Modified flower petal technique in the treatment of Medina type 0,0,1 or 0,1,0 lesions.

AIMS: The optimal strategy for patients with isolated ostial bifurcation lesions has not yet been determined. We propose the modified flower petal technique for the treatment of Medina type 0,0,1 or 0,1,0 coronary bifurcation lesions. METHODS AND RESULTS: We selected 64 patients who had Medina type 0,0,1 or 0,1,0 coronary bifurcation lesions. Percutaneous coronary intervention (PCI) was performed with the modified flower petal technique in all patients. After PCI, all patients were followed up to nine months after the intervention. Quantitative coronary angiography (QCA) analyses were performed for both the main and the side branch at baseline, after the stent implantation and at nine-month follow-up. Twenty patients (31.2%) had ostial left anterior descending artery lesions, nine patients (14.1%) had ostial circumflex artery lesions and the other patients had isolated ostial non-left main bifurcation lesions. The procedural success rate was 100%. There was no death, myocardial infarction, subacute or late stent thrombosis at nine-month follow-up. In one patient, in-stent restenosis requiring reintervention was noted. CONCLUSIONS: The modified flower petal technique has excellent acute results and midterm clinical outcomes in the management of Medina type 0,0,1 or 0,1,0 coronary bifurcation lesions.

TAP-Stenting Technique for Bifurcation Stenosis of Celiac Artery.

We report a clinical course of a patient who developed severe ischemic liver injury and total occlusion of the celiac artery (CA). A 40-year-old man presented with abdominal pain. Computed tomography indicated total occlusion of the CA. Laboratory data demonstrated markedly elevated hepatic enzymes. An exploratory laparotomy was not necessitated due to absence of peritonism. The patient was successfully treated by endovascular recanalization of the CA occlusion via transcatheter balloon angioplasty and TAP-stenting (T-stenting and small protrusion) technique. Endovascular intervention in patients solely with liver failure appears practicable and early treatment is advised.

Left ventricle geometry affects coronary flow reserve in diabetic patients.

OBJECTIVES: The aim of this study was to investigate the association between coronary flow reserve (CFR) and left ventricle (LV) geometric patterns in patients with newly-diagnosed diabetes mellitus (DM). STUDY DESIGN: We studied 116 patients with newly-diagnosed DM and 31 healthy control subjects. Echocardiographic examination was performed on all subjects. Four different geometric patterns were identified in diabetic patients, according to LV mass index (LVMI) and relative wall thickness (RWT) [NG: Normal geometry; CR: Concentric remodeling; EH: Eccentric hypertrophy; CH: Concentric hypertrophy]. CFR was calculated as the hyperemic to resting coronary diastolic peak velocities ratio. RESULTS: Compared with controls, CFR was decreased in diabetic patients (p<0.05). The lowest CFR values were observed in the CH group compared with control and other groups (p<0.05, for all). Also, CFR values of the CR and EH groups were lower than NG and the control group (p<0.05, for all). CFR was associated with LV geometry (r=-0.449, p=0.001), LVMI (r=-0.401, p<0.001), RWT (r=-0.247, p=0.008), HbA1c (r=-0.576, p<0.001) and mitral valve E/A ratio (r=0.239, p=0.01) in bivariate analysis. CFR was independently associated with LV geometry (ß=-0.449, p<0.001), LVMI (ß=-0.192, p=0.016), and HbA1c (ß=-0.576, p<0.001) in multivariate analysis. CONCLUSION: CFR was impaired in newly-diagnosed DM. The degree of this deformation increases from normal geometry towards to concentric hypertrophy. This condition suggests that myocardial structural remodeling due to diabetes might be effective on CFR.

Lower serum 25-hydroxyvitamin D level is associated with impaired myocardial performance and left ventricle hypertrophy in newly diagnosed hypertensive patients.

