Association of Left Atrial Spontaneous Echo Contrast to Uric Acid in Patients with Mitral Stenosis.

OBJECTIVES: Spontaneous echo contrast (SEC) is the presence of smoke-like echoes with a characteristic swirling motion of the blood in echocardiography. Previous clinical studies have shown that SEC is a risk factor for left atrial thrombus formation and a predictor of potential systemic embolism originating from the heart. There is an association between uric acid and prothrombotic state. Therefore, we aimed to investigate the role of uric acid in SEC in patients with mitral stenosis (MS). METHODS: A total of 85 consecutive patients with MS were enrolled in the study. Patients were divided into two groups according to whether SEC was present in the left atrium. RESULTS: There were 41 patients (mean age 46.4 ± 11.4 and 68% female) in the SEC(-) group and 44 patients (mean age 45.7 ± 7.2 and 64% female) in the SEC(+) group. High sensitive C-reactive protein (hs-CRP) levels were significantly higher in the SEC(+) group than in the SEC(-) group (9.5 ± 4.2 vs. 4.7 ± 2.2 mg/L, P < 0.001). Uric acid was also significantly higher in the SEC (+) group (6.3 ± 1.4 vs. 4.5 ± 1.3 mg/dL, P < 0.001). In receiver operating characteristics curve analysis, uric acid >5.2 mg/dL had a 73% sensitivity and 76% specificity in predicting SEC in patients with MS. At multivariate analysis, uric acid (OR 3.919, 95% CI 1.911-8.035; P < 0.002) was an independent risk factor for SEC in patients with MS. CONCLUSION: Uric acid is independently associated with SEC in patients with MS. Our findings suggest that this inexpensive, universally available marker may be a useful biomarker for the stratification of risk in patients with MS.

Mean platelet volume is associated with poor postinterventional myocardial blush grade in patients with ST-segment elevation myocardial infarction.

OBJECTIVE: In a significant proportion of patients with ST-elevation myocardial infarction (STEMI), microvascular and myocardial reperfusion cannot be regained despite successfully restored thrombolysis in myocardial infarction (TIMI) grade 3 epicardial blood flow. Myocardial blush grade (MBG) is a reliable marker for microvascular patency and predicts short-term and long-term mortality after primary percutaneous coronary intervention (PCI) in patients with acute STEMI, independent of other variables. Mean platelet volume (MPV), a unique measure of platelet size, is an indicator of platelet reactivity. In this study, we aimed to investigate the relation of admission MPV with postinterventional MBG in patients with STEMI and TIMI grade 3 flow at infarct artery after primary PCI. MATERIALS AND METHODS: Three hundred and ten patients were selected as a study group among patients with STEMI and TIMI grade 3 epicardial blood flow after primary PCI. Blood samples for analysis were obtained during the initial evaluation of patients at the emergency department. MBGs of patients were classified at the end of angioplasty. Patients with MBG 0 and 1 were defined as having poor myocardial blush and patients with MBG 2 and 3 were defined as having normal myocardial blush. RESULTS: Patients with poor myocardial blush had higher admission MPV (10.5±1.3 to 9.1±1 fl, P<0.001), higher peak creatine kinase myocardial band isoenzyme levels (260±53 to 190±38 U/l, P<0.001), higher white blood cell count (11.3±4 to 10.3±3×10/µl, P=0.012), and lower left ventricular ejection fraction (42±7 to 51±8%, P<0.001) compared with patients with normal myocardial blush. Linear regression analysis showed that admission MPV was significantly associated with postinterventional MBG (coefficient=0.598, P<0.001). Cardiovascular mortality (13-5%, P=0.013) and acute-subacute stent thrombosis at 3 months (12-8%, P=0.028) were significantly higher in patients with poor postinterventional myocardial blush compared with those with normal myocardial blush. CONCLUSION: The MPV measured at admission is significantly associated with poor postinterventional MBG in patients with STEMI and TIMI grade 3 flow at infarct artery after primary PCI.

The relation of serum γ-glutamyl transferase levels and coronary collateral circulation in patients with chronic coronary total occlusion.

OBJECTIVES: Sufficient coronary collateral circulation (CCC) protects myocardial tissue against ischemia in patients with coronary chronic total occlusion (CTO). In this study, we aimed to investigate whether there is an association between serum γ-glutamyl transferase (GGT) levels and development of CCC in patients with coronary CTO. MATERIALS AND METHODS: A total of 203 patients with CTO at coronary angiography were included in this study. On the day of admission to the hospital, blood samples were taken and GGT levels were analyzed for all patients. Development of collateral circulation was graded according to the Rentrop classification after coronary angiography. Then, patients were divided into two groups on the basis of CCC grades: group 1 included 99 patients (49%) with poorly developed CCC, and group 2 included 104 patients (51%) with well-developed CCC. RESULTS: Patients with poorly developed CCC had significantly higher serum GGT levels compared with those with well-developed CCC, (66.5±16 vs. 51.8±10 U/l, P<0.0001). Correlation analysis showed an inverse correlation between GGT levels and the Rentrope score (r=-0.579, P<0.001). Logistic regression analysis showed that GGT level was an independent predictor of poorly developed CCC (odds ratio 0.92, 95% confidence interval 0.90-0.94; P<0.001). CONCLUSION: Increased serum GGT levels independently predict poorly developed CCC in patients with coronary CTO. Our results show that GGT is a simple and readily available marker for sufficiency of CCC in patients with CTO.