Aziz Gunsel

Is SYNTAX Score Predictive of Atrial Fibrillation After On-Pump Coronary Artery Bypass Graft Surgery?

Background and Objectives The relationship of synergy between percutaneous coronary intervention with taxus and cardiac surgery (SYNTAX) score and development of atrial fibrillation (AF) after coronary artery bypass surgery (CABG) has not been studied. Therefore, we assessed the relationship between the SYNTAX score and development of AF after CABG (POAF). Subjects and Methods The medical records of consecutive patients, who underwent CABG surgery from January 2013 to September 2015, were retrospectively reviewed for the development of AF in the postoperative period. SYNTAX score, clinical and echocardiographic parameters were evaluated. The independent variables for the development of POAF were defined and their predictive values were measured. Results The study group consisted of 106 patients, of which 36 (34%) developed POAF. Age, hypertension, stroke, chronic obstructive pulmonary disease (COPD), heart failure (HF), diabetes mellitus (DM), left atrial diameter, neutrophil/lymphocyte ratio, platelet large cell ratio, creatinine, blood urea nitrogen and SYNTAX score were identified as important variables for the development of POAF. However, in logistic regression analysis COPD (OR=19.313, 95% CI=2.416-154.407, p=0.005), HF (OR=28.362, 95% CI=2.034-395.515, p=0.013), SYNTAX score (OR=0.863, 95% CI=0.757-0.983, p=0.026), and DM (OR=20.770, 95% CI=3.791-113.799, p<0.001) appeared as independent variables predicting the development of POAF. In receiver operation characteristic analysis, SYNTAX score (≥22.25) (AUC=0.777, 95% CI=0.676-0.877, p<0.001) was one of the strongest predictors for the development of POAF. Conclusion The SYNTAX score level was independently associated with the development of AF after CABG.

The relation between vitamin B12 and SYNTAX score

BACKGROUND Vitamin B12 is required in the metabolism of homocysteine. Vitamin B12 deficiency has been implicated in endothelial dysfunction and cardiovascular disease via hyperhomocysteinaemia. However, the association of vitamin B12 and the severity of coronary artery disease has not been studied to date. AIM This study was conducted with the aim of evaluating the relationship between vitamin B12 and SYNTAX score. METHODS Medical records of consecutive patients who underwent coronary artery bypass grafting surgery were retrospectively reviewed. The study group consisted of 127 patients. Vitamin B12, other biochemical parameters, clinical and echocardiographic parameters, and SYNTAX score were evaluated for all patients. RESULTS Patients with vitamin B12 deficiency had a higher prevalence of cardiovascular risk factors such as diabetes mellitus, and history of transient ischaemic attack/stroke and heart failure. The SYNTAX score was significantly higher in patients with vitamin B12 deficiency (29.2 ± 4.9 vs. 22.5 ± 4.5, p < 0.05). CONCLUSIONS In our study, we found a significant relationship between vitamin B12 deficiency and SYNTAX score, demon-strating the severity and complexity of coronary artery disease.

Isolated Persistent Left Superior Vena Cava, Sick Sinus Syndrome, and Challenging Pacemaker Implantation

Persistent left superior vena cava with absent right superior vena cava is a very rare venous anomaly and is known as isolated PLSVC. It is usually an asymptomatic anomaly and is mostly detected during difficult central venous access or pacemaker implantation, though it could also be associated with an increased incidence of congenital heart disease, arrhythmias, and conduction disturbances. Herein, we describe a dual-chamber pacemaker implantation in a patient with isolated PLSVC and sick sinus syndrome.

Double-edged blinde, hemorrhagic or cardioembolic cognitive impairment

We appreciated much for Dr. Cerits comments on our article. Evidence from meta-analysis conducted by Kalantarian, et al.,[1] has suggested that AF is associated with a high risk of cognitive impairment (CI) and dementia (D), with or without a history of clinical stroke. Several mechanisms have been considered for the relationship of AF and CI. One explanation is the presence of the same risk factors such as hypertension, heart failure, diabetes mellitus in the both of conditions. Another potential mechanism is that AF comprises all the components of Virchoffs triade (hyper-coagulable state in AF, statis of blood in remodeled left atrium and structural injury of the heart) that leads to thrombus formation in left atrium/left atrial appendage and finally to clinical and subclinical strokes. Other potential mechanisms include: brain hypo-perfusion due to beat-to-beat variability in the length of the cardiac cycle and reduced cardiac output, the pro-inflammatory state in AF and peri-ventricular white matter lesions.

Kink of Subclavian Artery Mimicking Stenosis

The treatment for subclavian artery stenosis includes the more common endovascular therapy rather than surgical intervention in symptomatic patients. We present a case of a 79-year-old man with coronary artery bypass graft where subclavian artery stenosis was found incidentally. In this asymptomatic case, we have merged clinical and multiple imaging modalities to secure the diagnosis and treatment plan.