Effect of Hand Dominance on Radial Artery Spasm and Occlusion: A Prospective Observational Study.

Transradial access has become the most commonly used method for cardiac catheterization. Many medical and technical applications have been proposed to reduce TRA complications. The aim of this study is to examine the effect of hand dominance on radial artery spasm and radial artery occlusionin subjects undergoing CC via TRA. Between April 2020 and August 2022, 1713 subjects who underwent CC via TRA were included in the study. Patient data were obtained in terms of hand dominance of the catheterized side and RAS and RAO during a 1-month follow-up period. RAS was seen in 9.6% of the subjects. The RAS in patients catheterized by the dominant hand was significantly higher than that performed by the non-dominant hand (12 vs 7.8%; P = .004). RAO was seen in 1% of the subjects. RAO was significantly higher in the spasm side than in the no-spasm side (3 vs .8%; P = .009). Hand dominance was determined as an independent predictor of radial artery spasm (P = .006). In our study, RAS and RAO were more common on the dominant hand side than on the non-dominant side. Choosing the non-dominant hand for TRA for CC may reduce the incidence of RAS and RAO.

The effect of propofol on frontal QRS-T angle in patients undergoing elective colonoscopy procedure.

WHAT IS KNOWN AND OBJECTIVE: Propofol is a most commonly used anaesthetic drug for conscious sedation in outpatient procedures. Previous studies have shown that propofol may affect ventricular repolarization based on QT and Tp-e intervals. Frontal QRS-T angle is a marker of ventricular depolarization and repolarization difference. However, there is no study investigating the effect of propofol on frontal QRS-T angle. In this study, we aimed to investigate the effect of propofol on frontal QRS-T angle in patients undergoing colonoscopy procedure. METHOD: A total of 56 patients (53.5% females) who underwent colonoscopy procedure were included in this study. All patients underwent 12-lead surface electrocardiograms (ECGs) just before colonoscopy and 15 minutes after colonoscopy. QT interval, QTc interval, Tp-e interval, Tp-e/QT, Tp-e/QTc and frontal QRS-T angle were calculated from 12-lead ECGs. RESULTS AND DISCUSSION: The frontal QRS-T angle was significantly increased 15 minutes after colonoscopy compared to basal value (36.2 ± 24.3 vs. 29.5 ± 23.6, P = .003). In addition, repolarization parameters including QT, QTc and Tp-e intervals were significantly prolonged at 15 minutes after colonoscopy compared to basal value, except Tp-e/QT and Tp-e/QTc. Significant ventricular or supraventricular arrhythmias were not observed in any patient during the procedure. WHAT IS NEW AND CONCLUSION: In this study, we found that propofol administration increased the frontal QRS-T angle in patients undergoing colonoscopy procedure. Given that a prolonged frontal QRS-T angle is associated with ventricular arrhythmias, it may be safer to monitor those patients receiving propofol during colonoscopy procedures.

Mean platelet volume is not associated with coronary slow flow: a retrospective cohort study.

OBJECTIVE: To investigate mean platelet volume (MPV) levels in patients with coronary slow flow (CSF). METHODS: 465 stable angina pectoris cases with angiographically normal coronary arteries were recruited [coronary slow flow group (n=76), control group (n=389)] in the observational retrospective cohort study. Clinical, biochemical and demographic variables including MPV were noted and coronary blood flow was assessed with TIMI frame count (TFC). RESULTS: Gender, smoking, height, serum creatinine, uric acid levels, hemoglobin, waist/hip ratio, systolic blood pressure but not MPV were significantly different among groups. Independent predictors of CSF were height (p=.029) and serum uric acid level (p=.045). Gender, height, weight, hip circumference, systolic blood pressure, fasting blood glucose, serum urea, creatinine, uric acid levels, hemoglobin and platelet count were associated with mean TFC whereas independent predictors of mean TIMI frame count were height (p=.010) and serum uric acid level (p=.041). CONCLUSION: Height and serum uric acid level but not MPV were independent predictors of both CSF and mean TFC.

