Decreased coronary blood flow velocity in patients with aortic insufficiency but normal coronary arteries: the use of TIMI frame count in aortic insufficiency cases.

Patients with aortic insufficiency (AI) may suffer from anginapector is in the absence of obstructive coronaryartery disease. In this study, we aimed to investigate coronary blood flow using the thrombolysis in myocardialinfarction (TIMI) frame count (TFC) method in patients with AI and normal coronaryarteries. The study included 64 patients (Group 1; meanage 62.4 ± 13.2 years) with moderate to severe AI who had under gonecoronaryangio graphy that resulted in angiographically normal coronaries, and 42 patients with a typical chest pain and angiographically normal coronaryarteriogram (Group 2; meanage 58.8 ± 9.8 years). All patients under went coronaryangiography either to exclude coronaryartery disease or to evaluate their coronaryanatomy before aorticvalve replacement. TFC was calculated and compared for each artery, including the left anterior descending (LAD), circumflex (LCX), and right coronaryartery (RCA) in both groups. The base line characteristics of the study groups were similar. In both groups, TIMI-3 flow was present in eachartery at the time of arteriography, and the coronaryarteries were entirely normal. LCx and RCA frame counts and corrected LAD frame counts were significantly higher in Group 1 than in Group 2 (26.4 ± 2.1 vs. 24.3 ± 3.6, P < 0.05; 22.1 ± 2.3 vs. 20.5 ± 2.9, P < 0.05; and 22.5 ± 1.8 vs. 20.5 ± 2.4, P < 0.05, respectively). The TFC method may be used as a marker forcoronary flowvelocity in patients with aortic insuffiency and angiographically normal coronaryarteries toestimate decreased coronary blood flowve locity.

Late in-stent coronary dissection in an elderly woman: an interesting case report.

Primary or de novo spontaneous coronary dissection has been reported in many cases; however, in-stent dissection was demonstrated in the previously stented segment of coronary artery only in an autopsy study. Therefore, we report a 78-year-old female presenting with angina pectoris and dyspnea for the last 20 days. She had undergone stent implantation for a significant stenosis in the left anterior descending artery 3 years ago. In-stent dissection flap limiting coronary flow was noted at the coronary angiography and successfully treated with coronary re-stenting. She had no symptoms at follow-up.

The diameters of the aorta and its major branches in patients with isolated coronary artery ectasia.

We designed this study to evaluate the diameters of the aorta and its major branches in patients who had coronary ectasia. We assigned 80 patients (mean age, 57 +/- 11 yr) with isolated coronary artery ectasia to the study group and 25 patients (mean age, 54 +/- 10 yr) without structural or coronary arterial disease to the control group. All patients underwent coronary angiography and angiography of the aorta and its branches. We used computed quantitative angiography to measure the diameters of the coronary arteries, the aorta, and the major aortic branches. Within the study group, the diameter indices of the proximal portions of the right common iliac artery (P=0.041) and the left common iliac artery (P=0.035) were significantly larger than the diameter indices within the control group. The diameter indices of all other evaluated arteries were similar in both groups (all P >0.05).

Tilt training for recurrent neurocardiogenic syncope: effectiveness, patient compliance, and scheduling the frequency of training sessions.

Unsatisfactory results obtained with medical therapy and dual-chamber pacing for prevention of recurrent neurocardiogenic syncope necessitated the development of new treatment modalities. Tilt-training, a novel treatment for recurrent neurocardiogenic syncope based on exercise sessions with prolonged upright posture (either on a tilt-table or standing on foot against a wall), was shown to be effective in preventing the recurrence of neurocardiogenic syncope. The purpose of this study was to demonstrate the long-term beneficial effects of a transient tilt training program lasting 2 months. Thirty-two patients with recurrent neurocardiogenic syncope (mean number of syncope episodes in the last 6 months was 3.4 +/- 2.3) constituted the study group. All of the patients were tilt test positive. The patients were taught a tilt training program with 2 phases (in-hospital training with repeated tilt procedures until 3 consecutive negative results were obtained and home exercises with standing against a wall) and home exercises lasted a maximum of 2 months. After this training program, the patients received no treatment and were followed for the recurrence of syncope. At the end of the follow-up period (376 +/- 45 days), 81% of the patients were free of recurrent syncope. This study revealed that similar successful results can also be obtained with a transient tilt training program as a first line treatment strategy. Less interference with the daily activities of the patients is the major advantage of this strategy. The ease of performance and high effectiveness rate will most likely result in more frequent utilization of this treatment modality.

P wave dispersion and left atrial appendage function for predicting recurrence after conversion of atrial fibrillation and relation of p wave dispersion to appendage function.

