we found that the CS serum sampling of galectin-3 levels increased with the extent of LVA and was an independent predictor for the presence of LVA.

Assessment of Arterial Stiffness with Cardio-Ankle Vascular Index in Patients with Mitral Annular Calcification.

OBJECTIVE: Arterial stiffness is related to arteriolosclerotic diseases and is a marker of adverse cardiovascular events. Mitral annular calcification (MAC) is progressive calcium deposition on the posterior and inferior mitral annulus and is associated with atherosclerotic cardiovascular diseases. Cardio-ankle vascular index (CAVI) is a measurement technique used to estimate the degree of arterial stiffness without effect from blood pressure. The aim of this study is to research arterial stiffness using CAVI in patients with MAC. MATERIALS AND METHODS: The study was cross-sectional and observational and included 98 patients with MAC confirmed by echocardiography who referred to the cardiology clinics and met study inclusion criteria and 38 controls without MAC. CAVI measurements were obtained by using the Vascular Screening System VaSera VS-1000 (Fukuda Denshi, Tokyo, Japan) device. RESULTS: The two groups were similar in terms of demographic characteristics, including age, sex, hypertension, coronary artery disease, body surface area, and smoking (P > .05). Left atrial volume index was significantly higher in patients with MAC compared with the control group (P < .001). Right arm CAVI, left arm CAVI, and mean CAVI were significantly higher in the MAC group than the control group (P = .037, P = .005, and P = .014, respectively) and increased with MAC severity. There was a significant positive correlation between mean CAVI and MAC grade (r = 0.278, P = .001). Also, when ankle-brachial index (ABI) was measured with CAVI, left and right extremity ABI values were significantly lower in patients with MAC (P = .017 and P = .005, respectively). CONCLUSION: CAVI increased in all patients with MAC and associated with increasing grade of calcification.

Usefulness of Heart-Type Fatty Acid-Binding Protein and Myocardial Performance Index for Early Detection of 5-Fluorouracil Cardiotoxicity.

In the present study, we aimed to evaluate temporal changes in heart-type fatty acid-binding protein (h-FABP) and myocardial performance index (Tei index) following administration of 5-fluorouracil (5-FU), a chemotherapeutic agent associated with myocardial ischemia induced by coronary vasospasm. Thirty-two patients with cancer receiving their first 5-FU-based chemotherapy were included in the study. Prior to chemotherapy and 24 hours after the initiation of chemotherapy, all patients underwent a comprehensive echocardiographic examination. Blood samples were taken for h-FABP and troponin I (TnI) measurements at different time points during the first 24 hours of 5-FU administration. Postinfusion echocardiography revealed worsening in Tei index (0.37 ± 0.08 vs 0.43 ± 0.07, P < .001). Clinically overt cardiotoxicity was evident in 4 (12.5%) of our patient population. Heart-type fatty acid binding protein and TnI levels were within normal ranges at all time points. Our results suggest that ischemia coronary vasospasm due to 5-FU cardiotoxicity should be reviewed. Furthermore, Tei index might be a sensitive indicator of occult 5-FU cardiotoxicity.

The Relationship between GRACE Score and Epicardial Fat Thickness in non-STEMI Patients / Relação entre Escore GRACE e Espessura da Gordura Epicárdica em Pacientes com IMSSST

Abstract Background: GRACE risk score (GS) is a scoring system which has a prognostic significance in patients with non-ST segment elevation myocardial infarction (non-STEMI). Objective: The present study aimed to determine whether end-systolic or end-diastolic epicardial fat thickness (EFT) is more closely associated with high-risk non-STEMI patients according to the GS. Methods: We evaluated 207 patients who had non-STEMI beginning from October 2012 to February 2013, and 162 of them were included in the study (115 males, mean age: 66.6 ± 12.8 years). End-systolic and end-diastolic EFTs were measured with echocardiographic methods. Patients with high in-hospital GS were categorized as the H-GS group (in hospital GS > 140), while other patients were categorized as the low-to-moderate risk group (LM-GS). Results: Systolic and diastolic blood pressures of H-GS patients were lower than those of LM-GS patients, and the average heart rate was higher in this group. End-systolic EFT and end-diastolic EFT were significantly higher in the H-GS group. The echocardiographic assessment of right and left ventricles showed significantly decreased ejection fraction in both ventricles in the H-GS group. The highest correlation was found between GS and end-diastolic EFT (r = 0.438). Conclusion: End-systolic and end-diastolic EFTs were found to be increased in the H-GS group. However, end-diastolic EFT and GS had better correlation than end-systolic EFT and GS.

