Eser Durmaz

Effectiveness of a lead cap in radiation protection of the head in the cardiac catheterisation laboratory

Introduction During the past 30 years, interventional cardiology has advanced dramatically resulting in outstanding increases in occupational radiation exposure of interventional cardiologists. Despite the remarkable changes in fluoroscopic procedures, radiation protection technology is not much different from how it was decades ago. Moreover, new evidence on occupational radiation suggests that low doses of ionising radiation exposure may be associated with the development of cancer in interventional cardiologists and radiologists1-6. The brain is of particular interest, because it is one of the least protected organs during interventional procedures2. The trunk and the thyroid are protected with lead aprons, and the eyes are protected by lead glasses; however the head is completely exposed. The annual head dose sustained by a cardiologist generally ranges between 20 and 30 mSv, and in some cases may reach up to 60 mSv per year7. This indicates a dose 10 times higher than whole body exposure8. Ceiling-suspended lead shields reduce radiation doses to the brain but they are designed to protect the face and head from primary scatter radiation from the patient. Therefore, a significant amount of secondary radiation scattered from the laboratory walls may reach the operator’s head, despite the presence of a ceilingmounted glass shield. Until now, operators have not used protective garments to protect their head from radiation.

Evaluation of association between common genetic variants on chromosome 9p21 and coronary artery disease in Turkish population

Objective: Coronary artery disease (CAD), which develops from complex interactions between genetic and enviromental factors, is a leading cause of death worldwide. Based on genome-wide association studies (GWAS), the chromosomal region 9p21 has been identified as the most relevant locus presenting a strong association with CAD in different populations. The aim of the present study was to investigate the association of two SNPs on chromosome 9p21 on susceptibility to CAD and the effect of these SNPs along with cardiovascular risk factors on the severity of CAD in the Turkish population. Methods: This study had an observational case-control design. We genotyped 460 subjects, aged 30-65 years, to investigate the association of 2 SNPs (rs1333049, rs2383207) on chromosome 9p21 and CAD risk in Turkish population. Real-time polymerase chain reaction (RT-PCR) was used to analyze the 2 SNPs in CAD patients and healthy controls. The genotype and allelic variations of these SNPs with the severity of CAD was also assessed using semi-quantitative methods such as the Gensini score. Student’s t test and multiple regression analysis were used for statistical analysis. Results: The SNPs rs1333049 and rs2383207 were found to be associated with CAD with an adjusted OR of 1.81 (95% Cl 1.05-3.12) and 2.12 (95% CI 1.19-4.10) respectively. After adjustment of CAD risk factors such as smoking, family history of CAD and diabetes, the homozygous AA genotype for rs2383207 increased the CAD risk with an OR 3.69. Also a very strong association was found between rs1333049 and rs2383207 and Gensini scores representing the severity of CAD (p<0.001). Conclusion: The rs2383207 and rs1333049 SNPs on 9p21 chromosome were significantly associated with the risk and severity of CAD in the Turkish population.

Acute myocardial infarction due to antiphospholipid antibody syndrome in a young pregnant woman

Myocardial infarction (MI) in pregnant patients confer additional risks and unique problems related to necessity of concomitant obstetric interventions and coexistence of disorders as hypercoagulability. Therefore, patients usually have a more complicated course which demands prompt diagnosis and appropriate treatment. Here we report a 22 year old pregnant woman with an acute anterior myocardial infarction and the complicated course of the management. Although the patient underwent a successful percutaneous coronary intervention at the first presentation with MI, one week later she suffered a stent thrombosis presumably due to cessation of clopidogrel in order to prevent bleeding before the termination of pregnancy. Later, a detailed examination of the patient has led to diagnosis of antiphospholipid antibody syndrome.

Brachial Artery Wall Stiffness Assessment by Shear Wave Elastography: A Promising New Diagnostic Tool for Endothelial Dysfunction Detection: Brachial Artery Wall Stiffness Assessment by Shear Wave Elastography

This study was designed to measure the changes in brachial artery wall stiffness by shear wave elastography (SWE) and evaluate the accuracy of SWE changes for detection of endothelial dysfunction.