OBJECTIVE: Vitamin D deficiency is an independent risk factor for cardiovascular mortality. The relationship between vitamin D level and left ventricle (LV) myocardial performance index (MPI=Tei index), which incorporates both LV systolic function and diastolic function, was not investigated in previous studies. We hypothesized that vitamin D level may be associated with LV function and geometry. We aimed to investigate the association between serum 25-hydroxyvitamin D (25 [OH] D) levels and MPI and LV hypertrophy in hypertensive patients with newly diagnosed and preserved ejection fraction. METHODS: We studied 151 sequential newly diagnosed hypertensive subjects who lived in the Çukurova region without known cardiovascular risk factors or overt heart disease (mean age: 62.8±10.4 years). Serum 25 (OH) D was measured using a direct competitive chemiluminescent immunoassay. The patients were divided into two groups according to serum 25 (OH) D level: vitamin D-non-deficient group (vitamin D≥ 20.00 ng/mL, n=53) and vitamin D-deficient group (vitamin D< 20.00 ng/mL, n=98). MPI was defined as the sum of isovolumic contraction and relaxation times divided by the ejection time. LV mass index (LVMI) was calculated by using the Devereux formula and body surface area. RESULTS: MPI and LVMI values were lower and low-density lipoprotein (LDL) levels were higher in patients who were vitamin D-non-deficient than patients who were vitamin D-deficient (p<0.05 for all). Multivariate linear regression analysis showed that serum 25 (OH) D was independently associated with MPI (ß=-0.426, p<0.001), LVMI (ß=-0.345, p=<0.001), and LDL (ß=0.140, p<0.026). CONCLUSION: Lower serum 25 (OH) D levels are significantly associated with impaired myocardial performance and LVMI.

The association between aortic distensibility and coronary flow reserve in newly diagnosed diabetic patients.

INTRODUCTION: Aortic distensibility (AD) is an important parameter affecting coronary hemodynamics. Coronary flow velocity reserve (CFVR) is a reliable marker of coronary endothelial function in diabetic patients. The aim of this study was to investigate the association between AD and CFVR in newly diagnosed diabetic patients. METHOD: We studied 77 patients with newly diagnosed diabetes mellitus (DM) and 30 age- and sex-matched healthy control subjects. CFVR was calculated as the hyperemic to resting coronary diastolic velocities ratio by using transthoracic echocardiography. Pulse pressure (PP) and AD were calculated. RESULTS: Fasting blood glucose, HbA1c and PP were significantly higher in patients with diabetes (P < 0.001, P < 0.001 and P = 0.009, respectively). Other clinical and demographical characteristics, laboratory findings and echocardiographic findings were similar in both groups (P > 0.05, for all). The measurement of CFVR and AD in patients with diabetes were significantly lower compared with the controls (P < 0.001 and P = 0.001, respectively). CFVR was significantly negatively correlated with age, body mass index, HbA1c, systolic blood pressure, and PP, while significantly positively correlated with AD (P < 0.05, for all). Multivariate regression analysis showed that only AD (ß = 0.485, P < 0.0001) and HbA1c (ß = -0.362, P < 0.0001) were independently associated with CFVR. The cutoff value of AD obtained by the receiver operator characteristic (ROC) curve analysis was 2.44 for the prediction of impaired CFVR. CONCLUSION: Aortic distensibility and HbA1c were independently associated with CFVR. The decrease in AD may be used as a marker of impaired coronary microcirculation in asymptomatic diabetic patients.

Epicardial fat thickness in stable coronary artery disease: its relationship with high-sensitive cardiac troponin T and N-terminal pro-brain natriuretic peptide.

OBJECTIVES: Epicardial adipose tissue is related to coronary atherosclerosis, left ventricle hypertrophy, myocardial dysfunction, cardiomyopathy, and inflammation, which produces a variety of cytokines that influence key pathogenic mechanisms of atherogenesis. The main goal of this study is to examine the relationship between epicardial fat thickness (EFT) and cardiovascular risk markers as well as the complexity of coronary artery disease (CAD) in patients with stable CAD. MATERIALS AND METHODS: We prospectively included 439 stable CAD patients undergoing coronary angiography in the present study (mean age: 62.2±10.7 years). Patients were divided into two groups (EFTlow and EFThigh groups) according to their median EFT values. EFT was evaluated by two-dimensional echocardiography before angiography. The SYNTAX score was calculated in all patients. N-terminal pro-brain natriuretic peptide (NT-proBNP), high-sensitive C-reactive protein (hs-CRP), high-sensitive cardiac troponin T (hs-cTnT), uric acid, and other biochemical markers were also measured. RESULTS: Age, SYNTAX score, frequencies of diabetes, hyperlipidemia, and hypertension, NT-proBNP, hs-CRP, hs-cTnT, and uric acid levels were higher in EFThigh group compared with the EFTlow group (P<0.05 for all). EFT was associated independently with age (ß=-0.102, P=0.001), diabetes (ß=-0.083, P=0.011), SYNTAX score (ß=0.352, P<0.001), hs-CRP level (ß=0.217, P<0.001), hs-cTnT level (ß=0.197, P<0.001), and NT-proBNP level (ß=0.300, P<0.001) in multivariate analysis. CONCLUSION: EFT obtained by echocardiograpy may not only be an easy tool but also an important tool for early detection of increased cardiac risk as well as the extent and complexity of CAD in patients with stable CAD.

