Abdulmelik Yıldız

Baseline SYNTAX Score and Long-Term Outcome in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Objectives: The SYNTAX score (SXscore) has emerged as a reproducible angiographic tool to quantify the extent of coronary artery disease based on the location and complexity of each lesion. The aim of this study was to evaluate whether the SXscore is an independent predictor of long-term cardiovascular outcomes in patients treated with primary percutaneous coronary intervention (PCI) for acute ST-segment elevation myocardial infarction (STEMI). Methods: A total of 2993 patients with acute STEMI who underwent primary PCI were stratified into the 4 groups according to the SXscore quartiles; quartile 1(Q1, SXscore ≤ 9, n = 819), Q2 (9 < SXscore < 16, n = 715), Q3 (16 ≤ SXscore < 20, n = 710), and Q4 (SXscore ≥ 20, n = 749). Results: There were significant differences among the quartiles with respect to age, basal creatinine and glucose levels, and the incidences of diabetes mellitus, Killip ≥2, and anemia. From Q1 to Q4, there were increasing rates of culprit left anterior descending lesion (P < .001), multivessel disease (P < .001), chronic total occlusion (P < .001), and proximal lesion localization (P < .001). At long-term follow-up, all-cause mortality, nonfatal myocardial infarction, stroke, rehospitalization due to heart failure, and the need of revascularization were significantly more frequent among the patients in the highest SXscore quartile. In multivariate analysis, after including the SXscore as a numerical variable into the model, every point of increase was determined as an independent predictor for long-term mortality (hazard ratio [HR] 1.03, 95% confidence interval [CI] 1.01-1.05, P = .008) and for overall major adverse cardiac events (MACEs; HR 1.02, 95% CI 1.01-1.04, P < .001). Conclusion: The SXscore is an independent predictor of both in-hospital and long-term mortality and MACE in patients with acute STEMI undergoing primary PCI.

Preprocedural red blood cell distribution width predicts bare metal stent restenosis

BackgroundIt has been shown that increased red blood cell distribution width (RDW) predicts adverse outcomes in cardiovascular disease and in patients undergoing a percutaneous coronary intervention. The aim of the present study was to assess the predictive value of preinterventional RDW on the development of in-stent restenosis (ISR) in patients undergoing stent implantation. Materials and methodsIn this retrospective study, we compared 131 patients with ISR and 138 patients without ISR who had undergone bare metal stent implantation. ResultsPreprocedural RDW was significantly higher in patients with ISR than those without restenosis (14.6±3.2 vs. 13.4±1.6%, P<0.001). Stent length was significantly longer in patients with than those without restenosis (17.9±5.6 vs. 16.2±5.2 mm, respectively, P=0.03). Compared with patients with restenosis, patients without restenosis had a lower rate of diabetes (28 vs. 61 patients, P=0.001), a significantly short period between two coronary angiographies (9.8±9.3 vs. 12.9±11.6 months, respectively, P=0.02), and lower triglyceride levels (133±53 vs. 198±121 mg/dl, respectively, P=0.05). In multivariate logistic regression analysis, diabetes mellitus, stent length, preprocedural RDW, and current smoking independently predicted ISR. ConclusionIncreased preinterventional RDW significantly predicts bare metal stent restenosis and might represent a useful screening tool to stratify patients according to a higher or a lower risk of ISR after stent implantation in patients with stable and unstable angina pectoris.

The incidence of coronary anomalies on routine coronary computed tomography scans.

Summary Objective This study aimed to assess the incidence of coronary anomalies using 64-multi-slice coronary computed tomography (MSCT). Methods The diagnostic MSCT scans of 745 consecutive patients were reviewed. Results The incidence of coronary anomalies was 4.96%. The detected coronary anomalies included the conus artery originating separately from the right coronary sinus (RCS) (n = 8, 1.07%), absence of the left main artery (n = 7, 0.93%), a superior right coronary artery (RCA) (n = 7, 0.93%), the circumflex artery (CFX) arising from the RCS (n = 4, 0.53%), the CFX originating from the RCA (n = 2, 0.26%), a posterior RCA (n = 1, 0.13%), a coronary fistula from the left anterior descending artery and RCA to the pulmonary artery (n = 1, 0.13%), and a coronary aneurysm (n = 1, 0.13%). Conclusions This study indicated that MSCT can be used to detect common coronary anomalies, and shows it has the potential to aid cardiologists and cardiac surgeons by revealing the origin and course of the coronary vessels.

