Relationship between red cell distribution width levels and severity of coronary artery ectasia.

OBJECTIVE: Coronary artery ectasia (CAE) is defined as abnormal dilatation of coronary arteries. Inflammation is thought to be important in the pathogenesis of CAE. Red blood cell distribution width (RDW) is also an inflammatory marker. In this study, we examined the association between RDW levels and CAE severity. PATIENTS AND METHODS: A total of 6737 patients who were admitted to the Cardiology Clinic of our hospital between January 2010 and December 2015 and diagnosed with coronary artery disease (CAD) were evaluated for inclusion. Of them, 126 patients who had CAE as a result of retrospective scanning, 104 randomly selected patients with CAD, and 76 patients who had normal coronary arteries were included in the study (n = 306). RESULTS: The severity and prevalence of CAE were evaluated according to the Markis ectasia classification, and the RDW value for type 1 CAE was significantly higher than that of other types of CAE. The RDW values for types 1-4 were 19.48 ± 11.81, 15.26 ± 9.17, 15.51 ± 8.07, and 15.33 ± 7.26, respectively (p= 0.098; r = 0.114). CONCLUSIONS: High RDW values are associated with CAE and CAD, and correlate with the severity of CAE. These findings indicate that RDW values can be used to estimate the severity of CAE disease.

Screening of coronary artery anomalies in 11,707 patients reveals that the radial approach is safe for cannulating coronary anomalies.

OBJECTIVE: This study evaluated the transradial approach for its ability to diagnose coronary artery anomalies, its requirement for catheter usage, the number of images obtained and fluoroscopy time required. PATIENTS AND METHODS: A total of 11,707 patients' coronary angiograph reports from January 2009 to January 2016 were evaluated with 179 patients identified as having coronary artery anomalies. Subsequent analyses compared patients' access sites with multiple angiographic parameters, including the number of images obtained, catheters used, and the fluoroscopy time required. RESULTSesults: The frequency of coronary artery anomalies identified by angiographies was 0.015%. Coronary anomalies were detected by transradial access (TRA) in 133 patients and by transfemoral access (TFA) in 46 patients. The most common anomaly was in the right coronary artery originating from the left sinus Valsalva (71 patients; 39.2%). The fluoroscopy times required and the number of catheters used was similar between the TRA and TFA groups (p = 0.887 and 0.302, respectively) while the number of images obtained during coronary angiographies was higher in the TFA group (p = 0.021). CONCLUSIONS: TRA is safe and effective for cannulation and the diagnosis of congenital coronary artery anomalies.

Total pulmonary vein diameter is a strong predictor of atrial fibrillation after coronary artery bypass graft surgery.

OBJECTIVE: Recent studies have shown that the pulmonary veins are important in atrial fibrillation (AF). This study evaluated the relationship between total pulmonary vein diameter and postoperative AF in on-pump coronary artery bypass graft (CABG) patients. PATIENTS AND METHODS: Our study enrolled 149 patients undergoing on-pump CABG. The primary endpoint was defined as postoperative new-onset in-hospital AF. All patients underwent preoperative non-contrast tomography to measure pulmonary vein diameter. RESULTS: The patients who developed AF had significantly greater total pulmonary vein diameters than those who remained in sinus rhythm. Logistic multivariate regression analysis revealed that only total pulmonary vein diameter was an independent predictor of the development of new-onset AF. CONCLUSIONS: To our knowledge, this is the first report of an association between total pulmonary vein diameter and the development postoperative AF. The identification of high-risk patients using pulmonary vein diameters should facilitate preventive measures.

QT dispersion ratio in patients with unstable angina pectoris (a new risk factor?).

BACKGROUND: QT dispersion has been shown to be associated with fatal arrhythmias and sudden death in coronary artery disease. A recent study indicated that marked QT dispersion in electrocardiograms (ECGs) obtained during acute ischemia demonstrated a significant correlation with ventricular fibrillation. HYPOTHESIS: This study investigated the ECG parameters for repolarization (QT dispersion, corrected QT, corrected QT dispersion, and QT dispersion ratio) and their interrelation with acute ischemia. METHODS: QT parameters as well as a newly developed repolarization index, QT dispersion ratio [(QT dispersion/RR interval) x 100] were calculated digitally during rest and ischemia in 32 patients with coronary artery disease (rest angina, Braunwald class III). Results were correlated with clinical consequences, mainly arrhythmias, within a follow-up period of 5 +/- 2 days. RESULTS: While most patients had an increase in all four parameters, only the QT dispersion ratio showed a significant difference when correlated with ventricular arrhythmias (p < 0.001, F ratio = 38). CONCLUSION: QT dispersion ratio appears to be a new and promising parameter in predicting ventricular arrhythmias in patients with acute ischemia.

Relationship between QRS score and the extent of coronary artery disease.

We studied 92 patients to determine the relationship between the QRS treadmill score (QTS) and extent of coronary artery disease. The results were compared to those of ST segment deviation in a < (+)QRS score > population. A cut off point of < 5 mm was used for mild to moderate risk patients whereas a QTS of < 3 was considered high risk for the patients. 43% of the patients had high risk QTS and 57% mild to moderate QTS. A highly significant correlation was observed between the extent of coronary artery disease and the high risk group of patients, whereas nonsignificant changes were observed in the control group (p < 0.001). Finally, the results indicate that in patients with a (+) QTS score (< 5 mm), coronary artery disease was significant and accordingly extensive during coronary angiography. On the other hand, a (+) QRS score proved to be superior to ST deviation in predicting critical coronary stenoses in the same population (F ratio; 41 vs 24).