Ayca Ata Korkmaz

Atherosclerosis burden and coronary artery lesion complexity in acute coronary syndrome patients

BACKGROUND Syntax score (SS) is a prognostic marker in patients with acute coronary sydromes (ACS). Carotid intima media thickness (CIMT) and cardio ankle vascular index (CAVI) are well known surrogate marker of atherosclerosis burden. But association between atherosclerosis burden and coronary artery disease (CAD) complexity in ACS patients has not been investigated yet. METHODS AND RESULTS Consecutive patients with first time diagnosis of ACS (n = 172) were enrolled. SS, a marker of CAD complexity, was assessed by dedicated computer software. CIMT was examined by B-mode ultrasound. CAVI was assessed by VaSera VS-1000 cavi instrument. SS for low, intermediate and high tertiles of CIMT value were 10.1 ± 8.2 vs 11.4 ± ± 7.9 and 15.2 ± 8.8; p = 0.02). SS for normal, borderline and abnormal CAVI values were 4 ± 3.7 vs 11.1 ± 7.2 and 14.1 ± 9.1, respectively p = 0.009). Also, there was independent association between SS and CIMT (95% coinfidence interval [CI] 2.1-19, p = 0.014) and CAVI (95% CI 15-29, p = 0.021]. Neither traditional cardiovascular risk factor nor thrombolysis in myocardial infarction (TIMI) risk score was independent determinant of SS. CONCLUSIONS We have shown that patients with higher atherosclerosis burden have more complex coronary artery lesions. Also these patients may be identified early by using surrogate markers of atherosclerosis. Its clinical significance requires further research.

Earlobe crease may provide predictive information on asymptomatic peripheral arterial disease in patients clinically free of atherosclerotic vascular disease.

The diagonal earlobe crease (ELC) has been regarded as a simple marker of atherosclerosis. There is no knowledge concerning the relation of ELC to the presence, extent, and severity of peripheral arterial disease (PAD). Patients (n = 253) without known atherosclerotic vascular disease and symptoms were enrolled consecutively. Ankle brachial index (ABI) was measured. Patients with ELC had lower ABI compared to those with no ELC (1.02 ± 0.12 vs 1.11 ± 0.08, P < .001). Multivariate analysis demonstrated ELC (95% confidence interval [CI]: 3.3-21.9; P: .001) and age (95% CI: 0.87-0.99; P = .02) as independent determinants of abnormal ABI. There was incremental increased frequency of ELC from normal ABI to significant PAD. We have shown for the first time a significant and independent association between presence of ELC and increased prevalence, extent, and severity of PAD in patients without overt atherosclerotic vascular disease.

Relationship of aortic knob width with cardio-ankle vascular stiffness index and its value in diagnosis of subclinical atherosclerosis in hypertensive patients: a study on diagnostic accuracy.

OBJECTIVE The aim of our study was to determine the usefulness of the aortic knob width (AKW) in the assessment of subclinical atherosclerosis in hypertensive patients. METHODS In this study on diagnostic accuracy, 374 consecutive hypertensive patients with at least one cardiovascular risk factor were enrolled. AKW was measured on chest X-ray. Cardio-ankle vascular index (CAVI) was measured by VaSera-1000 CAVI instrument. The diagnostic value of AKW was assessed using ROC analysis. RESULTS There was a significant correlation between aortic knob width and CAVI (r=0.45, p<0.001), age (0.39, p<0.001), systolic (r=0.17, p<0.001), diastolic (r=0.23, p<0.001) and mean (r=0.2, p<0.001) blood pressures. In linear regression analysis CAVI (β=0.3, 95% CI 0.33-0.98, p<0.001), age (β=0.3, 95% CI 0.09 - 0.21, p<0.001) and diastolic blood pressure β=0.2, 95% CI 0.08-1.9, p<0.001) were independently associated with AKW. It was significantly higher in patients with subclinical atherosclerosis (CAVI ≥9) than borderline (8 ≤CAVI <9) (41.4±5.5 versus 36.7±5.3 mm, p<0.001) and healthy (CAVI <8) subjects (41.4±5.5 versus 35.5±4.3 mm, p<0.001). Analysis using the ROC curve has demonstrated that aortic knob of 41 mm constitutes the cut-off value for the presence of subclinical atherosclerosis with 71% sensitivity and 77% specificity (AUC-0.67, 95% CI 0.51-0.82). CONCLUSION Observation of aortic knob on chest X-ray in hypertensive patients may provide important predictive information of subclinical atherosclerosis.

