Relation between dynamic change of red cell distribution width and 30-day mortality in patients with acute pulmonary embolism.

INTRODUCTION AND OBJECTIVES: Recent studies suggest that an increase in red cell distribution width (RDW) levels have a better prognostic value than a single measurement. In the current study, we investigated the predictive value of increasing RDW levels for mortality in acute pulmonary emboli (APE) patients. MATERIALS AND METHODS: For the study, 199 APE patients who were hospitalized were enrolled. Patients were divided into three groups according to their admission and 24th hour RDW values. Patients for whom both RDW values normal were put in group 1 (normal); patients with admission RDW > 14.5% and decreased 24th hour RDW values were in group 2 (decreased); patients whose 24th hour RDW levels were >14.5% and increased compared to their baseline RDW measurement were in group 3 (increased). Clinical and laboratory findings and 30-day mortality of these groups were compared. RESULTS: Mean patient age was 68 ± 16, and 48% of the patients were male. There were 98 patients (49%) in group 1, 59 patients (30%) in group 2, and 42 patients (21%) in group 3. Patients in group 3 were older, had lower eGFR and hemoglobin values, and had higher brain type natriuretic peptide values. Mortality rate was higher in group 3 (0%, 3.4%, 19%, respectively, P < .0001). Increase in RDW was independently related to mortality [HR: 4.9, (95%CI: 1.2-18, P = .02)]. CONCLUSION: APE patients with increasing RDW levels have higher mortality rates. Serial measurements of RDW may help us determine patients with high risk for mortality.

The Endothelial Nitric Oxide Synthase (NOS3-786T>C) Genetic Polymorphism in Chronic Heart Failure: Effects of Mutant -786C allele on Long-term Mortality.

BACKGROUND: Nitric oxide plays an important role in the regulation of basal vascular tone and cardiac myocyte function. We investigated the NOS3-786T>C polymorphism in chronic heart failure (CHF) and its effects on long-term mortality. METHODS: Ninety-one patients with CHF who were referred to the Department of Cardiology of Siyami Ersek Cardiovascular and Thoracic Surgery Center for cardiopulmonary exercise testing between April 2001 and January 2004 and 30 controls were enrolled in this study. Patient were followed prospectively for a period of 1 to 12 years. RESULTS: Patients and controls were divided into three groups: TT, TC and CC, according to their NOS3-786T>C polymorphism. We noted that there was no significant difference in the genotype distribution between patients and controls. There was also no significant difference in endothelial nitric oxide synthase (eNOS) gene polymorphism between ischemic HF and nonischemic HF. During the follow-up period, 61 (67%) deaths occurred. The nonsurvivor group had lower left ventricular ejection fraction (LVEF) (p = 0.01), reduced peak oxygen consumption (p = 0.04) and were of older age (p = 0.001). Age, LVEF, peak oxygen consumption and genotype were found to be predictors of mortality (p < 0.05). Additionally, mortality was significantly increased in -786CC genotype patients compared to TT genotype patients (hazard ratio = 2.2; p = 0.03). By multivariate analysis, age and eNOS genotype were determined to be significant independent predictors of death. Additionally, Kaplan-Meier analysis confirmed that homozygote -786C genotype was associated with an increased risk of death (χ2 = 4.6, p = 0.03). CONCLUSIONS: Our findings showed that the NOS3-786T>C polymorphism was associated with an increased risk of mortality in patients with CHF.

Relation of Low T3 to One-Year Mortality in Non-ST-Elevation Acute Coronary Syndrome Patients.