Automated functional imaging in atrioventricular delay time optimisation in patients with dual chamber pacemakers.

BACKGROUND: Optimisation of atrioventricular (AV) delay time has positive effects on left ventricular (LV) functions in patients with a DDD pacemaker. However, the method used for optimisation is still debated. AIM: To evaluate the effect of different AV delay times on various LV systolic performances by using automated functional imaging (AFI) in patients with a DDD pacemaker and preserved LV systolic function. METHODS: The study population consisted of 40 patients with a DDD pacemaker implanted for third degree AV block and preserved LV systolic function (19 men; mean age 64.3 ± 10.9 years). During each pacing period, blood samples were taken for the measurement of B-type natriuretic peptide (BNP) levels, and telemetric and echocardiographic evaluations were performed to all patients. Also peak systolic global longitudinal strain (PSGLS) was calculated using the AFI method. RESULTS: No significant differences except for LV outflow tract-velocity time integral (LVOT-VTI) were observed in pulse wave Doppler parameters with different AV delay times. PSGLS were better at 150 and 200 ms AV delay times compared to 100 ms (p < 0.001 for 100-150 ms and 100-200 ms). Similarly, LVOT-VTI values were significantly higher at 150 and 200 ms AV delay times compared to 100 ms (for 100-150 ms, p = 0.017 and for 100-200 ms, p = 0.013). Also there was a significant reduction in BNP levels at 150 ms and 200 ms compared to 100 ms AV delay time (for 100-150 ms, p = 0.001, and for 100-200 ms, p < 0.001). CONCLUSIONS: In patients with an implanted DDD pacemaker and preserved LV systolic function, increasing AV delay time has beneficial effects on LV systolic performance in the acute phase, as shown by the AFI method in our study.

Estimated glomerular filtration rate is associated with both arterial stiffness and N-terminal pro-brain natriuretic peptide in newly diagnosed hypertensive patients.

Even a slight decrease in the glomerular filtration rate (GFR) is an independent risk factor for cardiovascular disease. Arterial stiffness, left ventricular hypertrophy and N-terminal pro-brain natriuretic peptide (NT-proBNP) are independent risk factors for cardiovascular disease, which are particularly common in end-stage renal disease. We aimed to evaluate the association between GFR with arterial stiffness, left ventricle mass (LVM) and NT-proBNP in hypertensive subjects with normal to mildly impaired renal function. The study population consisted of 285 newly diagnosed hypertensive patients (mean age; 49.9 ± 11.8 years). GFR was estimated (eGFR) by the Modification of Diet in Renal Disease formula. Pulse wave velocity (PWV) and augmentation index (AIx), which reflects arterial stiffness, were calculated using the single-point method via the Mobil-O-Graph® ARCsolver algorithm. LVM was obtained by echocardiography. Plasma NT-proBNP was measured by electrochemiluminescence. The patients were divided into two groups according to the median eGFR value (eGFRlow group <101 ml/min/1.73 m(2) and eGFRhigh group ≥ 101 ml/min/1.73 m(2)). LVM and NT-proBNP values were higher in eGFRlow group compared with eGFRhigh group (p<0.05). Pulse wave velocity and augmentation index values were higher in eGFRlow group compared with eGFRhigh group (p<0.05, for all). Multiple linear regression analysis showed that eGFR was independently associated with PWV (ß=-0.422, p<0.001) and NT-proBNP (ß=-0.404, p<0.001). Present study showed that eGFR was independently associated with PWV and NT-proBNP values. Importantly, these findings may explain, in part, the increase in cardiovascular risk in with slightly impaired renal function.

Serum bilirubin level and aortic intima-media thickness in patients without clinical manifestation of atherosclerotic cardiovascular disease.