Increased Carotid Intima–Media Thickness is Associated With Higher SYNTAX Score

The main purpose of this study was to investigate the relation between carotid intima–media thickness (CIMT) and coronary artery disease (CAD) complexity. Consecutive patients (n = 360) with CAD confirmed by coronary angiography were enrolled. Mean CIMT and the overall SYNTAX score (SXscore) were 0.87 ± 0.12 mm and 15 ± 9, respectively. In univariate analysis, there was a significant correlation between the overall SXscore and CIMT (r = .42, P < .001), age (r = .23, P < .001), hypertension (r = .27, P = 0.001), diabetes (r = 0.11, P = 0.02), smoking (r = .24, P = .01), dyslipidemia (r = .2, P = 0.03), and β-blocker use (r = .19, P < .001). In multivariate analysis, CIMT (β = .34, P < .001) and age (β = .11, P < .019) were independently associated with SXscore. We have demonstrated a significant relation between CIMT and SXscore. Although this study is correlative and no causative conclusions can be drawn, our findings suggest that increased CIMT could reflect complex coronary artery lesions.

Association between mean platelet volume and coronary artery calcification in patients without overt cardiovascular disease: an observational study.

OBJECTIVE Platelets have an important role in the pathogenesis of atherothrombosis. It has been shown that platelet size measured by mean platelet volume (MPV), correlates with their reactivity and is still regarded as an easy, useful tool for indirect monitoring of platelet activity in different situations. Coronary artery calcification (CAC) has long been known to occur as a part of the atherosclerotic process. The aim of this study was to determine whether an association exists between MPV and CAC. METHODS In this observational study, we enrolled 259 participants with at least one cardiac risk factor but with unknown cardiovascular disease. Coronary calcification was assessed by multislice computerized tomography and MPV was measured in a blood sample collected in EDTA tubes. Statistical analysis was performed using Kruskal-Wallis, Chi-square, correlation tests and multiple regression analysis. RESULTS Calcium scores ranged from 0 to 735. There was a significant relation between CAC and MPV (r=0.24, p=0.02), age (r=0.32, p<0.001), hypertension (r=0.19, p=0.03), diabetes (r=0.16, p=0.005), smoking (r=0.17, p=0.001). In linear regression analysis, MPV (β=0.4, 95%CI 19.8- 31.1, p<0.001), age (β=0.13, 95%CI 0.23-2.4, p=0.01) and smoking (β=0.12, 95%CI 3.2-15.1, p=0.02) independently associated with CAC. In addition, there were significant differences in MPV between significant CAC group compared to the minimal and none (10.2 ± 2.4 versus 8.1 ± 0.9 and 7.6 ± 1.3; p<0.001). CONCLUSION We have found significant association between MPV and CAC. Although this study is purely correlative and no causative conclusions can be drawn, it may suggest that higher MPV may reflect increased atherosclerotic burden and cardiovascular risk.

Relation of epicardial adipose tissue with arterial compliance and stiffness in patients with hypertension.

The main aim of the present study was to investigate the association between epicardial adipose tissue (EAT) and arterial function in patients with asymptomatic hypertension. Patients with hypertension (n = 155) were enrolled consecutively. Patients with decreased arterial compliance (AC) and increased cardioankle vascular index (CAVI) had higher EAT values compared with those with normal AC and CAVI (6.23 ± 1.67 vs 4.91 ± 1.40, P < .001 and 6.02 ± 1.61 vs 4.96 ± 1.46, P = .01, respectively). Analysis using the receiver–operating characteristics curve demonstrated that EAT 5.5 mm constitutes the cutoff value for the presence of increased CAVI with 67% sensitivity and 62% specificity (area under the curve [AUC]: 0.702, 95% confidence interval [CI] 0.590-0.814) and decreased AC with 77% sensitivity and 65% specificity (AUC: 0.756, 95% CI 0.645-0.867). Assessment of EAT during echocardiography examination may provide information on arterial function in patients with asymptomatic hypertension. The link between EAT and arterial stiffness deserves further investigation.

Relation between carotid intima-media thickness and aortic knob width in patients with essential hypertension.

