Assessment of interleukin-1 gene cluster polymorphisms in lone atrial fibrillation: new insight into the role of inflammation in atrial fibrillation.

BACKGROUND: Systemic inflammation is accepted as one of the pathophysiological mechanisms of atrial fibrillation (AF). The role of inflammation has been shown previously. Interleukin (IL) system is the main modulator of the inflammatory responses and genetic polymorphisms of IL-1 cluster genes are associated with increased risk for inflammatory diseases. OBJECTIVES: To investigate the association between polymorphisms of IL-1 cluster genes and lone AF. SUBJECTS AND METHODS: DNA samples were collected from 70 proven lone AF patients and 70 healthy subjects. Genomic DNA was typed for the variable number of the tandem repeat (VNTR) IL-1 receptor antagonist (RN) gene polymorphism, IL-1B -511 C > T(rs16944) promoter polymorphism, and +3953 C > T(rs1143634) polymorphism in exon 5 by polymerase chain reaction. RESULTS: In lone AF group the frequency of IL-1RN2/2 and IL-1RN1/2 genotypes were higher than in the control group (7.2% vs 4.3% and 48.5% vs 22.8%, respectively; χ(2) = 14.1; P = 0.028). The frequency of allele 2 was significantly higher in the lone AF group (32.1% vs 15.7%; χ(2) = 10.7; P = 0.005). Allele and genotype distribution of IL-1B -511 C > T and +3953 C > T polymorphisms were not statistically different between the groups. C-reactive protein (CRP) levels were higher in lone AF patients compared to the control group (median = 1.25, interquartile range [IQR] = 0.85 vs median = 1.08, IQR 0.46 mg/L, respectively; P = 0.02). In multivariate regression analysis, presence of allele 2 of IL-1 VNTR polymorphism and elevated plasma high-sensitive-CRP levels were the independent predictors of lone AF. CONCLUSION: Presence of allele 2 of VNTR polymorphism of IL-1RN gene may cause increased risk for lone AF probably due to the inadequate limitation of inflammatory reactions.

Impact of a mass media campaign to increase public awareness of hypertension.

OBJECTIVES: We evaluated the effect of a nationwide media campaign on hypertension awareness in the population, which was implemented with the aim of spreading key messages related to optimal blood pressure levels and encouraging blood pressure measurements. STUDY DESIGN: A nationwide project called "12/8 Awareness Campaign" was implemented between October 2005 and January 2006 using all available mass and outdoor media aiming to improve the knowledge of people on normal blood pressure values and to encourage regular blood pressure measurements. Four survey questions to inquire the level of awareness related to optimal blood pressure levels, hypertension, and hypertension-related disease conditions were directed via face-to-face interviews to two separate samples representing the general Turkish population before (n=1716) and after (n=1725) the campaign, respectively. The answers of the pre- and post-campaign individuals were compared. RESULTS: After the campaign, the percentage of participants who did not know their blood pressure levels decreased from 54.8% to 47.8%, the percentage of those who checked their blood pressure within the past two months increased from 34.3% to 39.6%, and the percentage of those who were aware of the optimal blood pressure levels rose from 51.8% to 58.6% (p<0.001). CONCLUSION: The campaign contributed significantly to the awareness of hypertension in general population, which is highly encouraging for future efforts for early detection of hypertension and prevention of related morbidity and mortality.

Patients with anemia on admission who have undergone primary angioplasty for ST elevation myocardial infarction: in-hospital and long-term clinical outcomes.

OBJECTIVE: We investigated the in-hospital and long-term follow-up (mean 21 months) results of patients with and without anemia on admission and who have undergone primary angioplasty for ST elevation myocardial infarction (STEMI). STUDY DESIGN: A total of 2509 patients (616 patients with anemia on admission, 1893 patients without anemia on admission), who were treated with primary angioplasty due to STEMI, were included in this study. Demographics and basic clinical features of the patients, outcomes of the primary angioplasty procedures, and clinical course of the patients during and a mean period of 21-month follow-up after hospitalization were retrospectively evaluated. All the parameters were compared between anemic and nonanemic groups. RESULTS: The mean age of the patients in anemic group was found to be higher than nonanemic group (61.5 ± 11.4 vs. 54.8 ± 11.4, P<0.001). The rates of death, major cardiac events, and severe cardiac insufficiency were significantly higher in anemic patients during hospitalization period. Moreover, frequency of death was also higher in anemic patients when compared with the nonanemic ones after a mean follow-up period of 21 months (P<0.001). Anemia on admission is an independent predictive factor for mortality in patients with STEMI who were treated with primary angioplasty (odds ratio: 2.2; 95% confidence interval: 1.2-4.0; P<0.009). CONCLUSION: Patients with anemia on admission initially have high-risk profiles regarding their worse clinical outcomes during and 21 months after hospitalization. In accordance with the suggestion of the evidence-based medicine we conclude that etiology of anemia should be meticulously investigated and the oxygenization of the tissue should be provided with the appropriate treatment.

