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1.
J Coll Physicians Surg Pak ; 32(8): 975-979, 2022 Aug.
Article in English | MEDLINE | ID: mdl-35932118

ABSTRACT

OBJECTIVE: To investigate the clinical and demographic factors affecting the selection of angiography in patients with severe left ventricular systolic dysfunction (SLVSD, ejection fraction lower than 30%) developing non-ST-segment elevation (NSTEMI). STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: This study was conducted at the Department of Cardiology, School of Medicine, Izmir Katip Celebi University, Izmir, Turkey, between March 2018 and March 2021. METHODOLOGY: Patients with SLVSD (Ejection fraction <30%) developing Clinical and demographic factors were compared between the patients who were or were not decided for angiography. Associated factors for the decision of angiography were evaluated. RESULTS: Overall, 68 (46%) out of 147 patients underwent coronary angiography. Angiography led to coronary artery bypass grafting (CABG) in 14 (21%), percutaneous coronary intervention (PCI) in 30 (44%), and medical treatment in 24 (35%). Among the patients who decided for CABG, 10 (71%) underwent surgery. In multivariate analysis; Killip score ≥2 [Odds ratio (OR) :33.85, 95% Confidence Interval (CI): 5.03-227.405 p<0.001], lower education level (OR: 17.66, 95% CI: 2.25-138.44, p=0.006), anaemia (OR: 10.60, 95% CI: 2.07-54.28, p=0.005), age ≥65 years (OR: 7.124, 95% CI: 1.33-38.12, p=0.02), and PCI history (OR: 0.132, 95% CI: 0.02-0.84, p=0.032) were associated factors with the decision of only medical treatments instead of angiography. CONCLUSION: Demographic factors such as age and education level and clinical factors such as decompensation, PCI history, and anaemia significantly affect the decision of angiography in the patients with SLVSD and NSTEMI. KEY WORDS: Heart failure, NSTEMI, Revascularisation, Severe left ventricular systolic dysfunction, Ejection fraction.


Subject(s)
Non-ST Elevated Myocardial Infarction , Percutaneous Coronary Intervention , Ventricular Dysfunction, Left , Aged , Coronary Angiography , Humans , Non-ST Elevated Myocardial Infarction/therapy , Percutaneous Coronary Intervention/adverse effects , Stroke Volume , Treatment Outcome , Ventricular Dysfunction, Left/diagnostic imaging , Ventricular Dysfunction, Left/etiology
2.
Herz ; 47(1): 73-78, 2022 Feb.
Article in English | MEDLINE | ID: mdl-33895890

ABSTRACT

BACKGROUND: Coronary artery tortuosity (CAT) is a relatively common finding on coronary angiography and may be associated with impaired left ventricular relaxation and coronary ischemia However, the significance of CAT remains unknown. This study aimed to investigate whether the severity of tortuosity in the targeted coronary segment is a predictor of stent restenosis. METHODS: The study included a total of 637 patients undergoing drug-eluting stent implantation due to stable or unstable angina and who had no native coronary artery stenosis on their last coronary angiogram. The patients were separated into two groups: 312 patients with in-stent restenosis and 325 patients without in-stent restenosis. All patients underwent computed tomography (CT) coronary angiography after invasive angiography and CAT was calculated using the computer software. RESULTS: Patients with in-stent restenosis had higher CAT than those without restenosis (1.25 ± 0.11 vs. 1.11 + 0.07, p < 0.001). Multivariate Cox regression analysis showed that the tortuosity index (hazard ratio [HR]: 1.246 95% confidence interval [CI]: 1.127-1.376 p < 0.001) and the circumflex lesion (HR: 1.437 95% CI: 1.062-1.942 p = 0.019) were independently associated with in-stent restenosis. With the threshold value of severe tortuosity set at 1.15, the prediction of could be made with 81% sensitivity and 80% specificity. CONCLUSION: The severity of tortuosity is proportional to coronary in-stent stenosis in patients with stable and unstable angina pectoris undergoing drug-eluting stent implantation for a severe single coronary artery.