BACKGROUND: Low T3 which is defined as decreased triiodothyronine (T3) and normal thyroid-stimulating hormone (TSH) and thyroxin (T4) levels is present in many acute diseases and is related to increased mortality. We studied low T3 level's relation to long-term mortality in non-ST-elevation acute coronary syndrome (NSTE-ACS) patients. METHODS: T3, T4, and TSH levels of consecutive NSTE-ACS patients were measured. Patients with normal T4 and TSH levels, but low T3 level were defined as low T3 group. Patients with normal T3, T4, and TSH levels were defined as normal group. Clinical and laboratory findings in these two groups were compared. In addition, we examined low T3 level's relation to early and long-term mortality. RESULTS: Mean patient age was 61 ± 13 (67% male) and 31 (11%) patients had low T3 level. Free T3 values were negatively correlated with age, serum creatinine, and brain type natriuretic peptide values at the time of admission (r = -0.452, P < 0.0001; r = -0.255, P < 0.0001; r = -0.544, P < 0.0001, respectively). Mortality at 1 month and 1 year was higher in low T3 group (3% vs. 16%, P = 0.002; 6.4% vs. 23%, P = 0.003, respectively). In multivariate analysis, low T3 was found to be related to mortality at 1 year (OR: 2.6, 95% CI: 1.1-6.5, P = 0.02). In ROC analysis, free T3 had a good area under the curve (AUC) value for mortality at 1 year [AUC: 0.709 (95% CI: 0.619-0.799, SE: 0.0459)]. CONCLUSION: Low T3 is related to increased early and late mortality in NSTE-ACS patients. Free T3 levels may be used to identify NSTE-ACS patients with high mortality risk.

Clinical usefulness of red cell distribution width to angiographic severity and coronary stent thrombosis.

BACKGROUND: Red cell distribution width (RDW) is a quantitative measurement and shows heterogeneity of red blood cell size in peripheral blood. RDW has recently been associated with cardiovascular events and cardiovascular diseases, and it is a novel predictor of mortality. In this study, we aimed to evaluate the clinical usefulness of measuring RDW in patients with coronary stent thrombosis. PATIENTS AND METHODS: We retrospectively reviewed 3,925 consecutive patients who presented with acute coronary syndrome and who underwent coronary angiography at the Siyami Ersek Hospital between May 2011 and December 2013. Of the 3,925 patients, 73 patients (55 males, mean age 59±11 years, 55 with ST elevated myocardial infarction) with stent thrombosis formed group 1. Another 54 consecutive patients who presented with acute coronary syndrome (without coronary stent thrombosis, 22 patients with ST elevated myocardial infarction, 44 males, mean age 54±2 years) and underwent percutaneous coronary intervention in May 2011 formed group 2. Data were collected from all groups for 2 years. The RDW values were calculated from patients 1 month later at follow-up. Syntax scores were calculated for all the patients. The patients were also divided as low syntax score group and moderate-high syntax score group. RESULTS: The patients in group 1 with stent thrombosis had significantly higher RDW level (13.85) than the patients in group 2 without stent thrombosis (12) (P<0.001). In addition, in all study patients, the moderate-high syntax score group had significantly higher RDW level (13.6) than the low syntax score group (12.9) (P=0.009). A positive correlation was determined between RDW and syntax scores (r=0.204). CONCLUSION: RDW is a new marker of poor prognosis in coronary artery disease. Increased RDW level is correlated with angiographic severity of coronary artery disease, and RDW may be an important clinical marker of coronary stent thrombosis in patients undergoing coronary intervention.

The accuracy of combined use of troponin and red cell distribution width in predicting mortality of patients with acute pulmonary embolism.