[Primary percutaneous coronary intervention in patients admitted with cardiogenic shock and ST-elevation myocardial infarction: prognosis and predictors of in-hospital mortality]. / Kardiyojenik sokla basvuran ST yükselmeli miyokart enfarktüslü hastalarda primer perkütan koroner girisim: Prognoz ve hastane içi mortalitenin belirleyicileri.

OBJECTIVES: We investigated the efficacy and outcome of primary percutaneous coronary intervention (PCI) in patients admitted with cardiogenic shock and ST-elevation myocardial infarction (STEMI). STUDY DESIGN: We reviewed 91 consecutive patients (66 males, 25 females; mean age 61 ± 11 years) treated with primary PCI for cardiogenic shock due to STEMI. All clinical, angiographic data, and in-hospital and long-term outcomes were collected. The patients were classified into two groups depending on the presence (n = 59, 64.8%) or absence (n= 32, 35.2%) of in-hospital mortality. RESULTS: Hospital nonsurvivors were older (mean age 62.7 ± 11.1 vs. 57.7 ± 11.4 years; p = 0.04) and exhibited higher frequencies of diabetes mellitus (DM), renal failure, and history of myocardial infarction. Multi-vessel disease (p = 0.004) and circumflex artery involvement (p = 0.03) were more frequent and the rates of tirofiban administration (p = 0.02) and stenting (p = 0.007) were lower in nonsurvivors. Procedural success rate was substantially lower in nonsurvivors (39% vs. 84.4%; p < 0.001). Of 32 survivors, cardiovascular mortality occurred in only three patients (9.4%) during a median follow-up of 26 months. In multivariate regression analysis, unsuccessful procedure (OR 7.2, 95% CI 1.77-29.27; p = 0.006) and DM (OR 3.92, 95% CI 1.13-13.62; p = 0.03) were the independent predictors of in-hospital mortality. CONCLUSION: Mortality rate is considerably higher and successful procedure yields a two-fold decrease in in-hospital mortality in patients with cardiogenic shock complicated by STEMI. Unsuccessful procedure and DM represent as two independent predictors of in-hospital mortality.

[Gastrointestinal bleeding in patients undergoing primary angioplasty for acute myocardial infarction: incidence, risk factors and prognosis]. / Akut miyokart enfarktüsü nedeniyle primer anjiyoplasti uygulanan hastalarda gastrointestinal kanama sikligi, risk faktörleri ve prognoz.

OBJECTIVES: We investigated the incidence, predictors, and prognosis of gastrointestinal bleeding (GIB) in patients undergoing primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI). STUDY DESIGN: We reviewed 2,541 consecutive patients (2,111 males, 430 females; mean age 56.5+/-11.8 years) who underwent primary PCI for STEMI. Data on clinical, angiographic findings, and in-hospital outcomes were collected. Gastrointestinal bleeding was defined as apparent upper or lower GIB or melena requiring cessation of antiplatelet or anticoagulant therapy and administration of erythrocyte infusion. RESULTS: Gastrointestinal bleeding was observed in 27 patients (1.1%). Compared to 2,514 patients without GIB, patients with GIB were older (65.9+/-13.5 years vs. 56.4+/-11.8 years; p<0.001), exhibited higher frequencies of female gender (p=0.016), renal failure (p<0.001), and admission anemia (p<0.001), and had a lower procedural success rate (77.9% vs. 91.5%; p=0.02). The development of GIB was associated with significantly higher in-hospital mortality (18.5% vs. 2.9%; p<0.001), longer hospital stay (13.1+/-6.8 days vs. 7.0+/-3.7 days, p=0.02), and increased inotropic requirement (37% vs. 6.7%; p<0.001). In multivariate analysis, inotropic requirement (OR 4.17, 95% CI 1.7-10.4; p=0.002), age above 70 years (OR 3.33, 95% CI 1.4-8.0; p=0.007), and glomerular filtration rate lower than 60 ml/min/1.73 m(2) (OR 2.96, 95% CI 1.2-7.4; p=0.02) were independent predictors of in-hospital GIB. CONCLUSION: The development of GIB is not an uncommon complication after primary PCI for STEMI. These patients have a prolonged hospital stay and increased in-hospital mortality. Increased inotropic requirement, age above 70 years, and impaired renal function are independent predictors of this complication.

