[Show abstract][Hide abstract] ABSTRACT: Congenital coronary artery anomalies are rare and usually an incidental finding during selective coronary angiography. Most of these variations appear to be of no clinical significance but some do have potentially serious sequelae. Anomalous origin of the right coronary artery from the left sinus of valsalva with subsequent coursing between the aorta and pulmonary trunk called “malignant course” is a relatively uncommon congenital defect. In this report we present a patient with a malignant right coronary artery originating from left coronary sinus
[Show abstract][Hide abstract] ABSTRACT: Objective:
We aimed to examine the relationship between serum uric acid levels and left atrial appendage (LAA) peak flow velocity, an indicator of the mechanical functions of the LAA, and atrial fibrillation (AF).
Subjects and methods:
Transesophageal echocardiography was performed before cardioversion in 153 patients with AF. The patients were categorized into 2 groups based on their LAA blood flow velocity. Group 1 included 87 patients with a low LAA flow velocity (<35 cm/s), and group 2 comprised 66 patients with a normal LAA flow velocity (≥35 cm/s). The χ(2) and Student's t tests were used to compare categorical and quantitative data between the groups. Linear regression analyses were performed to demonstrate the independent association between serum uric acid levels and LAA peak flow velocity.
The LAA blood flow velocity was 24.62 ± 5.90 cm/s in group 1 and 49.28 ± 13.72 cm/s in group 2, respectively (p < 0.001). The serum uric acid levels were 6.88 ± 1.85 mg/dl in group 1 and 5.97 ± 1.51 mg/dl in group 2, and the difference was statistically significant (p = 0.001). There was a negative correlation between serum uric acid levels and LAA blood flow velocity (r = -0.216, p = 0.007). Multivariate regression analysis showed that serum uric acid levels, age and gender differences were significant predictors of the LAA peak flow velocity.
High serum uric acid levels were associated with a low contractile function of the LAA and could provide additional prognostic information on future thromboembolic events in patients with AF.
Full-text · Article · Feb 2015 · Medical Principles and Practice
[Show abstract][Hide abstract] ABSTRACT: Background: Neutrophil-to-lymphocyte ratio (NLR) has been found to be a good predictor of future adverse cardiovascular outcomes in patients with ST-segment elevation myocardial infarction (STEMI). Changes in the QRS terminal portion have also been associated with adverse outcomes following STEMI. Objective: To investigate the relationship between ECG ischemia grade and NLR in patients presenting with STEMI, in order to determine additional conventional risk factors for early risk stratification. Methods: Patients with STEMI were investigated. The grade of ischemia was analyzed from the ECG performed on admission. White blood cells and subtypes were measured as part of the automated complete blood count (CBC) analysis. Patients were classified into two groups according to the ischemia grade presented on the admission ECG, as grade 2 ischemia (G2I) and grade 3 ischemia (G3I). Results: Patients with G3I had significantly lower mean left ventricular ejection fraction than those in G2I (44.58 ± 7.23 vs. 48.44 ± 7.61, p = 0.001). As expected, in-hospital mortality rate increased proportionally with the increase in ischemia grade (p = 0.036). There were significant differences in percentage of lymphocytes (p = 0.010) and percentage of neutrophils (p = 0.004), and therefore, NLR was significantly different between G2I and G3I patients (p < 0.001). Multivariate logistic regression analysis revealed that only NLR was the independent variable with a significant effect on ECG ischemia grade (odds ratio = 1.254, 95% confidence interval 1.120-1.403, p < 0.001). Conclusion: We found an association between G3I and elevated NLR in patients with STEMI. We believe that such an association might provide an additional prognostic value for risk stratification in patients with STEMI when combined with standardized risk scores.
Preview · Article · Nov 2014 · Arquivos Brasileiros de Cardiologia
[Show abstract][Hide abstract] ABSTRACT: Totally implantable vascular catheters are used widely in patients who need long-term drug administration, parenteral nutrition and transfusion, because they allow safe and easily available vascular access. Pinch-off syndrome (POS) is described as breaking off the subclavian central venous catheter because of the compression by the surrounding tissues, first costa and clavicle. Embolization of the detached catheter part into ventricular space can cause serious arrhythmias. Today, with the help of advanced catheters used in the field of interventional radiology and cardiology, detached catheter part which causes embolism is successfully removed percutaneously, and no additional surgical procedure is required. In this case report, we present a case of POS suffering from serious arrhythmias because of fragmented catheter part moving into the heart and percutaneous treatment approach used to remove this detached fragment.