Resumo Fundamento: O escore de risco GRACE (SG) é um sistema com significado prognóstico para pacientes com infarto do miocárdio sem supradesnivelamento do segmento ST (IMSSST). Objetivo: Determinar se a espessura da gordura epicárdica (EGE) ao final da sístole ou da diástole é mais associada com pacientes de IMSSST de alto risco de acordo com o SG. Métodos: Este estudo avaliou 207 pacientes com IMSSST desde outubro de 2012 a fevereiro de 2013, sendo 162 deles incluídos no estudo (115 homens, idade média: 66,6 ± 12,8 anos). Mediu-se a EGE ao final da sístole e da diástole com métodos ecocardiográficos. Pacientes com alto SG intra-hospitalar (SG > 140) foram classificados como grupo SG-A, enquanto os outros foram classificados como grupo de risco baixo-a-moderado (grupo SG-BM). Resultados: As pressões arteriais sistólica e diastólica dos pacientes SG-A foram mais baixas do que as dos pacientes SG-BM, sendo a frequência cardíaca média mais alta nesse grupo. A EGE ao final da sístole e a EGE ao final da diástole foram significativamente mais altas no grupo SG-A. A avaliação ecocardiográfica dos ventrículos direito e esquerdo mostrou fração de ejeção significativamente reduzida em ambos os ventrículos no grupo SG-A. Observou-se maior correlação entre SG e EGE ao final da diástole (r = 0,438). Conclusão: A EGE ao final da sístole e a EGE ao final da diástole mostraram-se aumentadas no grupo SG-A. Entretanto, a EGE ao final da diástole apresentou melhor correlação com o SG do que a EGE ao final da sístole.

The Relationship between GRACE Score and Epicardial Fat Thickness in non-STEMI Patients.

BACKGROUND: GRACE risk score (GS) is a scoring system which has a prognostic significance in patients with non-ST segment elevation myocardial infarction (non-STEMI). OBJECTIVE: The present study aimed to determine whether end-systolic or end-diastolic epicardial fat thickness (EFT) is more closely associated with high-risk non-STEMI patients according to the GS. METHODS: We evaluated 207 patients who had non-STEMI beginning from October 2012 to February 2013, and 162 of them were included in the study (115 males, mean age: 66.6 ± 12.8 years). End-systolic and end-diastolic EFTs were measured with echocardiographic methods. Patients with high in-hospital GS were categorized as the H-GS group (in hospital GS > 140), while other patients were categorized as the low-to-moderate risk group (LM-GS). RESULTS: Systolic and diastolic blood pressures of H-GS patients were lower than those of LM-GS patients, and the average heart rate was higher in this group. End-systolic EFT and end-diastolic EFT were significantly higher in the H-GS group. The echocardiographic assessment of right and left ventricles showed significantly decreased ejection fraction in both ventricles in the H-GS group. The highest correlation was found between GS and end-diastolic EFT (r = 0.438). CONCLUSION: End-systolic and end-diastolic EFTs were found to be increased in the H-GS group. However, end-diastolic EFT and GS had better correlation than end-systolic EFT and GS.

Assessment of Silent Neuronal Injury Following Coronary Angiography and Intervention in Patients With Acute Coronary Syndrome.

The aim of this study is to evaluate the incidence and predictors of silent neuronal injury (SNI) after coronary angiography (CAG) and intervention by serial measurement of serum neuron-specific enolase (NSE) in patients presented with acute coronary syndrome (ACS). Ninety-eight consecutive patients presented with ACS and underwent CAG and intervention were included in the study. The NSE levels significantly increased after CAG and intervention compared to baseline levels (22.03 ± 27.70 and 10.08 ± 3.15 consecutively). Left ventricular ejection fraction in the SNI+ group was significantly lower than that in the SNI- group (43.71% ± 12.51%, 50.84% ± 9.34%, P = .002). Maximal creatinine kinase myocardial band, troponin I, and SYNTAX score of the SNI+ group were significantly higher than those of the SNI- group (103.83 ± 99.22, 51.92 ± 78.33, P = .006; 50.04 ± 66.18, 19.18 ± 30.50, P = .002; 103.83 ± 99.22, 51.92 ± 78.33, P = .006; and 50.04 ± 66.18, 19.18 ± 30.50, P = .002 successively). SYNTAX score and performing percutaneous coronary intervention were the independent predictors of SNI (P = .009, odds ratio [OR] = 1.06, 95% confidence interval [CI] = 1.014-1.107, P = .036, OR = 4.262, 95% CI = 1.097-16.56). Percutaneous coronary intervention and coronary artery lesion complexity may increase the risk of SNI in patients with ACS.