Subject(s)
Coronary Restenosis , Drug-Eluting Stents , Constriction, Pathologic , Coronary Angiography , Coronary Restenosis/diagnostic imaging , Coronary Restenosis/epidemiology , Coronary Vessels , Drug-Eluting Stents/adverse effects , Humans , Risk Factors , Stents , Treatment Outcome
3.
BMC Cardiovasc Disord ; 21(1): 564, 2021 11 23.
Article in English | MEDLINE | ID: mdl-34814842

ABSTRACT

BACKGROUND: Although the incidence of myocardial bridge (MB) has been defined in different femoral access conventional coronary angiography (FACCA) studies, the frequency of MB on radial access coronary angiography (RACA) is unknown. The aim of this study was to determine the difference in the incidence of MB between patients undergoing RACA and FACCA. METHOD: A total of 2500 consecutive patients who underwent RACA and a total of 1455 consecutive patients who underwent FACCA were retrospectively investigated to detect the presence of MB. The incidences of the groups were calculated separately and compared. The clinical and angiographic features of the patients with MB were analyzed. RESULTS: MB was detected at an incidence of 10.2%, in 255/2500 patients who underwent RACA, and 1.8% in 27/1455 patients who underwent FACCA (p < 0.001). In both RACA and FACCA patients, the most involved coronary artery was the left anterior descending artery (LAD) (86.9% and 93.1%) and the mid-segment (84.9% and 88.9%) was the most affected section. Co-involvement of multiple coronary arteries by MB was 7.8% in patients who underwent RACA and 7.4% in patients who underwent FACCA. Coronary artery disease (CAD) was determined in 111 (35.7%) of the coronary arteries with MB, of which 81.9% were proximal to the MB. No significant CAD was detected in any of the vessels of 69.8% (178/255) of the patients who underwent RACA for different clinical indications. CONCLUSION: These data demonstrated that the incidence of myocardial bridge able to be detected on RACA was much higher than FACCA.


Subject(s)
Cardiac Catheterization , Catheterization, Peripheral , Coronary Angiography , Femoral Artery , Myocardial Bridging/diagnostic imaging , Radial Artery , Aged , Female , Humans , Incidence , Male , Middle Aged , Myocardial Bridging/epidemiology , Predictive Value of Tests , Reproducibility of Results , Retrospective Studies , Turkey
4.
Turk Kardiyol Dern Ars ; 49(4): 334-338, 2021 06.
Article in English | MEDLINE | ID: mdl-34106068

ABSTRACT

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the global coronavirus disease 2019 (COVID-19) pandemic. Although the virus predominantly causes respiratory system infection, recent reports have shown that it is also associated with many cardiovascular complications. It has been reported that COVID-19 may cause myocarditis, type 1 and 2 acute myocardial infarction, and thrombotic complications.[1] Spontaneous coronary artery dissection (SCAD) is a rare form of coronary artery disease that has recently been associated with COVID-19 in a few case reports. The case reported here is of COVID-19 associated SCAD in a patient with no history of cardiovascular disease.


Subject(s)
COVID-19/complications , Coronary Artery Disease , Coronary Vessel Anomalies , Vascular Diseases/congenital , Coronary Artery Disease/physiopathology , Coronary Artery Disease/therapy , Coronary Artery Disease/virology , Coronary Vessel Anomalies/physiopathology , Coronary Vessel Anomalies/therapy , Coronary Vessel Anomalies/virology , Electrocardiography , Humans , Male , Middle Aged , Vascular Diseases/physiopathology , Vascular Diseases/therapy , Vascular Diseases/virology
5.
Clin Appl Thromb Hemost ; 27: 10760296211021495, 2021.
Article in English | MEDLINE | ID: mdl-34142564