Prediction of cardiovascular mortality in patients with ST-elevation myocardial infarction after primary percutaneous coronary intervention.

OBJECTIVES: We analyzed a large patient group to develop a clinical risk score that could be applied to patients after primary percutaneous coronary intervention (PCI). METHODS: We reviewed 2529 consecutive patients treated with primary PCI for ST-elevation myocardial infarction between 2003 and 2008. All clinical, angiographic and follow-up data were retrospectively collected. Independent predictors of in-hospital cardiovascular mortality were determined by multivariate Cox regression analysis in all study patients. RESULTS: Five variables (Killip class 2/3, unsuccessful procedure, contrast-induced nephropathy, diabetes mellitus, and age >70 years) were selected from the initial multivariate model. Each of them was weighted with 1 point according to their respective odds ratio for in-hospital mortality and then total risk score was calculated for each patient with a range of 0-5 points. For simplicity, four strata of risk were defined (low risk, score 0; intermediate risk, score 1; high risk, score 2 and very high risk, score > or =3). Each risk strata had a strong association with in-hospital cardiovascular mortality (P<0.001 for trend). Moreover, among survivors after an in-hospital period, our risk score continued to be a powerful predictor of long-term mortality (P<0.001 for trend). CONCLUSION: In patients treated with primary PCI, a risk score, which was developed from five risk factors readily available after intervention, may be useful to predict in-hospital and long-term cardiovascular mortality.

The outcome of primary percutaneous coronary intervention for stent thrombosis causing ST-elevation myocardial infarction.

BACKGROUND: There are very few scientific data about the effectiveness of primary percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI) due to stent thrombosis (ST). The purpose of the present study is to investigate the efficacy and outcome of primary PCI for STEMI due to ST in the largest consecutive patient population with ST reported to date. METHODS: A total of 2,644 consecutive STEMI patients undergoing primary PCI were retrospectively enrolled into the present study. The primary end point of this study was successful angiographic reperfusion defined as postprocedural Thrombolysis In Myocardial Infarction grade III flow. The secondary end points were cardiovascular death and reinfarction. RESULTS: Stent thrombosis was the cause of STEMI in 118 patients (4.4%). In patients with ST, angiographic success (postprocedural Thrombolysis In Myocardial Infarction grade III flow) was worse than in patients with de novo STEMI (76.3% vs 84.8%, P = .01). Patients with ST had significantly higher incidence of in-hospital cardiovascular mortality than patients with de novo STEMI (10.2% vs 5.3%, P = .02). In-hospital reinfarction rate was similar in both groups. In addition, long-term (mean 22 months) cardiovascular mortality and reinfarction rates were significantly higher in patients with ST compared with those without (17.4% vs 10.5%, P = .02 and 15.6% vs 9.5%, P = .03, respectively). CONCLUSIONS: Primary PCI for treatment of ST is less effective, and these patients are at increased risk for in-hospital and long-term mortality compared with patients undergoing primary PCI due to de novo STEMI.

[Efficacy and outcome of primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction due to saphenous vein graft occlusion]. / Safen ven greft tikanikligi nedeniyle ST yükselmeli miyokart enfarktüsü gelisen hastalarda primer perkütan koroner girisimin etkinligi ve sonuçlari

OBJECTIVES: We evaluated the efficacy and outcome of primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) due to saphenous vein graft (SVG) occlusion. STUDY DESIGN: We reviewed 2,646 consecutive patients (mean age 56.6±11.8 years) who underwent primary PCI for STEMI between 2003 and 2009. All clinical and angiographic data and in-hospital and long-term (median 22 months) outcomes were retrospectively collected. The patients were classified into two groups based on the lesions treated with primary PCI, i.e., native vessels (n=2,625) and SVG (n=21). RESULTS: Compared to patients with occluded native vessels, patients with SVG occlusion had significantly higher rates of coronary bypass operation (100% vs. 2.3%, p<0.001), previous myocardial infarction (52.4% vs. 10.8%, p<0.001), and diabetes mellitus (52.4% vs. 25.1%, p=0.002), but lower frequency of anterior myocardial infarction (9.5% vs. 49.3%, p<0.001). Tirofiban use (71.4% vs. 48.2%, p=0.01) and three-vessel disease (81% vs. 25.6%, p<0.001) were significantly more common in the SVG group. The rate of successful primary PCI was lower in SVG occlusions compared to native vessels (61.9% vs. 84.7%, p=0.01). The two groups did not differ significantly with respect to in-hospital and long-term cardiovascular events and mortality (p>0.05). In multivariate logistic regression analysis, application of PCI to SVG was found to be an independent predictor for unsuccessful procedure (OR 6.76, 95% CI 2.05-22.21; p=0.002). CONCLUSION: Although the success rate of primary PCI in SVG lesions was lower compared to native vessels, this did not have an adverse effect on postprocedural cardiovascular events and mortality in patients presenting with STEMI.

