The Mean Corrected TIMI Frame Count Could Predict Major Adverse Cardiovascular Events in Patients with Coronary Slow-Flow Phenomenon.

OBJECTIVE: The aim of the present study was to investigate the association between the mean corrected thrombolysis in myocardial frame count and major adverse cardiovascular events in patients with the coronary slow-flow phenomenon. METHODS: A total of 98 patients with coronary slow-flow phenomenon who met inclusion cri- teria from 2015 to 2020 were retrospectively included in the analysis. The patients were ranked according to their mean corrected thrombolysis in myocardial frame count values and were divided into quartiles based on those. Group 1 consisted of patients who had a mean corrected thrombolysis in myocardial frame count value >36.68 (third quartile), while group 2 consisted of patients who had a mean corrected thrombolysis in myocardial frame count value ≤36.68 (first quartile+second quartile). Mortality and non-fatal cardiovascular complications were compared between the groups. RESULTS: Mean follow-up duration was 3.93 ± 1.50 years. Recurrent chest pain and major adverse cardiovascular events increased in group 1 compared to group 2 (P ≤ .001, P ≤ .001, respectively). Hypertension (odds ratio 2.627, P=.033), hyperlipidemia (odds ratio 2.469, P = .028) and mean corrected thrombolysis in myocardial frame count (odds ratio 1.106, P = .002) were independent predictors of recurrent chest pain according to Cox regression analysis. Although older age (odds ratio 1.125, P=.011), hypertension (odds ratio 6.081, P=.026), hyperlipidemia (odds ratio 12.308, P = 0.019), and mean corrected thrombolysis in myocardial frame count (odds ratio 1.476, P = .001) were found to be significantly related with major adverse cardiovascular events in patients with coronary slow-flow phenomenon, only mean corrected thrombolysis in myocardial frame count (odds ratio 1.161, P = .021) was an indepen- dent predictor of major adverse cardiovascular events in Cox regression analysis. CONCLUSION: Higher mean corrected thrombolysis in myocardial frame count could predict major adverse cardiovascular events in patients with the coronary slow-flow phenomenon.

Transfemoral aortic valve implantation in the case of pre-existing mitral prosthesis and pure aortic regurgitation: A case report.

BACKGROUND: Transcatheter aortic valve replacement (TAVR) is recommended in patients with severe aortic stenosis who have high surgical risk. However, in the pre-existing mechanical mitral valve prosthesis and natural pure aortic regurgitation, TAVR is relatively contraindicated. In this report, we described one case of TAVR with native aortic regurgitation in the presence of mechanical mitral valve prosthesis. CASE SUMMARY: A 64-year-old man with a medical history of mitral valve replacement had severe dyspnea and was symptomatic even at rest for 3 mo. His echocardiography showed severe native pure aortic regurgitation. His euroscore was 15. A TAVR procedure with an evolut R was planned. A 34 mm evolut R was placed by transesophageal echocardiography. The mitral prosthesis was functioning normally, and mild-moderate paravalvular leakage was evident by transesophageal echocardiography. The patient recovered without any complication. At 1 mo follow up, the patient was well, and no paravalvular leakage was noted. CONCLUSION: TAVR for pure aortic regurgitation in the presence of prosthetic mitral valve can be a safe procedure.

The Endothelial Nitric Oxide Synthase (NOS3-786T>C) Genetic Polymorphism in Chronic Heart Failure: Effects of Mutant -786C allele on Long-term Mortality.

BACKGROUND: Nitric oxide plays an important role in the regulation of basal vascular tone and cardiac myocyte function. We investigated the NOS3-786T>C polymorphism in chronic heart failure (CHF) and its effects on long-term mortality. METHODS: Ninety-one patients with CHF who were referred to the Department of Cardiology of Siyami Ersek Cardiovascular and Thoracic Surgery Center for cardiopulmonary exercise testing between April 2001 and January 2004 and 30 controls were enrolled in this study. Patient were followed prospectively for a period of 1 to 12 years. RESULTS: Patients and controls were divided into three groups: TT, TC and CC, according to their NOS3-786T>C polymorphism. We noted that there was no significant difference in the genotype distribution between patients and controls. There was also no significant difference in endothelial nitric oxide synthase (eNOS) gene polymorphism between ischemic HF and nonischemic HF. During the follow-up period, 61 (67%) deaths occurred. The nonsurvivor group had lower left ventricular ejection fraction (LVEF) (p = 0.01), reduced peak oxygen consumption (p = 0.04) and were of older age (p = 0.001). Age, LVEF, peak oxygen consumption and genotype were found to be predictors of mortality (p < 0.05). Additionally, mortality was significantly increased in -786CC genotype patients compared to TT genotype patients (hazard ratio = 2.2; p = 0.03). By multivariate analysis, age and eNOS genotype were determined to be significant independent predictors of death. Additionally, Kaplan-Meier analysis confirmed that homozygote -786C genotype was associated with an increased risk of death (χ2 = 4.6, p = 0.03). CONCLUSIONS: Our findings showed that the NOS3-786T>C polymorphism was associated with an increased risk of mortality in patients with CHF.

