Hakan Erkan

Epicardial Adipose Tissue Increased in Patients with Newly Diagnosed Subclinical Hypothyroidism

Objective: To investigate whether or not patients with subclinical hypothyroidism (SH) have increased epicardial adipose tissue (EAT). Subjects and Methods: Sixty-one patients with newly diagnosed SH and without any known cardiovascular disease were enrolled. Twenty-four subjects matched for age, gender and body mass index without any thyroid dysfunctions were included as a control group. The EAT was measured by echocardiography and thyroid functions were assessed by routine blood examination. Results: Patients with SH had higher EAT values than control subjects (3.6 ± 0.9 vs. 2.8 ± 1.4, p = 0.005). Also, SH patients with thyroid-stimulating hormone (TSH) ≥10 mU/l had higher EAT than those with SH with TSH <10 mU/l and control subjects (p = 0.013). In addition, while there was significant correlation between EAT and TSH (r = 0.31, p = 0.014) in patients with SH, there was no significant relation between EAT and TSH in normal subjects (r = 0.09, p = 0.64). Conclusions: There was a higher level of EAT in patients with SH compared with normal subjects and a significant correlation between EAT and TSH was found.

Association between nonalcoholic fatty liver disease and coronary artery disease complexity in patients with acute coronary syndrome: a pilot study.

Nonalcoholic fatty liver disease (NAFLD) is highly prevalent in patients with acute coronary syndrome (ACS). We assessed the association between NAFLD and SYNTAX Score (SS) in patients with ACS. Eighty consecutive patients with ACS were enrolled. Patients were evaluated using ultrasound to detect NAFLD and hepatosteatosis stage. The prevalence of NAFLD was 81.2%; median SS was 15. The SS was significantly higher in patients with NAFLD (18 ± 8 vs. 11 ± 5, P = .001). Univariate analysis showed that the stage of NAFLD correlated with SS (r = .6, P < .001). In multivariate binary logistic analysis, increased age (odds ratio [OR], 1.05; 95% confidence interval [CI],1.00-1.10) and presence of NAFLD (OR, 13.20; 95% CI, 2.52-69.15) were independent factors associated with supramedian SS. In conclusion, among patients with ACS, those with NAFLD have more complex CAD as assessed by SS.

Conversion of Brugada type I to type III and successful control of recurrent ventricular arrhythmia with cilostazol

MOTS CLÉS Syndrome de Brugada ; nal agonal respiration and syncope that was occurring with a frequency of four to five episodes/year. The electrocardiogram (ECG) showed type I Brugada pattern with J waves seen on lateral leads (Fig. 1). Although the patient’s previous ECG records were all compatible with Brugada pattern, a specific diagnosis was not made and a specific treatment was not given. The patient’s family history was negative for sudden cardiac death. Echocardiography was free of any sign of structural heart disease, with normal left ventricular function. Cardiac magnetic resonance showed normal right ventricular anatomy and function. The patient was implanted an implantable cardioverter-defibrillator (ICD) for primary prophylaxis. A week after discharge, the patient was readmitted to the emergency department due to frequent ICD shocks. Device interrogation revealed four episodes of polymorphic ventricular tachycardia that initiated with premature ventricular contractions of different coupling intervals (Fig. 2), which were appropriately cardioverted to sinus rhythm during the previous week. Owing to frequent ICD shocks, we planned to give quinidine for arrhythmia control; however, as quinidine was not available in our country, we administered cilostazol at a dose of 100 mg twice daily. On the second day of cilostazol, the

Increased frequency of fragmented QRS in patients with severe aortic valve stenosis.

Objective: To investigate the presence of myocardial fibrosis determined by fragmented QRS in patients with severe aortic valve stenosis. Subjects and Methods: Eighty-seven consecutive patients with severe aortic valve stenosis and 83 age- and gender-matched control subjects were enrolled into this study. Severe aortic valve stenosis was defined as an aortic valve area <1 cm2, a Vmax >4 m/s, or a mean gradient ≥40 mm Hg. Fragmented QRS was assessed using a 12-lead electrocardiogram. Results: Fragmented QRS was detected in 40 (46%) patients in the aortic valve stenosis group and in 15 (18%) control subjects (p < 0.001). In multivariate binary logistic regression analysis, the presence of aortic valve stenosis was the only independent factor associated with fragmented QRS (OR = 3.69; 95% CI 1.81-7.55, p < 0.001). Conclusion: A higher frequency of fragmented QRS was detected in patients with severe aortic valve stenosis compared to controls.

