Pulmonary artery pressures and right ventricular dimensions of post-COVID-19 patients without previous significant cardiovascular pathology.

BACKGROUND: Pulmonary hypertension is a significant complication of COVID-19, but follow-up data on pulmonary artery pressure after recovery from COVID-19 are limited. OBJECTIVES: To investigate pulmonary artery pressure and heart dimensions in post-COVID-19 patients without a history of significant cardiac pathology. METHODS: Data for 91 eligible adult patients were subjected to 2 analyses. First, patients were grouped according to where they received COVID-19 treatment: the ICU, COVID-19 ward, or outpatient clinic. Second, the severity of COVID-19 was grouped as no pulmonary involvement, non-severe pulmonary involvement, or severe pulmonary involvement based on thoracic computed tomography scores. Heart dimensions were measured and pulmonary artery pressure was estimated using transthoracic echocardiography. The correlation between transthoracic echocardiography findings and COVID-19 severity was assessed. RESULTS: Pulmonary artery pressure and right-heart dimensions were significantly elevated in the post-COVID-19 patients without a history of risk factors for pulmonary hypertension that presented to the cardiology outpatient clinic with cardiac complaints. Both of these findings were correlated with the severity of COVID-19 and the extent of lung involvement based on thoracic computed tomography. CONCLUSION: The present findings confirm that increases in systolic pulmonary artery pressure and right ventricular dimensions persist 2-3 months after recovery from COVID-19 in patients without a history of risk factor for pulmonary hypertension. Furthermore, the increase in pulmonary artery pressure and right ventricular dimensions correlate with the severity of COVID-19 and the extent of lung involvement based on thoracic computed tomography.

New steps in acute coronary syndrome and antihyperlipidemic treatment: Determination of statins and metabolites by liquid chromatography tandem mass spectrometry.

Our aim in this study was to develop a validated liquid chromatography-tandem mass spectrometry (LC-MS/MS) method for the measurement of atorvastatin, rosuvastatin and their major metabolites, and furthermore to evaluate patients' adherence to statin therapy and to investigate the effect of statin therapy on various hematological and biochemical parameters. A simple protein precipitation was performed for the extraction of analytes and the extracted samples were injected directly. The levels of drugs and their metabolites were measured by the validated method in a total of 210 patients diagnosed with unstable angina pectoris (USAP), ST-elevation myocardial infarction (STEMI) or non-ST-elevation myocardial infarction (NSTEMI). Various biochemical and hematological parameters were measured. The linearity ranges for atorvastatin and rosuvastatin were 1.22-2,500 and 0.97-2000 ng/ml, respectively. The inter-assay coefficient of variation for all analytes was ≤ 6%. In patients diagnosed with USAP, STEMI and NSTEMI, treatment compliance rates were 22.1, 23.5 and 41.2% for atorvastatin and 36.1, 40.2 and 67.1% for rosuvastatin, respectively. An economical, simple and reliable measurement method has been developed. Our findings support the poor patient compliance with statin therapy in the included population. It was observed that 6 months of statin treatment caused slight changes in biochemical and hematological parameters.

Distal transradial versus conventional transradial access in acute coronary syndrome.

OBJECTIVE: Distal transradial access (TRA) has been recently introduced as an alternative access site for coronary angiography (CAG). Both procedures can be performed in cardiology clinics by interventional cardiologists. Although distal TRA is considered to be more difficult as it requires artery puncture and experienced cardiologists, it seems to be more advantageous because of the limited risk of arterial occlusion. In this study, we share our experiences with distal TRA and conventional TRA. METHODS: Seventy patients undergoing CAG via distal TRA and 63 patients via conventional TRA were included in this study. The patients' data were reviewed retrospectively and compared in terms of procedural characteristics and complications. RESULTS: There was no significant difference between the distal TRA group (94.2%) and the conventional TRA group (98.4%) in terms of success rate (p=0.217). In the distal TRA group, the total sheath emplacement time was longer (p<0.001), and hemostasis time was shorter (p<0.001) compared with conventional TRA. Total procedural time and hospitalization period were not statistically different between the groups (p>0.05). Radial spasm and radial occlusion were more common in the conventional TRA group than in the distal TRA group (7.9% vs 1.4% and 3.1% vs 1.4%, respectively), and hematomas were not statistically different between the groups. CONCLUSION: Although distal TRA seems more advantageous in terms of less hemostasis time and less vascular complications, it takes a longer time for sheath insertion and may cause more pain, which may diminish its efficiency. Large-scale studies are needed to address this issue.

Prevalence and Characteristics of Coronary Artery Anomalies Using Invasive Coronary Angiography in 6237 Consecutive Patients in a Single Center in Turkey.