Relation of Low T3 to One-Year Mortality in Non-ST-Elevation Acute Coronary Syndrome Patients.

BACKGROUND: Low T3 which is defined as decreased triiodothyronine (T3) and normal thyroid-stimulating hormone (TSH) and thyroxin (T4) levels is present in many acute diseases and is related to increased mortality. We studied low T3 level's relation to long-term mortality in non-ST-elevation acute coronary syndrome (NSTE-ACS) patients. METHODS: T3, T4, and TSH levels of consecutive NSTE-ACS patients were measured. Patients with normal T4 and TSH levels, but low T3 level were defined as low T3 group. Patients with normal T3, T4, and TSH levels were defined as normal group. Clinical and laboratory findings in these two groups were compared. In addition, we examined low T3 level's relation to early and long-term mortality. RESULTS: Mean patient age was 61 ± 13 (67% male) and 31 (11%) patients had low T3 level. Free T3 values were negatively correlated with age, serum creatinine, and brain type natriuretic peptide values at the time of admission (r = -0.452, P < 0.0001; r = -0.255, P < 0.0001; r = -0.544, P < 0.0001, respectively). Mortality at 1 month and 1 year was higher in low T3 group (3% vs. 16%, P = 0.002; 6.4% vs. 23%, P = 0.003, respectively). In multivariate analysis, low T3 was found to be related to mortality at 1 year (OR: 2.6, 95% CI: 1.1-6.5, P = 0.02). In ROC analysis, free T3 had a good area under the curve (AUC) value for mortality at 1 year [AUC: 0.709 (95% CI: 0.619-0.799, SE: 0.0459)]. CONCLUSION: Low T3 is related to increased early and late mortality in NSTE-ACS patients. Free T3 levels may be used to identify NSTE-ACS patients with high mortality risk.

Clinical usefulness of red cell distribution width to angiographic severity and coronary stent thrombosis.

BACKGROUND: Red cell distribution width (RDW) is a quantitative measurement and shows heterogeneity of red blood cell size in peripheral blood. RDW has recently been associated with cardiovascular events and cardiovascular diseases, and it is a novel predictor of mortality. In this study, we aimed to evaluate the clinical usefulness of measuring RDW in patients with coronary stent thrombosis. PATIENTS AND METHODS: We retrospectively reviewed 3,925 consecutive patients who presented with acute coronary syndrome and who underwent coronary angiography at the Siyami Ersek Hospital between May 2011 and December 2013. Of the 3,925 patients, 73 patients (55 males, mean age 59±11 years, 55 with ST elevated myocardial infarction) with stent thrombosis formed group 1. Another 54 consecutive patients who presented with acute coronary syndrome (without coronary stent thrombosis, 22 patients with ST elevated myocardial infarction, 44 males, mean age 54±2 years) and underwent percutaneous coronary intervention in May 2011 formed group 2. Data were collected from all groups for 2 years. The RDW values were calculated from patients 1 month later at follow-up. Syntax scores were calculated for all the patients. The patients were also divided as low syntax score group and moderate-high syntax score group. RESULTS: The patients in group 1 with stent thrombosis had significantly higher RDW level (13.85) than the patients in group 2 without stent thrombosis (12) (P<0.001). In addition, in all study patients, the moderate-high syntax score group had significantly higher RDW level (13.6) than the low syntax score group (12.9) (P=0.009). A positive correlation was determined between RDW and syntax scores (r=0.204). CONCLUSION: RDW is a new marker of poor prognosis in coronary artery disease. Increased RDW level is correlated with angiographic severity of coronary artery disease, and RDW may be an important clinical marker of coronary stent thrombosis in patients undergoing coronary intervention.