Atherosclerosis burden and coronary artery lesion complexity in acute coronary syndrome patients

BACKGROUND Syntax score (SS) is a prognostic marker in patients with acute coronary sydromes (ACS). Carotid intima media thickness (CIMT) and cardio ankle vascular index (CAVI) are well known surrogate marker of atherosclerosis burden. But association between atherosclerosis burden and coronary artery disease (CAD) complexity in ACS patients has not been investigated yet. METHODS AND RESULTS Consecutive patients with first time diagnosis of ACS (n = 172) were enrolled. SS, a marker of CAD complexity, was assessed by dedicated computer software. CIMT was examined by B-mode ultrasound. CAVI was assessed by VaSera VS-1000 cavi instrument. SS for low, intermediate and high tertiles of CIMT value were 10.1 ± 8.2 vs 11.4 ± ± 7.9 and 15.2 ± 8.8; p = 0.02). SS for normal, borderline and abnormal CAVI values were 4 ± 3.7 vs 11.1 ± 7.2 and 14.1 ± 9.1, respectively p = 0.009). Also, there was independent association between SS and CIMT (95% coinfidence interval [CI] 2.1-19, p = 0.014) and CAVI (95% CI 15-29, p = 0.021]. Neither traditional cardiovascular risk factor nor thrombolysis in myocardial infarction (TIMI) risk score was independent determinant of SS. CONCLUSIONS We have shown that patients with higher atherosclerosis burden have more complex coronary artery lesions. Also these patients may be identified early by using surrogate markers of atherosclerosis. Its clinical significance requires further research.

Earlobe crease may provide predictive information on asymptomatic peripheral arterial disease in patients clinically free of atherosclerotic vascular disease.

The diagonal earlobe crease (ELC) has been regarded as a simple marker of atherosclerosis. There is no knowledge concerning the relation of ELC to the presence, extent, and severity of peripheral arterial disease (PAD). Patients (n = 253) without known atherosclerotic vascular disease and symptoms were enrolled consecutively. Ankle brachial index (ABI) was measured. Patients with ELC had lower ABI compared to those with no ELC (1.02 ± 0.12 vs 1.11 ± 0.08, P < .001). Multivariate analysis demonstrated ELC (95% confidence interval [CI]: 3.3-21.9; P: .001) and age (95% CI: 0.87-0.99; P = .02) as independent determinants of abnormal ABI. There was incremental increased frequency of ELC from normal ABI to significant PAD. We have shown for the first time a significant and independent association between presence of ELC and increased prevalence, extent, and severity of PAD in patients without overt atherosclerotic vascular disease.

Relationship of aortic knob width with cardio-ankle vascular stiffness index and its value in diagnosis of subclinical atherosclerosis in hypertensive patients: a study on diagnostic accuracy.

OBJECTIVE The aim of our study was to determine the usefulness of the aortic knob width (AKW) in the assessment of subclinical atherosclerosis in hypertensive patients. METHODS In this study on diagnostic accuracy, 374 consecutive hypertensive patients with at least one cardiovascular risk factor were enrolled. AKW was measured on chest X-ray. Cardio-ankle vascular index (CAVI) was measured by VaSera-1000 CAVI instrument. The diagnostic value of AKW was assessed using ROC analysis. RESULTS There was a significant correlation between aortic knob width and CAVI (r=0.45, p<0.001), age (0.39, p<0.001), systolic (r=0.17, p<0.001), diastolic (r=0.23, p<0.001) and mean (r=0.2, p<0.001) blood pressures. In linear regression analysis CAVI (β=0.3, 95% CI 0.33-0.98, p<0.001), age (β=0.3, 95% CI 0.09 - 0.21, p<0.001) and diastolic blood pressure β=0.2, 95% CI 0.08-1.9, p<0.001) were independently associated with AKW. It was significantly higher in patients with subclinical atherosclerosis (CAVI ≥9) than borderline (8 ≤CAVI <9) (41.4±5.5 versus 36.7±5.3 mm, p<0.001) and healthy (CAVI <8) subjects (41.4±5.5 versus 35.5±4.3 mm, p<0.001). Analysis using the ROC curve has demonstrated that aortic knob of 41 mm constitutes the cut-off value for the presence of subclinical atherosclerosis with 71% sensitivity and 77% specificity (AUC-0.67, 95% CI 0.51-0.82). CONCLUSION Observation of aortic knob on chest X-ray in hypertensive patients may provide important predictive information of subclinical atherosclerosis.