Concomitant anterior and inferior myocardial infarctions.

Acute multicoronary occlusion is an extremely rare clinical and angiographic finding. Prompt diagnosis and treatment are extremely important. Herein, we present a 38-year-old man suffering from concomitant anterior and inferior myocardial infarctions due to simultaneous total occlusion of both the left anterior descending and right coronary arteries.

Assessment of cardiac autonomic functions by heart rate variability in patients with restless leg syndrome

OBJECTIVE The aim of the present study was to investigate cardiac autonomic effects in restless leg syndrome (RLS) using heart rate variability (HRV). METHODS A total of 35 patients with RLS and 35 healthy individuals were enrolled in the study. The severity of RLS symptoms was assessed using the International Restless Legs Syndrome Study Group rating scale (IRLS). The correlation between the severity of RLS symptoms and HRV parameters measured on an electrocardiogram was analyzed. RESULTS There were no statistically significant differences between the 2 groups with respect to age, gender, or body mass index. The mean heart rate was 85±7.1 bpm in the RLS group compared with 79.6±5.5 bpm in the control group (p=0.001). The standard deviation (SD) of all normal to normal (NN) intervals (SDNN), the mean of the deviation of 5-minute NN intervals over the entire recording (SDNN index), and the SD of the average NN intervals calculated over a 5-minute period of the entire recording (SDANN) were significantly lower in the RLS group compared with the control group (p<0.05 for all). There were no statistically significant differences between the 2 groups in the square root of the mean squared differences of successive NN intervals (RMSSD) and the proportion of adjacent RR intervals differing by >50 milliseconds in the 24-hour recording (pNN50) values (p=0.119 and p=0.07, respectively). In patients with RLS, the low frequency (LF) power and LF/high frequency (HF) ratio were significantly higher than those in the control group (2248.6±245.6 vs 712.1±346.3, 10.7±3.7 vs 2.9±1.8; p<0.0001 and p<0.0001, respectively). Compared with the control group, the RLS group had lower values for HF power, but the difference was not statistically significant (p=0.07). The severity of RLS symptoms was negatively correlated with the SDNN, SDANN index, and pNN50 (r=-0.453 and p=0.009, r=-0.340 and p=0.046, r=-0.446 and p=0.007, respectively), and positively correlated with LF power (r=0.681 and p<0.0001). CONCLUSION The study data demonstrated that cardiac autonomic impairment is associated with RLS.

Association of the Zwolle Score with Fragmented QRS Complex: A Combined Prognostic Tool for Primary Angioplasty in ST Elevation Myocardial Infarctions -

Introduction: We aimed to introduce the prognostic value of simultaneously calculated fragmented QRS and Zwolle scores as a new scoring system in primary PCI of the STEMI patients. Method: Two hundred fifty-nine STEMI patients were classified as fragmented QRS complex group (fQRS) and non-fragmented QRS complex group (non-fQRS) according to the fragmentation of QRS complex in electrocardiography. These two groups according to whether Zwolle score ≥3 were also classified as high Zwolle score with fQRS complex, high Zwolle score with the non-fQRS complex, the low Zwolle score with fQRS complex, and low Zwolle score with the non-fQRS complex group. The hospitalization data of the patients were analyzed. Results: In the fQRS group compared with the non-fQRS group, wider QRS (105.2±9.7 vs. 88±7.1, p

Assessment of relation between aortic elastic properties and the complexity of coronary artery disease.