[Current approach for the prosthesis patient mismatch]. / Hasta protez uyumsuzluguna güncel yaklasim.

All prosthetic valves are at least mildly stenotic and have relatively high transvalvular pressure gradients that can be observed despite normal prosthesis function. Such gradients may be due to a mismatch between prosthesis effective orifice area (EOA) and patient's body size. Valve prosthesis-patient mismatch (VP-PM) may occur due to mismatches of both parameters, the expected hemodynamic performance of the prosthesis and the cardiac output requirements of the patient, which are largely related to the body size at rest. In other words, a prosthesis may be adequate for patients with a small body surface area (BSA) but might become obstructive for patients with a large BSA. The only parameter that has proven to be consistently and realistically useful to predict and describe VP-PM is the effective orifice area index (EOAI). The projected EOAI was identified as the best parameter to predict the VP-PM occurrence after surgery. VP-PM has been known to be independently and significantly associated with clinical outcomes. Severe VP-PM has a significant impact on early and late mortality, whereas moderate VP-PM may have a significant effect on mortality only in vulnerable subsets of patients, and particularly in those with depressed LV systolic function. The surgeon's anticipation of VP-PM prior to surgery, and successfully implented preventive strategies can reduce the incidence of VP-PM. Preventive strategies to avoid VP-PM should be individualized according to the anticipated severity of VP-PM and of the patient's baseline risk profile.

Association of aortic flow propagation velocity with ankle-brachial blood pressure index in patients with hypertension: an observational study.

OBJECTIVE: Endothelial dysfunction is considered the first stage in the development of atherosclerosis and assessed by flow-mediated dilatation (FMD) and aortic flow velocity propagation (AVP). Ankle-brachial index (ABI) is used to assess peripheral arterial disease and is associated with FMD but the relationship between ABI and AVP is unknown. In this study, we aimed to search the association between AVP, and ABI in patients with newly diagnosed hypertension. METHODS: Sixty-eight patients with newly diagnosed hypertension and 34 healthy subjects were enrolled in the cross-sectional observational study. The maximum ankle arterial pressures were divided by the maximum of the brachial arterial pressures to calculate the ABI. AVP was calculated from dividing the distance between points corresponding to the beginning and end of the propagation slope, to the duration between corresponding time points proximally descending aorta. Statistical analysis was performed using Student t-test, Chi-square test, Pearson correlation and linear regression analyses. RESULTS: Age and gender of both groups were similar. Compared to control group E deceleration time of early diastolic flow velocity (184.0±32.2 vs. 217.1±38.6, p<0.001), isovolumic relaxation time (95.5±19.4 vs. 105.7±18.1, p<0.001) and body mass index (25.6±5.1 vs. 27.5±3.8, p=0.044) values were significantly higher, while ABI (1.08±0.07 vs. 1.14±0.07, p=0.001) and AVP (54.97±9.3 vs. 69.17±10.8 cm/sec, p=0.001) values were significantly lower in hypertensive patients. There was a significant correlation between AVP and ABI (r=0.279, p=0.005). Both ABI and AVP were independent predictors of hypertension (OR - 0.353, 95%CI 0.151-0.826, p=0.02 and OR - 0.133, 95%CI 0.0502-0.35, p=0.001, respectively). CONCLUSION: Our data indicate that in patients with isolated hypertension AVP and ABI decrease. We also conclude that AVP is directly associated with ABI.

Paraoxonase and arylesterase activities in stent restenosis in bare metal stent.