Comparison of outcomes in young versus nonyoung patients with ST elevation myocardial infarction treated by primary angioplasty.

OBJECTIVES: We sought to determine in-hospital and intermediate-term outcomes of primary percutaneous coronary intervention (PCI) for ST elevation myocardial infarction (STEMI) in young adults. METHODS: We reviewed 2424 consecutive patients treated with primary angioplasty for acute MI; 465 were aged 45 or less (young group) and 1959 were 46-74 years of age (nonyoung group). Clinical characteristics, in-hospital and intermediate-term outcomes of primary PCI were analyzed. RESULTS: Compared with nonyoung patients, the young patients had significantly lower in-hospital and intermediate-term mortality (for in-hospital mortaliy: 5.4 vs. 1.2%, P<0.001; for intermediate-term mortality: 5 vs. 1.3%, P<0.001). By multivariate Cox regression analysis in all 2424 patients; cardiogenic shock, diabetes mellitus, anterior MI and unsuccessful procedure were independent predictors of both in-hospital and intermediate-term mortality whereas age [odds ratio (OR): 1.07, P<0.001], female sex (OR: 1.88, P = 0.04), MI history (OR: 3.05, P = 0.001) and multivessel disease (OR: 2.15, P = 0.01) were independent predictors of only intermediate-term mortality. The young group had lower unsuccessful procedure rates of primary PCI for STEMI (4.9 vs. 10.1%, P = 0.001). CONCLUSION: These results suggest that young adults who underwent primary PCI have favorable in-hospital and intermediate-term outcomes. Moreover, primary PCI for young adults with STEMI is safer, more feasible and effective than for a relatively older population.

Ischaemic stroke complicating primary percutaneous coronary intervention in patients with ST elevation myocardial infarction.

OBJECTIVE: We sought to determine the in-hospital incidence and predictors of ischaemic stroke in patients with ST elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). METHODS: We reviewed 2638 consecutive patients undergoing 2722 pimary PCI procedures for STEMI during in-hospital stay. Stroke was defined as any new focal neurological deficit lasting > or =24 h, occurring anytime during or after PCI until discharge. Patients with haemorrhagic stroke were excluded. Clinical characteristics and in-hospital outcome were analysed regarding ischaemic stroke in patients undergoing primary PCI. RESULTS: Ischaemic stroke was observed in 20 of the 2722 procedures, an incidence of 0.73%. Patients with ischaemic stroke were older than patients without stroke (mean age 67 +/- 9.6 vs. 56.6 +/- 11.8, P < 0.001). Compared to patients without stroke, female gender, diabetes and hypertension were more prevalent in patients with stroke. Ischaemic stroke was found to be a powerful independent predictor of in-hospital cardiovascular mortality (odds ratio [OR] 6.32, 1.15-34.7; P < 0.001). Left ventricular ejection fraction (LVEF) < 35% (OR 3.13, P = 0.04), contrast-induced nephropathy (OR 2.91, P = 0.04) and tirofiban use (OR 0.23, P = 0.02) were the independent predictors for in-hospital ischaemic stroke. CONCLUSIONS: The present study shows that the incidence of ischaemic stroke in patients undergoing PCI for STEMI is higher and ischaemic stroke increases in-hospital mortality in these patients. Moreover, LVEF < 35% and contrast-induced nephropathy were independent predictors of ischaemic stroke, whereas tirofiban use demonstrated a protective effect to this potentially catastrophic complication.