Thoracoabdominal aortic mural and floating thrombus extending into superior mesenteric artery

Thrombus in the thoracic aorta not related to aneurysm or atherosclerosis is a rare clinical entity with a limited number of cases reported. Floating thrombus is defined as non-adherent part of the thrombus floating within the aortic lumen. Herein, we present a 48-year-old woman who presented with progressive midline dull, aching abdominal pain of 2-day duration. Thoracoabdominal computed tomography revealed a free floating thrombus extending from the aortic arch into the superior mesenteric artery. Transesophageal echocardiography confirmed the findings of a thrombus extending through the aortic arch. Floating thrombus within the aortic lumen in a morphologically normal descending thoracic and abdominal aorta is a rare entity.

Prognostic impact of diastolic blood pressure on long-term outcome in patients with non-ST-segment elevation myocardial infarction

Background: Hypertension is a well-established risk factor for cardiovascular disease, and low systolic blood pressure (SBP) is a powerful adverse prognosticator in acute coronary syndrome. We sought to investigate the relationships between diastolic blood pressure (DBP) and outcomes in patients with non-ST-segment elevation myocardial infarction (NSTE-MI). Methods: We performed a retrospective review of 122 consecutive medical records of patients (mean age: 58 10 years, 73% men) with NSTEMI who underwent coronary angiography. All patients did not have any previous cardiac events or valvular disease. Patients were classified as DBP 70 mmHg and DBP >70 mmHg. The number of diseased vessel (one vessel, two vessel and three vessel and/or left main coronary artery disease) and SYNTAX score were calculated from the angiograms to assessed the extent and severity of coronary artery disease (CAD). Two year cardiac mortality was evaluated based on medical records and telephone visits. Results: There were no significant differences between the groups in terms of age, gender, medical therapy during hospital stay and at discharge, glomerular filtration rate, and ejection fraction. As expected SBP was lower in patients with DBP 70 mmHg. The patients with DBP 70 mmHg tended to have multivessel coronary artery disease (47.5% vs 25.4%, P 1⁄4 0.009) and higher SYNTAX score (20.3 15.2 vs 14.8 70 13.6, P 1⁄4 0.037). The two year mortality rate was 10.2%. Mortality rates were not significantly different for the two groups (11.3% vs 6.5%, P 1⁄4 0.14). Conclusion: In this study, we showed that low DBP associated with severe CAD in patients with NSTE-MI. Although the mortality rate was higher in low DBP group, this difference did not reach statistical significance as the power of the study was possibly too small to reach significance.

Common genetic variants on chromosome 9p21 are associated with the risk and severity of coronary artery disease in Turkish population

Introduction While numerous SNPs on chromosome 9p21 have been associated with coronary artery disease (CAD) in various populations, there are no reports of association on this locus in Turkish patients with existing CAD. We assessed the hypothesis that the 9p21 polymorphisms may be associated with increased risk and severity in patients with documented CAD. Methods We genotyped 220 Turkish CAD patients and 240 Turkish disease-free controls by using real-time polymerase chain reaction (RT-PCR) to investigate the association between 2 SNPs, rs1333049 and rs2383207, on chromosome 9p21 and CAD risk and severity. Logistic regression was used to calculate the adjusted odds ratios (OR) and 95% CI. Results In this study, there was a significant difference in the genotype distribution of both SNPs, rs1333049 and rs2383207, between CAD patients and controls (p<0.05) with OR of 1.81 (95% CI 1.05 to 3.12) and 2.12 (95% CI 1.19 to 4.10), respectively. After adjustment of CAD risk factors such as smoking, family history of CAD and diabetes with multivariate logistic regression analysis, homozygous AA genotype increased CAD risk with an OR of 3.69 for rs2383207 paradoxically with other reports conducted in different patient populations. However, rs1333049 had lost its significance on risk of CAD with an OR of 0.49 after adjustment of CAD risk factors. We also found a significant relation between rs1333049 and rs2383207 and GENSINI scores representing the severity of the CAD in our patient (p<0.001). Conclusion This is the first study on the Turkish population showing an association between rs2383207 and rs1333049 polymorphisms on chromosome 9p21 and CAD. In conclusion, this study suggests that the polymorphisms rs2383207 and rs1333049 on chromosome 9p21 are associated with the increased risk and the severity of CAD. However, further confirmation of these findings is needed.