BACKGROUND: Cardiac troponins and red cell distribution width (RDW) are associated with increased mortality in acute pulmonary embolism (PE). In this study, we aimed to investigate the accuracy of the combined use of troponin and RDW in predicting short-term mortality in acute PE patients. METHODS: The data of 201 patients with the diagnosis of acute PE were retrospectively analyzed. We obtained troponin-RDW scores (TR scores) using a combination of troponin and RDW values, and then evaluated this score's accuracy in predicting mortality in patients with acute PE. RESULTS: The mean participant age was 68 ± 16 years, and 52 % of patients were female. Fifteen (7.4 %) patients died during the first month. Patients classified as high-risk according to TR scores were older (72 ± 15 vs. 66 ± 15 years, p = 0.005), and they had higher heart rates (101 ± 20 vs. 90 ± 15 beat/min, p < 0.001) and respiratory rates (23 ± 4 vs. 21 ± 3 breath/min, p = 0.001). In multivariate analysis, TR (odds ratio [OR] 4.93, 95 % confidence interval [CI] 1.13-21.38, p = 0.033) and simplified pulmonary embolism severity index (sPESI) scores (OR 3.78, 95 % CI 1.71-8.37, p = 0.002) were independent predictors of 30-day mortality. For 30-day mortality, the TR score had a slightly lower sensitivity (87 % vs. 93 %), but a higher specificity (69 % vs. 52 %) compared to the sPESI score. CONCLUSION: The TR score is easy to calculate, and it may be used to predict early mortality in patients with acute PE.

Relation of contrast nephropathy to adverse events in pulmonary emboli patients diagnosed with contrast CT.

OBJECTIVE: Limited data exist on the incidence of contrast induced nephropathy (CIN) and its impact on in-hospital prognosis of patients diagnosed with acute pulmonary embolism (APE) using contrast computerized tomography pulmonary angiography (CTPA). In this study, we examined the frequency of nephropathy after CTPA in APE patients and its link to in-hospital adverse outcomes. METHODS: This was a retrospective study of 189 patients (mean age 67+16years, 48% male) with APE who underwent CTPA. CIN was defined as a≥0.5mg/dl and/or ≥25% increase in serum creatinine levels >48hours after CTPA. Patients were divided into two groups according to the presence or absence of CIN to compare clinical characteristics, risk factors, and in-hospital adverse events. RESULTS: Twenty-four (13%) of the patients were diagnosed with CIN. Patients with CIN were older (73±17 vs. 67±15years, P=.01) and had higher rates of heart failure (17% vs. 6%, P=.04). Preexisting renal dysfunction and advanced age were found to be independent predictors of CIN (OR: 4.2, 95% CI: 1.5-11.9, P=.006; OR: 3.2, 95% CI: 1.1-9.8, P=.03 respectively). The in-hospital adverse event rate was significantly higher in patients with CIN (16.7% vs. 2.4%, P=.001). A multivariate analysis revealed CIN as an independent predictor of in-hospital adverse event rate (OR: 6.1, 95%CI: 1.2-29.3, P=.02). CONCLUSION: CIN is associated with a higher in-hospital adverse event rate in APE patients diagnosed using CTPA. This is first large study to focus specifically on CIN in patients diagnosed with APE using CTPA.

Impact of Nonalcoholic Fatty Liver Disease on Myocardial Perfusion in Nondiabetic Patients Undergoing Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction.

Limited data exist on the role of nonalcoholic fatty liver disease (FLD) as a potential independent risk factor in the setting of acute coronary syndromes. The aim of this study was to evaluate the impact of FLD on myocardial perfusion and inhospital major adverse cardiac events (MACE) in the setting of ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI). We examined 186 consecutive nondiabetic patients (mean age 58 ± 11 years and 76% men) who underwent primary PCI for STEMI by ultrasound within 72 hours of admission. FLD was graded according to a semiquantitative severity score as mild (score <3) or moderate to severe (score ≥3). Myocardial perfusion was determined by measuring myocardial blush grade (MBG) and ST-segment resolution (STR) analysis. Patients were divided into 2 groups according to FLD score (<3 or ≥3). There were no differences with regard to postprocedural Thrombolysis In Myocardial Infarction 3 flow grade between the 2 groups (89% vs 83%, p = 0.201). Patients with FLD score ≥3 were more likely to have absent myocardial perfusion (MBG 0/1, 37% vs 12%, p <0.0001), absent STR (27% vs 9%, p = 0.001), and higher inhospital MACE rate (31% vs 8%, p <0.0001). By multivariate analysis, FLD ≥3 score was found to be an independent predictor of absent MBG 0/1 (odds ratio [OR] 2.856, 95% confidence interval [CI] 1.214 to 6.225, p = 0.033), absent STR (OR 2.862, 95% CI 1.242 to 6.342, p = 0.031), and inhospital MACE (OR 2.454, 95% CI 1.072 to 4.872, p = 0.048). In conclusion, we found that despite similar high rates of Thrombolysis In Myocardial Infarction 3 after primary PCI, patients with FLD score ≥3 are more likely to have impaired myocardial perfusion which may contribute to adverse inhospital outcome.