ABSTRACT

The treatment process of patients using warfarin is expected to be hindered during the COVID-19 pandemic. Therefore we investigated whether the time in therapeutic range (TTR) and bleeding complications were affected during the COVID-19 pandemic. 355 patients using warfarin were included between March 2019 to March 2021. Demographic parameters, INR (international normalized ratio), and bleeding rates were recorded retrospectively. The TTR value was calculated using Rosendaal's method. The mean age of the patients was 61 ± 12 years and 55% of them were female. The mean TTR value during the COVID-19 pandemic was lower than the pre-COVID-19 period (56 ± 21 vs 68 ± 21, P < 0.001). Among the patients, 41% had a lack of outpatient INR control. During the COVID-19 pandemic, 71 (20%) patients using VKA suffered bleeding. Among patients with bleeding, approximately 60% did not seek medical help and 6% of patients performed self-reduction of the VKA dose. During the COVID-19 pandemic, TTR values have decreased with the lack of monitoring. Furthermore, the majority of patients did not seek medical help even in case of bleeding.


Subject(s)
Anticoagulants/pharmacology , Bleeding Time , Blood Coagulation/drug effects , COVID-19/blood , Hemorrhage/chemically induced , International Normalized Ratio , Pandemics , SARS-CoV-2 , Thrombophilia/blood , Warfarin/pharmacology , Aged , Anticoagulants/administration & dosage , Anticoagulants/adverse effects , Anticoagulants/therapeutic use , Atrial Fibrillation/complications , Atrial Fibrillation/drug therapy , COVID-19/complications , Dose-Response Relationship, Drug , Female , Heart Valve Prosthesis/adverse effects , Hemorrhage/psychology , Humans , Hypertension/complications , Male , Medication Adherence , Middle Aged , Patient Acceptance of Health Care , Pulmonary Embolism/drug therapy , Retrospective Studies , Self Medication , Thrombophilia/drug therapy , Thrombophilia/etiology , Warfarin/administration & dosage , Warfarin/adverse effects , Warfarin/therapeutic use
6.
J Clin Lab Anal ; 35(6): e23795, 2021 Jun.
Article in English | MEDLINE | ID: mdl-33945171

ABSTRACT

BACKROUND: We aimed to evaluate the utility of the preprocedural platelet-lymphocyte ratio (PLR) for predicting the no-reflow phenomenon after thrombus aspiration during percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI). METHOD: We retrospectively analyzed postprocedural thrombolysis in myocardial infarction (TIMI) flow grades and myocardial blush grades (MBG) of 247 patients who underwent a PCI procedure with thrombus aspiration.We divided these patients into two groups according to whether they had no-reflow (TIMI < 3, MBG < 2) or not (TIMI 3, MBG ≥ 2). RESULTS: No-reflow developed in 43 (17%) patients.Preprocedural PLR was significantly higher in the no-reflow group (183.76 ± 56.65 vs 118.32 ± 50.42 p < 0.001).Independent predictors of no-reflow were as follows: higher preprocedural platelet-lymphocyte ratio (PLR) (OR = 1.018; 95% CI = 1.004, 1.033; p = 0.013),mean corpuscular volume (MCV) (OR = 1.118; 95% CI = 1.024, 1.220; p = 0.012) and SYNTAX Score-2 (OR = 1.073; 95% CI = 1.005, 1.146; p = 0.036). PLR of 144 had 79% sensitivity and 75% specificity for the prediction of no-reflow. CONCLUSION: PLR is a reliable predictor for no-reflow in STEMI patients undergoing thrombus aspiration.


