Relationship between endothelial dysfunction and cardiovascular risk factors and the extent and severity of coronary artery disease.

OBJECTIVES: Endothelial dysfunction (ED) is associated with coronary artery disease (CAD) and cardiovascular risk factors. The relationship between cardiovascular risk factors, ED and the presence, extent and severity of CAD, was evaluated in patients with and without angiographically defined CAD in our study. STUDY DESIGN: Eighty patients with CAD and 20 subjects with normal coronary arteries were included. Endothelial function was evaluated by endothelium-dependent, flow-mediated dilatation (FMD) and nitroglycerine-mediated dilatation (NMD) measurements, using brachial artery Doppler ultrasonography (USG). Cardiovascular risk factors were identified. The extent and severity of CAD was determined via vessel and modified Gensini scores. RESULTS: FMD% and NMD% were significantly decreased in the CAD(+) group compared with the CAD(-) group (p=0.0001). In the CAD(+) group, the cut-off values of FMD% and NMD% in distinguishing between single-vessel and multi-vessel diseases were 8.5% (sensitivity: 95%, specificity: 62%) and 13.6% (sensitivity: 91%, specificity: 62%), respectively. Additionally, a modified Gensini score was significantly correlated with both FMD and NMD (r=-0.825, r=-0.778, respectively; p=0.0001) in the CAD(+) group. CONCLUSION: ED was more prevalent in the CAD(+) group, and the degree of ED correlated well with the extent and severity of CAD.

The evaluation of mitral valve stenosis: comparison of transthoracic echocardiography and cardiac magnetic resonance.

AIMS: Echocardiographic assessment of patients with mitral valve stenosis (MS) requires a detailed evaluation of mitral valve anatomy, mitral valve area (MVA), and pressure gradient and presence concomitant valve diseases. Our aim was to evaluate planimetric MVA and transmitral flow velocities using cardiac magnetic resonance (CMR) in patients with isolated MS and to compare with transthoracic echocardiography (TTE) to determine the reliability. METHODS AND RESULTS: Thirty-one patients (mean age 50.4 ± 10.2, 90.3% women) with isolated MS who were in a normal sinus rhythm were included in the study. Patients with ejection fraction <50%, atrial fibrillation, moderate-to-severe mitral valve insufficiency, moderate-to-severe stenosis and insufficiency of other valves, and previous commissurotomy and valvulotomy were excluded. Planimetric MVA and diastolic velocities were measured with TTE and CMR. There were strong correlations between measurements of planimetric MVA and transmitral diastolic velocities (P < 0.0001). Assessment of Bland-Altman analysis revealed strong agreement on measuring planimetric MVA with values -0.018 cm(2) (SD = 0.98 cm(2)) and the limits of agreement were -0.131 to 0.094. CONCLUSION: CMR is a reliable method in patients with MS for diagnosis and follow-up.

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.