BACKGROUND AND OBJECTIVE: The serum paraoxonase and arylesterase activities are related to coronary artery diseases. However, there are a few data about the association of paraoxonase and arylesterase activities with in-stent restenosis (ISR). The aim of this study was to evaluate the relationship between paraoxonase and arylesterase activities and ISR in patients with bare metal stent (BMS). MATERIALS AND METHODS: Thirty-one patients with normal coronary artery (group 1) and 60 with BMS were enrolled in this observational study. According to the ISR, the patients were classified as group 2, without the ISR (n=29) and group 3, with the ISR (n=31). Serum paraoxonase and arylesterase activities were measured spectrophotometrically. RESULTS: The paraoxonase and arylesterase activities were lower in patients with BMS than in the individuals with normal coronary artery (P < 0.001 and P = 0.001, respectively). The enzyme activities were also higher in patients without ISR than with ISR (both of P < 0.001). In bivariate correlation analyses in patients with BMS, ISR shows significant positive correlations with the presence of hypertension and hyperlipidemia, type C lesion, and stent length, but shows negative correlations with type A lesion stent diameter, high-density lipoprotein cholesterol, and paraoxonase and arylesterase activities. In regression analysis, ISR is independently associated with paraoxonase and arylesterase activities (ß = -0.216, P = 0.038 and ß = -0.452, P < 0.001, respectively), type A lesion (ß = -0.251, P = 0.013), and stent diameter (ß = -0.192, P = 0.024) in patients with BMS. CONCLUSION: Our study shows that decreased paraoxonase and arylesterase activities play a significant role in ethiopathogenesis ISR in patients with BMS.

Diagnostic accuracy of P-wave dispersion in prediction of maintenance of sinus rhythm after external cardioversion of atrial fibrillation.

OBJECTIVE: P-wave dispersion (PWD) is an electrocardiographic measurement, which reflects a disparity in an atrial conduction. In this study, we aim to demonstrate the diagnostic accuracy of PWD in predicting recurrence of atrial fibrillation (AF) in patients with sinus rhythm restoration after external cardioversion. METHODS: This prospective, observational study consists of 26 patients, who underwent external cardioversion for non-valvular persistent AF and successfully cardioverted to sinus rhythm (13 men, mean age 58.1 ± 11 years). Twelve-lead surface electrocardiogram of each patient was recorded immediately after the external cardioversion process to measure the P-wave duration. Recurrent AF was assessed for each patient during the 12-month follow-up after restoring the sinus rhythm. Patients were divided into the 2 groups with respect to the AF recurrence (recurrent AF group, (n=19), and sinus rhythm group, (n=7)) and variables that can affect AF development were compared between the two groups. Stepwise logistic regression analysis was used to identify the independent predictors of AF recurrence and ROC curve analysis was performed to determine the cut-off value of independent factors. RESULTS: The two groups have similar demographic, clinical and echocardiographic features. Patients with recurrent AF had significantly higher PWD than those who continued to have a sinus rhythm (80 ± 21 msec vs 53 ± 11 msec, p=0.001, respectively). There is a positive correlation observed between the increase in PWD and the risk of AF recurrence (r=0.643; p=0.001). In logistic regression analysis, PWD was found to be an independent predictor of AF recurrence (OR 1.192 (95% CI 1.032-1.375), p= 0.013). Receiver operating characteristic analysis revealed that the best cut-off value of PWD for maintenance of sinus rhythm was 58 msec (sensitivity: 86%, specificity: 95%, AUC=0.917, 95% CI=0.785-1.05, p=0.001). CONCLUSION: This study suggests that PWD analysis after successful external cardioversion has diagnostic accuracy to predict the recurrence of AF.

Thymosin beta4 levels after successful primary percutaneous coronary intervention for acute myocardial infarction.