BACKGROUND: Coronary artery anomalies (CAAs) include clinically and anatomically diverse types of congenital heart defects occurring in a complicated spectrum. The aim of the present study is to describe congenital anomalies of coronary arteries (CAs) and their variations, and also identify the prevalence of these anomalies in our center. METHODS: The study included a total of 6237 consecutive patients. Cine-angiographies and digital data of all patients undergoing coronary angiography (CAG) were reviewed by at least 2 independent and experienced observers. The Basic Anatomic Classification method was used to classify patients with CAAs. RESULTS: Of a total of 6237 patients, 2,313 were females (37.1%) and 3924 (62.9 %) were males. CAAs were detected in 247 out of 6237 patients (3.9%, 95% CI: 3.4-4.4). Of these patients, 48 (19.4%, 95% CI: 14.4-24.2) had absent left main coronary artery (LMCA), 21 (8.5%, 95% CI: 5-11.9) had anomalous origin from the appropriate sinus, 23 (9.3%, 95% CI: 5.7-12.9) had anomalous origin from structures other than appropriate sinus, 31 (12.6%, 95% CI: 8.5-16.6 ) had anomalous origin from the opposite sinus, 101 (40.9%, 95% CI: 34.8-46.9) had myocardial bridge, and 23 (9.3%, 95% CI: 5.7-12.9) had a coronary artery fistula. CONCLUSION: Our study results suggested that the total rate of coronary anomaly was found much higher than those reported in various invasive angiographic studies.

Focusing on a complete blood cell parameter: mean platelet volume levels may be a predictor of coronary slow flow.

BACKGROUND: The relationship between increased mean platelet volume (MPV) and atherosclerosis is well known. In the present study, MPV in patients with coronary slow flow (CSF) and in cases with normal coronary anatomy (NCA) was investigated and compared with the aim of identifying the relationship between CSF and MPV. PATIENTS AND METHODS: We studied 40 patients previously determined via coronary angiography as having NCA and 40 patients with CSF in the coronary blood stream, as identified by thrombolysis in myocardial infarction square. Thus, a total of 80 patients from the Elazig Education and Research Hospital (Elazig, Turkey) were included in the present study retrospectively and laboratory and anamnesis information was scanned into their files. The relationship between MPV and CSF was studied. RESULTS: MPV levels were observed to be significantly higher in the CSF group compared to the NCA group (10.05±1.3 and 8.6±0.6, p<0.001). In receiver operating characteristics analyses, it was determined that an MPV >9.05 measured in CSF patients at application had a predictive specificity of 77.5% and sensitivity of 77.5% for CSF (area under the curve: 0.825, 95% confidence interval [CI]: 0.726-0.924, p<0.0001). It was found that MPV level was an independent predictor of CSF (ß=-600, p<0.001, 95% CI: -0.383 to -0.176). CONCLUSION: MPV is increased in patients with CSF when compared to patients with NCA. This finding supports the fact that MPV could be a predictor of CSF.

Comparision of effects of rosuvastatin versus atorvastatin treatment on plasma levels of asymmetric dimethylarginine in patients with hyperlipidemia having coronary artery disease.

Elevated plasma levels of asymmetric dimethylarginine (ADMA) are prevalent in patients with hypercholesterolemia and coronary artery disease. A total of 83 patients with hypercholesterolemia and angiographically documented mild coronary artery stenosis were randomized to rosuvastatin treatment (20 mg) or atorvastatin treatment (40 mg) once daily for 6 weeks after a 4-week dietary lead-in phase. Both statins decreased total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and triglyceride levels effectively. Only rosuvastatin increased high-density lipoprotein cholesterol (HDL-C) levels. Both rosuvastatin and atorvastatin decreased plasma ADMA levels; rosuvastatin had a significantly greater effect. The reduction in ADMA levels were correlated with the reduction in TC and LDL-C levels as well as LDL-C-HDL-C ratio. Treatment with rosuvastatin or atorvastatin in patients with hyperlipidemia with mild coronary artery stenosis may lead to a decrease in ADMA levels, which may contribute to improved endothelial function.

Elevated red blood cell distribution width in healthy smokers.