We investigated the association between serum bilirubin level and thoracic aortic intima-media thickness (IMT). The study population consisted of 417 patients without coronary artery disease, who underwent transesophageal echocardiography examination for various indications. The highest aortic IMT values were observed in the bilirubinlow group compared with the bilirubinhigh group (P < .001). Serum bilirubin level was associated with high-density lipoprotein cholesterol level (r = .162, P = .001), high-sensitivity C-reactive protein (hsCRP; r = -.265, P < .001), and aortic IMT (r = -.551, P < .001) in bivariate analysis. Multivariate linear regression analysis showed that serum bilirubin level was independently and negatively associated with hsCRP (ß = -.095, P = .028) and aortic IMT (ß = -.513, P < .001). Serum bilirubin level may be an independent predictor of the extent of subclinical aortic atherosclerosis assessed by thoracic aortic IMT.

Contrast-induced nephropathy in patients with ST elevation myocardial infarction treated with primary percutaneous coronary intervention.

We assessed the relationship between contrast-induced nephropathy (CIN) and SYNTAX score (SS) and serum uric acid (SUA) levels in patients with ST elevation myocardial infarction (STEMI). A total of 835 STEMI patients in whom primary percutaneous coronary intervention was performed in our cardiology clinic were included in this study (615 male, 220 female; mean age 58.1 ± 12.2 years). The patients were divided into 2 groups (CIN and non-CIN). Contrast-induced nephropathy was observed in 9.6% (80) of patients; SS (13.9 ± 6.2/22.1 ± 5.8) and SUA (5.1 ± 0.9/6.2 ± 0.9) values in the CIN group were higher compared with the non-CIN group (P < .001, for all). All SS (95% confidence interval [CI] = 1.136-1.250, P = .001), SUA (95% CI = 1.877-3.236, P = .002), and diabetes (95% CI = 0.998-1.039, P = .026) were independent predictors of CIN in logistic regression analysis. Procedures that can prevent CIN may be beneficial in patients at high risk as identified by the SS and SUA levels.

N-terminal pro-brain natriuretic peptide levels and abnormal geometric patterns of left ventricle in untreated hypertensive patients.

N-terminal pro-brain natriuretic peptide (NT-proBNP) predicts cardiovascular events and mortality in hypertensive patients. Relationship between NT-proBNP level and left ventricular (LV) hypertrophy is well known in hypertensive patients. However, the studies investigating relationship between LV geometric patterns and serum NT-proBNP level have conflicting results and are in a limited number. The goal of the present study is to investigate relation between NT-proBNP and abnormal LV geometric patterns in untreated hypertensive patients. Measurements were obtained from 273 patients with untreated essential hypertension (mean age = 51.7 ± 5.8 years) and 44 healthy control subjects (mean age; 51.3 ± 4.7). Four different geometric patterns (NG: normal geometry; CR: concentric remodelling; EH: eccentric hypertrophy; CH: concentric hypertrophy) were determined according to LV mass index (LVMI) and relative wall thickness. NT-proBNP and other biochemical markers were measured in all subjects. The highest NT-proBNP levels were determined in the CH group compared with the control group and other geometric patterns (p < 0.05). NT-proBNP levels of all geometric patterns were higher than the control group (p < 0.05, for all). NT-proBNP levels were similar between CR and NG groups (p > 0.05). NT-proBNP was independently associated with LV geometry (ß = 0.304, p = 0.003) and LVMI (ß = 0.266, p = 0.007) in multiple linear regression analysis. Serum NT-proBNP level was independently associated with LVMI and LV geometry in untreated hypertensive patients with preserved ejection fraction.

Serum 25-hydroxyvitamin D level and extent and complexity of coronary artery disease.

