Fragmented QRS as a Predictor of Cardiovascular Events in Patients with Type 2 Diabetes Mellitus: A 36-Month Follow-Up Data.

BACKGROUND: Major cardiovascular events (MACE) are more common in type 2 diabetes mellitus (T2DM) patients, and early diagnosis can prevent significant morbidity and mortality. The aim of this study was to investigate the predictiveness of fragmented QRS (fQRS) showing MACE in T2DM patients. METHODS: A total of 227 T2DM patients (mean age 52, 51% male) without any cardiovascular disease who came to the cardiology outpatient clinic between March 01 and July 31, 2019, were included in the study. The patients were divided into 2 groups according to fQRS on electrocardiography (ECG), and 36 months of follow-up was done. The development of acute coronary syndrome, coronary revascularization, and cerebrovascular accident were accepted as MACE. RESULTS: More MACE was seen in the group with fQRS on ECG (P =.026). Although there were more fQRS in patients with proteinuria, it was not statistically significant (P =.069). More myocardial infarcts (7.9%) and more cerebrovascular events (6.3%) were seen in the group with fQRS. While revascularization was performed on 3 patients in the fQRS group, revascularization was not performed on the patients in the non-fqrs group. In multiple Cox regression analysis, fQRS showed an independent predictor of MACE [P =.025, hazard ratio = 2.42 (1.117-5.221)], more MACE was seen in the fQRS (+) group in the kaplan-meier analysis (P =.022). CONCLUSION: More MACE was seen in the fQRS group in T2DM patients without a previous history of cardiovascular events. Fragmented QRS was found to be an independent predictor in showing MACE. Care should be taken in terms of MACE development in T2DM patients with fQRS.

Changing face of pulmonary embolism with COVID-19.

AIM: This study aimed to describe the baseline characteristics of coronavirus disease 2019 (COVID-19) patients with pulmonary embolism, and to examine the Geneva score, pulmonary embolism severity index (PESI), radiological and biochemical findings. METHODS: From March 2020 to June 2021, the files of 41 COVID-19 patients with pulmonary embolism were accessed. RESULTS: Mean D-dimer value was 6.04 mg/dl and 61% of the patients received at least one dose of anticoagulant treatment. In patients receiving deep venous thrombosis prophlaxis, an optimal D-dimer cut-off point was calculated as 5.69 mg/dl. The area under the curve was 0.753 (p = 0.007; sensivity 64%; specificity 62.5%). The mean Geneva score was 4.31, mean PESI was 72.48 and mean Qanadli score was 11.29. CONCLUSIONS: According to this study, traditional clinical predictive scores had little discriminatory power in these patients, and a higher D-dimer cut-off value should be considered to better diagnose patients for pulmonary embolism.

The relationship between length of stay in intensive care unit and Tpeak-Tend and Tpeak-Tend/QTc ratio in COVID 19 patients with acute coronary syndrome.

Background: Patients with coronavirus disease 2019 (COVID-19) can develop cardiac injury resulting in cardiac arrhythmias, myocarditis, and acute coronary syndrome (ACS). In this study, we aimed to investigate whether COVID-19 infection affects ventricular repolarization parameters such as Tpeak-Tend interval (Tp-e), QT interval, corrected QT (QTc), Tp-e/QT, and Tp-e/cQT in patients with ACS. Methods: The study consisted of two groups. The first group included patients with ACS and COVID-19 (Group 1) (n = 50). Polymerase chain reaction test positive patients were enrolled. The second group included patients with only ACS (Group 2) (n = 100). The risk of ventricular arrhythmias was evaluated on the basis of the measured electrocardiographic Tp-e and QT interval, and QTc, Tp-e/QT, and Tp-e/QTc values. Results: Tp-e interval, QTc, and Tp-e/QTc were significantly higher in the group1 than group 2 (p < .001, p < .018, and p < .001, respectively). Significant positive correlations were found between Tp-e, D-dimer level, and C-reactive protein (CRP) level in the group1 (p = .002, p = 0 .03, and p = .021, respectively). Univariate and multivariate regression analyses revealed that Tp-e was one of the independent predictor of length of stay in the intensive care unit (ICU). (B = 1.662, p = .006 and B = 1.804, p = .021, respectively). Conclusions: In the patients with ACS, COVID-19 infection caused increases in QTc, Tp-e, and Tp-e/QTc ratio. In addition, age and prolonged Tp-e were found to be independent predictors of prolonged ICU stay.

Takayasu Arteritis with Multiple Coronary Artery Fistulas to Bronchial Arteries.

Takayasu arteritis (TA) is an inflammatory disease that commonly occurs in young females. Coronary involvement occurs rarely and mostly with stenosis. Here, we present a case of TA associated with fistulas between the coronary arteries and the bronchial arteries.

