Gökhan Alıcı

The Relation of Platelet–Lymphocyte Ratio and Coronary Collateral Circulation in Patients With Stable Angina Pectoris and Chronic Total Occlusion

Objectives: We aimed to investigate the relationship between the platelet-lymphocyte ratio (PLR) and coronary collateral circulation (CCC) in patients with stable angina pectoris (SAP) and chronic total occlusion (CTO). Methods: A total of 294 patients with both SAP and CTO were classified according to their Rentrop collateral grades as either poor (Rentrop grades/0-1) or good (Rentrop grades/2-3). Results: The PLR values were significantly higher in patients with poor CCC than in those with good CCC (156.8 + 30.7 vs 132.1 + 24.4, P < 0.001). In regression analysis, PLR (unit = 10) [odds ratio 1.48, 95% confidence interval (CI) 1.33 -1.65; P < 0.001] and high-sensitivity C-reactive protein were found to be the independent predictors of poor CCC. In receiver operator characteristic curve analysis, optimal cut-off value of PLR to predict poor CCC was found as 138.1, with 76% sensitivity and 65% specificity. Conclusion: PLR may be an important, simple, and cost effective tool predicting the degree of collateralization in patients with SAP and CTO.

Chronic mad honey intoxication syndrome: a new form of an old disease?

AIMS Although cases of acute mad honey intoxication have been reported earlier, chronic mad honey intoxication (CMHI) syndrome has not been described and we address this issue only in this study. METHODS AND RESULTS We prospectively evaluated the history of non-commercial honey intake in all patients referred to our institution for investigation of slow heart rate or atrioventricular (AV) conduction abnormalities. Between April 2008 and December 2008, 173 patients were referred to our institution for assessment of sinus bradycardia and various degrees of AV block and/or permanent pacemaker implantation. All patients were questioned about history of honey intake. Detailed evaluation revealed a history of daily honey intake for a long period of time in five of the patients (2.8%). This non-commercial honey was made by different amateur beekeepers in eastern Back Sea region of Turkey. Discontinuation of honey intake resulted in prompt normalization of conduction and significant symptomatic improvement. None of the patients were admitted to hospital and all were asymptomatic during 3 months follow-up. Holter monitoring for 24-h revealed no abnormality at first and third month. CONCLUSIONS This is the first report of CMHI. This issue should be suggested during assessment of patients with unexpected conduction abnormalities, because abandonment of honey intake results in prompt symptomatic and electrocardiographic improvement.

Evaluation of Autonomic Functions by Heart Rate Variability after Stenting in Patients with Carotid Artery Stenosis

Although carotid stenting is an effective treatment for severe carotid stenosis, it has been associated with alterations in autonomic functions during or shortly after the procedure. Heart rate variability (HRV) is an established tool for the asessment of autonumic functions. In this study, our aim was to investigate the relation between the alterations in autonomic functions and HRV by Holter monitoring parameters.

The Comparison in Reduction of QT Dispersion After Primary Percutaneous Coronary Intervention According to Existence of Thrombectomy in ST‐Segment Elevation Myocardial Infarction

Primary percutaneous coronary intervention (PPCI) is the standard treatment in patients with ST‐segment elevation myocardial infarction (STEMI). Thrombectomy devices are used to remove thrombus or to prevent embolization of thrombus and plaque during PPCI. QT dispersion (the difference between maximal and minimal QT interval calculated on a standard 12‐lead electrocardiogram) represents the regional nonuniformity of ventricular repolarization. It may reflect early coronary reperfusion in reducing electrophysiological instability by decreasing QT dispersion in the recovery phase after acute STEMI.

Effect of Seven Different Modalities of Antihypertensive Therapy on Pulse Pressure in Patients with Newly Diagnosed Stage I Hypertension

In this study, we investigated the effect of different antihypertensive agents on pulse pressure (PP). The study was designed in a prospective manner and patients were sequentially allocated to one of the seven different therapy groups, according to the order of enrollment (every first patient to group I, every second patient to group II, and etc). Patients in group I received 10 mg of lisinopril, in group II 10/6.25 mg of lisinopril/hydrochlorothiazide, in group III 80 mg of valsartan, in group IV 80/6.25 mg of valsartan/hydrochlorothiazide, in group V 5 mg of amlodipine, in group VI 1.25 mg of indapamide, and finally those in group VII received 50 mg of atenolol. The reduction in PP was more significant in patients receiving lisinopril, lisinopril hydrochlorothiazide, valsartan, and valsartan hydrochlorothiazide, when compared with patients receiving indapamide, atenolol, and amlodipine (P < 0.05 for each group). Factors such as age, gender, and body mass index were not found to significantly influence the effectiveness of antihypertensive agents on PP. The reduction in PP was more apparent with lisinopril, lisinopril hydrochlorothiazide, valsartan, and valsartan hydrochlorothiazide in diabetic patients, when compared with those without diabetes (P < 0.001, P < 0.05). And also patients on therapy with 3-hydroxy-3-methyl-glutaryl-CoA (HMG-CoA) reductase inhibitors had a greater reduction in PP with lisinopril, lisinopril hydrochlorothiazide, valsartan, and valsartan hydrochlorothiazide (P < 0.001, P < 0.05).