Subject(s)
Blood Platelets/pathology , Lymphocytes/pathology , No-Reflow Phenomenon/diagnosis , Percutaneous Coronary Intervention/adverse effects , ST Elevation Myocardial Infarction/therapy , Suction/adverse effects , Thrombosis/physiopathology , Female , Follow-Up Studies , Humans , Male , Middle Aged , No-Reflow Phenomenon/etiology , Prognosis , Retrospective Studies
7.
Phlebology ; 36(7): 570-575, 2021 Aug.
Article in English | MEDLINE | ID: mdl-33601963

ABSTRACT

OBJECTIVE: Physiologic studies have shown that atrium has an active role in venous blood return from lower extremity. In this context we investigated the association between AF and chronic venous disease (CVD). METHODS: In this observational study we included 392 AF patients which were divided into two groups (chronic AF, 218 (56%)) and non-chronic. AF, 174 (44%)). These two groups were compared in terms of CVD after matching conventional risk factors for CVD. RESULTS: CEAP classification was different between chronic and non-chronic patients (C0-C2: 72% vs 47%; C3-C6: 28% vs 53% <0.001). Chronic AF patients had also higher rate of venous reflux on Doppler ultrasound (38% vs 16% P < 0.05). There was a correlation between AF duration, right atrial volume index and CEAP classification respectively (rho:0.314 p < 0.001), (rho:0.258, p < 0.001). CONCLUSION: Prevalence of CVD is higher in patients with chronic AF. In addition, atrial volume is directly correlated with CVD.


Subject(s)
Atrial Fibrillation , Venous Insufficiency , Chronic Disease , Humans , Lower Extremity , Veins
8.
Eur J Rheumatol ; 7(1): 9-15, 2020 01.
Article in English | MEDLINE | ID: mdl-31782720

ABSTRACT

OBJECTIVE: To evaluate whether there is any difference between radiographic axial spondyloarthritis (r-axSpA), also termed ankylosing spondylitis (AS), and non-radiographic (nr-) axSpA, with respect to subclinial myocardial dysfunction using speckle tracking echocardiography (STE). METHODS: This was a cross-sectional case control study. We included 72 patients with AS, 38 patients with nr-axSpA, and 56 age-matched healthy subjects. Patients with cardiac disease and cardiac risk factors affecting STE were excluded. The disease burden evaluated by the BASDAI, BASFI, BAS-G, and ASAS-HI scores were comparable in both the r- and nr-axSpA groups. A detailed echocardiographic examination including the M-mode, Doppler, and STE was applied to whole study population. RESULTS: Duration of the disease, the use of an anti-TNFα agent, and CRP levels were higher in patients with AS. Although the AS, nr-axSpA, and control groups had similar ejection fraction values (59±5.2, 60±4.6, 60±4.6, respectively, and p=0.499), the global longitudinal peak systolic strain (GLS) (20.5±3.3, 21.1±3.5, and 22.3±2.4, respectively, and p<0.05) was different between the groups. In a post-hoc analysis, GLS was not different between the nr-axSpA and control groups, and it was significantly lower in patients with AS. In the univariate analysis, peripheral arthritis (p=0.035) and age (p=0.032) were correlated with GLS. A multivariate regression analysis demonstrated that peripheral arthritis (p=0.009) was the only independent GLS predictor. CONCLUSION: Subclinical myocardial dysfunction as assessed by GLS was present in AS, but not in nr-ax-SpA patients. Thus, GLS could be used as a differentiating factor between radiographic and nr-axSpA patients.