[Show abstract][Hide abstract] ABSTRACT: Objective
There is an increasing interest for the value of right ventricle (RV) in predicting exercise tolerance and prognosis in cardiovascular disease. However, there is relatively few data evaluating the effect of age on RV diastolic filling velocities during rest or exercise in healthy subjects.MethodsA total of 54 healthy subjects were enrolled in this study. Patients were divided into 2 groups according to their age: Group 1 (≤45-years-old) and Group 2 (>45-years-old). A treadmill exercise test was performed using modified Bruce protocol. Conventional pulsed-wave Doppler and tissue Doppler velocities were obtained both at rest and immediately after the end of exercise, respectively.ResultsIn the overall analysis, tricuspid flow Doppler analysis showed a significant increase in A-wave velocity, less marked rise in E-wave velocity, decreased E/A ratio and decreased E-wave deceleration time (EDT) with exercise. Tissue Doppler analysis revealed increased Aa velocity, decreased in Ea/Aa ratio and IVRT. No significant change was observed in Ea velocity and E/Ea ratio with exercise. Although diastolic velocities changed significantly with exercise, systolic velocities did not. Cardiac response to exercise differed slightly in the older subjects compared to younger ones. The older subjects were more likely to have a reduced mean rate of RV filling for the second half of diastole from baseline to peak exercise.Conclusion
To distinguish normal physiological changes due to aging from those of pathologic conditions may provide benefits while evaluating patients with known or suspected cardiovascular disease.
[Show abstract][Hide abstract] ABSTRACT: Vasovagal syncope (VVS) is supposed to be modulated by increased sympathetic tone following an orthostatic maneuver. Increased sympathetic activity may have an important role in mean platelet volume (MPV), either by peripheral activation or by effects on thrombocytopoiesis. We aimed to show the effects of increased sympathetic activity on platelet size in patients with VVS in the present study.
Thirty-seven patients with VVS were compared with age- and sex-matched 33 patients without VVS. All patients have undergone 24 hour holter monitoring for heart rate variability (HRV) and time-domain HRV analysis. Blood samples for MPV measurements were taken before 24 hour holter monitoring.
Group 1 was consisted of 37 patients with VVS and group 2 was consisted of 33 patients without VVS. We observed that SDNN, SDNN index, SDSD, RMSDD, PNN50 count were significantly lower and MPV was found significantly higher in patients with VVS (p < 0.05 for all). Pearson's correlation analysis showed that MPV was moderately negatively correlated with SDNN (r = -0.421), SDSD (r = -0.396), NN50 count (r = -0.395) and RMSDD (r = -0.393). Multivariate regression analysis showed that SDNN was the only independent variable, which had a significant effect on increased MPV level (β = -0.295 , p = 0.016).
We found that MPV was closely associated with increased sympathetic activity in patients with VVS. Our analysis supports the hypothesis that alterations in autonomic status might play a role in the development of platelet size.
No preview · Article · Feb 2014 · European review for medical and pharmacological sciences
[Show abstract][Hide abstract] ABSTRACT: Red cell distribution width (RDW) is associated with poor cardiovascular outcomes. We aimed to find out if this association could be explained by impaired exercise capacity in patients without obstructive coronary artery disease (CAD).
The patients who underwent exercise treadmill test (ETT) who have non-obstructive CAD and were free of heart failure symptoms were evaluated. Total of 132 patients were enrolled, and patients were divided into three groups according to their Metabolic Equivalent Task (MET) level measured by exercise treadmill test (ETT): Less than 7 METs (group 1), 7-10 METs (group 2) and greater than 10 METs (group 3).
The patients in Group 1 had significantly higher RDW levels (16.46 ± 2.79) compared to Group 2 (15.05 ± 2.03) and Group 3 (14.52 ± 1.37), independent of hemoglobin and hematocrit values. Significant differences for age, gender, duration of ETT and Duke Treadmill Score were also found in proportion to the reduced exercise capacity. In multivariate analysis, only duration of ETT (β = 1.017, p = < 0.001) and RDW (β = 0.040, p = 0.026) were found as independent variables, which had statistically significant effects on METs.
We found an independent association between RDW and exercise capacity in patients free of obstructive coronary disease suggesting that patients with elevated RDW values are expected to have impaired exercise capacity.
