Myocardial tissue perfusion predicts the evolution of fragmented QRS in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.

BACKGROUND: Fragmented QRS complex (fQRS) is associated with worse outcomes in several cardiovascular conditions. However, alterations in fQRS in patients with ST elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI) and association of fQRS with myocardial blush grade (MBG) has not been investigated until now. In this study, we aimed to investigate the association of MBG after primary PCI with evolution of fQRS. METHODS: Our study consisted of 401 consecutive patients with STEMI who underwent primary PCI. Patients were categorized into two subgroups according to persistence or new-onset of fQRS (Group 1) and absence or resolution of fQRS (Group 2) at 48 hours after primary PCI. The evolution of fQRS on pre- and post-PCI ECG and their relation with myocardial reperfusion parameters were investigated. RESULTS: Patients in group 1 showed older age, higher rate of smoking, lower HDL-cholesterol, lower LVEF, higher angina-to-door time, higher TIMI frame count, and high rate of patients with MBG <3 compared to patients with group 2 (P < 0.05). In correlation analysis, LVEF showed positive correlation with MBG (r = 0.448, P < 0.001) and negative correlation with the number of leads with fQRS (r = -0.335, P < 0.001). In multivariate regression analysis, new-onset or persistance of fQRS after primary PCI is significantly associated with MBG <3, peak CK-MB level, pre-PCI fQRS at anterior localization and smoking. CONCLUSION: Our findings showed that despite complete ST-segment resolution in all patients, fQRS is independently associated with impaired microvascular myocardial perfusion. So, fQRS, as a simple and easily available noninvasive marker, may be useful in stratification of high-risk patients with increased extent of infarcted myocardium who underwent primary PCI.

The effect of different circadian blood pressure rhythms on left ventricular systolic dyssynchrony in patients with newly diagnosed essential hypertension.

OBJECTIVES: Left ventricular (LV) synchronous contraction is impaired in patients with hypertension (HT). The deleterious effects of HT on cardiovascular system are more evident in patients with nondipper HT than dippers. In this study, we aimed to investigate the effect of nondipping HT on LV systolic synchronicity compared with dippers and controls. METHODS: One hundred patients with newly diagnosed essential HT and 50 normotensive subjects were enrolled in this study. The hypertensive patients were assigned 2 groups comprising 55 dippers and 45 nondippers. Each subject underwent a comprehensive transthoracic echocardiographic examination. The evaluation of systolic dyssynchrony was performed by tissue synchronization imaging, and the time to regional peak systolic tissue velocity (Ts) in LV was measured on the basis of 12 segmental models. The standard deviation (SD) of the 12 LV segments (Ts-SD-12) and maximal difference in Ts between any two of the 12 LV segments (Ts-12) were calculated. RESULTS: Compared with the control group, the synchronicity indexes were significantly prolonged in the hypertensive patients. Furthermore, Ts-SD-12 and Ts-12 values were found to be significantly impaired in patients with nondipper HT, compared with dippers: Ts-SD-12 (38.1 ± 18.7 vs. 31.8 ± 15.4, P ≤ 0.001); Ts-12 (123.0 ± 50.6 vs. 98.4 ± 42.3, P ≤ 0.001). Stepwise multivariate logistic regression analysis revealed a significant negative association between LV dyssynchrony indices and percentage decline in BP level from day to night. CONCLUSION: Synchronous systolic contraction of LV is found to be significantly impaired in patients with nondipping circadian pattern of HT compared with dippers and the controls.

Impaired coronary flow reserve evaluated by echocardiography is associated with increased aortic stiffness in patients with metabolic syndrome: an observational study.

OBJECTIVE: Metabolic syndrome (MetS) is a strong predictor of cardiovascular events and coronary flow reserve (CFR), an indicator of microvascular function, has been found to be impaired in MetS. Aortic stiffness (AS) is a simple and effective method for assessing arterial elasticity. The aim of this study was to evaluate whether there is an independent association of impaired coronary flow and aortic elasticity in patients with MetS. METHODS: Forty-six patients (mean age 47.3 ± 6.6 years) with the diagnosis of MetS according to the ATP III update criteria and 44 age and gender matched controls (mean age 46.0 ± 6.1 years) were included into the cross-sectional observational study. Peak diastolic coronary flow velocities were measured in left anterior descending artery by pulsed wave Doppler at baseline and after adenosine infusion, and CFR was calculated as the ratio of hyperemic to baseline velocities. Aortic strain, distensibility and stiffness were calculated by M-mode echocardiography. Statistical analysis was performed by using Student t-test, Chi-square test, Pearson correlation and linear regression analyses. RESULTS: CFR was significantly lower in patients with MetS than in controls (2.3 ± 0.2 vs 2.7 ± 0.2, p<0.001). In the MetS group, aortic distensibility (10.4 ± 3.5 cm².dyn⁻¹.10⁻6 vs. 12.7 ± 3.4 cm2.dyn⁻¹.10⁻6, p=0.002) was decreased and AS was significantly increased (6.5 ± 2.0 vs. 3.2 ± 0.8, p<0.001). In multivariate linear regression analysis, AS (ß=-0.217, p=0.047), systolic blood pressure (ß=-0.215, p=0.050) and waist circumference (ß=-0.272, p=0.012) had an independent relationship with impaired CFR. CONCLUSION: This study demonstrated that coronary flow reserve is impaired in patients with MetS and there is an independent relationship between impaired CFR and increased aortic stiffness, systolic blood pressure or waist circumference.