BACKGROUND: There are limited number of studies about relationship between serum vitamin D level and presence and severity of coronary artery disease (CAD). We assessed the relationship between the extent and complexity of CAD assessed by SYNTAX score and 25-hydroxyvitamin D level in patients with stable CAD. METHODS: In the study, 209 consecutive patients with stable CAD (age: 63.1 ± 10.0 years) and 102 healthy control subjects (age 61.3 ± 13.7 years) were included. Serum 25-hydroxyvitamin D was measured using a direct competitive chemiluminescent immunoassay and other biochemical markers were measured in all subjects. All subjects underwent coronary angiography and SS was calculated. RESULTS: The mean serum 25-hydroxyvitamin D level of CAD group was lower than the control group (P < 0,001). Multivariate regression analysis showed that serum 25-hydroxyvitamin D level was independently associated with SYNTAX score (ß = -0.396, P < 0.001), hypertension (ß = -0.183, P = 0.003), high sensitive C-reactive protein (ß = -0.141, P = 0.014), and body mass index (ß = -0.135, P = 0.023) in patient group. CONCLUSION: 25-Hydroxyvitamin D level was associated with extent and complexity of CAD. 25-Hydroxyvitamin D may play a role in pathogenesis and severity of coronary atherosclerosis.

Serum 25-hydroxyvitamin D is associated with both arterial and ventricular stiffness in healthy subjects.

BACKGROUND: Vitamin D regulates the renin-angiotensin system, suppresses proliferation of vascular smooth muscle and improves endothelial cell dependent vasodilatation. These mechanisms may play a role on pathogenesis of arterial and left ventricular stiffness. OBJECTIVES: We aimed to investigate the association between serum 25-hydroxyvitamin D with arterial and left ventricular stiffness in healthy subjects. METHODS: We studied 125 healthy subjects without known cardiovascular risk factors or overt heart disease (mean age: 60.2 ± 11.9 years). Serum 25-hydroxyvitamin D was measured using a direct competitive chemiluminescent immunoassay. The subjects were divided into two groups according to the serum vitamin D level; vitamin D sufficient (≥ 20 ng/ml, n = 56) and vitamin D deficient (<20 ng/ml, n = 69). Indexes of LV stiffness such as E/A and E/E' were measured. Pulse wave velocity (PWV), which reflects arterial stiffness, was calculated using the single-point method via the Mobil-O-Graph(®) ARC solver algorithm. RESULTS: Systolic blood pressure, level of serum calcium, PWV and E/E' values were higher and E/A values were lower in vitamin D deficient group compared with vitamin D sufficient group. Multiple linear regression analysis showed that vitamin D level was independently associated with E/E' (ß = -0.364, p<0.001), serum calcium (r = -0.136, p = 0.014), PWV (ß = -0.203, p = 0.003), E/A (ß = 0.209, p = 0.001) and systolic blood pressure (ß = -0.293, p<0.001). CONCLUSION: 25-Hydroxyvitamin D levels are associated with increased ventricular and arterial stiffness as well as systolic blood pressure in healthy subjects.

Coronary flow reserve and myocardial performance index in newly diagnosed diabetic patients.

BACKGROUND: Patients with diabetes mellitus (DM) are at high risk of left ventricular (LV) dysfunction. A reduction of coronary flow reserve (CFR) has been demonstrated in diabetic patients without coronary artery stenosis. In this study, we investigated the association between LV myocardial diastolic and systolic functions and the CFR in newly diagnosed diabetic patients in the absence of coronary artery disease. METHOD: We studied 88 patients (mean age 49 ± 10 years) with newly diagnosed DM and 40 healthy control subjects (mean age 50 ± 9 years). All subjects underwent transthoracic echocardiography. The myocardial performance index (MPI) was determined by using pulsed-wave Doppler. The CFR was calculated as the hyperemic to resting coronary diastolic peak velocities ratio. RESULTS: Patients with diabetes had significantly longer mitral E-wave deceleration time and higher MPI value than control group (P = 0.023 and P < 0.001, respectively). The mean CFR was lower in diabetic patients compared with controls (P = 0.001). The MPI was significantly correlated with CFR (r = -0.371, P < 0.001), LV ejection fraction (r = -0.274, P = 0.018) E/A ratio (r = -0.244, P = 0.024), and glycosylated hemoglobin (HbA1c) (r = 0.476, P < 0.001). Multivariate regression analysis showed that MPI was independently associated with CFR (ß = -0.292, P < 0.0001) and HbA1c level (ß = 0.372, P < 0.0001). CONCLUSIONS: The MPI was independently associated with CFR in newly diagnosed diabetic patients. The decrease in CFR may cause LV systolic and diastolic dysfunction in asymptomatic diabetic patients.

Serum 25-hydroxyvitamin D level is associated with aortic distensibility and left ventricle hypertrophy in newly diagnosed type 2 diabetes mellitus.