No preview · Article · Feb 2014 · European review for medical and pharmacological sciences
[Show abstract][Hide abstract] ABSTRACT: Although the origin of cardiac syndrome X (CSX) is still debated, endothelial dysfunction leading to reduced coronary microvascular dilatory response and increased coronary resistance is thought to have an important role in the pathogenesis. Erectile dysfunction (ED) is associated with risk factors resulting in endotelial dysfunction. Although the relationship between cardiovascular disease and ED has been well established; the relation between CSX and ED has not been extensively studied so far. We herein aimed to study ED in patients with CSX. The study was designed as a prospective case-control study. Blood samples were analyzed with respect to concentrations of low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and triglycerides. The subjects answered the native language five-item version of the International Index of Erectile Function Questionnaire (IIEF)-5. Each question was scored from 0 to 5 with a maximum score of 25 denoting healty subjects. We investigated the IIEF-5 score in 51 men with CSX (mean age=48.2±6.4 years), 53 men with demonstrated coronary artery disease (CAD) (mean age=48.3±4.8 years) and 52 male controls with normal coronary arteries (mean age=47.2±6.0 years). Mean IIEF-5 scores were 19.88±3.07 for CSX group, 18.83±3.31 for CAD group and 21.40±2.94 for control group. IIEF-5 scores in CSX group were found to be significantly lower than the those of control group (P<0.001). There were no significant differences in IIEF-5 scores between CSX and CAD groups (P=0.09). We have shown for the first time that patients with CSX have lower IIEF-5 scores compared with controls with normal coronary angiograms. This study suggests that ED and CSX may be different manifestations of a common underlying vascular pathology and vasculogenic ED is frequently seen in CSX at least as much as in CAD.International Journal of Impotence Research advance online publication, 19 December 2013; doi:10.1038/ijir.2013.49.
No preview · Article · Dec 2013 · International journal of impotence research
[Show abstract][Hide abstract] ABSTRACT: Although the vascular complications of bicuspid aortic valve (BAV) disease cause significant morbidity and mortality, the role of pulmonary artery in this pathogenesis is less understood. We aimed to assess the elastic properties of pulmonary artery with echocardiography in patients with BAV.
Thirty patients with BAV (26 males) were enrolled in this study. The presence of aortic stenosis was accepted as exclusion criteria. Thirty-two healthy subjects (27 males) with no any history of cardiovascular disease comprised the control group. In all patients, maximal frequency shift (MFS) and acceleration time (AcT) of the pulmonary artery flow trace were measured echocardiographically in parasternal short-axis view. Subsequently, pulmonary artery stiffness (PAS) was calculated by using the following formula PAS (kHz/sec) = MFS/AcT.
There were no significant differences in baseline demographic characteristics of the study population. Aortic strain and aortic distensibility index were lower, and aortic stiffness index (SI) higher, in patients with BAV. The PAS was significantly increased in patients with BAV compared with control subjects with tricuspid aortic valve (11.08 ± 2.27 vs. 7.11 ± 1.54, P < 0.001). There was a significant correlation between aortic diameters, aortic elasticity indexes, and PAS. Multivariate linear regression analysis, the only significant independent factor affecting the PAS was SI (β = 0.547, P < 0.001).
We demonstrated that elastic properties of pulmonary artery tend to be impaired as in the aorta in patients with BAV disease.
[Show abstract][Hide abstract] ABSTRACT: Revascularization treatment is mostly recommended for iatrogenic left main coronary artery dissection because of potential for catastrophic sequel, even in case of initial TIMI 3 flow and hemodynamic stability. However, conservative treatment seems to be feasible in asymptomatic and hemodinamically stable patient with low-grade dissection. We report two cases of iatrogenic left main coronary dissection managed conservatively.
[Show abstract][Hide abstract] ABSTRACT: Transesophageal echocardiography (TEE) is an important imaging technique used as a complementary tool to transthoracic echocardiography (TTE). TEE is a semi-invasive, diagnostic technique that is usually well tolerated by most patients with a very low complication risk. Most complications are minor such as shortness of breath, benign dysrhythmias, and minor bleeding due to throat or esophagus injury.Pneumomediastinum is defined as the presence of air in the mediastinum and may occur either spontaneously or following trauma or a pathologic process . It may also occur iatrogenically after a diagnostic procedure such as endoscopy or bronchoscopy , which sometimes requires surgical repair. Subcutaneous emphysema often accompanies pneumomediastinum.The TEE procedure is generally performed without direct visual control of the probe in the mouth, upper respiratory tract, and/or esophagus. Therefore, it carries the risk of injury to the throat or esophagus. Pneumomediastinum after TEE ha ...