Relation of contrast nephropathy to adverse events in pulmonary emboli patients diagnosed with contrast CT.

OBJECTIVE: Limited data exist on the incidence of contrast induced nephropathy (CIN) and its impact on in-hospital prognosis of patients diagnosed with acute pulmonary embolism (APE) using contrast computerized tomography pulmonary angiography (CTPA). In this study, we examined the frequency of nephropathy after CTPA in APE patients and its link to in-hospital adverse outcomes. METHODS: This was a retrospective study of 189 patients (mean age 67+16years, 48% male) with APE who underwent CTPA. CIN was defined as a≥0.5mg/dl and/or ≥25% increase in serum creatinine levels >48hours after CTPA. Patients were divided into two groups according to the presence or absence of CIN to compare clinical characteristics, risk factors, and in-hospital adverse events. RESULTS: Twenty-four (13%) of the patients were diagnosed with CIN. Patients with CIN were older (73±17 vs. 67±15years, P=.01) and had higher rates of heart failure (17% vs. 6%, P=.04). Preexisting renal dysfunction and advanced age were found to be independent predictors of CIN (OR: 4.2, 95% CI: 1.5-11.9, P=.006; OR: 3.2, 95% CI: 1.1-9.8, P=.03 respectively). The in-hospital adverse event rate was significantly higher in patients with CIN (16.7% vs. 2.4%, P=.001). A multivariate analysis revealed CIN as an independent predictor of in-hospital adverse event rate (OR: 6.1, 95%CI: 1.2-29.3, P=.02). CONCLUSION: CIN is associated with a higher in-hospital adverse event rate in APE patients diagnosed using CTPA. This is first large study to focus specifically on CIN in patients diagnosed with APE using CTPA.

Fragmented QRS on Admission Electrocardiography Predicts Long-Term Mortality in Patients with Non-ST-Segment Elevation Myocardial Infarction.

BACKGROUND: Early diagnosis and identification of high-risk non-ST elevation myocardial infarction (NSTEMI) is an important issue. Fragmented QRS (fQRS) complexes are defined as various RSR' patterns on 12-lead resting electrocardiography (ECG). Previous studies revealed that fQRS is related with increased ventricular arrhythmias and cardiovascular mortality. The relation between fQRS and mortality in acute coronary syndromes, mitral valve disease severity and structural heart disease has been shown in different studies. The aim of this study was to investigate relation between fQRS and long-term cardiovascular mortality in NSTEMI patients. METHODS: Patients who admitted to our emergency unit and diagnosed NSTEMI between 2012 and 2013, 433 patients were included prospectively. fQRS complexes determined in 85 patients. Patients were divided into two groups according to fQRS existence. All patients evaluated for their clinical, laboratory, electrocardiographic, and echocardiographic characteristics. Angiographic features of 315 patients who underwent coronary angiography was also recorded. In-hospital, 30-day and 12-month mortality was compared between these groups. RESULTS: Demographic characteristics and cardiovascular risk factors were similar in both groups except hyperlipidemia. GRACE risk score was higher in patients with fQRS and positively correlated with existence of fQRS. In hospital and 30-days mortality were similar but late mortality was higher in fQRS group. Predictors of late mortality were found to be age, heart rate, male sex in addition to fQRS. CONCLUSION: We found a relation between fQRS and late mortality. Fragmented QRS may be seen as a cautionary signal for extensive myocardial damage and thereby increased long-term mortality for patients with NSTEMI.

Impact of Nonalcoholic Fatty Liver Disease on Myocardial Perfusion in Nondiabetic Patients Undergoing Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction.