O polimorfismo VNTR no gene codificador do antagonista do receptor da interleucina-1 está associado com a doença arterial coronariana / Interleukin-1 receptor antagonist gene VNTR polymorphism is associated with coronary artery disease

FUNDAMENTO: A Doença Arterial Coronariana (DAC) é a aterosclerose das artérias coronárias que transportam o sangue para o coração. A aterosclerose é uma doença inflamatória. As variações gênicas das citocinas - como as associadas à família IL1 - fazem parte da patogênese da aterosclerose. OBJETIVO: O objetivo deste estudo foi determinar a relação entre os polimorfismos da família IL1 (VNTR do IL1RN, posições -511 e +3953 do IL1B) e a DAC na população turca. MÉTODOS: Um total de 427 indivíduos foram submetidos à angiografia coronariana e em seguida divididos da seguinte forma: 170 no grupo controle e 257 no grupo de pacientes com DAC. Os sujeitos com DAC foram divididos em dois subgrupos: 91 no grupo de Doença Coronariana em um único vaso (Single Vessel Disease - SVD) e 166 no grupo Doença Coronariana em múltiplos vasos (Multiple Vessel Disease - MVD). Os genótipos de IL1RN e IL1B (-511, +3953) foram determinados por reação em cadeia da polimerase (RCP), seguida de análise da digestão por enzima de restrição. RESULTADOS: Não foram observadas diferenças significantes nas distribuições de genótipos de IL1RN e IL1B (-511 e +3953) entre os sujeitos com DAC e os controles, ou entre sujeitos com MVD e controles. No entanto, observou-se uma relação significante no genótipo IL1RN 2/2 entre sujeitos portadores de SVD e controles (P= 0,016, x2: 10,289, OR: 2,94IC 95 por cento 1,183 - 7,229). Tampouco foi observada diferença estatisticamente significante nas freqüências dos alelos de IL1RN e IL1B (-511 e +3953) entre os sujeitos com DAC e controles, os sujeitos com MVD e controles, ou ainda os sujeitos SVD e controles. CONCLUSÃO: Não foi observada nenhuma relação na freqüência alélica e nem na distribuição genotípica dos polimorfismos de IL1RN e IL1B entre sujeitos com DAC e grupos controle. No entanto, o genótipo IL1RN 2/2 pode representar um fator de risco para sujeitos com SVD na população turca.

BACKGROUND: Coronary Artery Disease (CAD) is the atherosclerosis of coronary arteries that carry blood to the heart muscle. Atherosclerosis is an inflammatory disease. Cytokine gene variations such as those associated with the IL1 family are involved in the pathogenesis of atherosclerosis. OBJECTIVE: The purpose of this study was to determine the relationship between IL1 family polymorphisms (IL1RN VNTR, IL1B positions -511 and +3953) and CAD in Turkish population. METHODS: 427 individuals were submitted to coronary angiography and were grouped as 170 control subjects and 257 CAD patients. The CAD subjects were divided into two subgroups: 91 Single Vessel Disease (SVD) and 166 Multiple Vessel Disease (MVD) subjects. The genotypes of IL1RN and of IL1B (-511, +3953) were determined by polymerase chain reaction (PCR) followed by restriction digestion analysis. RESULTS: No significant difference was found in IL1RN and IL1B (-511 and +3953) genotype distributions between CAD and control subjects or MVD and control subjects. However, significant association was seen in IL1RN 2/2 genotype between SVD and control subjects (P= 0.016, x2: 10.289, OR: 2.94, 95 percent CI: 1.183-7.229). Similarly, no statistically significant difference was found in IL1RN and IL1B (-511 and +3953) allele frequencies between CAD and control subjects, MVD and control subjects or SVD and control subjects. CONCLUSION: No association was found in either allele frequency or genotype distribution of IL1RN and IL1B polymorphisms between CAD and the control groups. However; IL1RN 2/2 genotype may be a risk factor for SVD in the Turkish population.

Transthoracic Doppler echocardiographic coronary flow imaging in identification of left anterior descending coronary artery stenosis in patients with left bundle branch block.

BACKGROUND: Conventional noninvasive methods have well-known limitations for the detection of coronary artery disease (CAD) in patients with left bundle branch block (LBBB). However, advancements in Doppler echocardiography permit transthoracic imaging of coronary flow velocities (CFV) and measurement of coronary flow reserve (CFR). Our aim was to evaluate the diagnostic value of transthoracic CFR measurements for detection of significant left anterior descending (LAD) stenosis in patients with LBBB and compare it to that of myocardial perfusion scintigraphy (MPS). METHODS: Simultaneous transthoracic CFR measurements and MPS were analyzed in 44 consecutive patients with suspected CAD and permanent LBBB. Typical diastolic predominant phasic CFV Doppler spectra of distal LAD were obtained at rest and during a two-step (0.56-0.84 mg/kg) dipyridamole infusion protocol. CFR was defined as the ratio of peak hyperemic velocities to the baseline values. A reversible perfusion defect at LAD territory was accepted as a positive scintigraphy finding for significant LAD stenosis. A coronary angiography was performed within 5 days of the CFR studies. RESULTS: The hyperemic diastolic peak velocity (44 +/- 9 cm/sec vs 62 +/- 2 cm/sec; P=0.01) and diastolic CFR (1.38 +/- 0.17 vs 1.93 +/- 0.3; P=0.001) were significantly lower in patients with LAD stenosis compared to those without LAD stenosis. The diastolic CFR values of <1.6 yielded a sensitivity of 100% and a specificity of 94% in the identification of significant LAD stenosis. In comparison, MPS detected LAD stenosis with a sensitivity of 100% and a specificity of 29%. CONCLUSIONS: CFR measurement by transthoracic Doppler echocardiography is an accurate method that may improve noninvasive identification of LAD stenosis in patients with LBBB.