OBJECTIVES: Red blood cell distribution width (RDW) has been reported to be a marker of morbidity and mortality for some cardiovascular and pulmonary diseases. We aimed to evaluate RDW values in otherwise healthy smokers. STUDY DESIGN: Two hundred and twenty consecutive subjects with current smoking and 230 age- and gender-matched healthy subjects without smoking history were enrolled. Number of cigarettes smoked per day and duration of smoking, evaluated as pack years, were recorded. Complete blood count, high-sensitivity C-reactive protein (hs-CRP) levels and lipid profile were analyzed in all study participants. RESULTS: The mean RDW values were higher in smokers than in nonsmokers (13.9±1.2 vs. 13.1±0.8, p<0.0001). The mean leukocyte count, mean platelet volume and hs-CRP levels were also significantly greater in smokers when compared to nonsmokers (8440±1.750 vs. 7090±1550, p<0.0001; 8.7±0.8 fL vs. 8.3±0.6 fL, p<0.0001; 2.42±0.53 mg/L vs. 1.46±0.52 mg/L, p<0.0001, respectively). Significant positive correlations between RDW and number of cigarettes smoked per day and between RDW and duration of smoking were identified (r=0.565 and r=0.305, respectively). CONCLUSION: Elevated RDW is associated with cigarette smoking and may be a useful indicator of inflammatory activity in smokers.

Deficiency of a new protein associated with cardiac syndrome X; called adropin.

The pathophysiology of cardiac syndrome X (CSX) is still unclear, but most patients with CSX have endothelial dysfunction. It has been shown that adropin uniquely effects the regulation of endothelial function. The purpose of the study was to evaluate the role of adropin in CSX. Eighty-six consecutive cardiac syndrome X-diagnosed patients and 86 age-sex matched healthy subjects were enrolled into the study. Serum adropin levels, nitrite/nitrate levels were measured in each subject. The adropin levels were significantly lower in patients with CSX than healthy subjects (1.7 ± 0.8 ng/mL and 3.4 ± 1.8 ng/mL, respectively; P < 0.001). The BMI values of patients with CSX were significantly higher than control subjects (28.1 ± 2.4 kg/m(2) and 26.0 ± 3.7 kg/m(2) , respectively; P < 0.001). Plasma nitrite/nitrate levels were lower in patients with CSX than control subjects (15.9 ± 1.6 µmol/L vs. 25.4 ± 2.8 µmol/L, respectively; P < 0.001), and they have a significantly positive correlation with plasma adropin levels (r = 0.463, P < 0.001). In the multiple linear regression analysis, nitrite/nitrate levels, BMI, and adropin were found to be independent risk factors for CSX. A ROC curve is used to identify the ability of adropin levels to predict the cardiac syndrome X. The area under the ROC curve was 0.854 for adropin levels (P = 0.0001). The sensitivity and specificity values of adropin levels were 90.7 and 70.9%, respectively (cut-off value 2.73). In conclusion, lower serum adropin levels were associated with CSX. Adropin is an independent risk factor for CSX.

An investigation of tenascin-C levels in rheumatic mitral stenosis and their response to percutaneous mitral balloon valvuloplasty.

OBJECTIVE: The purpose of this study was to evaluate the tenascin-C levels in severe rheumatic mitral stenosis before and after percutaneous mitral balloon valvuloplasty (PMBV). SUBJECTS AND METHODS: Forty patients with severe mitral stenosis requiring PMBV and 20 age-matched healthy subjects were included in the study. The mitral valve areas, mitral gradients and systolic pulmonary artery pressure (sPAP) were measured by echocardiography. The sPAP values and mitral gradients were also measured by catheterization before and after PMBV. The blood tenascin-C levels were measured before PMBV and 1 month after the procedure. RESULTS: The echocardiographic mean mitral gradients had a significant decrease after PMBV (11.7 ± 2.8 vs. 5.6 ± 1.7 mm Hg; p < 0.001) and also those of catheterization (13.9 ± 4.4 vs. 4.0 ± 2.4 mm Hg; p < 0.001). Mitral valve areas increased significantly after PMBV (from 1.1 ± 0.1 to 1.8 ± 0.2 cm(2), p < 0.001). Tenascin-C levels decreased significantly in patients after PMBV (from 15.0 ± 3.8 to 10.9 ± 3.1 ng/ml; p < 0.001). Tenascin-C levels were higher in patients with mitral stenosis before PMBV than in healthy subjects (15.0 ± 3.8 and 9.4 ± 2.9 ng/ml; p < 0.001, respectively). There were no significant differences between patients with mitral stenosis after PMBV and healthy subjects (10.9 ± 3.1 and 9.4 ± 2.9 ng/ml; p = 0.09, respectively). There was a significant positive correlation between tenascin-C levels and sPAP (r = 0.508, p < 0.001). In multivariant analysis, tenascin-C predicted mitral stenosis (p = 0.004, OR: 2.31). CONCLUSIONS: Tenascin-C was an independent predictor for rheumatic mitral stenosis.