We aimed to evaluate the association between serum vitamin D status and elastic properties of aorta in patients with diabetes mellitus (DM). We studied 136 patients with newly diagnosed DM (mean age: 62.9 ± 10.6 years). Serum 25-hydroxyvitamin D was measured using a direct competitive chemiluminescent immunoassay. Aortic distensibility was calculated from the echocardiographically derived ascending aorta diameters and haemodynamic pressure measurements. Left ventricle mass index (LVMI) was determined according to the Devereux formula. Multiple linear regression analysis showed that vitamin D level is independently associated with LVMI (ß = -0.259, p = 0.001), aortic distensibility (ß = 0.369, p < 0.001), high-sensitive C-reactive protein (hs-CRP) (ß = -0.220, p = 0.002) and body mass index (ß = -0.167, p = 0.015) in patients with DM. In diabetic patients, serum 25-hydroxyvitamin D level is independently associated with aortic distensibility. Vitamin D may play a role on pathogenesis of impaired elastic properties of aorta in type 2 DM.

Serum 25-hydroxyvitamin D level is associated with arterial stiffness, left ventricle hypertrophy, and inflammation in newly diagnosed hypertension.

OBJECTIVES: Vitamin D may modulate vascular inflammation, vascular smooth muscle cell proliferation, the renin-angiotensin system, and cardiomyocyte proliferation, myocardial fibrosis, and proliferation. These mechanisms may play a role on arterial stiffness and left ventricle hypertrophy (LVH) in hypertensive patients. We aimed to evaluate the association between serum vitamin D with arterial stiffness and LVH in patients with hypertension. METHODS: We studied 133 patients with newly diagnosed hypertension [mean (SD) age, 62.9 (10.6) years]. Pulse wave velocity (PWV), which reflects arterial stiffness, was calculated using the single-point method via the Mobil-O-Graph ARCsolver algorithm. Left ventricular mass index (LVMI) was determined according to Deverux formula. The patients were divided into the following 2 groups according to serum vitamin D level: vitamin Dlow group with less than 20 ng/mL and vitamin Dhigh group with greater than or equal to 20 ng/mL. RESULTS: The highest PWV, high-sensitivity C reactive protein, and LVMI values were observed in vitamin Dlow group compared with vitamin Dhigh group. Multiple linear regression analysis showed that vitamin D level was independently associated with LVMI (ß = -0.235, P = 0.002) and PWV (ß = -0.432, P < 0.001). Adjustment for age, sex, parathyroid hormone level, body surface area, and mean blood pressure did not modify these associations. Vitamin D level was also independently associated with high-sensitivity C reactive protein (ß = -0.143, P = 0.047). However, adjustment for parathyroid hormone level or body surface area and mean blood pressure attenuate this association. CONCLUSIONS: Serum 25-hyroxyvitamin D is independently related with arterial stiffness, LVH, and inflammation. Vitamin D may play a role on pathogenesis of arterial stiffness and LVH in patient with newly diagnosed hypertension.

Myocardial performance index and aortic distensibility in patients with different left ventricle geometry in newly diagnosed essential hypertension.

BACKGROUND: Abnormal left ventricular (LV) geometric patterns, particularly concentric LV hypertrophy, are associated with a greater risk of hypertensive complications. The aim of this study was to investigate the association between LV myocardial performance index (LVMPI) and aortic distensibility (AD) with different LV geometric patterns in patients with newly diagnosed hypertension (HT). METHODS: We studied 181 patients with newly diagnosed HT (mean age 51.7 ± 5.4 years) and 39 healthy control subjects (mean age 51.2 ± 5.1 years). Echocardiographic examination was performed in all subjects. Four different geometric patterns were determined in hypertensive patients according to LV mass index (LVMI) and relative wall thickness (RWT). AD was calculated from the echocardiographically derived ascending aorta diameters and haemodynamic pressure measurements. LVMPI was calculated from the tissue Doppler-derived ejection time, isovolumic contraction and relaxation times. RESULTS: The highest LVMPI and the lowest AD values were observed in concentric hypertrophy group compared with control, normal geometry, concentric remodelling and eccentric hypertrophy groups (p < 0.05, for all). LVMPI was associated with LVMI (r = 0.497, p < 0.001), RWT (r = 0.270, p < 0.001), AD (r = -0.316, p < 0.001) and E deceleration time (r = 0.171, p = 0.02) in bivariate analysis. In multiple linear regression analysis, LVMPI was independently related to LVMI (ß = 0.381, p < 0.001) and AD (ß = -0.263, p = 0.001). CONCLUSIONS: The LVMPI was highest and AD was lowest in patients with concentric hypertrophy. The LVMPI was independently associated with LVMI and AD in hypertensive patients.