ObjectiveThe assessment of subclinical atherosclerosis is important in the evaluation of a hypertensive patient, as it provides information on the severity of the hypertension and the cardiovascular risk. The aim of this study was to determine the usefulness of the aortic knob width measured on chest radiography in the assessment of subclinical atherosclerosis in hypertensive patients. Method and resultsA total of 126 consecutive hypertensive patients were enrolled. In univariate analysis, there was a strong correlation between carotid intima media thickness (CIMT) and aortic knob width (r=0.62, P<0.001). In addition, there were statistically significant correlations between CIMT and age (r=0.42, P<0.001), systolic pressure (r=0.27, P=0.02), diastolic pressure (r=0.28, P<0.03), and pulse pressure (r=0.31, P<0.001). In linear regression analysis, the aortic knob width (&bgr;=0.5, P<0.001), age (&bgr;=0.02, P=0.03), and systolic pressure (&bgr;=0.03, P=0.005) were the only independent predictors of CIMT. ConclusionObservation of aortic knob on chest radiograph in hypertensive patients may provide important predictive information of subclinical atherosclerosis.

Predictive value of echocardiography-derived arterial compliance for increased arterial stiffness in hypertensive patients.

ObjectiveIncreased arterial stiffness is a predictor of cardiovascular events. The cardio-ankle vascular index (CAVI) is a measure of arterial stiffness. The stroke volume (SV) to pulse pressure (PP) ratio is an estimate of arterial compliance (AC). The main purpose of this study was to investigate the association between echocardiography-derived AC and arterial stiffness. MethodsOne hundred and forty asymptomatic hypertensive patients were enrolled consecutively. AC was calculated as SV/PP and adjusted to body surface area to calculate the SV/PP index (SV/PPi). Arterial stiffness was assessed by a VaSera-1000 CAVI instrument. ResultsThere was statistically significant negative correlation between SV/PPi and CAVI (r=−0.402; P<0.001). Multivariate binary logistic regression analysis demonstrated SV/PPi as an independent predictor of increased CAVI (CAVI≥9) (95% confidence interval: 0.001–0.147; P<0.001). There were lower SV/PPi values in abnormal CAVI groups (CAVI≥9) than normal and borderline CAVI (CAVI<9) (0.68±0.23 vs. 0.93±0.27; P<0.001). Analysis using the receiver operating characteristic curve has demonstrated that SV/PPi of 0.61 ml/m2/mmHg constitutes the cut-off value for the presence of abnormal CAVI with 89% sensitivity and 53% specificity (area under the curve: 0.771, 95% confidence interval 0.674–0.868). ConclusionAssessment of AC during echocardiography examination may provide predictive information of increased arterial stiffness in asymptomatic hypertensive patients.

Aortic knob calcification and cardioankle vascular index in asymptomatic hypertensive patients

Background Patients with hypertension are predisposed to atherosclerosis of large vessels and are at increased risk of target organ damage and related clinical sequelae. Cardioankle vascular index (CAVI) is a novel parameter of arterial stiffness and a surrogate marker of subclinical atherosclerosis. The aim of the present study was to investigate the relation between aortic knob calcification (AKC) and CAVI in asymptomatic hypertensive patients. Methods and results Sixty patients with AKC and age-matched sex-matched 60 control individuals without AKC were enrolled. Patients with known or having symptoms of atherosclerotic vascular diseases were excluded. AKC was assessed on chest radiography. CAVI was measured using the VaSera – 1000 CAVI instrument. AKC patients had higher CAVI values compared with those without AKC (11.8±3.9 vs. 8.2±2.1, P<0.001). Patients with subclinical atherosclerosis (CAVI≥9) had higher percent of AKC compared with those who had no atherosclerosis (CAVI<9) (72 vs. 34%, P<0.001). Conclusion The presence of AKC on chest radiography may provide important predictive information of arterial stiffness and subclinical atherosclerosis in asymptomatic hypertensive patients.

Novel treatment of coronary artery fistulae concealing severe coronary artery lesion： using thrombus aspiration catheter as a delivery guide

In this case report, we present the occlusion of multiple coronary artery fistulae originating from proximal left anterior descending (LAD) and right sinus valsavla and empting to the pulmonary artery at the same place. We occluded LAD fistulae by using thrombus aspiration catheter as a delivery guide. To the best of our knowlege, this is the first case of occlusion of coronary fistulae with the help of thrombus aspiration catheter. Our experience may suggest that thrombus aspiration catheters can be used in treating coronary artery fistulae with difficult anotomy.