Assessment of relation between aortic elastic properties and the complexity of coronary artery disease Ahmet Karakurt, Cennet Yildiz, Abdulmelik Yildiz & Hamit Serdar Başbuğ To cite this article: Ahmet Karakurt, Cennet Yildiz, Abdulmelik Yildiz & Hamit Serdar Başbuğ (2016) Assessment of relation between aortic elastic properties and the complexity of coronary artery disease, Acta Cardiologica, 71:3, 267-273, DOI: 10.1080/AC.71.3.3152086 To link to this article: https://doi.org/10.1080/AC.71.3.3152086

Cardiac Autonomic Impairment and Chronotropic Incompetence in Dipper and Nondipper Hypertension

ABS TRACT Objective: The aim of the present study was to compare the autonomic nervous system activity indexes obtained from treadmill exercise stress testing in dipper and non-dipper hypertensive patients. Material and Methods: This study included 214 hypertensive patients, under antihypertensive medication. All study participants underwent 24-hour ambulatory blood pressure monitoring (ABPM) and maximal exercise testing. Thereafter patients were divided into two groups: 94 dipper hypertensives and 120 non-dipper hypertensives. Heart-rate (HR) response during exercise was evaluated by the chronotropic index (CI). HR recovery (HRR) was defined as the difference between HR at peak exercise and first minute after the exercise test. Results: Daytime systolic and diastolic BP measurements were similar, however night-time measurements were significantly lower among dippers than nondippers (night-time systolic BP: 114.1±11.4 vs 126.3±15.0 mmHg, p<0.001; night-time diastolic BP: 72.3±7.3 vs 79.9±9.8 mmHg, p<0.001). Chronotropic index was lower than normal in both groups (0.79±0.1 vs 0.78±0.7 p=NS). Dippers had higher HRR values than non-dippers (31.8±4.6 vs 29.1±4.6 p<0,001). HRR was positively correlated with the percentage decline of systolic and diastolic BP from day to night (r=0.255 p<0.001 and r=0.228 p=0.001, respectively). There were no correlation between CI and percentage of systolic and diastolic BP reduction from day to night (r=0.067 p>0.05 and r=0.16 p>0.05, respectively). Conclusion: Hypertensive patients have abnormal HR response to exercise,. Nondippers had lower HRR values than dippers. This may due to a relative general decrease of parasympathetic reactivation after exercise that is linked to the failure of nighttime fall of BP.

Heart Rate Turbulence Analysis in Subclinical Hypothroidism Heart Rate Turbulence in Hypothyroidism.

BACKGROUND Heart rate turbulence (HRT) is a baroreflex-mediated biphasic reaction of heart rate in response to premature ventricular beats. Abnormal HRT identifies patients with autonomic dysfunction or impaired baroreflex sensitivity. The aim of the present study was to demonstrate the effect of subclinical hypothyroidism (SCH) on cardiac autonomic function using HRT parameters. METHODS The study sample consisted of 25 patients (10 men, 15 women with a mean age of 39.7 ± 15.5 years) who were diagnosed with SCH and 35 euthyroid patients (13 males, 22 females with a mean age 38.4 ± 11.7 years). All patients underwent 24 h ambulatory electrocardiography monitorization. The study calculated two HRT parameters, turbulence slope (TS) and turbulence onset (TO), and these HRT parameters were compared between the groups to examine the relationship between HRT and thyroid-stimulating hormone (TSH) levels. RESULTS The characteristics of SCH patients and control cases were similar with regard to age, sex except for TSH levels. Serum TSH levels were significantly higher in SCH patients than in the controls (7.3 ± 1.8 μIU/ml vs. 2.4 ± 1.0 μIU/ml, p < 0.001). TO was significantly higher in SCH patients compared with controls (-1.51 ± 0.5 vs. -2.2 ± 1.0, p = 0.002). SCH patients had lower TS values than controls (7.6 ± 2.4 vs. 10.8 ± 3.4, p < 0.001). TO was positively correlated with serum TSH levels (r = 0.276, p = 0.033). There was also a negative correlation between TS and serum TSH levels (r = -0.437, p < 0.001). CONCLUSIONS The results of our study indicated that cardiac autonomic function is impaired in patients with SCH. KEY WORDS Heart rate; Holter electrocardiography; Hypothyroidism.

Anomalous the Left Main Coronary Artery Originating from the Right Coronary Artery.

The coronary anomalies are rarely seen in clinical practice. A 47-year-old female patient presented to hospital with chest pain on exertion. The coronary angiography and cardiac tomography showed the anomalous origin of the left main from the right coronary artery.