Ender Emre

Evaluation of choroidal thickness via enhanced depth-imaging optical coherence tomography in patients with systemic hypertension

Purpose: The purpose was to evaluate choroidal thickness via spectral domain optical coherence tomography (SD-OCT) and to compare the data with those of 24-h blood pressure monitoring, elastic features of the aorta, and left ventricle systolic functions, in patients with systemic hypertension. Materials and Methods: This was a case-control, cross-sectional prospective study. A total of 116 patients with systemic hypertension, and 116 healthy controls over 45 years of age, were included. Subfoveal choroidal thickness (SFCT) was measured using a Heidelberg SD-OCT platform operating in the enhanced depth imaging mode. Patients were also subjected to 24-h ambulatory blood pressure monitoring (ABPM) and standard transthoracic echocardiography (STTE). Patients were divided into dippers and nondippers using ABPM data and those with or without left ventricular hypertrophy (LVH+ and LVH-) based on STTE data. The elastic parameters of the aorta, thus aortic strain (AoS), the beta index (BI), aortic distensibility (AoD), and the left ventricular mass index (LVMI), were calculated from STTE data. Results: No significant difference in SFCT was evident between patients and controls (P ≤ 0.611). However, a significant negative correlation was evident between age and SFCT in both groups (r = −0.66/−0.56, P ≤ 0.00). No significant SFCT difference was evident between the dipper and nondipper groups (P ≤ 0.67), or the LVH (+) and LVH (-) groups (P ≤ 0.84). No significant correlation was evident between SFCT and any of AoS, BI, AoD, or LVMI. Discussion: The choroid is affected by atrophic changes associated with aging. Even in the presence of comorbid risk factors including LVH and arterial stiffness, systemic hypertension did not affect SFCT.

Clinical effects of enhanced external counterpulsation treatment in patients with ischemic heart failure

OBJECTIVE Enhanced external counterpulsation (EECP) is a noninvasive treatment that is proven safe and effective in patients with coronary artery disease (CAD) and heart failure (HF). The aims of this study are to investigate the clinical effects of EECP therapy in patients with symptomatic CAD and chronic HF, and to find out an answer to the question: Does EECP therapy have any effect on the prognostic markers of HF? METHODS This study was designed as a prospective cohort study. A total of 68 consecutive patients with symptomatic CAD and chronic HF referred to EECP therapy were enrolled in this study between November 2007 and December 2010; 47 patients (39 males and 8 females, 65 ± 7, years), have undergone EECP treatment, and 21 patients (20 males and 1 female, 62 ± 10 years), who did not want to participate in the EECP program comprised the control group. Statistical analysis was performed using t tests for dependent and independent samples, Mann-Whitney U test, Chi-square and Fischer exact tests. RESULTS EECP therapy resulted in significant Improvement in post-intervention New York Heart Association functional class (p<0.001), left ventricular ejection fraction (p<0.001), B-type natriuretic peptide levels (p<0.003), uric acid levels (p<0.05), free-T3/free-T4 ratio (p<0.034) and mitral annular E (p<0.05) velocity, compared with baseline, a finding not evident in the control group. CONCLUSION EECP treatment significantly improved clinical and some biochemical parameters, which are mostly prognostic markers in patients with symptomatic CAD and chronic HF.

Effect of enhanced external counterpulsation treatment on mean platelet volume in patients affected by ischemic chronic heart failure.