Association of Mitral Annular Calcification with Left Ventricular Mechanics: A Speckle Tracking Study.

BACKGROUND: Mitral annular calcification (MAC) is a common echocardiographic finding in clinical practice and is associated with cardiovascular risk factors and atherosclerosis. However, data regarding left ventricular (LV) functions are lacking. We aimed to evaluate the relationship between MAC and LV mechanical functions with the utility of two-dimensional speckle tracking echocardiography (2DSTE). METHODS: The study involved 91 patients with MAC and 48 control subjects. Mitral annular thickness of 1-2 mm was reported as mild, 2-5 mm as moderate, and >5 mm as severe MAC. All patients underwent 2D echocardiography. RESULTS: MAC was observed in 91 (65.5%) patients. Of LV diastolic parameters, E/Em ratio, LAVI, LV mass index, and t-LV UR were increased. Of LV systolic parameters, GLS and Sm were decreased, whereas Ar, Ar-rate systole, peak LV twist, peak LV twist rate, LV-tor, and MPI were increased, which were all correlated with presence and severity of MAC. Multivariate linear regression analysis showed that LV mass index (ß = 0.225, P = 0.012), t-LV UR (ß = 0.370, P < 0.001), LV mass index (ß = 0.183, P = 0.025), MPI (ß = 0.288, P < 0.001), and GLS (ß = -0.385, P < 0.001) were significantly associated with MAC severity. CONCLUSION: The presence and severity of MAC is associated with impaired LV systolic and diastolic functions. Therefore, preventive strategies might be taken in patients with MAC to avoid LV systolic and diastolic dysfunction.

Relation of epicardial fat thickness to subclinical right ventricular dysfunction assessed by strain and strain rate imaging in subjects with metabolic syndrome: a two-dimensional speckle tracking echocardiography study.

BACKGROUND: Right ventricular (RV) function is known to be impaired in the presence of metabolic syndrome (MetS). Epicardial adipose tissue is a metabolically active organ that generates various bioactive molecules, which might affect cardiac function and morphology. Thus, we hypothesized that RV dysfunction in patients with MetS may be related to increased epicardial fat thickness (EFT) in these patients. In patients with MetS, we aimed to assess the relation of EFT with RV function using two-dimensional speckle tracking echocardiography (2DSTE)-derived strain and strain rate imaging. METHODS: The study involved 76 subjects with MetS and 61 subjects without MetS. Biventricular structure and function together with EFT were evaluated by conventional echocardiography. RV free and septal walls strain (RVFW-S & RVSW-S), systolic and early diastolic strain rates (RVSRs & RVSRe) were evaluated by 2DSTE. RESULTS: Epicardial fat thickness was significantly higher in subjects with MetS (6.45 ± 1.48 mm vs. 5.49 ± 1.05 mm, P < 0.001). RVFW-S (-22.95 ± 4.97% vs. -24.96 ± 3.63%; P = 0.007), RVSRs (1.53 ± 0.33/sec vs. -1.70 ± 0.33/sec; P = 0.002), and RVSRe (1.40 ± 0.44/sec vs. 1.75 ± 0.49/sec; P < 0.001) were all lower in subjects with MetS, while RVSW-S did not differ. Multiple regression analysis showed that EFT was independently associated with RVFW-S (ß = -0.547, P < 0.001), RVSRs (ß = -0.332, P = 0.001), and RVSRe (ß = -0.187, P = 0.019) in subjects with MetS. CONCLUSIONS: Metabolic syndrome is associated with subclinical RV systolic and diastolic dysfunction. In subjects with MetS, increased EFT is independently related to RV systolic and diastolic dysfunction.

The influence of dipper/nondipper blood pressure patterns on global left ventricular systolic function in hypertensive diabetic patients: a speckle tracking study.