Impaired coronary flow reserve is associated with increased echocardiographic epicardial fat thickness in metabolic syndrome patients.

OBJECTIVES: Metabolic syndrome (MetS) is a strong predictor of cardiovascular events and coronary flow reserve (CFR), an indicator of microvascular function, has been found to be impaired in MetS. Epicardial fat thickness (EFT) reflects visceral adiposity and is considered an important cardiometabolic marker. In this study, we aimed to examine the presence of an association between CFR and EFT in MetS patients. METHODS: Forty-six MetS patients (25 men, mean age 47.3±6.6 years) and 44 age-matched and sex-matched controls (24 men, mean age 46.0±6.1 years) were prospectively studied. Both CFR and EFT were measured by transthoracic echocardiography. Peak diastolic coronary flow velocities were measured in the left anterior descending artery by pulsed wave Doppler at the baseline and after adenosine infusion, and CFR was calculated as the ratio of hyperemic to baseline velocities. RESULTS: The waist circumference, total and low-density lipoprotein-cholesterol, fasting glucose, triglycerides, systolic and diastolic blood pressures, and high sensitive C-reactive protein were significantly higher in MetS patients. The mean EFT was significantly higher in MetS patients compared with the controls (8.7±0.2 vs. 4.8±0.1 mm, P<0.001); however, CFR was significantly lower in MetS patients (2.3±0.2 vs. 2.7±0.2, P<0.001). CFR was correlated significantly with BMI, waist circumference, high-density lipoprotein-cholesterol, triglycerides, fasting glucose, high sensitive C-reactive protein, and EFT. In regression analysis, MetS itself and EFT were found to be independent predictors of impaired CFR. CONCLUSION: CFR is impaired in MetS patients. MetS itself and increased EFT are associated independently with coronary microvascular dysfunction and EFT is a predictor of worse CFR even after accounting for the presence or absence of the MetS.

Increased epicardial fat thickness is associated with low grade systemic inflammation in metabolic syndrome.

OBJECTIVES: Epicardial fat tissue is a type of visceral adipose tissue that functions as a metabolically active endocrine organ. Most components of metabolic syndrome (MetS), especially visceral obesity, are associated with a low-grade systemic inflammatory state. In this study, we aimed to assess the relationship between echocardiographic epicardial fat thickness (EFT), MetS, the components of MetS, and high sensitivity C-reactive protein (hs-CRP) levels in patients with MetS. STUDY DESIGN: Forty-six patients (25 males, mean age 47.3±6.5 years) with the diagnosis of MetS (according to the Adult Treatment Panel III update criteria) but without clinical coronary artery disease, and 44 age and gender matched healthy volunteers (18 males, mean age 46.0±6.1 years) were included in the study. EFT, which was measured by transthoracic echocardiography, as well as clinical and biochemical parameters were compared between the two groups. RESULTS: Waist circumference, total and LDL-cholesterol, fasting glucose, triglycerides, systolic and diastolic blood pressure levels, hs-CRP, and uric acid levels were significantly higher in patients with MetS. EFT was also significantly increased in patients with MetS (8.7±0.2 mm vs. 4.8±0.1 mm, p<0.001). Multiple regression analysis determined that MetS itself (ß=0.929, p<0.001) and hs-CRP (r=-0.181, p=0.007) are independent predictors of increased EFT. CONCLUSION: This study demonstrates that EFT is higher in patients with MetS, and that MetS and hsCRP are independent predictors of this increased EFT. Increased EFT, which is associated with low-grade systemic inflammation, may play a role in the pathogenesis of atherosclerosis in MetS patients.

[Primary percutaneous coronary intervention for acute myocardial infarction in elderly aged 75 years and over: in-hospital mortality and clinical outcome]. / Yetmis bes yas ve üstündeki akut miyokart enfarktüslü hastalarda primer perkütan girisim: Hastane içi mortalite ve klinik sonuçlari

OBJECTIVES: We aimed to determine the in-hospital mortality and clinical outcome of patients older than 75 years who were admitted to our high-volume tertiary center with ST-elevation myocardial infarction (STEMI) and treated with primary percutaneous intervention (PCI). STUDY DESIGN: Our study included patients over 75 years old who were admitted with STEMI and underwent primary PCI at our center between January 2008 and September 2011. We retrospectively collected data from our hospital records for 1165 patients with STEMI. We found 186 patients that were eligible for our study. We defined major adverse cardiovascular events (MACE) as in-hospital mortality, repeated target vessel revascularization, and reinfarction. RESULTS: The mean age of the patients was 79.7±4.4 years and the mean pain-balloon inflation time was 4.7±2.3 hours. The procedure success rate was 71.5%. In-hospital mortality and MACE occurred in 20.4% and 25.8% of patients, respectively. Twenty patients had cardiogenic shock at admission. Patients with cardiogenic shock had significantly more MACE than the rest of the study population (76.5% vs. 17.5%, p<0.0001). Independent predictors of MACE included Killip class at admission (OR 4.98, 95% CI 1.25-19.8, p=0.02), white blood cell counting (OR 1.15, 95% CI 1.0-1.3, p=0.04), development of in-hospital heart failure (OR 3.34, 95% CI 1.07-10.58, p=0.04), the presence of atrioventricular block in the hospital (OR 3.98, 95% CI 1.09-14.5, p=0.04), and the TIMI flow rate after primary PCI (OR 3.42, 95% CI 1.19-10.76, p=0.04). CONCLUSION: Our study revealed a high rate of MACE in patients older than 75 years admitted with STEMI regardless of undergoing primary PCI.