Coronary artery fistula: review of 54 cases from single center experience.

BACKGROUND: Demographic and clinical characteristics and angiographic findings of Turkish patients with coronary artery fistula have been investigated in this study and diagnostic tests and treatment methods used in these patients have also been evaluated in detail. METHODS: We have examined the cardiac catheterization laboratory database retrospectively between March 2006 and July 2010. Among 49,567 patients, we have noted 60 patients diagnosed as coronary artery fistula. After coronary angiographic images were evaluated by two invasive cardiologists, 54 patients who had clear evidence of vessel of origin and drainage were included in the study. RESULTS: A total of 54 (0.1%) patients with coronary artery fistula were noted. Mean age was 56.7 ± 10.7 years; 42 out of 54 patients had accompanying cardiac disorders. Patients complaints were directly associated with the presence of the fistula. Chest pain was the admission symptom in all of the patients with isolated coronary artery fistula. Six patients had coexistent congenital anomalies. Myocardial infarction with ST segment elevation occurred in 11 of the patients. In contrast to the previous reports, the most common artery of origin of the fistula was left anterior descending artery (50.8%) and pulmonary artery was found to be the most frequent region of the fistula drainage by 53.7%. CONCLUSIONS: Our findings suggest that large fistulas originating from the proximal segments of coronary arteries may increase the likelihood of atherosclerosis and myocardial infarction even in asymptomatic patients with no evidence of ischemia in noninvasive tests and no dilatation of cardiac chambers, and should therefore be closed.

Red cell distribution width as a novel prognostic marker in patients undergoing primary angioplasty for acute myocardial infarction.

OBJECTIVES: Red cell distribution width (RDW), a measure of red blood cell size heterogeneity, was evaluated in patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). BACKGROUND: Higher RDW is associated with mortality in patients with symptomatic cardiovascular disease, heart failure, and also in the general population. We hypothesized that admission RDW would be predictive of adverse outcomes in patients after primary PCI. METHODS: Two thousand five hundred and six consecutive STEMI patients (mean age 56.6±11.8 years; 2075 males, 431 females) undergoing primary PCI were retrospectively enrolled into this study. Admission RDW was measured as part of the automated complete blood count. Patients were grouped as elevated or nonelevated RDW using the upper limit of normal value of 14.8% and were followed for in-hospital and long-term outcomes for a mean period of 1.8±1.3 years (median 21 months). RESULTS: A higher in-hospital mortality rate was observed among patients with elevated admission RDW (mean 16.1±1.6%) compared with those with nonelevated RDW (mean 13.4±0.8%) (7.6 vs. 3.6%, P<0.001). The long-term cardiovascular prognosis was worse for patients with elevated admission RDW (Kaplan-Meier, log-rank P<0.001). We used Cox proportional hazard models to examine the association between RDW and adverse clinical outcomes. After discharge, there were 129 deaths during follow-up. A significant association was noted between elevated admission RDW level and the adjusted risk of cardiovascular mortality (hazard ratio: 1.831, 95% confidence interval: 1.034-3.24, P=0.03). In addition, elevated admission RDW was also an independent predictor of cardiovascular mortality in the nonanemic subpopulation of patients (hazard ratio: 2.703, 95% confidence interval: 1.208-6.048, P=0.016). CONCLUSION: A high admission RDW level in patients with STEMI undergoing primary PCI was associated with increased risk for in-hospital and long-term cardiovascular mortality.