OBJECTIVES: Thymosin beta4 (Tß4) has been shown to have an important role in healing of damaged tissues and promoting cardiomyocyte survival in acute coronary syndromes. We evaluated endogenous Tß4 levels in patients presenting with ST-elevation acute myocardial infarction (STEMI) before and after successful primary percutaneous coronary intervention (PCI). STUDY DESIGN: The study included 24 consecutive patients (7 females, 17 males; mean age 55.0±10.9 years) who underwent successful primary PCI for STEMI and 24 age- and sex-matched healthy controls (13 females, 11 males; mean age 57.5±11.7 years) with angiographically normal coronary arteries. To determine Tß4 levels, blood samples were obtained from STEMI patients on admission and 48 hours after successful PCI, and from controls immediately after coronary angiography. RESULTS: Compared to controls, baseline levels of high-density lipoprotein cholesterol (46.2±8.9 vs. 34.2±7.2 mg/dl, p<0.001) and Tß4 (2.9±1.5 vs. 1.5±1.0 µg/ml, p<0.001) were significantly lower, and white blood cell counts (7.6±2.2 vs. 11.4±3.0 10³/µl, p<0.001) were significantly higher in the STEMI group. After 48 hours of PCI, the mean Tß4 level increased significantly to 2.3±0.8 µg/ml (p<0.001) and became similar to that of the control group (p=0.068). There was a significant negative correlation between serum Tß4 and white blood cell count (r=-0.347, p=0.016). CONCLUSION: Considering the significant increase in serum Tß4 levels following successful primary PCI in patients with STEMI, Tß4 may prove to be a new marker in the assessment of reperfusion success in addition to those used currently.

[The relation between exercise-induced myocardial ischemia and high-sensitive C-reactive protein and neopterin levels]. / Egzersizin neden oldugu miyokardiyal iskemi ile yüksek duyarlilikli C-reaktif protein ve neopterin iliskisi.

OBJECTIVE: High sensitivity C-reactive protein (hsCRP) and neopterin are associated with atherosclerosis. We aimed to evaluate the association between hsCRP and neopterin, and myocardial ischemia during exercise stress test (EST) in patients with stable angina pectoris (SAP) and to assess the predictive value of these mediators in obstructive coronary artery disease. METHODS: Forty-five patients with SAP were included in this prospective observational study. EST- positive group included 23 patients (15 males, mean age 54 ± 10 years) and EST-negative group-22 patients (14 males, mean age 52 ± 9 years). In each patient, blood samples were obtained 1 hour before and 30 minutes after EST. In EST-positive group, coronary angiography was performed to determine the presence and severity of coronary artery lesions as assessed by Gensini score. Statistical analysis was performed using Chi-square, unpaired t, Mann-Whitney U and Wilcoxon rank tests. Logistic regression analysis was used to establish the predictive value of tests. RESULTS: Before EST, hsCRP and neopterin levels were similar between the two groups, however, hsCRP levels were higher in EST-positive group after EST (p=0.03). There was no significant difference between the two groups with respect to neopterin levels after EST (p=0.4). In EST-positive group, EST resulted in significant increases in both hsCRP and neopterin levels (from 3.8 ± 2.8 mg/L to 4.3 ± 3.1 mg/L, p=0.001; from 8.7 ± 4.0 nmol/L to 13.1 ± 10.0 nmol/L, p=0.001, respectively). In EST-negative group only neopterin levels significantly increased after EST (from 6.9 ± 1.8 nmol/L to 9.0 ± 3.9 nmol/L, p=0.001). No relation was observed between the obstructive coronary lesions and the levels of hsCRP or neopterin at any point. CONCLUSION: In SAP patients, independent with the existence of obstructive coronary lesion, elevated levels of hsCRP after EST might be an indicator of immune activation caused by myocardial ischemia.

Effect of reperfusion therapy on index of myocardial performance in acute myocardial infarction: thrombolytics versus primary angioplasty.