BACKGROUND: We investigated P wave dispersion and left atrial appendage (LAA) function for predicting atrial fibrillation (AF) relapse, and the relationship between P wave dispersion and LAA function. METHODS: Sixty-four consecutive patients with AF lasting /=5 days, LA size >/=45 mm, maximum P wave duration >/=112 ms, P wave dispersion >/=47 ms, spontaneous echo contrast, minimum LAA area >/=166 mm(2), and LAA emptying velocity <36 cm/sec were univariate predictors of recurrence (each P < 0.05). By multivariate analysis, LA size (P = 0.02), P wave dispersion (P < 0.001), and LAA emptying flow (P = 0.01) identified patients with recurrent AF. Their positive predictive values were 91, 97, and 72%, respectively. CONCLUSION: The increased P wave dispersion in addition to the dilated LA and the depressed LAA emptying flow can identify patients at risk of recurrent AF after cardioversion.

Diagnostic value of D-dimer and antithrombin-III levels in predicting prosthetic heart valve thrombosis.

The aim of this prospective study was to investigate the diagnostic value of plasma D-dimer levels and antithrombin-III activity in predicting prosthetic valve thrombus. The study group comprised 97 consecutive patients with prosthetic heart valves (59 with mitral, 21 with aortic, and 17 with both mitral and aortic prostheses) and 35 healthy control subjects. Six patients presented with symptoms of obstruction; the remaining 91 were asymptomatic. Patients were evaluated by both transthoracic and transesophageal echocardiography. Asymptomatic nonobstructive thrombus was detected in 13 patients (13%), whereas obstructive thrombus was demonstrated in all symptomatic patients. Plasma antithrombin-III levels of patients with prosthetic valve thrombi were slightly lower than those of patients without thrombus and of the control group, but the difference was not statistically significant. However, significantly higher plasma D-dimer levels were observed in patients with prosthetic valve thrombi, compared with patients without thrombus and the control group (735 +/- 633 microg/L, 372 +/- 342 microg/L, and 228 +/- 219 microg/L, respectively). Valve thrombus, the prosthetic heart valve itself, and INR levels were identified as major determinants of plasma D-dimer levels. A plasma D-dimer level of >445 microg/L predicted the presence of a prosthetic valve thrombus with 57.8% sensitivity and 83.3% specificity (positive predictive value, 47.8%; negative predictive value, 87.8%). Current data suggest that increased plasma D-dimer levels can be clinically helpful in predicting the presence of prosthetic valve thrombus. Plasma antithrombin-III activity does not seem to have a diagnostic value in predicting prosthetic valve thrombi.

A case with coarctation of the aorta accompanied by coronary ectasia and dilatation of the ascending aorta.

Coarctation of the aorta is one of the congenital heart diseases diagnosed primarily in childhood and early adolescence. A 67-year-old female was admitted to the hospital with chest pain. Angiography revealed a coarctation of the aorta, coronary ectasia and dilatation of the ascending aorta. This case attracted our attention because the first diagnosis was made at such an advanced age and coarctation was accompanied by coronary ectasia and dilatation of the ascending aorta. Therefore, we decided to report the case.

Use of tissue Doppler echocardiography in early detection of left ventricular systolic dysfunction in patients with mitral regurgitation.

OBJECTIVE: Left ventricular ejection fraction (EF) and left ventricular (LV) end-systolic diameter measurements are the most widely accepted and utilized methods to demonstrate LV dysfunction in patients with mitral regurgitation (MR). However, these parameters still have many drawbacks in predicting early LV dysfunction. This study investigates the clinical usefulness of tissue Doppler echocardiography technique in detecting early disturbance of myocardial contractility in asymptomatic patients with chronic, severe MR and normal LV ejection fraction values. METHODS AND RESULTS: Regional systolic peak velocities of mitral annular motion during the ejection phase of systole (SW2) were obtained at the mitral annuli of the ventricular septal, lateral, anteroseptal, posterior, anterior and inferior wall sites in the long axis in 31 asymptomatic patients with severe MR (with a regurgitant volume of more than 50 ml) and with EFs more than 60%. The patients were grouped according to their dP/dt values (more or less than 1300 mmHg/s) estimated non-invasively by using continuous Doppler wave of MR SW2 measurements of Group I were higher than Group II in all of the analyzed segments. The difference was statistically significant for all of the segments. SW2 values of the whole study group was moderately correlated with dP/dt measurements in all of the analyzed segments other than the interventricular septum. CONCLUSION: SW2 measurements in the long axis, which are considered to be relatively independent from afterload conditions may be helpful in early detection (while EF is still in normal range) of LV systolic dysfunction during the follow-up of patients with chronic MR.