Impact of the metabolic syndrome on aortic pulse pressure and ascending aortic pulsatility in patients with angiographically normal coronary arteries.

BACKGROUND: Large artery stiffness is a major determinant of pulse pressure (PP), and PP at baseline has been associated with future coronary events. OBJECTIVE: To evaluate the impact of the metabolic syndrome on aortic PP and ascending aortic pulsatility (AP) in patients with angiographically normal coronary arteries. METHODS: Forty-two patients with the metabolic syndrome and 40 age matched control subjects without the metabolic syndrome were included in the study. All subjects had normal coronary arteries. Diagnosis of the metabolic syndrome was based on the International Diabetes Federation guidelines published in 2005. Ascending AP was estimated as the ratio of aortic PP to mean blood pressure. RESULTS: Aortic PP (59+/-12 mmHg versus 43+/-10 mmHg; P<0.001) and ascending AP (0.54+/-0.10 versus 0.48+/-0.10; P<0.001) were significantly higher in the metabolic syndrome group. Multiple regression analysis revealed statistically independent relationships between ascending AP and fasting blood glucose, waist circumference and systolic blood pressure (model R2=0.408; P<0.001). The metabolic syndrome, as a whole, was also independently associated with both ascending AP (P<0.01) and aortic PP (P<0.01). CONCLUSION: The data showed that the metabolic syndrome is independently associated with increased aortic PP and ascending AP in patients with normal coronary arteries, suggesting aortic stiffness as one of the possible mechanisms underlying the excess cardiovascular risk associated with the metabolic syndrome.

Relationship between aortic valve sclerosis and left ventricular hypertrophy in chronic haemodialysis patients.

BACKGROUND: Cardiac valve calcification is a frequent finding in chronic haemodialysis patients. Left ventricular hypertrophy (LVH) is a significant predictor of cardiovascular mortality in patients with end-stage renal disease. We evaluated the influence of aortic valve sclerosis (AVS) on the development of LVH in chronic haemodialysis patients. METHODS: A total of 82 consecutive patients (52 male, mean age 48 +/- 12 years) undergoing chronic haemodialysis treatment for > 1 year were subjected to echocardiography for the screening of AVS and the assessment of transaortic flow velocity and the left ventricular mass index (LVMI). The absence (group 1, n = 42) and presence of AVS (group 2, n = 40) was established. The average values of systolic, diastolic and pulse pressure were obtained. Plasma calcium, phosphorus, intact parathyroid hormone, C-reactive protein, haemoglobin and lipid levels were also measured. RESULTS: LVH was detected in 59 (72%) of the study patients. The LVMI was higher in the AVS group (171 +/- 39 vs. 132 +/- 41 g/m2, p < 0.001). Patients with AVS also had higher transaortic flow velocities (1.64 +/- 0.36 vs. 1.21 +/- 0.21 m/s, p < 0.01) and maximal pressure gradients (10.8 +/- 7.1 vs. 5.9 +/- 3.4 mmHg, p < 0.01). The LVMI showed a direct correlation with transaortic flow velocity in the AVS group (r = 0.60, p < 0.01). Stepwise linear regression analysis revealed transaortic flow velocity (p = 0.02), pulse pressure (p = 0.01) and haemoglobin levels (inverse relationship) (p = 0.02) to be independent predictors of the LVMI. CONCLUSION: These data suggest that AVS is strongly and independently interrelated with LVH in chronic haemodialysis patients. The underlying mechanism might be the valve resistance to left ventricular outflow, as shown by increased transaortic flow velocities and maximal pressure gradients in AVS patients.

Correlation of the myocardial performance index with plasma B-type natriuretic peptide levels in patients with mitral regurgitation.