It is known that primary angioplasty is more effective than thrombolytic therapy for the treatment of ST-segment elevation acute myocardial infarction. The aim of the present study is to compare the effects of the two strategies on the left ventricular functions using the Tei index (a combined myocardial performance index). Of 81 patients (11 female, mean age 52.7 +/- 11.9 years, and 70 male, mean age 54.8 +/- 11.5 years) matching the selection criteria, 41 patients were treated by primary percutaneous transluminal coronary angioplasty and stenting (group A, 41 patients) and 40 patients were treated by thrombolytic agents (streptokinase) (group B, 40 patients). All patients underwent a complete two-dimensional transthoracic echocardiographic and Doppler study in the left lateral decubitus position from multiple windows. There was no significant difference between the two groups in isovolumetric contraction time and ejection time. Isovolumetric relaxation time was 95.2 +/- 18.4 in group A and 116.2 +/- 28.1 in group B (P = 0.001) and the Tei index was 0.51 +/- 0.12 in group A and 0.59 +/- 0.16 in group B (P = 0.019). Isovolumetric relaxation time and Tei index were significantly higher in group B. Primary angioplasty is superior to thrombolytic therapy as assessed by the Tei index even in the first 3 h, with no apparent change in systolic function.

Antiphospholipid antibody syndrome: coexistence of left ventricular apical thrombus and deep vein thrombosis causing pulmonary thromboembolism in a patient with systemic lupus erythematosus.

We report a 36-year-old woman with a 1-year history of systemic lupus erythematosus who was admitted with acute onset of dyspnea and chest pain. She presented with a classic medical history of antiphospholipid antibody syndrome, including spontaneous abortion, deep venous thrombosis, and clinical manifestations of lupus activation. The differential diagnosis was made after a detailed history and examinations with transthoracic/transesophageal echocardiography, deep venous ultrasonography, chest computed tomography, and coronary angiography. This case demonstrates a left ventricular apical thrombus in angiographically normal coronary arteries and also deep vein thrombosis causing acute pulmonary thromboembolism. Antiaggregant and anticoagulant therapies were initiated as a result of the presence of a left ventricular apical thrombus and deep venous thrombosis, which is predisposed to recurrent pulmonary or systemic embolization. Control echocardiography demonstrated resolution of apical thrombus and normalized left ventricular systolic function after aspirin, warfarin, and immunosuppressive therapy for 2 months.

Diastolic heart failure in elderly: the prognostic factors and interventions regarding heart failure with preserved ejection fraction.

Heart failure with a preserved ejection fraction is more common in elderly. Common comorbidities may have an impact on management of heart failure with preserved ejection fraction. The prognosis in more recent studies has been shown to be essentially similar to heart failure with reduced ejection fraction. Unlike heart failure with reduced ejection fraction for which many medications have been demonstrated to improve morbidity and mortality, no treatment has yet been shown to reduce morbidity and mortality in heart failure with preserved ejection fraction. Therefore, current treatment recommendations are aimed at symptomatic management as well as management of concomitant comorbidities.

Influence of heavy cigarette smoking on heart rate variability and heart rate turbulence parameters.

BACKGROUND: Cigarette smoking increases the risk of cardiovascular events related with several mechanisms. The most suggested mechanism is increased activity of sympathetic nervous system. Heart rate variability (HRV) and heart rate turbulence (HRT) has been shown to be independent and powerful predictors of mortality in a specific group of cardiac patients. The goal of this study was to assess the effect of heavy cigarette smoking on cardiac autonomic function using HRV and HRT analyses. METHODS: Heavy cigarette smoking was defined as more than 20 cigarettes smoked per day. Heavy cigarette smokers, 69 subjects and nonsmokers 74 subjects (control group) were enrolled in this study. HRV and HRT analyses [turbulence onset (TO) and turbulence slope (TS)] were assessed from 24-hour Holter recordings. RESULTS: The values of TO were significantly higher in heavy cigarette smokers than control group (-1.150 +/- 4.007 vs -2.454 +/- 2.796, P = 0.025, respectively), but values of TS were not statistically different between two groups (10.352 +/- 7.670 vs 9.613 +/- 7.245, P = 0.555, respectively). Also, the number of patients who had abnormal TO was significantly higher in heavy cigarette smokers than control group (23 vs 10, P = 0.006). TO was correlated with the number of cigarettes smoked per day (r = 0.235, P = 0.004). While LF and LF/HF ratio were significantly higher, standard deviation of all NN intervals (SDNN), standard deviation of the 5-minute mean RR intervals (SDANN), root mean square of successive differences (RMSSD), and high-frequency (HF) values were significantly lower in heavy smokers. While, there was significant correlation between TO and SDNN, SDANN, RMSSD, LF, and high frequency (HF), only HF was correlated with TS. CONCLUSION: Heavy cigarette smoking has negative effect on autonomic function. HRT is an appropriate noninvasive method to evaluate the effect of cigarette on autonomic function. Simultaneous abnormal HRT and HRV values may explain increased cardiovascular event risk in heavy cigarette smokers.