SYNTAX score is a predictor of angiographic no-reflow in patients with ST-elevation myocardial infarction treated with a primary percutaneous coronary intervention.

OBJECTIVES: The no-reflow phenomenon has a negative prognostic value in patients with acute ST-elevation myocardial infarction (STEMI). The SYNTAX score (SS) quantifies the extent and complexity of angiographic disease and predicts long-term mortality and morbidity in STEMI. We aimed to assess the no-reflow and its possible relationships with SS and clinical characteristics in patients with STEMI treated with a primary percutaneous coronary intervention (PPCI). MATERIALS AND METHODS: In this study, 880 patients with STEMI treated with PPCI were included prospectively (646 men and 234 women, mean age 58.5±12.4 years). The SS, thrombolysis in myocardial infarction (TIMI) flow grade score, and TIMI myocardial blush grade score were determined in all patients. No-reflow was defined as TIMI grade 0, 1 and 2 flows or TIMI grade 3 with myocardial blush grade 0 and 1. The patients were divided into two groups: a normal flow group and a no-reflow group. RESULTS: No-reflow was observed in 32.8% of patients. The mean SS of the no-reflow group was higher than that of the normal flow group (19.2±6.8/12.9±6.1, P<0.001). On multivariate logistic regression analysis, SS [ß=0.872, 95% confidence interval (CI)=0.845-0.899, P<0.001], diabetes (ß=0.767, 95% CI=0.128-4.597, P=0.004), anterior myocardial infarction (ß=5.421, 95% CI=1.369-21.469, P=0.025), and thrombus grade after wiring (ß=2.537, 95% CI=1.506-4.273, P<0.001) were found to be independent predictors of no-reflow. The cutoff value of SS obtained by the receiver-operator characteristic curve analysis was 19.75 for the prediction of no-reflow (sensitivity: 70.6%, specificity: 69.4%). CONCLUSION: The SS is a predictor of no-reflow in patients with STEMI treated with PPCI.

Association of mean platelet volume and pre- and postinterventional flow with infarct-related artery in ST-segment elevation myocardial infarction.

Platelets play a role in the pathogenesis of ST-segment elevation myocardial infarction (STEMI). We assessed the relationship between mean platelet volume (MPV) on admission and pre- and postinterventional flow with the infarct-related artery (IRA) in patients with STEMI. We prospectively included 840 patients with STEMI who underwent primary percutaneous coronary intervention (PCI). The patients were divided into 3 groups according to MPV tertiles. Pre- and post-PCI Thrombolysis In Myocardial Infarction (TIMI) flow grade was determined. Initial TIMI flow grade 3 was accepted as patent IRA. After the primary PCI, normal flow was defined as post-PCI TIMI flow 3. When the MPV was increased, the incidence of pre-PCI patent IRA (P = .004) and post-PCI normal TIMI flow (P < .001) was significantly decreased. Multivariate analysis showed that MPV was independently associated with post-PCI TIMI flow grade.

Neutrophil to lymphocyte ratio is associated with the severity of coronary artery disease in patients with ST-segment elevation myocardial infarction.

We assessed the relationship between the severity of coronary artery disease assessed by SYNTAX score (SS) and neutrophil to lymphocyte ratio (N:L ratio) in patients with ST elevation myocardial infarction (STEMI). In total, 840 patients with STEMI in whom primary percutaneous coronary intervention was performed were prospectively included (622 male, 218 female; mean age 58.6 ± 12.4 years). Total and differential leukocyte counts and other biochemical markers were measured at admission. Patients were categorized into tertiles on the basis of SS. The N:L ratio of SShigh group was higher compared with SSlow and SSmid groups (P < .001 for all). Multivariate regression analysis showed that N:L ratio (ß = .277, P < .001), ejection fraction (ß = -.086, P = .012), age (ß = .104, P = .004), and diabetes (ß = .152, P < .001) were the independent predictors for SS in patients with STEMI.