Comparison of short-term outcomes after carotid artery stenting according to different stent designs

Introduction In the developed countries, stroke is the third most common cause of death. There are many data indicating that stents reduce the risk of embolism but there are few publications assessing whether different stent designs can influence the periprocedural complications. Aim To determine the effects of open- and closed-cell stent designs on 1-month results of carotid artery stenting (CAS). Material and methods The study group consisted of 290 consecutive patients (216 men and 74 women, mean age 66.6 ±8.7 years). Neuroprotection with a distal protection device was used in all cases. The patients were divided into two groups: the open-cell stent group (n = 144) and the closed-cell stent group (n = 138). Major adverse cardiac and cerebrovascular events (MACCE) described as myocardial infarction, stroke and death within 1 month were recorded and analysed subsequently. Periprocedural hypotension and transient cerebral ischaemia at 1 month after the CAS procedure were also assessed. Results We treated 290 carotid stenoses and stents were implanted in all patients. Fifteen patients (5.5%) were treated by staged CAS due to bilateral carotid artery disease. The technical success rate was 97.2%. There was no difference in the MACCE and transient cerebral ischaemia rate at 1 month between the two groups (p = 0.44 and p = 0.94, respectively). The incidence of ischaemic stroke was lower in the closed-cell stent group (2.77% vs. 0%; p = 0.04). The periprocedural rate of hypotension was higher in the closed-cell stent group (2.1% vs. 7.2%; p = 0.04). Conclusions Closed-cell stents are associated with a low rate of ischaemic stroke. We think that closed-cell stents may be preferred in patients at high risk of embolism.

Optimization of Repolarization during Biventricular Pacing: A New Target in Patients with Biventricular Devices?

Background: Evaluation of repolarization during sequentional biventricular pacing.

Decreased plasma adiponectin is associated with impaired left ventricular longitudinal systolic function in hypertensive patients: a two-dimensional speckle tracking study

Abstract The influence of plasma adiponectin levels on myocardial contractile function has not been fully examined. We aimed to investigate the relationship between three-directional systolic function and plasma adiponectin levels in asymptomatic hypertensive patients using two- dimensional speckle-tracking echocardiography. The study population consisted of 78 patients with hypertension and 40 healthy controls. Longitudinal strain was significantly reduced in all patients, including those without LV hypertrophy (p = 0.009). In multiple-regression analysis, plasma adiponectin levels (β = −0.273, p = 0.008) and LV mass index (β = 0.458, p < 0.001) independently correlated with LV longitudinal strain. Decreased plasma adiponectin concentrations were associated with the progression of LV hypertrophy with impaired LV longitudinal systolic function.

Percutaneous Coronary Intervention in an Elderly Patient with a Single Coronary Artery

months. Myocardial perfusion imaging with Tc 99m-MIBI showed a reversible perfusion defect in the inferoseptal wall. Then, the patient was referred for a diagnostic coronary angiography (CA). During CA, the ostium of the left main coronary artery could not be cannulated (Figure 1A). Cannulation of the right coronary artery (using Judkins Right-4 diagnostic catheter) revealed a single coronary artery (SCA) originating from the right sinus of the Valsalva, with branches to both right and left coronary systems, which was classified as type II-B (Lipton’s) (Figure 1B). A 70% lesion was noted in the circumflex artery (LCx) (Figure 1B). Contrast-enhanced cardiac computed tomography (CCT) revealed that the SCA was between the aorta and pulmonary artery (Figure 1C,D). Percutaneous intervention was performed by a femoral approach using a Judkins Right-4 6F guiding catheter. A 0.014-inch floppy guidewire advanced distally in the LCx, and a drug-eluting stent 2.5 × 16 mm in size was implanted successfully (Figure 1E). The final image revealed no complications, with excellent distal flow (Figure 1F). An isolated SCA is a rare congenital anomaly with a benign course in most patients. Nevertheless, it may be associated with angina pectoris, syncope, and sudden cardiac death. Contrast-enhanced CCT and magnetic resonance imaging are very helpful to rule out compression of anomalous coronary arteries coursing between the pulmonary artery and aorta. Moreover, PCI of a SCA is considered high-risk intervention due to potentially catastrophic consequences in case of complications, such as dissection or thrombosis. Hence, documentation of ischemia and gentle manipulation during PCI should be standard of care. Tek Koroner Arterli Yaşlı Bir Hastaya Perkütan Girişim Ahmet Güner1, Nuri Havan2, Gökhan Alıcı1, Elnur Alizade1 1 University Health Sciences, Kartal Koşuyolu High Specialization Health Application and Research Center, Clinic of Cardiology, İstanbul, Turkey 2 University Health Sciences, Kartal Koşuyolu High Specialization Health Application and Research Center, Clinic of Radiology, İstanbul, Turkey Percutaneous Coronary Intervention in an Elderly Patient with a Single Coronary Artery

Evaluation of QT Dispersion by 12-Lead Surface Electrocardiography Affer Stenting in Patients with Carotid Artery Stenosis

OBJECTIVE: Although carotid artery stenting (CAS) is an effective treatment for severe carotid stenosis, it has been associated with alterations in autonomic functions during or shortly after the procedure. The aim of this study was to investigate QT durations on 12-lead surface electrocardiography after CAS.METHODS: Patients (29 male, 12 female) that are suitable for CAS, without a history of hypertension, diabetes mellitus, severe coronary artery or valvular heart disease, were enrolled to our study. 12-lead surface electrocardiography recordings were obtained at the beginning, immediately after and at the 24 hour of the procedure. QT maximum, minimum and dispersion durations were analyzed by double blinded observers. Three distinct corrected QT intervals were determined according to Bazetts formula. Results were statistically analyzed using Friedman and Wilcoxon tests.RESULTS: The QT maximum and dispersion values were significantly decreased immediately after the procedure and continued with low levels at 24 hour recordings, respectively (455±44/58±11, 440±46/37±10, and 450±44/48±10 ms, p value