OBJECTIVE: This study was designed to investigate the effects of dipper and nondipper patterns on global longitudinal systolic functions of left ventricle (LV) by means of two-dimensional speckle tracking echocardiography in treated hypertensive diabetic patients with preserved left ventricular ejection fraction. PATIENTS AND METHODS: We enrolled 86 hypertensive diabetic patients. Twenty-four hour ambulatory blood pressure monitoring and echocardiography were performed in each patient. The relationship between dipper/nondipper patterns and global longitudinal strain (GLS) was analyzed. RESULTS: Fifty-one (59.3%) patients had a nondipper pattern. GLS and average global longitudinal strain rate systolic (GLSRs) were significantly decreased (-17.8±1.5, -19.6±1.9; P<0.001 vs. -1.01±0.171, -1.18±0.19; P<0.001) and E/E' was significantly increased (9.7±4.3, 7.7±3.8; P=0.033) in nondippers compared with dippers. Multivariate linear regression analysis showed that the difference between mean arterial pressure (MAP)-asleep and MAP-awake and left ventricular mass index (LVMI) was associated independently with GLS and GLSRs (MAP-asleep-MAP-awake ß=-0.292, P=0.004; ß=-0.305, P=0.001 and LVMI ß=-0.373, P=0.001, ß=-0.517, P<0.001; respectively). E/E' was associated independently with MAP-asleep-MAP-awake (ß=0.241, P=0.022), age (ß=-0.272, P=0.012), male sex (ß=0.351, P=0.001), and LVMI (ß=0.236, P=0.038). Also, SBP-asleep and LVMI were found to be associated independently with GLS and GLSRs (SBP-asleep ß=-0.405, P<0.001; ß=-0.271, P=0.004 and LVMI ß=-0.339, P=0.002; ß=-0.517, P<0.001; respectively). CONCLUSION: This study shows that the nondipper pattern is associated with subclinical LV systolic dysfunction in treated hypertensive diabetic patients with preserved left ventricular ejection fraction. Also, elevated night-time SBP was found to be related to impaired LV systolic functions.

The BODE index, a multidimensional grading system, reflects impairment of right ventricle functions in patients with chronic obstructive pulmonary disease: a speckle-tracking study.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is not only characterized by chronic airflow limitation, but is also a systemic disease. There is no information about alterations in right ventricle (RV) functions precipitated by systemic manifestations of COPD. OBJECTIVES: We aimed to evaluate the relationship between the BODE (body mass index, airflow obstruction, dyspnea, and exercise capacity) index that evaluates systemic manifestations of COPD and RV functions by means of 2-dimensional speckle-tracking echocardiography (2D-STE) in COPD patients. METHODS: The study involved 135 COPD patients and 37 control subjects. All patients underwent 2D-STE, pulmonary function tests and 6-min walk tests, and were divided into quartiles according to their calculated BODE index score. RESULTS: COPD patients had impaired RV and left-ventricle diastolic functions compared to controls. There was a decreasing trend from quartile 1 (Q1) to Q4 in RV functional parameters, i.e., RV free wall strain (RVFW-S, p < 0.001), tricuspid annular plane systolic excursion (p < 0.001), systolic myocardial velocity (p < 0.001), RV fractional area change (p < 0.001), RV myocardial performance index (p < 0.001) and pulmonary artery systolic pressure (p < 0.001). The transmitral Doppler E wave/lateral mitral annular tissue Doppler E wave ratio was similar in the 4 BODE index quartiles (p = 0.159). Multivariate analysis was performed to find independent predictors of decreased RVFW-S (≤19.06), and the BODE index (in quartiles; OR 4.61 and 95% CI 1.85-11.63) was found to be an independent predictor. In a partial correlation analysis adjusted for forced expiratory volume in 1s % predicted, RVFW-S was correlated with the 6-min walk distance (r = 0.498). CONCLUSION: The BODE index, which can be easily evaluated in office settings, may provide information about reduced RV functions as well as guiding treatment and helping to predict prognosis in COPD patients.

The relationship between C-reactive protein and the lapse of time since the onset of the symptoms after acute myocardial infarction: an prospective-observational study.

