Distal transradial versus conventional transradial access in acute coronary syndrome.

OBJECTIVE: Distal transradial access (TRA) has been recently introduced as an alternative access site for coronary angiography (CAG). Both procedures can be performed in cardiology clinics by interventional cardiologists. Although distal TRA is considered to be more difficult as it requires artery puncture and experienced cardiologists, it seems to be more advantageous because of the limited risk of arterial occlusion. In this study, we share our experiences with distal TRA and conventional TRA. METHODS: Seventy patients undergoing CAG via distal TRA and 63 patients via conventional TRA were included in this study. The patients' data were reviewed retrospectively and compared in terms of procedural characteristics and complications. RESULTS: There was no significant difference between the distal TRA group (94.2%) and the conventional TRA group (98.4%) in terms of success rate (p=0.217). In the distal TRA group, the total sheath emplacement time was longer (p<0.001), and hemostasis time was shorter (p<0.001) compared with conventional TRA. Total procedural time and hospitalization period were not statistically different between the groups (p>0.05). Radial spasm and radial occlusion were more common in the conventional TRA group than in the distal TRA group (7.9% vs 1.4% and 3.1% vs 1.4%, respectively), and hematomas were not statistically different between the groups. CONCLUSION: Although distal TRA seems more advantageous in terms of less hemostasis time and less vascular complications, it takes a longer time for sheath insertion and may cause more pain, which may diminish its efficiency. Large-scale studies are needed to address this issue.

S100A1 as a Potential Diagnostic Biomarker for Assessing Cardiotoxicity and Implications for the Chemotherapy of Certain Cancers.

This study examined the value of blood marker S100A1 in detecting cardiotoxicity induced by chemotherapy agents; trastuzumab and lapatinib, in normal rat heart. The rats were divided into three groups: control (n = 8, no treatment), T (n = 8, one time ip treatment with 10 mg/kg trastuzumab) and L (n = 8, oral treatment with 100 mg/kg/day lapatinib for 7 days). The activities of oxidative stress parameters Malondialdehyde (MDA), Superoxide dismutase (SOD), Catalase (CAT) and Glutathione (GSH) were measured from the extracted cardiac tissues. The levels of troponinI and S100A1 expressions were measured from blood samples. All biomarkers responded to the treatments as they exhibited alterations from their normative values, validating the chemically induced cardiotoxicity. S100A1 expression attenuated significantly (75%), which made the sensitive detection of cardiotoxicity feasible. Assessment of cardiotoxicity with S100A1 may be a valuable alternative in clinical oncology of cancers in some organs such as breast and prostate, as they do not overexpress it to compete against.

Severity of coronary artery disease and echocardiographic parameters of ventricular diastolic function.

OBJECTIVE: The objective of this study was to determine the relation between the severity of the coronary artery disease (CAD) and left ventricular (LV) diastolic function in patient with stable CAD and normal LV ejection fraction. METHODS: Sixty patients with stable CAD were included in the study. All angiographic variables pertinent to SYNTAX Score (SS) and Gensini score (GS) calculation were computed by two experienced interventional cardiologists. All patients underwent echocardiographic examination. RESULTS: We divided the patients into 4 groups according to median of SS and GS. It was observed that LV diastolic function was impaired in 26 patients (86.7%) in under group of SS, 23 patients (76.7%) in upper group of SS, and 27 patients (87.1%) in under group of GS, and 22 patients (75.9%) in upper group of GS. There was no significant difference between the SS, GS, clinical, and echocardiographic findings. CONCLUSION: The diastolic function did not demonstrate any impairment according to the severity of the CAD in patients which coronary angiography performed with the diagnosis of stable CAD.

QT dispersion during hypobaric hypoxia.

OBJECTIVE: Hypoxia is one of the major concerns in aviation. Clinical hypoxia has been shown to increase QT dispersion (QTd). We aimed to examine QTd during hypobaric chamber training to observe the effect of hypobaric hypoxia on QT dispersion. METHODS: A total of 38 healthy male aviators volunteered to take part in this longitudinal study. Subjects' electrocardiograms were recorded by 12-lead digital Holter device before, during, and after hypobaric exposure at simulated altitude of 30,000 ft. Data from 23 of the subjects, aged 27.91+/-6.02 years (range 22-39) was used. QT intervals were measured manually. QT dispersion and heart rate adjusted QTd (QTcd) were calculated for each subject. Statistical significance of changes in parameters was analyzed using the Friedman test. Comparison of pre-post exposure clusters was made using Dunn's test. RESULTS: QT dispersion values were as following: prehypoxic 64.09+/-8.39 ms, hypoxic 50.35+/-11.06 ms and posthypoxic 59.83+/-9.06 ms (Median: 64, 50, 60; Mean rank: 2.65, 1.28, 2.07) (p=0.0001 for prehypoxic-hypoxic, p=0.046-prehypoxic-posthypoxic, and p=0.002 for posthypoxic-hypoxic). Heart rate values were as following: prehypoxic 74.09+/-6.43 beats/min, hypoxic 127.1+/-17.39 beats/min, and posthypoxic 95.17+/-11.35 beats/min (Median: 75, 122, 92; Mean rank: 1, 3, 2) (p=0.0001 for prehypoxic-hypoxic, prehypoxic-posthypoxic, and posthypoxic-hypoxic). The change in QTd and HR during hypobaric chamber exposure was statistically significant but, the change in QTcd was not (p<0.001, p<0.001, p>0.1, respectively). CONCLUSION: From the findings of present study, it is not possible to directly comment on the validity of QTd in revealing arrhythmogenic predisposition of healthy subjects exposed to hypobaric hypoxia. The relationship between QT dispersion and hypobaric hypoxic exposure is not clear, particularly when QTd is corrected for the increased heart rate. QT dispersion measurement has not been proven a reliable and practical method to show arrhythmia predisposition during a hypobaric hypoxic exposure in healthy individuals.