Interleukin-1B (-511) gene polymorphism is associated with acute coronary syndrome in the Turkish population.

OBJECTIVES: acute coronary syndrome (ACS) is defined as an inflammatory disease associated with development of atherosclerosis and instability. IL-1 is a candidate inflammatory cytokine that is thought to trigger ACS. The purpose of this study was to determine the relationship between IL-1 gene family polymorphisms (IL-1RN, IL-1B in positions -511 and +3953) and ACS in the Turkish population. METHODS: a total of 381 people participated in the study, with 117 control subjects and 264 ACS patients. Of the 264 ACS patients, 112 were diagnosed with stable angina pectoris (SAP) and 152 were diagnosed with unstable angina pectoris (USAP). The polymerase chain reaction (PCR) was used to determine the genotype of IL-1RN. The genotypes of IL-1B (-511 and +3953) were determined by PCR, followed by restriction enzyme digestion of the PCR products. RESULTS: there were no significant differences in both IL-1RN, IL-1B (-511 and +3953) genotype distributions and IL-1RN allele frequencies between ACS patients and the control subjects. In addition, no association was observed in the allele frequency of IL-1B (-511 and +3953) between ACS patients and controls (p = 0.113 and p = 0.859, respectively), or between SAP patients and controls (p = 0.575 and p = 0.359, respectively). However, IL-1B allele 1 (C) (-511) polymorphism in USAP patients was found to be significantly different from that of control subjects (p = 0.041, OR: 2.01; 95% CI: 1.985-3.933). A significant difference was also observed between USAP and SAP patients for IL-1B (+3953) allele 1 (C) polymorphism; (p = 0.043, OR: 1.522; 95% CI: 1.012-2.88). CONCLUSION: these results show that IL-1RN gene polymorphism has no association with ACS. However, the allele 1 (C) of IL-1B (-511) may be a risk factor for susceptibility to USAP in the Turkish population.

Interleukin-1 receptor antagonist gene VNTR polymorphism is associated with coronary artery disease.

BACKGROUND: Coronary Artery Disease (CAD) is the atherosclerosis of coronary arteries that carry blood to the heart muscle. Atherosclerosis is an inflammatory disease. Cytokine gene variations such as those associated with the IL1 family are involved in the pathogenesis of atherosclerosis. OBJECTIVE: The purpose of this study was to determine the relationship between IL1 family polymorphisms (IL1RN VNTR, IL1B positions -511 and +3953) and CAD in Turkish population. METHODS: 427 individuals were submitted to coronary angiography and were grouped as 170 control subjects and 257 CAD patients. The CAD subjects were divided into two subgroups: 91 Single Vessel Disease (SVD) and 166 Multiple Vessel Disease (MVD) subjects. The genotypes of IL1RN and of IL1B (-511, +3953) were determined by polymerase chain reaction (PCR) followed by restriction digestion analysis. RESULTS: No significant difference was found in IL1RN and IL1B (-511 and +3953) genotype distributions between CAD and control subjects or MVD and control subjects. However, significant association was seen in IL1RN 2/2 genotype between SVD and control subjects (P= 0.016, x2: 10.289, OR: 2.94, 95% CI: 1.183-7.229). Similarly, no statistically significant difference was found in IL1RN and IL1B (-511 and +3953) allele frequencies between CAD and control subjects, MVD and control subjects or SVD and control subjects. CONCLUSION: No association was found in either allele frequency or genotype distribution of IL1RN and IL1B polymorphisms between CAD and the control groups. However; IL1RN 2/2 genotype may be a risk factor for SVD in the Turkish population.

Sympathetic overactivity in patients with left ventricular aneurysm in early period after anterior myocardial infarction: does sympathetic activity predict aneurysm formation?