Limited data exist on the role of nonalcoholic fatty liver disease (FLD) as a potential independent risk factor in the setting of acute coronary syndromes. The aim of this study was to evaluate the impact of FLD on myocardial perfusion and inhospital major adverse cardiac events (MACE) in the setting of ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI). We examined 186 consecutive nondiabetic patients (mean age 58 ± 11 years and 76% men) who underwent primary PCI for STEMI by ultrasound within 72 hours of admission. FLD was graded according to a semiquantitative severity score as mild (score <3) or moderate to severe (score ≥3). Myocardial perfusion was determined by measuring myocardial blush grade (MBG) and ST-segment resolution (STR) analysis. Patients were divided into 2 groups according to FLD score (<3 or ≥3). There were no differences with regard to postprocedural Thrombolysis In Myocardial Infarction 3 flow grade between the 2 groups (89% vs 83%, p = 0.201). Patients with FLD score ≥3 were more likely to have absent myocardial perfusion (MBG 0/1, 37% vs 12%, p <0.0001), absent STR (27% vs 9%, p = 0.001), and higher inhospital MACE rate (31% vs 8%, p <0.0001). By multivariate analysis, FLD ≥3 score was found to be an independent predictor of absent MBG 0/1 (odds ratio [OR] 2.856, 95% confidence interval [CI] 1.214 to 6.225, p = 0.033), absent STR (OR 2.862, 95% CI 1.242 to 6.342, p = 0.031), and inhospital MACE (OR 2.454, 95% CI 1.072 to 4.872, p = 0.048). In conclusion, we found that despite similar high rates of Thrombolysis In Myocardial Infarction 3 after primary PCI, patients with FLD score ≥3 are more likely to have impaired myocardial perfusion which may contribute to adverse inhospital outcome.

Predictive Value of the No-Reflow Phenomenon and Epicardial Adipose Tissue for Clinical Outcomes After Primary Percutaneous Coronary Intervention.

INTRODUCTION: The determinants of clinical outcomes in patients with acute ST-elevation myocardial infarction (STEMI) are still being debated. The aim of this study was to investigate the prognostic value of the no-reflow phenomenon and epicardial adipose tissue (EAT) thickness for clinical outcomes in patients undergoing primary percutaneous coronary intervention (pPCI) for STEMI. METHODS: The present study prospectively included 114 consecutive patients (mean age 54 ± 10 years, 15 women) who underwent successful pPCI. Patients were divided into two groups according to the occurrence of the no-reflow phenomenon and further subdivided according to the tertile of EAT thickness (Group I <5.1 mm, Group II ≥5.1 mm). We assessed the composite and separate occurrence of major adverse cardiac events. RESULTS: Throughout the 3-year follow up, the number of admissions for heart failure was significantly higher in patients with no-reflow (n=5 [20%] vs. n=1 [1%], p=0.003) and in female patients (n=4 [26%] vs. n=2 [2%], p=0.004). In the subgroup analysis, group I patients with no-reflow showed a higher frequency of admission for heart failure (n=4 [44%] vs. n=1 [6%], p=0.04). However, multivariate logistic regression analysis demonstrated that only no-reflow and female sex independently predicted admission for heart failure (OR: 19.3, 95%CI: 1.4-269.7, p=0.03, and OR: 24.9, 95%CI: 2.2-288.8, p=0.01, respectively). CONCLUSION: No-reflow and female sex are independent predictors of admission for heart failure in the longterm follow up of patients with STEMI. However, EAT thickness is not associated with clinical outcomes after pPCI.

The relationship between epicardial adipose tissue and ST-segment resolution in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.

The relationship between epicardial adipose tissue (EAT) and coronary artery disease has been predominantly demonstrated in the last two decades. The aim of this study was to investigate the predictive value of EAT thickness on ST-segment resolution that reflects myocardial reperfusion in patients undergoing primary percutaneous coronary intervention (pPCI) for acute ST-segment elevation myocardial infarction (STEMI). The present study prospectively included 114 consecutive patients (mean age 54 ± 10 years, range 35-83, 15 women) with first acute STEMI who underwent successful pPCI. ST-segment resolution (ΔSTR) <70 % was accepted as ECG sign of no-reflow phenomenon. The EAT thickness was measured by two-dimensional echocardiography. EAT thickness was increased in patients with no-reflow (3.9 ± 1.7 vs. 5.4 ± 2, p = 0.001). EAT thickness was also found to be inversely correlated with ΔSTR (r = -0.414, p = 0.001). Multivariate logistic regression analysis demonstrated that EAT thickness independently predicted no-reflow (OR 1.43, 95 % CI 1.13-1.82, p = 0.003). Receiver operating characteristic curve analysis demonstrated good diagnostic accuracy for EAT thickness in predicting no-reflow [area under curve (AUC) = 0.72, 95 % CI 0.63-0.82, p < 0.001]. In conclusion, increased EAT thickness may play an important role in the prediction of no-reflow in STEMI treated with pPCI.