Mean platelet volume (MPV) is increased in chronic heart failure (CHF) and is an independent predictor of mortality in CHF patients. It is not known whether enhanced external counterpulsation (EECP) therapy leads to decreased MPV values or not. The purpose of this study was to examine the effects of EECP on platelet count and MPV values and to assess the influence of MPV on the risk of death and recurrent ischemic events in ischemic CHF patients. A total of 68 ischemic heart failure patients with CHF symptoms and refractory angina pectoris were included in the study, 47 consecutive patients (39 males and eight females) aged 44–82 years. Although follow-up period started after completion of EECP in treated patients, control group follow-up started at the end of 7-week treatment without EECP. All patients were monitored for a mean duration of 13 ± 8 months (range, 1–36 months). The primary endpoints of the study were effects of EECP treatment on platelets after treatment period (7 weeks) and the recurrence of ischemic events. Secondary endpoint was cardiovascular death during the follow-up period. We observed a significant increase in platelet count and decrease in MPV levels (P = 0.044 and P = 0.004, respectively) in the control group. There were no significant differences in platelet count and MPV levels in the EECP group (P > 0.05). After the treatment period, New York Heart Association functional classification (2.60 ± 0.75 vs. 1.72 ± 0.68, P < 0.001) and Canadian Cardiovascular Society functional classification of angina (2.50 ± 0.90 vs. 1.60 ± 0.74, P < 0.001) improved in patients with EECP treatment. In our study, we found that EECP therapy had a neutral effect on MPV values and platelet count.

Major depressive disorder in chronic heart failure patients: Does silent cerebral infarction cause major depressive disorder in this patient population?

OBJECTIVE Depression frequently occurs in patients with heart failure as similar pathophysiological mechanisms present in both these diseases. Patients with dilated cardiomyopathy (DCM) have a high incidence of clinically asymptomatic silent cerebral infarction (SCI). This study aimed to evaluate the relation between SCI and major depressive disorder (MDD), and between MDD and clinical and biochemical parameters in DCM patients. METHODS Patients with ischemic and non-ischemic DCM who had chronic heart failure (CHF) (39 male, 10 female, age 60±10 years) were included in the study. Mean patient ejection fraction (EF) was 34±10%. Patients had no localized neurological symptoms or stroke history. The etiology of DCM was ischemic in 40 and non-ischemic in 9 patients. Twenty-five age-matched healthy volunteers served as a control group for comparison of SCI and MDD prevalence. RESULTS Patients had mild to severe CHF symptoms. Prevalence of SCI and MDD was significantly higher in patients with DCM than in the control group; 63% vs 8%; p<0.001, and 52% vs 20%; p<0.001 respectively. Patients with SCI had a higher prevalence of MDD than patients without SCI in DCM (61% vs 27%, p=0.02). CONCLUSION CHF patients have an increased prevalence of SCI and MDD. Patients with SCI have a higher prevalence of MDD compared to patients without SCI in CHF.

Renal function has an effect on cardiovascular mortality in patients with dilated cardiomyopathy.

Background Chronic heart failure (CHF) is a major and growing public health problem resulting from the cardiac damage caused by a variety of disease processes. CHF has many comorbid conditions such as hypertension, coronary artery disease, peripheral artery disease and chronic kidney disease (CKD). Some of the chronic conditions may have an effect on cardiac mortality in CHF patients. We have investigated the effect of renal dysfunction on cardiovascular mortality in patients with ischemic dilated cardiomyopathy (DCM) and nonischemic DCM. Methods Six hundred and thirty-seven patients with DCM were evaluated between January 2003 and January 2011. All individuals in the study population were admitted to the cardiology clinic because of decompensated heart failure. In this prospective observational study, a total of 637 patients [409 men, 228 women, 18–94 years old, mean age 63 ± 13 years; New York Heart Association (NYHA) functional class II–IV] with diagnoses of ischemic (402) and nonischemic (235) DCM were enrolled in the study. Baseline glomerular filtration rate was calculated using the Cockcroft–Gault equation. Results By the end of the study, 228 patients had died due to cardiovascular reasons. Both DCM types had similar cardiovascular mortality [151 patients with ischemic DCM (37%) vs. 77 patients with nonischemic DCM (32%); P = NS]. Renal dysfunction had an effect on cardiovascular mortality in patients with ischemic and nonischemic DCM (respectively, glomerular filtration rate 54 ± 24, 56 ± 24; P < 0.001). Conclusion We have demonstrated that renal function is a prognostic risk marker in patients with ischemic and nonischemic DCM.

Ischemic stroke history predicts increased cardiovascular mortality in chronic heart failure.

