Aydin Dursun

Predictors of atrial fibrillation after coronary artery bypass surgery.

ObjectiveAtrial fibrillation is one of the most common arrhythmias associated with not only increased morbidity after coronary artery bypass grafting but also increased healthcare costs. Many factors are associated with atrial fibrillation onset after coronary artery bypass grafting. We prospectively examined which factors could predict atrial fibrillation after coronary artery bypass grafting. MethodsFifty-seven consecutive patients (37 men, mean age=60.2±12 years) with sinus rhythm before coronary artery bypass grafting are included the study. Clinical, demographic, laboratory and echocardiographic characteristics are all evaluated prospectively. The maximum and minimum P-wave duration (Pmax and Pmin) were measured from the 12-lead surface electrocardiogram. The difference between the Pmax and the Pmin was calculated and defined as P-wave dispersion. Preoperative venous blood samples were taken for N-terminal proBrain natriuretic peptide level analysis. ResultsTen (17%) patients had postoperative atrial fibrillation. Patients with postoperative atrial fibrillation were older (69.4±6 versus 58.2±12 years, P=0.01), had lower ejection fraction (44.1±8.9% versus 54.3±9; P=0.002), higher proBrain natriuretic peptide levels (538±136 pg/ml versus 293±359 pg/ml; P=0.03), longer Pmax (142.2±13.7 ms versus 120.8±21.2 ms; P=0.006) and longer P-wave dispersion (55.0±8.2 ms versus 41.3±14.3 ms; P=0.008) compared with the patients without atrial fibrillation. Univariate analysis showed that increased age (P=0.01), lower ejection fraction (P=0.02), enlargement of left atrium (P=0.02), increased Pmax (P=0.006) and increased P-wave dispersion (P=0.008) and increased level of preoperative proBrain natriuretic peptide (P=0.03) were associated with postoperative atrial fibrillation. Positive correlation was seen between the age and level of proBrain natriuretic peptide (r=0.322 and P=0.015). In multivariate analysis, age (P=0.05), lower ejection fraction (P=0.03), left atrial enlargement (P=0.05), longer Pmax (P=0.01) and P-wave dispersion (P=0.01) were found to be independent predictors of postoperative atrial fibrillation. ConclusionAge, poor left ventricular functions, Pmax and P-wave dispersion are found to be independent predictors of atrial fibrillation after coronary artery bypass grafting.

N-terminal probrain natriuretic peptide predicts altered circadian variation in essential hypertension.

Diminished nocturnal blood pressure fall in nondipper hypertensive patients are closely associated with poor prognosis. N-terminal probrain natriuretic peptide can also identify poor prognosis in miscellaneous heart diseases. In this study, we aimed to clarify the association between probrain natriuretic peptide levels and diminished nocturnal blood pressure fall in patients with essential hypertension. Twenty-six consecutive nondipper (age: 53±8 years, 14 men) (group 1), and 26 dipper hypertensive patients (age: 52±9 years, 16 men) (group 2), based on ambulatory blood pressure monitoring, and age and sex-matched 28 normotensive participants (age: 50±11 years, 16 men) (group 3) were compared with each other. Although systolic and diastolic ambulatory blood pressure values were similar in hypertensives during the day, those at night were higher in group 1 (P<0.0001). Echocardiographic findings revealed that the left ventricular mass index was higher in both group 1 (184±47) and group 2 (142±39) compared with control participants (102±19) (P<0.0001), but ejection fraction and relative wall thickness were similar in all groups. The transmitral E-wave velocity decreased in group 1 (0.62±0.15 m/s) and group 2 (0.7±0.14 m/sec) compared with group 3 (0.95±0.22 m/s) (P<0.01). The transmitral E/A ratio decreased (0.71±0.12, 0.81±0.2 and 0.79±0.57, respectively P<0.05), and the transmitral E-wave deceleration time increased in group 1 (208±46, 203±38 and 169±42 ms, respectively, P<0.05). The isovolumic relaxation time increased (112±23, 110±18 and 86±11 m/s, respectively, P<0.01). Although group 1 and 2 have a similar number of patients with diastolic dysfunction (23/26 and 22/26, respectively, P>0.05), there were great differences between plasma probrain natriuretic peptide levels (88±20, 58±22 and 47±20 pg/ml, respectively, P<0.0001). In addition, serum uric acid (6.5±1.4, 5.3±1.5 and 5.0±1.9, respectively P<0.001), and creatinine levels (0.88±0.2 and 0.78±0.2 vs. 0.72±0.3, respectively P<0.05) were higher in group 1. These observations suggest that nondipper state may be related to the increase in left ventricular mass index and probrain natriuretic peptide levels and elevation in both plasma uric acid and creatinine levels. Serum probrain natriuretic peptide levels are found to be correlated with left ventricular mass index (Pearsons correlation 469 P<0.0001); but not creatinine (Pearsons correlation 188 P>0.05).

Diagnosis of the left circumflex coronary artery fistula drainage into the left ventricle by echocardiographic color Doppler flow imaging

Congenital coronary fistula is consisted of a communication between a coronary artery and a cardiac chamber or pulmonary vessel. Congenital left coronary artery-left ventricle fistula is uncommon. A 41-year-old female patient admitted to our institution for evaluation of heart murmur etiology. A loud continuous murmur heard at the apex area was detected at auscultation. Echocardiography showed a large fistula draining into the left ventricle apex. Coronary angiography revealed fistula from left circumflex coronary artery to left ventricular cavity. Since the patient was asymptomatic and no concomitant cardiac pathology was detected, we advised endocarditis prophylaxis and medical follow-up.