Unusual case of aortic valve involvement in patient with Löffler's endomyocarditis: management, follow-up and short review of the literature.

Idiopathic hypereosinophilic syndrome (IHES) is an uncommon systemic disease which is characterised by blood eosinophilia and multiple clinical presentations. Cardiac involvement is the major cause of mortality and morbidity. Here we describe a 59-year-old man with symptoms of progressive dyspnea on exertion, and productive cough as an unusual case of Löffler endomyocarditis with a mass on the aortic valve which showed regression with treatment.

Increased Carotid Intima–Media Thickness is Associated With Higher SYNTAX Score

The main purpose of this study was to investigate the relation between carotid intima–media thickness (CIMT) and coronary artery disease (CAD) complexity. Consecutive patients (n = 360) with CAD confirmed by coronary angiography were enrolled. Mean CIMT and the overall SYNTAX score (SXscore) were 0.87 ± 0.12 mm and 15 ± 9, respectively. In univariate analysis, there was a significant correlation between the overall SXscore and CIMT (r = .42, P < .001), age (r = .23, P < .001), hypertension (r = .27, P = 0.001), diabetes (r = 0.11, P = 0.02), smoking (r = .24, P = .01), dyslipidemia (r = .2, P = 0.03), and β-blocker use (r = .19, P < .001). In multivariate analysis, CIMT (β = .34, P < .001) and age (β = .11, P < .019) were independently associated with SXscore. We have demonstrated a significant relation between CIMT and SXscore. Although this study is correlative and no causative conclusions can be drawn, our findings suggest that increased CIMT could reflect complex coronary artery lesions.

Is Coronary Artery Disease Complexity Valuable in the Prediction of Contrast Induced Nephropathy Besides Mehran Risk Score, in Patients with ST Elevation Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention?

BACKGROUND The association of coronary artery disease complexity with contrast induced nephropathy (CIN) in patients with acute ST segment elevation myocardial infarction (STEMI) is inadequately evaluated and to our knowledge the association between SYNTAX score (SS) and Mehran score (MS) have not been studied. The aim of the present study is to clarify the incidence of CIN and to identify demographic, clinical and procedural variables associated with CIN in patients who underwent primary percutaneous coronary intervention (PPCI) due to acute STEMI, besides the association between MS and SS with CIN. METHODS We analysed the clinical data of 402 patients (309 male, 93 female, mean age 63.8 ± 12.65 year) with 179 (44.5%) anterior MI, 104 (25.9%) inferior MI, 119 (29.6%) inferior MI with right ventricular involvement who underwent PPCI. RESULTS We found that CIN was observed in 32.6% of patients. The SS (OR=1.037, %95CI=1.012-1.062, p=0.003), MS (OR=1.072, %95CI=1.025-1.121, p=0.003), HDL (OR=0.974, %95CI=0.949-0.999, p=0.044) were the independent predictors of CIN. The cut off value to show CIN for SS was 31.5 (sensitivity=79.4%, specificity=88.6%) and MS was 12.5 (sensitivity=73.3%, specificity=88.9%) in ROC curve analysis. CONCLUSION In conclusion, besides MS, SS may be a valuable marker to identify patients at high risk for CIN in patients undergoing primary percutaneous intervention.