Anomalous the Left Main Coronary Artery Originating from the Right Coronary Artery.

The coronary anomalies are rarely seen in clinical practice. A 47-year-old female patient presented to hospital with chest pain on exertion. The coronary angiography and cardiac tomography showed the anomalous origin of the left main from the right coronary artery.

Anomalous origin of the left main coronary artery from the right coronary artery with a preaortic course.

We report the case of a 51-year-old woman who presented with stable angina pectoris and Canadian Cardiovascular Society class II functional capacity. An electrocardiogram during a treadmill exercise test showed substantial ST-segment depression in the inferolateral leads. Coronary angiograms revealed an anomalous origin of the left main coronary artery from the opposite sinus of Valsalva and an interarterial course between the ascending aorta and pulmonary artery. Although this phenomenon is dangerous, the patient refused further examination. We discuss the diagnosis and treatment of patients who have an anomalous origin of a coronary artery from the opposite sinus of Valsalva.

Concomitant anterior and inferior myocardial infarctions.

Acute multicoronary occlusion is an extremely rare clinical and angiographic finding. Prompt diagnosis and treatment are extremely important. Herein, we present a 38-year-old man suffering from concomitant anterior and inferior myocardial infarctions due to simultaneous total occlusion of both the left anterior descending and right coronary arteries.

Multiple coronary thrombi with cisplatin.

Testicular cancer is the most common malignancy in young men (15-29 years old). Combination therapy with bleomycin, etoposide, and cisplatin has been the standard first-line treatment for testicular metastatic disease. We present a case of multicoronary thrombi causing acute inferior myocardial infarction in a patient who recently received chemotherapy for testicular tumor.

The incidence of coronary anomalies on routine coronary computed tomography scans.

OBJECTIVE: This study aimed to assess the incidence of coronary anomalies using 64-multi-slice coronary computed tomography (MSCT). METHODS: The diagnostic MSCT scans of 745 consecutive patients were reviewed. RESULTS: The incidence of coronary anomalies was 4.96%. The detected coronary anomalies included the conus artery originating separately from the right coronary sinus (RCS) (n = 8, 1.07%), absence of the left main artery (n = 7, 0.93%), a superior right coronary artery (RCA) (n = 7, 0.93%), the circumflex artery (CFX) arising from the RCS (n = 4, 0.53%), the CFX originating from the RCA (n = 2, 0.26%), a posterior RCA (n = 1, 0.13%), a coronary fistula from the left anterior descending artery and RCA to the pulmonary artery (n = 1, 0.13%), and a coronary aneurysm (n = 1, 0.13%). CONCLUSIONS: This study indicated that MSCT can be used to detect common coronary anomalies, and shows it has the potential to aid cardiologists and cardiac surgeons by revealing the origin and course of the coronary vessels.

A new stenting technique for bifurcation lesions a nine-patient case series.

AIMS: This study describes and reports preliminary outcomes using kissing T-stenting and small protrusion (K-TAP), a novel modification of traditional T-stenting and small protrusion (TAP). METHODS AND RESULTS: Nine patients who were treated with K-TAP between May 2008 and February 2012 at two hospitals were retrospectively included in this study. The primary endpoints were angiographic success, procedural success, and the composite 30-day and long-term occurrences of major adverse cardiac events (MACEs), which consisted of death, coronary artery bypass graft surgery, repeated percutaneous coronary intervention of the target vessel, and non-Q-wave and Q-wave myocardial infarctions. Data were obtained from the review of institutional databases, folder auditing, a telephone survey of the patients, and the review of angiograms. Angiographic success and procedural success were achieved in all patients. The mean fluoroscopy time for the total procedure was 24.1 min (range 20-28). No complications occurred during the procedures. The MACE rate during the mean follow-up period of 102 weeks (range 22-196 weeks) was 0%. CONCLUSIONS: K-TAP, a new coronary bifurcation stenting method, has favorable angiographic and procedural success rates and a low early post-procedure MACE rate. Further studies are needed to evaluate the clinical efficacy of the K-TAP method.

Intercoronary continuity: a case report.

Intercoronary continuity is a rare variance of coronary circulation. The importance of this rare anomaly is unknown. We present this rare anomaly in a patient with acute myocardial infarction.

Celiac artery aneurysm.

Coeliac artery aneurysms are rare and frequently detected incidentally. It is usually with associated aneurysms. Herein we present accidentally detected, asymptomatic coeliac aneurysm in a patient with acute myocardial infarction. Multi-slice tomography and invasive angiography images are provided along with brief discussion on clinical presentation, diagnostic tools and treatment options.

Spontaneous left main coronary artery dissection treated with primary stenting.