The relationship between Gensini score and ST-segment resolution in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.

BACKGROUND: Clinical outcomes of patients with myocardial infarction are primarily determined by the successful restoration of myocardial reperfusion and the severity of coronary atherosclerosis. AIM: To investigate the predictive value of Gensini score on ST-segment resolution (STR) in patients undergoing primary percutaneous coronary intervention (pPCI) for acute ST-elevation myocardial infarction (STEMI). METHODS: The present study prospectively included 114 consecutive patients (mean age 54 ± 10 years, 15 women) with STEMI who underwent successful pPCI. Sum of ST-segment elevation amount in millimetres was obtained before angioplasty and 60 min after pPCI. ΣSTR < 50% was accepted as a ECG sign of no-reflow phenomenon. Thrombus grading was calculated according to the results of coronary angiography, and Gensini score (GS-pPCI) was calculated after pPCI without incorporating culprit lesion. Patients were divided into two groups according to STR: those with STR(-), and those with STR(+). Patients were also analysed according to the infarct-related artery. RESULTS: GS-pPCI was significantly higher in patients with STR(-) (10.1 ± 11.8 vs. 22 ± 18.6, p = 0.005). GS-pPCI was inversely correlated with STR (r = -0.287, p = 0.002). In subgroup analysis, patients in the STR(-) group with culprit lesion in left anterior descending artery and left circumflex artery also showed higher GS-pPCI (10.9 ± 13.5 vs. 23.5 ± 21.3, p = 0.03 and 9.6 ± 8.7 vs. 24.1 ± 21, p = 0.04, respectively). High thrombus burden was also observed more frequently in patients with STR(-) (68% vs. 43%, p = 0.03). Multivariate logistic regression analysis demonstrated that GS-pPCI and high thrombus burden independently predicted inadequate STR (OR 1.07, 95% CI 1.03-1.12, p = 0.001 and OR 3.28, 95% CI1.11-9.72, p = 0.03, respectively). CONCLUSIONS: GS-pPCI and high thrombus burden play an important role in predicting inadequate STR in patients with STEMI treated with pPCI.

Infective endocarditis caused by group G streptococcus with multiple cerebral emboli.

The group G streptococcal endocarditis is a rare form of infective endocarditis. In this form of infective endocarditis, serious neurological complications most commonly develop. We reported this case because of its being an unusual form of infective endocarditis that was caused by Group G Streptococcus. We also reviewed the literature. The patient was admitted to infectious disease service with a presumptive diagnosis of central nervous system infection. Blood cultures were positive for group G streptococcus. There was a mass on the posterior surface of the mitral valve which was 2 x 2.5 cm in length on the echocardiography. In the cranial computerized tomography of our patient, slightly increased contrast media uptake was observed in the both parietal lobes, in the both frontal lobes, and in the anterior areas of right occipital lobe. Therefore, this case was assumed as infective endocarditis caused by group G streptococcus with multiple cerebral emboli. Ceftriaxone was given for 4 weeks and gentamicin was given for 2 weeks, and progressive improvement of the patient's condition was seen.

Effects of losartan, somatostatin and losartan plus somatostatin on portal hemodynamics and renal functions in cirrhosis.

BACKGROUND/AIMS: Several drugs have been used to reduce portal hypertension. Losartan constitutes arteriolar and venous vasodilation by inhibiting the effects of the increased angiotensin II in cirrhotic patients. In this study, we analyzed the effects of losartan, when used alone and when combined with somatostatin, on portal and renal hemodynamics. METHODOLOGY: Seventeen patients with cirrhosis were enrolled. During the study, the patients were administered 250 micrograms of somatostatin i.v. bolus and subsequent infusion at a rate of 250 micrograms/hr for 2 hours on the second day; 25 mg losartan orally on the fourth day; and losartan and somatostatin together, in the same doses as the second and the fourth day, were given on the sixth day. RESULTS: The portal flow volume and the velocity that were measured after the administration of somatostatin, losartan and the combination of each drug, were found to be increased when compared with the initial values (P < 0.001). Additionally, the creatinine clearances were increased and statistically significant with somatostatin. CONCLUSIONS: Considering its low cost, easy usability, long lasting effect, we suggest that losartan can be used as an alternative treatment in the clinical conditions where portal pressure should be reduced and can be combined with somatostatin without any significant adverse effects.