9.
Turk Kardiyol Dern Ars ; 45(8): 690-701, 2017 Dec.
Article in English | MEDLINE | ID: mdl-29226889

ABSTRACT

OBJECTIVE: We investigated the frequency of different bicuspid aortic valve disease (BAV) phenotypes,the associated valvular pathologies, and the aortopathy phenotypes, using 2-dimensional (2D) transthoracic, 2D transesophageal echocardiography (TEE) and 3-dimensional (3D) TEE. METHODS: A total of 154 patients with BAV were included. Five BAV phenotypes were detected. To better define valvular pathologies, binary classifications of BAV were used: BAV with antero-posterior commisural line (BAV-AP) and right-left commissural line (BAV-RL). Aortopathy phenotype was classified according to the involved tract(s). RESULTS: Of the patients, 53.2% had type 1, 16.2% type 2, 15.6% type 3, 1.3% type 4, and 13.6% had type 5 BAV. The prevalence of BAV-AP and BAV-RL was 68.2% and 31.8%, respectively. No difference was detected with respect to aortic regurgitation between BAV-AP and BAV-RL (p=0.9), but the BAVRL group had an increased propensity to have a stenotic aortic valve (p=0.003). The indexed aortic diameter was larger in BAV-AP cases than BAV-RL at the sinus of Valsalva (p=0.008). In patients with dilatation of the root and tubular portion, a predominance of BAV-AP versus BAV-RL was observed (85% vs 15%). A markedly low prevalence of the root phenotype (3.2%) was observed. In 90.1% of the patients, 2D TEE was sufficient to classify BAV phenotypes; further 3D imaging was needed in 9.9% of the cases. CONCLUSION: There may be racial differences in the frequency of valvular and aortopathy phenotypes in patients with BAV. BAV phenotypes differ with respect to aortic stenosis and aortopathy phenotypes. TEE may have good diagnostic utility in differentiating BAV phenotypes.


Subject(s)
Aortic Valve/abnormalities , Echocardiography, Transesophageal , Heart Valve Diseases/diagnostic imaging , Heart Valve Diseases/epidemiology , Adolescent , Adult , Aged , Aortic Valve/diagnostic imaging , Aortic Valve/pathology , Bicuspid Aortic Valve Disease , Cohort Studies , Female , Heart Valve Diseases/pathology , Humans , Male , Middle Aged , Phenotype , Young Adult
10.
Kardiol Pol ; 74(9): 978-84, 2016.
Article in English | MEDLINE | ID: mdl-27040017

ABSTRACT

BACKGROUND: The HATCH score predicts the development of persistent and permanent atrial fibrillation (AF) one year after spontaneous or pharmacological conversion to sinus rhythm in patients with AF. However, it remains unknown whether HATCH score predicts short-term success of the procedure at early stages for patients who have undergone electrical cardioversion (EC) for AF. AIM: The present study evaluated whether HATCH score predicts short-term success of EC in patients with AF. METHODS: The study included patients aged 18 years and over, who had undergone EC due to AF lasting less than 12 months, between December 2011 and October 2013. HATCH score was calculated for all patients. The acronym HATCH stands for Hypertension, Age (above 75 years), Transient ischaemic attack or stroke, Chronic obstructive pulmonary disease, and Heart failure. This scoring system awards two points for heart failure and transient ischaemic attack or stroke and one point for the remaining items. RESULTS: The study included 227 patients and short-term EC was successful in 163 of the cases. The mean HATCH scores of the patients who had undergone successful or unsuccessful EC were 1.3 ± 1.4 and 2.9 ± 1.4, respectively (p < 0.001). The area of the HATCH score under the curve in receiver operating characteristics analysis was (AUC) 0.792 (95% CI 0.727-0.857, p < 0.001). A HATCH score of two and above yielded 77% sensitivity, 62% specificity, 56% positive predictive value, and 87% negative predictive value in predicting unsuccessful cardioversion. CONCLUSIONS: HATCH score is useful in predicting short-term success of EC at early stages for patients with AF, for whom the use of a rhythm-control strategy is planned.


Subject(s)
Atrial Fibrillation/therapy , Electric Countershock , Severity of Illness Index , Adult , Aged , Female , Heart Failure , Humans , Hypertension , Ischemic Attack, Transient , Male , Middle Aged , Prognosis , Pulmonary Disease, Chronic Obstructive , ROC Curve , Risk Assessment , Young Adult
11.
Turk Kardiyol Dern Ars ; 43(4): 356-60, 2015 Jun.
Article in Turkish | MEDLINE | ID: mdl-26142789