Left ventricular aneurysm (LVA) is an important complication of acute transmural myocardial infarction (MI) that bears great clinical significance because of high mortality. Heart rate variability (HRV) analysis is extensively used to evaluate autonomic modulation of sinus node and to identify patients at risk for an increased cardiac mortality. In this study, the authors evaluated HRV in patients with LVA in the early period after acute anterior wall MI. They compared 18 patients (7 men, 11 women, with an average age of 56.1 +/-8.2 years) with LVA and 46 patients (34 men, 12 women, with an average age of 56.4 +/-5.9 years) without LVA. Mean heart rate, low frequency (LF) and low-frequency/high-frequency (LF/HF) ratio were significantly higher and standard deviation of normal-to-normal RR intervals (SDNN), root mean square of successive differences (RMSSD), number of NN intervals that differed by more than 50 ms from adjacent interval divided by the total number of all NN intervals (PNN50), and HF were lower in the patients with LVA. A SDNN <78 ms separated the patients with aneurysm from those without aneurysm with a sensitivity of 78%, specificity of 83%, positive predictive accuracy of 79%; a LF/HF ratio >2.4 with a sensitivity of 92%, specificity of 88%, and positive predictive accuracy of 92%. Single-vessel disease increased the left ventricular aneurysm formation by 5.1 fold, total left anterior descending artery (LAD) occlusion by 3.1 fold, mean heart rate >75 beats/minute by 2.3 fold, SDNN <78 ms by 7.9 fold, and LF/HF ratio >2.4 by 12.9 fold, but well-developed collaterals decreased the aneurysm formation by 4.4 fold. As a result, HRV analysis supplies parameters with high predictive value for LVA formation in the early period after acute anterior MI. The higher sympathetic activity and reduced heart rate variability may be associated with a higher incidence of complications such as ventricular arrhythmias and increased mortality in patients with LVA.

Correlation between Doppler derived dP/dt and left ventricular asynchrony in patients with dilated cardiomyopathy: A combined study using strain rate imaging and conventional Doppler echocardiography.

AIM: To evaluate the relationship between Doppler-derived left ventricular (LV) dP/dt and the degree of LV mechanical asynchrony measured by strain rate imaging. METHODS AND RESULTS: The study group consisted of 69 patients with variable degree of LV dysfunction and mitral regurgitation (MR). Conventional echo variables and LV dP/dt were calculated from the MR Doppler spectrum by rate-pressure-rise method. Strain rate traces were obtained by 12-segment model and LV long axis images were analyzed off-line. The longest time intervals between the peak negative strain rate waves at isovolumic contraction period and peak systole from reciprocal segments were defined as asynchrony index AIc or AIs, respectively. The maximum differences in time-to-peak systolic velocities between opposing walls were also measured as asynchrony index by tissue Doppler (AItd). The dP/dt, mean QRS duration, AIc, AIs, and AItd were 836 +/- 266 mmHg/sec, 125 +/- 31, 38 +/- 28, 64 +/- 44, and 52 +/- 32 m, respectively. No significant correlation between the dP/dt and the LV dimension, ejection fraction or QRS duration was observed. However, dP/dt correlated negatively with AIc, or AIs (r:-0.78, -0.72, P < or = 0.0001) and AItd (r:-0.65, P < or = 0.001). A cutoff dP/dt value of under 700 mmHg/sec can discriminate patients over median AIs (55 ms) or patients with AIc over 30 ms with high sensitivity and specificity. CONCLUSIONS: Doppler-derived LV dP/dt is related to the degree of LV dyssynchrony rather than the conventional systolic function indices such as EF% in patients with severe heart failure. Noninvasive dP/dt assessment in addition to advanced imaging techniques can be used to define patients for cardiac resynchronization therapy (CRT).

Cardiac resynchronization improves coronary blood flow.