OBJECTIVE: It is important to know the elapsed symptom-to-door (StD) time between the emergence of ST-elevation myocardial infarction (STEMI) symptoms and admission to the hospital in terms of the selection of appropriate treatment and prognosis. In this study, we aimed to assess the relationship between serum C-reactive protein (CRP) and StD time after STEMI. METHODS: 436 of the patients admitted to our center with STEMI between August 2012-February 2013 (338 male, mean age, 63.9±12.8) were included in this prospective-observational cohort study. Blood samples were obtained from laboratory results of the first reference period. Patients were divided into four groups according to the duration of StD time [0-1. hour; group 1 (G1), 1-3. hour; group 2 (G2), 3-6. hour; group 3 (G3), 6-12. hour; group 4 (G4)]. Statistical analysis was performed via chi-squre test, ANOVA test, Pearson's correlation analysis and receiver operator charecteristic (ROC) analysis. RESULTS: As the time progressed, an increase in CRP levels was observed. The difference among the means of the G1-G3 (p=0.002), G1-G4 (p<0.001), G2-G4 (p<0.001) and G3-G4 (p<0.001) groups was found to be statistically significant. There was a good correlation between the StD time and CRP levels (r=0.676). ROC analysis of the predictive value of CRP for the third hour was determined as 0.78 mg/dL, respectively (AUC was 0.824; 95% C.I. was 0.785-0.859; 73.9% sensitivity, 78.1% specificity). CONCLUSION: According to serum CRP levels after STEMI at hospital admission, StD time can be estimated.

Cardio-ankle vascular index may be an important marker of silent neuronal injury after percutaneous coronary angiography and intervention: a prospective observational study on diagnostic accuracy.

OBJECTIVE: The relationship between silent neuronal injury (SNI) and arterial stiffness assessed by cardio-ankle vascular index (CAVI) has not been evaluated in patients treated with coronary angiography and intervention due to acute coronary syndrome (ACS). The aim of this study is to evaluate the value of CAVI in prediction of SNI after percutaneous coronary angiography and intervention in patients presented with ACS. METHODS: Eighty-three consecutive patients presented with ACS, who underwent percutaneous coronary angiography and intervention, were included in this prospective observational study on diagnostic accuracy. Neuron specific enolase (NSE) was studied before and 18 hour after the coronary angiography and intervention. CAVI was measured by VaSera-1000 instrument. Clinical and echocardiographic characteristics were analyzed and independent predictors of SNI were evaluated. Chi-square, Student t-test, Mann-Whithney U test, correlation analysis and logistic regression analysis was used for statistical analysis. RESULTS: NSE levels significantly increased after cardiac catheterization (9.82±3.22 mg/dL vs. 13.15±8.55 mg/dL, p<0.001). CAVI (OR=2.992, 95% CI: 1.494-5.713, p=0.002), left ventricular ejection fraction (LVEF) (OR=0.911, 95% CI: 0.843-0.983, p=0.017) and undergoing percutaneous coronary intervention (OR=4.430, 95% CI: 1.034-18.97, p=0.045) were the independent predictors of SNI in logistic regression analysis. The cut-off value to show SNI for CAVI was 10.45 (sensitivity=71.8%, specificity=91.5%) in receiver operator charecteristic (ROC) curve analysis. The area under curve was 0.832 (95% CI=0.746-0.918, p<0.001). CONCLUSION: Besides undergoing PCI and having LVEF, measurement of CAVI may be a useful tool for predicting the development of SNI after percutaneous coronary angiography and intervention in patients with ACS.

Value of coronary artery calcium score to predict severity or complexity of coronary artery disease.

BACKGROUND: Prediction of severity or complexity of coronary artery disease (CAD) is valuable owing to increased risk for cardiovascular events. Although the association between total coronary artery calcium (CAC) score and severity of CAD, Gensini score was not used, it has been previously demonstrated. There is no information about the association between total CAC score and complexity of CAD. OBJECTIVES: To investigate the association between severity or complexity of coronary artery disease (CAD) assessed by Gensini score and SYNTAX score (SS), respectively, and coronary artery calcium (CAC) score, which is a noninvasive method for CAD evaluation in symptomatic patients with accompanying significant CAD. METHODS: Two-hundred-fourteen patients were enrolled. Total CAC score was obtained before angiography. Severity and complexity of CAD was assessed by Gensini score and SS, respectively. Associations between clinical and angiographic parameters and total CAC score were analyzed. RESULTS: Median total CAC score was 192 (23.0-729.8), and this was positively correlated with both Gensini score (r: 0.299, p<0.001) and SS (r: 0.577, p<0.001). At multivariate analysis, it was independently associated with age (ß: 0.154, p: 0.027), male gender (ß: 0.126, p: 0.035) and SS (ß: 0.481, p<0.001). Receiver-operating characteristic (ROC) curve analysis revealed a cut-off value>809 for SS>32 (high SS tertile). CONCLUSION: In symptomatic patients with accompanying significant CAD, total CAC score was independently associated with SS and patients with SS>32 may be detected through high Agatston score.