Spontaneous left main coronary artery (LMCA) dissection is an unusual cause of myocardial ischemia and sudden death. It is defined as an intramural hematoma of the media of the vessel wall. A 56-year-old male who underwent a two-vessel bypass ten years previous presented with chest pain for two hours. His blood pressure and heart rate were 60/35 mmHg and 120 beats per minute, respectively. The ECG showed inferior ST-segment elevation. Coronary angiography revealed total LMCA occlusion with dissection flap. A dissection flap was collapsing the true lumen of the LMCA. A bare metal stent was implanted after the flap was perforated and fenestrated by a stiff guide wire. Good TIMI 3 flow was achieved in the circumflex artery. Three months after the index procedure, coronary computed tomography angiography disclosed thrombosis of the false lumen beneath the patent left main stent. In conclusion, primer stenting can be successfully performed in the presence of spontaneous LMCA dissection.

Two-Year Follow-up of Sirolimus-Eluting Stents versus Paclitaxel-Eluting Stents in Acute Myocardial Infarction.

It has been shown that drug-eluting stents (DESs) significantly reduce restenosis rate when compared with bare-metal stents in a broad range of patients with coronary artery disease. However, current data are limited about the efficacy of different DESs in treatment of ST segment elevation myocardial infarction (STEMI). The aim of this study was to compare the effectiveness and safety of sirolimus-eluting stents (SESs) with paclitaxel-eluting stents (PESs) in primary percutaneous coronary intervention. We retrospectively examined 127 STEMI patients who underwent primary percutaneous coronary intervention. PES group consisted of 79 patients and SES group consisted of 48 patients. Patients were analyzed for major adverse cardiac events (MACE) and stent thrombosis (ST). The mean follow-up period was 2 years. The mean age was 53 ± 11 years in the SES group and 59 ± 11 years in the PES group (p = 0.03). Baseline and procedural characteristics were similar in the two groups except stent lengths, which was longer in the SES group. Two-year MACE rates were 8.3% in the SES group and 16.4% in the PES group (p = 0.28). Rates for ST for SES and PES groups were as follows: early ST was 2.08 versus 2.53%; late ST was 2.08 versus 2.53%; and very late ST was 2.08 versus 2.53% (p > 0.05). There were no statistically significant differences in MACE and ST rates between the SES and PES groups in the 2-year follow-up period. High ST rates detected in our study need to be clarified with future prospective and randomized clinical trials.

Recurrent left ventricular apical ballooning syndrome in a patient with pheochromocytoma.

Transient left ventricular apical ballooning syndrome is characterized by reversible left ventricular wall motion abnormalities, chest pain or dyspnea, ST-segment elevation, and mild elevation of cardiac enzyme levels in the absence of obstructive coronary artery disease. The pathophysiology of the syndrome is still unknown. The probable mechanism is supposed to be a catecholamine discharge. We report the case of a 66-year-old woman with recently diagnosed pheochromocytoma who presented with chest pain and ST-segment elevation. Coronary angiography revealed normal coronaries and apical dyskinesia at ventriculography. A similar episode of chest pain occurred 4 years ago with same angiographic findings and reversible inferobasal akinesia. In-hospital course was uneventful and the patient was discharged from the hospital 4 days later with treatment of aspirin 1 × 100 mg, metoprolol 1 × 50 mg, lisinopril 1 × 10 mg, and atorvastatin 1 × 20 mg. At 2 years follow-up after the event, the patient remained asymptomatic.

Broken guidewire fragment.

Advances in technology and greater operator experience have increased the success rate of percutaneous coronary intervention while lowering the complication rates. The broken guidewire is a rare complication of percutaneous coronary intervention. We present this rare complication in a patient who was medically treated.

A very rare combination of four coronary artery anomalies in a patient with acute inferior myocardial infarction.

We present a combination of four rarely seen coronary anomalies: double right coronary artery originating from the right coronary sinus (RCS) and left main coronary artery, respectively, and separate origination of the left anterior descending (LAD) artery, circumflex artery (Cx), and septal perforator artery from the RCS. These anomalies were encountered in a 46-year-old male patient who had a previous diagnosis of spina bifida occulta and renal pelvis and presented with the complaint of chest pain of two-hour onset. He had no conventional coronary risk factors and no history of chest pain or syncope. Electrocardiography showed ST-segment elevation and cardiac enzyme levels were elevated. Coronary angiography was performed with the diagnosis of acute inferior myocardial infarction, which showed a severe stenosis in the mid portion of the LAD and total occlusion in the proximal part of the Cx. Balloon dilatation and stent implantation were performed for the Cx lesion and TIMI 3 flow was achieved. One month after the procedure, percutaneous coronary intervention was repeated for the LAD lesion and patency was achieved with balloon dilatation and stenting. Since visualization of all the coronary anomalies mentioned above posed some difficulties during coronary angiography, cardiac computed tomography angiography was also used to reveal the ostia and the courses of coronary arteries. This combination of four rare coronary anomalies has not been reported before.