ABSTRACT

OBJECTIVE: Atrioventricular nodal reentrant tachycardia (AVNRT) attacks is one of the common arrhythmias adversely affecting quality of life. The Umea 22 (U22) is a questionnaire developed for the assessment of symptoms associated with supraventricular tachycardia (SVT), and it is found to be effective in evaluation of quality of life after radiofrequency ablation. Using this questionnaire, the study aimed to assess quality of life among Turkish patients with ANRT before and after the successful RFA. METHODS: The study was conducted between January 2011 and September 2013, and included 57 patients who had undergone RFA due to AVNRT. The U22 questionnaire was administered pre-procedure and at 6 months post-procedure. The participants were asked to report on their general well-being, arrhythmia effects on their wellbeing, and intensity of discomfort associated with episodes. They were asked to provide a score from 1 to 10 in order to determine to severity of discomfort, and the quantity of symptoms was then assessed according to the visual analogue scale (VAS). RESULTS: Patients' general wellbeing (7.5±2.3 vs. 8.7±1.8, p<0.001), the effects of arrhythmia episodes on general well-being (8.1±1.7 vs. 1.0±2.1, p<0.001), frequency of symptoms (2.8±0.8 vs. 0.4±0.9, p<0.001) and duration of symptoms were reduced significantly after RFA. The rate of drug use among patients also decreased after RFA (70% vs. 23%, p=0.017). CONCLUSION: Treatment success was high in patients undergoing RFA due to AVNRT according to the U22 quality of life questionnaire. General and arrhythmia-associated quality of life had improved significantly by the 6th month post-procedure.


Subject(s)
Catheter Ablation/statistics & numerical data , Quality of Life/psychology , Tachycardia, Atrioventricular Nodal Reentry/epidemiology , Tachycardia, Atrioventricular Nodal Reentry/psychology , Tachycardia, Atrioventricular Nodal Reentry/surgery , Adult , Female , Humans , Male , Middle Aged , Surveys and Questionnaires
12.
J Cardiothorac Surg ; 9: 153, 2014 Sep 02.
Article in English | MEDLINE | ID: mdl-25179559

ABSTRACT

OBJECTIVES: The aim of the present study was to retrospectively evaluate the prevalence of concurrent coronary artery disease in patients who underwent surgery due to severe valvular heart disease. The study also investigated the association of coronary artery disease with the type of valvular heart disease. MATERIALS AND METHODS: A total of 241 patients (123 females [51%]), who had underwent single valvular heart surgery, were included in the study. The patients who underwent valve replacement surgery were divided into four groups: patients with severe mitral stenosis (MS), patients with severe mitral regurgitation (MR), patients with severe aortic regurgitation (AR), and patients with severe aortic stenosis (AS). Age, DM, HT, history of smoking, and LDL values were recorded as the risk factors for CAD. RESULTS: Coronary artery disease was detected in 26.4% of patients with mitral stenosis and 57.7% of patients with aortic stenosis. Of the patients with mitral insufficiency, 41.9% had CAD, and 44.4% of the patients with aortic insufficiency had CAD. CONCLUSION: The comparison of MS and AS groups revealed significantly higher prevalence of CAD in the AS group. There was no statistically significant difference between the MR and AR groups in terms of the prevalence of CAD. The comparison of MS and MR groups revealed significantly higher prevalence of CAD in the MR group. Furthermore, the comparison of these groups in terms of the extensiveness of the coronary artery disease revealed significantly higher Gensini score in the MR group.


Subject(s)
Coronary Artery Disease/epidemiology , Heart Valve Diseases/epidemiology , Adult , Aged , Aortic Valve Insufficiency/epidemiology , Aortic Valve Insufficiency/surgery , Aortic Valve Stenosis/epidemiology , Aortic Valve Stenosis/surgery , Coronary Artery Disease/complications , Female , Heart Valve Diseases/surgery , Heart Valve Prosthesis Implantation , Humans , Male , Middle Aged , Mitral Valve Insufficiency/epidemiology , Mitral Valve Insufficiency/surgery , Mitral Valve Stenosis/epidemiology , Mitral Valve Stenosis/surgery , Prevalence , Retrospective Studies , Risk Factors , Turkey/epidemiology
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