OBJECTIVE: The Myocardial performance index (MPI) is an echocardiographic index of combined systolic and diastolic function, calculated as isovolumetric relaxation time plus isovolumetric contraction time divided by ejection time. The aim of this study was to define the correlation of the MPI with plasma B-type natriuretic peptide (BNP) levels and echocardiographic parameters in patients with chronic mitral regurgitation (MR). METHODS: About 33 patients with at least moderate MR of organic etiology were enrolled to the study. All patients undergone complete 2D and Doppler echocardiography. Plasma BNP levels were studied. RESULTS: BNP levels in NYHA classes I-III were 9.3 +/- 2.2 pg/ml, 61.3 +/- 12.2 pg/ml, and 199.6 +/- 55.2 pg/ml, respectively (I vs. II P < 0.001, I vs. III P < 0.001 and II vs. III P = 0.004). Myocardial performance index were 0.42 +/- 0.02, 0.49 +/- 0.02, and 0.52 +/- 0.03 in MR patients with NYHA I-III, respectively. MPI was significantly higher in patients with NYHA class III compared to NYHA I (P = 0.001) and NYHA II (P = 0.005). There were no correlations between MPI and left atrial diameter, MR jet area, MR index and systolic pulmonary artery pressure whereas left ventricle (LV) end-systolic volume (r = 0.38), LV end-diastolic volume (LVDV) (r = 0.40), LV ejection fraction (r = -0.59), NYHA class (r = 0.51) and plasma BNP levels (r = 0.67) were strongly correlated. Only independent variable affecting MPI was plasma BNP level (odds ratio [CI]: 2.18[0.002-0.098], P = 0.041). CONCLUSIONS: MPI is a powerful index in assessing the severity of left ventricular function and symptom severity in patients with MR. Plasma BNP is an independent predictor of MPI where both parameters assess combined systolic and diastolic LV function, effectively.

Tissue Doppler imaging adds incremental value in predicting exercise capacity in patients with congestive heart failure.

Left ventricular (LV) systolic and diastolic parameters derived from Doppler echocardiography have been used widely to predict functional capacity but diastolic filling is affected by various factors. Tissue Doppler imaging (TDI) that records systolic and diastolic velocities within the myocardium and at the corners of the mitral annulus, has been shown to provide additional information about regional and global LV function. The goal of this study was to examine whether TDI-derived parameters add incremental value to other standard Doppler echocardiographic measurements in predicting exercise capacity. The study enrolled 59 consecutive patients with stable congestive heart failure (CHF). The etiology of heart failure was coronary artery disease in 42 patients and dilated cardiomyopathy in 17. Twenty-three age-matched healthy subjects were recruited as controls. Conventional echocardiographs and TDI were obtained. Early (Ea) and late (Aa) diastolic and systolic (Sa) mitral annulus velocities, the Ea/Aa and E/Ea ratios, were measured by pulsed wave TDI placed at the septal side of the mitral annulus and results were compared with results of cardiopulmonary exercise testing. Systolic and early diastolic velocities of mitral annulus were decreased and the E/Ea ratio was increased in the restrictive group as compared to controls (P = 0.02, P = 0.03, P < 0.001, respectively) but there was no significant difference in late diastolic velocity and the Ea/Aa ratio between the restrictive group and controls. The average peak VO2 of the patients were 14.9 +/- 4.9 ml/min per kg. Achieved peak VO2 of the patients with E/Ea ratio 7.5 (P < 0.001). Interestingly, the patients with the nonrestrictive pattern and E/Ea ratio >7.5 had reduced exercise capacity, as did the group with restrictive LV filling patterns (12.8 +/- 3.3 vs 12.9 +/- 4.0 ml/min per kg, P = 0.9). Similarly, there was no significant difference in the mean exercise capacity between the patients with a nonrestrictive pattern vs restrictive pattern with E/Ea ratio 7.5 was used, 21 out of 24 patients in the reduced exercise capacity group were identified with 16 false positives in the preserved exercise capacity group (P = 0.001). Mitral annular systolic and diastolic velocities of TDI were associated with cardiopulmonary exercise capacity in patients with LV systolic dysfunction. Index of the E/Ea ratio was found to be the most powerful predictor of peak oxygen uptake.