OBJECTIVE To investigate comorbidities that predict cardiac mortality and re-hospitalization in chronic heart failure (CHF) patients. METHODS Five hundred eighty patients (mean age 63 ± 13 years, 373 male, 207 female, mean ejection fraction (EF) 26 ± 9%) with mild, moderate or severe CHF [NYHA class II-IV] were included in this prospective observational study. We evaluated all comorbidities such as history of ischemic stroke, coronary artery disease, peripheral arterial disease, chronic obstructive lung disease, hypertension, diabetes mellitus and chronic kidney disease in CHF patients who were hospitalized due to decompensated heart failure in Kocaeli University, Faculty of Medicines Hospital between January 2003 and July 2009. Cox regression and Kaplan-Meier survival analyses were used to establish predictors of unfavorable outcomes. RESULTS Of 580 patients 207 (36%) patients died due to cardiovascular reasons. In multivariable Cox regression analysis age (HR-1.06, 95% CI 1.04-1.08, p<0.001), NYHA functional class (HR-3.20 95% CI, 1.90-5.41, p<0.001), history of ischemic stroke (HR-2.48, 95% CI 1.14-5.37, p=0.022), high-sensitive C-reactive protein (HR-1.09, 95% CI, 1.04-1.15, p=0.001), brain natriuretic peptide (HR-1.00, 95% CI 1.00-1.00, p=0.01) and hemoglobin (HR-0.90, 95% CI 0.81-0.99, p=0.038) were independent predictors of cardiac death in the present study. History of ischemic stroke was demonstrated as an important comorbidity that predicts cardiovascular mortality beyond other co-morbidities in CHF patients. NYHA functional class (HR-2.85, 95% CI 1.80-4.65, p<0.001), left ventricular EF [(HR-0.98, 95% CI 0.95-0.99, p=0.039) and ischemic stroke history (HR-2.41, 95% CI 1.15-5.05, p=0.019) were independent predictors for recurrence hospitalization. The stroke history was only predictor showing recurrent hospitalization at least in one year among the other comorbid conditions, which were evaluated during study. CONCLUSION History of ischemic stroke may be an important risk factor for increased cardiac mortality and recurrence hospitalization in CHF patients.

Effect of thrombus aspiration on postprocedural outcomes in elderly patients with acute ST-elevation myocardial ınfarction

The effects of thrombus aspiration (TA) during primary percutaneous coronary intervention (PCI) for ST‐elevation myocardial infarction (STEMI) have been evaluated in several studies. The aim of the present study was to evaluate postprocedural outcomes in elderly STEMI patients who have a tendency for vasoconstruction and decreased coronary flow reserve.

Rare multiple fistulas with large saccular aneurysms originating from left anterior descending artery and left main coronary artery.

A 49-year-old female patient consulted us for a cardiac evaluation before undergoing colon adenocarcinoma surgery. Three years prior, the patient underwent coronary angiography for dyspnea. The coronary angiography examination revealed a fistula originating from the left anterior descending artery and left main coronary artery, which had soft aneurysmal sacs and most likely drained into the pulmonary artery. Parasternal short axis echocardiography revealed a color flow that could be related to the fistula, but the other echocardiographic findings were normal. The patient did not accept the proposed examination and invasive treatment.

Incidentally Detected Cardiac Cyst Hydatid after Blunt Thoracic Trauma

Cardiac involvement in hydatid disease is more seldom than the involvement of the liver and the lungs. Cardiac cyst hydatid disease is diagnosed incidentally or by means of symptoms such as dyspnea and angina pectoris. Here, we present the case of a 45-year-old male patient who underwent open heart surgery for a randomly detected cardiac cyst hydatid during investigations carried out in a healthcare institution after accidentally falling from height. On the other hand, this patient did not have any complaints associated with hydatid disease before this event.

The Better Outcomes Associated with Warfarin use in Patients with Heart Failure in Either Atrial Fibrillation or Sinus Rhythm

PP-051 Warfarin use and associated outcomes in patients with chronic heart failure (HF) have not been well described previously. We hypothesized that warfarin is associated with lower risks of cardiovascular mortality in patients with sinus rhythm, atrial fibrillation and pacemaker rhythm. We