P-wave dispersion increases in prehypertension.

BACKGROUND: Prolongation of P-wave durations and increased P-wave dispersion are independent predictors of atrial fibrillation (AF). AF is the most common arrhythmia of the general population. Prehypertension, including those with systolic blood pressure ranging from 120-139 mmHg or diastolic blood pressure ranging from 80-89 mmHg was described by JNC7. Prehypertension is the predictor of development of hypertension in the future. Prehypertension is associated with excess cardiovascular morbidity and mortality. In this study, we evaluated relationship between prehypertension and P-wave dispersion. METHODS: Seventy-eight prehypertensive patients (group 1: mean age 44.6+/-11.2 years; 45 male) and 78 normotensive patients (group 2: mean age 43.3+/-7.0 years; 43 male) were enrolled in this study. Standard 12-lead ECGs were recorded in all patients using a paper speed of 50 mm/s. In all patients, transthoracic echocardiographic examination was performed. RESULTS: Pmax and P-wave dispersion were significantly higher in group 1 compared with group 2 (103.59+/-19.8 ms vs 93.59+/-13.4 ms, p<0.001; 50.51+/-18.6 ms vs 39.85+/-10.6 ms, p<0.001, respectively). CONCLUSION: Pmax and P-wave dispersion increase in prehypertensive patients compared with normotensive patients. This data might show increased risk of AF in prehypertension.

Multisided cardiac hemangiomas mimicking biatrial thrombus: atypically located cardiac hemangiomas of left atrial appendage and right atrium.

Hemangiomas are rare benign tumors of the heart. Clinical presentation is highly variable according to the location, size, and extension of the tumor. Hemangiomas have been described in all cardiac chambers, but most occur on the right side of the heart and in the left atrium. Although diagnosis is typically made by echocardiography, the definite diagnosis can be made with certainty only from a very careful histopathologic examination. The authors report a case of atypically located hemangiomas originating from the left atrial appendage and right atrium in a 71-year-old woman who presented with ischemic stroke. Transthoracic and transesophageal echocardiography demonstrated an elongated left atrial mass originating in the atrial appendage and extending well into the left atrium to the mitral orifice, as well as a right atrial mass and intense biatrial spontaneous echo contrast. It was unclear whether the masses represented thrombus or an unusually located atrial tumor. Immunohistologic examinations revealed a biatrial cavernous hemangioma with no signs of malignancy.

Coronary saddle embolism causing myocardial infarction in a patient with mechanical mitral valve prosthesis: treatment with thrombolytic therapy.

Coronary embolism is an uncommon cause for myocardial infarction in clinical practice and there is no consensus on the treatment of this subject. Thrombolytic agents and percutaneous intervention are up to date options and yet there are only a few case reports regarding thrombolytic therapy in this special subgroup of patients suffering from myocardial infarction. We reported a 37-year-old woman patient with non-ST elevation myocardial infarction due to coronary embolism who was successfully treated using intravenous thrombolytic therapy with tissue plasminogen activator.