Comparison of neutrophil to lymphocyte ratio in patients with coronary artery ectasia versus patients with obstructive coronary artery disease.

BACKGROUND: Previous studies have demonstrated that inflammation, neurohormonal process and cardiovascular risk factors are associated with the development of coronary artery ectasia (CAE). However, the underlying mechanisms responsible for ectasia formation are not fully understood. The neutrophil to lymphocyte (N/L) ratio has recently emerged as a new inflammation marker for cardiovascular disease. AIM: In this study, we hypothesised that CAE could be associated with more severe inflammation compared to obstructive coronary artery disease (O-CAD) with regard to N/L ratio values. METHODS: A total of 405 patients with isolated CAE, O-CAD and insignificant CAD (controls) were enrolled. Severity of isolated CAE was determined according to the Markis classification. N/L ratio values were compared between the three groups. RESULTS: We determined that the patients with isolated CAE had significantly elevated N/L ratio values compared to O-CAD and control groups (2.5 vs. 1.9, p < 0.001 and vs. 1.6, p < 0.001, respectively). In multivariate analysis adjusted for age, sex, diabetes mellitus (DM) and hypertension, N/L ratio was independently associated with the presence (N/L ratio, OR = 2.48, 95% CI 2.03-3.02, p < 0. 001) and severity (DM, OR = 2.90, 95% CI 1.02-8.18, p = 0.044, N/L ratio, OR = 1.88, 95% CI 1.47-2.41, p = 0.004) of isolated CAE. ROC curve analysis revealed that a N/L ratio value of > 2.06 identified the patients with isolated CAE. CONCLUSIONS: We showed that patients with isolated CAE had a significantly higher N/L ratio than patients with O-CAD and control groups. This finding suggests that a more severe inflammatory process could be involved in the development of CAE.

Effect of transcatheter aortic valve implantation on QT dispersion in patients with aortic stenosis.

BACKGROUND: QT dispersion (QTd) is a predictor of ventricular arrhythmia. Ventricular arrhythmia is an important factor influencing morbidity and mortality in patients with aortic stenosis. Surgical aortic valve replacement reduced the QTd in this patients group. However, the effect of transcatheter aortic valve implantation (TAVI) on QTd in patients with aortic stenosis is unknown. The aim of this study was to investigate the effect of TAVI on QTd in patients with aortic stenosis. METHODS: Patients with severe aortic stenosis, who were not candidates for surgical aortic valve replacement due to contraindications or high surgical risk, were included in the study. All patients underwent electrocardiographic and echocardiographic evaluation before, and at the 6(th) month after TAVI, computed QTd and left ventricular mass index (LVMI). RESULTS: A total 30 patients were admitted to the study (mean age 83.2 ± 1.0 years, female 21 and male 9, mean valve area 0.7 ± 3 mm(2)). Edwards SAPIEN heart valves, 23 mm (21 patients) and 26 mm (9 patients), by the transfemoral approach were used in the TAVI procedures. All TAVI procedures were successful. Both QTd and LVMI at the 6(th) month after TAVI were significantly reduced compared with baseline values of QTd and LVMI before TAVI (73.8 ± 4 ms vs. 68 ± 2 ms, P = 0.001 and 198 ± 51 g/m(2) vs. 184 ± 40 g/m(2), P = 0.04, respectively). There was a significant correlation between QTd and LVMI (r = 0.646, P < 0.001). CONCLUSIONS: QTd, which malign ventricular arrhythmia marker, and LVMI were significantly reduced after TAVI procedure. TAVI may decrease the possibility of ventricular arrhythmia in patients with aortic stenosis.

Effects of non-dipper blood pressure pattern on left ventricular rotational mechanics in hypertensive patients with type 2 diabetes mellitus: a speckle tracking study.