Asynchronous ventricular activation, induced by left bundle branch block, is known to have deleterious effects on the systolic and diastolic functions of the left ventricle (LV). Cardiac resynchronization therapy (CRT) has been proposed as a complementary method to improve the LV systolic performance by restoring the synchronized contraction patterns in patients with advanced heart failure and left bundle branch block. However, the effect of CRT on myocardial blood flow is not well established. In the present study, we therefore examined the coronary blood flow in 20 patients with idiopathic dilated cardiomyopathy, implanted with a biventricular pacemaker according to the established CRT criteria. Color Doppler settings were adjusted for the optimal coronary flow imaging, and coronary flow velocities were obtained in all patients. Typical diastolic predominant phasic Doppler spectrum of the distal left anterior descending coronary artery (LAD) was recorded. Conventional echocardiographic variables, peak values of the diastolic and systolic LAD velocities, and the velocity time integrals were measured for three or five consecutive beats during CRT with pacemaker on and off. Successful CRT with biventricular pacing increased coronary blood flow velocities of the distal LAD in addition to its well-known benefits on the systolic and diastolic LV performance in patients with significant dyssynchrony. CRT decreased duration of mitral regurgitation and increased diastolic filling time. Peak diastolic velocities and velocity time integral of the distal LAD were increased significantly. In conclusion, successful CRT with biventricular pacing improves coronary blood flow velocities of the distal LAD.

Influence of different echocardiographic imaging modes on the assessment of anterior mitral leaflet thickness.

BACKGROUND AND AIM OF THE STUDY: The study aim was to compare fundamental imaging (FI) measurements with harmonic imaging (HI) measurements and surgical measurements (SM) in the assessment of mitral anterior leaflet thickness. METHODS: Forty-three patients scheduled to undergo mitral valve replacement were included. Before surgery, routine echocardiography was performed in all patients using an instrument fitted with a 2.5 MHz broadband transducer. The anterior mitral leaflet was measured with different echocardiographic imaging modalities, and also surgically. During FI, the transducer transmission frequencies were 2.5 MHz and 2 MHz, while transmission frequencies of 1.7 MHz and 1.5 MHz were used during HI. Surgical measurements were taken immediately after surgery from a mitral valve specimen that was removed intact. RESULTS: Mitral anterior leaflet thickness measurements derived from FI at 2 MHz transmission frequency (3.8 +/- 1.1 mm, p = 0.020), HI at 1.7 MHz (4.4 +/- 1.2 mm, p < 0.001), and HI at 1.5 MHz (4.5 +/- 1.2 mm, p < 0.001) were significantly larger than those made surgically (3.3 +/- 0.6 mm). However, no significant differences were seen between thickness measurements derived from FI at 2.5 MHz transmission frequency and SM (3.7 +/- 1 mm versus 3.3 +/- 0.6 mm, p = 0.063). Mitral anterior leaflet thickness was greater with HI than with FI (1.7 MHz versus 2.5 MHz, p < 0.001; 1.7 MHz versus 2 MHz, p < 0.005; 1.5 MHz versus 2.5 MHz, p < 0.001; 1.5 MHz versus 2 MHz; p < 0.002). The closest measurement to SM was that obtained at a transmission frequency of 2.5 MHz (mean difference 0.3 +/- 0.6 mm; SEE 0.1 mm). CONCLUSION: Mitral anterior leaflet thickness measurements made with HI appear to be greater than those made with either FI or SM.

Comparison of coronary flow velocities between patients with obstructive and nonobstructive type hypertrophic cardiomyopathy: noninvasive assessment by transthoracic Doppler echocardiography.

BACKGROUND: We aimed to compare coronary flow velocity (CFV) measurements of patients with nonobstructive (NHCM) and obstructive hypertrophic cardiomyopathy (HOCM) by using transthoracic Doppler echocardiography (TTDE). METHODS AND RESULTS: In 11 patients with NHCM and 26 with HOCM, CFV in the distal left anterior descending (LAD) coronary was measured by TTDE (3.5 MHz) under the guidance of color Doppler flow mapping in addition to standard 2D and Doppler echocardiography. The results were compared with 24 normal participants who had no evidence of cardiac disease. Peak diastolic velocity of LAD was also higher in NHCM and HOCM than controls (52 +/- 14 cm/sec and 54 +/- 20 cm/sec vs 41 +/- 11 cm/sec, respectively, P < 0.01). The analysis of systolic velocities revealed abnormal flow patterns in 16 (61%) patients with HOCM (12 systolic-reversal flow and 4 no systolic flow) and 6 (54%) (5 reversal flow and 1 zero flow) patients with NHCM (-11 +/- 30 cm/sec and -13 +/- 38 cm/sec, vs 24 +/- 9 cm/sec, respectively, P < 0.001). Linear regression analysis demonstrated no correlation between intraventricular pressure gradient and coronary flow velocities in HOCM patients. However, there were significant positive and negative correlations between septal thickness and diastolic and systolic velocities, respectively (r = 0.50, P < 0.002, and r =-0.43, P < 0.005). CONCLUSION: We conclude that the coronary flow velocity abnormalities are independent from the type of hypertrophic cardiomyopathy.