Exercise-induced increase in lipid peroxidation in patients with chronic heart failure: relation to exercise intolerance.

BACKGROUND: Little is known about the relationship between exercise intolerance and lipid peroxidation in chronic heart failure (CHF) patients. This study was designed to investigate the relationship between exercise-induced plasma malondialdehyde (MDA) changes in CHF patients and to determine whether there is any association between plasma MDA levels and exercise capacity assessed by cardiopulmonary exercise testing. METHODS: Cardiopulmonary exercise testing was applied to 31 CHF patients (16 ischemic, 15 idiopathic) and controls. Rest and peak exercise blood samples were analyzed for MDA. RESULTS: Patients with CHF had elevation of plasma MDA levels during exercise compared with controls (p < 0.001 vs. p = 0.588). MDA change remained significant both in ischemic and idiopathic cardiomyopathy groups (p < 0.05 and p < 0.01, respectively). Delta MDA (peak exercise MDA - rest MDA) showed significant inverse correlation with peak oxygen consumption in patients with CHF. CONCLUSION: Lipid peroxidation is increased in patients with CHF during exercise regardless of etiology, and this increase is inversely related to oxygen consumption.

Plasma homocysteine concentration in patients with poor or good coronary collaterals.

BACKGROUND: Elevated plasma homocysteine (Hcy) concentrations are associated with an increased risk of vascular disease. Hcy is known to inhibit endothelial cell proliferation in vitro. The purpose of the present study was to investigate the role of plasma Hcy concentrations on development of collateral circulation in single-vessel chronic total occlusion. METHODS AND RESULTS: Collateral status was determined by Rentrop's classification. Of 817 patients, 56 cases of pure single-vessel chronic total occlusion were studied. Plasma Hcy concentrations in patients with single-vessel total coronary occlusion were higher compared with controls (17.3 +/-12.6 micromol/L vs 10.9+/-4.9 micromol/L, p=0.015). There was no significant difference in plasma Hcy concentrations of the good and poor collateral groups (17.2+/-13.7 micromol/L vs 15.3+/-9.3 micromol/L, p=0.834). Plasma Hcy concentrations in individual Rentrop subclasses 0, 1, 2 and 3 were as follows: 15.9 +/-9.1, 16.3+/-12.4, 17.1+/-14.1 and 20.1+/-13.5 micromol/L (p=0.893). There was a positive linear correlation between Rentrop subclass and angina pectoris duration (r=0.41, p=0.003). Angina pectoris duration was the only independent variable affecting the development of coronary collaterals in the present study (odds ratio [confidence interval]: 1.85 [1.12-2.91], p=0.014). CONCLUSION: Patients with single-vessel chronic total occlusion had higher plasma Hcy concentrations than controls, but similar Hcy concentrations when compared according to the presence of poor or good coronary collaterals. There is a lack of association between plasma Hcy concentration and coronary collateral status in the current study.

A case of prosthetic mitral valve Brucella endocarditis complicated with torsades de pointes.

Brucella endocarditis is a zoonosis transmitted by contaminated dairy products. Endocarditis is a rare complication of brucellosis and mainly the aortic valve is infected. We present the case of a female patient with prosthetic mitral valve endocarditis associated with QT prolongation and torsades de pointes. Transesophageal echocardiography revealed vegetation on both anterior and posterior mitral annulus. She was seropositive with Brucella agglutination titers of up to 1/320. The QT interval was markedly prolonged upon admission (QTc 530 ms). She experienced torsades de pointes several times. She underwent reoperation under an appropriate antibiotic regimen. She continued on triple antibiotic therapy for 12 months. She is now well and free of symptoms.