We aimed to evaluate the effects of non-dipper BP pattern on left ventricular (LV) rotational mechanics in hypertensive patients with type 2 diabetes mellitus (T2DM) with the utility of two-dimensional speckle tracking echocardiography (2D-STE). Eighty-six hypertensive patients with T2DM were enrolled. All patients underwent 2D-echocardiography and 24-h-ambulatory blood pressure monitoring. Fifty-nine (59.3%) patients had non-dipper BP pattern and all subjects had normal LV function. Patients with non-dipper BP pattern had decreased systolic tissue velocity (p: 0.006), increased peak systolic apical rotation and rotation rate (p: 0.008 and p: 0.014, respectively), and peak LV twist and twist rate (p: 0.005 and p: 0.012, respectively). Analysis of LV diastolic parameters showed that, early diastolic tissue velocity (Em) was decreased and E/Em ratio and LV mass (LVM) index were increased in non-dipper group while the time to LV untwisting rate was delayed. In multivariate analysis, peak LV twist (ß = 0.459, p: < 0.001) and twist rate (ß = 0.388, p: 0.001) were independently associated with the difference between mean arterial pressure (MAP)-asleep and MAP-awake. In correlation analysis adjusted for age, sex and LVM index, the time to LV untwisting rate was positively correlated with the difference between MAP-asleep and MAP-awake (r: 0.290 vs. p: 0.008) and E/Em ratio (r: 0.280 vs. p: 0.010). LV rotational mechanics are impaired in T2DM non-dipper hypertensive patients, indicating LV systolic and diastolic dysfunction. 2D-STE may permit better understanding of the underlying pathophysiology and development of preventive strategies.

SYNTAX score predicts the left ventricle thrombus development in patients undergoing primary percutaneous coronary intervention for first anterior myocardial infarction.

OBJECTIVES: The aim of this study is to investigate the relationship between left ventricular thrombus (LVT) developments and the SYNTAX score (SS) in patients undergoing primary percutaneous coronary intervention (PPCI) for first anterior wall ST-segment elevation myocardial infarction (STEMI). METHODS: We enrolled 160 patients. All participants were evaluated by serial transthoracic echocardiography. Baseline clinical, echocardiographic, and procedural features of PPCI were analyzed to find predictors of LVT development. RESULTS: The LVT was detected in 32 (20%) patients. Left ventricular ejection fraction (LVEF) and SS-I were found to be independent predictors of LVT development. Receiver-operating characteristic curve analysis revealed a cutoff value >19.5 for SS-I (area under the curve: 0.697, 95% confidence interval 0.620-0.767, P < .001) with a specificity of 45.3% and a sensitivity of 84.3%. CONCLUSION: High SS which was obtained through diagnostic angiogram of PPCI may be associated with LVT development in patients with first anterior wall STEMI.

Assessment of cardio-ankle vascular index in patients with cardiac syndrome-X: an observational study.

OBJECTIVE: Arterial stiffness is associated with major adverse cardiovascular events. Cardio-ankle vascular index (CAVI), a novel marker of arterial stiffness, which is weakly influenced by systolic blood pressure, is a sensitive marker the atherosclerosis and arteriolosclerosis. The aim of this study is to investigate arterial stiffness by CAVI in patients with cardiac syndrome X (CSX). METHODS: The present study was observational and cross sectional, and involved 49 patients (26 male) with CSX (angina-like chest pain, positive electrocardiographic ischemic changes at treadmill exercise test, angiographically normal coronary arteries) and 54 healthy subjects (21 male). CAVI was measured by VaSera-1000 CAVI instrument. Statistical analysis was performed using the Chi-square, Student t-test, correlation analysis and logistic regression analysis. RESULTS: The CAVI and pulse pressure were significantly increased in patients with CSX compared to control group (7.50 ± 1.50, 6.49 ± 0.77, p<0.001; 53.00 ± 10.06, 47.39 ± 8.17, p=0.002, consecutively). In contrast, there were no significant differences in the age, weight, height, body mass index, waist circumference, hip circumference, systolic blood pressure, diastolic blood pressure, mean blood pressure, glucose, low density lipoprotein level, high density lipoprotein level, triglyceride, estimated creatinine clearance, hemoglobin, left atrium diameter, left ventricular mass, LVM index and ejection fraction. CAVI was the only independent predictor of CSX in logistic regression analysis (OR=1.780, 95% CI: 1.157-2.737, p=0.009). CONCLUSION: CAVI is increased in syndrome X patients and is an independent predictor of this syndrome.